Federal Register / Vol. 78, No. 53 / Tuesday, March 19, 2013 / Rules and Regulations 16795 

CALIFORNIA—PM10

Designated Area 

Designation Classification 

Date Type Date Type 

*******

Imperial County 

Imperial Valley planning area: That portion 

of Imperial County that is defined as follows: 

11/15/90 Nonattainment 9/10/04 Serious 

Commencing at the southwest corner of Imperial County and extending north along 

the Imperial-San Diego County line to the 

northwest corner of Imperial County; then 

east along the Imperial-Riverside County 

line to the point of intersection of the 

eastern boundary line of Hydrologic Unit 

#18100200; then southeasterly along the 

eastern boundary line of Hydrologic Unit 

#18100200 to the Imperial County-Mexico 

Border; then west along the Imperial 

County-Mexico Border to the point of the 

beginning.

* * * * * * * 

[FR Doc. 2013–06208 Filed 3–18–13; 8:45 am] 

BILLING CODE 6560–50–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Parts 483, 488, 489, and 498 

[CMS–3230–F] 

RIN 0938–AQ09 

Medicare and Medicaid Programs; 

Requirements for Long-Term Care 

(LTC) Facilities; Notice of Facility 

Closure 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Final rule. 

SUMMARY: This rule adopts, with 

technical changes, the interim rule that 

published February 18, 2011. That 

interim rule revised the requirements 

that a long-term care (LTC) facility must 

meet in order to qualify to participate as 

a skilled nursing facility (SNF) in the 

Medicare program, or a nursing facility 

(NF) in the Medicaid program. The 

requirements implemented section 6113 

of the Patient Protection and Affordable 

Care Act to ensure that, among other 

things, in the case of an LTC facility 

closure, individuals serving as 

administrators of a SNF or NF provide 

written notification of the impending 

closure and a plan for the relocation of 

residents at least 60 days prior to the 

impending closure or, if the Secretary 

terminates the facility’s participation in 

Medicare or Medicaid, not later than the 

date the Secretary determines 

appropriate. 

DATES: Effective on April 18, 2013. 

FOR FURTHER INFORMATION CONTACT: 

Mary Collins, (410) 786–3189. 

Ronisha Davis, (410) 786–6882. 

Lisa Parker, (410) 786–4665. 

SUPPLEMENTARY INFORMATION: 

I. Background 

A. Overview 

According to the Centers for Medicare 

& Medicaid Services (CMS) data, as of 

October 2011, there were 15,720 longterm care (LTC) facilities (commonly 

referred to as nursing homes) in the 

United States. These facilities are 

generally referred to as skilled nursing 

facilities (SNFs) in the Medicare 

program and as nursing facilities (NFs) 

in the Medicaid program. For the past 

decade, CMS Survey and Certification 

Tabulation of Certification and Survey 

Provider Enhanced Reporting (CASPER) 

data have shown a decline in the 

number of nursing homes, from 17,508 

in 1999 to 15,720 in 2011. In 2010, there 

were 141 nursing home closures. In 

2011, there were 90 closures. 

LTC facility closures have 

implications related to access to care, 

the quality of care, availability of 

services, and the overall health of 

residents. Therefore, having an 

organized process that facilities must 

follow in the event of a nursing home 

closure will protect residents’ health 

and safety, and make the transition as 

smooth as possible for residents, as well 

as family members and facility staff. 

On February 18, 2011, we published 

in the Federal Register an interim final 

rule with comment period, entitled 

‘‘Requirements for Long-Term Care 

(LTC) Facilities; Notice of Facility 

Closure’’ (76 FR 9503). In that rule, we 

revised the current requirements for 

LTC facilities under the provisions of 

section 1128I(h) of the Social Security 

Act (the Act), as added by section 

6113(a) of the Patient Protection and 

Affordable Care Act (Pub. L. 111–148, 

March 23, 2010)(Affordable Care Act). 

The new statutory provision requires us, 

among other things, to impose sanctions 

on the administrator of an LTC facility 

for failure to provide proper notice to 

specified parties, including CMS, that 

the facility is about to close. 

B. Legislative History and Statutory 

Background 

Sections 1819(b)(1)(A) of the Act for 

SNFs and 1919(b)(1)(A) of the Act for 

NFs both state that a SNF/NF must care 

for its residents in a manner and in an 

environment that will promote 

maintenance or enhancement of the 

quality of life of each resident. 

Sections 1819(c)(2)(A)(vi) and 

1919(c)(2)(A)(vi) of the Act state that in 

general, with certain specified 

exceptions, a SNF/NF must permit each 

resident to remain in the facility and 

must not transfer or discharge the 

resident from the facility, except under 

specified circumstances, including, at 

clause (vi), when the facility ceases to 

operate. 


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As described in detail in the preamble 

of the February 18, 2011 interim final 

rule, section 6113 of the Affordable Care 

Act added subsection 1128I(h) to the 

Act, setting forth certain requirements 

for LTC facility closures, effective 

March 23, 2011. We issued this rule in 

the form of an interim final rule because 

we believed delaying implementation 

would continue to cause unjustified 

harm to LTC facility residents, families 

and visitors, and to meet the March 23, 

2011 statutory deadline for 

implementation (76 FR 9508). 

II. Health Disparities 

In the February 18, 2011 interim final 

rule, we discussed our goal of 

addressing health care disparities (76 FR 

9505). We noted that research has 

extensively documented the 

pervasiveness of vulnerable populations 

which can be defined by race/ethnicity, 

socioeconomic status, geography, 

gender, age, disability status, sexual 

orientation, and other factors. Although 

there has been much attention at the 

national level to ideas for reducing 

health disparities in vulnerable 

populations, we remain vigilant in our 

efforts to improve health care quality for 

all persons by improving health care 

access and by eliminating real and 

perceived barriers to care that may 

contribute to less than optimal health 

outcomes for vulnerable populations. 

We specifically requested comments 

in regard to how our revised LTC 

facility closure requirements could be 

used to address disparities among 

facility residents. 

The comments we received on this 

provision and our responses are set 

forth below. 

Comment: Several commenters 

encouraged CMS to review a number of 

policies and make changes that would 

have a positive impact on health 

disparities. One commenter encouraged 

CMS to review disparate treatment of all 

the populations that were identified in 

the preamble of the regulation and 

provide the appropriate information and 

support that would improve access to 

culturally competent care, language 

access, legal and counseling services. 

The commenter suggested that CMS also 

work with the patient advocacy 

community. 

Another commenter suggested that 

CMS examine all of the facilities owned 

by the provider to determine whether 

there are differences in the quality of 

care provided, including significant 

differences between predominantly 

Caucasian and predominantly minority 

facilities. 

Other commenters suggested that 

CMS should require more monitoring of 

facility finances, following up on all 

indicators of financial problems through 

special surveys of compliance and 

financial audits. It was also suggested 

that the concentration of Medicaid 

beneficiaries in a small number of 

facilities would be reduced if CMS 

clarified that financial screening is 

illegal under existing law. Another 

commenter recommended CMS issue 

new guidance to State Survey Agencies 

of existing conditions of participation 

that prohibit discriminatory admissions 

practices and provide training for State 

Survey Agencies on how to identify 

discriminatory practices by facilities. 

Response: We appreciate the 

comments received on this very 

important issue. CMS is committed to 

addressing health care inequalities for 

racial and ethnic minorities that rely on 

Medicare and Medicaid for quality 

health care. We will consider these 

comments in the development of future 

regulations. 

III. Provisions of the Proposed 

Regulations and Analysis of and 

Responses to Public Comments 

In response to the February 18, 2011 

interim final rule, we received 15 public 

comments. Interested parties that 

submitted comments included 

individuals, advocacy organizations, 

and industry associations. In this final 

rule, we provide a summary of each 

provision, a summary of the public 

comments received and our responses, 

and any changes to the interim final rule 

we are implementing as a result of 

comments received. 

A. Transfer and Discharge (§ 483.12(a)) 

Timing of Notice 

We revised § 483.12(a)(5)(i), Timing of 

the Notice, to accommodate the closure 

notice provisions of § 483.12(a)(8) and 

§ 483.75(r)(1)(i). The February 18, 2011 

interim final rule requires the 

administrator of a facility to provide 

written notification of a facility’s 

closure to specified individuals, 

including facility residents, at least 60 

days prior to the date of a voluntary 

closure. This 60-day notice requirement 

is an exception to the general 30-day 

advance notice requirement governing 

transfer and discharge of individual 

patients from an LTC facility. The 

comments we received on this provision 

and our responses are set forth below. 

Comment: One commenter requested 

clarification regarding the interaction 

between existing State policies (where 

applicable) and Federal regulations 

when the State requires no less than 60 

days notice. The commenter stated that 

many States already have notification of 

closure requirements in place, and 

expressed concern that in those States, 

a nursing facility administrator will be 

required to complete two notifications: 

one consistent with State law and 

regulations and one consistent with 

Federal law and regulations. 

