18728 Federal Register / Vol. 74, No. 78 / Friday, April 24, 2009 / Notices 

programs, depending upon the 

legislative intent of the program, 

programmatic purpose of the low 

income level, as well as the age and 

circumstances of the average 

participant, will use the student’s family 

as long as he or she is not listed as a 

dependent upon the parents’ tax form. 

Each program will announce the 

rationale and choice of methodology for 

determining low income levels in their 

program guidance. The Department’s 

poverty guidelines are based on poverty 

thresholds published by the U.S. Bureau 

of the Census, adjusted annually for 

changes in the Consumer Price Index. 

The Secretary annually adjusts the 

low-income levels based on the 

Department’s poverty guidelines and 

makes them available to persons 

responsible for administering the 

applicable programs. The income 

figures below have been updated to 

reflect increases in the Consumer Price 

Index through December 31, 2008. 

Size of parents’ family * Income 

level ** 

1 .................................................. $21,660 

2 .................................................. 29,140 

3 .................................................. 36,620 

4 .................................................. 44,100 

5 .................................................. 51,580 

6 .................................................. 59,060 

7 .................................................. 66,540 

8 .................................................. 74,020 

* Includes only dependents listed on Federal 

income tax forms. Some programs will use the 

student’s family rather than his or her parents’ 

family. 

** Adjusted gross income for calendar year 

2008. 

Dated: April 17, 2009. 

Marcia K. Brand, 

Deputy Administrator. 

[FR Doc. E9–9381 Filed 4–23–09; 8:45 am] 

BILLING CODE 4165–15–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–2299–PN] 

Medicare and Medicaid Programs; 

Application of the American 

Osteopathic Association for Continued 

Deeming Authority for Hospitals 

AGENCY: Centers for Medicare and 

Medicaid Services (CMS), HHS. 

ACTION: Proposed notice. 

SUMMARY: This proposed notice with 

comment period acknowledges the 

receipt of a deeming application from 

the American Osteopathic Association 

for continued recognition as a national 

accrediting organization for hospitals 

that wish to participate in the Medicare 

or Medicaid programs. 

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

Security Act 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. May 26, 2009. 

ADDRESSES: In commenting, please refer 

to file code CMS–2299–PN. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

four ways (please choose only one of the 

ways listed): 

1. Electronically. You may submit 

electronic comments on this regulation 

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

the instructions under the ‘‘More Search 

Options’’ tab. 

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–2299–PN, P.O. Box 8016, 

Baltimore, MD 21244–8016. 

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–2299–PN, 

Mail Stop C4–26–05, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

4. By hand or courier. If you prefer, 

you may deliver (by hand or courier) 

your written comments before the close 

of the comment period to either of the 

following addresses: 

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, 

please call telephone number (410) 786– 

7195 in advance to schedule your 

arrival with one of our staff members. 

Comments 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: 

Lillian Williams, (410) 786–8636. 

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 a hospital provided 

certain requirements are met. Sections 

1861(e) of the Social Security Act (the 

Act) establish distinct criteria for 

facilities seeking designation as a 

hospital. Regulations concerning 

provider agreements are located at 42 

CFR part 489 and those pertaining to 

activities relating to the survey and 

certification of facilities are located at 

42 CFR part 488. The regulations at 42 

CFR part 482, specify the conditions 

that a hospital must meet in order to 

participate in the Medicare program, the 

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Federal Register / Vol. 74, No. 78 / Friday, April 24, 2009 / Notices 18729 

scope of covered services and the 

conditions for Medicare payment for 

Hospitals. 

Generally, in order to enter into a 

provider agreement with the Medicare 

program, a hospital must first be 

certified by a State survey agency as 

complying with the conditions or 

requirements set forth in part 482 of 

CMS regulations. Thereafter, the 

hospital 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 (as 

redesignated under section 125 of the 

Medicare Improvements for Patients and 

Providers Act of 2008 (MIPPA) (Pub. L. 

110–275) 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 will deem those 

provider entities as having met the 

requirements. (We note that section 125 

of MIPPA redesignated paragraphs (b) 

through (e) of section 1865 of the Act as 

paragraphs (a) through (d) respectively). 

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. 

Our regulations concerning the 

reapproval of accrediting organizations 

are set forth at § 488.4 and § 488.8(d)(3). 

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

accrediting organizations to reapply for 

continued deeming authority every 6 

years or sooner as determined by CMS. 

The American Osteopathic 

Association’s (AOA) term of approval as 

a recognized accreditation program for 

hospitals expires September 25, 2009. 

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 

reapproval 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 notice 

of approval or denial of the application. 

