Federal Register / Vol. 63, No. 78 /Thursday, April 23, 1998 /Rules and Regulations 20107

E. Unfunded Mandates Act

Under section 202 of the Unfunded

Mandates Reform Act of 1995

(‘‘Unfunded Mandates Act’’), signed

into law on March 22, 1995, EPA must

prepare a budgetary impact statement to

accompany any proposed or final rule

where the estimated costs to State, local,

or tribal governments, or to the private

sector, will be $100 million or more.

Under section 205, EPA must select the

most cost-effective and least

burdensome alternative that achieves

the objective of the rule and is

consistent with statutory requirements.

Section 203 requires EPA to establish a

plan for informing and advising any

small governments that may be

significantly impacted by the rule. To

the extent that the rules being adopted

in this action would impose any

mandate at all as defined in section 101

of the Unfunded Mandates Act upon the

state, local, or tribal governments, or the

private sector, as explained above, this

rule is not estimated to impose costs in

excess of $100 million. EPA has

determined that today’s action simply

delays the purchase requirements under

state CFFPs and does not impose

additional costs or regulatory burdens.

In fact, the one-year delay of

implementation of the purchase

requirements is expected to reduce costs

of compliance and ease regulatory

burdens.

List of Subjects in 40 CFR Part 88

Environmental protection, Labeling,

Motor vehicle pollution, Reporting and

recordkeeping requirements.

Dated: April 3, 1998.

Carol M. Browner,

Administrator.

For the reasons set out in the

preamble, 40 CFR part 88 is amended as

follows:

PART 88—[AMENDED]

1. The authority citation for part 88

continues to read as follows:

Authority: 42 U.S.C. 7410, 7418, 7581,

7582, 7583, 7584, 7586, 7588, 7589, 7601(a).

2. Section 88.308.94 is amended by

designating the existing text as

paragraph (a) and by adding paragraph

(b) to read as follows:

§ 88.308.94 Programmatic requirements

for clean-fuel fleet vehicles.

* * * * *

(b) Program start date. The SIP

revision shall provide that the clean fuel

vehicle purchase requirements begin to

apply no later than model year 1999.

[FR Doc. 98–10151 Filed 4–22–98; 8:45 am]

BILLING CODE 6560–50–P

ENVIRONMENTAL PROTECTION

AGENCY

40 CFR Part 132

[FRL–5999–8]

Amendment of the Provisions To

Eliminate and Phase-Out Mixing Zones

for Bioaccumulative Chemicals of

Concern and Amendment to Procedure

8.D. of Appendix F (Pollutant

Minimization Program) for the Final

Water Quality Guidance for the Great

Lakes System

AGENCY: Environmental Protection

Agency (EPA).

ACTION: Final rule; partial amendments.

SUMMARY: As a result of the decision in

American Iron and Steel Institute, et al.

v. EPA (AISI), 115 F.3d 979 (D.C. Cir.

1997), EPA today is amending the final

Water Quality Guidance for the Great

Lake System (Guidance) (40 CFR part

132) by removing the provisions to

eliminate and phase-out mixing zones

for bioaccumulative chemicals of

concern (BCCs). Also in response to the

AISI decision, EPA is today amending

the Guidance by revising Procedure 8.D.

of Appendix F to remove language in

the Pollutant Minimization Program

(PMP) provisions that might imply

authorization for imposing water

quality-based effluent limits (WQBELs)

on internal waste streams or for

requiring specific control measures to

meet WQBELs.

EFFECTIVE DATE: April 23, 1998.

ADDRESSES: The public docket for this

and earlier rulemakings concerning the

Water Quality Guidance for the Great

Lakes System, including the proposal,

public comments in response to the

proposal, other major supporting

documents, and the index to the docket

are available for inspection and copying

at U.S. EPA Region 5, 77 West Jackson

Blvd., Chicago, IL 60604 by

appointment only. Appointments may

be made by calling Mary Jackson-Willis

(telephone 312–886–3717).

FOR FURTHER INFORMATION CONTACT:

Mark Morris (4301), U.S. EPA, 401 M

Street, SW, Washington, D.C. 20460

(202–260–0312).

