Federal Register / Vol. 63, No. 141 /Thursday, July 23, 1998 /Rules and Regulations 39515

the near future. Accordingly, this final

rule does not make changes regarding

anesthesia services. They remain subject

to the payment provisions for those

cases not covered by the Medicare

formula (i.e., lesser of the actual amount

billed or the amount calculated using

the 75th percentile methodology; or the

usual and customary rate if there are

fewer than 8 treatment occurrences for

a procedure during the previous fiscal

year).

Regulatory Flexibility Act

The Secretary hereby certifies that

this final rule will not have a significant

economic impact on a substantial

number of small entities as they are

defined in the Regulatory Flexibility

Act, 5 U.S.C. 601 through 612. The rule

would not cause a significant economic

impact on health care providers,

suppliers, or entities since only a small

portion of the business of such entities

concerns VA beneficiaries. Therefore,

pursuant to 5 U.S.C. 605(b), the rule is

exempt from the initial and final

regulatory flexibility analysis

requirements of sections 603 and 604.

Catalog of Federal Domestic Assistance

Numbers

The Catalog of Federal Domestic

Assistance Numbers are 64.009, 64.010

and 64.011.

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 home care,

Philippines, Reporting and

recordkeeping requirements,

Scholarships and fellowships, Travel

and transportation expenses, Veterans.

Approved: May 8, 1998.

Togo D. West, Jr.,

Acting Secretary.

For the reasons set forth in the

preamble, 38 CFR part 17 is amended as

follows:

PART 17—MEDICAL

1. The authority citation for part 17

continues to read as follows:

Authority: 38 U.S.C. 501, 1721, unless

otherwise noted.

§ 17.55 [Amended]

2. In § 17.55, in the introductory text

remove ‘‘38 U.S.C. 1703 or 38 CFR

17.52’’ and add, in its place ‘‘38 U.S.C.

1703 and 38 CFR 17.52 of this part or

under 38 U.S.C. 1728 and 38 CFR

17.120’’; paragraph (h) is removed; and

paragraphs (i), (j) and (k) are redesigned

as paragraphs (h), (i) and (j),

respectively.

3. Section 17.56 is redesignated as

§ 17.57 and a new § 17.56 is added to

read as follows:

§ 17.56 Payment for non-VA physician

services associated with outpatient and

inpatient care provided at non-VA facilities.

(a) Except for anesthesia services,

payment for non-VA physician services

associated with outpatient and inpatient

care provided at non-VA facilities

authorized under § 17.52, or made

under § 17.120 of this part, shall be the

lesser of the amount billed or the

amount calculated using the formula

developed by the Department of Health

& Human Services, Health Care

Financing Administration (HCFA)

under Medicare’s participating

physician fee schedule for the period in

which the service is provided (see 42

CFR Parts 414 and 415). This payment

methodology is set forth in paragraph

(b) of this section. If no amount has been

calculated under Medicare’s

participating physician fee schedule or

if the services constitute anesthesia

services, payment for such non-VA

physician services associated with

outpatient and inpatient care provided

at non-VA facilities authorized under

§ 17.52, or made under § 17.120 of this

part, shall be the lesser of the actual

amount billed or the amount calculated

using the 75th percentile methodology

set forth in paragraph (c) of this section;

or the usual and customary rate if there

are fewer than 8 treatment occurrences

for a procedure during the previous

fiscal year.

(b) The payment amount for each

service paid under Medicare’s

participating physician fee schedule is

the product of three factors: a nationally

uniform relative value for the service; a

geographic adjustment factor for each

physician fee schedule area; and a

nationally uniform conversion factor for

the service. The conversion factor

converts the relative values into

payment amounts. For each physician

fee schedule service, there are three

relative values: An RVU for physician

work; an RVU for practice expense; and

an RVU for malpractice expense. For

each of these components of the fee

schedule, there is a geographic practice

cost index (GPCI) for each fee schedule

area. The GPCIs reflect the relative costs

of practice expenses, malpractice

insurance, and physician work in an

area compared to the national average.