Response: Only one notification 

would be required by this regulation, 

either 60 days prior to closure for 

voluntary closures or as the Secretary 

determines appropriate for involuntary 

closures. CMS does not have authority 

over State licensure, health, reporting, 

or facility requirements. However, 

according to § 488.3(b)(3), any time a 

State law applicable to providers or 

suppliers of Medicaid services in that 

State is more stringent that the Federal 

requirements, as is hypothesized here, 

CMS must enforce the more stringent 

State requirement as a condition of 

Medicare payment. For example, if the 

State law requires the administrator of 

a NF participating in its State Medicaid 

program to provide a 90-day notice of 

closure, the administrator would 

provide 90 days notice, since it is more 

stringent for compliance with Federal 

law. Failure to do so would put both its 

Medicaid and Medicare payments at 

risk. We also note that regardless of 

whether State or Federal regulations 

provide for a longer notification period, 

no-preemption issue arises because a 

facility complies with both laws by 

complying with the longer notification 

period. 

Notice of Closure 

We added a new § 483.12(a)(8) to 

require that, in the case of a facility 

closure, any individual who is the 

administrator of the facility must 

provide written notification prior to the 

impending closure to the Secretary, the 

State LTC ombudsman, the residents of 

the facility, and the legal representatives 

of the resident or other responsible 

parties, as well as provide a plan for the 

transfer and adequate relocation of the 

residents, in accordance with the new 

section § 483.75(r). As discussed in 

detail below, in section III. B of this 

preamble, we have revised § 483.12(a)(8) 

to conform with changes to § 483.75(r). 

The comments we received on this 

provision and our responses are set 

forth below. 

Comment: One commenter suggested 

that in the final rule, the LTC facility be 

required to notify the medical director, 

attending physicians and other 

clinicians who regularly provide 

healthcare services within the LTC 

facility of that facility’s closure. 

Response: We appreciate the 

commenter’s suggestion; however, we 

do not consider it necessary to provide 


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additional language in the final rule 

regarding notices to physicians and/or 

other clinicians providing services to 

the resident. We believe this issue is 

sufficiently addressed in 

§ 483.12(a)(3)(i), ‘‘Documentation,’’ 

which requires that when a facility 

transfers or discharges a resident, the 

resident’s clinical records must be 

documented and the documentation 

must be made by the resident’s 

physician. Therefore, a resident’s 

physician and/or other practitioners 

would have received notice of the 

impending closure because they are 

required to be involved in the discharge 

plan for the resident. We will 

incorporate language into the State 

Operations Manual (SOM) to specify 

that a resident’s practitioner(s) must be 

involved as soon as the notice of closure 

has been sent to the residents to assure, 

as stated in § 483.75(r)(3), that the 

residents would be transferred to the 

most appropriate facility or other setting 

in terms of quality, services and 

location, taking into consideration the 

needs, choice, and best interests of each 

resident. 

B. Facility Closure—Administrator 

(§ 483.75(r)) 

We added a new paragraph (r) to 

§ 483.75, which requires any individual 

who is the administrator of the facility 

to submit to the Secretary, the State LTC 

ombudsman, residents of the facility, 

and the legal representative of such 

residents (or other responsible parties) 

written notification of an impending 

closure at least 60 days prior to the date 

of closure; or, in the case of a facility 

where the Secretary terminates the 

facility’s participation in the Medicare 

and/or Medicaid programs, no later than 

the date that the Secretary determines 

appropriate for such notification. The 

language of this paragraph parallels that 

of section 1128I(h) of the Act, as added 

by section 6113(a) of the Affordable 

Care Act. The comments we received on 

this provision and our responses are set 

forth below. 

Comment: The majority of 

commenters supported the February 18, 

2011 interim final rule, stating that they 

believe the rule would improve resident 

notification and facility planning, and 

would ensure a smooth relocation of 

LTC facility residents in the event of a 

facility closure or relocation. 

Response: We appreciate the support 

from the commenters on this rule. We 

believe that having a requirement that 

establishes an organized process that 

facilities must follow in the event of an 

LTC facility closure protects residents’ 

health and safety, and makes the 

transition as smooth as possible for 

residents, family members and facility 

staff. 

Comment: A few commenters 

recommended that the final rule define 

the term ‘‘closure.’’ Another commenter 

suggested specific changes to the 

language in § 483.75(r)(1). The 

commenter suggested that we revise the 

regulation to require that the 

administrator submit, ‘‘written 

notification of an impending closure 

whenever 10 or more residents are 

likely to be transferred due to any 

voluntary or involuntary change in the 

status of the license or operation of a 

facility, including but not limited to, a 

facility closure or voluntary or 

involuntary termination of a facility’s 

Medicaid or Medicare certification.’’ 

One commenter recommended that an 

exception be made to the requirement of 

written notification for unplanned 

events, such as a fire, major storms, or 

flooding. 

Response: For the purpose of this 

regulation, ‘‘closure’’ means an LTC 

facility that ceases to operate under 

§ 483.12(a)(2)(vi), and therefore, is no 

longer providing care and services to 

residents. We believe that the 

notification requirements should be met 

regardless of the number of residents 

likely to be transferred. We do not 

believe that establishing criteria for a 

minimum number of residents that must 

be affected before the notice 

requirements apply promotes the 

highest quality of care during what can 

be a difficult situation. We believe that 

all residents should be made aware of a 

facility closure in a reasonable amount 

of time, regardless of the size of the 

facility, as this regulation currently 

requires. 

Regarding unplanned events, current 

regulations at § 488.426(a), ‘‘Transfer of 

residents,’’ or closure of the facility and 

transfer of residents, gives a State the 

authority to transfer Medicare and 

Medicaid patients out of a facility 

(temporarily or permanently) in 

emergency situations. If the State orders 

the temporary relocation of residents 

during an emergency, with the 

expectation that the residents will 

return to the facility, this would not be 

regarded as a facility closure under this 

requirement and the notification 

requirements under § 483.75(r) would 

not be applicable. For example, if a 

facility’s air conditioning failed during 

a heat wave, the State could order the 

facility to relocate all of its residents 

while the problem was being 

investigated, without closing the 

facility. 

Comment: One commenter suggested 

that the final rule allow for a longer 

notification period for residents and 

their families, as well as others, in the 

case of an involuntary closure. A longer 

notice period would give family 

members time to consider whether a 

home and community-based setting 

would better meet the LTC facility 

resident’s needs than placement in 

another LTC facility. The commenter 

further recommended that, to the extent 

possible, the closure notification 

requirement for involuntary 

terminations should be at least 60 days 

in advance of closure, consistent with 

the rule for voluntary closures, or at a 

minimum, 30 days, consistent with the 

transfer/discharge provisions at 

§ 483.12(a)(5)(i), unless there is an 

immediate threat to the health and 

safety of residents that necessitates a 

shorter notification timeframe. 

Response: This regulation does not 

preclude a facility from providing a 

longer notification period if it chooses. 

Only the State has the authority to close 

a facility. CMS has authority to 

terminate provider agreements and 

thereby Medicare payments, as well as 

the Federal Medicaid matching payment 

to the State. In this case, the notification 

requirements are determined by the 

Secretary in collaboration with the 

State. In the preamble of the February 

18, 2011 interim final rule, we provided 

background information regarding how 

the Secretary may determine a date for 

notification (76 FR 9506). 

Additionally, § 483.75(r)(3) requires 

that the administrator include in the 

written notification of closure 

assurances that the residents would be 

transferred to the most appropriate 

facility or other setting in terms of 

quality, services, and location, taking 

into consideration the needs, choice, 

and best interests of each resident. We 

believe that this requirement 

sufficiently addresses the commenter’s 

concern about ensuring that the 

resident’s needs are successfully met 

upon relocation to another facility or 

location. 

Comment: One commenter suggested 

that in addition to State’s approving the 

closure plan prior to notification and 

overseeing closures, LTC facility 

administrators should also be required 

to send the notice directly to the State 

Survey Agencies. 

Response: We agree with the 

commenter that the written notification 

should also be given to the State Survey 

Agency. The State Survey Agency acts 

on the behalf of the Secretary and the 

intent of the February 18, 2011 interim 

final rule was to ensure that the 

notification went to the State Survey 

Agency. Therefore, we are revising the 

regulation at § 483.75(r)(1) to clarify that 

any individual who is the administrator 


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of the facility must submit to the State 

Survey Agency, the State LTC 

ombudsman, residents of the facility, 

and the legal representatives of such 

residents or other responsible parties, 

written notification of an impending 

closure. As noted above, we have also 

revised § 483.12(a)(8) to clarify that the 

written closure notification must be 

submitted to the State Survey Agency. 

C. New Admissions After Closure Notice 

(§ 483.75(r)(2)) 

At § 483.75(r)(2), we require any 

individual who is the administrator of 

the LTC facility to ensure that the 

facility does not admit any new 

residents on or after the date, which 

such written notification of facility 

closure is submitted to the Secretary, 

the State LTC ombudsman, and the 

residents, and/or their representatives or 

other responsible parties. 

We did not receive any public 

comments regarding this requirement; 

therefore, we are finalizing § 483.75(r)(2) 

as published in the interim final rule. 

D. Closure Notice (§ 483.75(r)(3)) 

At § 483.75(r)(3), we require that any 

individual who is the administrator of 

an LTC facility include in the written 

notice of closure, a plan that has been 

approved by the State for the transfer 

and adequate relocation of the residents 

by a date that must be specified by the 

State prior to closure. The plan must 

include assurances that the residents 

will be transferred to the most 

appropriate facility or other setting in 

terms of quality, services, and location, 

taking into consideration the needs, 

choice, and best interests of each 

resident. 