SUPPLEMENTARY INFORMATION:

I. Discussion

A. Potentially Affected Entities

Citizens concerned with water quality

in the Great Lakes System may be

interested in this rulemaking. Also,

entities potentially affected by today’s

action are those discharging pollutants

to waters of the United States in the

Great Lakes System. Categories and

entities which may ultimately be

affected include:

Category Examples of potentially affected

entities

Industry .... Industries discharging to waters

in the Great Lakes System as

defined in 40 CFR 132.2.

MunicipalitiesPublicly-owned treatment works

discharging to waters of the

Great Lakes System as defined in 40 CFR 132.2.

This table is not intended to be

exhaustive, but rather provides a guide

for readers regarding entities likely to be

affected by this final rule. This table

lists the types of entities that EPA is

now aware could potentially be affected

by this action. Other types of entities

not listed in the table could also be

affected. To determine whether your

facility may be affected by this final

rule, you should carefully examine the

definition of ‘‘Great Lakes System’’ in 40

CFR 132.2 and examine 40 CFR 132.2

which describes the part 132

regulations. If you have any questions

regarding the applicability of this action

to a particular entity, consult the person

listed in the preceding FOR FURTHER

INFORMATION CONTACT section.

B. Today’s Rule

The final Guidance included ambient

water quality criteria setting maximum

ambient concentrations for pollutants to

be met in all waters of the Great Lakes

Basin and implementation procedures

used to develop WQBELs for facilities

discharging these pollutants. States and

Tribes were required to adopt

regulations consistent with EPA’s

Guidance criteria and implementation

procedures by March 23, 1997. Once the

criteria and implementation procedures

take effect, permits for discharges of the

pollutants they cover must include

WQBELs needed to attain the criteria if

the discharge has or may have the

reasonable potential to cause or

contribute to an exceedance of the water

quality standard.

On June 6, 1997, the U.S. Court of

Appeals for the District of Columbia

Circuit issued its decision upholding,

with three minor exceptions, the Great

Lakes Water Quality Guidance which

EPA promulgated on March 23, 1995.

American Iron and Steel Institute, et al.

v. EPA (AISI), 115 F.3d 979 (D.C. Cir.

1997). The Court vacated three

provisions of the Guidance. The Court

vacated the criteria for polychlorinated

biphenlys (PCBs), and the provisions of

the Guidance ‘‘insofar as it would

eliminate mixing zones for

bioaccumulative chemicals of concern

(BCCs) and impose water quality-based
20108 Federal Register / Vol. 63, No. 78 /Thursday, April 23, 1998 /Rules and Regulations

effluent limitations (WQBELs) upon

internal facility waste streams.’’ 115

F.3d at 985. On October 9, 1997, EPA

published a notice revoking the PCB

human health criteria pursuant to the

Court’s decision (62 FR 52922). Today’s

notice addresses the other two

provisions of the Guidance vacated by

the Court.

First, EPA is today removing the

mixing zone elimination and phase-out

provision in the Guidance. Procedure

3.C. of the Guidance contained the

provision to eliminate mixing zones for

BCCs for new discharges and to phase

them out over the next 10 years for

existing discharges. The Court vacated

this provision from the Guidance stating

that the Agency had failed to show that

the provision was justified.

Second, EPA is amending Procedure

8.D. of Appendix F in response to the

AISI decision. Procedure 8.D.

establishes requirements for a

‘‘Pollutant Minimization Program,’’

which is required anytime a permit

includes a WQBEL below the level of

quantification (i.e., level of pollutant

that can be reliably quantified by the

specified method). In the AISI decision,

the Court vacated Procedure 8.D. insofar

as it authorized internal WQBELs, 115

F.3d at 979, 996. The Court expressed

concern that internal WQBELs would

deprive a permittee of the ability to

choose an end-of-pipe control system to

meet the water quality based effluent

limits rather than controls on internal

waste streams. Id. Although EPA

explained in the Supplementary

Information Document to the Great

Lakes Water Quality Guidance (SID) that

it had no intent to impose specific

control measures on permittees through

the PMP provision, it is revising the

Procedure 8.D. language to allay

concerns about possible

misinterpretation of the language as

authorizing imposition of internal

WQBELs or specific control measures.

1. Mixing Zone Elimination and PhaseOut Provisions

One of the implementation

procedures EPA promulgated in the

Guidance was Procedure 3.C. of

Appendix F, mixing zones for BCCs.

