61540 Federal Register / Vol. 72, No. 210 / Wednesday, October 31, 2007 / Rules and Regulations 

Authority: 5 U.S.C. 5707; 31 U.S.C. 3726; 

40 U.S.C. 121(c). 

§ 301–72.203 [Amended] 

■ 45. Amend § 301–72.203 by adding a 

comma after ‘‘e.g.’’, in two places. 

PART 301–73—TRAVEL PROGRAMS 

■ 46. The authority citation for 41 CFR 

part 301–73 continues to read as 

follows: 

Authority: 5 U.S.C. 5707; 40 U.S.C. 121(c). 

§ 301–73.1 [Amended] 

■ 47. Amend § 301–73.1(d), by 

removing the words ‘‘Federal Premier 

Lodging Program (FPLP)’’ and add 

‘‘FedRooms’’, in its place. 

§ 301–73.2 [Amended] 

■ 48. Amend § 301–73.2(c), by removing 

the words ‘‘eTravel Program 

Management Office’’ and add ‘‘E-Gov 

Travel Program Management Office’’, in 

its place. 

§ 301–73.104 [Amended] 

■ 49. Amend § 301–73.104(a)(1), by 

removing the words ‘‘Travel 

Management System’’ and add ‘‘Travel 

Management Service’’, in its place. 

§ 301–73.106 [Amended] 

■ 50. Amend § 301–73.106 by—

■ a. Removing in paragraph (a)(2), the 

words ‘‘Federal Premier Lodging 

Program’’ and add ‘‘FedRooms’’, in its 

place.; and 

■ b. Removing in paragraph (a)(3), the 

words ‘‘Military Traffic Management 

Command (MTMC)’’ and adding 

‘‘Surface Deployment and Distribution 

Command (SDDC)’’ in its place. 

§§ 301–73.1 through 301–73.106 

[Amended] 

■ 51. In addition to the amendments set 

forth above, in 41 CFR part 301–73 

remove the words ‘‘eTravel Service’’

and add, in their place, the words ‘‘EGov Travel Service’’ in the following 

places: 

(a) Note to § 301–73.1; 

(b) § 301–73.100, section heading; 

(c) § 301–73.103, section heading; 

(d) § 301–73.104, section heading; and 

(e) § 301–73.105, section heading. 

■ 52. In addition to the amendments set 

forth above, in 41 CFR part 301–73 

remove the word ‘‘eTS’’ and add, in 

their place, the word ‘‘ETS’’ in the 

following places: 

(a) Note to § 301–73.1; 

(b) § 301–73.2(a); (b), two times; (c); 

(d); (e); 

(c) § 301–73.100, five times; 

(d) Note to § 301–73.100, five times; 

(e) § 301–73.103; 

(f) § 301–73.104(a); (a)(1), two times; 

(a)(2); (a)(3); (a)(4); 

(g) § 301–73.105, two times; 

(h) § 301–73.106, section heading; and 

(i) Note to § 301–73.106, three times. 

PART 301–75—PRE-EMPLOYMENT 

INTERVIEW TRAVEL 

■ 53. The authority citation for 41 CFR 

part 301–75 continues to read as 

follows: 

Authority: 5 U.S.C. 5707. 

§ 301–75.4 [Amended] 

■ 54. Amend § 301–75.4, paragraph (f), 

by removing ‘‘18 U.S.C. 287 and 1001.’’

and adding ‘‘(See 18 U.S.C. 287 and 

1001).’’ in its place. 

PART 301–76—COLLECTION OF 

UNDISPUTED DELINQUENT AMOUNTS 

OWED TO THE CONTRACTOR 

ISSUING THE INDIVIDUALLY BILLED 

TRAVEL CHARGE CARD 

■ 55. The authority citation for 41 CFR 

part 301–76 is revised to read as 

follows: 

Authority: 5 U.S.C. 5707; 40 U.S.C. 121(c); 

Sec. 2, Pub. L. 105–264, 112 Stat. 2350 (5 

U.S.C. 5701 note). 

■ 56. Amend Appendix B to Chapter 

301 by revising the introductory 

paragraph to read as follows: 

Appendix B to Chapter 301—

Allocation of M&IE Rates To Be Used in 

Making Deductions From the M&IE 

Allowance 

Deductions to M&IE rates for localities in 

both nonforeign areas and foreign areas shall 

be allocated as shown in this table. For 

information as to where to access per diem 

rates for various types of Government travel, 

please consult the table in § 301–11.6. 

