[Federal Register Volume 60, Number 188 (Thursday, September 28, 1995)]
[Rules and Regulations]
[Pages 50115-50120]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-23780]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Parts 431, 440, 442, 488, 489, and 498
[HSQ-156-CN]
RIN 0938-AD94
Medicare and Medicaid Programs; Survey, Certification and
Enforcement of Skilled Nursing Facilities and Nursing Facilities
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Final rule and correction to final regulations.
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SUMMARY: In the November 10, 1994 issue of the Federal Register (FR
Doc. 94-27703) (59 FR 56116), we established rules for survey of
skilled nursing facilities that participate in the Medicare program,
and nursing facilities that participate in the Medicaid program. We
also established remedies that we impose on facilities that do not
comply with Federal participation requirements, as alternatives to
program termination. This document corrects errors made in that
document.
EFFECTIVE DATE: This correction and amendments to Secs. 493.53 and
493.90 are effective on July 1, 1995.
FOR FURTHER INFORMATION CONTACT: Deborah Kaplan Schoenemann (410) 786-
6771.
SUPPLEMENTARY INFORMATION: On November 10, 1994, we published in the
Federal Register, at 59 FR 56116, a final rule which established
significant revisions to the process we use to survey skilled nursing
facilities that participate in the Medicare program, and nursing
facilities that participate in the Medicaid program. The rule also
established remedies that we impose on facilities that do not comply
with the Federal participation requirements, as alternatives to program
termination. This notice corrects both typographical and technical
errors made in that document.
I. Technical Corrections
In Sec. 431.153(a), we are correcting an inadvertent error in
terminology. Paragraph (a) states that, for actions specified in
Sec. 431.151, the ``Medicaid agency'' must give a provider the
opportunity for a full evidentiary hearing. This change in reference
was unintentional since we never intended to limit the latitude that
States have had for many years under the existing regulation. The
existing regulation provided only that the ``State'' had the hearing
responsibility thereby leaving it to the discretion of each State how
best to organize its hearing system. Some States chose to have the
Medicaid agency conduct hearings, while others have left this
responsibility to the survey agencies. We are correcting this
regulation by restoring the original language as intended.
In Secs. 442.13 and 489.13, we inadvertently carried forward
provisions pertaining to the effective date of a provider agreement
that we have had for many years, and that are inconsistent with other
provisions of the November 10, 1994 rule. Sections 442.13 and 489.13,
which cut across provider types, specify that a provider agreement is
effective on the date that the provider meets all requirements or the
date on which it meets condition level requirements with an acceptable
plan of correction for lower level standard requirements, whichever is
earlier. Because there are no longer standard level requirements for
nursing homes, and because the definition of substantial compliance has
been significantly redrawn, we need to conform these sections to
reflect the new standard of compliance for nursing homes.
Under the rule published on November 10, 1994, a nursing home may
continue to participate in the Medicare or Medicaid programs if it is
in substantial compliance with Federal requirements. Because this
standard is stricter than its predecessor, we now realize that once a
nursing home achieves substantial compliance, it has made a sufficient
demonstration to participate, and we do not require a plan of
correction before the provider agreement is effective. Thus, if a
nursing home is in substantial compliance on the date of the survey,
its provider agreement is effective on the date of the survey. However,
we still require that it submit an acceptable plan of correction at a
later date for requirements that it does not fully meet. This is
consistent with Sec. 488.402(d), which provides that facility with
deficiencies in program requirements must submit a plan of correction
for approval except when the deficiencies are isolated and have a
potential for minimal harm, but no actual harm has occurred. Therefore,
we are removing the requirement in Secs. 442.13(c)(3)(ii) and
489.13(b)(3)(ii) that a provider that is in substantial
[[Page 50116]]
compliance with Federal requirements submit a plan of correction before
the provider agreement is effective.
In Secs. 488.303(d) and 488.406(a) and (b), we are reordering the
list of remedies to separate ``transfer of residents'' from ``closure
of the facility in emergency situations or transfer of residents, or
both.'' We are making this change to avoid any misunderstanding that
might otherwise occur that would lead to a conclusion that in order for
there to be a transfer of residents there must be a facility closure. A
transfer of residents may occur when there is no facility closure, as
would be the case when a facility's provider agreement is terminated.