The GPCIs reflect the full variation from

the national average in the costs of

practice expenses and malpractice

insurance, but only one-quarter of the

difference in area costs for physician

work. The general formula calculating

the Medicare fee schedule amount for a

given service in a given fee schedule

area can be expressed as: Payment =

[(RVUwork × GPCIwork) + (RVUpractice

expense × GPCIpractice expense) +

(RVUmalpractice × GPCImalpractice)] ×

CF.

(c) Payment under the 75th percentile

methodology is determined for each VA

medical facility by ranking all

occurrences (with a minimum of eight)

under the corresponding code during

the previous fiscal year with charges

ranked from the highest rate billed to

the lowest rate billed and the charge

falling at the 75th percentile as the

maximum amount to be paid.

(d) Payments made in accordance

with this section shall constitute

payment in full. Accordingly, the

provider or agent for the provider may

not impose any additional charge for

any services for which payment is made

by VA.

4. Section 17.128 is revised to read as

follows:

§ 17.128 Allowable rates and fees.

When it has been determined that a

veteran has received public or private

hospital care or outpatient medical

services, the expenses of which may be

paid under § 17.120 of this part, the

payment of such expenses shall be paid

in accordance with §§ 17.55 and 17.56

of this part.

(Authority: Section 233, Pub. L. 99–576)

[FR Doc. 98–19682 Filed 7–22–98; 8:45 am]

BILLING CODE 8320–01–U

ENVIRONMENTAL PROTECTION

AGENCY

40 CFR Part 52

[WI76–02–7305; FRL–6128–4]

Approval and Promulgation of State

Implementation Plan; Wisconsin; SiteSpecific SIP Revision for Amron

Corporation

AGENCY: Environmental Protection

Agency (EPA).

ACTION: Final rule.

SUMMARY: This rulemaking finalizes the

Environmental Protection Agency’s

(EPA’s) disapproval of a site-specific

State Implementation Plan (SIP)

revision for the Amron Corporation

facility located at 525 Progress Avenue
39516 Federal Register / Vol. 63, No. 141 /Thursday, July 23, 1998 /Rules and Regulations

in Waukesha. The SIP revision was

submitted by the Wisconsin Department

of Natural Resources (WDNR) on

February 21, 1997, and would exempt

the facility from the volatile organic

compound (VOC) emission limits

applicable to miscellaneous metal

coating operations. The EPA proposed

to disapprove this request on April 28,

1998. No negative comments were

submitted during the comment period.

DATES: This disapproval is effective

August 24, 1998.

ADDRESSES: Copies of the documents

relevant to this action are available for

public inspection during normal

business hours at the U.S.

Environmental Protection Agency, 77

West Jackson Boulevard, Chicago,

Illinois 60604. (Please telephone

Kathleen D’Agostino at (312) 886–1767

before visiting the Region 5 Office.)

FOR FURTHER INFORMATION CONTACT:

Kathleen D’Agostino, Environmental

Engineer, Regulation Development

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

U.S. Environmental Protection Agency,

Region 5, Chicago, Illinois 60604, (312)

886–1767.

SUPPLEMENTARY INFORMATION:

I. Background

On April 28, 1998, EPA proposed to

disapprove the site-specific SIP revision

for Amron Corporation (63 FR 23239).

This proposed disapproval was based

on numerous factors which are

discussed in detail in the proposed

disapproval. EPA received no negative

comments during the public comment

period. Therefore, EPA is finalizing the

disapproval proposed on April 28, 1998.

II. Miscellaneous

A. Applicability to Future SIP Decisions

Nothing in this action should be

construed as permitting, allowing or

establishing a precedent for any future

request for revision to any SIP. The EPA

shall consider each request for revision

to the SIP in light of specific technical,

economic, and environmental factors

and in relation to relevant statutory and

regulatory requirements.

B. Executive Orders 12866 and 13045

The Office of Management and Budget

has exempted this regulatory action

from Executive Order (E.O.) 12866

review.

The final rule is not subject to E.O.