* * * * * 

■ 57. Amend Appendix D to Chapter 

301 by removing the acronym ‘‘GEBAT’’

and alphabetically adding or changing 

the following acronyms to read as 

follows: 

Appendix D to Chapter 301—Glossary 

of Acronyms 

* * * * * 

CAS: Commercial Aviation Service(s) 

CDW: Collision Damage Waiver 

* * * * * 

CTO: Commercial Ticket Office 

* * * * * 

ETS: E-Gov Travel Service(s) 

FAA: Federal Aviation Administration 

* * * * * 

FECA: Federal Employees’ Compensation 

Act 

Fedrooms: Enhanced Federal Premier 

Lodging Program (formally known as FPLP) 

* * * * * 

FICA: Federal Insurance Contribution Act 

* * * * * 

HHG: Household Goods 

* * * * * 

ISSA: Inter-service Support Agreement(s) 

ITRA: Income Tax Reimbursement 

Allowance 

* * * * * 

MARS: Military Affiliate Radio System 

* * * * * 

NARA: National Archives and Records 

Administration 

* * * * * 

NTE: Not to Exceed 

OBE: Online Self-service Booking Tool 

* * * * * 

PBP&E: Professional Books, Papers, and 

Equipment 

* * * * * 

PMO: E-Gov Travel Program Management 

Office 

* * * * * 

SDDC: Surface Deployment and 

Distribution Command 

* * * * * 

SIT: Storage in Transit 

* * * * * 

TMS: Travel Management Service 

* * * * * 

U.S.: United States 

* * * * * 

[FR Doc. E7–21254 Filed 10–30–07; 8:45 am] 

BILLING CODE 6820–14–S 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Part 488 

[CMS–2278–IFC] 

RIN 0938–AP22 

Revisit User Fee Program for Medicare 

Survey and Certification Activities 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Interim final rule with comment 

period. 

SUMMARY: This interim final rule with 

comment period implements the 

continuation of the revisit user fee 

program for Medicare Survey and 

Certification activities, in accordance 

with the statutory authority in the 

Continuing Appropriations Resolution 

(‘‘Continuing Resolution’’) budget 

legislation passed by the Congress and 

signed by the President on September 

29, 2007. On September 19, 2007, we 

published a final rule that established a 

system of revisit user fees applicable to 

health care facilities that have been 

cited for deficiencies during initial 

certification, recertification or 

substantiated complaint surveys and 

require a revisit to confirm that 

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Federal Register / Vol. 72, No. 210 / Wednesday, October 31, 2007 / Rules and Regulations 61541 

corrections to previously-identified 

deficiencies have been corrected. 

DATES: Effective date: These regulations 

are effective October 1, 2007. 

Comment date: To be assured 

consideration, comments must be 

received at one of the addresses 

provided below, no later than 5 p.m. on 

December 31, 2007. 

ADDRESSES: In commenting, please refer 

to file code CMS–2278–IFC. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (Fax) 

transmission. 

You may submit comments in one of 

four ways (no duplicates, please): 

1. Electronically. You may submit 

electronic comments on specific issues 

in this regulation to http:// 

www.cms.hhs.gov/eRulemaking. Click 

on the link ‘‘Submit electronic 

comments on CMS regulations with an 

open comment period.’’ (Attachments 

should be in Microsoft Word, 

WordPerfect, or Excel; however, we 

prefer Microsoft Word.) 

2. By regular mail. You may mail 

written comments (one original and two 

copies) to the following address only: 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, Attention: CMS–2278–

IFC, P.O. Box 8010, 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 (one 

original and two copies) to the following 

address only: Centers for Medicare & 

Medicaid Services, Department of 

Health and Human Services, Attention: 

CMS–2278–IFC, 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 (one original 

and two copies) before the close of the 

comment period to one of the following 

addresses. 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. 

Room 445–G, Hubert H. Humphrey 

Building, 200 Independence Avenue, 

SW., Washington, DC 20201; or 7500 

Security Boulevard, Baltimore, MD 

21244–1850. 

(Because access to the interior of the 

HHH 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.) 

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: 

Kathryn Linstromberg, (410) 786–8279. 

SUPPLEMENTARY INFORMATION: 

Submitting Comments: As the public 

was provided an opportunity to 

comment on the substance of the rule 

during the comment period prior to the 

publication of the September 19, 2007 

final rule, and as the substance of the 

rule is not changed by this interim final 

rule with comment period, we are 

accepting comments only to the extent 

that they pertain to the applicability of 

the new authority for the rule. You can 

assist us by referencing the file code 

CMS–2278–IFC. 

