Federal Register / Vol. 60, No. 44 / Tuesday, March 7, 1995 / Rules and Regulations 12417

to OSHA’s. The State has no appreciable

backlog of workplace complaints and is

conducting programmed inspection.

These and others actions have also

resolved all issues raised in the AFL–

CIO’s petition for withdrawal of

approval of the North Carolina State

Plan.

OSHA has issued three evaluation

reports on North Carolina’s performance

since the Special Evaluation. All have

documented continuing improvement

and indicate that the program is now

operating in a more than acceptable

manner with an outstanding

commitment to necessary enforcement

as well as creative outreach and other

voluntary compliance activities.

As a result of these actions, OSHA

was prepared to suspend its exercise of

concurrent Federal jurisdiction in North

Carolina by mid-1994. However, two

initiatives that the State had undertaken

were brought to OSHA’s attention as

potential problems—the conditions

attendant to the establishment of a joint

Ergonomics Center with North Carolina

State University; and an amendment to

State law establishing a two-step contest

procedure as a means of expediting

review of contested cases and achieving

more timely abatement of hazards. Both

of these issues have now been resolved.

The ergonomics program has been

revised to eliminate any possibility or

perception that inspection or citation

exemption could result from employer

participation in the Ergonomics Center

program. The informal conference

procedures have been revised through

an internal operating procedure and a

proposed regulation to specify that any

informal conference resulting from the

contest process must be held within 20

days.

B. Decision

Based on the foregoing, OSHA has

determined that the exercise of

concurrent Federal enforcement

jurisdiction is no longer warranted, and

it is hereby suspended. Federal

enforcement authority will be exercised

only with regard to those issues not

covered by the State and in specific

areas defined in the following

modification to 29 CFR 1952.155 ‘‘Level

of Federal Enforcement.’’

OSHA has similarly determined that

no further action is necessary or

appropriate with regard to the AFL–CIO

petition for North Carolina plan

withdrawal. This does not preclude the

resubmission of a petition at any time

on substantive issues of State Plan

structure or performance.

List of Subjects in 29 CFR Part 1952

Intergovernmental relations, Law

enforcement, Occupational safety and

health.

Accordingly, 29 CFR 1952.155 is

amended as set forth below.

Signed in Washington, DC, this 28th day of

February 1995.

Joseph A. Dear,

Assistant Secretary.

PART 1952—[AMENDED]

1. The authority citation for 29 CFR

part 1952 continues to read as follows:

Authority: Sec. 18, 84 Stat. 1608 (29 U.S.C.

667); 29 CFR part 1902, Secretary of Labor’s

Order No. 1–90 (55 FR 9033).

2. Section 1952.155 of part 1952,

subpart I—North Carolina is revised to

read as follows:

Subpart I—North Carolina

§ 1952.155 Level of Federal enforcement.

Pursuant to § 1902.20(b)(1)(iii),

discretionary Federal enforcement

authority under Section 18(e) of the Act

(29 U.S.C. 667(e)) will not be initiated

with regard to Federal occupational

safety and health standards in issues

covered under 29 CFR part 1910, 29

CFR part 1926, and 29 CFR part 1928.

The U.S. Department of Labor will

continue to exercise authority, among

other things, with regard to: complaints

filed with the U.S. Department of Labor

alleging discrimination under Section

11(c) of the Act (29 U.S.C. 660(c));

enforcement with respect to private

sector maritime activities, including

enforcement of all provisions of the Act,

rules or orders and all Federal

standards, current or future, applicable

to private sector maritime employment

including 29 CFR part 1915, shipyard

employment (including boat building

establishments in SIC 3732 located on

the navigable waters and all

establishments in SIC 3731); 29 CFR

part 1917, marine terminals; 29 CFR

part 1918, longshoring (including all

private sector and Federal sector marine

cargo handling establishments or

operations in SIC 4491 located within

the State of North Carolina), 29 CFR part

1919, gear certification; all marinas in

SIC 4493 located on the navigable

waters; enforcement of marine

construction activities on the navigable

waters which are not directly accessible

by land; and, enforcement of general

industry and construction standards (29

CFR parts 1910 and 1926) appropriate to

hazards found in these employments,

which issues have been specifically

excluded from coverage in the North

Carolina plan; the enforcement of

occupational safety and health

standards on Indian reservations;

enforcement relating to any contractors

or subcontractors on any Federal

establishment where the land has been

ceded to the Federal Government;

enforcement on military bases;

enforcement of new Federal standards

until the State adopts a comparable

standard; situations where the State is

refused entry and is unable to obtain a

warrant or enforce the right of entry;

enforcement of unique and complex

standards as determined by the

Assistant Secretary; enforcement in

situations where the State is temporarily

unable to exercise its enforcement

authority fully or effectively;

completion of enforcement actions

initiated prior to the effective date of

this notice; and investigations for the

purpose of the evaluation of the North

Carolina plan under sections 18 (e) and

(f) of the Act (29 U.S.C. 667 (e) and (f)).

