80_FR_56031 80 FR 55851 - Medicare Program; Approval of Request for an Exception to the Prohibition on Expansion of Facility Capacity Under the Hospital Ownership and Rural Provider Exceptions to the Physician Self-Referral Prohibition

80 FR 55851 - Medicare Program; Approval of Request for an Exception to the Prohibition on Expansion of Facility Capacity Under the Hospital Ownership and Rural Provider Exceptions to the Physician Self-Referral Prohibition

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services

Federal Register Volume 80, Issue 180 (September 17, 2015)

Page Range55851-55853
FR Document2015-23363

This final notice announces our decision to approve the request from Doctors Hospital at Renaissance for an exception to the prohibition against expansion of facility capacity.

Federal Register, Volume 80 Issue 180 (Thursday, September 17, 2015)
[Federal Register Volume 80, Number 180 (Thursday, September 17, 2015)]
[Notices]
[Pages 55851-55853]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2015-23363]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1640-FN]


Medicare Program; Approval of Request for an Exception to the 
Prohibition on Expansion of Facility Capacity Under the Hospital 
Ownership and Rural Provider Exceptions to the Physician Self-Referral 
Prohibition

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Final notice.

-----------------------------------------------------------------------

SUMMARY: This final notice announces our decision to approve the 
request from Doctors Hospital at Renaissance for an exception to the 
prohibition against expansion of facility capacity.

DATES: Effective Date: This notice is effective on September 11, 2015.

FOR FURTHER INFORMATION CONTACT: Patricia Taft, (410) 786-4561 or 
Teresa Walden, (410) 786-3755.

SUPPLEMENTARY INFORMATION:

I. Background

    Section 1877 of the Social Security Act (the Act), also known as 
the physician self-referral law--(1) prohibits a physician from making 
referrals for certain ``designated health services'' (DHS) payable by 
Medicare to an entity with which he or she (or an immediate family 
member) has a financial relationship (ownership or compensation), 
unless the requirements of an applicable exception are satisfied; and 
(2) prohibits the entity from filing claims with Medicare (or billing 
another individual, entity, or third party payer) for those DHS 
furnished as a result of a prohibited referral.
    Section 1877(d)(2) of the Act provides an exception, known as the 
rural provider exception, for physician ownership or investment 
interests in rural providers. In order for an entity to qualify for the 
rural provider exception, the DHS must be furnished in a rural area (as 
defined in section 1886(d)(2)(D) of the Act) and substantially all the 
DHS furnished by the entity must be furnished to individuals residing 
in a rural area.
    Section 1877(d)(3) of the Act provides an exception, known as the 
hospital

[[Page 55852]]

ownership exception, for physician ownership or investment interests 
held in a hospital located outside of Puerto Rico, provided that the 
referring physician is authorized to perform services at the hospital 
and the ownership or investment interest is in the hospital itself (and 
not merely in a subdivision of the hospital).
    Section 6001(a)(3) of the Patient Protection and Affordable Care 
Act (Pub. L. 111-148) as amended by the Health Care and Education 
Reconciliation Act of 2010 (Pub. L. 111-152) (hereafter referred to 
together as ``the Affordable Care Act'') amended the hospital ownership 
and rural provider exceptions to the physician self-referral 
prohibition to impose additional restrictions on physician ownership 
and investment in hospitals. Since March 23, 2010, a physician-owned 
hospital that seeks to avail itself of either exception is prohibited 
from expanding facility capacity unless it qualifies as an ``applicable 
hospital'' or ``high Medicaid facility'' (as defined in sections 
1877(i)(3)(E), (F) of the Act and 42 CFR 411.362(c)(2), (3) of our 
regulations) and has been granted an exception to the facility 
expansion prohibition by the Secretary of the Department of Health and 
Human Services (the Secretary). Section 1877(i)(3)(A)(ii) of the Act 
provides that individuals and entities in the community in which the 
provider requesting the exception is located must have an opportunity 
to provide input with respect to the provider's request for an 
exception. Section 1877(i)(3)(H) of the Act states that the Secretary 
shall publish in the Federal Register the final decision with respect 
to a request for an exception to the prohibition against facility 
expansion not later than 60 days after receiving a complete 
application.

