Federal Register / Vol. 60, No. 45 / Wednesday, March 8, 1995 / Proposed Rules 12717

(b) Upon the accumulation of 8 years or

1,000 hours TIS on the oil cooler assembly,

whichever occurs first, and thereafter at

every 8 years or 1,000 hours TIS (whichever

occurs first), accomplish one of the

following:

(1) Replace the oil cooler hose assembly

with a part number specified in the

APPLICABILITY section of this AD, and

reinspect in accordance with paragraph (a) of

this AD at intervals not to exceed 100 hours

TIS; or

(2) Replace the oil cooler assembly with an

approved TSO–C53a, Type D, hose assembly

ensuring that there is a minimum of 2 inches

between the oil cooler hoses and exhaust

stacks (as applicable) upon installation.

(c) The replacement specified in paragraph

(b)(2) of this AD may be accomplished at any

time prior to the 8-year or 1,000-hour

compliance time as terminating action for the

100-hour TIS repetitive inspection

requirement of this AD.

(d) After adjusting or installing oil cooler

hoses, prior to further flight, run the engine

for 5 minutes to ensure that there are no oil

leaks and that the 2-inch clearance is

maintained (as applicable) when the engine

is warm. Prior to further flight, replace any

leaking oil cooler hoses and adjust the

clearance accordingly.

Note 3: Although not required by this AD,

it is recommended that a hose flexibility test

be accomplished at each 100-hour TIS

inspection interval. Hose flexibility may be

determined by gently lifting the hose in

several places from the bottom of its

downward arc to the oil cooler. If the hose

moves slightly either from side-to-side or

upward with the hand at the center of an

even arc, then some flexibility remains. If the

hose appears hardened or inflexible, hose

replacement is recommended.

(e) Special flight permits may be issued in

accordance with sections 21.197 and 21.199

of the Federal Aviation Regulations (14 CFR

21.197 and 21.199) to operate the airplane to

a location where the requirements of this AD

can be accomplished.

(f) An alternative method of compliance or

adjustment of the initial or repetitive

compliance times that provides an equivalent

level of safety may be approved by the

Manager, Atlanta Aircraft Certification Office

(ACO), Campus Building, 1701 Columbia

Avenue, suite 2–160, College Park, Georgia

30337–2748. The request shall be forwarded

through an appropriate FAA Maintenance

Inspector, who may add comments and then

send it to the Manager, Atlanta ACO.

Note 4: Information concerning the

existence of approved alternative methods of

compliance with this AD, if any, may be

obtained from the Atlanta ACO.

(g) Figure 1 of this AD may be obtained

from the Atlanta ACO at the address

specified in paragraph (f) of this AD. This

document or any other information that

relates to this AD may be inspected at the

FAA, Central Region, Office of the Assistant

Chief Counsel, Room 1558, 601 E. 12th

Street, Kansas City, Missouri.

(h) This amendment supersedes AD 76–

25–06, Amendment 39–2788.

Issued in Kansas City, Missouri, on March

2, 1995.

Henry A. Armstrong,

Acting Manager, Small Airplane Directorate,

Aircraft Certification Service.

[FR Doc. 95–5601 Filed 3–7–95; 8:45 am]

BILLING CODE 4910–13–U

DEPARTMENT OF DEFENSE

Office of the Secretary

32 CFR Part 199

[DoD 6010.8–R]

RIN–0720–AA27

Civilian Health and Medical Program of

the Uniformed Services (CHAMPUS);

Provider Certification Requirements—

Corporate Services Provider Class;

Occupational Therapists

AGENCY: Office of the Secretary, DoD.

ACTION: Proposed rule.

SUMMARY: This proposed rule presents

requirements to permit payment of

professional or technical health care

services rendered by certain corporate

providers and to self-employed

occupational therapists; makes changes

to clarify the general requirements for

individual professional providers; and

adds standard provider participation

agreement provisions when such

agreements are otherwise required.

DATES: Comments must be submitted on

or before May 8, 1995.

ADDRESSES: Office of CHAMPUS (PDD),

Aurora, CO 80045–6900.

FOR FURTHER INFORMATION CONTACT:

Theresa R. Gilstrap, telephone (303)

361–1309.

SUPPLEMENTARY INFORMATION: The

Civilian Health and Medical Program of

the Uniformed Services (CHAMPUS)

supplements the availability of health

care in military hospitals and clinics.