While we believe that the regulations provided the necessary separation
of these two events, we are correcting the text to make certain that
there is no chance for ambiguity.
In Secs. 488.303(d) and 488.406(b), in reference to the remedies
that the State must establish, we are clarifying that, ``in addition to
termination of the provider agreement,'' the State must establish
certain remedies or approved alternatives to these remedies. The reason
for this clarification is that termination is a remedy that States must
establish, but it is unlike the other remedies listed, because there
are circumstances in which termination is the only option available.
In Sec. 488.330(e)(1)(ii), we are replacing the phrase, ``the
pendency of any hearing'' with ``any pending hearing'' because it is
simpler, more easily understood, and consistent with paragraph
(e)(2)(ii).
In Sec. 488.335(f), regarding the report of findings that an
individual has neglected or abused a resident or misappropriated
resident property, we are correcting an unintentional error in the
text, which resulted in the implication that it is always the State
survey agency that must report the findings. In a particular State, an
agency other than the State survey agency may be responsible for
reporting the findings, except for reporting to the nurse aide
registry. Only the State survey agency may report the findings to the
nurse aide registry, and it may not delegate this responsibility, in
accordance with Sec. 483.156(b)(2). Therefore, we are revising
Sec. 488.335(f) to make this distinction clear. In
Secs. 488.335(c)(3)(iv) and 488.335(c)(3)(v), we are making conforming
changes by removing references to the survey agency.
In Sec. 488.401, in the definition of ``plan of correction,'' we
are replacing the term, ``certifying agency'' with ``HCFA or the survey
agency'' to make clearer the identity of the certifying agency.
Section 488.402(f)(1), regarding notification requirements for all
facilities other than non-State operated NFs, provides that HCFA gives
the provider notice of the remedy. As currently written, the regulation
does not acknowledge that, while we impose all remedies on facilities
other than non-State operated NFs, we permit States to send notices of
adverse actions in certain cases of minimal noncompliance, but only as
we direct. Leaving the regulation in its current published form would
give the erroneous impression that HCFA must be the sole entity to
provide such notice, which would not comport with program practice
under these regulations. Therefore, we are revising Sec. 488.402(f)(1)
to specify that, except when the State is taking action against a non-
State operated NF, HCFA ``or the State (as authorized by HCFA)'' gives
the provider notice of the remedy.
In Sec. 488.402(f)(7), regarding State monitoring, we are removing
an incorrect reference to immediate jeopardy. We do not give a facility
notice before we impose State monitoring, even when there is immediate
jeopardy. We discussed this in the preamble (59 FR 56171, column two)
and failed to correct this error in the text of the regulations.
Section 488.408(d)(3) concerns our option and a State's option to
apply remedies in Category 2 to any deficiency. We are correcting an
omission by clarifying that HCFA or the State may apply one or more of
the remedies in Category 2 to any deficiency except when the facility
is in substantial compliance, or when HCFA or the State imposes a civil
money penalty for a deficiency that constitutes immediate jeopardy, in
which case, the penalty must be in the upper range of penalty amounts,
as specified in Sec. 488.438(a).
In Sec. 488.410(c)(2), we are correcting an inadvertent error.
Paragraph (c)(2) provides that when a facility has deficiencies that
pose immediate jeopardy, we will or the State must take immediate
action to remove the jeopardy and correct the noncompliance through
temporary management or terminate the facility's participation under
the State plan (and we will terminate the facility's Medicare
participation if it is a dually-participating facility).
In Sec. 488.412(a)(2), we are changing ``State survey agency'' to
``State'' because we inadvertently failed to recognize that, in fact,
the submission of plans and timetables for corrective action are as
likely to be generated by agencies other than the State survey agency
and it was not our intent to limit States' discretion. We are also
changing ``plan of correction'' to ``plan and timetable for corrective
action'' for consistency with terminology used in Sec. 488.450.
