5444 Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 

developmental disabilities; (9) 

collaborates with international 

organizations in developing strategies 

for the prevention of developmental 

disabilities; (10) disseminates findings 

of research through direct contact with 

health authorities, publication and 

distribution of special reports, 

publication in scientific and technical 

journals, conference presentations, and 

other appropriate means; and (11) 

provides training in the epidemiology of 

developmental disabilities to 

professionals throughout the United 

States and abroad. 

Delete in its entirety the title and 

function statement for the Epidemiology 

and Surveillance Branch (CUBDB) and 

insert the following: 

Epidemiology and Surveillance 

Branch (CUBDB). (1) Provides scientific 

leadership in the design and 

implementation of monitoring systems 

as well as designs and conducts 

epidemiologic and genetic research to 

identify causes, risk factors and 

complications of blood disorders in 

affected populations; (2) designs and 

manages surveillance systems to 

evaluate the incidence, morbidity, and 

mortality associated with blood diseases 

and disorders; (3) plans, develops and 

coordinates special surveys and 

populations studies to monitor and 

assess the complications of blood 

disorders; (4) designs and implements 

studies using surveillance data to 

identify risk factors for the 

complications of blood disorders, and 

evaluating the effectiveness of the 

prevention activities; (5) provides 

epidemiologic and medical consultation 

and technical assistance, including 

epidemic aids to state and local health 

departments, other governmental 

agencies, and other public and private 

institutions in the investigation of blood 

disorders and related complications; (6) 

designing and implements studies to 

evaluate the effectiveness of 

implemented prevention strategies in 

the treatment centers, (7) works closely 

with internal and external organizations 

in applying prevalence and incidence 

data to target and evaluate programs to 

prevent the complications of blood 

diseases and chronic hereditary 

disorders, (8) publishes findings and 

advances arising out of surveillance and 

epidemiologic research to the scientific 

and public health communities; (9) 

provides training services to states, 

localities, and other countries in 

investigation, diagnosis, prevention, and 

control of blood diseases and chronic 

hereditary disorders; (10) assists in 

designing, implementing, and 

evaluating prevention and counseling 

programs for persons and their families 

with chronic blood diseases and 

selected chronic hereditary disorders; 

(11) designs, implements and 

coordinates the prevention and 

surveillance activities of specialized 

federally funded prevention centers 

organized to prevent the complications 

of blood diseases and chronic hereditary 

disorders; (12) conducts and supports 

both qualitative and quantitative 

research to expand the knowledge base 

related to blood disorders across the 

lifespan; (13) collaborates with 

hemostasis laboratory branch and 

incorporates the findings of these 

branches’ activities which leads to 

prevention of complications of blood 

disorders; (14) supports public health 

analysis to include facilitating data 

collection, data management, data 

manipulation, analysis, project 

reporting and presentation; and (15) 

conducts applied research to develop, 

evaluate, improve and standardize 

public information systems and 

educational modules which support the 

prevention of complications from blood 

disorders. 

Delete in its entirety the title and 

function statement for the Laboratory 

Research Branch (CUBDC) and insert 

the following: 

Hemostasis Laboratory Branch 

(CUBDC). (1) Identifies new genetic 

markers of risk factors and clotting 

defects for affected groups; (2) provides 

reference laboratory diagnosis for multisite epidemiologic and surveillance 

studies; (3) develops techniques and 

interpretation methods to improve 

molecular and coagulation diagnosis; (4) 

provides diagnostic support for 

epidemiologic studies and epidemic 

aids on emerging blood disorders and 

chronic hereditary disorders; (5) 

determines the mechanisms of 

pathogenesis and complications of 

blood disorders and chronic hereditary 

disorders; 

(6) conducts research and providing 

reference services on diagnostic 

techniques for blood disorders and 

chronic hereditary disorders; (7) 

conducts research to improve laboratory 

methodologies and materials; (8) where 

appropriate, maintains the national 

reference laboratory for blood disorders 

and chronic hereditary disorders; (9) 

works closely with entities and 

organizations within the agency and 

organizations external to the agency to 

provide laboratory services in support of 

projects whose primary aim is to 

prevent and reduce complications 

associated with blood disorders and 

chronic hereditary disorders; and (10) 

publishes findings and advances arising 

out of surveillance and epidemiologic 

research to the scientific and public 

health communities. 