Services and items allowable as

CHAMPUS benefits must be obtained

from CHAMPUS authorized civilian

providers to be considered for

CHAMPUS payment. Requirements for

CHAMPUS provider authorization are

published as regulation.

This amendment proposes to create a

fourth class of CHAMPUS provider

consisting of freestanding corporations

and foundations that render principally

professional ambulatory or in-home care

and technical diagnostic procedures.

Such organizations are currently

excluded as an allowable type of

CHAMPUS-authorized institutional

provider, and employees of these

organizations are excluded as

CHAMPUS-authorized individual

professional providers.

The CHAMPUS currently has

requirements for three classes of

providers. The institutional provider

class includes hospitals and other

categories of similar facilities. The

individual professional provider class

includes physicians and other categories

of licensed individuals who render

professional services independently,

and certain allied health and extra

medical providers that must function

under physician orders and supervision.

The third class of providers consists of

sellers of items and supplies of an

ancillary or supplemental nature, such

as durable equipment.

CHAMPUS payment depends upon a

service being both allowable as a benefit

and rendered by a CHAMPUS

authorized provider. Consequently, it is

currently possible that, for example,

outpatient treatment by an occupational

therapist employed by a hospital may be

paid (to the hospital) while the same

service provided by an employee of a

freestanding clinic, home care agency,

or self-employed occupational therapist

is denied payment.

This administrative exclusion is

difficult for beneficiaries to apply when

seeking health care services because it

requires an understanding of the

underlying business structure of the

provider. But the underlying business

structure of a provider organization is

important to CHAMPUS management

decisions regarding quality assurance

and payment methods.

Corporations, both not-for-profit and

shareholder, and foundations are an

alternative source of ambulatory and inhome care. The proposed addition of the

corporate provider class will recognize

the current range of providers within

today’s health care delivery structure

and give beneficiaries access to another

segment of the health care delivery

industry.

This amendment proposes to allow

qualified self-employed occupational

therapists to be authorized for direct

CHAMPUS payment for allowable

services as individual professional

providers.

This amendment proposes to more

clearly establish that a professional

corporation or association is not itself a

provider but may file claims and receive

payment on behalf of an individual

professional provider member, and to

more clearly state the other general

requirements for these providers.

This amendment proposes to establish

standard general provisions for

agreements with certain providers when

such agreements are otherwise required.

These provisions will improve
12718 Federal Register / Vol. 60, No. 45 / Wednesday, March 8, 1995 / Proposed Rules

efficiency in CHAMPUS oversight of

providers and will limit beneficiary

liability related to claims denied due to

provider noncompliance with

CHAMPUS requirements.

This amendment proposes to remove

two provisions which exclude

CHAMPUS coverage of civilian

diagnostic and consultation services

requested by a Military Treatment

Facility (MTF) physician in support of

continued MTF care of a CHAMPUSeligible beneficiary. Because MTFs vary

in size and clinical capacity for the care

of CHAMPUS-eligible beneficiaries, the

lack of access to specialized diagnostic

and consultation resources through

CHAMPUS may result in the MTF

purchasing the civilian services directly

without the advantage of CHAMPUS

price requirements; the beneficiary

paying the total cost of such non-MTF

services; or the beneficiary choosing to

obtain all care in the civilian

community in order to take advantage of

CHAMPUS cost-share of all the

necessary care. Removal of these

exclusions will allow flexibility in the

implementation of an MTF-based planof-care resulting in continuity of care at

a lower cost to both the beneficiary and

the government.

Executive Order 12866. OMB has

determined this is not a significant rule

as defined by Executive Order 12866.

The Regulatory Flexibility Act of 1980

requires that a federal agency prepare an

analysis when the agency issues

regulations which would have

significant impact upon a substantial

number of small entities. An estimated

2,200 occupational therapists in private

practice; approximately 850 corporate or

foundation physician groups; and

approximately 4,500 freestanding

Medicare certified in-home health care

agencies would become eligible to apply

for CHAMPUS provider status if this

proposed rule is finalized. These

changes are expected to competitively

redistribute ambulatory care benefit

costs for already existing benefits. We

certify that this proposed rule will not

have a significant economic impact on

a substantial number of small entities

under the criteria of the Regulatory

Flexibility Act.

Paperwork Reduction Act of 1980

requires all Departments to submit to

the Office of Management and Budget

(OMB) for review and approval any

reporting or record keeping

requirements in a proposed or final rule.