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.cms.hhs.gov/ 

eRulemaking. Click on the link 

‘‘Electronic Comments on CMS 

Regulations’’ on that Web site to view 

public comments. 

Comments received timely will be 

also available for public inspection as 

they are received, generally beginning 

approximately three 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. 

SUPPLEMENTARY INFORMATION: 

I. Background 

In the June 29, 2007 Federal Register 

(72 FR 35673), we published the 

proposed rule entitled, ‘‘Establishment 

of Revisit User Fee Program for 

Medicare Survey and Certification 

Activities’’ and provided for a 60-day 

comment period. In the September 19, 

2007 Federal Register (72 FR 53628) we 

published the Revisit User Fee Program 

final rule. That final rule set forth final 

requirements and a final fee schedule 

for providers and suppliers who require 

a revisit survey as a result of 

deficiencies cited during an initial 

certification, recertification, or 

substantiated complaint survey. 

The Centers for Medicare & Medicaid 

Services (CMS) has in place an 

outcome-oriented survey process that is 

designed to determine whether existing 

Medicare-certified providers and 

suppliers or providers and suppliers 

seeking initial Medicare certification are 

actually meeting statutory and 

regulatory requirements, conditions of 

participation, or conditions for 

coverage. These health and safety 

requirements apply to the environments 

of care and the delivery of services to 

residents or patients served by these 

facilities and agencies. The Secretary of 

the Department of Health and Human 

Services (HHS) has designated CMS to 

enforce the conditions of participation/ 

coverage and other requirements of the 

Medicare program. The revisit user fee 

will be assessed for revisits conducted 

in order to determine whether 

deficiencies cited as a result of failing to 

satisfy federal quality of care 

requirements have been corrected. 

Pursuant to the requirements of the 

Continuing Appropriations Resolution 

budget bill for fiscal year (FY) 2007, 

which was passed by the Congress and 

signed by the President, we were 

directed by the Secretary to implement 

the revisit user fees for FY 2007 for 

certain providers and suppliers for 

which a revisit was required to confirm 

that previously-identified failures to 

meet federal quality of care 

requirements had been remedied. The 

fees recover the costs associated with 

the Medicare Survey and Certification 

program’s revisit surveys. The primary 

purpose for implementing the revisit 

user fees is to ensure the continuance of 

CMS Survey and Certification quality 

assurance functions that improve 

patient care and safety. The fees became 

effective upon publication September 

19, 2007, when the final rule was 

published. 

II. Provisions of the Interim Final Rule 

The current Continuing Resolution 

(Pub. L. 110–92, H. J. Res. 52 §§ 101 & 

106(2007)) authorizes HHS to continue 

the revisit user fees until November 16, 

2007, as follows: 

* * * 

Sec. 101. Such amounts as may be 

necessary, at a rate for operations as provided 

in the applicable appropriations Acts for 

fiscal year 2007 and under the authority and 

conditions provided in such Acts, for 

continuing projects or activities (including 

the costs of direct loans and loan guarantees) 

that are not otherwise specifically provided 

for in this joint resolution, that were 

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61542 Federal Register / Vol. 72, No. 210 / Wednesday, October 31, 2007 / Rules and Regulations 

conducted in fiscal year 2007, and for which 

appropriations, funds, or other authority 

were made available in the following 

appropriations Acts: 

* * * 

(3) The Continuing Appropriations 

Resolution, 2007 (division B of Public Law 

109–289, as amended by Pub. L. 110–5). (H.J. 

Res. 20, § 101(2007)). 

Sec. 106. Unless otherwise provided for in 

this joint resolution or in the applicable 

appropriations Act for fiscal year 2008, 

appropriations and funds made available and 

authority granted pursuant to this joint 

resolution shall be available until whichever 

of the following first occurs: 

* * * 

(3) November 16, 2007. 

As directed by the Secretary, in the 

September 19, 2007 Federal Register (72 

FR 53628), we established revisit user 

fees for revisit surveys and put forth in 

regulation the definitions, criteria for 

determining the fee, the fee schedule, 

collection of fees, reconsideration 

process for revisit user fees, 

enforcement and regulatory language 

addressing enrollment and billing 

privileges, and provider agreements. In 

the September 19, 2007 final rule, cost 

projections were based on FY 2006 

actual data and were expected to 

amount to $37.3 million on an annual 

basis for FY 2007. These calculations 

were included in section IV of the final 

rule (72 FR 53642). 

