Federal Register / Vol. 61, No. 93 / Monday, May 13, 1996 / Rules and Regulations 21969

‘‘§ 17.250 through § 17.266’’ is added in

place thereof.

§ 17.254 [Amended]

99. In redesignated § 17.254

introductory text, ‘‘Chief Medical

Director’’ is removed both times it

appears and ‘‘Under Secretary for

Health’’ is added in place thereof both

times it appears.

§ 17.255 [Amended]

100. In redesignated § 17.255,

‘‘§ 17.266’’ is removed and ‘‘§ 17.254’’ is

added in place thereof.

§ 17.257 [Amended]

101. In redesignated § 17.257

introductory text, ‘‘Chief Medical

Director’’ is removed and ‘‘Under

Secretary for Health’’ is added in place

thereof.

102. In redesignated § 17.257(b),

‘‘§ 17.271’’ is removed and ‘‘§ 17.258’’ is

added in place thereof.

103. In redesignated § 17.257(c),

‘‘§§ 17.266 through 17.268’’ is removed

and ‘‘§§ 17.254 through 17.256’’ is

added in place thereof.

§ 17.258 [Amended]

104. In redesignated § 17.258(b),

‘‘§§ 17.266 through 17.267’’ is removed

and ‘‘§§ 17.254 through 17.256’’ is

added in place thereof.

105. In redesignated § 17.258(c),

‘‘§§ 17.275 through 17.277’’ is removed

and ‘‘§§ 17.259 through 17.261’’ is

added in place thereof.

§ 17.262 [Amended]

106. In redesignated § 17.262, ‘‘Chief

Medical Director’’ is removed and

‘‘Under Secretary for Health’’ is added

in place thereof.

§ 17.350 [Amended]

107. In § 17.350, ‘‘§§ 17.37 through

17.42’’ is removed and ‘‘38 U.S.C. 1724

and § 1732, and 38 CFR 17.36 through

17.40’’ is added in place thereof.

§ 17.355 [Amended]

108. In § 17.355, ‘‘Chief Medical

Director’’ is removed and ‘‘Under

Secretary for Health’’ is added in place

thereof.

§ 17.364 [Amended]

109. In § 17.364(a), ‘‘§§ 17.37 through

17.39’’ is removed and ‘‘38 U.S.C. 1724

and 1732, and 38 CFR 17.36 through

17.37’’ is added in place thereof.

§ 17.367 [Amended]

110. In § 17.367, ‘‘§§ 17.37 through

17.42’’ is removed and ‘‘38 U.S.C. 1724

and 1732, and 38 CFR 17.36 through

17.40’’ is added in place thereof.

* * * * *

111. In § 17.601 paragraph (f) is

revised to read as follows:

§ 17.601 Definitions.

(f) Under Secretary for Health means

the Under Secretary for Health for

Veterans Health Administration or

designee.

* * * * *

§ 17.603, 17.608, 17.609 [Amended]

112. In §§ 17.603, 17.608(c)

introductory text, and 17.609, ‘‘Chief

Medical Director’’ is removed and

‘‘Under Secretary for Health’’ is added

in each place thereof.

[FR Doc. 96–11637 Filed 5–10–96; 8:45 am]

BILLING CODE 8320–01–P

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

42 CFR Part 412

[BPD–856–FC]

Medicare and Medicaid Program;

Criteria for a Rural Hospital To Be

Designated as an Essential Access

Community Hospital (EACH)

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Final rule with comment period.

SUMMARY: This final rule revises the

criteria that a rural hospital must meet

to be designated as an Essential Access

Community Hospital (EACH). The

revised criteria permit HCFA to

designate a hospital as an EACH if the

hospital cannot be designated as an

EACH by the State only because it has

fewer than 75 beds and is located 35

miles or less from another hospital.

Hospitals in rural areas that are

designated as EACHs by HCFA are

treated, for payment purposes, as sole

community hospitals.