This proposed rule will, if adopted,

require information from the provider

applicant to document that the criteria

for CHAMPUS-provider status are met.

List of Subjects in 32 CFR Part 199

Claims, Disability, Handicapped,

Health insurance, and Military

personnel.

PART 199—[AMENDED]

Accordingly, 32 CFR part 199 is

amended as follows:

1. The authority citation for part 199

is proposed to be to revised to read as

follows:

Authority: 5 U.S.C. 301; 10 U.S.C. chapter

55.

2. Section 199.2(b) is proposed to be

amended by revising the definition for

‘‘Participating provider,’’ and by adding

definitions for ‘‘Corporate services

provider,’’ ‘‘Economic interest,’’ and

‘‘Qualified accreditation organization’’

in alphabetical order to read as follows:

§ 199.2 Definitions.

(b) * * *

Corporate services provider. A health

care provider which meets the

applicable requirements established by

§ 199.6(e).

* * * * *

Economic interest. (i) Any right, title,

or share in the income, remuneration,

payment, or profit of a CHAMPUSauthorized provider, or of an individual

or entity eligible to be a CHAMPUSauthorized provider, resulting, directly

or indirectly, from a referral

relationship; or any direct or indirect

ownership, right, title, or share,

including a mortgage, deed of trust,

note, or other obligation secured (in

whole or in part) by one entity for

another entity in a referral or

accreditation relationship, which is

equal to or exceeds 5 percent of the total

property and assets of the other entity.

(ii) A referral relationship exists when

a CHAMPUS beneficiary is sent,

directed, assigned or influenced to use

a specific CHAMPUS-authorized

provider, or a specific individual or

entity eligible to be a CHAMPUSauthorized provider.

(iii) An accreditation relationship

exists when a CHAMPUS-approved

accreditation organization evaluates for

accreditation an entity that is an

applicant for, or recipient of,

CHAMPUS-authorized provider status.

* * * * *

Participating provider. A CHAMPUSauthorized provider that is required, or

has agreed by entering into a CHAMPUS

participation agreement or by act of

indicating ‘‘accept assignment’’ on the

CHAMPUS claim form, to accept the

CHAMPUS-allowable amount as the

maximum total charge for a service or

item rendered to a CHAMPUS

beneficiary whether the amount is paid

for fully by the CHAMPUS or requires

cost-sharing by the CHAMPUS

beneficiary.

* * * * *

Qualified accreditation organization.

A not-for-profit corporation or a

foundation that:

(i) Develops process standards and

outcome standards for health care

delivery programs, or knowledge

standards and skill standards for health

care professional certification testing,

using experts both from within and

outside of the health care program area

or individual speciality to which the

standards are to be applied;

(ii) Creates measurable criteria that

demonstrate compliance with each

standard;

(iii) Publishes the organization’s

standards, criteria and evaluation

processes so that they are available to

the general public;

(iv) Performs on-site evaluations of

health care delivery programs, or

provides testing of individuals, to

measure the extent of compliance with

each standard;

(v) Provides on-site evaluations or

individual testing on a national or

international basis;

(vi) Provides to evaluated programs

and tested individuals time-limited

written certification of compliance with

the organization’s standards;

(vii) Excludes certification of any

program operated by an organization

which has an economic interest, as

defined by § 199.2, in the accreditation

organization or in which the

accreditation organization has an

economic interest;

(viii) Publishes promptly the

certification outcome of each program

evaluation or individual test so that it is

available to the general public; and

(ix) Has been found by the Director to

apply standards, criteria, and

certification processes which reinforce

CHAMPUS provider authorization

requirements and promote efficient

delivery of CHAMPUS benefits.

* * * * *

3. Section 199.4 is proposed to be

amended by revising paragraph (c)(3)(x)

and by removing and reserving (g)(70)

and (g)(71) to read as follows:

§ 199.4 Basic program benefits.

* * * * *

(c) * * *

(3) * * *

(x) Physical and occupational

therapy. Assessment and treatment

services of a CHAMPUS-authorized

physical or occupational therapist may

be cost-shared when:
Federal Register / Vol. 60, No. 45 / Wednesday, March 8, 1995 / Proposed Rules 12719

(A) The services are prescribed and

monitored by a physician;

(B) The purpose of the prescription is

to reduce the disabling effects of an

illness, injury, or neuromuscular

disorder; and

(C) The prescribed treatment

increases, stabilizes, or slows the

deterioration of, the beneficiary’s ability

to perform specified purposeful activity

in the manner, or within the range

considered normal, for a human being.