In the preamble of the February 18, 

2011 interim final rule, we expressed 

our expectation that the closure plan 

would include sufficient detail to 

identify clearly the steps the facility 

would take, and would specify the 

individual responsible for ensuring the 

steps were successfully carried out (76 

FR 9507). We note that we inadvertently 

omitted language regarding the statutory 

requirement at section 1128I(h)(1)(C) of 

the Act for State approval of the plan. 

We are correcting the language 

accordingly in section § 483.75(r)(3) of 

the regulations text in this final rule. 

The comments we received on this 

provision and our responses are set 

forth below. 

Comment: Several commenters 

suggested that the final rule include 

regulations text specifying the minimum 

requirements for the facility closure 

plan, including information on transfer 

and discharge rights. 

Response: We appreciate the 

commenter’s suggestion; however, we 

do not believe it is necessary to include 

specific requirements for the plan in the 

regulation text. We want to allow each 

LTC facility the flexibility to develop a 

plan that would most effectively protect 

the residents’ health, safety, and wellbeing. We note that we included 

detailed examples of elements of a 

closure plan in the preamble of the 

February 18, 2011 interim final rule (76 

FR 9507). In addition, we intend to 

issue further guidance regarding the 

elements of a closure plan subsequent to 

the publication of this final rule. 

Comment: One commenter 

recommended that CMS require the 

facility administrator to share the 

required relocation plan with residents 

and family members, as well as making 

it available upon request and/or publish 

the plan on State government nursing 

home information Web sites. 

Response: We appreciate the 

commenter’s suggestion. However, we 

do not believe that sharing the facility’s 

relocation plan with residents would be 

appropriate, since the plan includes 

information that does not directly 

pertain to the health, safety, and wellbeing of the residents (for example, 

continuation of appropriate staffing 

levels and paychecks at the facility; 

method for communicating with staff 

and/or unions; and ongoing provision of 

necessary supplies, for example, food, 

linens, and utilities). The facility must 

meet its obligation set out at existing 

§ 483.12(a)(4), ‘‘Notice before transfer,’’ 

to provide notice to the resident before 

the transfer or discharge of the resident. 

Our requirements at existing 

§ 483.12(a)(6), ‘‘Contents of the notice,’’ 

specifically set out what must be 

included in the notice of transfer given 

to residents and, if known, a family 

member or legal representative. Since 

the transfer and discharge requirements 

are tailored specifically to each 

resident’s unique needs, we believe that 

the required information will 

sufficiently address the commenter’s 

concerns. 

Additionally, the Nursing Home 

Compare Web site is a tool available to 

individuals looking for updated 

comparative information regarding 

functioning LTC facilities; this 

information can be utilized during the 

relocation process, and is available 

online at: http://www.medicare.gov/

nhcompare/include/datasection/

questions/proximitysearch.asp?bhcp=1. 

Comment: Some commenters 

expressed concern that CMS was 

requiring the facility closure plan to 

include a commitment to retain and pay 

employees at the facility until it was 

closed (76 FR 9507). In particular, the 

commenters were concerned that the 

administrator might be held accountable 

for civil monetary penalties for any 

failure to adequately staff and pay 

employees. The commenters observed 

that unless the facility administrator 

was also the owner, the administrator 

generally would not have authority 

over, or access to, the funds that would 

be used to pay staff. 

Response: While we expect the LTC 

facility administrator will be able to 

identify the necessary steps for a 

successful transfer of the residents, we 

note that the contents of the closure 

plan described in the preamble of the 

February 18, 2011 interim final rule 

were examples, not requirements (as 

incorrectly characterized by the 

commenter). Additionally, as mentioned 

in the preamble of the February 18, 2011 

interim final rule, we expect that the 

closure plan include sufficient detail to 

clearly identify the steps the facility 

would take, and the individual 

responsible for ensuring the steps are 

successfully carried out, such as 

continuation of appropriate staffing 

levels, and paychecks at the facility. We 

intend to provide more detail on the 

contents of the closure plan in the 

interpretive guidance. 

Comment: Several commenters 

requested clarification as to how a 

resident would be assessed for transfer 

to either an LTC facility or other 

community and home-based settings. 

Additionally, one commenter requested 

clarification regarding what would 

happen if admission to any of the 

settings deemed most appropriate for 

the resident were denied. 

Response: We believe existing 

requirements at § 483.20(l), ‘‘Discharge 

summary,’’ should sufficiently address 

the commenter’s concerns regarding 

how a resident would be assessed for 

transfer. According to those 

requirements, when the facility 

anticipates discharge, a resident must 

have a discharge summary that includes 

a final summary of the resident’s status 

to include the elements in the 

comprehensive assessment of a 

resident’s needs located in § 483.20(b). 

Section 483.20(l) also requires a postdischarge plan of care to be developed 

with the participation of the resident 

and his or her family. The plan of care 

will assist the resident with adjusting to 

his or her new living environment. 

Additionally, § 483.75(r)(3) requires 

the LTC facility to include in the notice, 

the plan for the transfer and adequate 

relocation of the residents of the facility 

by a date that would be specified by the 

State prior to closure, that has been 

approved by the State, including 


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assurances that the residents would be 

transferred to the most appropriate 

facility or other setting in terms of 

quality, services, and location, taking 

into consideration the needs, choice, 

and best interests of each resident. If 

admission to any of the settings deemed 

most appropriate for the resident were 

denied, the facility would still be 

responsible for locating another setting 

comparable in terms of quality, services, 

and location, taking into consideration 

the needs, choice, and best interests of 

the resident, in order to comply with the 

requirements of this regulation. 

Comment: One commenter 

recommended that CMS require that 

SNFs and NFs give residents, to the 

extent possible, an opportunity to visit 

facilities in advance so that they can 

choose the facility they would like to 

move. 

Response: This regulation does not 

prohibit residents of a SNF or NF from 

visiting other facilities in advance. 

Additionally, existing regulations at 

§ 483.12(a)(7), state that a facility must 

provide sufficient preparation and 

orientation to residents to ensure safe 

and orderly transfer or discharge from 

the facility. The facility should actively 

involve, to the extent possible, the 

resident and the resident’s family in 

selecting the new residence. Some 

examples of orientation may include 

trial visits, if possible, by the resident to 

a new location; orienting staff in the 

receiving facility to the resident’s daily 

patterns; and reviewing with staff 

routines for handling transfer and 

discharges in a manner that minimizes 

unnecessary and avoidable anxiety or 

depression for the resident. 

Comment: One commenter suggested 

that the facility’s closure plan include a 

requirement to ensure that other nursing 

homes, including those owned by the 

same company as the facility that is 

closing, do not have access to a 

resident’s record in order to ‘‘cherry 

pick’’ private pay residents or those 

with lighter care needs. Additionally, 

one commenter suggested that the 

facility’s closure plan include 

information on how residents may 

contact the State’s long-term care 

ombudsman and access CMS’s Nursing 

Home Compare Web site since the 

updated data planned for the site will 

increase its value as a tool for residents 

to select an alternate nursing home in 

the event of a facility closure. 

Response: The selection of an 

alternate facility is a decision 

collectively made by the resident (or 

their responsible party) and the care 

planning team. We believe that the 

provision at § 483.75(r)(3), which 

requires the written notice to assure 

residents that they will be transferred to 

the most appropriate facility or other 

setting in terms of quality, services, and 

location, taking into consideration the 

needs, choice, and best interests of each 

resident, adequately addresses the 

commenter’s concerns. In addition, to 

ensure that the residents’ rights are 

protected, § 483.75(r)(1) requires the 

ombudsman to be contacted as part of 

the closure notice. Under the Federal 

Older Americans Act, every State is 

required to have an Ombudsman 

Program that addresses complaints and 

advocates for improvements in the LTC 

system 

(http://www.ltcombudsman.org/). 

Comment: Several commenters 

offered suggestions to CMS on what 

should be included in the SOM 

regarding the implementation 

guidelines for this regulation. One 

commenter suggested that CMS include 

in the SOM that nursing home residents 

displaced due to a facility closure be 

provided with information about and 

access to home and community-based 

setting options as appropriate. 

Another commenter suggested that 

CMS provide additional guidance to 

State Survey Agencies regarding how to 

use monitors and temporary managers 

more effectively in facility closure 

situations. Additionally, one commenter 

recommended that the SOM should 

include guidance related to timeframes 

for completion of all paperwork 

assuring successful resident relocation. 

Another commenter recommended that 

CMS include guidance regarding posttransfer assessments of the residents’ 

emotional health. The commenter stated 

that an assessment would ensure that 

evaluating the success of the residents 

relocation would not be limited to the 

mere physical move itself, but would 

also consider the residents’ 

psychosocial adjustment. 

Response: We appreciate the 

commenters’ suggestions regarding 

guidance for surveyors. We will 

consider these comments when making 

changes to the interpretive guidance. 

E. Facility Closure (§ 483.75(s)) 

At § 483.75(s), we require that the 

facility have in place policies and 

procedures that will ensure the 

administrator’s duties and 

responsibilities involve providing the 

appropriate notices in the event of a 

facility closure. In the preamble to the 

February 18, 2011 interim final rule, we 

noted that the facility will not be 

sanctioned for noncompliance with this 

rule; however, it may be cited for a 

deficiency during the survey process (76 

FR 9507). We are finalizing these 

provisions as set forth in the interim 

final rule. 

The comments we received on this 

provision and our responses are set 

forth below. 

