82_FR_16212 82 FR 16150 - Medicare and Medicaid Programs; Conditions of Participation for Home Health Agencies; Delay of Effective Date

82 FR 16150 - Medicare and Medicaid Programs; Conditions of Participation for Home Health Agencies; Delay of Effective Date

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

Federal Register Volume 82, Issue 62 (April 3, 2017)

Page Range16150-16152
FR Document2017-06540

This proposed rule would delay the effective date for the final rule entitled ``Medicare and Medicaid Programs: Conditions of Participation for Home Health Agencies'' published in the Federal Register on January 13, 2017. The current effective date for the final rule is July 13, 2017, and this rule proposes to delay the effective date for an additional 6 months until January 13, 2018. This proposed rule would also make two conforming changes to dates that are included in the regulations text.

Federal Register, Volume 82 Issue 62 (Monday, April 3, 2017)
[Federal Register Volume 82, Number 62 (Monday, April 3, 2017)]
[Proposed Rules]
[Pages 16150-16152]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2017-06540]



[[Page 16150]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 409, 410, 418, 440, 484, 485 and 488

[CMS-3819-P2]
RIN 0938-AG81


Medicare and Medicaid Programs; Conditions of Participation for 
Home Health Agencies; Delay of Effective Date

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

ACTION: Proposed rule.

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

SUMMARY: This proposed rule would delay the effective date for the 
final rule entitled ``Medicare and Medicaid Programs: Conditions of 
Participation for Home Health Agencies'' published in the Federal 
Register on January 13, 2017. The current effective date for the final 
rule is July 13, 2017, and this rule proposes to delay the effective 
date for an additional 6 months until January 13, 2018. This proposed 
rule would also make two conforming changes to dates that are included 
in the regulations text.

DATES: To be assured consideration, comments must be received at one of 
the addresses provided below, no later than 5 p.m. on June 2, 2017.

ADDRESSES: In commenting, please refer to file code CMS-3819-P2. 
Because of staff and resource limitations, we cannot accept comments by 
facsimile (FAX) transmission.
    You may submit comments in one of four ways (please choose only one 
of the ways listed):
    1. Electronically. You may submit electronic comments on this 
regulation to http://www.regulations.gov. Follow the ``Submit a 
comment'' instructions.
    2. By regular mail. You may mail written comments to the following 
address ONLY: Centers for Medicare & Medicaid Services, Department of 
Health and Human Services, Attention: CMS-3819-P2, P.O. Box 8010, 
Baltimore, MD 21244-1850.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send written comments to 
the following address ONLY: Centers for Medicare & Medicaid Services, 
Department of Health and Human Services, Attention: CMS-3819-P2, Mail 
Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    4. By hand or courier. Alternatively, you may deliver (by hand or 
courier) your written comments ONLY to the following addresses prior to 
the close of the comment period:
    a. For delivery in Washington, DC--Centers for Medicare & Medicaid 
Services, Department of Health and Human Services, Room 445-G, Hubert 
H. Humphrey Building, 200 Independence Avenue SW., Washington, DC 
20201.
    (Because access to the interior of the Hubert H. Humphrey Building 
is not readily available to persons without Federal government 
identification, commenters are encouraged to leave their comments in 
the CMS drop slots located in the main lobby of the building. A stamp-
in clock is available for persons wishing to retain a proof of filing 
by stamping in and retaining an extra copy of the comments being 
filed.)
    b. For delivery in Baltimore, MD-- Centers for Medicare & Medicaid 
Services, Department of Health and Human Services, 7500 Security 
Boulevard, Baltimore, MD 21244-1850.
    If you intend to deliver your comments to the Baltimore address, 
call telephone number (410) 786-9994 in advance to schedule your 
arrival with one of our staff members.
    Comments erroneously mailed to the addresses indicated as 
appropriate for hand or courier delivery may be delayed and received 
after the comment period.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Danielle Shearer (410) 786-6617. Mary 
Rossi-Coajou (410) 786-6051. Maria Hammel (410) 786-1775.

SUPPLEMENTARY INFORMATION: Inspection of Public Comments: All comments 
received before the close of the comment period are available for 
viewing by the public, including any personally identifiable or 
confidential business information that is included in a comment. We 
post all comments received before the close of the comment period on 
the following Web site as soon as possible after they have been 
received: http://www.regulations.gov. Follow the search instructions on 
that Web site to view public comments.
    Comments received timely will also be available for public 
inspection as they are received, generally beginning approximately 3 
weeks after publication of a document, at the headquarters of the 
Centers for Medicare & Medicaid Services, 7500 Security Boulevard, 
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 
a.m. to 4 p.m. To schedule an appointment to view public comments, 
phone 1-800-743-3951.

