Federal Register / Vol. 76, No. 209 / Friday, October 28, 2011 / Notices 66929 

LIST OF PUMPOUTS IN THE BAY NDZ PROPOSED AREA AVAILABLE FOR RECREATIONAL VESSELS—Continued 

Number Name Location Contact information Dates/days/hours of 

operation 

Water depth 

(feet) Cost 

2 ......... Coney Island WWTP ...... Shellbank Creek ............. 718–743–0990; Channel 

13.

May 1–Oct 31; 24 hrs ..... 8–10 Free. 

3 ......... Rockaway WWTP ........... Jamaica Bay ................... 718–474–3663; Channel 

68.

May 1–Oct 31; 24 hrs ..... 10–14 Free. 

4 ......... NY/NJ Baykeeper’s 24 

foot sewage-pumpout 

vessel.

Jamaica Bay ................... 732–337–9262; Channel 

9.

Memorial Day to Labor 

Day; Sunrise to sunset.

N/A Free. 

Based on the above, EPA hereby makes 

a final affirmative determination that 

adequate facilities for the safe and 

sanitary removal and treatment of 

sewage from all vessels are available for 

the open waters and tributaries of the 

Bay of the New York City metropolitan 

area. 

Dated: September 30, 2011. 

Judith A. Enck, 

Regional Administrator, Region 2. 

[FR Doc. 2011–27990 Filed 10–27–11; 8:45 am] 

BILLING CODE 6560–50–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare and Medicaid 

Services 

[CMS–2901–PN] 

Medicare and Medicaid Programs; The 

American Association for 

Accreditation of Ambulatory Surgery 

Facilities for Approval of Deeming 

Authority for Rural Health Clinics 

AGENCY: Centers for Medicare and 

Medicaid Services, HHS. 

ACTION: Proposed notice. 

SUMMARY: This proposed notice with 

comment period acknowledges the 

receipt of a deeming application from 

the American Association for 

Accreditation of Ambulatory Surgery 

Facilities (AAAASF) for recognition as a 

national accrediting organization for 

rural health clinics (RHCs) that wish to 

participate in the Medicare or Medicaid 

programs. The statute requires that 

within 60 days of receipt of an 

organization’s complete application, we 

publish a notice that identifies the 

national accrediting body making the 

request, describes the nature of the 

request, and provides at least a 30-day 

public comment period. 

DATES: To be assured consideration, 

comments must be received at one of 

the addresses provided below, no later 

than 5 p.m. on November 28, 2011. 

ADDRESSES: In commenting, please refer 

to file code CMS–2901–PN. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (Fax) 

transmission. 

You may submit comments in one of 

four ways (no duplicates, please): 

1. Electronically. You may submit 

electronic comments on this notice to 

http://www.regulations.gov. Follow the 

‘‘Submit a comment’’ instructions. 

2. By regular mail. You may mail 

written comments to the following 

address only: Centers for Medicare & 

Medicaid Services, Department of 

Health and Human Services, Attention: 

CMS–2901–PN, P.O. Box 8010, 

Baltimore, MD 21244–8010. 

Please allow sufficient time for mailed 

comments to be received before the 

close of the comment period. 

3. By express or overnight mail. You 

may send written comments to the 

following address only: Centers for 

Medicare & Medicaid Services, 

Department of Health and Human 

Services, Attention: CMS–2901–PN, 

Mail Stop C4–26–05, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

4. By hand or courier. Alternatively, 

you may deliver (by hand or courier) 

your written comments only to the 

following addresses prior to the close of 

the comment period: 

a. For delivery in Washington, DC— 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, Room 445–G, Hubert 

H. Humphrey Building, 200 

Independence Avenue SW., 

Washington, DC 20201. 

(Because access to the interior of the 

Hubert H. Humphrey Building is not 

readily available to persons without 

Federal government identification, 

commenters are encouraged to leave 

their comments in the CMS drop slots 

located in the main lobby of the 

building. A stamp-in clock is available 

for persons wishing to retain a proof of 

filing by stamping in and retaining an 

extra copy of the comments being filed.) 

b. For delivery in Baltimore, MD— 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

If you intend to deliver your 

comments to the Baltimore address, call 

telephone number (410) 786–9994 in 

advance to schedule your arrival with 

one of our staff members. 