Under this procedure, no mixing zones

were to be granted for new dischargers

of BCCs after March 23, 1997. Mixing

zones for existing dischargers of BCCs

were, moreover, to have been phased

out by March 23, 2007. Various

industries and trade associations

challenged these mixing zone

provisions for BCCs. They alleged that

the elimination of mixing zones for

BCCs would not significantly reduce

pollutant loadings to the Great Lakes but

would inflict costs upon industry that

are excessive in relation to the degree of

pollution reduction achieved, even if

that reduction were significant.

In the AISI litigation, EPA explained

to the Court the significance of

removing BCCs from the Great Lakes

Basin because of the closed nature of the

system and its unique environmental

characteristics. While the Court

acknowledged the possibility of

environmental benefit of the mixing

zone provisions, the Court found that

EPA failed to show that the provisions

were justified in light of the costs. The

Court therefore vacated the provisions.

115 F.3d. at 997.

Pursuant to the Court’s decision, EPA

is today amending the Guidance by

removing Procedure C.3. In the interim,

pursuant to independent State or Tribal

authority, Great Lakes States and Tribes

may adopt a mixing zone elimination

and phase-out provision. EPA intends to

propose reinstating this provision in the

near future and continues to support

eliminating mixing zones for BCCs

within the Great Lakes Basin wherever

it is technically and economically

feasible to do so.

2. Pollutant Minimization Program

(PMP) Revisions

Procedure 8 of Appendix F of the

Guidance addresses situations where

WQBELs are below the level of

quantification of the specified analytical

method (i.e., the level that can be

reliably quantified). A WQBEL of this

nature must be included in the permit

as calculated and is the enforceable

limit. However, because compliance

with the limit cannot be measured endof-pipe, Procedure 8 includes special

provisions to help ensure that the

WQBEL is being met, including the

development and implementation by

the permittee of a Pollutant

Minimization Program (PMP),

Procedure 8.D. Procedure 8.D. called

for, in part, internal monitoring, a

survey of all potential sources of the

pollutant of concern to the waste

stream, a control strategy,

implementation of cost-effective control

measures consistent with the control

strategy, and reporting on, among other

things, all actions taken to reduce or

eliminate the identified sources of the

pollutant. In the SID, EPA explained

that:

‘‘In procedure 8, EPA does not go so far as

to set in-plant effluent limitations, but rather

simply provides for internal monitoring and

adoption of control strategies with a goal of

maintaining all sources of the pollutant to the

wastewater collection system below the

WQBEL. The WQBEL itself continues to

apply only at the end of the pipe, after

treatment.’’ SID at 425.

EPA further explained that ‘‘the ‘PMP’

makes no attempt to dictate the

treatment or source reduction strategies

that a permittee could or should

implement.’’ SID at 426.

Industry litigants challenged

Procedure 8 as impermissibly

establishing internal WQBELs and

dictating how they complied with endof-pipe limits, i.e., through source

reduction measures. In AISI, the Court

found that, although the CWA clearly

allows for monitoring of internal waste

streams to evaluate compliance with

end-of-pipe limits and establishing endof-pipe WQBELs that effectively force

changes to internal equipment or

processes, it does not allow imposition

of WQBELs for internal sources.

Accordingly, the Court vacated

Procedure 8.D. ‘‘insofar as it would

impose the point-source WQBEL upon a

facility’s internal waste streams.’’ 115

F.3d at 996. The Court did not specify

what language in Procedure 8.D., if any,

needed to be changed.

Although EPA has never interpreted

Procedure 8.D. to authorize imposition

of internal WQBELs or to dictate control

strategies, EPA is today amending the

language in Procedure 8.D. to address

the Court’s concerns and eliminate any

ambiguity about how EPA intends

Procedure 8.D. to be interpreted.

Today’s amendments cover the two

related concerns raised by the Court:

First, that WQBELs not be imposed on

internal waste streams; and second, that

permittees retain the ability to choose

how they will comply with permit

limits. Eliminating the references to

internal waste stream goals in the

introduction to 8.D. and in paragraph

8.D.3. addresses the first concern. To

address the second concern, EPA is

amending language that might imply

either that permitting authorities

establish control measures in the PMP

(introduction to 8.D.) or that permittees

are restricted in determining how they

will meet their end-of-pipe WQBELs

(references to pollutant sources in

paragraphs 8.D.4 and 8.D.5.c).