Comment: One commenter suggested 

that CMS withdraw § 483.75(s) from the 

final rule due to its inconsistency with 

the Congressional intent, which is to 

hold the administrator, not the facility, 

accountable for failure to provide proper 

notification in advance of a facility 

closure. Alternatively, a few 

commenters suggested that the final rule 

should establish a process for 

sanctioning facility owners in addition 

to administrators who do not comply 

with the closure provisions. Some 

commenters suggested that the 

provision was unnecessary because 

when a facility decides to close, the rule 

requires the administrator to prepare the 

closure plan and seek appropriate 

approvals, regardless of whether the 

facility has policies and procedures. 

Response: As we stated in the 

preamble of the February 18, 2011 

interim final rule, while this provision 

is not explicitly required by section 

1128I(h) of the Act, we believe that it is 

implicitly authorized by this section of 

the Act, which set forth requirements 

for LTC facility closures. Moreover, 

issuance of this regulatory provision is 

permitted by the general rulemaking 

authority of sections 1819(d)(4)(B) and 

1919(d)(4)(B) of the Act, which 

explicitly permits the Secretary to issue 

rules relating to the health, safety, and 

well-being of residents, as well as rules 

concerning physical facilities. 

Additionally, § 483.75(d), Governing 

body, requires the facility to have a 

governing body, or designated persons 

functioning as a governing body, that is 

legally responsible for establishing and 

implementing polices regarding the 

management and operation of the 

facility. Therefore, the facility is 

responsible for the overall functioning 

of the LTC facility, though it will not be 

sanctioned for noncompliance with this 

rule, a facility that does not meet the 

requirements at § 483.75(s) could be 

cited for a deficiency during the survey 

process. We continue to believe this 

level of added protection will ensure 

that the intent of the Congress is 

implemented and that residents receive 

adequate notice before a facility closure. 

F. Transfer of Residents, or Closure of 

the Facility and Transfer of Residents 

(§ 488.426) 

We revised § 488.426, Transfer of 

residents, or closure of the facility and 

transfer of residents, at § 488.426(b) to 

include a cross-reference to the new 

requirements at § 483.75(r). We also 


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added a new requirement at § 488.426(c) 

to address the required notifications 

when a facility closes. We are finalizing 

these provisions set forth in the interim 

final rule. 

The comments we received on this 

provision and our responses are set 

forth below. 

Comment: A few commenters 

mentioned that the Affordable Care Act 

requires the notices issued by 

administrators to include a closure plan 

that has been approved by the State; 

however, the regulation does not 

establish any process for State review 

and action on facility closure plans. It 

was suggested that the final rule 

establish these procedures under which 

States would review and act on 

proposed closure plans. The commenter 

suggested that CMS prescribe in 

regulations (rather than through subregulatory guidance in the SOM) that 

States will be required to ensure safe 

relocation of residents following their 

facility’s closure and that CMS has 

authority to enforce the requirements 

directly. 

Response: Section 1128(h)(1)(C) of the 

Act states any individual who is the 

administrator of a facility must include 

in the notice a plan for the transfer and 

adequate relocation of the residents of 

the facility by a specified date prior to 

closure that has been approved by the 

State, including assurances that the 

residents will be transferred to the most 

appropriate facility or other setting in 

terms of quality, services, and location, 

taking into consideration the needs, 

choice, and best interests of each 

resident. In accordance with the statute, 

States are required to approve the plan. 

We expect the State Survey Agency to 

manage the approval process. Thus, we 

do not believe it is necessary to add 

these requirements to the regulation, but 

will address it in the SOM. In this final 

rule, we have revised the language at 

§ 483.75(r)(3) of the regulations text to 

incorporate the explicit requirement. 

The regulation text will now read, 

‘‘Include in the notice the plan, that has 

been approved by the State, for the 

transfer and adequate relocation of the 

residents of the facility by a date that 

would be specified by the State prior to 

closure, including assurances that the 

resident would be transferred to the 

most appropriate facility or other setting 

in terms of quality, services, and 

location, taking into consideration the 

needs, choice, and best interests of each 

resident.’’ 

G. Administrator Sanctions: Long-Term 

Care Facility Closures (§ 488.446) 

As required by section 6113 of the 

Affordable Care Act, we added a new 

§ 488.446, which will potentially subject 

to sanctions any administrator of a 

facility that fails to comply with the 

requirements at § 483.75(r). We are 

finalizing these provisions as set forth in 

the interim final rule. The comments we 

received on this provision and our 

responses are set forth below. 

Comment: Several commenters had 

concerns that an owner of a nursing 

facility could arrange for the closure of 

the facility after the prescribed 

timeframe for notification, without 

knowledge or involvement of the 

administrator, thus exposing the facility 

administrator to the sanction when they 

were not aware of the owner’s plans to 

close the facility. Additionally, 

commenters requested that CMS 

consider waiving sanctions for 

administrators that are hired after the 

decision is made to close a facility. 

Response: We agree with the 

commenters that the administrator may 

encounter a situation where adequate 

time to submit a notification of closure 

to the specified entities, as required by 

§ 483.75(r)(1), was not given. In some 

cases, an administrator may not have 

had control over implementing the 

notice procedures. For example, an 

administrator may have been hired to 

oversee the facility’s impending closure, 

although he or she was not present 

when the decision was made to close 

the facility. The administrator may have 

been employed less than 60 days prior 

to closure. Another possibility is that 

the facility owner may not have even 

informed the new administrator of plans 

to close the facility. However, the lack 

of previous involvement does not 

relieve the administrator (at the time of 

closing) of the responsibility for 

implementing the plan and the 

procedures as required to the extent 

possible. In these instances, the 

administrator would be expected to 

provide the closure notice as soon as 

possible and begin implementing the 

plan for closure, working with the State 

Survey Agency for transferring the 

residents. The administrator hired to 

assist with closure would be expected to 

implement the closure plan and work 

closely with the State and CMS to 

assure that appropriate procedures were 

implemented. From the time that the 

administrator was made aware of the 

closure, he or she would be responsible 

for compliance with this regulation. 

Additionally, while it was not 

mandated by the Affordable Care Act, 

we have added § 498.5(m), which allows 

for appeal rights of an individual who 

is the administrator of a SNF or NF. 

Therefore, if an individual who is the 

administrator of a SNF or NF is 

dissatisfied with the decision of CMS to 

impose sanctions, he or she would be 

entitled to a hearing before an 

Administrative Law Judge (ALJ), to 

request the Departmental Appeals Board 

review of the hearing decision, and to 

seek judicial review of the Board’s 

decision. 

Comment: A few commenters 

expressed concerns about the Civil 

Monetary Penalty (CMP) levels being 

too low, considering that section 6113 of 

the Affordable Care Act permits fines of 

up to $100,000 and subsequent 

exclusion from participating in any 

Federal healthcare programs and 

suggested increasing the minimum 

penalty. Another commenter 

recommended enforcing CMPs from 

$100.00 up to $1,000.00, multiplying 

the amount of the CMP by the number 

of residents who were admitted after 

written notice of closure was provided 

to the State. Another commenter 

suggested that those facilities that 

committed multiple offenses should 

incur all penalties to the fullest extent 

possible, while another commenter 

requested clarification and/or criteria 

for what would constitute multiple 

offenses that would result in increased 

amounts of CMPs. 

Response: We believe that the 

Congress intended for CMS to use 

sanctions as a method to ensure that the 

statutory requirements are enforced. The 

statutory language that was enacted 

stated ‘‘up to $100,000.’’ This language 

established a maximum limit, but 

afforded CMS the discretion to 

determine the actual amount of the 

sanctions. Due to the many possible 

combinations of violations that could be 

cited, the amount of the penalty will be 

determined based on the survey 

findings. For example, if it is 

determined that an administrator of 

record completely fails to take the 

necessary and timely actions to adhere 

to the closure requirements, thus 

potentially causing harm to residents, 

then the administrator could be subject 

to additional CMPs. Any sanctions that 

have been levied against an 

administrator could also be reviewed by 

the State’s licensing agency for possible 

disciplinary action, including 

suspension or termination of the 

administrator’s license, in those States 

that provide for the licensing of LTC 

facility administrators. Interpretive 

guidelines are being developed that will 

establish criteria for determination of its 

CMP amounts. 

Comment: One commenter suggested 

that CMS and State licensing agencies 

consider sharing a percentage of any 

resultant CMP proceeds with any parties 

that may have directly been injured 


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because of failures to notify and/or plan 

for relocation, 

Response: Existing requirements at 

§ 488.433, ‘‘Civil money penalties: Uses 

and approval of civil money penalties 

imposed by CMS,’’ state that 10 percent 

of the collected CMP funds that are 

required to be held in escrow and that 

remain after a final administrative 

decision will be deposited with the 

Department of Treasury. The remaining 

90 percent of the collected CMP funds 

that are required to be held in escrow 

and that remain after a final 

administrative decision may not be used 

for survey and certification operations, 

but must be used entirely for activities 

that protect or improve the quality of 

care for residents. These activities must 

be approved by CMS and may include, 

but are not limited to: support and 

protection of residents of a facility that 

closes, time-limited expenses incurred 

in the process of relocating residents to 

home and community-based settings or 

another facility when a facility is closed 

or downsized pursuant to an agreement 

with a State Medicaid agency, facility 

improvement initiatives approved by 

CMS, such as, joint training or facility 

staff and surveyors or technical 

assistance for facility implementing 

quality assurance and performance 

improvement program, when facilities 

have been cited by CMS for deficiencies 

in the applicable requirements. While 

the collected CMPs are not dispersed to 

the affected parties directly, the money 

will be used to protect and improve the 

quality of care for residents. Therefore, 

we believe they ultimately will derive 

benefits from the collected CMP funds. 

