19862 Federal Register / Vol. 60, No. 77 / Friday, April 21, 1995 / Rules and Regulations

practitioners, but the State does define

qualifications for nurses in advanced

practice or general nurse practitioners,

the practitioner must—

(i) Meet qualifications for nurses in

advanced practice or general nurse

practitioners as defined by the State;

and

(ii) Have a family nurse practice

limited to providing primary health care

to individuals and families.

(d) Payment for nurse practitioner

services. The Medicaid agency must

reimburse nurse practitioners for their

services in accordance with § 441.22(c)

of this subchapter.

4. In § 440.210, the introductory text

of paragraph (a) and paragraph (a)(1) are

revised to read as follows:

§ 440.210 Required services for the

categorically needy.

(a) A State plan must specify that, at

a minimum, categorically needy

recipients are furnished the following

services:

(1) The services defined in §§ 440.10

through 440.50, 440.70, and (to the

extent nurse-midwives and nurse

practitioners are authorized to practice

under State law or regulation) the

services defined in §§ 440.165 and

440.166, respectively.

* * * * *

5. A new § 440.225 is added to read

as follows:

§ 440.225 Optional services.

Any of the services defined in subpart

A of this part that are not required

under §§ 440.210 and 440.220 may be

furnished under the State plan at the

State’s option.

B. Part 441 is amended as follows:

PART 441—SERVICES:

REQUIREMENTS AND LIMITS

APPLICABLE TO SPECIFIC SERVICES

1. The authority citation for part 441

continues to read as follows:

Authority: Sec. 1102 of the Social Security

Act (42 U.S.C. 1302).

2. Section 441.10 is revised to read as

follows:

§ 441.10 Basis.

This subpart is based on the following

sections of the Act which state

requirements and limits on the services

specified or provide Secretarial

authority to prescribe regulations

relating to services:

(a) Section 1102 for end-stage renal

disease (§ 441.40).

(b) Section 1138(b) for organ

procurement organization services

(§ 441.13(c)).

(c) Sections 1902(a)(10)(A) and

1905(a)(21) for nurse practitioner

services (§ 441.22).

(d) Sections 1902(a)(10)(D) and

1905(a)(7) for home health services

(§ 441.15).

(e) Section 1903(i)(1) for organ

transplant procedures (§ 441.35).

(f) Section 1903(i)(5) for certain

prescribed drugs (§ 441.25).

(g) Section 1903(i)(6) for prohibition

(except in emergency situations) of FFP

in expenditures for inpatient hospital

tests that are not ordered by the

attending physician or other licensed

practitioner (§ 441.12).

(h) Section 1905(a)(4)(C) for family

planning (§ 441.20).

(i) Sections 1905 (a)(12) and (e) for

optometric services (§ 441.30).

(j) Section 1905(a)(17) for nursemidwife services (§ 441.21).

(k) Section 1905(a) (following (a)(24))

for prohibition of FFP in expenditures

for certain services (§ 441.13).

3. A new § 441.22 is added to read as

follows:

§ 441.22 Nurse practitioner services.

With respect to nurse practitioner

services that meet the definition of

§ 440.166(a) and the requirements of

either § 440.166(b) or § 440.166(c), the

State plan must meet the following

requirements:

(a) Provide that nurse practitioner

services are furnished to the

categorically needy.

(b) Specify whether those services are

furnished to the medically needy.

(c) Provide that services furnished by

a nurse practitioner, regardless of

whether the nurse practitioner is under

the supervision of, or associated with, a

physician or other health care provider,

may—

(1) Be reimbursed by the State

Medicaid agency through an

independent provider agreement

between the State and the nurse

practitioner; or

(2) Be paid through the employing

provider.

(Catalog of Federal Domestic Assistance

Program No. 93.778, Medical Assistance

Program)

Dated: August 30, 1994.

Bruce C. Vladeck,

Administrator, Health Care Financing

Administration.

Dated: January 24, 1995.

Donna E. Shalala,

Secretary.

[FR Doc. 95–9954 Filed 4–20–95; 8:45 am]

BILLING CODE 4120–01–P

Administration for Children and

Families

45 CFR Part 212

RIN 0970–AB45

Assistance for United States Citizens

Returned From Foreign Countries

AGENCY: Administration for Children

and Families, HHS, Office of Refugee

Resettlement.

ACTION: Final rule.

