Federal Register / Vol. 90, No. 27 / Tuesday, February 11, 2025 / Notices 9343 

ability to investigate and respond 

appropriately to complaints against 

accredited facilities. 

++ TJC’s processes and procedures 

for monitoring a hospital found out of 

compliance with TJC’s program 

requirements. These monitoring 

procedures are used only when TJC 

identifies noncompliance. If 

noncompliance is identified through 

validation reviews or complaint 

surveys, the SA monitors corrections as 

specified at § 488.9. 

++ TJC’s capacity to report 

deficiencies to the surveyed facilities 

and respond to the facility’s plan of 

correction in a timely manner. 

++ TJC’s capacity to provide CMS 

with electronic data and reports 

necessary for effective validation and 

assessment of the organization’s survey 

process. 

++ The adequacy of TJC’s staff and 

other resources, and its financial 

viability. 

++ TJC’s capacity to adequately fund 

required surveys. 

++ TJC’s policies with respect to 

whether surveys are announced or 

unannounced, to assure that surveys are 

unannounced. 

++ TJC’s policies and procedures to 

avoid conflicts of interest, including the 

appearance of conflicts of interest, 

involving individuals who conduct 

surveys or participate in accreditation 

decisions. 

++ TJC’s agreement to provide CMS 

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. Collection of Information 

Requirements 

This document does not impose 

information collection requirements, 

that is, reporting, recordkeeping or 

third-party disclosure requirements. 

Consequently, there is no need for 

review by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 3501 et seq.). 

V. Response to Public 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. 

The Acting Administrator of the 

Centers for Medicare & Medicaid 

Services (CMS), Stephanie Carlton, 

having reviewed and approved this 

document, authorizes Vanessa Garcia, 

who is the Federal Register Liaison, to 

electronically sign this document for 

purposes of publication in the Federal 

Register. 

Vanessa Garcia, 

Federal Register Liaison, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2025–02436 Filed 2–10–25; 8:45 am] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–1838–PN] 

Medicare Program; Announcement of 

Request for an Exception From the 

Prohibition on Expansion of Facility 

Capacity Under the Hospital 

Ownership and Rural Provider 

Exceptions to the Physician SelfReferral Prohibition 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Notice with request for 

comment. 

SUMMARY: The Social Security Act 

prohibits a hospital with physician 

ownership that relies on the exception 

to the physician self-referral law for 

hospitals outside of Puerto Rico or for 

rural providers from expanding its 

facility capacity unless the Secretary of 

the Department of Health and Human 

Services grants the hospital’s request for 

an exception from that prohibition after 

considering input on the request from 

individuals and entities in the 

community where the hospital is 

located. The Centers for Medicare & 

Medicaid Services has received a 

request from a hospital with physician 

ownership for an exception from the 

prohibition on expansion of facility 

capacity. This notice solicits comments 

on the request from individuals and 

entities in the community in which the 

hospital is located. Community input 

may inform our decision to approve or 

deny the hospital’s request for an 

exception from the prohibition on 

expansion of facility capacity. 

DATES: To be assured consideration, 

comments must be received at one of 

the addresses provided below by April 

14, 2025. 

ADDRESSES: In commenting, refer to file 

code CMS–1838–PN. 

Comments, including mass comment 

submissions, must be submitted in one 

of the following three ways (please 

choose only one of the ways listed): 

1. Electronically. You may submit 

electronic comments on this notice to 

https://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–1838–PN, P.O. Box 8010, 

Baltimore, MD 21244–1850. 

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–1838–PN, 

Mail Stop C4–26–05, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

For information on viewing public 

comments, see the beginning of the 

SUPPLEMENTARY INFORMATION section. 

FOR FURTHER INFORMATION CONTACT: 

POH-ExceptionRequests@cms.hhs.gov. 

Joi Hosley, (410) 786–2194. 

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 

website as soon as possible after they 

have been received: https://

www.regulations.gov. Follow the search 

instructions on that website to view 

public comments. CMS will not post on 

https://www.regulations.gov public 

comments that make threats to 

individuals or institutions or suggest 

that the commenter will take actions to 

harm an individual. CMS encourages 

commenters not to submit duplicative 

comments. We will post acceptable 

comments from multiple unique 

commenters even if the content is 

identical or nearly identical to other 

comments. 