Comment: A few commenters 

requested clarification regarding what 

would constitute ‘‘unjustified harm’’ to 

the resident, family, and visitors, as 

mentioned in the preamble to the 

February 18, 2011 interim final rule 

with comment period cited as a 

justification for harsher administrator 

sanctions (75 FR 9507). One commenter 

stated that it was not clear how or why 

the administrator would have any legal 

obligation to third parties such as family 

members or visitors. A commenter 

suggested that we remove the language 

in the preamble suggesting that the 

administrator could be subject to 

additional CMPs if it was determined 

that family members and visitors of the 

resident experienced ‘‘unjustified harm’’ 

(75 FR 9507). 

Response: We are clarifying that it 

was not our intention to make an LTC 

facility administrator personally liable 

to family members and visitors for harm 

resulting from a failure to notify. We 

used a technical term to describe 

deficiencies; however, this terminology 

does not create either a Federal or State 

standard of care. We do not believe that 

any level of harm, whether based on 

intent or negligence, is acceptable. 

H. Period of Continued Payments 

(§ 488.450(c)) 

We revised § 488.450 by adding a new 

requirement to provide that, in the case 

of a facility closure, the Secretary may, 

as appropriate, continue to make 

payments under this title with respect to 

residents of an LTC facility that has 

submitted a notification of closure, 

during the period beginning on the date 

such notification is submitted and 

ending on the date, which the resident 

is successfully relocated. We note that 

in this final rule, we are correcting a 

typographical error in the regulations 

text. The provision in section 

§ 488.450(c)(2) will now read, ‘‘ * * * 

ending on the date on which the 

residents are successfully relocated.’’ 

The comments we received on this 

provision and our responses are set 

forth below. 

Comment: One commenter suggested 

that CMS provide a procedure for 

residents, their representatives, citizen 

advocacy groups, and the State LTC 

ombudsman to comment on when 

payments can be terminated. 

Response: We appreciate the 

commenter’s concern regarding 

termination of payment in the event of 

a facility closure. However, we do not 

believe that any changes in this aspect 

of the rule are needed because the 

statute and our regulatory requirements 

address the concerns of the commenter. 

Section 1128I(h)(3) of the Act and 

requirements at § 488.450(c), authorize 

the Secretary to continue to make 

payments with respect to residents of an 

LTC facility that has submitted a 

notification of closure during the period 

beginning on the date such notification 

is submitted to CMS and ending on the 

date on which all residents are 

successfully relocated. Therefore, CMS 

will determine, as appropriate, whether 

to continue to make payments with 

respect to residents of an LTC facility 

that has submitted a notification of 

closure as required at § 483.75(r). We 

believe this matter is purely operational 

and not amenable to the discretion 

implied by an opportunity for public 

comment. If residents have concerns 

regarding a facility closure and 

relocation process, we would encourage 

them to make their concerns known to 

the State LTC Ombudsman. 

I. Notice to CMS (§ 489.52(a)) 

We revised § 489.52(a)(1) to provide 

an exception for SNFs, and by adding a 

new requirement specific to SNF 

notifications to CMS. Specifically, at 

§ 489.52(a)(2), we specify that a SNF 

provider that wishes to terminate its 

agreement must send CMS written 

notice of its intent at least 60 days prior 

to the date of closure, in accordance 

with § 483.75(r)(1)(i). 

We did not receive any public 

comments regarding this provision. 

Therefore, we are finalizing the 

revisions of § 489.52(a)(2) as set forth in 

the interim final rule. 

J. Skilled Nursing Facility Closure 

(§ 489.53(d)(3)) 

We added a new requirement at 

§ 489.53(d)(3), to state that when CMS 

terminates a facility’s participation 

under Medicare or Medicaid, CMS will 

determine the date of the required 

notifications. We also revised 

§ 489.53(d)(1) to reflect this change. 

We did not receive any public 

comments regarding this provision. 

Therefore, we are finalizing 

§ 489.53(d)(1) and (d)(3) as set forth in 

the interim final rule. 

K. Exceptions to Effective Date of 

Termination (§ 489.55) 

We added a new requirement at 

§ 489.55 that authorizes the Secretary to 

continue to make payments to the SNF 

or, for a NF, to the State, as the 

Secretary considers appropriate, during 

the period beginning at the time the 

notification is submitted and until the 

resident is successfully relocated. In this 

final rule, we are correcting a 

typographical error in the regulations 

text at § 489.55(a)(1). The provision will 

now read, ‘‘Inpatient hospital services 

(including inpatient psychiatric hospital 

services) and post hospital extended 

care services * * * ’’ 

The comments we received on this 

provision and our responses are set 

forth below. 

Comment: A few commenters 

recommended CMS consider the role 

economic factors play in a decision to 

close, the potential impact of 

discontinued funding to resident care 

and services during the closure process, 

and to support ongoing policy for 

continued payment through the 60-day 

notice period or until the last resident 

is successfully relocated, whichever is 

earlier. 

Response: We agree with the need to 

provide continued funding until all of 

the residents are successfully relocated. 

As stated in a previous response, section 

1128I(h)(3) of the Act authorizes the 

Secretary to continue to make payments 

with respect to residents of an LTC 

facility that has submitted the required 

notification of closure to CMS. 


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L. Scope and Applicability (§ 498.3) 

We added a new requirement at 

§ 498.3(a)(2)(iv) to clarify that CMS may 

also impose sanctions on NF 

administrators for noncompliance with 

§ 483.75(r). We also added a new 

requirement at § 498.3(a)(3)(ii) to 

indicate that the appeals process applies 

to NFs as well as SNFs. In addition, a 

new requirement was added at 

§ 498.3(b)(18) to indicate that a sanction 

imposed on a SNF or NF administrator 

for noncompliance with the 

requirements set out at § 483.75(r) 

constitutes an initial determination of 

the agency. 

We did not receive any public 

comments regarding this provision. 

Therefore, we are finalizing the 

revisions at § 498.3(a)(2)(iv) as set forth 

in the interim final rule. However, we 

are correcting a typographical error at 

§ 498.3(a)(3), to include, ‘‘(iii)’’ when 

referring to Part 488, subpart E 

(§ 488.330(e)) and subpart F 

(§ 488.446)—for SNFs and NFs and their 

administrators. 

M. Appeal Rights (§ 498.5) 

We added a new requirement at 

§ 498.5(m), to establish appeal rights for 

administrator sanctions for 

noncompliance with the requirements 

set out at § 483.75(r). 

We did not receive any public 

comments regarding this provision. 

However, we are making a technical 

correction at § 498.5(m) to include, ‘‘or 

NF’’ when referring to the appeal rights 

of an individual who is the 

administrator. We had included the 

term ‘‘NF’’ in the February 18, 2011 

interim final rule’s preamble language 

on this provision, but inadvertently 

omitted it from the corresponding 

regulations text. 

IV. Provisions of the Final Regulations 

We are adopting as final the 

requirements set forth in the interim 

final rule published in the Federal 

Register on February 18, 2011 (76 FR 

9503), with the following changes: 

• We are revising § 483.12(a)(8) and 

§ 483.75(r)(1) to clarify that the facility 

must submit written notification of an 

impending closure to ‘‘the State Survey 

Agency’’ instead of ‘‘the Secretary’’. 

• We note that we inadvertently 

omitted language regarding the statutory 

requirement at 1128I(h)(1)(C) for State 

approval of the plan. We are correcting 

the language accordingly in section 

§ 483.75(r)(3) of the regulations text in 

this final rule. 

• We are correcting a typographical 

error in the provision regarding the 

period of continued payments at 

§ 488.450(c)(2), which will now read, 

‘‘ * * * ending on the date on which 

the residents are successfully 

relocated.’’ 

• We are correcting a typographical 

error in the provisions regarding 

Exceptions to the effective date of 

termination at § 489.55(a)(1), which will 

now read, ‘‘Inpatient hospital services 

(including inpatient psychiatric hospital 

services) and post hospital extended 

care services * * * ’’ 

• We are correcting a typographical 

error at § 498.3(a)(3), to include, ‘‘(iii)’’ 

when referring to Part 488, subpart E 

(§ 488.330(e)) and subpart F 

(§ 488.446)—for SNFs and NFs and their 

administrators. 

• We are making a technical 

correction at § 498.5(m) to include, ‘‘or 

NF’’ when referring to the appeal rights 

of an individual who is the 

administrator. We included NFs in the 

preamble language and inadvertently 

omitted it from the regulation text. 

• We inadvertently omitted a citation 

from all authority citations in the 

regulation text. We are correcting that 

error by adding ‘‘1320a–7j’’ to all 

authority citations. 

V. Collection of Information 

Requirements 

Under the Paperwork Reduction Act 

of 1995, we are required to provide 30- 

day notice in the Federal Register and 

solicit public comment before a 

collection of information requirement is 

submitted to the Office of Management 

and Budget (OMB) for review and 

approval. In order to fairly evaluate 

whether an information collection 

should be approved by OMB, section 

3506(c)(2)(A) of the Paperwork 

Reduction Act of 1995 requires that we 

solicit comment on the following issues: 

• The need for the information 

collection and its usefulness in carrying 

out the proper functions of our agency. 