SUMMARY: This rule amends the

regulations for the U.S. Repatriate

Program. Under the U.S. Repatriate

Program, State agencies provide

assistance to groups of United States

citizens who are returned from foreign

countries to the United States by the

Department of State due to war, threat

of war, civil disorder, or natural

disaster. This rule requires such

agencies to request and obtain advance

approval from the Administration for

Children and Families (ACF) to incur

expenses for developing and preparing

to implement repatriation plans for

groups of eligible persons. This rule is

necessary in order for ACF to provide

appropriate oversight of the limited

funding available for such activities.

EFFECTIVE DATE: This rule is effective

May 22, 1995.

FOR FURTHER INFORMATION CONTACT:

David B. Smith, Director, Division of

State Legalization and Repatriation,

Office of Refugee Resettlement,

Administration for Children and

Families, 370 L’Enfant Promenade, SW.,

6th floor, Washington, DC 20447.

Telephone: 202–401–9255.

SUPPLEMENTARY INFORMATION:

Background

The U.S. Repatriate Program is

authorized by Section 1113 of the Social

Security Act and is responsive to

Executive Order 12656 regarding

services provided to repatriated U.S.

citizens. The program provides

temporary assistance through State

agencies to needy U.S. citizens and their

dependents who are returned to the

United States by the Department of State

for reasons of destitution, illness, war,

threat of war, invasion, civil unrest, or

natural disaster in a foreign country.

Under current law and regulations,

assistance provided through the

program to repatriates must be repaid to

the United States Government unless

the Administration for Children and

Families specifically waives this

requirement.
Federal Register / Vol. 60, No. 77 / Friday, April 21, 1995 / Rules and Regulations 19863

Group Repatriation

When groups of U.S. citizens and

their dependents must be evacuated

from foreign countries and returned to

the United States due to war, threat of

war, invasion, civil unrest, or natural

disaster, States provide the necessary

reception and assistance. These

repatriation events are generally referred

to as Group Repatriations. In the event

that the President declares a national

security emergency under Executive

Order 12656, ‘‘Assignment of

Emergency Preparedness

Responsibilities,’’ the Secretary of

Health and Human Services is required

to coordinate such a repatriation. This

type of group repatriation is referred to

as Emergency Repatriation.

In response to E.O. 12656, the U.S.

Repatriate Program has developed a

National Emergency Repatriation Plan

which calls for States to develop their

own Emergency Repatriation Plans.

Under these plans, the States provide

the logistical arrangements for receiving

U.S. citizens repatriated as part of a

declared national security emergency

and for providing assistance for their

travel to their final destinations. The

States also provide necessary assistance

to ensure the immediate welfare of the

repatriates. States’ Emergency

Repatriation Plans are activated upon

the request of the Secretary if, and only

if, the President declares a national

security emergency under E.O. 12656.

The States’ Emergency Repatriation

Plans are suitable for use when groups

of American citizens are evacuated due

to war or threat of war, invasion or other

civil violence, or natural disaster in

foreign countries—but a national

security emergency is not declared

under Executive Order 12656. The U.S.

Repatriate Program recognizes that

States could use these plans as both

Emergency Repatriation Plans and

Group Repatriation Plans, and

encourages them to do so.

Administrative Costs

The statutory authority, as well as the

current regulations, provide that States

or other agencies providing repatriation

assistance be reimbursed by the U.S.

Repatriate Program for their

administrative expenses. Since funds

are limited and since group/emergency

repatriations are relatively rare events,

the Administration for Children and

Families (ACF) wishes to ensure that the

amount of administrative expenses

incurred by States in advance planning

or preparing for receiving group

repatriations is reasonable and

appropriate.

To this end, ACF published a notice

of proposed rulemaking on August 19,

1994 (59 FR 42795). In the NPRM, we

proposed that, if States wish to be

reimbursed for their administrative

expenses, they must seek and receive

prior approval from ACF before

incurring expenses associated with

developing group/emergency

repatriation plans. We further proposed

that States must also receive prior

approval to be reimbursed for the costs

of preparing to implement the plans,

such as conducting training exercises or

making physical preparations to a

reception site, unless notified by the

Assistant Secretary that such

preparations are necessary due to a

crisis in a foreign country.

Comments and Response on Advance

Approval Requirement

We received four comments on the

proposed rule. One of the commenters

agreed that the existing emergency plan

should operate as a group repatriation

plan, and enclosed a copy of the State’s

staff critique of the repatriation process

experienced during the Persian Gulf

evacuation. The commenter hoped that

the points made in the letter would be

addressed in guidelines for any group

repatriation of U.S. citizens. We

appreciate these suggestions, and will

take them into consideration when

addressing benefit levels and other

aspects of providing services to

repatriates during a group/emergency

repatriation.