Delete in its entirety the title and 

function statement for the Prevention 

Research and Informatics Branch 

(CUBDD). 

Sherri A. Berger, 

Chief Operating Officer, Centers for Disease 

Control and Prevention. 

[FR Doc. 2016–01833 Filed 2–1–16; 8:45 am] 

BILLING CODE 4160–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–6059–N4] 

Medicare, Medicaid, and Children’s 

Health Insurance Programs: 

Announcement of the Extended 

Temporary Moratoria on Enrollment of 

Ground Ambulance Suppliers and 

Home Health Agencies in Designated 

Geographic Locations 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Extension of temporary 

moratoria. 

SUMMARY: This document announces the 

extension of temporary moratoria on the 

enrollment of new Medicare Part B 

ground ambulance suppliers and 

Medicare home health agencies, 

subunits, and branch locations in 

specific locations within designated 

metropolitan areas in Florida, Illinois, 

Michigan, Texas, Pennsylvania, and 

New Jersey to prevent and combat fraud, 

waste, and abuse. These moratoria also 

apply to the enrollment of home health 

agencies and ground ambulance 

suppliers in Medicaid and the 

Children’s Health Insurance Program. 

DATES: Effective Date: January 29, 2016. 

FOR FURTHER INFORMATION CONTACT: 

Belinda Gravel, (410) 786–8934. News 

media representatives must contact 

CMS’ Public Affairs Office at (202) 690– 

6145 or email them at press@

cms.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

I. Background 

A. CMS’ Imposition of Temporary 

Enrollment Moratoria 

Section 6401(a) of the Affordable Care 

Act added a new section 1866(j)(7) to 

the Social Security Act (the Act) to 

provide the Secretary with authority to 

impose a temporary moratorium on the 

enrollment of new Medicare, Medicaid, 

or Children’s Health Insurance Program 


wgreen on DSK2VPTVN1PROD with NOTICES
Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 5445 

1As noted in the preamble to the final rule with 

comment period implementing the moratorium 

authority (February 2, 2011, CMS–6028–FC (76 FR 

5870), home health agency subunits and branch 

locations are subject to the moratoria to the same 

extent as any other newly enrolling home health 

agency. 

(CHIP) providers and suppliers, 

including categories of providers and 

suppliers, if the Secretary determines a 

moratorium is necessary to prevent or 

combat fraud, waste, or abuse under 

these programs. For a more detailed 

explanation of these authorities, please 

see the July 31, 2013 notice (78 FR 

46339) that first established temporary 

moratoria in certain geographic 

locations, or the February 4, 2014 (79 FR 

6475) document that extended and 

expanded such moratoria (hereinafter 

referred to as the February 4, 2014 

moratoria document). 

Based on this authority and our 

regulations at § 424.570, we initially 

imposed moratoria to prevent 

enrollment of new home health 

agencies, subunits, and branch 

locations 1 (hereafter referred to as 

HHAs) in Miami-Dade County, Florida 

and Cook County, Illinois, as well as 

surrounding counties, and Medicare 

Part B ground ambulance suppliers in 

Harris County, Texas and surrounding 

counties, in a notice issued on July 31, 

2013 (78 FR 46339). We exercised this 

authority again in a document 

published on February 4, 2014 (79 FR 

6475) when we extended the existing 

moratoria for an additional 6 months 

and expanded it to include enrollment 

of HHAs in Broward County, Florida; 

Dallas County, Texas; Harris County, 

Texas; and Wayne County, Michigan 

and surrounding counties, and 

enrollment of ground ambulance 

suppliers in Philadelphia, Pennsylvania 

and surrounding counties. Then, we 

further extended these moratoria in 

documents issued on August 1, 2014 (79 

FR 44702), February 2, 2015 (80 FR 

5551), and July 28, 2015 (80 FR 44967). 

