33160 Federal Register / Vol. 81, No. 101 / Wednesday, May 25, 2016 / Proposed Rules 

List of Subjects in 38 CFR Part 17 

Administrative practice and 

procedure, Alcohol abuse, Alcoholism, 

Claims, Day care, Dental health, Drug 

abuse, Foreign relations, Government 

contracts, Grant programs—health, 

Grant programs—veterans, Health care, 

Health facilities, Health professions, 

Health records, Homeless, Medical and 

dental schools, Medical devices, 

Medical research, Mental health 

programs, Nursing homes, Philippines, 

Reporting and recordkeeping 

requirements, Scholarships and 

fellowships, Travel and transportation 

expenses, Veterans. 

Dated: May 20, 2016. 

Michael Shores, 

Acting Director, Office of Regulation Policy 

& Management, Office of Secretary, 

Department of Veterans Affairs. 

For the reasons set forth in the 

preamble, we propose to amend 38 CFR 

part 17 as follows: 

PART 17—MEDICAL 

■ 1. The authority citation for part 17 

continues to read as follows: 

Authority: 38 U.S.C. 501, and as noted in 

specific sections. 

■ 2. Amend part 17 by adding an 

undesignated center heading and 

§ 17.415 immediately after § 17.410 to 

read as follows: 

Nursing Services 

§ 17.415 Full practice authority for 

advanced practice registered nurses. 

(a) Advanced practice registered nurse 

(APRN). For purposes of this section, an 

advanced practice registered nurse 

(APRN) is an individual who: 

(1) Has completed a nationallyaccredited, graduate-level educational 

program that prepares them for one of 

the four APRN roles of Certified Nurse 

Practitioner (CNP), Certified Registered 

Nurse Anesthetist (CRNA), Clinical 

Nurse Specialist (CNS), or Certified 

Nurse-Midwife (CNM); 

(2) Has passed a national certification 

examination that measures knowledge 

in one of the APRN roles described in 

paragraph (a)(1) of this section; 

(3) Has obtained a license from a State 

licensing board in one of four 

recognized APRN roles described in 

paragraph (a)(1) of this section; and 

(4) Maintains certification and 

licensure as required by paragraphs 

(a)(2) and (3) of this section. 

(b) Full practice authority. For 

purposes of this section, full practice 

authority means the authority of an 

APRN to provide services described in 

paragraph (d) of this section without the 

clinical oversight of a physician, 

regardless of State or local law 

restrictions, when that APRN is working 

within the scope of their VA 

employment. 

(c) Granting of full practice authority. 

VA may grant full practice authority to 

an APRN subject to the following: 

(1) Verification that the APRN meets 

the requirements established in 

paragraph (a) of this section; and 

(2) Determination that the APRN has 

demonstrated the knowledge and skills 

necessary to provide the services 

described in paragraph (d) of this 

section without the clinical oversight of 

a physician, and is thus qualified to be 

privileged for such scope of practice. 

(d) Services provided by an APRN 

with full practice authority. (1) Subject 

to the limitations established in 

paragraph (d)(2) of this section, the full 

practice authority for each of the four 

APRN roles includes, but is not limited 

to, providing the following services: 

(i) A CNP has full practice authority 

to: 

(A) Take comprehensive histories, 

provide physical examinations and 

other health assessment and screening 

activities, diagnose, treat, and manage 

patients with acute and chronic 

illnesses and diseases; 

(B) Order, perform, supervise, and 

interpret laboratory and imaging 

studies; 

(C) Prescribe medication and durable 

medical equipment; 

(D) Make appropriate referrals for 

patients and families, and request 

consultations; 

(E) Aid in health promotion, disease 

prevention, health education, and 

counseling as well as the diagnosis and 

management of acute and chronic 

diseases. 

(ii) A CRNA has full practice 

authority to: 

(A) Plan and initiate anesthetic 

techniques (general, regional, local) and 

sedation; 

(B) Provide post-anesthesia evaluation 

and discharge; 

(C) Order and evaluate diagnostic 

tests; 

(D) Request consultations; 

(D) Perform point-of-care testing; and 

(E) Respond to emergency situations 

for airway management. 

(iii) A CNS has full practice authority 

to provide diagnosis and treatment of 

health or illness states, disease 

management, health promotion, and 

prevention of illness and risk behaviors 

among individuals, families, groups, 

and communities within their scope of 

practice. 

(iv) A CNM has full practice authority 

to provide a range of primary health 

care services to women, including 

gynecologic care, family planning 

services, preconception care (care that 

women veterans receive before 

becoming pregnant, including reducing 

the risk of birth defects and other 

problems such as the treatment of 

diabetes and high blood pressure), 

prenatal and postpartum care, 

childbirth, and care of a newborn, and 

treating the partner of their female 

patients for sexually transmitted disease 

and reproductive health, if the partner 

is also enrolled in the VA healthcare 

system or is not required to enroll. 