We stated in the final rule that, ‘‘if 

authority for the revisit user fee is 

continued, we will use the current fee 

schedule in [the final rule] for the 

assessment of such fees until such time 

as a new fee schedule notice is proposed 

and published in final form.’’ (72 FR 

53628). The current Continuing 

Resolution continues the authority of 

the FY 2007 Continuing Resolution from 

October 1, 2007 through November 16, 

2007. Accordingly, the revisit fees will 

continue to be assessed for the entire 

time period authorized by the current 

Continuing Resolution. 

III. 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. 

IV. Waiver of Proposed Rulemaking 

and Delay in Effective Date 

We ordinarily publish a notice of 

proposed rulemaking in the Federal 

Register and invite public comment on 

the proposed rule in accordance with 5 

U.S.C. section 553(b) of the 

Administrative Procedure Act (APA). 

The notice of proposed rulemaking 

includes a reference to the legal 

authority under which the rule is 

proposed, and the terms and substances 

of the proposed rule or a description of 

the subjects and issues involved. This 

procedure can be waived, however, if an 

agency finds good cause that a noticeand-comment procedure is 

impracticable, unnecessary, or contrary 

to the public interest and incorporates a 

statement of the finding and its reasons 

in the rule issued. We find that the 

notice-and-comment procedure is 

unnecessary in this circumstance 

because providers and suppliers have 

already been provided notice and an 

opportunity to comment on the 

substance of this rule. This interim final 

rule with comment merely updates the 

Congressional authority under which 

the rule operates. 

Therefore, we find good cause to 

waive the notice of proposed 

rulemaking and to issue this final rule 

on an interim basis. We are providing a 

60-day public comment period. 

We ordinarily provide a 30-day delay 

in the effective date of the provisions of 

a rule in accordance with the 

Administrative Procedure Act (APA) 5 

U.S.C. 553(d). However, the delay in the 

effective date may be waived as, in 

pertinent part, ‘‘provided by the agency 

for good cause found and published 

with the rule’’ 5 U.S.C. 553(d)(3). The 

Secretary finds that good cause exists to 

waive the 30-day effective date delay. 

The good cause exception to the 30 

day effective date delay provision of 

section 553(d) of the APA is read to be 

broader than the good cause exception 

to the notice and comment provision of 

section 553(b)of the APA. 

The legislative history of the APA 

indicates that the purpose for deferring 

the effectiveness of a rule under section 

553(d) was to ‘‘afford persons affected a 

reasonable time to prepare for the 

effective date of a rule or rules or to take 

other action which the issuance may 

prompt.’’ S. Rep. No. 752, 79th Cong., 

1st Sess. 15 (1946); H.R. Rep. No. 1980, 

79th Cong. 2d Sess. 25 (1946). In this 

case, affected parties do not need time 

to adjust their behavior before this rule 

takes effect. This rule merely updates 

the authority under which the revisit fee 

is assessed and does not provide any 

additional requirements for the affected 

parties. Moreover, with or without a 

revisit fee, a provider or supplier must 

be found to have corrected significant 

deficiencies in order to avoid 

termination. Additionally, the 

application of a fee for the revisit does 

not place appreciable administrative 

burdens on the affected providers or 

suppliers. We do not expect appreciable 

cost to State survey agencies because we 

are undertaking the billing and 

collection of the revisit user fee. 

We identified in the proposed rule the 

immediacy of this revisit user fee 

program and the limited nature of FY 

2007, Continuing Resolution 

Appropriation (Pub. L. 110–5). 

Specifically, the Continuing Resolution 

required us to implement the revisit fee 

program in FY 2007. Accordingly, 

providers and suppliers have been on 

notice for some time that these fees will 

be imposed, and do not need additional 

time to be prepared to comply with the 

requirements of this regulation. We 

believe that given the short timeframe 

that we have to collect fees before the 

statutory authority of the current 

Continuing Resolution expires, there is 

good cause to waive the 30-day effective 

date. 

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. 

VI. Regulatory Impact Analysis 

A. Overall Impact 

We have examined the impacts of this 

rule as required by Executive Order 

12866 (September 1993, Regulatory 

Planning and Review), the Regulatory 

Flexibility Act (RFA) (September 19, 

1980, Pub. L. 96–354), section 1102(b) of 

the Social Security Act, the Unfunded 

Mandates Reform Act of 1995 (Pub. L. 

104–4), and Executive Order 13132. 