B. Determination of the Need for 

Moratoria 

In imposing these enrollment 

moratoria, CMS considered both 

qualitative and quantitative factors 

suggesting a high risk of fraud, waste, or 

abuse. CMS relied on law enforcement’s 

longstanding experience with ongoing 

and emerging fraud trends and activities 

through civil, criminal, and 

administrative investigations and 

prosecutions. CMS’ determination of a 

high risk of fraud, waste, or abuse in 

these provider and supplier types 

within these geographic locations was 

then confirmed by CMS’ data analysis, 

which relied on factors the agency 

identified as strong indicators of risk. 

(For a more detailed explanation of this 

determination process and of these 

authorities, see the July 31, 2013 notice 

(78 FR 46339) or February 4, 2014 

moratoria document (79 FR 6475)). 

1. Consultation With Law Enforcement 

In consultation with the HHS Office 

of Inspector General (OIG) and the 

Department of Justice (DOJ), CMS 

identified two provider and supplier 

types in nine geographic locations that 

warrant a temporary enrollment 

moratorium. For a more detailed 

discussion of this consultation process, 

see the July 31, 2013 notice (78 FR 

46339) or February 4, 2014 moratoria 

document (79 FR 6475). 

2. Beneficiary Access to Care 

Beneficiary access to care in 

Medicare, Medicaid, and CHIP is of 

critical importance to CMS and its state 

partners, and CMS carefully evaluated 

access for the target moratorium 

locations. Prior to imposing these 

moratoria, CMS reviewed Medicare data 

for these areas and found no concerns 

with beneficiary access to HHAs or 

ground ambulance suppliers. CMS also 

consulted with the appropriate State 

Medicaid Agencies and with the 

appropriate State Departments of 

Emergency Medical Services to 

determine if the moratoria would create 

access to care concerns for Medicaid 

and CHIP beneficiaries in the targeted 

locations and surrounding counties. All 

of CMS’ state partners were supportive 

of CMS’ analysis and proposals, and 

together with CMS, determined that 

these moratoria would not create access 

to care issues for Medicaid or CHIP 

beneficiaries. 

3. Lifting a Temporary Moratorium 

In accordance with § 424.570(b), a 

temporary enrollment moratorium 

imposed by CMS will remain in effect 

for 6 months. If CMS deems it 

necessary, the moratorium may be 

extended in 6-month increments. CMS 

will evaluate whether to extend or lift 

the moratorium before any subsequent 

moratorium periods. If one or more of 

the moratoria announced in this 

document are extended or lifted, CMS 

will publish a document to that effect in 

the Federal Register. 

Once a moratorium is lifted, the 

provider or supplier types that were 

unable to enroll because of the 

moratorium will be designated to CMS’ 

high screening level under 

§ 424.518(c)(3)(iii) and § 455.450(e)(2) 

for 6 months from the date the 

moratorium is lifted. 

II. Extension of Home Health and 

Ambulance Moratoria—Geographic 

Locations 

As noted earlier, we previously 

imposed moratoria on the enrollment of 

new HHAs in the Florida counties of 

Broward, Miami-Dade, and Monroe; the 

Illinois counties of Cook, DuPage, Kane, 

Lake, McHenry, and Will; the Michigan 

counties of Macomb, Monroe, Oakland, 

Washtenaw, and Wayne; and the Texas 

counties of Brazoria, Chambers, Collin, 

Fort Bend, Galveston, Dallas, Harris, 

Liberty, Denton, Ellis, Kaufman, 

Montgomery, Rockwall, Tarrant, and 

Waller. Further, we previously imposed 

moratoria on the enrollment of new 

ground ambulance suppliers in the 

Texas counties of Brazoria, Chambers, 

Fort Bend, Galveston, Harris, Liberty, 

Montgomery, and Waller; the 

Pennsylvania counties of Bucks, 

Delaware, Montgomery, and 

Philadelphia; and the New Jersey 

counties of Burlington, Camden, and 

Gloucester. These moratoria became 

effective upon publication of the notice 

in the Federal Register on July 31, 2013 

(78 FR 46339) and the moratoria 

document on February 4, 2014 (79 FR 

6475), and were subsequently extended 

by documents published in the Federal 

Register on August 1, 2014 (79 FR 

44702), February 2, 2015 (80 FR 5551), 

and July 28, 2015 (80 FR 44967). 