* * * * *

(g) Exclusions and limitations

(70)–(71)[Reserved]

* * * * *

4. Section 199.6 is proposed to be

amended by adding new paragraphs

(a)(13) and (a)(14); removing paragraph

(b)(1)(ii); revising paragraphs (a)(8),

(c)(1), (c)(2) and (c)(3)(iii)(I)(3),

redesignating paragraph (e) as (a)(15)

and paragraph (f) as (a)(16) and by

adding a new paragraph (e) to read as

follows:

§ 199.6 Authorized providers.

* * * * *

(a) * * *

(8) Participating providers. A

CHAMPUS-authorized provider is a

participating provider, as defined in

§ 199.2, under the following

circumstances:

(i) Mandatory participation.

(A) All medicare-participating

hospitals must be CHAMPUS

participating providers for all inpatient

CHAMPUS claims.

(B) Hospitals that are not Medicareparticipating but are subject to the

CHAMPUS-DRG-based payment

methodology or the CHAMPUS mental

health payment methodology as

established by § 199.14(a), must enter

into a participating agreement with the

CHAMPUS for all inpatient claims in

order to be a CHAMPUS-authorized

provider.

(C) Corporate services providers

authorized as CHAMPUS providers

under the provisions of paragraph (e) of

this section.

(ii) Voluntary participation.

(A) Total claims participation: The

participating provider program. A

CHAMPUS-authorized provider that is

not required to participate by this part

may become a participating provider by

entering into an agreement or

memorandum of understanding (MOU)

with the Director, OCHAMPUS, which

includes, but is not limited to, the

provisions of paragraph (a)(14) of this

section. The Director, OCHAMPUS, may

include in a participating provider

agreement/MOU provisions that

establish between OCHAMPUS and a

class, category, type, or specific

provider, uniform procedures and

conditions which encourage provider

participation while improving

beneficiary access to benfits and

contributing to CHAMPUS efficiency.

Such provisions shall be otherwise

allowed by this part or by DoD Directive

or DoD Instruction. Participating

provider program provisions may be

incorporated into an agreement/MOU to

establish a specific CHAMPUS-provider

relationship, such as a preferred

provider arrangement.

(B) Claim-specific participation. A

CHAMPUS-authorized provider that is

not required to participate and that has

not entered into a participation

agreement pursuant to paragraph

(a)(8)(ii)(A) of this section may elect to

be a participating provider on a claimby-claim basis by indicating ‘‘accept

assignment’’ on each CHAMPUS claim

form for which participation is elected.

* * * * *

(13) Medical records: CHAMPUSauthorized provider organizations and

individuals providing clinical services

shall maintain adequate clinical records

to substantiate that specific care was

actually furnished, was medically

necessary, and appropriate, and

identify(ies) the individual(s) who

provided the care. This applies whether

the care is inpatient or outpatient. The

minimum requirements for medical

record documentation are set forth by

all of the following:

(i) The cognizant state licensing

authority;

(ii) The Joint Commission on

Accreditation of Healthcare

Organizations, or the appropriate

Qualified Accreditation Organization as

defined in § 199.2;

(iii) Standards of practice established

by national medical organizations; and

(iv) This part.

(14) Participation agreements. Except

for agreements in effect on September

30, 1994, a participation agreement

otherwise required by this part shall

include, in part, all of the following

provisions requiring that the provider

shall:

(i) Not charge a beneficiary for the

following:

(A) Services for which the provider is

entitled to payment from CHAMPUS;

(B) Services for which the beneficiary

would be entitled to have CHAMPUS

payment made had the provider

complied with certain procedural

requirements;

(C) Services not medically necessary

and appropriate for the clinical

management of the presenting illness,

injury, disorder or maternity;

(D) Services for which a beneficiary

would be entitled to payment but for a

reduction or denial in payment as a

result of quality review; and

(E) Services rendered during a period

in which the provider was not in

compliance with one or more conditions

of authorization;

(ii) Comply with the applicable

provisions of this part and related

CHAMPUS administrative policy;

(iii) Accept the CHAMPUS

determined allowable payment

combined with the cost-share,

deductible, and other health insurance

amounts payable by, or on behalf of, the

beneficiary, as full payment for

CHAMPUS allowed services;