The purpose of this proposed notice 

is to inform the public of AOA’s request 

for continued deeming authority for 

hospitals. This notice also solicits 

public comment on whether AOA’s 

requirements meet or exceed the 

Medicare conditions for participation 

for hospitals. 

Evaluation of Deeming Authority 

Request 

AOA submitted all the necessary 

materials to enable us to determine its 

application to be complete on February 

20, 2009. Under section 1865(a)(2) of the 

Act and our regulations at § 488.8 

(Federal review of accreditation 

organizations), our review and 

evaluation of AOA will be conducted in 

accordance with, but not necessarily 

limited to, the following factors: 

• The equivalency of AOA’s 

standards for a hospital as compared 

with CMS’ hospital conditions of 

participation. 

• AOA’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 AOA’s 

processes to those of State agencies, 

including survey frequency, and the 

ability to investigate and respond 

appropriately to complaints against 

accredited facilities. 

+ AOA’s processes and procedures 

for monitoring hospitals found out of 

compliance with AOA’s program 

requirements. These monitoring 

procedures are used only when AOA 

identifies noncompliance. If 

noncompliance is identified through 

validation reviews, the State survey 

agency monitors corrections as specified 

at § 488.7(d). 

+ AOA’s capacity to report 

deficiencies to the surveyed facilities 

and respond to the facility’s plan of 

correction in a timely manner. 

+ AOA’s capacity to provide us with 

electronic data and reports necessary for 

effective validation and assessment of 

the organization’s survey process. 

+ The adequacy of AOA’s staff and 

other resources, and its financial 

viability. 

+ AOA’s capacity to adequately fund 

required surveys. 

+ AOA’s policies with respect to 

whether surveys are announced or 

unannounced, to assure that surveys are 

unannounced. 

+ AOA’s agreement 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). 

Response to Comments 

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 we receive 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. 

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). 

VI. Regulatory Impact Statement 

In accordance with the provisions of 

Executive Order 12866, this regulation 

was not reviewed by the Office of 

Management and Budget. 

In accordance with Executive Order 

13132, we have determined that this 

proposed notice would not have 

significant effect on the rights of State, 

local, or tribal governments. 

Authority: Section 1865 of the Social 

Security Act (42 U.S.C. 1395bb) 

(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) 

mstockstill on PROD1PC66 with NOTICES

18730 Federal Register / Vol. 74, No. 78 / Friday, April 24, 2009 / Notices 

Dated: April 8, 2009. 

Charlene Frizzera, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

[FR Doc. E9–8782 Filed 4–23–09; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

National Institutes of Health 

National Institute on Deafness and 

Other Communication Disorders; 

Notice of Closed Meetings 

Pursuant to section 10(d) of the 

Federal Advisory Committee Act, as 

amended (5 U.S.C. App.), notice is 

hereby given of the following meetings. 

The meetings will be closed to the 

public in accordance with the 

provisions set forth in sections 

552b(c)(4) and 552b(c)(6), Title 5 U.S.C., 

as amended. The grant applications and 

the discussions could disclose 

confidential trade secrets or commercial 

property such as patentable material, 

and personal information concerning 

individuals associated with the grant 

applications, the disclosure of which 

would constitute a clearly unwarranted 

invasion of personal privacy. 

Name of Committee: National Institute on 

Deafness and Other Communication. 

Disorders Special Emphasis Panel. 

Investigator-Initiated Clinical Trials. 

Date: May 12, 2009. 

Time: 12 p.m. to 4 p.m. 

Agenda: To review and evaluate grant 

applications. 

Place: National Institutes of Health, 6120 

Executive Blvd., Rockville, MD 20852. 

(Telephone Conference Call). 

Contact Person: Christine A. Livingston, 

PhD, Scientific Review Officer, Division of 

Extramural Activities, National Institutes of 

Health/NIDCD, 6120 Executive Blvd.—MSC 

7180, Bethesda, MD 20892. (301) 496–8683. 

livingsc@mail.nih.gov. 

Reviewers confirmed late. 

Name of Committee: National Institute on 

Deafness and Other Communication. 

Disorders Special Emphasis Panel. Chemical 

Senses Clinical Research. 

Date: May 19, 2009. 

Time: 12:30 p.m. to 4 p.m. 

Agenda: To review and evaluate grant 

applications. 

Place: National Institutes of Health, 6120 

Executive Blvd., Rockville, MD 20852. 

(Telephone Conference Call). 

Contact Person: Sheo Singh, PhD, 

Scientific Review Officer, Scientific Review 

Branch, Division of Extramural Activities, 

Executive Plaza South, Room 400C, 6120 

Executive Blvd., Bethesda, MD 20892. 301– 

496–8683. singhs@nidcd.nih.gov. 