I. Background

    On October 9, 2014, we published the proposed rule ``Medicare and 
Medicaid Programs: Conditions of Participation for Home Health 
Agencies'' (hereinafter ``October 2014 HHA CoPs proposed rule'') in the 
Federal Register (79 FR 61164) and provided a 60 day comment period. On 
December 1, 2014, in response to public comments requesting additional 
time to respond to the proposed rule, we published a notice of 
extension of the comment period (79 FR 71081), which extended the 
public comment period for the October 2014 HHA CoPs proposed rule an 
additional 30 days, from December 8, 2014 to January 7, 2015. The vast 
majority of commenters on the October 2014 HHA CoPs proposed rule made 
suggestions related to the effective date of the final rule (``Medicare 
and Medicaid Programs; Conditions of Participation for Home Health 
Agencies'', January 13, 2017, (82 FR 4504), hereinafter ``January 2017 
HHA CoPs final rule''). Commenters strongly expressed a need for a 
significant period of time to prepare for implementation of the new 
rules, noting that HHAs would need to adjust resource allocation, 
staffing, and potentially even infrastructure. Recommended effective 
date time frames ranged from 6 months after publication of the final 
rule to 5 years after publication of the final rule. The most frequent 
recommendation received was to finalize an effective date that was 1 
year after the publication of the final rule. We agreed with commenters 
that it was appropriate to allow additional time for HHAs to prepare 
for the changes being set forth in the HHA CoPs final rule. Therefore, 
when we published the January 2017 HHA CoPs final rule in the Federal 
Register on January 13, 2017, we finalized an effective date of July 
13, 2017 (that is, 6 months after the final rule was published in the 
Federal Register).
    The January 2017 HHA CoPs final rule revised the CoPs that HHAs 
must meet in order to participate in the Medicare and Medicaid 
programs. The requirements focus on the care delivered to patients by 
HHAs, reflect an interdisciplinary view of patient care, allow HHAs 
greater flexibility in meeting quality care standards, and eliminate 
unnecessary procedural requirements. These changes are an integral part 
of our overall effort to achieve broad-based, measurable improvements 
in the quality of care furnished through the Medicare and Medicaid 
programs, while at the same time eliminating unnecessary procedural 
burdens on providers. We

[[Page 16151]]

believe that the overall approach of the CoPs provides HHAs with 
greatly enhanced flexibility. At the same time, we believe the new 
requirements help HHAs achieve needed and desired outcomes for 
patients, increasing patient satisfaction with the services provided.

II. Provisions of the Proposed Regulations

    Following publication of the January 2017 HHA CoPs final rule, we 
received inquiries that represented a large number of HHAs requesting 
that the agency delay the effective date for the new HHA CoPs. The 
inquiries asserted that HHAs were not able to effectively implement the 
new CoPs until CMS issued its revised Interpretive Guidelines (State 
Operations Manual, CMS Pub. 100-07, Appendix B). In addition, one of 
the inquiries stated that HHAs were unable to effectively implement the 
new CoPs until CMS issued further sub-regulatory guidance related to 
converting subunits to branches or independent HHAs, which would impact 
216 HHAs nationwide. One of the inquiries cited the estimated $300 
million cost to implement the new requirements as a reason for delaying 
the effective date.
    We believe that the concerns expressed in the inquiries have merit, 
so in response to the concerns summarized above, we propose to delay 
the effective date of the January 2017 HHA CoPs final rule for an 
additional 6 months. The effective date for the January 2017 HHA CoPs 
final rule, which is currently set to become effective on July 13, 
2017, would be delayed until January 13, 2018.
    We also propose to make two conforming changes to dates that appear 
in the regulations text of the January 2017 HHA CoPs final rule. First, 
we included a phase-in date for the requirements at Sec.  484.65(d)--
``Standard: Performance improvement projects.'' This phase-in date 
allowed HHAs an additional 6 months after the January 2017 HHA CoPs 
final rule became effective to collect data before implementing data-
driven performance improvement projects. We continue to believe that it 
is appropriate to phase-in the performance improvement project 
requirement 6 months after the provisions of the January 2017 HHA CoPs 
final rule become effective. Therefore, we propose to revise the phase-
in date for the requirements at Sec.  484.65(d) by replacing the 
January 13, 2018 date with a July 13, 2018 date.
    Second, we propose to revise Sec.  484.115(a)--``Standard: 
Administrator, home health agency.'' In this provision, we 
grandfathered in all administrators employed by HHAs prior to the 
effective date of the January 2017 HHA CoPs final rule, meaning that 
those administrators employed by an HHA prior to July 13, 2017 would 
not have to meet the new personnel requirements. We propose to replace 
the July 13, 2017 effective date at Sec.  484.115(a)(1) and (2) with 
the proposed effective date of January 13, 2018.

III. 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.).

IV. Response to Comments

    Because of the large number of public comments we normally receive 
on Federal Register documents, we are not able to acknowledge or 
respond to them individually. We will consider all comments we receive 
by the date and time specified in the DATES section of this preamble, 
and, when we proceed with a subsequent document, we will respond to the 
comments in the preamble to that document.