The three remaining commenters took

issue with our proposal based on a

misunderstanding of its provisions. Two

commenters mistakenly took the

proposal that States seek and receive

prior approval before incurring

administrative costs in advance

planning for an emergency/group

repatriation to mean that this

requirement would apply in the event of

an actual emergency or crisis situation.

One commented, ‘‘The very nature of an

emergency repatriation does not lend

itself to pre-approval,’’ while the other

commented, ‘‘States are due

reimbursement for activities in this

regard and this proposed rule appears to

be an attempt to place barriers to

access.’’

Although the third comment pointed

out the differences between advance

planning and actual implementation, it

also thought prior approval applied to

both, noting that the proposed approval

process ‘‘* * * is an appropriate

request in relation to a state’s planning

in the absence of an impending event.

However, we believe the process

outlined is unreasonable when an

immediate response is required.’’ This

view is a misunderstanding of the

proposal which was not intended to

apply to activities undertaken in

response to an actual repatriation event.

The third commenter proposed

additional language to clarify the intent

of the proposal. With some

modification, we have adopted the

language of this commenter and

incorporated it into the final rule, which

now makes clear that prior approval is

not required for administrative

expenditures incurred by a State in

implementing approved repatriation

plans as a result of Federal notification

that an evacuation may be necessary

due to a crisis in a foreign country.

Format for the Request

In order to keep administrative

requirements to a minimum, we did not

propose any particular format for States

to request approval. In submitting a

written request for reimbursement of

administrative expenses in advance of

incurring costs, a State may use any

format the State chooses. States should

include an estimate of the expenses they

will incur, along with a description of

the activities to be undertaken and a

rationale for the expenditure.

ACF review of the request will consist

of (1) determining if the activities are, in

fact, necessary, and (2) evaluating

whether the estimated cost is reasonable

for the activities to be conducted.

Technical Amendments

We are also making technical changes

throughout 45 CFR part 212 to update

references to the office’s designation

and the agency official’s title.

Regulatory Procedures

Regulatory Flexibility Act

The Regulatory Flexibility Act (Public

Law 96–354) requires the Federal

Government to anticipate and reduce

the impact of regulations and paperwork

requirements on small entities.

The primary impact of this rule is on

State governments. Therefore, we certify

that this rule does not have a significant

economic impact on a substantial

number of small entities because it

would simply require agencies to obtain

advance approval before incurring

administrative costs in developing

implementation plans for the

repatriation of groups of eligible

individuals. Thus, a regulatory

flexibility analysis is not required.

Executive Order 12866

Executive Order 12866 requires that

regulations be reviewed to ensure that

they are consistent with the priorities

and principles set forth in the Executive

Order. ACF determined that this rule is
19864 Federal Register / Vol. 60, No. 77 / Friday, April 21, 1995 / Rules and Regulations

consistent with these priorities and

principles. An assessment of the costs

and benefits of available regulatory

alternatives (including not regulating)

demonstrated that the approach taken in

the regulation is the most cost effective

and least burdensome while still

achieving the regulatory objectives.

Paperwork Reduction Act

This final rule would require States to

submit information regarding their

activities and estimated costs for ACF

approval prior to the incurring of

administrative expenses for planning

and preparing to implement group/

emergency repatriation procedures. The

Office of Management and Budget

(OMB) clearance under the Paperwork

Reduction Act of 1980 (44 U.S.C.

chapter 35) has been requested.

(Catalog of Federal Domestic Assistance

Program No. 93.579, U.S. Repatriate Program)

List of Subjects in 45 CFR Part 212

Administrative cost, Repatriation,

Reporting and recordkeeping

requirements, Social Security Act, U.S.

Repatriate Program.

Approved: April 4, 1995.

Mary Jo Bane,

Assistant Secretary for Children and Families.

For the reasons set forth in the

preamble, part 212 of subtitle B of title

45 of the Code of Federal Regulations is

amended as follows:

PART 212—ASSISTANCE FOR UNITED

STATES CITIZENS RETURNED FROM

FOREIGN COUNTRIES

1. The authority citation for part 212

continues to read as follows:

Authority: Sec. 302, 75 Stat. 142, sec. 1102,

49 Stat. 647; 42 U.S.C. 1313, 1302.

2. Section 212.1 is amended by

revising paragraph (d) and (e) to read as

follows:

§ 212.1 General definitions.

* * * * *

(d) The term Administration means

the Administration for Children and

Families, Department of Health and

Human Services;

(e) The term Assistant Secretary

means the Assistant Secretary for

Children and Families;

* * * * *

2. Section 212.8 is amended by

redesignating the current text as

paragraph (a), and by adding a new

paragraph (b) to read as follows:

§ 212.8 Federal payments.