Executive Order 12866 (as amended 

by Executive Order 13258, which 

merely reassigns responsibility of 

duties) directs agencies to assess all 

costs and benefits of available regulatory 

alternatives and, if regulation is 

necessary, to select regulatory 

approaches that maximize net benefits 

(including potential economic, 

environmental, public health and safety 

effects, distributive impacts, and 

equity). A regulatory impact analysis 

(RIA) must be prepared for major rules 

with economically significant effects 

($100 million or more in any one year). 

This rule is not a major rule. The 

aggregate costs will total approximately 

$37.3 million in any one year. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

businesses. For purposes of the RFA, 

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Federal Register / Vol. 72, No. 210 / Wednesday, October 31, 2007 / Rules and Regulations 61543 

small entities include small businesses, 

nonprofit organizations, and small 

governmental jurisdictions. Individuals 

and States are not included in the 

definition of a small entity. Small 

businesses are small entities, either by 

nonprofit status or by having revenues 

of $6.5 million to $31.9 million or less 

in any one year for purposes of the RFA. 

The September 19, 2007 final rule 

provided an analysis on the impact of 

small entities (72 FR 53642–3). The 

analysis published in the final rule 

remains valid. Since this interim final 

rule with comment merely updates the 

Congressional authority under which 

the rule operates, we have determined, 

and the Secretary certifies, that this rule 

will not have a significant impact on 

small entities based on the overall effect 

on revenues. 

Section 1102(b) of the Act requires us 

to prepare a regulatory impact analysis 

if a rule may have a significant impact 

on the operations of a substantial 

number of small rural hospitals. This 

analysis must conform to the provisions 

of section 604 of the RFA. For purposes 

of section 1102(b) of the Act, we define 

a small rural hospital as a hospital that 

is located outside of a Metropolitan 

statistical Area (superseded by Core 

Based Statistical Areas) and has fewer 

than 100 beds. This rule affects those 

small rural hospitals that have been 

cited for a deficiency based on 

noncompliance with required 

conditions of participation and for 

which a revisit is needed to make sure 

that the deficiency has been corrected. 

We identified in the September 19, 2007 

final rule that for the effective period of 

that rule that less than 3 percent of all 

hospitals may be assessed a revisit user 

fee and that less than 1 percent of those 

hospitals would be rural hospitals (72 

FR 53643). The analysis published in 

the final rule remains valid. Since this 

interim final rule with comment merely 

updates the Congressional authority 

under which the rule operates, we 

maintain that given the effective period 

of this rule, we have determined, and 

the Secretary certifies, that this rule will 

not have a significant impact on small 

rural hospitals. 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 also 

requires that agencies assess anticipated 

costs and benefits before issuing any 

rule whose mandates require spending 

in any one year of $100 million in 1995 

dollars, updated annually for inflation. 

That threshold level is currently 

approximately $120 million. This 

interim final rule with comment will 

have no mandated effect on State, local, 

or tribal governments and the impact on 

the private sector is estimated to be less 

than $120 million and will only affect 

those Medicare providers or suppliers 

for which a revisit user fee is assessed 

based on the need to conduct a revisit 

survey to ensure deficient practices that 

were cited have been corrected. 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it promulgates a 

proposed rule (and subsequent final 

rule) that imposes substantial direct 

requirement costs on State and local 

governments, preempts State law, or 

otherwise has Federalism implications. 

This interim final rule with comment 

will not substantially affect State or 

local governments. This rule establishes 

user fees for providers and suppliers for 

which CMS has identified deficient 

practices and requires a revisit to assure 

that corrections have been made. 

Therefore, we have determined that this 

interim final rule with comment will 

not have a significant effect on the 

rights, roles, and responsibilities of 

State or local governments. 

B. Impact on Providers/Suppliers 

There is no change on the impact on 

providers and suppliers with the 

publication of this interim final rule 

with comment. The impact remains as 

discussed in the final rule (72 FR 

53643). 

Final Fee Schedule for Onsite and 

Offsite Revisit Surveys 

The FY 2007 fee schedule published 

on September 19, 2007 (72 FR 53647) in 

the final rule will be retained. As noted 

in the final rule, the published fee 

schedule will be utilized by CMS for the 

assessment of such fees until such time 

as a new fee schedule notice is proposed 

and published in final form. The 

calculations utilized to determine the 

fee as identified in the final rule will be 

the same (72 FR 53645–6). We will 

continue to assess a flat fee based on 

provider or supplier type and type of 

revisit survey conducted. Table A below 

identifies the final fee schedule. 