V. Regulatory Impact Statement

    We have examined the impact of this rule as required by Executive 
Order 12866 on Regulatory Planning and Review (September 30, 1993), 
Executive Order 13563 on Improving Regulation and Regulatory Review 
(January 18, 2011), the Regulatory Flexibility Act (RFA) (September 19, 
1980, Pub. L. 96-354), section 1102(b) of the Social Security Act, 
section 202 of the Unfunded Mandates Reform Act of 1995 (March 22, 
1995; Pub. L. 104-4), Executive Order 13132 on Federalism (August 4, 
1999), the Congressional Review Act (5 U.S.C. 804(2), and Executive 
Order 13771 on Reducing Regulation and Controlling Regulatory Costs 
(January 30, 2017).
    Executive Orders 12866 and 13563 direct agencies to assess all 
costs and benefits of available regulatory alternatives and, if 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, distributive impacts, and equity). A 
regulatory impact analysis (RIA) must be prepared for major rules with 
economically significant effects ($100 million or more in any 1 year). 
This rule does not reach the economic threshold and thus is not 
considered a major rule.
    The RFA requires agencies to analyze options for regulatory relief 
of small entities. For purposes of the RFA, small entities include 
small businesses, nonprofit organizations, and small governmental 
jurisdictions. Most hospitals and most other providers and suppliers 
are small entities, either by nonprofit status or by having revenues of 
less than $7.5 million to $38.5 million in any 1 year. Individuals and 
States are not included in the definition of a small entity. We are not 
preparing an analysis for the RFA because we have determined, and the 
Secretary certifies, that this proposed rule would not have a 
significant economic impact on a substantial number of small entities.
    In addition, section 1102(b) of the Social Security Act requires us 
to prepare a regulatory impact analysis if a rule may have a 
significant impact on the operations of a substantial number of small 
rural hospitals. This 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 of 
a Metropolitan Statistical Area for Medicare payment regulations and 
has fewer than 100 beds. We are not preparing an analysis for section 
1102(b) of the Act because we have determined, and the Secretary 
certifies, that this proposed rule would not have a significant impact 
on the operations of a substantial number of small rural hospitals.
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any rule whose mandates require spending in any 1 year of $100 
million in 1995 dollars, updated annually for inflation. Currently, 
that threshold is approximately $146 million. This rule will have no 
consequential effect on state, local, or tribal governments or on the 
private sector.
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a proposed rule (and subsequent 
final rule) that imposes substantial direct requirement costs on state 
and local governments, preempts state law, or otherwise has Federalism 
implications. Since this regulation does not impose any costs on state 
or local governments, the requirements of Executive Order 13132 are not 
applicable.
    Executive Order 13771, entitled ``Reducing Regulation and 
Controlling Regulatory Costs,'' was issued on January 30, 2017 (82 FR 
9339, February 3, 2017). Section 2(a) of Executive Order

[[Page 16152]]

13771 requires an agency, unless prohibited by law, to identify at 
least two existing regulations to be repealed when the agency publicly 
proposes for notice and comment or otherwise promulgates a new 
regulation. In furtherance of this requirement, section 2(c) of 
Executive Order 13771 requires that the new incremental costs 
associated with new regulations shall, to the extent permitted by law, 
be offset by the elimination of existing costs associated with at least 
two prior regulations. OMB's interim guidance, issued on February 2, 
2017, https://www.whitehouse.gov/the-press-office/2017/02/02/interim-guidance-implementing-section-2-executive-order-january-30-2017, 
explains that for Fiscal Year 2017 the above requirements only apply to 
each new ``significant regulatory action that imposes costs.'' It has 
been determined that this proposed rule is not a ``significant 
regulatory action that imposes costs'' and thus does not trigger the 
above requirements of Executive Order 13771.
    In accordance with the provisions of Executive Order 12866, this 
regulation was reviewed by the Office of Management and Budget.

List of Subjects

42 CFR Part 409

    Health facilities, Medicare.

42 CFR Part 410

    Health facilities, Health professions, Kidney diseases, 
Laboratories, Medicare, Reporting and recordkeeping requirements, Rural 
areas, X-rays.

42 CFR Part 418

    Health facilities, Hospice care, Medicare, Reporting and 
recordkeeping requirements.

42 CFR Part 440

    Grant programs--health, Medicaid.

42 CFR Part 484

    Health facilities, Health professions, Medicare, Reporting and 
recordkeeping requirements.

42 CFR Part 485

    Grant programs--health, Health facilities, Medicaid, Medicare, 
Reporting and recordkeeping requirements.

42 CFR Part 488

    Administrative practice and procedure, Health facilities, Medicare, 
Reporting and recordkeeping requirements.
    For the reasons set forth in the preamble, the Centers for Medicare 
& Medicaid Services proposes to delay the effective date for the final 
rule published on January 13, 2017 (82 FR 4504) and to further amend 42 
CFR chapter IV as set forth below:

PART 484--HOME HEALTH SERVICES

0
1. The authority citation for part 484 continues to read as follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395(hh)) unless otherwise indicated.


Sec.  484.65  [Amend]

0
2. In Sec.  484.65, amend paragraph (d) by removing the date ``January 
13, 2018'' and adding in its place ``July 13, 2018''.


Sec.  484.115  [Amend]

0
3. In Sec.  484.115, amend paragraphs (a)(1) and (2) by removing the 
date ``July 13, 2017'' and adding in its place ``January 13, 2018''.