(Catalogue of Federal Domestic Assistance 

Program Nos. 93.173, Biological Research 

Related to Deafness and Communicative 

Disorders, National Institutes of Health, HHS) 

Dated: April 16, 2009. 

Jennifer Spaeth, 

Director, Office of Federal Advisory 

Committee Policy. 

[FR Doc. E9–9251 Filed 4–23–09; 8:45 am] 

BILLING CODE 4140–01–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

National Institutes of Health 

Center for Scientific Review; Amended 

Notice of Meeting 

Notice is hereby given of a change in 

the meeting of the Center for Scientific 

Review Special Emphasis Panel, April 

30, 2009, 9 a.m. to May 1, 2009, 5 p.m., 

National Institutes of Health, 6701 

Rockledge Drive, Bethesda, MD 20892, 

which was published in the Federal 

Register on April 10, 2009, 74 FR 

16407–16408. 

The meeting will be held May 12, 

2009 to May 13, 2009. The meeting time 

and location remain the same. The 

meeting is closed to the public. 

Dated: April 16, 2009. 

Jennifer Spaeth, 

Director, Office of Federal Advisory 

Committee Policy. 

[FR Doc. E9–9253 Filed 4–23–09; 8:45 am] 

BILLING CODE 4140–01–M 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

National Institutes of Health 

National Institute on Deafness and 

Other Communication Disorders; 

Notice of Meeting 

Pursuant to section 10(d) of the 

Federal Advisory Committee Act, as 

amended (5 U.S.C. App.), notice is 

hereby given of a meeting of the 

National Deafness and Other 

Communication Disorders Advisory 

Council. 

The meeting will be open to the 

public as indicated below, with 

attendance limited to space available. 

Individuals who plan to attend and 

need special assistance, such as sign 

language interpretation or other 

reasonable accommodations, should 

notify the Contact Person listed below 

in advance of the meeting. 

The meeting will be closed to the 

public in accordance with the 

provisions set forth in sections 

552b(c)(4) and 552b(c)(6), Title 5 U.S.C., 

as amended. The grant applications and 

the discussions could disclose 

confidential trade secrets or commercial 

property such as patentable material, 

and personal information concerning 

individuals associated with the grant 

applications, the disclosure of which 

would constitute a clearly unwarranted 

invasion of personal privacy. 

Name of Committee: National Deafness and 

Other Communication Disorders. Advisory 

Council. 

Date: June 5, 2009. 

Closed: 8:30 a.m. to 11 a.m. 

Agenda: To review and evaluate grant 

applications. 

Place: National Institutes of Health, 

Building 31, 31 Center Drive, Conference 

Room 10, Bethesda, MD 20892. 

Open: 11 a.m. to 2:30 p.m. 

Agenda: Staff reports on divisional, 

programmatic, and special activities. 

Place: National Institutes of Health, 

Building 31, 31 Center Drive, Conference 

Room 10, Bethesda, MD 20892. 

Contact Person: Craig A. Jordan, PhD, 

Director, Division of Extramural Activities, 

NIDCD, NIH, Executive Plaza South, Room 

400C, 6120 Executive Blvd., Bethesda, MD 

20892–7180. 301–496–8693. 

jordanc@nidcd.nih.gov. 

Any interested person may file written 

comments with the committee by forwarding 

the statement to the Contact Person listed on 

this notice. The statement should include the 

name, address, telephone number and when 

applicable, the business or professional 

affiliation of the interested person. 

In the interest of security, NIH has 

instituted stringent procedures for entrance 

onto the NIH campus. All visitor vehicles, 

including taxicabs, hotel, and airport shuttles 

will be inspected before being allowed on 

campus. Visitors will be asked to show one 

form of identification (for example, a 

government-issued photo ID, driver’s license, 

or passport) and to state the purpose of their 

visit. 

Information is also available on the 

Institute’s/Center’s home page: http:// 

www.nidcd.nih.gov/about/groups/ndcdac/, 

where an agenda and any additional 

information for the meeting will be posted 

when available. 

(Catalogue of Federal Domestic Assistance 

Program Nos. 93.173, Biological Research 

Related to Deafness and Communicative 

Disorders, National Institutes of Health, HHS) 

Dated: April 16, 2009. 

Jennifer Spaeth, 

Director, Office of Federal Advisory 

Committee Policy. 

[FR Doc. E9–9254 Filed 4–23–09; 8:45 am] 

BILLING CODE 4140–01–M 

mstockstill on PROD1PC66 with NOTICES