Comments erroneously mailed to the 

addresses indicated as appropriate for 

hand or courier delivery may be delayed 

and received after the comment period. 

For information on viewing public 

comments, see the beginning of the 

SUPPLEMENTARY INFORMATION section. 

FOR FURTHER INFORMATION CONTACT: L. 

Tyler Whitaker, (410) 786–5236. Patricia 

Chmielewski, (410) 786–6899. 

SUPPLEMENTARY INFORMATION: Inspection 

of Public Comments: All comments 

received before the close of the 

comment period are available for 

viewing by the public, including any 

personally identifiable or confidential 

business information that is included in 

a comment. We post all comments 

received before the close of the 

comment period on the following Web 

site as soon as possible after they have 

been received: http:// 

www.regulations.gov. Follow the search 

instructions on that Web site to view 

public comments. 

Comments received timely will also 

be available for public inspection as 

they are received, generally beginning 

approximately 3 weeks after publication 

of a document, at the headquarters of 

the Centers for Medicare & Medicaid 

Services, 7500 Security Boulevard, 

Baltimore, Maryland 21244, Monday 

through Friday of each week from 8:30 

a.m. to 4 p.m. To schedule an 

appointment to view public comments, 

phone 1–(800) 743–3951. 

I. Background 

Under the Medicare program, eligible 

beneficiaries may receive covered 

services from an rural health clinic 

(RHC) provided certain requirements are 

met. Sections 1861(aa) of the Social 

Security Act (the Act) establish distinct 

criteria for facilities seeking designation 

as RHCs. Regulations concerning 

provider agreements are at 42 CFR part 

489 and those pertaining to activities 

relating to the survey and certification 


sroberts on DSK5SPTVN1PROD with NOTICES
66930 Federal Register / Vol. 76, No. 209 / Friday, October 28, 2011 / Notices 

of facilities are at 42 CFR part 488. The 

regulations at 42 CFR part 491, subpart 

A, specify the conditions that an RHC 

must meet in order to participate in the 

Medicare program, the scope of covered 

services, and the conditions for 

Medicare payment for RHCs. 

Generally, in order to enter into a 

provider agreement with the Medicare 

program, an RHC must first be certified 

by a State survey agency as complying 

with the conditions or requirements set 

forth in part 42 CFR part 491, subpart 

A, of our regulations. Thereafter, the 

RHC is subject to regular surveys by a 

State survey agency to determine 

whether it continues to meet these 

requirements. There is an alternative, 

however, to surveys by State agencies. 

Section 1865(a)(1) of the Act provides 

that, if a provider entity demonstrates 

through accreditation by an approved 

national accrediting organization that all 

applicable Medicare conditions are met 

or exceeded, we would deem those 

provider entities as having met the 

requirements. Accreditation by an 

accrediting organization is voluntary 

and is not required for Medicare 

participation. 

If an accrediting organization is 

recognized by the Secretary as having 

standards for accreditation that meet or 

exceed Medicare requirements, any 

provider entity accredited by the 

national accrediting body’s approved 

program would be deemed to meet the 

Medicare conditions. A national 

accrediting organization applying for 

deeming authority under part 488, 

subpart A must provide us with 

reasonable assurance that the 

accrediting organization requires the 

accredited provider entities to meet 

requirements that are at least as 

stringent as the Medicare conditions. 

The regulations at § 488.8(d)(3) require 

accrediting organizations to reapply for 

continued deeming authority every 6 

years or as we determine. 

II. Approval of Deeming Organizations 

Section 1865(a)(2) of the Act and our 

regulations at § 488.8(a) require that our 

findings concerning review and 

approval of a national accrediting 

organization’s requirements consider, 

among other factors, the applying 

accrediting organization’s: requirements 

for accreditation; survey procedures; 

resources for conducting required 

surveys; capacity to furnish information 

for use in enforcement activities; 

monitoring procedures for provider 

entities found not in compliance with 

the conditions or requirements; and 

ability to provide us with the necessary 

data for validation. 