The revised criteria are designed to

facilitate development of network

affiliations between rural EACHs and

small rural facilities, known as Rural

Primary Care Hospitals (RPCHs). The

revisions would affect only hospitals

located in rural areas of the States of

California, Colorado, Kansas, South

Dakota, New York, West Virginia, and

North Carolina, or in an adjacent State.

DATES: Effective Date: This regulation is

effective May 13, 1996.

Comment Period: Comments will be

considered if received at the appropriate

address, as provided below, no later

than 5 p.m. on July 12, 1996.

ADDRESSES: Mail written comments (one

original and three copies) to the

following address: Health Care

Financing Administration, Department

of Health and Human Services,

Attention: BPD–856–FC, P.O. Box 7517,

Baltimore, MD 21207–0517.

If you prefer, you may deliver your

written comments (one original and

three copies) to one of the following

addresses:

Room 309–G, Hubert H. Humphrey

Building, 200 Independence Avenue

SW., Washington, DC 20201, or

Room C5–09–26, Central Building, 7500

Security Boulevard, Baltimore, MD

21244–1850.

Because of staffing and resource

limitations, we cannot accept comments

by facsimile (FAX) transmission. In

commenting, please refer to file code

BPD–856–FC. Comments received

timely will be available for public

inspection as they are received,

generally beginning approximately 3

weeks after publication of a document,

in Room 309–G of the Department’s

offices at 200 Independence Avenue

SW., Washington, DC, on Monday

through Friday of each week from 8:30

a.m. to 5 p.m. (phone: (202) 690–7890).

For comments that relate to

information collection requirements,

mail a copy of comments to: Health Care

Financing Administration, Office of

Financial and Human Resources,

Management Planning and Analysis

Staff, Room C2–26–17, 7500 Security

Boulevard, Baltimore, MD 21244–1850.

Copies: To order copies of the Federal

Register containing this document, send

your request to: New Orders,

Superintendent of Documents, P.O. Box

371954, Pittsburgh, PA 15250–7954.

Specify the date of the issue requested

and enclose a check or money order

payable to the Superintendent of

Documents, or enclose your Visa or

Master Card number and expiration

date. Credit card orders can also be

placed by calling the order desk at (202)

512–1800 or by faxing to (202) 512–

2250. The cost for each copy is $8.00.

As an alternative, you can view and

photocopy the Federal Register

document at most libraries designated

as Federal Depository Libraries and at

many other public and academic

libraries throughout the country that

receive the Federal Register.

FOR FURTHER INFORMATION CONTACT:

George Morey, (410) 786–4653.

SUPPLEMENTARY INFORMATION:

I. Background

On May 26, 1993, we published in the

Federal Register (58 FR 30630) a final

rule to implement the Essential Access

Community Hospital (EACH) Program.

That program, which is authorized by
21970 Federal Register / Vol. 61, No. 93 / Monday, May 13, 1996 / Rules and Regulations

section 1820 of the Social Security Act

(the Act), is intended to promote

regionalization of health services in

rural areas, improve access to hospital

and other health services for rural

residents, and enhance the provision of

emergency and other transportation

services related to health care. The

program is not national in scope, but is

limited to the States (not to exceed

seven) that have been given Federal

grants for their activities in support of

it. The States that have received such

grants are California, Colorado, Kansas,

South Dakota, New York, West Virginia,

and North Carolina.

An important component of the EACH

program is the rural health network,

which is an organization made up of at

least one Rural Primary Care Hospital

(RPCH), and at least one EACH, regional

referral center, or hospital located in an

urban area that meets the criteria for

classification as a regional referral

center. An RPCH is a small, limitedservice facility that is located in a rural

area and furnishes outpatient and shortterm inpatient care needed to stabilize

a patient before discharge or transfer to

another facility for further care. An

EACH is a larger, full-service hospital

that has agreed to provide emergency

and medical backup services to the

RPCH (or RPCHs) participating in its

network. Network membership is

optional for RPCHs, but a hospital

cannot be designated as an EACH unless

it has a network agreement. EACHs in

rural areas are treated for Medicare

payment purposes as sole community

hospitals, which typically entitles the

facilities to a higher level of payment for

their inpatient services than they would

otherwise receive.

