Federal Register / Vol. 72, No. 242 / Tuesday, December 18, 2007 / Rules and Regulations 71579 

EPA-APPROVED REGULATIONS IN THE WEST VIRGINIA SIP—Continued 

State citation [Chapter 16–20 or 45 CSR] Title/subject 

State 

effective 

date 

EPA approval date Additional explanation/citation at 40 CFR 

§ 52.2565 

Section 45–40–42 .... CAIR NOX Ozone Season Allowance Allocations.5/1/06 12/18/07 [Insert 

page number 

where the document begins].

1. Except for subsections 42.2.d, 42.2.e, 

42.3.a.2, and 42.4.b. 

2. Only Phase I (2009–2014). 

* * * * * (e) * * * 

Name of non-regulatory SIP revision 

Applicable 

geographic 

area 

State 

submittal 

date 

EPA approval date Additional explanation 

* * * * * * * 

Article 3, Chapter 64 of the Code of West 

Virginia, 1931.

Statewide ............... 5/1/06 12/18/07 [Insert 

page number 

where the document begins].

Effective date of March 11, 2006. 

PART 97—[AMENDED] 

■ 3. The authority citation for 40 CFR 

part 97 continues to read as follows: 

Authority: 42 U.S.C. 7401, 7403, 7410, 

7426, 7601, and 7651, et seq. 

■ 4. Appendix A to Subpart EE is 

amended by adding the entry for ‘‘West 

Virginia’’ in alphabetical order under 

paragraph 1. to read as follows: 

Appendix A to Subpart EE of Part 97—States 

With Approved State Implementation Plan 

Revisions Concerning Allocations 

1. * * * 

West Virginia (for control periods 2009–

2014) 

* * * * * 

■ 5. Appendix A to Subpart EEEE is 

amended by adding the entry for West 

Virginia in alphabetical order to read as 

follows: 

Appendix A to Subpart EEEE of Part 97— 

States With Approved State Implementation 

Plan Revisions Concerning Allocations 

* * * * * 

West Virginia (for control periods 2009–

2014) 

* * * * * 

[FR Doc. E7–24367 Filed 12–17–07; 8:45 am] 

BILLING CODE 6560–50–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Part 488 

[CMS–2278–IFC2] 

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 

Further Continuing Appropriations, 

2008 Resolution (‘‘Continuing 

Resolution’’) budget legislation passed 

by the Congress and signed by the 

President on November 13, 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 previously-identified 

deficiencies have been corrected. 

DATES: Effective date: These regulations 

are effective December 14, 2007, and 

applicable beginning November 17, 

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 

February 19, 2008. 

ADDRESSES: In commenting, please refer 

to file code CMS–2278–IFC2. 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–

IFC2, 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–IFC2, 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 


yshivers on PROD1PC62 with RULES
71580 Federal Register / Vol. 72, No. 242 / Tuesday, December 18, 2007 / Rules and Regulations 

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: 

Kelley Tinsley, (410) 786–6664. 

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–IFC2. 

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 

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 ensure that existing 

Medicare-certified providers and 

suppliers or providers and suppliers 

seeking initial Medicare certification, 

meet 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, the 

Secretary directed CMS 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. 110–16 Division B of HR 3222 

which amends Pub. L. 110–92 H. J. Res. 

52 §§ 101 & 106(2007), authorizes HHS 

to continue to impose revisit user fees 

until December 14, 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 

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 Public Law 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) December 14, 2007. 

As directed by the Secretary, in the 

September 19, 2007 Federal Register (72 

FR 53628), we established the revisit 

user fee program for revisit surveys. We 

put forth in regulation the relevant 

definitions, criteria for determining the 

fees, the fee schedule, procedures for 

the collection of fees, the 

reconsideration process, 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 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 

November 17, 2007 through December 

14, 2007. Accordingly, the revisit fees 

will continue to be assessed for the 

entire time period authorized by the 

current Continuing Resolution. 