* * * * *

(b) To receive reimbursements, States,

or other agencies, shall request and

receive prior approval from the

Assistant Secretary for administrative

expenses incurred in developing or

preparing to implement repatriation

plans for groups of eligible persons.

Such requests should include a

description of the activities to be

undertaken, an estimate of the expenses

and a rationale for the expenditures. In

reviewing requests, the Assistant

Secretary will consider the necessity

and reasonableness of the costs. Prior

approval is not required for

administrative expenditures incurred by

a State in implementing approved

repatriation plans as a result of Federal

notification that an evacuation may be

necessary.

§§ 212.1, 212.2, 212.8 and 212.9 [Amended]

4. In addition to the amendments set

forth above, in 45 CFR 212 remove the

word ‘‘Administrator’’ and add, in its

place, the words ‘‘Assistant Secretary’’

in the following places: (a) Section

212.1(i); (b) Section 212.2; (c) section

212.8, as redesignated; and (d) Section

212.9 (a)(4) and (b).

§§ 212.3 and 212.10 [Amended]

5. Also, in 45 CFR 212 remove the

words ‘‘the Service’’ and add, in their

place, the words ‘‘the Administration’’

in the following places: (a) Section

212.3(b); and (b) Section 212.10(b).

[FR Doc. 95–9913 Filed 4–20–95; 8:45 am]

BILLING CODE 4184–01–M

DEPARTMENT OF COMMERCE

National Oceanic and Atmospheric

Administration

50 CFR Part 675

[Docket No. 950206040–5040–01; I.D.

041795A]

Groundfish of the Bering Sea and

Aleutian Islands Area; Pacific Ocean

Perch in the Aleutian Islands Subarea

AGENCY: National Marine Fisheries

Service (NMFS), National Oceanic and

Atmospheric Administration (NOAA),

Commerce.

ACTION: Closure.

SUMMARY: NMFS is closing the directed

fishery for Pacific ocean perch (POP) in

the Aleutian Islands subarea (AI) of the

Bering Sea and Aleutian Islands

management area (BSAI). This action is

necessary to prevent exceeding the POP

total allowable catch (TAC) in the AI.

EFFECTIVE DATE: Effective 12 noon,

Alaska local time (A.l.t.), April 17, 1995,

until 12 midnight, A.l.t., December 31,

1995.

FOR FURTHER INFORMATION CONTACT:

Andrew N. Smoker, 907–586-7228.

SUPPLEMENTARY INFORMATION: The

groundfish fishery in the BSAI exclusive

economic zone is managed by NMFS

according to the Fishery Management

Plan for the Groundfish Fishery of the

Bering Sea Aleutian Islands Area (FMP)

prepared by the North Pacific Fishery

Management Council under authority of

the Magnuson Fishery Conservation and

Management Act. Fishing by U.S.

vessels is governed by regulations

implementing the FMP at 50 CFR parts

620 and 675.

In accordance with § 675.20(a)(7)(ii)

the POP TAC for the AI was established

by the final groundfish specifications

(60 FR 8479, February 14, 1995) as 8,925

metric tons (mt).

The Director, Alaska Region, NMFS

(Regional Director), has determined, in

accordance with § 675.20(a)(8), that the

POP TAC in the AI soon will be

reached. Therefore, the Regional

Director has established a directed

fishing allowance of 6,925 mt, with

consideration that 2,000 mt will be

taken as incidental catch in directed

fishing for other species in the AI. The

Regional Director has determined that

the directed fishing allowance has been

reached. Consequently, NMFS is

prohibiting directed fishing for POP in

the AI.

Directed fishing standards for

applicable gear types may be found in

the regulations at § 675.20(h).

Classification

This action is taken under § 675.20

and is exempt from review under E.O.

12866.

Authority: 16 U.S.C. 1801 et seq.

Dated: April 17, 1985.

Richard W. Surdi,

Acting Director, Office of Fisheries

Conservation and Management, National

Marine Fisheries Service.

[FR Doc. 95–9862 Filed 4–17–95; 4:53 pm]

BILLING CODE 3510–22–F

50 CFR Part 675

[Docket No. 950206040–5040–01, I.D.

041795B]

Groundfish of the Bering Sea and

Aleutian Islands Area; Trawl Rock

Sole/Flathead Sole/‘‘Other Flatfish’’

Fishery Category

AGENCY: National Marine Fisheries

Service (NMFS), National Oceanic and

Atmospheric Administration (NOAA),

Commerce.

ACTION: Closure.