I. Background 

Section 1877 of the Social Security 

Act (the Act), also known as the 

physician self-referral law: (1) prohibits 

a physician from making referrals for 

certain designated health services 

payable by Medicare to an entity with 

which he or she (or an immediate family 

member) has a financial relationship 


KHAMMOND on DSK9W7S144PROD with NOTICES
9344 Federal Register / Vol. 90, No. 27 / Tuesday, February 11, 2025 / Notices 

unless the requirements of an applicable 

exception are satisfied; and (2) prohibits 

the entity from filing claims with 

Medicare (or billing another individual, 

entity, or third party payer) for any 

improperly referred designated health 

services. A financial relationship may 

be an ownership or investment interest 

in the entity or a compensation 

arrangement with the entity. The statute 

establishes a number of specific 

exceptions and grants the Secretary of 

the Department of Health and Human 

Services (the Secretary) the authority to 

create regulatory exceptions for 

financial relationships that do not pose 

a risk of program or patient abuse. 

Section 1877(d) of the Act sets forth 

exceptions related to ownership or 

investment interests held by a physician 

(or an immediate family member of a 

physician) in an entity that furnishes 

designated health services. Section 

1877(d)(2) of the Act provides an 

exception for ownership or investment 

interests in rural providers (the ‘‘rural 

provider exception’’). To satisfy the 

requirements of the rural provider 

exception, the designated health 

services must be furnished in a rural 

area (as defined in section 1886(d)(2) of 

the Act) and substantially all of the 

designated health services furnished by 

the entity must be furnished to 

individuals residing in a rural area, and, 

in the case where the entity is a 

hospital, the hospital must meet the 

requirements of section 1877(i)(1) of the 

Act no later than September 23, 2011. 

Section 1877(d)(3) of the Act provides 

an exception for ownership or 

investment interests in a hospital 

located outside of Puerto Rico (the 

‘‘whole hospital exception’’). To satisfy 

the requirements of the whole hospital 

exception, the referring physician must 

be authorized to perform services at the 

hospital, the ownership or investment 

interest must be in the hospital itself 

(and not merely in a subdivision of the 

hospital), and the hospital must meet 

the requirements of section 1877(i)(1) of 

the Act no later than September 23, 

2011. 

II. Prohibition on Expansion of Facility 

Capacity 

Section 6001(a)(3) of the Patient 

Protection and Affordable Care Act 

(Affordable Care Act) (Pub. L. 111–148) 

amended section 1877 of the Act, by 

adding the requirements in section 

1877(i) of the Act for a hospital to 

qualify for the rural provider and whole 

hospital exceptions, including that the 

hospital may not increase the number of 

operating rooms, procedure rooms, and 

beds beyond that for which the hospital 

was licensed on March 23, 2010 (or, in 

the case of a hospital that did not have 

a provider agreement in effect as of this 

date, but did have a provider agreement 

in effect on December 31, 2010, the 

effective date of such provider 

agreement) unless the Secretary grants 

an exception from the prohibition on 

facility expansion. We refer to this 

prohibition herein as the ‘‘prohibition 

on facility expansion.’’ Section 

1877(i)(3)(A)(i) of the Act requires the 

Secretary to establish and implement a 

process under which a hospital that is 

an ‘‘applicable hospital’’ (as defined at 

section 1877(i)(3)(E) of the Act) or a 

‘‘high Medicaid facility’’ (as defined at 

section 1877(i)(3)(F) of the Act) may 

apply for an exception from the 

prohibition on facility expansion. The 

process for requesting an exception from 

the prohibition on facility expansion is 

discussed in section III. below. 

The criteria that a hospital must meet 

to be an applicable hospital are set forth 

at § 411.363(c). An applicable hospital: 

(1) is located in a county that has a 

percentage increase in the population 

that is at least 150 percent of the 

percentage increase in population of the 

State in which the hospital is located 

during the most recent 5-year period for 

which data are available as of the date 

that the hospital submits its request, as 

estimated by the Bureau of the Census; 

(2) has an annual percent of total 

inpatient admissions under Medicaid 

that is equal to or greater than the 

average percent with respect to such 

admissions for all hospitals (including 

the requesting hospital) that have 

Medicare participation agreements with 

CMS and are located in the county in 

which the hospital is located during the 

most recent 12-month period for which 

data are available as of the date that the 

hospital submits its request; (3) does not 

discriminate against beneficiaries of 

Federal health care programs and does 

not permit physicians practicing at the 

hospital to discriminate against such 

beneficiaries; (4) is located in a State in 

which the average bed capacity in the 

State is less than the national average 

bed capacity during the most recent 

fiscal year for which the Healthcare Cost 

Report Information System (HCRIS), as 

of the date that the hospital submits its 

request, contains data from a sufficient 

number of hospitals to determine a 

State’s average bed capacity and the 

national average bed capacity; and (5) 

has an average bed occupancy rate that 

is greater than the average bed 

occupancy rate in the State in which the 

hospital is located during the most 

recent fiscal year for which HCRIS, as of 

the date that the hospital submits its 

request, contains data from a sufficient 

number of hospitals to determine the 

requesting hospital’s average bed 

occupancy rate and the relevant State’s 

average bed occupancy rate. The 

regulation at § 411.363(c)(2) and (c)(5)(i) 

specify acceptable data sources for 

determining whether a hospital meets 

the criteria for an applicable hospital. 