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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. 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 substance 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 notice-and-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-andcomment 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 September 19, 

2007 final rule the immediacy of this 

revisit user fee program and the specific 

statutory requirement contained limited 

in the Continuing Resolution that 

required us to implement the revisit 

user 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, 

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 

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 ensure 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 this rule will not have a 


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71582 Federal Register / Vol. 72, No. 242 / Tuesday, December 18, 2007 / Rules and Regulations 

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 effect 

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 affect 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 

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 amount, since CMS did not 

charge for revisits that occurred prior to 

publication of the final regulation. Since 

we continue to operate under this same 

estimate for FY 07, we provide below 

monthly estimates of the impact for the 

period of the current Continuing 

Resolution 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 

current 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 

current Continuing Resolution to total 

approximately $2.9 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 per provider or 

supplier of onsite revisit surveys to 

obtain the total costs for onsite revisit 

surveys for the period of the current 

Continuing Resolution (roughly 1 

month). We then totaled all providers 

and suppliers to achieve the total costs 

for all onsite revisit surveys for the 

period of this current Continuing 

Resolution. 

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 * 

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

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

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

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

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

RHC ................................................................................................................................. 12 851 10,567 

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

Total .......................................................................................................................... 1,427 ............................ 2,880,480 

* Monthly costs may differ from the multiple of monthly revisits and fee per revisit due to rounding. The time period of this CR is roughly 1 

month. 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 $229,250 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 


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Federal Register / Vol. 72, No. 242 / Tuesday, December 18, 2007 / Rules and Regulations 71583 

by 12 to obtain the monthly cost of 

offsite revisit surveys to obtain the total 

costs for offsite revisit surveys for the 

period of the current Continuing 

Resolution (roughly 1 month). 

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* 

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

Hospitals .......................................................................................................................... 23 168 3,892 

HHA ................................................................................................................................. 43 168 7,238 

Hospice ............................................................................................................................ 4 168 714 

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

RHC ................................................................................................................................. 6 168 938 

ESRD ............................................................................................................................... 19 168 3,234 

Total .......................................................................................................................... 1,365 ............................ 229,250 

* Monthly costs may differ from the multiple of monthly revisits and fee per revisit due to rounding. The time period of this CR is roughly 1 

month. 

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 $2,880,480 

Offsite Revisit Surveys .................................................................................................................................... 2,751,000 229,250 

Total Costs All Revisits ............................................................................................................................ 37,316,760 3,109,730 

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

E. Alternatives Considered 

We considered a number of 

alternatives to the revisit user fee 

program. 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. 

■ 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)); Continuing 

Resolution Pub. L. 101–16 Division B of HR 

3222. 

(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: December 3, 2007. 

Kerry Weems, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Approved: December 13, 2007. 

Michael O. Leavitt, 

Secretary. 

[FR Doc. 07–6093 Filed 12–14–07; 12:13 pm] 

BILLING CODE 4120–01–P 

DEPARTMENT OF COMMERCE 

National Oceanic and Atmospheric 

Administration 

50 CFR Part 660 

[Docket No. 060824226 6322 02] 

RIN 0648–AW34 

Magnuson-Stevens Act Provisions; 

Fisheries Off West Coast States; 

Pacific Coast Groundfish Fishery; 

Biennial Specifications and 

Management Measures; Inseason 

Adjustments 

AGENCY: National Marine Fisheries 

Service (NMFS), National Oceanic and 

Atmospheric Administration (NOAA), 

Commerce. 

ACTION: Final rule; inseason adjustments 

to biennial groundfish management 

measures; request for comments. 

SUMMARY: This final rule announces 

inseason changes to management 

measures in the commercial Pacific 

Coast groundfish fishery. These actions, 

which are authorized by the Pacific 

Coast Groundfish Fishery Management 

Plan (FMP), are intended to allow 

fisheries to access more abundant 


yshivers on PROD1PC62 with RULES