As provided in § 424.570(b), CMS 

may deem it necessary to extend 

previously-imposed moratoria in 6- 

month increments. Under this authority, 

CMS is extending the temporary 

moratoria on the Medicare enrollment of 

HHAs and ground ambulance suppliers 

in the geographic locations discussed 

herein. Under regulations at §§ 455.470 

and 457.990, these moratoria also apply 

to the enrollment of HHAs and ground 

ambulance suppliers in Medicaid and 

CHIP. Under § 424.570(b), CMS is 

required to publish a document in the 

Federal Register announcing any 

extension of a moratorium, and this 

extension of moratoria document fulfills 

that requirement. 

CMS consulted with the HHS OIG 

regarding the extension of the moratoria 

on new HHAs and ground ambulance 

suppliers in all of the moratoria 

counties, and the HHS OIG agrees that 

a significant potential for fraud, waste, 

and abuse continues to exist in these 

geographic areas. The circumstances 

warranting the imposition of the 

moratoria have not yet abated, and CMS 

has determined that the moratoria are 

still needed as we monitor the 

indicators and continue with 

administrative actions, such as payment 

suspensions and revocations of 


wgreen on DSK2VPTVN1PROD with NOTICES
5446 Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 

provider/supplier numbers. (For more 

information regarding the monitored 

indicators, see the February 4, 2014 

moratoria document (79 FR 6475)). 

Based upon CMS’ consultation with 

the relevant State Medicaid Agencies, 

CMS has concluded that extending 

these moratoria will not create an access 

to care issue for Medicaid or CHIP 

beneficiaries in the affected counties at 

this time. CMS also reviewed Medicare 

data for these areas and found there are 

no current problems with access to 

HHAs or ground ambulance suppliers. 

Nevertheless, the agency will continue 

to monitor these locations to make sure 

that no access to care issues arise in the 

future. 

Based upon our consultation with law 

enforcement and consideration of the 

factors and activities described 

previously, CMS has determined that 

the temporary enrollment moratoria 

should be extended for an additional 6 

months. 

III. Summary of the Moratoria 

Locations 

CMS is executing its authority under 

sections 1866(j)(7), 1902(kk)(4), and 

2107(e)(1)(D) of the Act to extend the 

enrollment moratoria in the following 

counties for HHAs and ground 

ambulance suppliers: 

TABLE 1—HHA MORATORIA

State City/metropolitan 

area Counties 

FL ..... Fort Lauderdale Broward. 

FL ..... Miami ................. Monroe 

Miami-Dade. 

IL ....... Chicago ............. Cook. 

DuPage. 

Kane. 

Lake. 

McHenry. 

Will. 

MI ...... Detroit ................ Macomb. 

Monroe. 

Oakland. 

Washtenaw. 

Wayne. 

TX ..... Dallas ................. Collin. 

Dallas. 

Denton. 

Ellis. 

Kaufman. 

Rockwall. 

Tarrant. 

TX ..... Houston ............. Brazoria. 

Chambers. 

Fort Bend. 

Galveston. 

Harris. 

Liberty. 

Montgomery. 

Waller. 

TABLE 2—GROUND AMBULANCE

MORATORIA

State City/metropolitan 

area Counties 

PA/NJ Philadelphia ....... Bucks. 

Burlington (NJ). 

Camden (NJ). 

Delaware. 

Gloucester (NJ). 

Montgomery. 

Philadelphia. 

TX ..... Houston ............. Brazoria. 

Chambers. 

Fort Bend. 

Galveston. 

Harris. 

Liberty. 

Montgomery. 

Waller. 

IV. Clarification of Right to Judicial 

Review 

Section 1866(j)(7)(B) of the Act states 

that there shall be no judicial review 

under section 1869, section 1878, or 

otherwise, of a temporary moratorium 

imposed on the enrollment of new 

providers of services and suppliers if 

the Secretary determines that the 

moratorium is necessary to prevent or 

combat fraud, waste, or abuse. 