Today’s revisions to Procedure 8.D.

do not change the Agency’s intent with

respect to implementation of the

pollutant minimization programs; it

continues to be that such programs will

assist in ensuring that the WQBELs are

met at the end of the pipe. The

permittee must inventory all sources of

the pollutant to the waste stream, but in

developing and implementing a control

strategy, the permittee may choose any

appropriate control measure(s) that it

expects will reduce pollutant levels so
Federal Register / Vol. 63, No. 78 /Thursday, April 23, 1998 /Rules and Regulations 20109

as to meet the WQBEL. States and

Tribes may evaluate the adequacy of the

permittee’s control strategy to achieve

the stated goal, but nothing in Procedure

8.D. authorizes a permitting authority to

dictate specific control measures. EPA

strongly encourages permittees to

consider source reduction approaches,

such as process changes and product

substitution, when determining how to

obtain necessary reductions because

these measures are often more costeffective than treatment alternatives. A

permittee may, of course, choose instead

to install wastewater treatment or

institute other control measures to

reduce the level of the pollutant in its

discharge.

C. Consequences of Today’s Action

As a result of today’s action, States

and Tribes need not adopt or submit to

EPA for review a procedure to eliminate

or phase-out mixing zones for BCCs for

new and existing discharges to waters

within the Great Lakes Basin. States and

Tribes may adopt the mixing zone

elimination and phase-out provisions

pursuant to independent State or Tribal

authority. The Agency continues to

support eliminating mixing zones for

BCCs within the Great Lakes Basin

wherever it is technically and

economically feasible to do so.

States which have language in their

regulations or other implementation

documents that parallels the language in

the original Procedure 8.D. would be

considered consistent with 40 CFR part

132. However, to minimize confusion

about how a State interprets its

provision, EPA encourages States to

issue interpretations of their PMP

procedures to specify whether they

interpret those procedures consistent

with EPA’s interpretation of Procedure

8.D. and today’s revisions or whether

they intend to require internal WQBELs

or to categorically require specific

control measures (e.g., source reduction

as a water quality-based requirement)

pursuant to independent State authority

as provided for in section 510 of the

CWA.

II. ‘‘Good Cause’’ Under the

Administrative Procedure Act

EPA has determined that it has ‘‘good

cause’’ under section 553(b)(3) of the

Administrative Procedure Act, 5 U.S.C.

553(b)(3), to promulgate this final rule

without prior opportunity for notice and

comment. EPA finds it ‘‘unnecessary’’ to

provide an opportunity to comment on

the strictly legal issue of the impact of

the AISI decision on the provisions to

eliminate and phase-out mixing zones

for BCCs in the March 1995 Guidance or

changes to language in Procedure 8.D. to

conform to the Court’s decision. Today’s

rule merely implements the decision of

the Court.

EPA also believes the public interest

is best served by reacting to the Court’s

decision without further delay. For this

reason, EPA has also determined that it

has ‘‘good cause’’ under 5 U.S.C. 553(d)

to make the rule effective upon

publication.

III. Executive Order 12866

Under Executive Order 12866 (58 FR

51735, October 4, 1993), EPA must

determine whether the regulatory action

is ‘‘significant’’ and therefore subject to

Office of Management and Budget

(OMB) review and the requirements of

the Executive Order. The Order defines

‘‘significant regulatory action’’ as one

that is likely to result in a rule that may:

(1) Have an annual effect on the

economy of $100 million or more or

adversely affect in a material way the

economy, a sector of the economy,

productivity, competition, jobs, the

environment, public health or safety, or

State, local, or Tribal governments or

communities;

(2) Create a serious inconsistency or

otherwise interfere with an action taken

or planned by another agency;

(3) Materially alter the budgetary

impact of entitlements, grants, user fees,

or loan programs or the rights and

obligations of recipients thereof; or

(4) Raise novel legal or policy issues

arising out of legal mandates, the

President’s priorities, or the principles

set forth in the Executive Order.

Pursuant to the terms of Executive

Order 12866, it has been determined

that this final rule is not a ‘‘significant

regulatory action’’ and is therefore not

subject to OMB review.