As is the case with any other

relationships between providers or

between providers and other persons or

entities, any arrangements are subject to

the provisions of the Medicare and

Medicaid anti-kickback statute (section

1128B(b) of the Social Security Act, 42

U.S.C. 1320a–7b(b)). That statute

prohibits knowingly and willfully

offering, paying, soliciting or receiving

remuneration in order to induce

business reimbursed under the

Medicare, Medicaid or other State

health care programs. Prohibited

conduct includes the transferring of

anything of value intended to induce

referrals of patients, as well as soliciting

or receiving remuneration in return for

the purchasing, leasing, ordering or

arranging for any good, facility, service

or item paid for by Medicare, Medicaid,

or other State health care program.

II. Criteria for Designation of EACHs

Under section 1820(I)(1)(A) of the Act,

HCFA can designate a hospital as an

EACH only if it meets specific

requirements and is first designated as

such by the grant State. The criteria for

State designation are set forth in section

1820(e). Under these criteria, a State

may designate a rural facility as an

EACH only if the hospital—

• Is located in a rural area, as defined

in section 1886(d)(2)(D);

• Is located more than 35 miles from

any hospital that—

+ Has been designated as an essential

access community hospital;

+ Is classified by the Secretary as a

rural referral center under section

1886(d)(5)(C); or

+ Meets such other criteria relating to

geographic location as the State may

impose with the approval of the

Secretary;

• Has at least 75 inpatient beds or is

located more than 35 miles from any

other hospital;

• Has in effect an agreement to

provide emergency and medical backup

services to rural primary care hospitals

participating in the rural health network

of which it is a member and throughout

its service area;

• Has in effect an agreement, with

each rural primary care hospital

participating in the rural health network

of which it is a member, to accept

patients transferred from such primary

care hospital, to receive data from and

transmit data to such primary care

hospital, and to provide staff privileges

to physicians providing care at such

primary care hospital; and

• Meets any other requirements

imposed by the State with the approval

of the Secretary.

Section 1820 also contains a provision

that allows the Secretary some

flexibility in designating hospitals as

EACHs even though they do not meet

the general bed size and geographic

location criteria. Section 1820(i)(1)(B) of

the Act allows the Secretary to designate

a hospital as an EACH if it is not eligible

for designation by the State only

because it does not have 75 or more

beds, or is not located more than 35

miles from another hospital. While we

were preparing the final rule published

May 26, 1993 (58 FR 30629), we

received comments suggesting that we

use this authority to designate facilities

as EACHs, even though they do not

meet the bed size and geographic

criteria specified in section 1820(e)(2).

We considered these comments

carefully but decided to exercise the

authority only with respect to hospitals

that have fewer than 75 beds and are

located within 35 miles of another

hospital, but are not located within 35

miles of any hospital having 75 or more

beds. Where such hospitals meet other

applicable criteria and are

recommended by the State as the EACH

member of a proposed network, HCFA

will designate them as EACHs.

Regulations permitting such

designations are set forth at 42 CFR

412.109(c)(2) (ii) and (iii).

Based on our further experience in

administering the EACH program, we

now believe that in order to increase

access to hospital services in rural areas,

there may be other circumstances in

which it would be appropriate to

exercise our section 1820(i)(1)(B)

authority for rural hospitals. For

example, a full-service hospital that

meets other requirements to be the

EACH member of a network may be

located within 35 miles of another

hospital that has 75 or more beds. In

this situation the hospital could not,

under existing regulations, be

designated as an EACH, even if it is the

only hospital that is willing and able to

furnish the rural health network

emergency and medical backup services

available from EACHs that might be

needed to permit a third facility to

operate successfully as an RPCH, thus

preserving access to care in its area.