The Regional Administrator for

Occupational Safety and Health will

make a prompt recommendation for the

resumption of the exercise of Federal

enforcement authority under section

18(e) of the Act (29 U.S.C. 667(e))

whenever, and to the degree, necessary

to assure occupational safety and health

protection to employees in North

Carolina.

[FR Doc. 95–5504 Filed 3–6–95; 8:45 am]

BILLING CODE 4510–26–M

29 CFR Part 1952

Approved State Plans for Enforcement

of State Standards; Approval of

Supplements to the Hawaii State Plan

AGENCY: Occupational Safety and Health

Administration, Labor.

ACTION: Approval of supplements to the

Hawaii State Plan.

SUMMARY: This document gives notice of

Federal approval of supplements to the

Hawaii State occupational safety and

health plan. These supplements are:

regulations concerning the Division of

Occupational Safety and Health’s

Access to Employee Medical Records;

changes to previously approved

regulations covering the Labor and

Industrial Relations Appeals, Board,

General Provisions and Definitions,

Recording and Reporting Occupational

Injuries and Illnesses, Inspections,

Citations, and Proposed Penalties, and

Variances; an amendment to the Hawaii

Occupational Safety and Health Law

enacted in 1987; the Hawaii

Consultation Policies and Procedures

Manual; and the Hawaii Occupational
12418 Federal Register / Vol. 60, No. 44 / Tuesday, March 7, 1995 / Rules and Regulations

Safety and Health Administration

Technical Manual.

EFFECTIVE DATE: March 7, 1995.

FOR FURTHER INFORMATION CONTACT:

Director, Office of Information and

Consumer Affairs, Occupational Safety

and Health Administration, Room

N3647, 200 Constitution Avenue NW.,

Washington, DC 20210. Telephone:

(202) 523–8148.

SUPPLEMENTARY INFORMATION:

Background

The Hawaii Occupational Safety and

Health Plan was approved under section

18(c) of the Occupational Safety and

Health Act of 1970 (29 U.S.C. 667(c))

(hereinafter referred to as the Act) and

Part 1902 of this chapter on January 4,

1974 (39 FR 1010). Part 1953 of this

chapter provides procedures for the

review and approval of State change

supplements by the Assistant Secretary

of Labor for Occupational Safety and

Health (hereinafter referred to as the

Assistant Secretary).

Description of Supplements

A. Regulations

On September 16, 1982, the State

submitted its regulation concerning the

Division of Occupational Safety and

Health’s Access to Employee Medical

Records. This regulation is identical to

the Federal regulation set out in part

1913 of this Chapter. On March 11,

1988, the State submitted minor

editorial revisions to this regulations.

On October 7, 1983, the State

submitted a revised version of the Rules

of Practice and Procedure of the Hawaii

Labor and Industrial Relations Appeals

Board. These rules have been reviewed

and found to be as effective as the

regulations governing the Federal

Occupational Safety and Health Review

Commission.

On June 27, 1983, the State submitted

a revision to its regulation on Recording

and Reporting Occupational Injuries

and Illnesses (Chapter 52) to incorporate

a change in the Federal regulation at

Part 1904 of this Chapter concerning an

exemption from requirements for

recording occupational injuries and

illnesses for certain low hazard

industries. The State change is identical

to the Federal revision. On March 11,

1988, the State submitted minor

editorial changes to this regulation.

On June 27, 1983, the State submitted

revisions to its regulations on

Inspections, Citations, and Proposed

Penalties (Chapter 51), to incorporate a

change in the Federal regulation at Part

1903 of this Chapter concerning the use

of personal sampling devices during

inspections. On March 11, 1988, the

State submitted further revisions to this

regulation. OSHA’s review of an earlier

version of this regulation had expressed

concern about the provisions for

Petition for Modification of Abatement

dates (PMAs). (See 43 FR 5820,

February 10, 1978.) In response, the

State revised its regulation to provide

for employee contest of a PMA within

ten days of posting of the petition and

an opportunity for contest PMAs to be

heard by the Appeals Board, with the

burden of proof placed on the employer.

In addition, the State has issued a

Guideline which provides that the

employer will be informed of the right

to contest the denial of a PMA and that

the Director will not grant an

uncontested PMA before the ten day

contest period has expired. These

revisions make the Hawaii regulations at

least as effective as the Federal

regulations in Part 1903 of this Chapter.

This submission also contained a

change in the State’s provision for filing

complaints of discrimination for

exercising rights under the Act. The

change incorporates a revision to the

Federal regulation at Part 1977 of this

Chapter concerning time limits for filing

such complaints.