II. Exception Approval Process

    On November 30, 2011, we published a final rule in the Federal 
Register (76 FR 74122, 74517 through 74525) that, among other things, 
finalized Sec.  411.362(c), which specifies the process for submitting, 
commenting on, and reviewing a request for an exception to the 
prohibition on expansion of facility capacity. We published a 
subsequent final rule in the Federal Register on November 10, 2014 (79 
FR 66770, 66987 through 66997) that made certain revisions. These 
revisions include, among other things, permitting the use of data from 
an external data source, as defined in our regulations, or from the 
Hospital Cost Report Information System (HCRIS) for specific 
eligibility criteria.
    As stated in our regulations at Sec.  411.362(c)(5), we solicit 
community input on a request for an exception by publishing a notice of 
the request in the Federal Register. Individuals and entities have 30 
days to submit written comments on the request, which may include 
documentation demonstrating that the physician-owned hospital 
requesting the exception does or does not qualify as an ``applicable 
hospital'' or ``high Medicaid facility,'' as defined in Sec.  
411.362(c)(2) and (c)(3), respectively. We notify the hospital of 
comments received, and the hospital has 30 days after such notice to 
submit a rebuttal statement (Sec.  411.362(c)(5)(ii)). Section 
411.362(c)(5) also specifies the timing for when CMS deems a request 
for an exception to the facility expansion prohibition complete.
    If we grant the request for an exception, the expansion may occur 
only in facilities on the hospital's main campus and may not result in 
the number of operating rooms, procedure rooms, and beds for which the 
hospital is licensed to exceed 200 percent of the hospital's baseline 
number of operating rooms, procedure rooms, and beds (Sec.  
411.362(c)(6)).

III. Public Response to Notice With Comment Period

    On May 8, 2015, we published a notice in the Federal Register (80 
FR 26566) entitled, ``Request for an Exception to the Prohibition on 
Expansion of Facility Capacity under the Hospital Ownership and Rural 
Provider Exceptions to the Physician Self-Referral Prohibition.'' In 
the May 8, 2015 notice, we stated that as permitted by section 
1877(i)(3) of the Act and our regulations at Sec.  411.362(c), the 
following physician-owned hospital requested an exception to the 
prohibition on expansion of facility capacity:

    Name of Facility: Doctors Hospital at Renaissance (DHR).
    Location: 5501 South McColl Road, Edinburg, Texas 78539.
    Basis for Exception Request: Applicable Hospital.

    In the May 8, 2015 notice, we also solicited comments from 
individuals and entities in the community in which DHR is located.
    We received 21 comments, 14 of which were variations of a form 
letter, and commenters generally opposed DHR's request to expand.
    One or more of the commenters raised questions or concerns 
regarding:
     Whether DHR's request conforms to the procedural 
requirements set forth at Sec.  411.362(c);
     Whether DHR demonstrated that it satisfied the population 
growth criterion using the data required under Sec.  411.362(c)(2)(i);
     Whether the data source used by DHR to demonstrate 
satisfaction of the inpatient Medicaid admissions criterion at Sec.  
411.362(c)(2)(ii) was permissible;
     Whether DHR satisfied the non-discrimination criterion at 
Sec.  411.362(c)(2)(iii);
     How a facility expansion by DHR would affect the community 
in which it is located; and
     The amount of increased facility capacity requested by 
DHR.
    On June 16, 2015, as required by Sec.  411.362(c)(5)(ii), we 
notified DHR that we received comments in response to the May 8, 2015 
notice and that these comments were available for public viewing at 
http://www.regulations.gov. DHR submitted a rebuttal statement on July 
15, 2015. The statement rebutted each of the commenters' assertions 
regarding the applicable hospital eligibility criteria and addressed 
the concerns expressed by the commenters regarding an expansion by the 
hospital.