Under these circumstances, section

1820(i)(1)(B) authority may

appropriately be exercised to permit

designation of an EACH, thus allowing

the small facility to be converted

successfully to an RPCH and to continue

providing services to its patients.

To allow for designation of facilities

as EACHs in these circumstances while

not defeating the purpose of the basic

statutory requirements for EACH

designations, we are revising

§ 412.109(c) of our regulations to specify

additional criteria under which

designations by HCFA will be made. As

revised, the regulations allow a hospital

located 35 miles or less from another

hospital to be designated as an EACH

only if—

• The hospital is not eligible for State

designation as an EACH solely because

it has fewer than 75 beds and is located

35 miles or less from any other hospital;

and

• The hospital is located more than

35 miles from the nearest hospital

having 75 or more beds, and is

recommended by the State for

designation as the EACH member of a

proposed network; or

• The following criteria are met—

—The hospital seeking EACH

designation has entered into a

network agreement under 42 CFR
Federal Register / Vol. 61, No. 93 / Monday, May 13, 1996 / Rules and Regulations 21971

485.603 with a facility that the State

has designated as an RPCH, and the

hospital designated as an RPCH by the

State does not have a network

agreement with any existing EACH;

—The facility that the State has

designated as an RPCH, and that has

entered into the network agreement

described above, is located more than

35 miles from any other hospital

having 75 or more inpatient beds;

—The distance between the facility that

the State has designated as an RPCH

and the hospital seeking designation

as an EACH is less than the distance

between the facility that the State has

designated as an RPCH and the

nearest hospital that has 75 or more

inpatient beds or is designated as an

EACH; and

—The State certifies to HCFA that—

+The rural health network emergency

and medical backup services actually

being provided by the hospital seeking

EACH designation are essential to the

continued existence of the facility as an

RPCH; and

+The existence of the facility as an

RPCH is needed to ensure access to

health care services in the area of the

State served by the facility that the State

has designated as an RPCH.

The criteria described above are

designed to ensure that the section

1820(i)(1)(B) authority is exercised only

in appropriate cases. First, there must be

a network agreement in effect between

the hospital seeking EACH designation

and a particular facility that the State

has designated an RPCH, and the RPCH

must not have entered into any network

agreement with any other hospital that

is currently an EACH. This criterion is

needed to ensure that there is a valid

network agreement linking the two

facilities, and that only one hospital is

able to achieve EACH designation based

on its agreement with a particular

RPCH. In addition, a prospective EACH

will not be able to qualify if the RPCH

with which it has entered into a

network agreement is within 35 miles of

any other hospital having 75 or more

inpatient beds or is designated as an

EACH. We also are requiring that the

hospital seeking designation as an

EACH under these criteria be closer to

the RPCH than the nearest hospital that

has 75 or more beds or is designated as

an EACH. We are including these

provisions because we do not wish to

encourage EACH designations that are

inappropriate in terms of the location of

the EACH or RPCH relative to other

facilities.

In applying these criteria, we will

consider only a hospital’s location

relative to other facilities that

participate in Medicare as general

hospitals (that is, under the criteria in

42 CFR 482.1 through 482.57). We will

not take into account the location of

nonparticipating hospitals or of those

that participate in Medicare as

psychiatric hospitals, since those

hospitals would not be appropriate

referral sites for most Medicare patients

following care at an RPCH.

In addition, we require that the State

make certain certifications to HCFA.

These are—

• That the rural health network and

emergency medical backup services

actually being provided by the hospital

seeking EACH designation are essential

to the continued existence of the facility

as an RPCH; and

• That the RPCH is needed to ensure

access to health care services in its

service area.

We have decided not to prescribe

specific criteria for the State to follow in

determining what constitutes a desirable

level of patient access to care in rural

areas, or whether the assistance of the

EACH is needed to help ensure that a

certain level of access is maintained. We

believe each State should develop its

own criteria and procedures for making

these determinations, based on local

and Statewide characteristics such as

population density, travel conditions,

existing referral patterns, availability of

health care professionals, and other

factors that affect access.