TABLE A.—FINAL FEE SCHEDULE

Facility 

Fee 

assessed 

per offsite 

revisit 

survey 

Fee 

assessed 

per onsite 

revisit 

survey 

SNF & NF ......... $168 $2,072 

Hospitals ........... 168 2,554 

TABLE A.—FINAL FEE SCHEDULE—

Continued 

Facility 

Fee 

assessed 

per offsite 

revisit 

survey 

Fee 

assessed 

per onsite 

revisit 

survey 

HHA .................. 168 1,613 

Hospice ............. 168 1,736 

ASC .................. 168 1,669 

RHC .................. 168 851 

ESRD ................ 168 1,490 

Costs for All Revisit User Fees Assessed 

We anticipated that the combined 

costs for all providers and suppliers for 

all revisit surveys in FY 2007 would 

total approximately $37.3 million on an 

annual basis, with onsite revisit surveys 

amounting to approximately $34.6 

million and offsite revisit surveys 

totaling approximately $2.7 million (72 

FR 53645). However, actual fees 

assessed in FY 2007 were much less 

than this annual amount, since CMS did 

not charge for revisits that occurred 

prior to publication of the final 

regulation. Since we continue to operate 

under these same annual estimates, we 

provide here estimates of the impact for 

the period of the current continuing 

resolution as listed below in monthly 

estimates in Tables B and C. For the 

period of the current continuing 

resolution, we will use the FY 2007 fee 

schedule established in the final rule for 

the assessment of fees until a new fee 

schedule notice is proposed and 

published as final. 

In Table B below, we provide the 

projected costs for the period of this 

continuing resolution based on the fee 

schedule of the final rule. We expect the 

combined costs for all providers and 

suppliers for all onsite revisit surveys 

for the period of this continuing 

resolution to total approximately $4.3 

million. We first multiplied the total 

number of onsite revisit surveys in one 

year by the expected revisit user fees 

assessed per revisits as finalized in 

Table A above, estimated by provider or 

supplier, to obtain the annual cost of 

revisit surveys. We then divided this 

number by 12 to obtain the monthly cost 

of onsite revisit surveys and multiplied 

by the effective period of the continuing 

resolution (roughly 1.5 months) to 

obtain the total costs for onsite revisit 

surveys for the period of the continuing 

resolution. We then totaled all providers 

and suppliers to achieve the total costs 

for all onsite revisit surveys for the 

period of this continuing resolution. 

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61544 Federal Register / Vol. 72, No. 210 / Wednesday, October 31, 2007 / Rules and Regulations 

TABLE B.—ONSITE REVISIT SURVEYS—ESTIMATED MONTHLY COSTS

Facility 

Monthly number of onsite 

revisit surveys 

Fee assessed 

per onsite revisit surveys 

(hrs × $112) 

Monthly costs 

for onsite revisit surveys* 

Total costs for 

onsite revisit 

surveys for period of CR ** 

SNF & NF ........................................................................................................ 1,191 $2,072 $2,467,061 $3,700,592 

Hospitals .......................................................................................................... 48 2,554 122,379 183,569 

HHA ................................................................................................................. 89 1,613 143,557 215,336 

Hospice ............................................................................................................ 21 1,736 37,035 55,552 

ASC .................................................................................................................. 8 1,669 13,213 19,819 

RHC ................................................................................................................. 12 851 10,567 15,850 

ESRD ............................................................................................................... 58 1,490 86,668 130,003 

Total .......................................................................................................... 1,427 ........................ 2,880,480 4,320,721 

* Monthly costs may differ from the multiple of monthly revisits and fee per revisit due to rounding. 

** Monthly costs were multiplied by the effective period of the CR (roughly 1.5 months) Total numbers of onsite revisit surveys were rounded 

up based on FY 2006 actual data presented in the final rule. 

We expect the combined costs for all 

providers and suppliers for all offsite 

revisit surveys to total $343,875 for the 

period of the current continuing 

resolution. In Table C below, we first 

estimated by provider or supplier the 

number of offsite revisit surveys 

expected for an entire fiscal year, and 

multiplied this number by the expected 

revisit user fee of $168 per offsite revisit 

survey to obtain the annual cost of 

surveys. We then divided this number 

by 12 to obtain the monthly cost of 

offsite revisit surveys and multiplied 

this number by the effective period of 

the continuing resolution (roughly 1.5 

months) to obtain the total costs for 

offsite revisit surveys for the period of 

the continuing resolution. 