    Dated: March 28, 2017.
Seema Verma,
Administrator, Centers for Medicare & Medicaid Services.
    Dated: March 28, 2017.
Thomas E. Price,
Secretary, Department of Health and Human Services.
[FR Doc. 2017-06540 Filed 3-31-17; 8:45 am]
BILLING CODE 4120-01-P



                                                    16150                     Federal Register / Vol. 82, No. 62 / Monday, April 3, 2017 / Proposed Rules

                                                    DEPARTMENT OF HEALTH AND                                your written comments ONLY to the                     I. Background
                                                    HUMAN SERVICES                                          following addresses prior to the close of                On October 9, 2014, we published the
                                                                                                            the comment period:                                   proposed rule ‘‘Medicare and Medicaid
                                                    Centers for Medicare & Medicaid                            a. For delivery in Washington, DC—                 Programs: Conditions of Participation
                                                    Services                                                Centers for Medicare & Medicaid                       for Home Health Agencies’’ (hereinafter
                                                                                                            Services, Department of Health and                    ‘‘October 2014 HHA CoPs proposed
                                                    42 CFR Parts 409, 410, 418, 440, 484,                   Human Services, Room 445–G, Hubert                    rule’’) in the Federal Register (79 FR
                                                    485 and 488                                             H. Humphrey Building, 200                             61164) and provided a 60 day comment
                                                    [CMS–3819–P2]                                           Independence Avenue SW.,                              period. On December 1, 2014, in
                                                                                                            Washington, DC 20201.                                 response to public comments requesting
                                                    RIN 0938–AG81                                              (Because access to the interior of the             additional time to respond to the
                                                                                                            Hubert H. Humphrey Building is not                    proposed rule, we published a notice of
                                                    Medicare and Medicaid Programs;                         readily available to persons without
                                                    Conditions of Participation for Home                                                                          extension of the comment period (79 FR
                                                                                                            Federal government identification,                    71081), which extended the public
                                                    Health Agencies; Delay of Effective
                                                                                                            commenters are encouraged to leave                    comment period for the October 2014
                                                    Date
                                                                                                            their comments in the CMS drop slots                  HHA CoPs proposed rule an additional
                                                    AGENCY:  Centers for Medicare &                         located in the main lobby of the                      30 days, from December 8, 2014 to
                                                    Medicaid Services (CMS), HHS.                           building. A stamp-in clock is available               January 7, 2015. The vast majority of
                                                    ACTION: Proposed rule.                                  for persons wishing to retain a proof of              commenters on the October 2014 HHA
                                                                                                            filing by stamping in and retaining an                CoPs proposed rule made suggestions
                                                    SUMMARY:    This proposed rule would                    extra copy of the comments being filed.)
                                                    delay the effective date for the final rule                                                                   related to the effective date of the final
                                                                                                               b. For delivery in Baltimore, MD—                  rule (‘‘Medicare and Medicaid
                                                    entitled ‘‘Medicare and Medicaid                        Centers for Medicare & Medicaid
                                                    Programs: Conditions of Participation                                                                         Programs; Conditions of Participation
                                                                                                            Services, Department of Health and                    for Home Health Agencies’’, January 13,
                                                    for Home Health Agencies’’ published                    Human Services, 7500 Security
                                                    in the Federal Register on January 13,                                                                        2017, (82 FR 4504), hereinafter ‘‘January
                                                                                                            Boulevard, Baltimore, MD 21244–1850.                  2017 HHA CoPs final rule’’).
                                                    2017. The current effective date for the                   If you intend to deliver your
                                                    final rule is July 13, 2017, and this rule                                                                    Commenters strongly expressed a need
                                                                                                            comments to the Baltimore address, call               for a significant period of time to
                                                    proposes to delay the effective date for                telephone number (410) 786–9994 in
                                                    an additional 6 months until January 13,                                                                      prepare for implementation of the new
                                                                                                            advance to schedule your arrival with                 rules, noting that HHAs would need to
                                                    2018. This proposed rule would also                     one of our staff members.
                                                    make two conforming changes to dates                                                                          adjust resource allocation, staffing, and
                                                                                                               Comments erroneously mailed to the                 potentially even infrastructure.
                                                    that are included in the regulations text.              addresses indicated as appropriate for
                                                    DATES: To be assured consideration,
                                                                                                                                                                  Recommended effective date time
                                                                                                            hand or courier delivery may be delayed               frames ranged from 6 months after
                                                    comments must be received at one of                     and received after the comment period.
                                                    the addresses provided below, no later                                                                        publication of the final rule to 5 years
                                                                                                               For information on viewing public                  after publication of the final rule. The
                                                    than 5 p.m. on June 2, 2017.                            comments, see the beginning of the                    most frequent recommendation received
                                                    ADDRESSES: In commenting, please refer                  SUPPLEMENTARY INFORMATION section.
                                                                                                                                                                  was to finalize an effective date that was
                                                    to file code CMS–3819–P2. Because of                    FOR FURTHER INFORMATION CONTACT:                      1 year after the publication of the final
                                                    staff and resource limitations, we cannot               Danielle Shearer (410) 786–6617. Mary                 rule. We agreed with commenters that it
                                                    accept comments by facsimile (FAX)                      Rossi-Coajou (410) 786–6051. Maria                    was appropriate to allow additional
                                                    transmission.                                           Hammel (410) 786–1775.
                                                       You may submit comments in one of                                                                          time for HHAs to prepare for the
                                                                                                            SUPPLEMENTARY INFORMATION: Inspection                 changes being set forth in the HHA CoPs
                                                    four ways (please choose only one of the
                                                    ways listed):                                           of Public Comments: All comments                      final rule. Therefore, when we
                                                       1. Electronically. You may submit                    received before the close of the                      published the January 2017 HHA CoPs
                                                    electronic comments on this regulation                  comment period are available for                      final rule in the Federal Register on
                                                    to http://www.regulations.gov. Follow                   viewing by the public, including any                  January 13, 2017, we finalized an
                                                    the ‘‘Submit a comment’’ instructions.                  personally identifiable or confidential               effective date of July 13, 2017 (that is,
                                                       2. By regular mail. You may mail                     business information that is included in              6 months after the final rule was
                                                    written comments to the following                       a comment. We post all comments                       published in the Federal Register).
                                                    address ONLY: Centers for Medicare &                    received before the close of the                         The January 2017 HHA CoPs final
                                                    Medicaid Services, Department of                        comment period on the following Web                   rule revised the CoPs that HHAs must
                                                    Health and Human Services, Attention:                   site as soon as possible after they have              meet in order to participate in the
                                                    CMS–3819–P2, P.O. Box 8010,                             been received: http://www.regulations.                Medicare and Medicaid programs. The
                                                    Baltimore, MD 21244–1850.                               gov. Follow the search instructions on                requirements focus on the care
                                                       Please allow sufficient time for mailed              that Web site to view public comments.                delivered to patients by HHAs, reflect
                                                    comments to be received before the                         Comments received timely will also                 an interdisciplinary view of patient
                                                    close of the comment period.                            be available for public inspection as                 care, allow HHAs greater flexibility in
                                                       3. By express or overnight mail. You                 they are received, generally beginning                meeting quality care standards, and
                                                    may send written comments to the                        approximately 3 weeks after publication               eliminate unnecessary procedural
mstockstill on DSK3G9T082PROD with PROPOSALS