IV. Submission to Congress and the

General Accounting Office

Under 5 U.S.C. 801(a)(1)(A) as added

by the Small Business Regulatory

Enforcement Fairness Act of 1996, EPA

submitted a report containing this rule

and other required information to the

U.S. Senate, the U.S. House of

Representatives and the Comptroller

General of the General Accounting

Office prior to publication of the rule in

today’s Federal Register. This rule is

not a ‘‘major rule’’ as defined by 5

U.S.C. 804(2).

V. Regulatory Flexibility Act as

Amended by the Small Business

Regulatory Enforcement Fairness Act of

1996

Under the Regulatory Flexibility Act

(RFA) (5 U.S.C. 601 et seq.), whenever

a Federal agency promulgates a final

rule after being required to publish a

general notice of proposed rulemaking

under section 553 of the Administrative

Procedures Act (APA), the agency

generally must prepare a final regulatory

flexibility analysis describing the

economic impact of the regulatory

action on small entities. EPA has not

prepared a final regulatory flexibility

analysis for this action because the

Agency was not required to publish a

general notice of proposed rulemaking

for this rule.

As explained above, section 553 of the

APA provides that, when an agency for

good cause finds that notice and public

procedure are impracticable,

unnecessary and contrary to the public

interest, an agency may first issue a rule

without providing notice and an

opportunity for public comment. EPA

has determined that there is good cause

for making today’s rule final without

notice and opportunity for comment for

the reasons spelled out above. In these

circumstances, the RFA does not require

preparation of a final regulatory

flexibility analysis. Today’s final rule

establishes no requirements applicable

to small entities.

VI. Unfunded Mandates Reform Act

Title II of the Unfunded Mandates

Reform Act of 1995 (UMRA), Pub. L

104–4, establishes requirements for

federal agencies to assess the effects of

their regulatory actions on State, local

and tribal governments and the private

sector. Under section 202 of UMRA,

EPA generally must prepare a written

statement, including a cost-benefit

analysis, for proposed and final rules

with ‘‘Federal mandates’’ that may

result in expenditures to State, local,

and tribal governments, in the aggregate,

or to the private sector, of $100 million

or more in any one year. Before

promulgating a rule for which a written

statement is needed, section 205 of

UMRA generally requires EPA to

identify and consider a reasonable

number of regulatory alternatives and

adopt the least costly, most costeffective or least burdensome alternative

that achieves the objectives of the rule.

The provision of section 205 do not

apply when they are inconsistent with

applicable law. Moreover, section 205

allows EPA to adopt an alternative other

than the least costly, most cost-effective

or least burdensome alternative if the

Administrator publishes with the final

rule an explanation why that alternative

was not adopted.

The requirements in section 202 and

205 apply to general notices of proposed

rulemaking and any final rule for which

a general notice of proposed rulemaking

was published. For reasons explained

previously, a notice of proposed
20110 Federal Register / Vol. 63, No. 78 /Thursday, April 23, 1998 /Rules and Regulations

rulemaking was not published in this

proceeding. Therefore, sections 202 and

205 do not apply to EPA’s action here.

Before EPA establishes any regulatory

requirements that may significantly or

uniquely affect small governments,

including tribal governments, it must

have developed under section 203 of

UMRA a small government agency plan.

The plan must provide for notifying

potentially affected small governments,

enabling officials of affected small

governments to have meaningful and

timely input in the development of EPA

regulatory proposals with significant

Federal intergovernmental mandates,

and informing, educating, and advising

small governments on compliance with

the regulatory requirements. EPA has

determined that this rule contains no

regulatory requirements that might

significantly or uniquely affect small

governments. As explained above,

today’s rule withdrawals provisions and

therefore, does not contain any

regulatory requirements. Thus this rule

is not subject to the requirements of

section 203 of UMRA.

VII. Executive Order 12875

For the same reasons as stated above

in section VI., EPA has determined this

final rule does not impose federal

mandates on State, local or Tribal

governments. Therefore this rule is not

subject to the provisions E.O. 12875.

Nonetheless, in compliance with

Executive Order 12875, Enhancing the

Intergovernmental Partnership, EPA has

extensively involved Great Lakes State,

Tribal and local governments in the

development of the 1995 Guidance. The

rulemaking which promulgated the

Guidance in 1995 was subject to

Executive Order 12875. The process

used to develop the Guidance marked

the first time that EPA had developed a

major rulemaking effort in the water

program through a regional public

forum. The public process which lasted

over a seven year period and involved

Great Lakes States, EPA, and other

Federal agencies in open dialogue with

citizens, Tribal and local governments,

and industry in the Great Lakes Basin is

described further in the preamble to the

final Guidance. See 56 FR 15383–15384

(March 23, 1995).