(iv) Collect from the CHAMPUS

beneficiary those amounts that the

beneficiary has a liability to pay for the

CHAMPUS deductible and cost-share;

(v) Permit accessed by the Director to

the clinical record of any CHAMPUS

beneficiary, to the financial and

organizational records of the provider,

and to reports of evaluations and

inspections conducted by state of

private agencies or organizations;

(vi) Provide to the Director prompt

written notification of the provider’s

employment of an individual who, at

any time during the twelve months

preceding such employment, was

employed in a managerial, accounting,

auditing, or similar capacity by an

agency or organization which is

responsible, directly or indirectly for

decisions regarding Department of

Defense payments to the provider;

(vii) Cooperate fully with a designated

utilization and clinical quality

management organization which has a

contract with the Department of Defense

for the geographic area in which the

provider renders services;

(viii) Obtain written authorization

before rendering designated services or

items for which CHAMPUS cost-share

may be expected;

(ix) Maintain clinical and other

records related to individuals for whom

CHAMPUS payment was made for

services rendered by the provider, or

otherwise under arrangement, for a

period of 60 months from the date of

service;

(x) Maintain contemporaneous

clinical records that substantiate the

clinical rationale for each course of

treatment, the methods, modalities or

means of treatment, periodic evaluation

of the efficacy of treatment, and the

outcome at completion or

discontinuation of treatment;

(xi) Refer CHAMPUS beneficiaries

only to providers with which the

referring provider does not have an
12720 Federal Register / Vol. 60, No. 45 / Wednesday, March 8, 1995 / Proposed Rules

economic interest, as defined in § 199.2;

and

(xii) Limit services furnished under

arrangement to those for which receipt

of payment by the CHAMPUS

authorized provider discharges the

payment liability of the beneficiary.

* * * * *

(c) Individual professional providers

of care.

(1) General.

(i) Purpose. This individual

professional provider class is

established to accommodate individuals

who are recognized by 10 U.S.C. 1079(a)

as authorized to assess or diagnose

illness, injury, or bodily malfunction as

a prerequisite for CHAMPUS cost-share

of otherwise allowable related

preventive or treatment services or

supplies, and to accommodate such

other qualified individuals who the

Director may authorize to render

otherwise allowable services essential to

the efficient implementation of a planof-care established and managed by a 10

U.S.C. 1079(a) authorized professional.

(ii) Professional corporation

affiliation or association membership

permitted. Paragraph (c) of this section

applies to those individual health care

professionals who have formed a

professional corporation or association

pursuant to applicable state laws. Such

a professional corporation or association

may file claims on behalf of a

CHAMPUS-authorized individual

professional provider and be the payee

for any payment resulting from such

claims when the CHAMPUS-authorized

individual certifies to the Director in

writing that the professional corporation

or association is acting on the

authorized individual’s behalf.

(iii) Scope of practice limitation. For

CHAMPUS cost-sharing to be

authorized, otherwise allowable services

provided by a CHAMPUS-authorized

individual professional provider shall

be within the scope of the individual’s

license as regulated by the applicable

state practice act of the state where the

individual rendered the service to the

CHAMPUS beneficiary or shall be

within the scope of the test which was

the basis for the individual’s qualifying

certification.

(iv) Employee status exclusion. An

individual employed, directly, or

indirectly by contract, by an individual

or entity to render professional services

otherwise allowable by this part is

excluded from provider status as

established by paragraph (c) of this

section for the duration of such

employment.

(v) Training status exclusion.

Individual health care professionals

who are allowed to render health care

services only under direct and ongoing

supervision as training to be credited

towards earning a clinical academic

degree or other clinical credential

required for the individual to practice

independently are excluded from

provider status as established by

paragraph (c) of this section for the

duration of such training.

(2) Conditions of authorization.

(i) Professional license requirement.

The individual must be currently

licensed to render professional health

care services in each state in which the

individual renders services to

CHAMPUS beneficiaries. Such license

is required when a specific state

provides, but does not require, license

for a specific category of individual

professional provider. The license must

be at a full clinical practice level to meet

this requirement. A temporary license at

the full clinical practice level is

acceptable.

(ii) Professional certification

requirement. When a state does not

license a specific category of individual

professional certification by a Qualified

Accreditation Organization, as defined

in § 199.2 of this part is required.