On March 11, 1988, Hawaii submitted

revisions to its Rules of Practice for

Variances (Chapter 53). The State

amended its regulations to allow for

acceptance of Federally granted

variances from standards which are

identical to Federal standards.

The March 11, 1988 submission also

included minor editorial changes to

Hawaii’s General Provisions and

Definitions (Chapter 50). In addition, on

March 13, 1992, the State submitted a

revision to this regulation to include a

definition of nationally recognized

testing laboratories, in response to

changes in the Federal definition. On

July 13, 1993, the State submitted an

updated Guideline on Nationally

Recognized Testing Laboratories, which

states that Hawaii will not establish its

own testing program but will recognize

Federally approved laboratories.

B. Amendment to Hawaii Occupational

Safety and Health Law

In 1987, the State enacted an

amendment to its Occupational Safety

and Health Law. The amendment,

submitted as a plan supplement on

March 13, 1992, expands the type of

information that is protected from

disclosure in any discovery or civil

action arising out of enforcement or

administration of the law.

C. Consultation Manual

On June 12, 1987, the State submitted

its Consultation Policies and Procedures

Manual. This manual is identical to Part

I of the Federal Consultation Policies

and Procedures Manual.

D. Industrial Hygiene Technical Manual

On August 8, 1991, the State

submitted notice of its adoption of the

Federal OSHA Technical Manual,

through Change 1. The State manual is

identical to the Federal Technical

Manual.

E. Revised Plan

On January 28, 1992, Hawaii

submitted a reorganized State plan,

incorporating the plan supplements

approved herein as well as previously

approved plan changes and other

supplements still under review.

Location of Supplements for Inspection

and Copying

A copy of the plan and the

supplements may be inspected and

copied during normal business hours at

the following locations: Office of the

Regional Administrator, Occupational

Safety and Health Administration,

Room 415, 71 Stevenson Street, San

Francisco, California 94105; Director,

Hawaii Department of Labor and

Industrial Relations, 830 Punchbowl

Street, Honolulu, Hawaii 96813; and the

Office of the Director of Federal-State

Operations, Room N3700, 200

Constitution Avenue NW., Washington,

DC 20210.

Public Participation

Under § 1953.2(c) of this chapter, the

Assistant Secretary may prescribe

alternative procedures to expedite the

review process or for any other good

cause which may be consistent with

applicable law. The Assistant Secretary

finds that the Hawaii plan supplements

are consistent with Federal

requirements and with commitments

contained in the plan and previously

made available for public comment.

Good cause is therefore found for

approval of these supplements, and

further public participation would be

unnecessary.

Decision

After careful consideration and

extensive review by the Regional and

National Offices, the Hawaii plan

supplements described above are found

to be in substantial conformance with

comparable Federal provisions and are

hereby approved under Part 1953 of this

chapter. The decision incorporates the

requirements and implementing

regulations applicable to State plans

generally.
Federal Register / Vol. 60, No. 44 / Tuesday, March 7, 1995 / Rules and Regulations 12419

List of Subjects in 29 CFR Part 1952

Intergovernmental relations, Law

enforcement, Occupational safety and

health.

Signed at Washington, DC, this 20th day of

February, 1995.

Joseph A. Dear,

Assistant Secretary.

Accordingly, 29 CFR Part 1952 is

hereby amended as follows:

PART 1952—[AMENDED]

1. The authority citation for part 1952

continues to read:

Authority: Secs. 8, 18 Pub. L. 91–596, 84

Stat. 1608 Occupational Safety and Health

Act of 1970 (29 U.S.C. 657, 667); Secretary

of Labor’s Order No. 12–71 (36 FR 8754), 8–

76 (41 FR 25059), or 9–83 (48 FR 35736), as

applicable.

2. New paragraphs (b) through (f) are

added to § 1952.316 of Subpart Y to read

as follows:

§ 1952.316 Changes to approved plans.

* * * * *

(b) Regulations.

(1) The State’s regulation on the

Division of Occupational Safety and

Health’s Access to Employee Medical

Records, and amendments to State

regulations covering the Labor and

Industrial Relations Appeals Board;

General Provisions and Definitions;

Recording and Reporting Occupational

Injuries and Illnesses; Inspections,

Citations, and Proposed Penalties; and

Variances, promulgated by the State

through March 22, 1991, were approved

by the Assistant Secretary on February

20, 1995.

(2) [Reserved]

(c) Legislation.

(1) An amendment to the Hawaii

Occupational Safety and Health Law,

enacted in 1987, which expands the

type of information that is protected

from disclosure in any discovery or civil

action arising out of enforcement or

administration of the law, was approved

by the Assistant Secretary on February

20, 1995.