The criteria that a hospital must meet 

to be a high Medicaid facility are set 

forth at § 411.363(d). A high Medicaid 

facility: (1) is not the sole hospital in the 

county in which the hospital is located; 

(2) with respect to each of the three 

most recent 12-month periods for which 

data are available as of the date the 

hospital submits its request, has an 

annual percent of total inpatient 

admissions under Medicaid that is 

estimated to be greater than such 

percent with respect to such admissions 

for each other hospital that has a 

Medicare participation agreement with 

CMS and is located in the county in 

which the hospital is located; and (3) 

does not discriminate against 

beneficiaries of Federal health care 

programs and does not permit 

physicians practicing at the hospital to 

discriminate against such beneficiaries. 

The regulation at § 411.363(d)(2) 

specifies the acceptable data source for 

determining whether a hospital meets 

the criteria for a high Medicaid facility. 

III. Expansion Exception Process 

The process for requesting an 

exception from the prohibition on 

facility expansion (also referred to as 

‘‘expansion exception request’’ or 

‘‘request’’ for purposes of this notice) is 

set forth at § 411.363 and addresses the 

procedure for submitting a request, 

community input, the timing of a 

complete request, the determination that 

a hospital is an applicable hospital or a 

high Medicaid facility, and CMS’ 

decision to approve or deny a request. 

CMS takes a two-step approach to 

considering expansion exception 

requests. First, CMS will determine 

whether the requesting hospital meets 

the criteria for an applicable hospital or 

a high Medicaid facility using the 

information provided by the hospital in 

its expansion exception request and 

rebuttal statement, if any, and the 

community input, if any. Second, using 

data and information provided from 

these sources, as well as any other data 

and information that is relevant to its 

decision, CMS will decide whether to 

approve or deny the expansion 

exception request. 

Individuals and entities in the 

hospital’s community may provide 

input with respect to the hospital’s 

request for an exception from the 

prohibition on facility expansion, 


KHAMMOND on DSK9W7S144PROD with NOTICES
Federal Register / Vol. 90, No. 27 / Tuesday, February 11, 2025 / Notices 9345 

including, but not limited to, input 

regarding whether the hospital meets 

the criteria for an applicable hospital or 

a high Medicaid facility and the factors 

that CMS will consider in deciding 

whether to approve or deny the 

hospital’s expansion exception request. 

Community input must be in the form 

of written comments, submitted 

according to the instructions in this 

Federal Register notice, and be received 

no later than 60 days after the 

publication date of this notice in the 

Federal Register. If CMS receives 

written comments from the community, 

the hospital will have 60 days after CMS 

notifies the hospital of the written 

comments to submit a rebuttal 

statement. 

The hospital’s community includes 

the geographic area served by the 

hospital (as defined at § 411.357(e)(2)) 

and all of the following: 

• The county in which the hospital’s 

main campus is located. 

• The counties in which the hospital 

provides inpatient or outpatient hospital 

services as of the date the hospital 

submits the request. 

The factors that CMS will consider in 

deciding whether to approve or deny a 

hospital’s request for an exception from 

the prohibition on facility expansion are 

set forth at § 411.363(i)(2) and include, 

but are not limited to, the following: 

• The specialty (for example, 

maternity, psychiatric, or substance use 

disorder care) of the hospital or the 

services furnished by or to be furnished 

by the hospital if CMS approves the 

request. 

• Program integrity or quality of care 

concerns related to the hospital. 

• Whether the hospital has a need for 

additional operating rooms, procedure 

rooms, or beds. 

• Whether there is a need for 

additional operating rooms, procedure 

rooms, or beds in the county in which 

the main campus of the hospital is 

located or in any county in which the 

hospital provides inpatient or outpatient 

hospital services as of the date the 

hospital submits the request. 