(2) The full practice authority of an 

APRN is subject to the limitations 

imposed by the Controlled Substances 

Act, 21 U.S.C. 801 et seq., and that 

APRN’s State licensure on the authority 

to prescribe, or administer controlled 

substances, as well as any other 

limitations on the provision of VA care 

set forth in applicable Federal law and 

policy. 

(e) Preemption of State and local law. 

To achieve important Federal interests, 

including but not limited to the ability 

to provide the same comprehensive care 

to veterans in all States under 38 U.S.C. 

7301, this section preempts conflicting 

State and local laws relating to the 

practice of APRNs when such APRNs 

are working within the scope of their 

VA employment. Any State or local law, 

or regulation pursuant to such law, is 

without any force or effect on, and State 

or local governments have no legal 

authority to enforce them in relation to 

this section or decisions made by VA 

under this section. 

(Authority: 38 U.S.C. 7301, 7304, 7402, and 

7403) 

[FR Doc. 2016–12338 Filed 5–24–16; 8:45 am] 

BILLING CODE 8320–01–P 

ENVIRONMENTAL PROTECTION 

AGENCY 

40 CFR Part 52 

[EPA–R01–OAR–2014–0364; A–1–FRL– 

9936–62–Region 1] 

Air Plan Approval; Connecticut; Sulfur 

Content of Fuel Oil Burned in 

Stationary Sources 

AGENCY: Environmental Protection 

Agency (EPA). 

ACTION: Proposed rule. 

SUMMARY: The Environmental Protection 

Agency (EPA) is proposing to approve a 

State Implementation Plan (SIP) 

revision submitted by the State of 

Connecticut on April 22, 2014, with 

supplemental submittals on June 18, 


Lhorne on DSK30JT082PROD with PROPOSALS
Federal Register / Vol. 81, No. 101 / Wednesday, May 25, 2016 / Proposed Rules 33161 

2015 and September 25, 2015. This 

revision establishes sulfur in fuel oil 

content limits for use in stationary 

sources. In addition, the submittal 

includes minor clarifying revisions to 

the methods for sampling, emission 

testing, sample analysis, and reporting. 

The intended effect of this action is to 

propose approval of these requirements 

into the Connecticut SIP. This action is 

being taken under the Clean Air Act. 

DATES: Written comments must be 

received on or before June 24, 2016. 

ADDRESSES: Submit your comments, 

identified by Docket ID Number EPA– 

R01–OAR–2014–0364 by one of the 

following methods: 

1. www.regulations.gov: Follow the 

on-line instructions for submitting 

comments. 

2. Email: arnold.anne@epa.gov. 

3. Fax: (617) 918–0047. 

4. Mail: ‘‘Docket Identification 

Number EPA–R01–OAR–2014–0364, 

Anne Arnold, U.S. Environmental 

Protection Agency, EPA New England 

Regional Office, Office of Ecosystem 

Protection, Air Quality Planning Unit, 5 

Post Office Square—Suite 100, (Mail 

code OEP05–2), Boston, MA 02109– 

3912. 

5. Hand Delivery or Courier: Deliver 

your comments to: Anne Arnold, 

Manager, Air Quality Planning Unit, 

U.S. Environmental Protection Agency, 

EPA New England Regional Office, 

Office of Ecosystem Protection, Air 

Quality Unit, 5 Post Office Square— 

Suite 100, (mail code OEP05–2), Boston, 

MA 02109–3912. Such deliveries are 

only accepted during the Regional 

Office’s normal hours of operation. The 

Regional Office’s official hours of 

business are Monday through Friday, 

8:30 a.m. to 4:30 p.m., excluding legal 

holidays. 

Instructions: Direct your comments to 

Docket ID No. EPA–R01–OAR–2014– 

0364. EPA’s policy is that all comments 

received will be included in the public 

docket without change and may be 

made available online at 

www.regulations.gov, including any 

personal information provided, unless 

the comment includes information 

claimed to be Confidential Business 

Information (CBI) or other information 

whose disclosure is restricted by statute. 

Do not submit through 

www.regulations.gov, or email, 

information that you consider to be CBI 

or otherwise protected. The 

www.regulations.gov Web site is an 

‘‘anonymous access’’ system, which 

means EPA will not know your identity 

or contact information unless you 

provide it in the body of your comment. 