Section 1865(a)(3)(A) of the Act 

further requires that we publish, within 

60 days of receipt of an organization’s 

complete application, a notice 

identifying the national accrediting 

body making the request, describing the 

nature of the request, and providing at 

least a 30-day public comment period. 

We have 210 days from the receipt of a 

complete application to publish a notice 

of approval or denial of the application. 

The purpose of this proposed notice 

is to inform the public of American 

Association for Accreditation of 

Ambulatory Surgery Facilities 

(AAAASF’s) request for deeming 

authority for RHCs. This notice also 

solicits public comment on whether 

AAAASF’s requirements meet or exceed 

the Medicare conditions for coverage for 

RHCs. 

III. Evaluation of Deeming Authority 

Request 

AAAASF submitted all the necessary 

materials to enable us to make a 

determination concerning its request for 

approval as a deeming organization for 

RHCs. This application was determined 

to be complete on August 29, 2011. 

Under Section 1865(a)(2) of the Act and 

our regulations at § 488.8 (Federal 

review of accrediting organizations), our 

review and evaluation of the AAAASF 

would be conducted in accordance 

with, but not necessarily limited to, the 

following factors: 

• The equivalency of AAAASF’s 

standards for RHCs as compared with 

CMS’ RHC conditions for coverage. 

• AAAASF’s survey process to 

determine the following: 

—The composition of the survey team, 

surveyor qualifications, and the 

ability of the organization to provide 

continuing surveyor training. 

—The comparability of the AAAASF’s 

processes to those of State agencies, 

including survey frequency, and the 

ability to investigate and respond 

appropriately to complaints against 

accredited facilities. 

—The processes and procedures 

AAAASF uses for monitoring RHCs 

found out of compliance with 

AAAASF’s program requirements. 

These monitoring procedures are used 

only when AAAASF identifies 

noncompliance. If noncompliance is 

identified through validation reviews, 

the State survey agency monitors 

corrections as specified at § 488.7(d). 

—The capacity AAAASF uses to report 

deficiencies to the surveyed facilities 

and respond to the facility’s plan of 

correction in a timely manner. 

—The capacity AAAASF uses to 

provide us with electronic data and 

reports necessary for effective 

validation and assessment of the 

organization’s survey process. 

—The adequacy of AAAASF’s staff and 

other resources, and its financial 

viability. 

—The capacity AAAASF uses to 

adequately fund required surveys. 

—The policies AAAASF uses with 

respect to whether surveys are 

announced or unannounced, to assure 

that surveys are unannounced. 

—The agreement AAAASF uses to 

provide us with a copy of the most 

current accreditation survey together 

with any other information related to 

the survey as we may require 

(including corrective action plans). 

IV. Response to Public Comments and 

Notice Upon Completion of Evaluation 

Because of the large number of public 

comments we normally receive on 

Federal Register documents, we are not 

able to acknowledge or respond to them 

individually. We will consider all 

comments received by the date and time 

specified in the DATES section of this 

preamble, and, when we proceed with 

a subsequent document, we will 

respond to the comments in the 

preamble to that document. 

Upon completion of our evaluation, 

including evaluation of comments 

received as a result of this notice, we 

will publish a final notice in the Federal 

Register announcing the result of our 

evaluation. 

V. Collection of Information 

Requirements 

This document does not impose 

information collection and 

recordkeeping requirements. 

Consequently, it need not be reviewed 

by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 35). 

(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program; No. 93.773 Medicare—Hospital 

Insurance Program; and No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: October 13, 2011. 

Donald M. Berwick, 

Administrator, Centers for Medicare & 

Medicaid Services. 

[FR Doc. 2011–27962 Filed 10–27–11; 8:45 am] 

BILLING CODE 4120–01–P 


sroberts on DSK5SPTVN1PROD with NOTICES