                                                    following address ONLY: Centers for                     of a document, at the headquarters of                 requirements. These changes are an
                                                    Medicare & Medicaid Services,                           the Centers for Medicare & Medicaid                   integral part of our overall effort to
                                                    Department of Health and Human                          Services, 7500 Security Boulevard,                    achieve broad-based, measurable
                                                    Services, Attention: CMS–3819–P2,                       Baltimore, Maryland 21244, Monday                     improvements in the quality of care
                                                    Mail Stop C4–26–05, 7500 Security                       through Friday of each week from 8:30                 furnished through the Medicare and
                                                    Boulevard, Baltimore, MD 21244–1850.                    a.m. to 4 p.m. To schedule an                         Medicaid programs, while at the same
                                                       4. By hand or courier. Alternatively,                appointment to view public comments,                  time eliminating unnecessary
                                                    you may deliver (by hand or courier)                    phone 1–800–743–3951.                                 procedural burdens on providers. We


                                               VerDate Sep<11>2014   16:05 Mar 31, 2017   Jkt 241001   PO 00000   Frm 00013   Fmt 4702   Sfmt 4702   E:\FR\FM\03APP1.SGM   03APP1


                                                                              Federal Register / Vol. 82, No. 62 / Monday, April 3, 2017 / Proposed Rules                                           16151