Certification must be at the full clinical

practice level. A temporary certification

at the full clinical practice level is

acceptable.

(ii) Education, training, and

experience requirement. The director

may establish for each category or type

of provider allowed by paragraph (c) of

this section specific education, training,

and experience requirements as

necessary to promote the delivery of

services by fully qualified individuals.

(iv) Physician referral and

supervision. When physician referral

and supervision is a prerequisite for

CHAMPUS cost-sharing of the services

of a provider authorized under

paragraph (c) of this section, such

referral and supervision means that the

physician must actually see the patient

to evaluate and diagnose the condition

to be treated prior to referring the

beneficiary to another provider and that

the referring physician provides ongoing

oversight of the course of referral related

treatment throughout the period during

which the beneficiary is being treated in

response to the referral. Written

contemporaneous documentation of the

referring physician’s basis for referral,

and of ongoing communication between

the referring and treating provider

regarding the oversight of the treatment

rendered as a result of the referral must

meet all requirements for medical

records established by this part.

Referring physician supervision does

not require physical location on the

premises of the treating provider or at

the site of treatment.

(3) * * *

(iii) * * *

(I) * * *

(3) Licensed registered physical

therapists and occupational therapists.

* * * * *

(e) Corporate services providers.

(1) General.

(1) This corporate services provider

class is established to accommodate

individuals who would meet the criteria

for status as a CHAMPUS authorized

individual professional provider as

established by paragraph (c) of this

section but for the fact that they are

employed directly or contractually by a

corporation or foundation that provides

principally professional services which

are within the scope of the CHAMPUS

benefit.

(ii) Payment for otherwise allowable

services may be made to a CHAMPUSauthorized corporate services provider

subject to the applicable requirements,

exclusions and limitations of this part.

(iii) The Director may create discrete

types within any allowable category of

provider established by paragraph (e) of

this section to improve the efficiency of

CHAMPUS management.

(iv) The Director may require, as a

condition of authorization, that a

specific category or type of provider

established by paragraph (e) of this

section:

(A) Maintain certain accreditation in

addition to or in lieu of the

requirements of paragraph (e)(2)(v) of

this section;

(B) Cooperate fully with a designated

utilization and clinical quality

management organization which has a

contract with the Department of Defense

for the geographic area in which the

provider does business;

(C) Render services for which direct

or indirect payment is expected to be

made by the CHMPUS only after

obtaining CHAMPUS written

authorization; and

(D) Maintain Medicare approval for

payment when the Director determines

that a category, or type, of provider

established by paragraph (e) of this

section is substantially comparable to a

provider or supplier for which Medicare

has regulatory conditions of

participation or conditions of coverage;

(v) Otherwise allowable services may

be rendered at the authorized corporate

services provider’s place of business, or

in the beneficiary’s home under such

circumstances as the Director

determines to be necessary for the

efficient delivery of such in-home

services.
Federal Register / Vol. 60, No. 45 / Wednesday, March 8, 1995 / Proposed Rules 12721

(vi) The Director may limit the term

of a participation agreement for any

category or type of provider established

by paragraph (e) of this section.

(vii) Corporate services providers

shall be assigned to only one of the

following allowable categories based

upon the predominate type of procedure

rendered by the organization:

(A) Medical treatment procedures;

(B) Surgical treatment procedures;

(C) Maternity management

procedures;

(D) Rehabilitation and/or habilitation

procedures; or

(E) Diagnostic technical procedures.

(viii) The Director shall determine the

appropriate procedural category of a

qualified organization and may change

the category based upon the provider’s

CHAMPUS claim characteristics. The

category determination of the Director is

conclusive and may not be appealed.

(2) Conditions of authorization. An

applicant must meet the following

conditions to be eligible for

authorization as a CHAMPUS corporate

services provider:

(i) Be a corporation or a foundation,

but not a professional corporation or

professional association, and

(ii) be institution-affiliated or

freestanding as defined in § 199.2 and

(iii) Provide:

(A) Services and related supplies of a

type rendered by CHAMPUS individual

professional providers or diagnostic

technical services and related supplies

of a type which requires direct patient

contact and a technologist who is

licensed by the state in which the

procedure is rendered for who is

certified by a Qualified Accreditation

Organization as defined in § 199.2 and

(B) A level of care which does not

necessitate that the beneficiary be

provided with on-site sleeping

accommodations and food in

conjunction with the delivery of

services and

(iv) Complies with all applicable

organizational and individual licensing

or certification requirements that are

extant in the state, county, municipality,

or other political jurisdiction in which

the provider renders services and

(v) Be approved for Medicare payment

when determined to be substantially

comparable under the provisions of

paragraph (e)(1)(iv)(D) of this section or,

when Medicare approved status is not

required, be accredited by a qualified

accreditation organization, as defined in

§ 199.2 and

(vi) Has entered into a participation

agreement approved by the Director

which at least complies with the

minimum participation agreement

requirements of this section.