IV. Decision

    This final notice announces our decision to approve DHR's request 
for an exception to the prohibition against expansion of facility 
capacity. As required by our current regulations and public guidance 
documents, DHR submitted the data and certifications necessary to 
demonstrate that it satisfies the criteria to qualify as an applicable 
hospital. Further, CMS considered the assertions of the commenters 
about DHR's compliance with the procedural requirements set forth at 
Sec.  411.362(c), the population growth criterion under Sec.  
411.362(c)(2)(i), the data source used by DHR to demonstrate 
satisfaction of the inpatient Medicaid admissions criterion at Sec.  
411.362(c)(2)(ii), and the non-discrimination criterion at Sec.  
411.362(c)(2)(iii). Following our review of the information provided by 
the commenters, we are not persuaded that DHR failed to satisfy one or 
more of the applicable hospital eligibility criteria or that its 
request failed to conform to our procedural requirements. Also, CMS 
cannot consider any concerns unrelated to the statutory and regulatory 
eligibility criteria when determining whether to grant an exception to 
a requesting hospital. In addition, if a hospital qualifies as either 
an applicable hospital or high Medicaid facility, CMS does not have the 
discretion to grant less than the requested increase in facility 
capacity.
    In accordance with section 1877(i)(3) of the Act, we are granting 
DHR's request for an exception to the prohibition against expansion of 
facility capacity based on the following criteria:

[[Page 55853]]

     DHR is located in Hidalgo County, which has a percentage 
increase in population that is at least 150 percent of the percentage 
increase in Texas' population during the most recent 5-year period for 
which data was available as of the date that DHR submitted its request;
     DHR has an annual percentage of total inpatient admissions 
under Medicaid that is equal to or greater than the average percentage 
with respect to such admissions for all hospitals located in Hidalgo 
County during the most recent 12-month period for which data are 
available as of the date that DHR submitted its request;
     DHR certified and provided satisfactory documentation that 
it does not discriminate against beneficiaries of Federal health care 
programs and does not permit physicians practicing at the hospital to 
discriminate against such beneficiaries;
     DHR is located in Texas, which has an average bed capacity 
that is less than the national average bed capacity during the most 
recent fiscal year for which HCRIS, as of the date that the hospital 
submitted its request, contained data from a sufficient number of 
hospitals to determine Texas' average bed capacity and the national 
average bed capacity; and
     DHR has an average bed occupancy rate that is greater than 
the average bed occupancy rate in Texas during the most recent fiscal 
year for which HCRIS, as of the date that DHR submitted its request, 
contained data from a sufficient number of hospitals to determine its 
average bed occupancy rate and Texas' average bed occupancy rate.
    In determining that DHR satisfied the Medicaid inpatient 
admissions, bed capacity and bed occupancy criteria, we deemed the 
HCRIS and Texas State Medicaid Agency data used by DHR to satisfy the 
standards set forth in the regulations published on November 10, 2014, 
for those criteria.
    Our approval grants DHR's request to add a total of 551 operating 
rooms, procedure rooms, and beds for which DHR is licensed. Pursuant to 
Sec.  411.362(c)(6), the expansion may occur only in facilities on the 
hospital's main campus and may not result in the number of operating 
rooms, procedure rooms, and beds for which the hospital is licensed to 
exceed 200 percent of the hospital's baseline number of operating 
rooms, procedure rooms, and beds. DHR certified that its baseline 
number of operating rooms, procedure rooms, and beds for which it was 
licensed as of March 23, 2010, was 551. Accordingly, we find that 
granting the additional 551 operating rooms, procedure rooms, and beds 
will not exceed the limitation on a permitted expansion.

IV. Collection of Information Requirements

    This document does not impose information collection requirements, 
that is, reporting, recordkeeping or third-party disclosure 
requirements. Consequently, there is no need for review by the Office 
of Management and Budget under the authority of the Paperwork Reduction 
Act of 1995 (44 U.S.C. 3501 et seq.).

    Dated: September 4, 2015.
Andrew M. Slavitt,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2015-23363 Filed 9-16-15; 8:45 am]
BILLING CODE 4120-01-P



                                                                       Federal Register / Vol. 80, No. 180 / Thursday, September 17, 2015 / Notices                                                 55851