                                                    believe that the overall approach of the                employed by HHAs prior to the effective               threshold and thus is not considered a
                                                    CoPs provides HHAs with greatly                         date of the January 2017 HHA CoPs final               major rule.
                                                    enhanced flexibility. At the same time,                 rule, meaning that those administrators                  The RFA requires agencies to analyze
                                                    we believe the new requirements help                    employed by an HHA prior to July 13,                  options for regulatory relief of small
                                                    HHAs achieve needed and desired                         2017 would not have to meet the new                   entities. For purposes of the RFA, small
                                                    outcomes for patients, increasing patient               personnel requirements. We propose to                 entities include small businesses,
                                                    satisfaction with the services provided.                replace the July 13, 2017 effective date              nonprofit organizations, and small
                                                                                                            at § 484.115(a)(1) and (2) with the                   governmental jurisdictions. Most
                                                    II. Provisions of the Proposed                                                                                hospitals and most other providers and
                                                                                                            proposed effective date of January 13,
                                                    Regulations                                                                                                   suppliers are small entities, either by
                                                                                                            2018.
                                                       Following publication of the January                                                                       nonprofit status or by having revenues
                                                    2017 HHA CoPs final rule, we received                   III. Collection of Information                        of less than $7.5 million to $38.5
                                                    inquiries that represented a large                      Requirements                                          million in any 1 year. Individuals and
                                                    number of HHAs requesting that the                         This document does not impose                      States are not included in the definition
                                                    agency delay the effective date for the                 information collection requirements,                  of a small entity. We are not preparing
                                                    new HHA CoPs. The inquiries asserted                    that is, reporting, recordkeeping or                  an analysis for the RFA because we have
                                                    that HHAs were not able to effectively                  third-party disclosure requirements.                  determined, and the Secretary certifies,
                                                    implement the new CoPs until CMS                        Consequently, there is no need for                    that this proposed rule would not have
                                                    issued its revised Interpretive                         review by the Office of Management and                a significant economic impact on a
                                                    Guidelines (State Operations Manual,                    Budget under the authority of the                     substantial number of small entities.
                                                    CMS Pub. 100–07, Appendix B). In                        Paperwork Reduction Act of 1995 (44                      In addition, section 1102(b) of the
                                                    addition, one of the inquiries stated that              U.S.C. 3501 et seq.).                                 Social Security Act requires us to
                                                    HHAs were unable to effectively                                                                               prepare a regulatory impact analysis if
                                                    implement the new CoPs until CMS                        IV. Response to Comments
                                                                                                                                                                  a rule may have a significant impact on
                                                    issued further sub-regulatory guidance                    Because of the large number of public               the operations of a substantial number
                                                    related to converting subunits to                       comments we normally receive on                       of small rural hospitals. This analysis
                                                    branches or independent HHAs, which                     Federal Register documents, we are not                must conform to the provisions of
                                                    would impact 216 HHAs nationwide.                       able to acknowledge or respond to them                section 603 of the RFA. For purposes of
                                                    One of the inquiries cited the estimated                individually. We will consider all                    section 1102(b) of the Act, we define a
                                                    $300 million cost to implement the new                  comments we receive by the date and                   small rural hospital as a hospital that is
                                                    requirements as a reason for delaying                   time specified in the DATES section of                located outside of a Metropolitan
                                                    the effective date.                                     this preamble, and, when we proceed                   Statistical Area for Medicare payment
                                                       We believe that the concerns                         with a subsequent document, we will                   regulations and has fewer than 100
                                                    expressed in the inquiries have merit, so               respond to the comments in the                        beds. We are not preparing an analysis
                                                    in response to the concerns summarized                  preamble to that document.                            for section 1102(b) of the Act because
                                                    above, we propose to delay the effective                                                                      we have determined, and the Secretary
                                                    date of the January 2017 HHA CoPs final                 V. Regulatory Impact Statement
                                                                                                                                                                  certifies, that this proposed rule would
                                                    rule for an additional 6 months. The                       We have examined the impact of this                not have a significant impact on the
                                                    effective date for the January 2017 HHA                 rule as required by Executive Order                   operations of a substantial number of
                                                    CoPs final rule, which is currently set to              12866 on Regulatory Planning and                      small rural hospitals.
                                                    become effective on July 13, 2017,                      Review (September 30, 1993), Executive                   Section 202 of the Unfunded
                                                    would be delayed until January 13,                      Order 13563 on Improving Regulation                   Mandates Reform Act of 1995 also
                                                    2018.                                                   and Regulatory Review (January 18,                    requires that agencies assess anticipated
                                                       We also propose to make two                          2011), the Regulatory Flexibility Act                 costs and benefits before issuing any
                                                    conforming changes to dates that appear                 (RFA) (September 19, 1980, Pub. L. 96–                rule whose mandates require spending
                                                    in the regulations text of the January                  354), section 1102(b) of the Social                   in any 1 year of $100 million in 1995
                                                    2017 HHA CoPs final rule. First, we                     Security Act, section 202 of the                      dollars, updated annually for inflation.
                                                    included a phase-in date for the                        Unfunded Mandates Reform Act of 1995                  Currently, that threshold is
                                                    requirements at § 484.65(d)—‘‘Standard:                 (March 22, 1995; Pub. L. 104–4),                      approximately $146 million. This rule
                                                    Performance improvement projects.’’                     Executive Order 13132 on Federalism                   will have no consequential effect on
                                                    This phase-in date allowed HHAs an                      (August 4, 1999), the Congressional                   state, local, or tribal governments or on
                                                    additional 6 months after the January                   Review Act (5 U.S.C. 804(2), and                      the private sector.
                                                    2017 HHA CoPs final rule became                         Executive Order 13771 on Reducing                        Executive Order 13132 establishes
                                                    effective to collect data before                        Regulation and Controlling Regulatory                 certain requirements that an agency
                                                    implementing data-driven performance                    Costs (January 30, 2017).                             must meet when it promulgates a
                                                    improvement projects. We continue to                       Executive Orders 12866 and 13563                   proposed rule (and subsequent final
                                                    believe that it is appropriate to phase-                direct agencies to assess all costs and               rule) that imposes substantial direct
                                                    in the performance improvement project                  benefits of available regulatory                      requirement costs on state and local
                                                    requirement 6 months after the                          alternatives and, if regulation is                    governments, preempts state law, or
                                                    provisions of the January 2017 HHA                      necessary, to select regulatory                       otherwise has Federalism implications.
                                                    CoPs final rule become effective.                       approaches that maximize net benefits                 Since this regulation does not impose
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                                                    Therefore, we propose to revise the                     (including potential economic,                        any costs on state or local governments,
                                                    phase-in date for the requirements at                   environmental, public health and safety               the requirements of Executive Order
                                                    § 484.65(d) by replacing the January 13,                effects, distributive impacts, and                    13132 are not applicable.
                                                    2018 date with a July 13, 2018 date.                    equity). A regulatory impact analysis                    Executive Order 13771, entitled
                                                       Second, we propose to revise                         (RIA) must be prepared for major rules                ‘‘Reducing Regulation and Controlling
                                                    § 484.115(a)—‘‘Standard: Administrator,                 with economically significant effects                 Regulatory Costs,’’ was issued on
                                                    home health agency.’’ In this provision,                ($100 million or more in any 1 year).                 January 30, 2017 (82 FR 9339, February
                                                    we grandfathered in all administrators                  This rule does not reach the economic                 3, 2017). Section 2(a) of Executive Order


