342 Federal Register / Vol. 61, No. 3 / Thursday, January 4, 1996 / Proposed Rules

the Director, OCHAMPUS, to be cost

effective and clinically appropriate. To

qualify for a waiver of benefit limits of

custodial care, the patient must meet all

eligibility requirements of this

paragraph (i), including an acute

condition or an acute exacerbation of a

chronic condition.

(A) The patient must have been

rehospitalized for exacerbations or

complications of his/her custodial

condition on a recurring basis in the

prior year;

(B) The proposed case management

treatment must be cost effective when

compared to alternative treatment

which would otherwise occur;

(C) The patient’s condition at referral

for case management is either acute or

there are indicators of a rapidly

approaching acute episode; and

(D) There is a primary caregiver.

(iii) Domiciliary care. The cost of

services or supplies rendered to a

beneficiary that would otherwise be

excluded as domiciliary care (as defined

in § 199.2) may be shared when

determined by the Director,

OCHAMPUS to be cost effective and

clinically appropriate.

(iv) In home services. The cost of the

following in-home services may be

shared when determined by the

Director, OCHAMPUS to be cost

effective and clinically appropriate:

nursing care, physical, occupational,

speech therapy, medical social services,

intermittent or part-time services of a

home health aide, beneficiary

transportation required for treatment

plan implementation, and training for

the beneficiary and primary caregiver

sufficient to allow them to assume all

feasible responsibility for the care of the

beneficiary that will facilitate movement

of the beneficiary to the least resourceintensive, clinically appropriate setting.

(Qualifications for home health aides

shall be based on the standards at 42

CFR 484.36.)

(v) Waiver of custodial care limits.

The Director, OCHAMPUS may, in

extraordinary cases, waive the custodial

care day limits described in paragraph

(e)(5)(ii) of this section and authorize

this exception to benefits beyond the 30-

day limit. The criteria for waiver of the

30-day limit shall be those set in

paragraph (e)(5)(ii) of this section.

Additionally, there must be a specific

determination that discontinuation of

this waiver of benefit limits will result

in immediate onset or exacerbation of

an acute care episode and require

hospitalization or services or supplies

which increase significantly the cost

and intensity of care.

(6) Case management

acknowledgment. The beneficiary, or

representative, and the primary

caregiver, shall sign a case management

acknowledgment as a prerequisite to

prior authorization of case management

services. The acknowledgment shall

include, in part, all of the following

provisions:

(i) The right to participate fully in the

development and ongoing assessment of

the treatment;

(ii) That all health care services for

which CHAMPUS cost sharing is sought

shall be authorized by the case manager

prior to their delivery;

(iii) That there are limitations in

scope and duration of the planned case

management treatment, including

provisions to transition to other

arrangements;

(iv) The conditions under which case

management services are provided,

including the requirement that the

services must be cost effective and

clinically appropriate; and

(v) That a beneficiary’s participation

in the case management program shall

be discontinued for any of the following

reasons:

(A) The loss of CHAMPUS eligibility;

(B) A determination that the services

or supplies provided are not cost

effective or clinically appropriate;

(C) The beneficiary, or representative,

and/or primary caregiver, terminates

participation in writing;

(D) The beneficiary and/or primary

caregiver’s failure to comply with

requirements in this paragraph (i); or

(E) A determination that the

beneficiary’s condition no longer meets

the requirements of participation as

described in this paragraph (i).

(7) Other administrative requirements.

(i) Qualified providers of services or

items not covered under the basic

program, or who are not otherwise

eligible for CHAMPUS-authorized

status, may be authorized for a timelimited period when such authorization

is essential to implement the planned

treatment under case management. Such

providers must not be excluded or

suspended as a CHAMPUS provider,

and must agree to participate on all

claims related to the case management

treatment.

(ii) Retrospective requests for

authorization of waiver of benefit limits

will not be considered. Authorization of

waiver of benefit limits is allowed only

after all other options for services or

supplies have been considered and

either appropriately utilized or

determined to be clinically

inappropriate and/or not cost-effective.

(iii) Experimental or investigational

treatment or procedures shall not be

cost-shared as an exception to standard

benefits under this part.

(iv) CHAMPUS case management

services may be provided by contractors

designated by the Director,

OCHAMPUS.

Dated: December 28, 1995.

L.M. Bynum,

Alternate OSD Federal Register Liaison

Officer, Department of Defense.

[FR Doc. 96–65 Filed 1–3–96; 8:45 am]

BILLING CODE 5000–04–M

DEPARTMENT OF TRANSPORTATION

Research and Special Programs

Administration

49 CFR Part 195

[Docket PS–140(b), Notice 4]

RIN 2137–AC34

Areas Unusually Sensitive to

Environmental Damage

AGENCY: Research and Special Programs

Administration (RSPA), DOT.