(2) [Reserved]

(d) Consultation Manual. The State’s

Consultation Policies and Procedures

Manual was approved by the Assistant

Secretary on February 20, 1995.

(e) Occupational Safety and Health

Administration Technical Manual. The

State’s adoption of the Federal OSHA

Technical Manual, through Change 1,

was approved by the Assistant Secretary

on February 20, 1995.

(f) Reorganized Plan. The

reorganization of the Hawaii plan was

approved by the Assistant Secretary on

February 20, 1995.

[FR Doc. 95–5505 Filed 3–6–95; 8:45 am]

BILLING CODE 4510–26–M

DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

RIN 0720–AA23

Civilian Health and Medical Program of

the Uniformed Services (CHAMPUS);

Mental Health Services

AGENCY: Office of the Secretary, DoD.

ACTION: Final rule.

SUMMARY: This final rule is to reform

CHAMPUS quality of care standards

and reimbursement methods for

inpatient mental health services. The

rule updates existing standards for

residential treatment centers (RTCs) and

establishes new standards for approval

as CHAMPUS-authorized providers for

substance use disorder rehabilitation

facilities (SUDRFs) and partial

hospitalization programs (PHPs);

implements recommendations of the

Comptroller General of the United

States that DoD establish cost-based

reimbursement methods for psychiatric

hospitals and residential treatment

facilities; adopts another Comptroller

General recommendation that DoD

remove the current incentive for the use

of inpatient mental health care; and

eliminates payments to residential

treatment centers for days in which the

patient is on a leave of absence.

DATES: This rule is effective April 6,

1995, except amendments to § 199.4

which are effective October 1, 1995.

ADDRESSES: Office of the Civilian Health

and Medical Program of the Uniformed

Services (OCHAMPUS), Office of

Program Development; Aurora,

Colorado 80045–6900.

FOR FURTHER INFORMATION CONTACT:

CAPT Deborah Kamin, NC, USN, Office

of the Assistant Secretary of Defense

(Health Affairs), (703) 697–8975.

Questions regarding payment of

specific claims should be addressed to

the appropriate CHAMPUS contractor.

SUPPLEMENTARY INFORMATION: Provisions

of this rule apply to the CHAMPVA

(Civilian Health and Medical Program of

the Department of Veterans Affairs) in

the same manner as they apply to

CHAMPUS.

I. Introduction

Quality assurance and cost

effectiveness of mental health care

services under CHAMPUS continue to

be major reform issues for the Defense

Department and Congress. In recent

years, a series of DoD initiatives,

legislative and regulatory actions, and

Congressional hearings have spotlighted

both progress made and the need for

more improvement.

Two recent Comptroller General

Reports are indicative of the importance

of these issues and the need for reform.

The first of these, ‘‘Defense Health Care:

Additional Improvements Needed in

CHAMPUS’s Mental Health Program,’’

GAO/HRD–93–34, May 1993, stated

that, although DoD has taken actions to

improve the program ‘‘several problems

persist.’’ The Report (hereafter referred

to as ‘‘GAO Report #1’’) elaborated:

For example, reviews of medical records

have identified numerous instances of poor

medical record documentation, potentially

inappropriate admissions, excessive hospital

stays, and poor-quality care. Also,

inspections of RTCs [Residential Treatment

Centers] continue to reveal significant health

and safety problems, and corrective actions

often take many months.

Moreover, DoD * * * pays considerably

higher rates for comparable services than do

other public programs.

GAO Report #1, p. 2. The Report

referenced the General Accounting

Office’s 1991 Congressional testimony

regarding CHAMPUS mental health care

and inspections of residential treatment

facilities conducted for DoD since then:

Inspections conducted since our 1991

testimony have identified some of the same

problems we described then: unlicensed and

unqualified staff, inappropriate use of

seclusion and medication, inadequate staffto-patient ratios, and inadequate

documentation of treatment.

The principal conclusions of this

Report were: (1) ‘‘Standards, which

include termination for noncompliance,

should be specified and termination

proceedings, time frames, and

reinspection provisions * * * should be

adopted;’’ and (2) because ‘‘DoD

reimburses psychiatric hospitals and

RTCs at higher rates than do other

government payers, it should modify its

payment system to more closely

resemble other programs such as

Medicare.’’ GAO Report #1, p. 9.

A second recent Comptroller General

Report, ‘‘Psychiatric Fraud and Abuse:

Increased Scrutiny of Hospital Stays Is

Needed to Lessen Federal Health

Program Vulnerability,’’ GAO/HRD–93–

92, September 1993, also called for

improvements in the CHAMPUS mental

health program. The Report (hereafter

referred to as GAO Report #2) said:

Investigations to date have revealed that

federal health programs have been subject to

fraudulent and abusive psychiatric hospital