• The accuracy of our estimate of the 

information collection burden. 

• The quality, utility, and clarity of 

the information to be collected. 

• Recommendations to minimize the 

information collection burden on the 

affected public, including automated 

collection techniques. 

We requested public comment on 

each of these issues for the following 

sections of this document that contain 

information collection requirements 

(ICRs): 

The revisions at § 483.12(a)(8) require 

any individual who is the administrator 

of the facility to submit to the Secretary, 

the State LTC ombudsman, residents 

and their legal representatives, or other 

responsible parties, written notification 

of an impending closure at least 60 days 

prior to such closure; or not later than 

the date that the Secretary deems 

appropriate in the case of a facility 

where the Secretary terminates the 

facility’s participation under this title. 

Current regulations at § 483.12(a)(5) 

require notification of transfer or 

discharge to a resident and, if known, a 

family member or legal representative, 

in writing. Except in certain specified 

circumstances, notification must be 

made at least 30 days prior to transfer 

or discharge. Facility closure is not a 

circumstance that permits a facility to 

make notification in fewer than 30 days. 

Although the requirement extends the 

time period for notification from 30 

days to 60 days (or a date determined 

by the Secretary in case of CMS 

termination of the facility), we do not 

believe the change in the time period for 

reporting imposes any additional 

burden. In addition, notification of 

transfer or discharge to residents and 

their representatives is already a usual 

and customary business practice. 

Therefore, in accordance with 5 CFR 

1320.3(b)(2), we will not include this 

activity in the ICR burden analysis. 

Although there are no existing Federal 

regulatory requirements for LTC 

facilities to notify other individuals or 

entities of an impending closure, 

according to feedback to CMS from State 

surveyors for LTC facilities, nearly all 

States already require LTC facilities to 

notify the State within 30 to 90 days. 

Because we have found that 

notifications of impending closure are a 

standard business practice for most LTC 

facilities, we believe that this 

requirement would impose burden on 

only a small number of facilities. 

Each facility that does not already 

notify the State and the State LTC 

ombudsman must develop a process for 

notifying these entities. We estimate 

that the burden associated with 

complying with this requirement would 

be due to the resources required to 

develop a process for notifying the State 

and the State LTC ombudsman and the 

time it takes to notify those entities. We 

expect that the notification process 

would involve the administrator of the 

facility and administrative support 

person and an attorney to review the 

plan. 

The revisions at § 483.75(r)(2) require 

that the administrator of the facility 

ensure that the facility does not admit 

any new residents on or after the date 

written notification is submitted. We do 

not anticipate any ICR burden 

associated with this requirement. 

Section 483.75(r)(3) requires the 

administrator of the facility to include 

in the notice the plan for the transfer 

and adequate relocation of the residents 


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of the facility by a date that is specified 

by the State prior to closure, that has 

been approved by the State, including 

assurances that the residents would be 

transferred to the most appropriate 

facility or other setting in terms of 

quality, services, and location, taking 

into consideration the needs, choice, 

and best interests of each resident. 

Section 483.75(s) requires the facility 

to have in place policies and procedures 

to ensure that the administrator’s duties 

and responsibilities include the 

provision of the appropriate notices in 

the event of a facility closure. 

In our experience, based on feedback 

to CMS from State surveyors of LTC 

facilities, most facilities already have 

plans for transfer of residents, regardless 

of whether closure of the facility is 

expected. For example, most facilities 

have plans for transfer of residents to 

another facility in the event of an 

emergency. Also, based on our 

experience, nearly all facilities 

anticipating closure develop plans for 

the relocation of residents and other 

closure-related activities. Many States 

require these plans. For example, 

Vermont requires that the State 

licensing agency and the LTC 

ombudsman be notified by the 

administrator of the facility 90 days 

prior to the proposed date of closure. 

Additionally, the facility administrator 

is required to provide to the State 

licensing agency and LTC ombudsman a 

written transfer plan 60 days prior to 

closure. See http://www.sph.umn.edu/

hpm/nhregsplus/NH%20Regs%20by%

20Topic/NH%20Regs%

20Topic%20Pdfs/Admission/

admission_transfer_and_discharge_

rights_ALL_STATES.pdf. 

Because we have found that transfer 

plans are a standard business practice 

for most LTC facilities, we believe that 

this requirement would impose burden 

on only a small number of facilities. 

Each facility that does not already 

have a plan in place must develop a 

plan for the transfer and adequate 

relocation of residents of the facility. We 

estimate that the burden associated with 

complying with this requirement would 

be due to the resources required to 

develop and review a new plan or, if 

necessary, modify an existing plan for 

the transfer of residents in the event of 

facility closure. We expect that 

development of a plan would involve 

the administrator of the facility, an 

administrative support person, and an 

attorney to review the plan. 

LTC facilities are currently required to 

have a plan under § 483.12 for discharge 

and transfer of residents. A facility must 

provide sufficient preparation and 

orientation to residents to ensure safe 

and orderly transfer or discharge from 

the facility. Therefore, we anticipate 

that, on average, it will take 3 hours to 

develop the plan, 1 hour to ensure that 

the administrator’s duties include 

policies and procedures relating to 

facility closures, 2 hours for an 

administrative support person to 

prepare the document(s), and 1 hour for 

an attorney to review the document(s), 

for a total estimated burden of 7 hours 

per facility. We also believe that the 

burden would remain approximately the 

same for the first year and beyond. 

Currently, there are 15,720 LTC 

facilities in the U.S. Based on an hourly 

rate of $58.17 for a nursing home 

administrator, we estimate that 

development of the plan and 

incorporating facility closure policies 

and procedures into the administrator’s 

duties would cost $3,657,729.60 (15,720 

facilities × 4 hours per facility) × $58.17 

per hour). Based on an hourly rate of 

$20.11 for an administrative assistant, 

we estimate that preparing the plan 

documents would cost $632,258.40 

((15,720 facilities × 2 hours per facility) 

× $20.11 per hour). Finally, based on an 

hourly rate of $82.50 for an attorney, we 

estimate that reviewing the plan 

document would cost $1,296,900.00 

((15,720 facilities × 1 hour per facility) 

× $82.50 per hour). The salary estimates 

include 33 percent of the mean hourly 

rate for overhead and fringe benefits 

(Source: BLS.gov). Therefore, we 

anticipate that the total burden 

associated with this provision is 

$5,586,888.00 (15,720 facilities × 7 

hours per facility at $355.40). 

If you comment on these information 

collection and recordkeeping 

requirements, please submit your 

comments to the Office of Information 

and Regulatory Affairs, Office of 

Management and Budget, Attention: 

CMS Desk Officer, CMS–3230–F Fax: 

(202) 395–6974; or 

Email: 

OIRA_submission@omb.eop.gov 

VI. Regulatory Impact Analysis 

A. Statement of Need 

Executive Order 13563 directs 

agencies to consider and discuss 

qualitatively values that are difficult to 

quantify, including equity, human 

dignity, fairness and distributive 

impacts. This final rule will implement 

section 1128I(h) of the Act (as amended 

by section 6113 of the Affordable Care 

Act), which mandates specific 

procedures in the event of a closure of 

a nursing home. LTC facility closure 

procedures have implications related to 

access to care, the quality of care, and 

the overall health of residents. These 

procedures help protect the resident, the 

resident’s family, and visitors because 

they require the facility to provide an 

organized plan that allows the resident, 

family, and visitors to make the 

necessary adjustments within a 

reasonable time frame. 

B. Overall Impact 

We have examined the impacts of this 

rule as required by Executive Order 

12866 on Regulatory Planning and 

Review (September 30, 1993), Executive 

Order 13563 on Improving Regulation 

and Regulatory Review (January 18, 

2011), the Regulatory Flexibility Act 

(RFA) (September 19, 1980, Pub. L. 96– 

354), section 1102(b) of the Social 

Security Act, section 202 of the 

Unfunded Mandates Reform Act of 1995 

(March 22, 1995; Pub. L. 104–4), 

Executive Order 13132 on Federalism 

(August 4, 1999) and the Congressional 

Review Act (5 U.S.C. 804(2). 

Executive Orders 12866 and 13563 

direct 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 in any 1 year). 

This rule does not qualify as a major 

rule as the estimated economic impact. 

We estimate that these requirements 

will cost $355.40 (5,586,888.00/15,720) 

per facility the first year and each year 

thereafter. Due to the increase in the 

number of long-term care facilities, we 

recalculated the economic impact of the 

February 18, 2011 IFC and have 

determined that it has slightly increased 

by $2,488 in total. (The number of longterm care facilities has increased 

slightly since publication of the interim 

final rule.) As a result, the economic 

impact for the February 18, 2011 IFC is 

$5,586,888. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

businesses, if a rule has a significant 

impact on a substantial number of small 

entities. For purposes of the RFA, small 

entities include small businesses, 

nonprofit organizations, and small 

government jurisdictions. The great 

majority of hospitals and most other 

health care providers and suppliers are 

small entities, either by being nonprofit 

organizations or by meeting the SBA 

definition of a small business (having 

revenues of less than $7.0 million to 

$34.5 million in any 1 year). For 

purposes of the RFA, most physician 


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practices, hospitals, and other providers 

are small entities, either by nonprofit 

status or by qualifying as small 

businesses under the Small Business 

Administration’s size standards 

(revenues of less than $7.0 to $34.5 

million in any 1 year). States and 

individuals are not included in the 

definition of a small entity. For details, 

see the Small Business Administration’s 

Web site at http://www.sba.gov/aboutsba-services/7591. A rule has a 

significant economic impact on the 

small entities it affects, if it significantly 

affects their total costs or revenues. 