                                                 Frequency of Response: On occasion                   form and instructions. Changes to the                 Federal Deposit Insurance Corporation.
                                              and annual reporting requirements and                   form include updating the edition form                Robert E. Feldman,
                                              third party disclosure requirement.                     date for the electronic form to reflect the           Executive Secretary.
                                                 Obligation to Respond: Required to                   current date, and adding certain                      [FR Doc. 2015–23349 Filed 9–16–15; 8:45 am]
                                              obtain or retain benefits. Statutory                    additional language drawn from the                    BILLING CODE 6714–01–P
                                              authority for this information collection               instructions to the question on device
                                              is contained in 47 U.S.C. Sections 151,                 disclosures through Public Web sites. In
                                              154(i), 157, 160, 201, 202, 208, 214, 301,              the instructions, the Commission is                   DEPARTMENT OF HEALTH AND
                                              303, 308, 309(j), 310 and 610 of the                    updating the edition form date to reflect             HUMAN SERVICES
                                              Communications Act of 1934, as                          the current date, updating a Web site
                                              amended.                                                link that has become inactive, adding                 Centers for Medicare & Medicaid
                                                 Total Annual Burden: 12,063 hours.                   certain informational text to make the                Services
                                                 Total Annual Cost: No costs.                         instructions easier to understand, and
                                                 Privacy Impact Assessment: No                                                                              [CMS–1640–FN]
                                                                                                      updating figures as necessary to reflect
                                              impact(s).                                              the non-substantive changes in the form.
                                                 Total Cost: No costs.                                                                                      Medicare Program; Approval of
                                                 Privacy Impact Assessment: No                        Federal Communications Commission.                    Request for an Exception to the
                                              impact(s).                                              Marlene H. Dortch,                                    Prohibition on Expansion of Facility
                                                 Nature and Extent of Confidentiality:                Secretary, Office of the Secretary.                   Capacity Under the Hospital
                                              Information requested in the reports                    [FR Doc. 2015–23308 Filed 9–16–15; 8:45 am]           Ownership and Rural Provider
                                              may include confidential information.                                                                         Exceptions to the Physician Self-
                                                                                                      BILLING CODE 6712–01–P
                                              However, covered entities are allowed                                                                         Referral Prohibition
                                              to request that such materials submitted                                                                      AGENCY:  Centers for Medicare &
                                              to the Commission be withheld from                                                                            Medicaid Services (CMS), HHS.
                                              public inspection.                                      FEDERAL DEPOSIT INSURANCE                             ACTION: Final notice.
                                                 Needs and Uses: The Commission                       CORPORATION
                                              will submit this information collection                                                                       SUMMARY:   This final notice announces
                                              as an extension to the Office of                        Notice to All Interested Parties of the               our decision to approve the request from
                                              Management and Budget (OMB) after                       Termination of the Receivership of                    Doctors Hospital at Renaissance for an
                                              this 60-day comment period to obtain                    10303, Progress Bank of Florida,                      exception to the prohibition against
                                              the full three year clearance for the                   Tampa, Florida                                        expansion of facility capacity.
                                              collection. There is no change in                                                                             DATES: Effective Date: This notice is
                                              number of respondents/responses, total                     Notice is hereby given that the Federal            effective on September 11, 2015.
                                              annual burden hours, or total annual                    Deposit Insurance Corporation (‘‘FDIC’’)              FOR FURTHER INFORMATION CONTACT:
                                              cost from the previously approved                       as Receiver for Progress Bank of Florida,             Patricia Taft, (410) 786–4561 or Teresa
                                              estimates. As part of the extension                     Tampa, Florida (‘‘the Receiver’’) intends             Walden, (410) 786–3755.
                                              request, the Commission will submit                     to terminate its receivership for said
                                                                                                                                                            SUPPLEMENTARY INFORMATION:
                                              certain non-substantive changes for                     institution. The FDIC was appointed
                                              approval, as described below.                           receiver of Progress Bank of Florida on               I. Background
                                                 The collection is necessary to                       October 22, 2010. The liquidation of the                 Section 1877 of the Social Security
                                              implement certain disclosure                            receivership assets has been completed.               Act (the Act), also known as the
                                              requirements that are part of the                       To the extent permitted by available                  physician self-referral law—(1) prohibits
                                              Commission’s wireless hearing aid                       funds and in accordance with law, the                 a physician from making referrals for
                                              compatibility rule. In a Report and                     Receiver will be making a final dividend              certain ‘‘designated health services’’
                                              Order in WT Docket No. 01–309, FCC                      payment to proven creditors.                          (DHS) payable by Medicare to an entity
                                              03–168, adopted and released in                            Based upon the foregoing, the                      with which he or she (or an immediate
                                              September 2003, implementing a                          Receiver has determined that the                      family member) has a financial
                                              mandate under the Hearing Aid                           continued existence of the receivership               relationship (ownership or
                                              Compatibility Act of 1988, the                          will serve no useful purpose.                         compensation), unless the requirements
                                              Commission required digital wireless                    Consequently, notice is given that the                of an applicable exception are satisfied;
                                              phone manufacturers and service                         receivership shall be terminated, to be               and (2) prohibits the entity from filing
                                              providers to make certain digital                       effective no sooner than thirty days after            claims with Medicare (or billing another
                                              wireless phones capable of effective use                the date of this Notice. If any person                individual, entity, or third party payer)
                                              with hearing aids, label certain phones                 wishes to comment concerning the                      for those DHS furnished as a result of a
                                              they sold with information about their                  termination of the receivership, such                 prohibited referral.
                                              compatibility with hearing aids, and                    comment must be made in writing and                      Section 1877(d)(2) of the Act provides
                                              report to the Commission (at first every                sent within thirty days of the date of                an exception, known as the rural
                                              six months, then on an annual basis) on                 this Notice to: Federal Deposit                       provider exception, for physician
                                              the numbers and types of hearing aid-                   Insurance Corporation, Division of                    ownership or investment interests in
                                              compatible phones they were producing                   Resolutions and Receiverships,                        rural providers. In order for an entity to
                                              or offering to the public. These reporting              Attention: Receivership Oversight                     qualify for the rural provider exception,
                                              requirements were subsequently                          Department 32.1, 1601 Bryan Street,                   the DHS must be furnished in a rural
tkelley on DSK3SPTVN1PROD with NOTICES