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                                                    16152                     Federal Register / Vol. 82, No. 62 / Monday, April 3, 2017 / Proposed Rules

                                                    13771 requires an agency, unless                        effective date for the final rule                     Notice of Proposed Rulemaking released
                                                    prohibited by law, to identify at least                 published on January 13, 2017 (82 FR                  on March 20, 2017. The full text of this
                                                    two existing regulations to be repealed                 4504) and to further amend 42 CFR                     document may be accessed at the
                                                    when the agency publicly proposes for                   chapter IV as set forth below:                        following internet address: https://
                                                    notice and comment or otherwise                                                                               apps.fcc.gov/edocs_public/attachmatch/
                                                    promulgates a new regulation. In                        PART 484—HOME HEALTH SERVICES                         FCC-17-22A1.docx.
                                                    furtherance of this requirement, section                                                                         Pursuant to sections 1.415 and 1.419
                                                    2(c) of Executive Order 13771 requires                  ■ 1. The authority citation for part 484              of the Commission’s rules, 47 CFR
                                                    that the new incremental costs                          continues to read as follows:                         1.415, 1.419, interested parties may file
                                                    associated with new regulations shall, to                 Authority: Secs. 1102 and 1871 of the               comments and reply comments on or
                                                    the extent permitted by law, be offset by               Social Security Act (42 U.S.C. 1302 and               before the dates indicated on the first
                                                    the elimination of existing costs                       1395(hh)) unless otherwise indicated.                 page of this document. Comments may
                                                    associated with at least two prior                                                                            be filed using the Commission’s
                                                                                                            § 484.65    [Amend]
                                                    regulations. OMB’s interim guidance,                                                                          Electronic Comment Filing System
                                                                                                            ■ 2. In § 484.65, amend paragraph (d) by              (ECFS). See Electronic Filing of
                                                    issued on February 2, 2017, https://                    removing the date ‘‘January 13, 2018’’
                                                    www.whitehouse.gov/the-press-office/                                                                          Documents in Rulemaking Proceedings,
                                                                                                            and adding in its place ‘‘July 13, 2018’’.            63 FR 24121 (1998). Section 1.415(b) of
                                                    2017/02/02/interim-guidance-
                                                    implementing-section-2-executive-order-                 § 484.115    [Amend]                                  the Commission’s rules does not
                                                    january-30-2017, explains that for Fiscal               ■  3. In § 484.115, amend paragraphs                  establish a minimum time period for the
                                                    Year 2017 the above requirements only                   (a)(1) and (2) by removing the date ‘‘July            Commission to receive comments on
                                                    apply to each new ‘‘significant                                                                               proposed rules. Rather, the rule states
                                                                                                            13, 2017’’ and adding in its place
                                                    regulatory action that imposes costs.’’ It                                                                    that a ‘‘reasonable time will be provided
                                                                                                            ‘‘January 13, 2018’’.
                                                    has been determined that this proposed                                                                        for submission of comments.’’ In this
                                                                                                              Dated: March 28, 2017.                              proceeding, because the current
                                                    rule is not a ‘‘significant regulatory
                                                                                                            Seema Verma,                                          separations freeze will otherwise expire
                                                    action that imposes costs’’ and thus
                                                    does not trigger the above requirements                 Administrator, Centers for Medicare &                 on June 30, 2017, and because we
                                                                                                            Medicaid Services.                                    expect our proposal to extend the freeze
                                                    of Executive Order 13771.
                                                       In accordance with the provisions of                   Dated: March 28, 2017.                              will not generate controversy, we find
                                                    Executive Order 12866, this regulation                  Thomas E. Price,                                      that it is reasonable to allow 14 days
                                                    was reviewed by the Office of                           Secretary, Department of Health and Human             after Federal Register publication for
                                                    Management and Budget.                                  Services.                                             the filing of comments and seven days
                                                                                                            [FR Doc. 2017–06540 Filed 3–31–17; 8:45 am]           after that for the filing of any reply
                                                    List of Subjects                                                                                              comments.
                                                                                                            BILLING CODE 4120–01–P
                                                    42 CFR Part 409                                                                                                  D Electronic Filers: Comments may be
                                                                                                                                                                  filed electronically using the Internet by
                                                      Health facilities, Medicare.                                                                                accessing the ECFS: http://