We are including a requirement under

which EACH designation made under

our revised regulation will remain in

effect only as long as the criteria in

§ 412.109(c)(2)(D)(ii) continue to be met.

Thus, for EACH designation to continue,

the EACH must continue to carry out its

network responsibilities with respect to

the RPCH, and the continued existence

of the facility as an RPCH must remain

necessary to ensure patient access to

care in the facility’s service area. If we

determine that these criteria are no

longer met (because, for example,

another source of care becomes

available to patients in the area of the

RPCH), or if a false certification was

made, we will terminate the EACH

status of the hospital prospectively,

effective with discharges occurring on

or after 30 days after the date of the

determination. We are redesignating

§ 412.109(f) as new paragraph (g), and

adding a new paragraph (f) that specifies

this requirement.

Although we expect that States will

notify us promptly of any changes in

hospitals’ activities and will not make

false or inaccurate certifications, we

reserve the right to review any

information that calls the accuracy of a

certification into question, and to

terminate a hospital’s EACH designation

if we find factual information sufficient

to convince us that the designation is no

longer appropriate. The hospital’s

Medicare participation would not be

affected by this change but, as of the

effective date of the change, it would no

longer be paid by Medicare as a sole

community hospital. As in the case of

any other determination that the

hospital does not meet the criteria for

EACH designation or that a hospital’s

EACH designation should be

terminated, the determination would be

subject to review under the provider

appeals regulations at 42 CFR Part 405,

Subpart R.

We note that a separate provision of

the law and regulations allows a

hospital to be designated as an EACH

only if it has in effect an agreement for

acceptance of patients and sharing of

patient data with each RPCH in the

network of which it is a member

(section 1820(e)(4) of the Act and the

implementing regulations at 42 CFR

412.109(d)(3)). Since an agreement of

this kind can be made only with a

facility participating in Medicare as an

RPCH, the effect of this requirement is

to allow EACH status for any hospital to

be effective no earlier than the first date

of participation of an affiliated RPCH.

This provision is not subject to waiver

under section 1820(I)(1)(B), and thus is

not affected by this final rule.

III. Other Required Information

A. Paperwork Reduction Act

Under the Paperwork Reduction Act

of 1995, agencies are required to provide

60 days’ notice in the Federal Register

to solicit public comments before a

collection of information requirement is

submitted to the Office of Management

and Budget (OMB) for review and

approval. In order to fairly evaluate

whether an information collection

should be approved by OMB, section

3504(c)(2)(A) of the Paperwork

Reduction Act of 1995 requires that we

solicit comment in the following issues:

• Whether the information collection

is necessary and useful to carry out the

proper functions of the agency;

• The accuracy of the agency’s

estimate of the information collection

burden;

• The quality, utility, and clarity of

the information to be collected; and

• Recommendation to minimize the

information collection burden on the

affected public, including automated

collection technique.

Following is a discussion of these

requirements:

Under § 412.109(c), a hospital can be

considered for HCFA designation as an
21972 Federal Register / Vol. 61, No. 93 / Monday, May 13, 1996 / Rules and Regulations

EACH, even though it does not meet the

requirements for State designation as set

forth in § 412.109(d), if the State makes

certain certifications to HCFA. These

include the importance of the EACH to

the continued existence of the facility as

an RPCH, by providing emergency and

medical backup services with respect to

the RPCH under its network agreement,

and the importance of RPCH ongoing

operation to access to care for residents

of its service area. While the regulations

do not require direct reporting of

information to HCFA, we expect that as

a practical matter the prospective EACH

will be required to furnish the State

with some information in order to

support the second item of the

certification, and that the prospective

RPCH will need to supply the State with

information in support of the other

items.