                                              amended on several occasions, and the                   Dallas, TX 75201.                                     area (as defined in section 1886(d)(2)(D)
                                              existing, OMB-approved collection                                                                             of the Act) and substantially all the DHS
                                              under this OMB control number                              No comments concerning the                         furnished by the entity must be
                                              includes these modifications.                           termination of this receivership will be              furnished to individuals residing in a
                                                 As part of this extension request, the               considered which are not sent within                  rural area.
                                              Commission is requesting approval of                    this time frame.                                         Section 1877(d)(3) of the Act provides
                                              certain non-substantive changes to the                    Dated: September 14, 2015.                          an exception, known as the hospital


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                                              55852                    Federal Register / Vol. 80, No. 180 / Thursday, September 17, 2015 / Notices

                                              ownership exception, for physician                      input on a request for an exception by                   • Whether the data source used by
                                              ownership or investment interests held                  publishing a notice of the request in the             DHR to demonstrate satisfaction of the
                                              in a hospital located outside of Puerto                 Federal Register. Individuals and                     inpatient Medicaid admissions criterion
                                              Rico, provided that the referring                       entities have 30 days to submit written               at § 411.362(c)(2)(ii) was permissible;
                                              physician is authorized to perform                      comments on the request, which may                       • Whether DHR satisfied the non-
                                              services at the hospital and the                        include documentation demonstrating                   discrimination criterion at
                                              ownership or investment interest is in                  that the physician-owned hospital                     § 411.362(c)(2)(iii);
                                              the hospital itself (and not merely in a                requesting the exception does or does                    • How a facility expansion by DHR
                                              subdivision of the hospital).                           not qualify as an ‘‘applicable hospital’’             would affect the community in which it
                                                 Section 6001(a)(3) of the Patient                    or ‘‘high Medicaid facility,’’ as defined             is located; and
                                              Protection and Affordable Care Act                      in § 411.362(c)(2) and (c)(3),                           • The amount of increased facility
                                              (Pub. L. 111–148) as amended by the                     respectively. We notify the hospital of               capacity requested by DHR.
                                              Health Care and Education                               comments received, and the hospital                      On June 16, 2015, as required by
                                              Reconciliation Act of 2010 (Pub. L. 111–                has 30 days after such notice to submit               § 411.362(c)(5)(ii), we notified DHR that
                                              152) (hereafter referred to together as                 a rebuttal statement (§ 411.362(c)(5)(ii)).           we received comments in response to
                                              ‘‘the Affordable Care Act’’) amended the                Section 411.362(c)(5) also specifies the              the May 8, 2015 notice and that these
                                              hospital ownership and rural provider                   timing for when CMS deems a request                   comments were available for public
                                              exceptions to the physician self-referral               for an exception to the facility                      viewing at http://www.regulations.gov.
                                              prohibition to impose additional                        expansion prohibition complete.                       DHR submitted a rebuttal statement on
                                              restrictions on physician ownership and                    If we grant the request for an
                                                                                                                                                            July 15, 2015. The statement rebutted
                                              investment in hospitals. Since March                    exception, the expansion may occur
                                                                                                                                                            each of the commenters’ assertions
                                              23, 2010, a physician-owned hospital                    only in facilities on the hospital’s main
                                                                                                                                                            regarding the applicable hospital
                                              that seeks to avail itself of either                    campus and may not result in the
                                                                                                                                                            eligibility criteria and addressed the
                                              exception is prohibited from expanding                  number of operating rooms, procedure
                                                                                                                                                            concerns expressed by the commenters
                                              facility capacity unless it qualifies as an             rooms, and beds for which the hospital
                                                                                                                                                            regarding an expansion by the hospital.
                                              ‘‘applicable hospital’’ or ‘‘high Medicaid              is licensed to exceed 200 percent of the
                                              facility’’ (as defined in sections                      hospital’s baseline number of operating               IV. Decision
                                              1877(i)(3)(E), (F) of the Act and 42 CFR                rooms, procedure rooms, and beds
                                                                                                                                                              This final notice announces our
                                              411.362(c)(2), (3) of our regulations) and              (§ 411.362(c)(6)).
                                                                                                                                                            decision to approve DHR’s request for