TABLE C.—OFFSITE REVISIT SURVEYS—ESTIMATED MONTHLY COSTS

Facility 

Monthly number of offsite 

revisit surveys 

Fee assessed 

per offsite revisit survey 

($112 × 1.5 

hrs) 

Monthly costs 

for offsite revisit surveys* 

Total costs for 

offsite revisit 

surveys for period of CR ** 

SNF & NF ........................................................................................................ 1,262 $168 $211,932 $317,898 

Hospitals .......................................................................................................... 23 168 3,892 5,838 

HHA ................................................................................................................. 43 168 7,238 10,857 

Hospice ............................................................................................................ 4 168 714 1,071 

ASC .................................................................................................................. 8 168 1,302 1,953 

RHC ................................................................................................................. 6 168 938 1,407 

ESRD ............................................................................................................... 19 168 3,234 4,851 

Total .......................................................................................................... 1,365 ........................ 229,250 343,875 

* Monthly costs may differ from the multiple of monthly revisits and fee per revisit due to rounding. 

** Monthly costs were multiplied by the effective period of the CR (roughly 1.5 months). 

As shown in Table D below, we 

provide the aggregate costs expected as 

projected for the entire FY 2007, as well 

as the costs we would expect to offset 

for the period of the current continuing 

resolution. 

TABLE D.—TOTAL COSTS COMBINED FOR ALL REVISITS SURVEYS PER FISCAL YEAR & PERIOD OF CR 

FY 2007 Period of CR * 

Onsite Revisit Surveys ............................................................................................................................................ $34,565,760 $4,320,512 

Offsite Revisit Surveys ............................................................................................................................................ 2,751,000 343,980 

Total Costs All Revisits .................................................................................................................................... 37,316,760 4,664,492 

* CR period’s costs are based on CR period revisit surveys rounded up to the nearest whole number as shown in Table B & C. 

C. Alternatives Considered 

CMS considered a number of 

alternatives to the Revisit User Fee. 

Such alternatives were discussed in the 

final rule published on September 19, 

2007 (72 FR 53647). We affirm the 

continuing validity of that analysis. The 

current continuing resolution provides 

CMS with the authority to continue 

projects or activities as was otherwise 

provided for in FY 2007, and as such 

CMS is required to publish an interim 

final rule with comment. This interim 

final rule with comment merely updates 

the Congressional authority under 

which the rule operates. 

In accordance with Executive Order 

12866, this rule has been reviewed by 

the Office of Management and Budget. 

List of Subjects in 42 CFR Part 488 

Administrative practice and 

procedure, Health facilities, Medicare, 

Reporting and recording requirements. 

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Federal Register / Vol. 72, No. 210 / Wednesday, October 31, 2007 / Rules and Regulations 61545 

■ For the reasons set forth in the 

preamble, the Centers for Medicare & 

Medicaid Services amends 42 CFR 

chapter IV, part 488 as set forth below: 

PART 488—SURVEY, CERTIFICATION, 

AND ENFORCEMENT PROCEDURES 

■ 1. The authority citation for part 488 

is revised to read as follows: 

Authority: Secs. 1102 and 1871 of the 

Social Security Act, unless otherwise noted 

(42 U.S.C. 1302 and 1395(hh)); Pub. L. 110–

92, H. J. Res. 52 §§ 101 & 106 (2007). 

(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) 

Dated: October 11, 2007. 

Kerry Weems, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Approved: October 25, 2007. 

Michael O. Leavitt, 

Secretary. 

[FR Doc. 07–5400 Filed 10–26–07; 12:02 pm] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HOMELAND 

SECURITY 

Federal Emergency Management 

Agency 

44 CFR Part 78 

[Docket ID FEMA–2007–0003] 

RIN 1660–AA00 

Flood Mitigation Assistance 

AGENCY: Federal Emergency 

Management Agency, DHS. 

ACTION: Final rule. 

SUMMARY: The Federal Emergency 

Management Agency (FEMA) is 

adopting as final, without substantive 

change, an interim rule that implements 

sections 553 and 554 of the National 

Flood Insurance Reform Act of 1994. 

Section 553 authorizes a flood 

mitigation assistance program through 

which FEMA is authorized to provide 

grants to States and communities for 

planning assistance and for mitigation 

projects that reduce the risk of flood 

damage to structures covered under 

contracts for flood insurance. Section 

554 establishes the National Flood 

Mitigation Fund to fund assistance 

provided under section 553. 

DATES: Effective Date: November 30, 

2007. 

FOR FURTHER INFORMATION CONTACT: 

Cecelia Rosenberg, Mitigation 

Directorate, Federal Emergency 

Management Agency, 500 C Street, SW., 

Washington, DC 20472, (phone) 202–

646–3321, (facsimile) 202–646–2719, or 

(e-mail) cecelia.rosenberg@dhs.gov. 