ACTION: Public workshop.

SUMMARY: RSPA invites industry,

government representatives, and the

public to a third workshop on unusually

sensitive areas (USAs). The workshop’s

purpose is to openly discuss the guiding

principles for determining areas

unusually sensitive to environmental

damage from a hazardous liquid

pipeline release. This workshop is a

continuation of the June 15–16, 1995

and October 17, 1995 workshops on

USAs.

DATES: The workshop will be held on

January 18, 1996 from 8:30 a.m. to 4

p.m. Persons who are unable to attend

may submit written comments in

duplicate by February 5, 1996. However,

persons submitting guiding principles to

be considered at the January 18

workshop must do so by January 12,

1996. Interested persons should submit

as part of their written comments all

material that is relevant to a statement

of fact or argument. Late filed comments

will be considered so far as practicable.

ADDRESSES: The workshop will be held

at the U.S. Department of

Transportation, Nassif Building, 400

Seventh Street, SW, Room 6200–04,

Washington, DC. Non-federal employee

visitors are admitted into the DOT

headquarters building through the

southwest entrance at Seventh and E

Streets, SW. Persons who want to

participate in the workshop should call

(202) 366–2392 or e-mail their name,

affiliation, and phone number to

samesc@rspa.dot.gov before close of

business January 12, 1996. The
Federal Register / Vol. 61, No. 3 / Thursday, January 4, 1996 / Proposed Rules 343

workshop is open to all interested

persons but RSPA may limit

participation because of space

considerations and the need to obtain a

spectrum of views. Callers will be

notified if participation is not open.

Send written comments in duplicate

to the Dockets Unit, Room 8421,

Research and Special Programs

Administration, U.S. Department of

Transportation, 400 Seventh Street, SW,

Washington, DC 20590–0001. Identify

the docket and notice numbers stated in

the heading of this notice.

All comments and docketed materials

will be available for inspection and

copying in Room 8421 between 8:30

a.m. and 4:30 p.m. each business day. A

summary of the workshop will be

available from the Dockets Unit about

three weeks after the workshop.

FOR FURTHER INFORMATION CONTACT:

Christina Sames, (202) 366–4561, about

this document, or the Dockets Unit,

(202) 366–5046, for copies of this

document or other material in the

docket.

SUPPLEMENTARY INFORMATION: 49 U.S.C.

60109 requires the Secretary of

Transportation to:

• Consult with the Environmental

Protection Agency and describe areas

that are unusually sensitive to

environmental damage if there is a

hazardous liquid pipeline accident, and

• Establish criteria for identifying

each hazardous liquid pipeline facility

and gathering line, whether otherwise

subject to regulation, located in an area

unusually sensitive to environmental

damage in the event of a pipeline

accident.

Consistent with the President’s

regulatory policy (E.O. 12866), RSPA

wants to accomplish this congressional

mandate at the least cost to society.

Toward this end, RSPA is seeking early

public participation in the rulemaking

process by holding public workshops at

which participants, including RSPA

staff, may exchange views on relevant

issues. RSPA hopes these workshops

will enable government and industry to

reach a better understanding of the

problem and the potential solutions

before proposed rules are issued.

On June 15 and 16, 1995, RSPA held

a public workshop to openly discuss the

criteria being considered to determine

USAs (60 FR 27948; May 26, 1995).

Participants included representatives

from the hazardous liquid pipeline

industry; the Departments of Interior,

Agriculture, Transportation, and

Commerce; the Environmental

Protection Agency; non-government

agencies; and the public. Participants at

the workshop requested that additional

workshops be held to further discuss

this complex topic.

On October 17, 1995, RSPA held a

second public workshop on USAs (60

FR 44824; August 29, 1995). The second

workshop focused on developing a

process that can be used to determine if

an area is unusually sensitive to

environmental damage. The American

Petroleum Institute (API) provided

information on their current research on

USAs and recommended that the final

definition consider the resource to be

protected, the likelihood of a given

pipeline to impact that resource, and

what can be done to reduce the risk to

the resource. Other participants

recommended integrating factors

concerning the likelihood of a rupture

occurring and the severity of the

consequence into the USA definition.

Participants at the workshop

brainstormed guiding principles that

could be used when determining if a

given area is a USA and possible topics

for additional USA workshops. API

volunteered to conduct mini-workshops

to discuss some of the technical issues

and to bring their findings into larger

forums.