If you send an email comment directly 

to EPA without going through 

www.regulations.gov your email address 

will be automatically captured and 

included as part of the comment that is 

placed in the public docket and made 

available on the Internet. If you submit 

an electronic comment, EPA 

recommends that you include your 

name and other contact information in 

the body of your comment and with any 

disk or CD–ROM you submit. If EPA 

cannot read your comment due to 

technical difficulties and cannot contact 

you for clarification, EPA may not be 

able to consider your comment. 

Electronic files should avoid the use of 

special characters, any form of 

encryption, and be free of any defects or 

viruses. 

Docket: All documents in the 

electronic docket are listed in the 

www.regulations.gov index. Although 

listed in the index, some information is 

not publicly available, i.e., CBI or other 

information whose disclosure is 

restricted by statute. Certain other 

material, such as copyrighted material, 

is not placed on the Internet and will be 

publicly available only in hard copy 

form. Publicly available docket 

materials are available either 

electronically in www.regulations.gov or 

in hard copy at U.S. Environmental 

Protection Agency, EPA New England 

Regional Office, Office of Ecosystem 

Protection, Air Quality Planning Unit, 5 

Post Office Square—Suite 100, Boston, 

MA. EPA requests that if at all possible, 

you contact the contact listed in the FOR

FURTHER INFORMATION CONTACT section to 

schedule your inspection. The Regional 

Office’s official hours of business are 

Monday through Friday, 8:30 a.m. to 

4:30 p.m., excluding legal holidays. 

In addition, copies of the state 

submittal are also available for public 

inspection during normal business 

hours, by appointment at the State Air 

Agency; Bureau of Air Management, 

Department of Energy and 

Environmental Protection, State Office 

Building, 79 Elm Street, Hartford, CT 

06106–1630. 

FOR FURTHER INFORMATION CONTACT: 

Anne K. McWilliams, Air Quality 

Planning Unit, U.S. Environmental 

Protection Agency, New England 

Regional Office, 5 Post Office Square— 

Suite 100, (Mail code OEP05–2), Boston, 

MA 02109–3912, telephone (617) 918– 

1697, facsimile (617) 918–0697, email 

mcwilliams.anne@epa.gov. 

SUPPLEMENTARY INFORMATION: In the 

Final Rules Section of this Federal 

Register, EPA is approving the State’s 

SIP submittals as a direct final rule 

without prior proposal because the 

Agency views this as a noncontroversial 

submittal and anticipates no adverse 

comments. A detailed rationale for the 

approval is set forth in the direct final 

rule. If no adverse comments are 

received in response to this rule, no 

further activity is contemplated. If EPA 

receives adverse comments, the direct 

final rule will be withdrawn and all 

public comments received will be 

addressed in a subsequent final rule 

based on this proposed rule. EPA will 

not institute a second comment period. 

Any parties interested in commenting 

on this action should do so at this time. 

Please note that if EPA receives adverse 

comment on an amendment, paragraph, 

or section of this rule and if that 

provision may be severed from the 

remainder of the rule, EPA may adopt 

as final those provisions of the rule that 

are not the subject of an adverse 

comment. 

For additional information, see the 

direct final rule which is located in the 

Rules Section of this Federal Register. 

Dated: November 5, 2015. 

H. Curtis Spalding, 

Regional Administrator, EPA New England. 

[FR Doc. 2016–12118 Filed 5–24–16; 8:45 am] 

BILLING CODE 6560–50–P 

ENVIRONMENTAL PROTECTION 

AGENCY 

40 CFR Parts 52 and 81 

[EPA–R06–OAR–2015–0721; FRL–9946–85– 

Region 6] 

Clean Air Act Redesignation Substitute 

for the Dallas-Fort Worth 1-Hour Ozone 

and 1997 8-Hour Ozone Nonattainment 

Areas; Texas 

AGENCY: Environmental Protection 

Agency (EPA). 

ACTION: Proposed rule. 

SUMMARY: The Environmental Protection 

Agency (EPA) is proposing to approve a 

redesignation substitute and make a 

finding of attainment for both the 1-hour 

ozone and the 1997 8-hour ozone 

National Ambient Air Quality Standards 

(NAAQS) for the Dallas-Fort Worth 

nonattainment area (DFW area). The 

redesignation substitute demonstration 

states that the area has attained both the 

revoked 1-hour ozone and the revoked 

1997 8-hour ozone NAAQS due to 

permanent and enforceable emission 

reductions, and that it will maintain 

those NAAQS for ten years from the 

date of the EPA’s approval of this 

demonstration. Final approval of the 

redesignation substitute will result in 

the area no longer being subject to any 

remaining applicable anti-backsliding 

requirements and the nonattainment 


Lhorne on DSK30JT082PROD with PROPOSALS