SUPPLEMENTARY INFORMATION: 

I. Background 

Sections 553 and 554 of the National 

Flood Insurance Reform Act of 1994 

(NFIRA) (Pub. L. 103–325, enacted 

September 23, 1994) (also known as 

Title V of the Riegle Community 

Development and Regulatory 

Improvement Act of 1994) amended the 

National Flood Insurance Act of 1968 

(42 U.S.C. 4101 et seq.). Specifically, 

section 553 authorized the Director 

(now Administrator) of the Federal 

Emergency Management Agency 

(FEMA) to carry out a flood mitigation 

assistance program, known as the Flood 

Mitigation Assistance Program (FMA). 

Through the FMA Program, FEMA is 

authorized to provide grants to States 

and communities for planning 

assistance and mitigation projects that 

reduce the risk of flood damage to 

structures covered under contracts for 

flood insurance. Section 554 required 

FEMA to establish the National Flood 

Mitigation Fund (NFMF) to provide 

funds for flood mitigation program 

assistance described in section 553. On 

March 20, 1997 (62 FR 13346), FEMA 

published an interim rule implementing 

section 553 and 554 of the National 

Flood Insurance Reform Act. 

This final rule adopts, without 

substantive change, the regulations 

established by the March 20, 1997 

interim rule. It addresses the comments 

received from the public in response to 

the interim rule, and finalizes the 

regulations contained in 44 CFR part 78. 

Records Management 

The Regulation Identifier Number 

(RIN) listed in the March 20, 1997 

interim final rule was 3067–AC45. Since 

FEMA became a component of the 

Department of Homeland Security 

(DHS), FEMA’s RINs were renumbered 

and 3067–AC45 became 1660–AA00. 

II. Discussion of Public Comments 

FEMA received seven public 

comments on the interim rule. The 

seven commenters included five States, 

one local government, and one 

association. The comments received, 

together with FEMA’s responses, are set 

forth below. 

The Community Rating System. One 

commenter wrote that while it is good 

that the Community Rating System 

(CRS) criterion may be a basis for a 

floodplain management plan, CRS 

communities with repetitive loss or 

floodplain management plans 

developed prior to the publishing of 44 

CFR part 78 in March 1997 may not 

realize that their plans will require 

modification to meet the new criteria of 

44 CFR 78.5, and States and regions 

should be counseled to closely review 

these older plans. The commenter wrote 

that the CRS plan reviewer for the 

Insurance Services Organization (ISO) 

should be consulted before any FEMA 

region approves any CRS plans 

developed prior to 1997 for the purpose 

of receiving FMA project funds unless 

the region or State carefully reviews 

them to see that they meet FMA criteria. 

The commenter wrote that the States 

and regions should accept nothing less 

than plan adoption by resolution of the 

community’s governing board. The 

commenter also wanted FEMA not to 

accept as evidence of adoption a letter 

from the Mayor stating that the 

community will follow the plan since 

the CRS criterion requires full adoption 

by the governing board. The commenter 

thought that FMA should be consistent 

with the CRS plan adoption process and 

require that all local elected officials see 

the proposed plan and ratify it. 

FEMA’s Response: The CRS program 

is a voluntary program that predates 

these regulations and creates an 

incentive for communities that 

participate in the National Flood 

Insurance Program (NFIP) to implement 

floodplain management practices that 

exceed NFIP minimum requirements. 

The CRS program, which was 

established in 1993, provides credit for 

communities in the form of lower flood 

insurance premium rates for property 

owners. The CRS has been and is 

currently operated by FEMA through an 

agreement with ISO. The schedule of 

creditable activities is described in its 

reference guide, the CRS Coordinator’s 

Manual available through http:// 

www.fema.gov/business/nfip/ 

intnfip.shtm. One of the approved CRS 

activities that communities may receive 

credit for is to develop a flood 

mitigation or repetitive flood loss plan. 

FEMA has addressed CRS plans 

developed prior to 1997 by coordinating 

with CRS staff to ensure that all review 

criteria are consistent with FMA and 

CRS plans. As a result, FEMA has 

accepted CRS plans based on guidance 

provided in FEMA Publication No. 299: 

The FMA Program Guidance (August 

1997), as meeting the requirements of 

§ 78.5 as approvable local Flood 

Mitigation Plans. Further, ISO continues 

to review CRS plans submitted by local 

communities against the requirements 

of § 78.5 if requested by a local 

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