Public reporting burden for this

collection of information is estimated to

be 2 hours for the hospital’s first year of

operation as an EACH and one hour for

each subsequent year of operation as an

EACH. Existing regulations require

EACHs to furnish HCFA with

information regarding their agreements

with RPCHs, and we believe very little

additional time will be required to

supply the State with similar

information.

Public reporting burden for the RPCH

for this collection of information is

estimated to be 6 hours for the hospital’s

first year of operation as an RPCH and

2 hours for each subsequent year of

operation as an RPCH. These

information collection and record

keeping requirements are not effective

until they have been approved by OMB.

A notice will be published in the

Federal Register when approval is

obtained. Organizations and individuals

desiring to submit comments on these

information collection and record

keeping requirements should direct

them to the Health Care Financing

Administration, Office of Financial and

Human Resources, Management

Planning and Analysis Staff, Room C2–

26–17, 7500 Security Boulevard,

Baltimore, MD 21244–1850.

B. Regulatory Flexibility Analysis

We generally prepare an initial

regulatory flexibility analysis that is

consistent with the Regulatory

Flexibility Act (RFA)(5 U.S.C. 601

through 612) unless the we certify that

the final rule will not have a significant

economic impact on a substantial

number of small entities. For purposes

of the RFA, we consider all hospitals to

be small entities. Individuals and States

are not included in the definition of a

small entity.

Also, section 1102(b) of the Act

requires us to prepare a regulatory

impact analysis for any final rule that

may have a significant impact on a

substantial number of small rural

hospitals. Such an analysis must

conform to the provisions of section 603

of the RFA. For purposes of section

1102(b) of the Act, we define a small

rural hospital as a hospital that is

located outside a Metropolitan

Statistical Area and has fewer than 50

beds.

We have determined, and certify, that

these regulations will not have a

significant impact on a substantial

number of small rural hospitals. As

noted earlier, EACH designation is

available only in seven States and in the

States adjacent to those seven States.

Moreover, only a few prospective

EACHs would be so located relative to

other hospitals that they would be

affected by the changes in this rule.

Therefore, we have not prepared a

regulatory flexibility analysis or an

analysis of the effect on small rural

hospitals.

In accordance with the provisions of

Executive Order 12866, this regulation

was not reviewed by the Office of

Management and Budget.

Under the provisions of Public Law

104–121, we have determined that the

rule is not a major rule.

C. Waiver of Notice of Proposed

Rulemaking and 30–Day Delay in the

Effective Date

We ordinarily publish a notice of

proposed rulemaking for a rule to

provide a period for public comment.

However, we may waive that procedure

if we find good cause that prior notice

and comment are impractical,

unnecessary, or contrary to public

interest. We find good cause to

implement this rule as a final rule

because the delay involved in prior

notice and comment procedures for the

new provisions of this rule would be

contrary to the public interest.

This rule does not impose an

additional burden or obligation on any

hospital or community; on the contrary,

it relaxes a restriction on the

designation of certain rural hospitals as

EACHs. We expect that the resulting

assistance will enable the small

facilities to avoid closure and to

continue to provide needed services to

their communities. In view of the

precarious financial status of many

small rural hospitals, and in

consideration of the likelihood that

Medicare beneficiaries and other

patients served by these facilities would

be left without access to care if they

closed, we believe it is necessary to

implement this change as soon as

possible. Thus, we find that the delay

involved in prior notice and comment

would be contrary to the public interest.

We have concluded that it is

appropriate to implement the revisions

to § 412.109 as final in this instance.

We also normally provide a delay of

30 days in the effective date of a

regulation. However, if adherence to

this procedure would be impractical,

unnecessary, or contrary to public

interest, we may waive the delay in the

effective date. We may also waive the

delay in the case of a rule that grants an

exemption or relieves a restriction. We

find good cause to waive the usual 30-

day delay in this instance. As explained

above, it is in the public interest for the

transition from hospital to RPCH to be

made by many small facilities as soon

as possible, so as to avert insolvency

and complete closure. A 30-day delay in

the effective date would only postpone

unnecessarily the start of the transition

for many facilities, and place them at

greater risk. Therefore, we believe that

a 30-day delay in the effective date for

this provision would be contrary to the

public interest, and we find good cause

to waive the usual 30-day delay in the

effective date.