                                              has been granted an exception to the
                                                                                                      III. Public Response to Notice With                   an exception to the prohibition against
                                              facility expansion prohibition by the
                                                                                                      Comment Period                                        expansion of facility capacity. As
                                              Secretary of the Department of Health
                                                                                                         On May 8, 2015, we published a                     required by our current regulations and
                                              and Human Services (the Secretary).
                                                                                                      notice in the Federal Register (80 FR                 public guidance documents, DHR
                                              Section 1877(i)(3)(A)(ii) of the Act
                                              provides that individuals and entities in               26566) entitled, ‘‘Request for an                     submitted the data and certifications
                                              the community in which the provider                     Exception to the Prohibition on                       necessary to demonstrate that it satisfies
                                              requesting the exception is located must                Expansion of Facility Capacity under                  the criteria to qualify as an applicable
                                              have an opportunity to provide input                    the Hospital Ownership and Rural                      hospital. Further, CMS considered the
                                              with respect to the provider’s request for              Provider Exceptions to the Physician                  assertions of the commenters about
                                              an exception. Section 1877(i)(3)(H) of                  Self-Referral Prohibition.’’ In the May 8,            DHR’s compliance with the procedural
                                              the Act states that the Secretary shall                 2015 notice, we stated that as permitted              requirements set forth at § 411.362(c),
                                              publish in the Federal Register the final               by section 1877(i)(3) of the Act and our              the population growth criterion under
                                              decision with respect to a request for an               regulations at § 411.362(c), the following            § 411.362(c)(2)(i), the data source used
                                              exception to the prohibition against                    physician-owned hospital requested an                 by DHR to demonstrate satisfaction of
                                              facility expansion not later than 60 days               exception to the prohibition on                       the inpatient Medicaid admissions
                                              after receiving a complete application.                 expansion of facility capacity:                       criterion at § 411.362(c)(2)(ii), and the
                                                                                                         Name of Facility: Doctors Hospital at              non-discrimination criterion at
                                              II. Exception Approval Process                                                                                § 411.362(c)(2)(iii). Following our
                                                                                                      Renaissance (DHR).
                                                 On November 30, 2011, we published                      Location: 5501 South McColl Road,                  review of the information provided by
                                              a final rule in the Federal Register (76                Edinburg, Texas 78539.                                the commenters, we are not persuaded
                                              FR 74122, 74517 through 74525) that,                       Basis for Exception Request:                       that DHR failed to satisfy one or more
                                              among other things, finalized                           Applicable Hospital.                                  of the applicable hospital eligibility
                                              § 411.362(c), which specifies the process                  In the May 8, 2015 notice, we also                 criteria or that its request failed to
                                              for submitting, commenting on, and                      solicited comments from individuals                   conform to our procedural
                                              reviewing a request for an exception to                 and entities in the community in which                requirements. Also, CMS cannot
                                              the prohibition on expansion of facility                DHR is located.                                       consider any concerns unrelated to the
                                              capacity. We published a subsequent                        We received 21 comments, 14 of                     statutory and regulatory eligibility
                                              final rule in the Federal Register on                   which were variations of a form letter,               criteria when determining whether to
                                              November 10, 2014 (79 FR 66770, 66987                   and commenters generally opposed                      grant an exception to a requesting
                                              through 66997) that made certain                        DHR’s request to expand.                              hospital. In addition, if a hospital
                                              revisions. These revisions include,                        One or more of the commenters raised               qualifies as either an applicable hospital
                                              among other things, permitting the use                  questions or concerns regarding:                      or high Medicaid facility, CMS does not
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                                              of data from an external data source, as                   • Whether DHR’s request conforms to                have the discretion to grant less than the
                                              defined in our regulations, or from the                 the procedural requirements set forth at              requested increase in facility capacity.
                                              Hospital Cost Report Information                        § 411.362(c);                                           In accordance with section 1877(i)(3)
                                              System (HCRIS) for specific eligibility                    • Whether DHR demonstrated that it                 of the Act, we are granting DHR’s
                                              criteria.                                               satisfied the population growth criterion             request for an exception to the
                                                 As stated in our regulations at                      using the data required under                         prohibition against expansion of facility
                                              § 411.362(c)(5), we solicit community                   § 411.362(c)(2)(i);                                   capacity based on the following criteria:


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                                                                          Federal Register / Vol. 80, No. 180 / Thursday, September 17, 2015 / Notices                                                55853

                                                • DHR is located in Hidalgo County,                         Our approval grants DHR’s request to                  OMB No.: New Collection
                                              which has a percentage increase in                         add a total of 551 operating rooms,                      Description: The Administration for
                                              population that is at least 150 percent of                 procedure rooms, and beds for which                    Children and Families (ACF) is
                                              the percentage increase in Texas’                          DHR is licensed. Pursuant to                           proposing a data collection activity as
                                              population during the most recent 5-                       § 411.362(c)(6), the expansion may                     part of the Goal-Oriented Adult
                                              year period for which data was available                   occur only in facilities on the hospital’s
                                                                                                                                                                Learning in Self-Sufficiency (GOALS)
                                              as of the date that DHR submitted its                      main campus and may not result in the
                                              request;                                                                                                          study. The purpose of the GOALS
                                                                                                         number of operating rooms, procedure
                                                • DHR has an annual percentage of                        rooms, and beds for which the hospital                 project is to address the nexus between
                                              total inpatient admissions under                           is licensed to exceed 200 percent of the               the growing knowledge base in the
                                              Medicaid that is equal to or greater than                  hospital’s baseline number of operating                psychological sciences and long-
                                              the average percentage with respect to                     rooms, procedure rooms, and beds. DHR                  standing approaches to self-sufficiency
                                              such admissions for all hospitals located                  certified that its baseline number of                  programs targeted to adults and young
                                              in Hidalgo County during the most                          operating rooms, procedure rooms, and                  adults. The project will explore the
                                              recent 12-month period for which data                      beds for which it was licensed as of                   programmatic implications of existing
                                              are available as of the date that DHR                      March 23, 2010, was 551. Accordingly,                  research on psychological processes
                                              submitted its request;                                     we find that granting the additional 551               associated with goal-directed behaviors,
                                                • DHR certified and provided                             operating rooms, procedure rooms, and                  including socio-emotional regulation
                                              satisfactory documentation that it does                    beds will not exceed the limitation on                 and cognitive skills, executive
                                              not discriminate against beneficiaries of                  a permitted expansion.                                 functioning, and related areas. The
                                              Federal health care programs and does                                                                             project will synthesize current research
                                              not permit physicians practicing at the                    IV. Collection of Information
                                                                                                         Requirements                                           on these topics; address how insights
                                              hospital to discriminate against such
                                                                                                                                                                gained from research can be used to
                                              beneficiaries;                                               This document does not impose
                                                 • DHR is located in Texas, which has                                                                           promote economic advancement among
                                                                                                         information collection requirements,                   low-income populations, identify
                                              an average bed capacity that is less than                  that is, reporting, recordkeeping or
                                              the national average bed capacity during                                                                          promising strategies, or strengthen
                                                                                                         third-party disclosure requirements.
                                              the most recent fiscal year for which                                                                             underlying skills in these areas; and
                                                                                                         Consequently, there is no need for
                                              HCRIS, as of the date that the hospital                                                                           inform measurement of changes and
                                                                                                         review by the Office of Management and
                                              submitted its request, contained data                      Budget under the authority of the                      developments in skill acquisition.
                                              from a sufficient number of hospitals to                   Paperwork Reduction Act of 1995 (44                      The proposed information collection
                                              determine Texas’ average bed capacity                      U.S.C. 3501 et seq.).                                  activity consists of exploratory calls
                                              and the national average bed capacity;                                                                            with program directors and