Under statute, we are required to assess 

the compliance burden the regulation 

will impose on small entities. Generally, 

we analyze the burden in terms of the 

impact it will have on entities’ costs if 

these are identifiable or revenues. As a 

matter of sound analytic methodology, 

to the extent that data are available, we 

attempt to stratify entities by major 

operating characteristics such as, size 

and geographic location. If the average 

annual impact on small entities is 3 to 

5 percent or more, it is to be considered 

significant. 

We estimate that these requirements 

will cost $355.40 ($5,586,888.00/15,720 

facilities) per facility initially and 

$355.40 ($5,586,888.00/15,720 facilities) 

thereafter. This clearly is far below 1 

percent of total facility costs or 

revenues; therefore, we do not 

anticipate it to have a significant 

impact. We do not have any data related 

to the number of LTC facilities that have 

facility closure plans in place; however, 

we are aware through our experience 

with LTC facilities and the survey 

process that most facilities have a plan 

for closure either because they are 

required to have a plan in place at the 

State level or because of their 

understanding that this is a standard 

business practice. 

In addition, section 1102(b) of the Act 

requires us to prepare a regulatory 

impact analysis 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 604 of the 

RFA. For the 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 100 

beds. This rule would only affect those 

institutions that meet the definition of a 

‘‘facility’’ in section 1128I(a) of the Act; 

that is, SNFs and NFs. Therefore, the 

Secretary has determined that this final 

rule would not have any impact on the 

operations of small rural hospitals. 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 (UMRA) 

also requires that agencies assess 

anticipated costs and benefits before 

issuing any rule whose mandates 

require spending in any 1 year of $100 

million in 1995 dollars, updated 

annually for inflation. In 2012, that 

threshold is approximately $139 

million. This rule would not have a 

significant impact on the governments 

mentioned or on private sector costs. 

The estimated economic effect of this 

rule is $5,586,888.00 the first year and 

$5,586,888.00, thereafter. These 

estimates are derived from our analysis 

of burden associated with these 

requirements in section IV, ‘‘Collection 

of Information Requirements.’’ 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it promulgates a 

proposed rule (and subsequent final 

rule) that imposes substantial direct 

requirement costs on State and local 

governments, preempts State law, or 

otherwise has Federalism implications. 

This rule will not have any effect on 

State or local governments. 

C. Anticipated Effects 

1. Effects on LTC Facilities 

The purpose of this final rule is to 

ensure that, among other things, in the 

case of a facility closure, any individual 

who is the administrator of the facility 

will provide written notification of the 

closure and the plan for the relocation 

of residents at least 60 days prior to the 

impending closure or, if the Secretary 

terminates the facility’s participation in 

Medicare or Medicaid, not later than the 

date the Secretary determines 

appropriate. This rule will protect 

residents’ health and safety and make 

the transition to closure as smooth as 

possible for residents, as well as family 

members and facility staff. 

2. Effects on Other Providers 

This rule is expected to allow for a 

smoother transition when a facility 

closes. It requires facilities and facility 

administrators to prepare in advance for 

closure so that, in the event of a closure, 

the facility is equipped to protect 

resident rights and continue to provide 

quality care to residents who must be 

relocated. This final rule will also 

improve coordination of care between 

the transferring LTC facility and the 

chosen destination setting. For example, 

if a resident is transferred from an LTC 

facility to a non-LTC facility such as an 

assisted living facility, we do not 

believe that non-LTC facilities would 

experience any increase in 

administrative burden as a result of 

these provisions. In fact, we anticipate 

that the receiving facility would benefit 

from increased coordination with the 

transferring LTC facility. 

3. Effects on the Medicare and 

Medicaid Programs 

This rule will require that the State 

and CMS be notified in the case of a 

facility closure and provides them with 

the ability to make determinations 

regarding the timing of termination of 

provider agreements and continuation 

of payments to LTC facilities. This rule 

will also support efforts directed toward 

broad-based improvements in the 

quality of health care furnished by 

Medicare and Medicaid providers. 

D. Alternatives Considered 

We considered the effects of not 

addressing specific requirements for the 

notification of facility closures in LTC 

facilities, although these requirements 

are statutory and only allow limited 

discretion on the part of the Secretary. 

However, we strongly believe that to 

improve quality and ensure consistency 

in the provision of care in LTC facilities, 

it is important to ensure that residents 

rights are protected in LTC facilities and 

that they are relocated appropriately, 

taking into consideration the needs, 

choice, and best interest of each resident 

should a facility closure take place. We 

expect that these requirements will 

result in improvement in the quality of 

services provided to LTC residents 

when they need to be involuntarily 

relocated as a result of the closures. 

E. Conclusion 

This final rule ensures that, among 

other things, in the case of a facility 

closure, any individual who is the 

administrator of the facility provide 

written notification of the closure and 

the plan for the relocation of residents 

at least 60 days prior to the impending 

closure or, if the Secretary terminates 

the facility’s participation in Medicare 

or Medicaid, not later than the date the 

Secretary determines appropriate. 

It is consistent with the requirements 

set forth in section 6113 of the 

Affordable Care Act and the 

Administration’s efforts toward broadbased improvements in the quality of 

health care furnished by Medicare and 

Medicaid providers. 

This final rule clarifies the 

responsibility of the administrator of a 

facility (which is to ensure that the 

designated parties are notified of an 

impending closure within a specified 

timeframe), and identifies penalties for 

non-compliance. It also clarifies the 

responsibility of the administrator of the 

facility to ensure that no new residents 

are admitted after written notice is 

submitted and that the notice of closure 

must include a plan for transfer and 

adequate relocation to another facility. 

These facilities must take into 


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Federal Register / Vol. 78, No. 53 / Tuesday, March 19, 2013 / Rules and Regulations 16805 

consideration the needs, choice, and 

best interests of each resident. 

In accordance with the provisions of 

Executive Order 12866, this regulation 

was not reviewed by the Office of 

Management and Budget. 

List of Subjects 

42 CFR Part 483 

Grant programs-health, Health 

facilities, Health professions, Health 

records, Medicaid, Medicare, Nursing 

homes, Nutrition, Reporting and 

recordkeeping requirements, Safety. 

42 CFR Part 488 

Administrative practice and 

procedure, Health facilities, Medicare, 

Reporting and recordkeeping 

requirements. 

42 CFR Part 489 

Health facilities, Medicare, Reporting 

and recordkeeping requirements. 

42 CFR Part 498 

Administrative practice and 

procedure, Health facilities, Health 

professions, Medicare, Reporting and 

recordkeeping requirements. 

Accordingly, the interim rule 

amending 42 CFR Parts 483, 488, 489, 

and 498, which was published at 76 FR 

9503 on February 18, 2011, is adopted 

as final with the following changes: 

PART 483—REQUIREMENTS FOR 

STATES AND LONG TERM CARE 

FACILITIES 

■ 1. The authority citation for part 483 

is revised to read as follows: 

Authority: Secs. 1102, 1128I and 1871 of 

the Social Security Act (42 U.S.C. 1302, 

1320a–7j, and 1395hh). 

Subpart B—Requirements for Long 

Term Care Facilities 

■ 2. Section 483.12 is amended by 

revising paragraph (a)(8) to read as 

follows: 

§ 483.12 Admission, transfer and 

discharge rights. 

(a) * * * 

(8) Notice in advance of facility 

closure. In the case of facility closure, 

the individual who is the administrator 

of the facility must provide written 

notification prior to the impending 

closure to the State Survey Agency, the 

State LTC ombudsman, residents of the 

facility, and the legal representatives of 

the residents or other responsible 

parties, as well as the plan for the 

transfer and adequate relocation of the 

residents, as required at § 483.75(r). 

* * * * * 

■ 3. Section 483.75 is amended by 

revising paragraphs (r)(1) introductory 

text and (r)(3) to read as follows: 

§ 483.75 Administration. 

* * * * * 

(r) * * * 

(1) Submit to the State Survey 

Agency, the State LTC ombudsman, 

residents of the facility, and the legal 

representatives of such residents or 

other responsible parties, written 

notification of an impending closure: 

* * * * * 

(3) Include in the notice the plan, that 

has been approved by the State, for the 

transfer and adequate relocation of the 

residents of the facility by a date that 

would be specified by the State prior to 

closure, including assurances that the 

residents would be transferred to the 

most appropriate facility or other setting 

in terms of quality, services, and 

location, taking into consideration the 

needs, choice, and best interests of each 

resident. 

* * * * * 

PART 488—SURVEY, CERTIFICATION, 

AND ENFORCEMENT PROCEDURES 

■ 4. The authority citation for part 488 

is revised to read as follows: 

Authority: Secs. 1102, 1128I and 1871 of 

the Social Security Act, unless otherwise 

noted (42 U.S.C. 1302, 1320a–7j, and 

1395hh); Pub. L. 110–149, 121 Stat. 1819. 

Subpart F—Enforcement of 

Compliance for Long-Term Care 

Facilities With Deficiencies 

■ 5. Section 488.450 is amended by 

revising paragraph (c)(2) to read as 

follows: 

§ 488.450 Continuation of payments to a 

facility with deficiencies. 