If CMS determines that the requesting 

hospital does not meet the criteria for an 

applicable hospital or a high Medicaid 

facility, CMS will publish in the Federal 

Register notice of such determination. If 

CMS determines that the hospital meets 

the criteria for an applicable hospital or 

a high Medicaid facility, CMS will 

publish in the Federal Register notice of 

such determination and its decision 

regarding the hospital’s request for an 

exception from the prohibition on 

facility expansion. 

IV. Hospital’s Expansion Exception 

Request 

As permitted by section 1877(i)(3) of 

the Act and our regulations at § 411.363, 

the following hospital with physician 

ownership has requested an exception 

from the prohibition on facility 

expansion: 

Name of Facility: Mountain View 

Hospital. 

Location: 2325 Coronado Street, Idaho 

Falls, Idaho 83404. 

Basis for this Expansion Exception 

Request: High Medicaid Facility. 

We seek comments on this request 

from individuals and entities in the 

community in which the hospital is 

located. We encourage parties that wish 

to have their input considered to 

address how they are part of the 

requesting hospital’s community in 

their submissions. We also encourage 

interested parties review the hospital’s 

request, which is posted on the CMS 

website at https://www.cms.gov/ 

Medicare/Fraud-and-Abuse/Physician

SelfReferral/Physician_Owned_

Hospitals.html. We especially welcome 

comments regarding whether the 

hospital meets the criteria for a high 

Medicaid facility and the factors that 

CMS will consider in deciding whether 

to approve or deny the hospital’s 

request for an exception from the 

prohibition on facility expansion. 

We suggest that parties review the 

DATES and ADDRESSES sections of this 

notice to ensure timely submission of 

their comments. 

V. Collection of Information 

Requirements 

This document does not impose 

information collection requirements, 

that is, reporting, recordkeeping or 

third-party disclosure requirements. 

Consequently, there is no need for 

review by the Office of Management and 

Budget under the authority of the 

Paperwork Reduction Act of 1995 (44 

U.S.C. 3501 et seq.). 

VI. Response to Comments 

We will consider all comments we 

receive by the date and time specified 

in the DATES section of this preamble. 

The Acting Administrator of the 

Centers for Medicare & Medicaid 

Services (CMS), Stephanie Carlton, 

having reviewed and approved this 

document, authorizes Vanessa Garcia, 

who is the Federal Register Liaison, to 

electronically sign this document for 

purposes of publication in the Federal 

Register. 

Vanessa Garcia, 

Federal Register Liaison, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2025–02441 Filed 2–10–25; 8:45 am] 

BILLING CODE 4120–01–P 

INTERNATIONAL TRADE 

COMMISSION 

[Investigation Nos. 701–TA–731 and 731– 

TA–1700 (Final)] 

Low Speed Personal Transportation 

Vehicles (LSPTVs) From China; 

Scheduling of the Final Phase of 

Countervailing Duty and Antidumping 

Duty Investigations 

AGENCY: United States International 

Trade Commission. 

ACTION: Notice. 

SUMMARY: The Commission hereby gives 

notice of the scheduling of the final 

phase of antidumping and 

countervailing duty investigation Nos. 

701–TA–731 and 731–TA–1700 (Final) 

pursuant to the Tariff Act of 1930 (‘‘the 

Act’’) to determine whether an industry 

in the United States is materially 

injured or threatened with material 

injury, or the establishment of an 

industry in the United States is 

materially retarded, by reason of 

imports of low speed personal 

transportation vehicles (LSPTVs) from 

China, provided for in subheadings 

8703.10.50, 8703.90.01, 8706.00.15, and 

8707.10.00 of the Harmonized Tariff 

Schedule of the United States, 

preliminarily determined by the 

Department of Commerce (‘‘Commerce’’) 

to be subsidized and sold at less-thanfair-value. 

DATES: January 30, 2025. 

FOR FURTHER INFORMATION CONTACT: 

Nitin Joshi ((202) 708–1669), Office of 

Investigations, U.S. International Trade 

Commission, 500 E Street SW, 

Washington, DC 20436. Hearingimpaired persons can obtain 

information on this matter by contacting 

the Commission’s TDD terminal on 202– 

205–1810. Persons with mobility 

impairments who will need special 

assistance in gaining access to the 

Commission should contact the Office 

of the Secretary at 202–205–2000. 

General information concerning the 

Commission may also be obtained by 

accessing its internet server (https://

www.usitc.gov). The public record for 

these investigations may be viewed on 

the Commission’s electronic docket 

(EDIS) at https://edis.usitc.gov. 

SUPPLEMENTARY INFORMATION: 


KHAMMOND on DSK9W7S144PROD with NOTICES