13045, entitled ‘‘Protection of Children

from Environmental Health Risks and

Safety Risks,’’ because it is not an

‘‘economically significant’’ action under

E.O. 12866.

C. Regulatory Flexibility

The Regulatory Flexibility Act (RFA)

generally requires an agency to conduct

a regulatory flexibility analysis of any

rule subject to notice and comment

rulemaking requirements unless the

agency certifies that the rule will not

have a significant economic impact on

a substantial number of small entities.

Small entities include small businesses,

small not-for-profit enterprises, and

small governmental jurisdictions. This

final rule will not have a significant

impact on a substantial number of small

entities because this disapproval only

affects one source, Amron Corporation.

Therefore, I certify that this action will

not have a significant economic impact

on a substantial number of small

entities. Furthermore, as explained in

this document, the request does not

meet the requirements of the Clean Air

Act and EPA cannot approve the

request. EPA has no option but to

disapprove the submittal.

EPA’s disapproval of the State request

under section 110 and subchapter I, part

D of the Clean Air Act does not affect

any existing requirements applicable to

small entities. Any pre-existing Federal

requirements remain in place after this

disapproval. Federal disapproval of the

State submittal does not affect Stateenforceability. Moreover, EPA’s

disapproval of the submittal does not

impose any new Federal requirements.

Therefore, I certify that this action will

not have a significant economic impact

on a substantial number of small

entities.

D. Unfunded Mandates

Under section 202 of the Unfunded

Mandates Reform Act of 1995, signed

into law on March 22, 1995, EPA must

prepare a budgetary impact statement to

accompany any proposed or final rule

that includes a Federal mandate that

may result in estimated costs to State,

local, or tribal governments in the

aggregate, or to the private sector, of

$100 million or more. Under section

205, EPA must select the most costeffective and least burdensome

alternative that achieves the objectives

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

or uniquely impacted by the rule.

EPA has determined that this

disapproval does not include a Federal

mandate that may result in estimated

costs of $100 million or more to either

State, local, or tribal governments in the

aggregate, or to the private sector. This

Federal disapproval action imposes no

new requirements. Accordingly, no

additional costs to State, local, or tribal

governments, or to the private sector,

result.

E. Small Business Regulatory

Enforcement Fairness Act

The Congressional Review Act, 5

U.S.C. 801 et seq., as added by the Small

Business Regulatory Enforcement

Fairness Act of 1996, generally provides

that before a rule may take effect, the

agency promulgating the rule must

submit a rule report, which includes a

copy of the rule, to each House of the

Congress and to the Comptroller General

of the United States. Section 804,

however, exempts from section 891 the

following types of rules: rules of

particular applicability; rules relating to

agency management or personnel; and

rules of agency organization, procedure,

or practice that do not substantially

affect the rights or obligations of nonagency parties. 5 U.S.C. 804(3). EPA is

not required to submit a rule report

regarding this action under section 801

because this is a rule of particular

applicability.

List of Subjects in 40 CFR Part 52

Environmental protection, Air

pollution control, Intergovernmental

relations, Ozone, Reporting and

recordkeeping requirements, Volatile

organic compounds.

Authority: 42 U.S.C. 7401–7671q

Dated: July 9, 1998.

David A. Ullrich,

Acting Regional Administrator.

[FR Doc. 98–19656 Filed 7–22–98; 8:45 am]

BILLING CODE 6560–50–P

ENVIRONMENTAL PROTECTION

AGENCY

40 CFR Part 63

[AD–FRL–6112–7]

National Emission Standards for

Hazardous Air Pollutants for Industrial

Process Cooling Towers

AGENCY: Environmental Protection

Agency (EPA).

ACTION: Direct final rule.

SUMMARY: This action corrects and

clarifies regulatory text of the ‘‘National

Emission Standard for Hazardous Air

Pollutants for Industrial Process Cooling

Towers,’’ which was issued as a final

rule on September 8, 1994. The rule is

being revised to clarify that the owner

or operator of a source that ceases use

of chromium-based chemicals may

demonstrate compliance with the

standard through recordkeeping.