* * * * * 

(c) * * * 

(2) Facility closure. In the case of a 

facility closure, the Secretary may, as 

the Secretary determines appropriate, 

continue to make payments with respect 

to residents of a long-term care facility 

that has submitted a notification of 

closure during the period beginning on 

the date such notification is submitted 

to CMS and ending on the date on 

which the residents are successfully 

relocated. 

* * * * * 

PART 489—PROVIDER AGREEMENTS 

AND SUPPLIER APPROVAL 

■ 6. The authority citation for part 489 

is revised to read as follows: 

Authority: Secs. 1102, 1128I and 1819, 

1820(e), 1861, 1864(m), 1866, 1869, and 1871 

of the Social Security Act (42 U.S.C. 1302, 

1320a–7j, 1351i73,1395x, 1395aa(m), 1395cc, 

1395ff, and 1395hh). 

Subpart E—Termination of Agreement 

and Reinstatement After Termination 

■ 7. Section § 489.55 is amended by 

revising paragraph (a)(1) to read as 

follows: 

§ 489.55 Exceptions to effective date of 

termination. 

(a) * * * 

(1) Inpatient hospital services 

(including inpatient psychiatric hospital 

services) and post hospital extended 

care services (except as specified in 

paragraph (b) of this section with 

respect to LTC facilities) furnished to a 

beneficiary who was admitted before the 

effective date of termination; and 

* * * * * 

PART 498—APPEAL PROCEDURES 

FOR DETERMINATIONS THAT AFFECT 

PARTICIPATION IN THE MEDICARE 

PROGRAM AND FOR 

DETERMINATIONS THAT AFFECT THE 

PARTICIPATION OF ICFs/MR AND 

CERTAIN NFs IN THE MEDICAID 

PROGRAM 

■ 8. The authority citation for part 498 

is revised to read as follows: 

Authority: Secs. 1102, 1128I and 1871 of 

the Social Security Act (42 U.S.C. 1302, 

1320a–7j, and 1395hh). 

Subpart A—General Provisions 

■ 9. Section 498.3 is amended by 

revising paragraph (a)(3) to read as 

follows: 

§ 498.3 Scope and applicability. 

(a) * * * 

(3) The following parts of this chapter 

specify the applicability of the 

provisions of this part 498 to sanctions 

or remedies imposed on the indicated 

entities or individuals: 

(i) Part 431, subpart D—for nursing 

facilities (NFs). 

(ii) Part 488, subpart E 

(§ 488.330(e))—for SNFs and NFs. 

(iii) Part 488, subpart E (§ 488.330(e)) 

and subpart F (§ 488.446)—for SNFs and 

NFs and their administrators. 

* * * * * 

■ 10. Section 498.5 is amended by 

revising paragraph (m) to read as 

follows: 

§ 498.5 Appeal rights. 

* * * * * 

(m) Appeal rights of an individual 

who is the administrator of a SNF or NF. 

An individual who is the administrator 

of a SNF or NF who is dissatisfied with 


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16806 Federal Register / Vol. 78, No. 53 / Tuesday, March 19, 2013 / Rules and Regulations 

the decision of CMS to impose sanctions 

authorized under § 488.446 of this 

chapter is entitled to a hearing before an 

ALJ, to request Board review of the 

hearing decision, and to seek judicial 

review of the Board’s decision. 

(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program) 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: May 23, 2012. 

Marilyn Tavenner, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Approved: July 20, 2012. 

Kathleen Sebelius, 

Secretary, Department of Health and Human 

Services. 

Editorial Note: This document was 

received at the Office of the Federal Register 

on March 14, 2013. 

[FR Doc. 2013–06276 Filed 3–15–13; 11:15 am] 

BILLING CODE 4120–01–P 

FEDERAL COMMUNICATIONS 

COMMISSION 

47 CFR Part 10 

[PS Docket No. 07–287; DA 13–280] 

The Commercial Mobile Alert System 

AGENCY: Federal Communications 

Commission. 

ACTION: Final rule. 

SUMMARY: In this document, the 

Commission amends its rules to change 

the name of the Commercial Mobile 

Alert System (CMAS) to Wireless 

Emergency Alerts (WEA). This is 

intended to conform the name used for 

the wireless alert system regulated 

under Commission rules to the name 

used by the major commercial mobile 

service providers that participate in that 

system. 

DATES: Effective: March 19, 2013. 

FOR FURTHER INFORMATION CONTACT: Lisa 

Fowlkes, Deputy Bureau Chief, Public 

Safety and Homeland Security Bureau, 

at (202) 418–7452, or by email at 

Lisa.Fowlkes@fcc.gov. 

SUPPLEMENTARY INFORMATION: This is a 

summary of the Order in PS Docket No. 

07–287, DA 13–280, adopted on 

February 25, 2013, and released on 

February 25, 2013. The full text of this 

document is available for inspection 

and copying during normal business 

hours in the FCC Reference Center 

(Room CY–A257), 445 12th Street SW., 

Washington, DC 20554. The complete 

text of this document also may be 

purchased from the Commission’s copy 

contractor, Best Copy and Printing, Inc., 

445 12th Street SW., Room, CY–B402, 

Washington, DC 20554. The full text 

may also be downloaded at: 

www.fcc.gov. 

1. The Warning Alert and Response 

Network Act (WARN Act) required the 

Commission to adopt the technical 

requirements necessary for commercial 

mobile service providers to transmit 

emergency alerts, if they elect to 

transmit those alerts. In the rulemaking 

proceeding that the Commission 

launched to implement this WARN Act 

requirement, the Commission used the 

name Commercial Mobile Alert System 

(CMAS) to describe the system that 

commercial mobile service providers 

could use to transmit emergency alerts 

to the public. The regulations governing 

this system are codified in part 10 of the 

Commission’s rules and also refer to this 

system as CMAS. Recently, however, an 

increasing number of the commercial 

mobile service providers that participate 

in the system are referring to it as 

Wireless Emergency Alerts (WEA) in the 

information that they provide to their 

subscribers. 

2. In this Order, the Commission 

revises part 10 of its rules by changing 

the name ‘‘Commercial Mobile Alert 

System’’ to ‘‘Wireless Emergency 

Alerts’’ throughout the part and by 

changing references to ‘‘CMAS’’ to 

‘‘WEA.’’ These revisions will conform 

the name used for the wireless alert 

system regulated under our rules to the 

name used by the major commercial 

mobile service providers that participate 

in that system. Accordingly, the rules 

will more accurately reflect common 

parlance and thus reduce confusion. 

3. The revisions adopted in this Order 

and set forth below merely change the 

name of the commercial mobile alert 

service regulated under Part 10 of the 

Commission’s rules. These revisions are 

thus ministerial, non-substantive, and 

editorial. Accordingly, the Commission 

found good cause to conclude that 

notice and comment procedures are 

unnecessary and would not serve any 

useful purpose. 

4. Because the rule revisions will not 

affect the substantive rights or interests 

of any licensee, the Commission also 

found good cause to make these nonsubstantive, editorial revisions of the 

rules effective upon publication in the 

Federal Register. 

5. The Commission’s Public Safety 

and Homeland Security Bureau adopted 

this Order pursuant to its delegated 

authority to ‘‘conduct[] rulemaking 

proceedings’’ in matters pertaining to 

public safety and homeland security. 

Pursuant to § 0.392 of the Commission’s 

rules, the Bureau Chief is ‘‘delegated 

authority to perform all functions of the 

Bureau, described in . . . § 0.191’’ with 

certain specified exceptions. None of 

those exceptions are present here. 

I. Procedural Matters 

A. Paperwork Reduction Act Analysis 

6. This document does not contain 

new or modified information collection 

requirements subject to the Paperwork 

Reduction Act of 1995, Public Law 104– 

13. In addition, therefore, it does not 

contain any new or modified 

information collection burden for small 

business concerns with fewer than 25 

employees, pursuant to the Small 

Business Paperwork Relief Act of 2002, 

Public Law 107–198, see 44 U.S.C. 

3506(c)(4). 

II. Final Regulatory Flexibility Analysis 

7. Because the Commission adopted 

this Order without the publication of a 

notice of proposed rulemaking, the 

Regulatory Flexibility Act, 5 U.S.C. 601 

et seq., does not require the Commission 

to prepare a regulatory flexibility 

analysis. 

III. Ordering Clauses 

8. Accordingly, it is ordered that, 

effective upon publication in the 

Federal Register, part 10 of the 

Commission’s rules is revised, as set 

forth below, pursuant to the authority 

contained in sections 4(i), 5(c), and 

303(r) of the Communications Act, 47 

U.S.C. 154(i), 155(c), and 303(r), and 

§§ 0.231(b) and 0.392(e) of the 

Commission’s regulations, 47 CFR 

0.191(e) and 0.392. 

9. It is further ordered that the 

Secretary shall cause a copy of this 

Order to be published in the Federal 

Register. 

10. It is further ordered that the 

Bureau shall send a copy of this Order 

in a report to Congress and the 

Government Accountability Office 

pursuant to the Congressional Review 

Act. See 5 U.S.C. 801(a)(1)(A). 

List of Subjects in 47 CFR Part 10 

Communications common carriers, 

Radio. 

Federal Communications Commission. 

David S. Turetsky 

Chief, Public Safety and Homeland Security 

Bureau. 

For the reasons discussed in the 

preamble, the Federal Communications 

Commission amends 47 CFR Part 10 as 

follows: 


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