                                              and                                                          Dated: September 4, 2015.
                                                                                                                                                                administrators, semi-structured
                                                 • DHR has an average bed occupancy                      Andrew M. Slavitt,
                                                                                                         Acting Administrator, Centers for Medicare             interviews with key program staff and
                                              rate that is greater than the average bed
                                                                                                         & Medicaid Services.                                   community partner organization staff,
                                              occupancy rate in Texas during the most
                                              recent fiscal year for which HCRIS, as of                  [FR Doc. 2015–23363 Filed 9–16–15; 8:45 am]            and focus group discussions with
                                              the date that DHR submitted its request,                   BILLING CODE 4120–01–P
                                                                                                                                                                program participants. ACF seeks to gain
                                              contained data from a sufficient number                                                                           an in-depth, systematic understanding
                                              of hospitals to determine its average bed                                                                         of program administration and
                                              occupancy rate and Texas’ average bed                      DEPARTMENT OF HEALTH AND                               implementation, service delivery and
                                              occupancy rate.                                            HUMAN SERVICES                                         operation, outputs and outcomes, and
                                                 In determining that DHR satisfied the                                                                          identify promising practices and other
                                              Medicaid inpatient admissions, bed                         Administration for Children and                        areas for further study.
                                              capacity and bed occupancy criteria, we                    Families
                                                                                                                                                                  Respondents: Key program directors
                                              deemed the HCRIS and Texas State                                                                                  and administrators, program staff and
                                                                                                         Submission for OMB Review;
                                              Medicaid Agency data used by DHR to                                                                               community partner organization staff,
                                                                                                         Comment Request
                                              satisfy the standards set forth in the                                                                            and program participants at selected
                                              regulations published on November 10,                        Title: Goal-Oriented Adult Learning in
                                                                                                                                                                program sites.
                                              2014, for those criteria.                                  Self-Sufficiency Study
                                                                                                                 ANNUAL BURDEN ESTIMATES
                                                                                                                                               Annual           Number of           Average
                                                                                                                         Total number                                                            Total burden
                                                                           Instrument                                                        number of        responses per       burden hours
                                                                                                                        of respondents                                                              hours
                                                                                                                                            respondents         respondent        per response

                                              Exploratory telephone call semi-structured interview—pro-
                                                gram directors and administrators ...................................                  24                12                 1                1             12
                                              Site visit semi-structured interview—program staff and
                                                community partner organization staff ...............................                  180                90                 1             1.25            113
                                              Site visit group discussion—program participants ...............                         84                42                 1             1.25             53
tkelley on DSK3SPTVN1PROD with NOTICES




                                                Estimated Total Annual Burden                            Children and Families, Office of                       be identified by the title of the
                                              Hours: 178.                                                Planning, Research and Evaluation, 370                 information collection. Email address:
                                                Additional Information: Copies of the                    L’Enfant Promenade SW., Washington,                    OPREinfocollection@acf.hhs.gov.
                                              proposed collection may be obtained by                     DC 20447, Attn: OPRE Reports                             OMB Comment: OMB is required to
                                              writing to the Administration for                          Clearance Officer. All requests should                 make a decision concerning the


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Document Created: 2015-12-15 09:34:02
Document Modified: 2015-12-15 09:34:02
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionNotices
ActionFinal notice.
ContactPatricia Taft, (410) 786-4561 or Teresa Walden, (410) 786-3755.
FR Citation80 FR 55851 

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