List of Subjects in 42 CFR Part 412

Administrative practice and

procedure, Health facilities, Medicare,

Puerto Rico, Reporting and record

keeping requirements.

42 CFR part 412 is amended as set

forth below:

PART 412—PROSPECTIVE PAYMENT

SYSTEMS FOR INPATIENT HOSPITAL

SERVICES

1. The authority citation for part 412

continues to read as follows:

Authority: Secs. 1102 and 1871 of the

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

1395hh).

Subpart G—Special Treatment of

Certain Facilities Under the

Prospective Payment System for

Inpatient Operating Costs

2. In § 412.109, paragraph (c) is

revised, paragraph (f) is redesignated as

paragraph (g), and a new paragraph (f)

is added to read as follows:

§ 412.109 Special treatment: Essential

access community hospitals (EACHs).

* * * * *

(c) Criteria for HCFA designation.

(1) HCFA designates a hospital as an

EACH if the hospital is located in a

State that has received a grant under

section 1820(a)(1) of the Act or in an

adjacent State and is designated as an
Federal Register / Vol. 61, No. 93 / Monday, May 13, 1996 / Rules and Regulations 21973

EACH by the State that has received the

grant.

(2) HCFA designates a hospital as an

EACH if—

(i) The hospital—

(A) Is not eligible for State designation

as an EACH solely because the hospital

has fewer than 75 inpatient beds and is

located 35 miles or less from any other

hospital; and

(B) Is located more than 35 miles from

the nearest hospital having 75 or more

inpatient beds, and is recommended by

the State for designation as the EACH

member of a proposed network; or

(ii) The following criteria are met—

(A) The hospital seeking EACH

designation has entered into a network

agreement under § 485.603 of this

chapter with a facility that the State has

designated as an RPCH, and the hospital

designated as an RPCH by the State does

not have a network agreement with any

existing EACH;

(B) The facility that the State has

designated as an RPCH, and that has

entered into the network agreement

described in paragraph (c)(2)(ii)(A) of

this section, is located more than 35

miles from any other hospital having 75

or more inpatient beds;

(C) The distance between the facility

that the State has designated as an

RPCH and the hospital seeking

designation as an EACH is less than the

distance between the facility that the

State has designated as an RPCH and the

nearest hospital that has 75 or more

inpatient beds or is designated as an

EACH;

(D) The State certifies to HCFA that—

(1) The rural health network

emergency and medical backup services

actually being provided by the hospital

seeking EACH designation are essential

to the continued existence of the facility

as a RPCH; and

(2) The existence of the facility as an

RPCH is needed to ensure access to

health care services in the area of the

State served by the RPCH.

For purposes of this paragraph

(c)(2)(ii), the location of a hospital will

not be considered unless the hospital

participates in Medicare under §§ 482.1

through 482.57 of this chapter.

* * * * *

(f) Termination of EACH designation

under paragraph (c)(2)(ii)(D). If HCFA

determines that the criteria in paragraph

(c)(2)(ii)(D) of this section are no longer

met with respect to a hospital HCFA has

designated as an EACH under that

paragraph, HCFA will terminate the

EACH designation of the hospital,

effective with discharges occurring on

or after 30 days after the date of the

determination.

* * * * *

(Catalog of Federal Domestic Assistance

Program No. 93.773, Medicare—Hospital

Insurance, and Program No. 93.774,

Medicare—Supplementary Medical

Insurance Program)

Dated: May 6, 1996.

Bruce C. Vladeck,

Administrator, Health Care Financing

Administration.

Dated: May 8, 1996.

Donna E. Shalala,

Secretary.