Accordingly, our regulations at 42 CFR 

498.5(l)(4) state that for appeals of 

denials based on a temporary 

moratorium, the scope of review will be 

limited to whether the temporary 

moratorium applies to the provider or 

supplier appealing the denial. The 

agency’s basis for imposing a temporary 

moratorium is not subject to review. Our 

regulations do not limit the right to seek 

judicial review of a final agency 

decision that the temporary moratorium 

applies to a particular provider or 

supplier. In the preamble to the 

February 2, 2011 (76 FR 5918) final rule 

with comment period establishing this 

regulation, we explained that ‘‘a 

provider or supplier may 

administratively appeal an adverse 

determination based on the imposition 

of a temporary moratorium up to and 

including the Department Appeal Board 

(DAB) level of review.’’ We are 

clarifying that providers and suppliers 

that have received unfavorable 

decisions in accordance with the 

limited scope of review described in 

§ 498.5(l)(4) may seek judicial review of 

those decisions after they exhaust their 

administrative appeals. We reiterate, 

however, that section 1866(j)(7)(B) of 

the Act precludes judicial review of the 

agency’s basis for imposing a temporary 

moratorium. 

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. Regulatory Impact Statement 

CMS has examined the impact of this 

document as required by Executive 

Order 12866 on Regulatory Planning 

and Review (September 30, 1993), 

Executive Order 13563 on Improving 

Regulation and Regulatory Review 

(January 18, 2011), the Regulatory 

Flexibility Act (RFA) (September 19, 

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

the Social Security Act, section 202 of 

the Unfunded Mandates Reform Act of 

1995 (March 22, 1995; Pub. L. 104–4), 

Executive Order 13132 on Federalism 

(August 4, 1999) and the Congressional 

Review Act (5 U.S.C. 804(2)). 

Executive Orders 12866 and 13563 

direct 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 

regulatory actions with economically 

significant effects ($100 million or more 

in any one year). This document will 

prevent the enrollment of new home 

health providers and ground ambulance 

suppliers in Medicare and new home 

health providers and ground ambulance 

suppliers in Medicaid and CHIP. 

Though savings may accrue by denying 

enrollments, the monetary amount 

cannot be quantified. After the 

imposition of the initial moratoria on 

July 31, 2013, 848 HHAs and 14 

ambulance companies in all geographic 

areas affected by the moratoria had their 

applications denied. We have found the 

number of applications that are denied 

after 60 days declines dramatically, as 

most providers and suppliers will not 

submit applications during the 

moratoria period. Therefore, this 

document does not reach the economic 

threshold, and thus is not considered a 

major action. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

entities. For purposes of the RFA, small 

entities include small businesses, 

nonprofit organizations, and small 


wgreen on DSK2VPTVN1PROD with NOTICES
Federal Register / Vol. 81, No. 21 / Tuesday, February 2, 2016 / Notices 5447 

governmental jurisdictions. Most 

hospitals and most other providers and 

suppliers are small entities, either by 

nonprofit status or by having revenues 

of $7.0 million to $35.5 million in any 

one year. Individuals and states are not 

included in the definition of a small 

entity. CMS is not preparing an analysis 

for the RFA because it has determined, 

and the Secretary certifies, that this 

document will not have a significant 

economic impact on a substantial 

number of small entities. 

In addition, section 1102(b) of the Act 

requires us to prepare a regulatory 

impact analysis if an action 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, CMS defines a small rural 

hospital as a hospital that is located 

outside of a Metropolitan Statistical 

Area for Medicare payment purposes 

and has fewer than 100 beds. CMS is not 

preparing an analysis for section 1102(b) 

of the Act because it has determined, 

and the Secretary certifies, that this 

document will not have a significant 

impact on the operations of a substantial 

number of 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 

regulatory action whose mandates 

require spending in any one year of 

$100 million in 1995 dollars, updated 

annually for inflation. In 2015, that 

threshold is approximately $144 

million. This document will have no 

consequential effect on state, local, or 

tribal governments or on the private 

sector. 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it promulgates a 

proposed regulatory action (and 

subsequent final action) that imposes 

substantial direct requirement costs on 

state and local governments, preempts 

state law, or otherwise has Federalism 

implications. Because this document 

does not impose any costs on state or 

local governments, the requirements of 

Executive Order 13132 are not 

applicable. 