The following is a summary of the

guiding principles that were discussed

at the October 17 workshop or

submitted after the workshop by

members of the pipeline industry or

other Federal agencies. The guiding

principles are separated into two

categories: Substance and Process.

Guiding principles on substance relate

to the criteria that should be included

in the USA definition. Guiding

principles on process relate to how to

evaluate the criteria to be included in

the USA definition, the process to create

the USA definition, and how to apply

the USA definition. The lists are not

prioritized or final. The lists sometimes

include more than one recommendation

which may conflict with one another.

Conflicting views are labeled a. and b.

under a common number for

comparison. RSPA invites comments on

these recommended guiding principles

and invites submissions of additional

guiding principles. This list and any

additional guiding principles that are

submitted to the docket before January

12 will be considered at the January 18

workshop:

Substance

1. Human health and safety are

primary concerns.

2. Areas where there is serious threat

of contamination to a drinking water

‘‘zone of influence’’ should be

considered USAs.

3a. A resource must be subject to or

threatened by irretrievable loss or injury

before it can be considered a USA. or

3b. Areas where there is serious threat

of contamination to a significant

environmental or cultural resource

should be considered a USA.

4a. USAs are biological or ecological

in nature and should not include

cultural, economic, or recreational

resources. Cultural, economic, or

recreational resources should be

designated as separate categories and

viewed as distinct entities. or

4b. Consider cultural resources and

Indian tribal concerns when defining

USAs.

5. Only areas in the trajectory of a

potential spill, e.g. down gradient,

should be considered when determining

USAs.

6. It is expected that no pipeline

operator is required to collect natural

resources field data to determine USAs.

7. Highly volatile liquid (HVL)

pipelines should not be included.

Process

1. The standards and criteria for

resource sensitivity should be uniform

on a national basis such that equivalent

resources receive equivalent sensitivity

assessments regardless of regionally

based priorities.

2. The government agencies should

describe and identify USAs so that the

data will not be subject to various

interpretations and will be applied

consistently.

3. USAs should be subject to a

systematic review process since USAs

may change through time as species

migrate, change location, or for other

reasons. The USA definition should be

explicit and practical in application.

4. The USA definition should be pilot

tested, complete, and fully defined

before OPS uses the definition in

rulemaking. Each part of the USA

definition should be pilot tested for

validity, practicability, and workability.

5. Sources of USA data should be

readily available to the public and

uniform in criteria and standards.

6. Data quality objectives should

include consistency, accuracy, and

extent of coverage.

7. The extent of how much additional

geographic area a criterion adds should

be considered.

8. Risk elements mandated in 49

U.S.C. § 60109 to NOAA’s Guidance for

Facility and Vessel Response Plans (59

FR 14714; March 29, 1994) should be

applied when determining USAs.

9. OPS should exempt operators that

take proactive measures to minimize the

potential for spills from additional

requirements to protect USAs.
344 Federal Register / Vol. 61, No. 3 / Thursday, January 4, 1996 / Proposed Rules

10. Consultation with land or resource

managers may be necessary when

operators consider a range of

preventative measures in significant

environmental resource areas.

11. The process should clarify how

sensitive areas are protected under the

Pipeline Safety Act of 1992 separate and

apart from protection under the Oil

Pollution Act of 1990.

Several recommendations were made

that RSPA has determined are

acceptable but are not guiding

principles. These are:

1. Workshops for each phase of

developing a USA definition should

include appropriate technical experts,

representatives, and field personnel

with appropriate experience from

agencies as well as industry.

2. Public workshops should be used

to gather information on the criteria that

will determine USAs. The USA

definition should be complete before its

use in a rulemaking. The

implementation of resource assessment

and protection under the USA

definition could be phased.

3. All terms used in the USA

definition should be defined.

4. National consistency in interpreting

all definitions should be the goal.

The following are the additional

workshops that were recommended

during the October 17 workshop:

1. Guiding Principles Workshop.

2. Definitions of Terms Workshop.

3. Source Water Supply Workshop

(Surface and Subsurface).

4. Biological Resources Workshop.

5. Cultural Resources and Indian

Tribal Concerns Workshop.

6. Pilot Testing Process Workshop.

Persons interested in receiving a

transcript of the first workshop or the

summary of the second workshop,

material presented at the first or second

workshop, or comments submitted on

the material presented in the first or

second public workshop notice should

contact the Dockets Unit at (202) 366–

5046 and reference docket PS–140(b).

Issued in Washington, DC, on December

28, 1995.

Cesar DeLeon,

Deputy Associate Administrator for Pipeline

Safety.

[FR Doc. 96–107 Filed 1–3–96; 8:45 am]

BILLING CODE 4910–60–P