[FR Doc. 96–11990 Filed 5–9–96; 10:26 am]

BILLING CODE 4120–01–P

FEDERAL COMMUNICATIONS

COMMISSION

47 CFR Part 73

[MM Docket No. 94–156; RM–8564]

Radio Broadcasting Services;

Hawesville, KY and Tell City, IN

AGENCY: Federal Communications

Commission.

ACTION: Final rule.

SUMMARY: The Commission, at the

request of WLME, Inc, substitutes

Channel 246A for Channel 289A at

Hawesville, Kentucky, and modifies

Station WKCM-FM’s license

accordingly. To accommodate the

allotment, we also substitute Channel

289A for vacant Channel 245A at Tell

City, Indiana. See 60 FR 90, January 3,

1995. Channel 246A can be substituted

for Channel 289A at Hawesville in

compliance with the Commission’s

minimum distance separation

requirements with a site restriction of

3.7 kilometers (2.3 miles) northeast at

petitioner’s presently licensed site. The

reference coordinates for Channel 246A

at Hawesville are North Latitude 37–55–

33 and West Longitude 86–43–19. See

Supplementary Information, infra.

EFFECTIVE DATE: June 17, 1996.

FOR FURTHER INFORMATION CONTACT:

Sharon P. McDonald, Mass Media

Bureau, (202) 418–2180.

SUPPLEMENTARY INFORMATION: This is a

synopsis of the Commission’s Report

and Order, MM Docket No. 94–156,

adopted April 24, 1996, and released

May 3, 1996. The full text of this

Commission decision is available for

inspection and copying during normal

business hours in the FCC Reference

Center (Room 239), 1919 M Street, NW.,

Washington, DC. The complete text of

this decision may also be purchased

from the Commission’s copy

contractors, International Transcription

Service, Inc., (202) 857–3800, 2100 M

Street, NW., Suite 140, Washington, DC

20037.

Additionally, Channel 289A can be

substituted for vacant Channel 245A at

Tell City, Indiana, in compliance with

the Commission’s minimum distance

separation requirements with a site

restriction of 12.6 kilometers (7.8 miles)

south in order to avoid short-spacings to

the licensed sites of Station WASE(FM),

Channel 288A, Fort Knox, Kentucky,

and Station WUZR(FM), Channel 289A,

Bicknell, Indiana. The modified

reference coordinates for Channel 289A

at Tell City are North Latitude 37–50–

49 and West Longitude 86–43–27. With

this action, this proceeding is

terminated.

List of Subjects in 47 CFR Part 73

Radio broadcasting.

Part 73 of title 47 of the Code of

Federal Regulations is amended as

follows:

PART 73—[AMENDED]

1. The authority citation for part 73

continues to read as follows:

Authority: Sections 303, 48 Stat., as

amended, 1082; 47 U.S.C. 154, as amended.

§ 73.202 [Amended]

2. Section 73.202(b), the Table of FM

Allotments under Kentucky, is amended

by removing Channel 289A and adding

Channel 246A at Hawesville.

3. Section 73.202(b), the Table of FM

Allotments under Indiana, is amended

by removing Channel 245A and adding

Channel 289A at Tell City.

Federal Communications Commission.

Andrew J. Rhodes,

Acting Chief, Allocations Branch, Policy and

Rules Division, Mass Media Bureau.

[FR Doc. 96–11815 Filed 5–10–96; 8:45 am]

BILLING CODE 6712–01–F

DEPARTMENT OF DEFENSE

48 CFR Part 231

[DFARS Case 96–D303]

Defense Federal Acquisition

Regulation Supplement; Cost

Reimbursement Rules for Indirect

Costs—Private Sector

AGENCY: Department of Defense (DoD).

ACTION: Interim rule with request for

comments.

SUMMARY: The Director of Defense

Procurement has issued an interim rule

amending the Defense Federal

Acquisition Regulation Supplement to

permit the DoD to enter into a defense