                                                                                                            FEDERAL COMMUNICATIONS                                fjallfoss.fcc.gov/ecfs2/.
                                                    42 CFR Part 410                                         COMMISSION                                               D Paper Filers: Parties who choose to
                                                      Health facilities, Health professions,                                                                      file by paper must file an original and
                                                    Kidney diseases, Laboratories,                          47 CFR Part 36
                                                                                                                                                                  one copy of each filing. If more than one
                                                    Medicare, Reporting and recordkeeping                   [CC Docket No. 80–286; FCC 17–22]                     docket or rulemaking number appears in
                                                    requirements, Rural areas, X-rays.                                                                            the caption of this proceeding, filers
                                                                                                            Jurisdictional Separations and Referral               must submit two additional copies for
                                                    42 CFR Part 418
                                                                                                            to the Federal-State Joint Board                      each additional docket or rulemaking
                                                      Health facilities, Hospice care,
                                                                                                            AGENCY:  Federal Communications                       number.
                                                    Medicare, Reporting and recordkeeping                                                                            D Filings can be sent by hand or
                                                    requirements.                                           Commission.
                                                                                                                                                                  messenger delivery, by commercial
                                                                                                            ACTION: Proposed rule.
                                                    42 CFR Part 440                                                                                               overnight courier, or by first-class or
                                                      Grant programs—health, Medicaid.                      SUMMARY:   The Commission proposes a                  overnight U.S. Postal Service mail. All
                                                                                                            further eighteen month extension of the               filings must be addressed to the
                                                    42 CFR Part 484                                         current freeze of category relationships              Commission’s Secretary, Office of the
                                                      Health facilities, Health professions,                and allocation factors for price cap                  Secretary, Federal Communications
                                                    Medicare, Reporting and recordkeeping                   carriers and all allocation factors for               Commission.
                                                    requirements.                                           rate-of-return carriers and seeks                        D All hand-delivered or messenger-
                                                                                                            comment on several issues regarding the               delivered paper filings for the
                                                    42 CFR Part 485                                         potential effects of the freeze extension.            Commission’s Secretary must be
                                                      Grant programs—health, Health                         DATES: Comments are due on or before
                                                                                                                                                                  delivered to FCC Headquarters at 445
                                                    facilities, Medicaid, Medicare,                         April 17, 2017. Reply comments are due                12th St. SW., Room TW–A325,
                                                    Reporting and recordkeeping                             on or before April 24, 2017.                          Washington, DC 20554. The filing hours
                                                    requirements.                                                                                                 are 8:00 a.m. to 7:00 p.m. All hand
                                                                                                            ADDRESSES: Federal Communications
                                                                                                                                                                  deliveries must be held together with
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                                                    42 CFR Part 488                                         Commission, 445 12th St. SW.,                         rubber bands or fasteners. Any
                                                      Administrative practice and                           Washington, DC 20554.                                 envelopes and boxes must be disposed
                                                    procedure, Health facilities, Medicare,                 FOR FURTHER INFORMATION CONTACT:                      of before entering the building.
                                                    Reporting and recordkeeping                             Rhonda Lien, Wireline Competition                        D Commercial overnight mail (other
                                                    requirements.                                           Bureau, Pricing Policy Division at (202)              than U.S. Postal Service Express Mail
                                                      For the reasons set forth in the                      418–1540 or at rhonda.lien@fcc.gov.                   and Priority Mail) must be sent to 9300
                                                    preamble, the Centers for Medicare &                    SUPPLEMENTARY INFORMATION: This a                     East Hampton Drive, Capitol Heights,
                                                    Medicaid Services proposes to delay the                 summary of the Commission Further                     MD 20743.


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Document Created: 2017-04-01 09:36:26
Document Modified: 2017-04-01 09:36:26
CategoryRegulatory Information
CollectionFederal Register
sudoc ClassAE 2.7:
GS 4.107:
AE 2.106:
PublisherOffice of the Federal Register, National Archives and Records Administration
SectionProposed Rules
ActionProposed rule.
DatesTo be assured consideration, comments must be received at one of
ContactDanielle Shearer (410) 786-6617. Mary Rossi-Coajou (410) 786-6051. Maria Hammel (410) 786-1775.
FR Citation82 FR 16150 
RIN Number0938-AG81
CFR Citation42 CFR 409
42 CFR 410
42 CFR 418
42 CFR 440
42 CFR 484
42 CFR 485
42 CFR 488
CFR AssociatedHealth Facilities; Medicare; Health Professions; Kidney Diseases; Laboratories; Reporting and Recordkeeping Requirements; Rural Areas; X-Rays; Hospice Care; Grant Programs-Health; Medicaid and Administrative Practice and Procedure

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