(3) Transfer of participation

agreement. In order to provide

continuity of care for beneficiaries when

there is a change of provider ownership,

the provider agreement is automatically

assigned to the new owner, subject to all

the terms and conditions under which

the original agreement was made.

(i) The merger of the provider

corporation or foundation into another

corporation or foundation, or the

consolidation of two or more

corporations or foundations, resulting in

the creation of a new corporation or

foundation constitutes a change of

ownership.

(ii) Transfer of corporate stock or the

merger of another corporation or

foundation into the provider

corporation or foundation does not

constitute change of ownership.

(iii) The surviving corporation or

foundation shall notify the Director in

writing of the change of ownership

promptly after the effective date of the

transfer or change in ownership.

(4) Pricing and payment methodology.

The pricing and payment of procedures

rendered by a provider authorized

under paragraph (e) of this section shall

be limited to those methods for pricing

and payment allowed by this part which

the Director determines contribute to

the efficient management of the

CHAMPUS.

(5) Termination of participation

agreement. A provider may terminate a

participation agreement upon 45 days

written notice to the Director and to the

public.

Dated: March 1, 1995.

L.M. Bynum,

Alternate OSD Federal Register Liaison

Officer, Department of Defense.

[FR Doc. 95–5377 Filed 3–7–95; 8:45 am]

BILLING CODE 5000–04–M

ENVIRONMENTAL PROTECTION

AGENCY

40 CFR Part 52

[WA–18–1–5933b; FRL–5152–1]

Approval and Promulgation of State

Implementation Plans: Washington

AGENCY: Environmental Protection

Agency (EPA).

ACTION: Proposed rule.

SUMMARY: The EPA proposes to approve

the State Implementation Plan (SIP)

revision submitted by the State of

Washington for the purpose of

establishing a Small Business Stationary

Source Technical and Environmental

Compliance Assistance Program. The

SIP revision was submitted by the State

to satisfy the Federal mandate of the

Clean Air Act (CAA or Act), to ensure

that small businesses have access to the

technical assistance and regulatory

information necessary to comply with

the CAA. In the final rules section of

this Federal Register, the EPA is

approving the State’s SIP revision as a

direct final rule without prior proposal

because the Agency views this as a

noncontroversial revision amendment

and anticipates no adverse comments. A

detailed rationale for the approval is set

forth in the direct final rule. If no

adverse comments are received in

response to this proposed rule, no

further activity is contemplated in

relation to this rule. If the EPA receives

adverse comments, the direct final rule

will be withdrawn and all public

comments received will be addressed in

a subsequent final rule based on this

proposed rule. The EPA will not

institute a second comment period on

this document.

DATES: Comments on this proposed rule

must be received in writing by April 7,

1995.

ADDRESSES: Written comments should

be addressed to Montel Livingston,

Environmental Protection Specialist

(AT–082), Air Programs Section, at the

EPA Regional Office listed. Copies of

the documents relevant to this proposed

rule are available for public inspection

during normal business hours at the

following locations. The interested

persons wanting to examine these

documents should make an

appointment with the appropriate office

at least 24 hours before the visiting day.

U.S. Environmental Protection

Agency, Region 10, Air Programs

Section, 1200 6th Avenue, Seattle, WA

98101.

Washington State Department of

Ecology, P.O. Box 47600, Olympia, WA

98504.

FOR FURTHER INFORMATION CONTACT:

David J. Dellarco, Air and Radiation

Branch (AT–082), EPA, 1200 Sixth

Avenue, Seattle, WA 98101, (206) 553–

4978.

SUPPLEMENTARY INFORMATION: See the

information provided in the direct final

rule which is located in the rules

section of this Federal Register.

Dated: February 1, 1995.

Chuck Clarke,

Regional Administrator.

[FR Doc. 95–5448 Filed 3–7–95; 8:45 am]

BILLING CODE 6560–50–F