In accordance with the provisions of 

Executive Order 12866, the Office of 

Management and Budget reviewed this 

document. 

Authority: Sections 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395hh) and 44 U.S.C. Chapter 35. 

Dated: December 7, 2015. 

Andrew M. Slavitt, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

[FR Doc. 2016–01835 Filed 1–29–16; 4:15 pm] 

BILLING CODE 4120–01–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

[CMS–3323–N] 

Request for Information: Certification 

Frequency and Requirements for the 

Reporting of Quality Measures Under 

CMS Programs; Extension of Comment 

Period 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Request for information; 

extension of comment period. 

SUMMARY: This document extends the 

comment period for the December 31, 

2015 request for information entitled 

‘‘Request for Information: Certification 

Frequency and Requirements for the 

Reporting of Quality Measures Under 

CMS Programs’’ (80 FR 81824) (referred 

to in this document as December 31 

RFI). The comment period for the 

December 31 RFI, which would have 

ended on February 1, 2016, is extended 

for 15 days. 

DATES: The comment period is extended 

to February 16, 2016. To be assured 

consideration, written or electronic 

comments on the December 31 RFI must 

be received at one of the addresses 

provided below no later than February 

16, 2016. 

ADDRESSES: In commenting on the 

December 31 RFI, please refer either to 

file code CMS–3323–NC and comment 

as indicated in that document (80 FR 

81824) or file code CMS–3323–N and 

comment as provided in this document. 

Because of staff and resource 

limitations, we cannot accept comments 

by facsimile (FAX) transmission. 

You may submit comments in one of 

four ways (please choose only one of the 

ways listed): 

1. Electronically. You may submit 

electronic comments on this regulation 

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

the ‘‘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–3323–N, P.O. Box 8013, 

Baltimore, MD 21244–8013. 

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–3323–N, Mail 

Stop C4–26–05, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

4. By hand or courier. Alternatively, 

you may deliver (by hand or courier) 

your written comments ONLY to the 

following addresses: 

a. For delivery in Washington, DC— 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, Room 445–G, Hubert 

H. Humphrey Building, 200 

Independence Avenue SW., 

Washington, DC 20201. 

(Because access to the interior of the 

Hubert H. Humphrey Building is not 

readily available to persons without 

Federal government identification, 

commenters are encouraged to leave 

their comments in the CMS drop slots 

located in the main lobby of the 

building. A stamp-in clock is available 

for persons wishing to retain a proof of 

filing by stamping in and retaining an 

extra copy of the comments being filed.) 

b. For delivery in Baltimore, MD— 

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, 7500 Security 

Boulevard, Baltimore, MD 21244–1850. 

If you intend to deliver your 

comments to the Baltimore address, call 

telephone number (410) 786–9994 in 

advance to schedule your arrival with 

one of our staff members. 

Comments erroneously mailed to the 

addresses indicated as appropriate for 

hand or courier delivery may be delayed 

and received after the comment period. 

Inspection of Public Comments: All 

comments received before the close of 

the comment period are available for 

viewing by the public, including any 

personally identifiable or confidential 

business information that is included in 

a comment. We post all comments 

received before the close of the 

comment period on the following Web 

site as soon as possible after they have 

been received: http://

www.regulations.gov. Follow the search 

instructions on that Web site to view 

public comments. Comments received 

timely will also be available for public 

inspection as they are received, 

generally beginning approximately 3 

weeks after publication of a document, 

at the headquarters of the Centers for 

Medicare & Medicaid Services, 7500 

Security Boulevard, Baltimore, 

Maryland 21244, Monday through 


wgreen on DSK2VPTVN1PROD with NOTICES