As described above, this action by

EPA merely conforms the regulations to

the Court order in AISI and therefore,

does not create any federal mandates.

VIII. Paperwork Reduction Act

This action includes no information

collection activities subject to the

Paperwork Reduction Act (44 U.S.C.

3501 et seq.) Therefore, no Information

Collection Request is required to be

prepared or submitted to OMB for

approval.

IX. National Technology Transfer and

Advancement Act

Under section 12(d) of the National

Technology Transfer and Advancement

Act (NTTAA), the Agency is required to

use voluntary consensus standards in its

regulatory activities unless to do so

would be inconsistent with applicable

law or otherwise impractical. Voluntary

consensus standards are technical

standards (e.g., materials specifications,

test methods, sampling procedures,

business practices, etc.) that are

developed or adopted by voluntary

consensus standard bodies. Where

available and potentially applicable

voluntary consensus standards are not

used by EPA, the Act requires the

Agency to provide Congress, through

the Office and Management and Budget,

an explanation of the reasons for not

using such standards.

This final rule does not prescribe any

technical standards, so we have

determined that the NTTAA

requirements are not applicable.

List of Subjects in 40 CFR Part 132

Environmental protection,

Administrative practice and procedure,

Great Lakes, Indians-lands,

Intergovernmental relations, Reporting

and recordkeeping requirements, Water

pollution control.

Dated: April 14, 1998.

Carol M. Browner,

Administrator.

For the reasons set out in the

preamble Title 40, Chapter I of the Code

of Federal Regulations is to be amended

as follows:

PART 132—WATER QUALITY

GUIDANCE FOR THE GREAT LAKES

SYSTEM

1. The authority citation for part 132

continues to read as follows:

Authority: 33 U.S.C. 1251 et seq.

2. Procedure 3 of Appendix F to part

132 is amended by removing Procedure

3.C.

3. Procedure 8 of Appendix F to part

132 is amended by revising in the

introductory text of 8.D. the second

sentence and the third sentence; by

revising paragraph 8.D.3; by revising

paragraph 8.D.4; and by revising

paragraph 8.D.5.c. to read as follows:

Procedure 8: Water Quality-based Effluent

Limitations Below the Quantification Level

* * * * *

D. Pollutant Minimization Program. * * *

The goal of the pollutant minimization

program shall be to maintain the effluent at

or below the WQBEL. In addition, States and

Tribes may consider cost-effectiveness when

evaluating the requirements of a PMP. * * *

1. * * *

2. * * *

3. Submittal of a control strategy designed

to proceed toward the goal of maintaining the

effluent below the WQBEL;

4. Implementation of appropriate, costeffective control measures consistent with

the control strategy; and

5. * * *

a. * * *

b. * * *

c. A summary of all action undertaken

pursuant to the control strategy.

6. * * *

* * * * *

[FR Doc. 98–10717 Filed 4–22–98; 8:45 am]

BILLING CODE 6560–50–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 410, 417, 424, and 482

[HCFA–3706–F]

RIN 0938–AE99

Medicare Program; Scope of Medicare

Benefits and Application of the

Outpatient Mental Health Treatment

Limitation to Clinical Psychologist and

Clinical Social Worker Services

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Final rule.

SUMMARY: This rule addresses

requirements for Medicare coverage of

services furnished by a clinical

psychologist or as an incident to the

services of a clinical psychologist and

for services furnished by a clinical

social worker. The requirements are

based on section 6113 of the Omnibus

Budget Reconciliation Act of 1989,

section 4157 of the Omnibus Budget

Reconciliation Act of 1990, and section

147(b) of the Social Security Act

Amendments of 1994 (SSA ’94). This

rule also addresses the outpatient

mental health treatment limitation as it

applies to clinical psychologist and

clinical social worker services.

This final rule also conforms our

regulations to section 104 of the Social

Security Act Amendments of 1994.

Section 104 provides that a Medicare

patient in a Medicare-participating

hospital who is receiving qualified

psychologist services may be under the

care of a clinical psychologist with

respect to those services, to the extent

permitted under State law.

In addition, this final rule requires

that clinical psychologists and clinical