In Sec. 488.417(c)(1) and (c)(2), with regard to resumption of
payments when a facility has repeated instances of substandard quality
of care, we clarify that, when the facility is a State-operated NF
participating in the Medicaid program, HCFA, rather than the State,
makes the determination that the facility has achieved substantial
compliance and is capable of remaining in substantial compliance. To
permit a State to make this determination for a facility that the State
itself operates, would be an obvious conflict of interest and
inconsistent with the law's directive that the Secretary be the
certifying entity for these facilities. We are also clarifying that
HCFA makes the determination for all facilities except non-State
operated NFs against which HCFA is imposing no remedies, and the State
makes the determination for non-State operated NFs against which HCFA
is imposing no remedies.
Section 488.422(c)(1) provides that State monitoring is
discontinued when the facility demonstrates that it is in substantial
compliance with the requirements, and it will remain in compliance for
a period of time specified by HCFA or the State, or until termination
procedures are complete. We are correcting an inadvertent error in the
text by clarifying that the facility only has to demonstrate that it
will remain in compliance, in addition to demonstrating that it has
achieved substantial compliance, if the remedy was imposed for repeated
instances of substandard quality of care.
In Sec. 488.426, we are rewording the section title to remove the
erroneous implication that closure of a facility can occur without
transfer of residents. In paragraph (a), we are revising the heading to
more accurately reflect the content of the paragraph. In paragraph (b),
we are revising the heading to reflect the content, which is transfer
of residents when HCFA or the State terminates the facility's provider
agreement, and we are removing the reference to ``immediate jeopardy''
because we inadvertently failed to recognize in the final rule that
provider agreement terminations cause residents to be transferred
regardless of whether immediate jeopardy exists. We are also removing
paragraph (c) because it would be redundant after the change to
paragraph (b).
Section 488.432(a)(1)(i), regarding when a civil money penalty is
collected after a facility requests a hearing,
[[Page 50117]]
provides that a facility must request a hearing within the time
specified in Sec. 498.40 for a SNF, a dually participating facility, or
State-operated NF. We inadvertently omitted from the list, ``non-State
operated NF against which HCFA is imposing remedies.'' Similarly, in
Sec. 488.432(a)(1)(ii), we are correcting an error by clarifying that a
facility must request a hearing on the determination of noncompliance
that is the basis for imposition of the civil money penalty within the
time specified in Sec. 431.153 for a non-State operated NF ``that is
not subject to imposition of remedies by HCFA.''
In Sec. 488.434, with regard to written notice of our intent to
impose a civil money penalty, we are removing the phrase, ``intent to
impose.'' The proposed rule provided that the effective date of a civil
money penalty would be the 10th day after the last day of the survey in
immediate jeopardy situations, and the 20th day after the last day of
the survey in non-immediate jeopardy situations.
Consequently, the proposed rule referred to ``the intent'' to
impose a civil money penalty because a provider always had a window of
opportunity in which to correct the noncompliance and avoid the
imposition of the civil money penalty. (If a facility corrected the
deficiency before the 10th or 20th day, we would not impose a civil
money penalty.) However, on page 56200 of the preamble to the final
rule, we noted that a notice of imposition of the penalty is not
required before a civil money penalty can begin to accrue, since the
Act permits the imposition of a civil money penalty for past violations
that have been corrected, and the civil money penalty may start
accruing as early as the date that the facility was first out of
compliance, as determined by HCFA or the State. For these reasons, we
are removing the phrase, ``intent to impose,'' (the civil money
penalty) in Sec. 488.434.
In Sec. 488.442(c)(2), we correct an inadvertent error regarding
the Medicare rate of interest assessed on the unpaid balance of a civil
money penalty. Paragraph (c)(2) should have specified that the Medicare
rate of interest is ``the higher of'' the rate fixed by the Secretary
of the Treasury after taking into consideration private consumer rates
of interest prevailing on the date of the notice of the penalty amount
due (published quarterly in the Federal Register by HHS under 45 CFR
30.13(a)), or the current value of funds (published annually in the
Federal Register by the Secretary of the Treasury, subject to quarterly
revisions). Our intention to use ``the higher of'' the two amounts is
indicated in the discussion of Sec. 488.442(c) on page 56209 of the
preamble.
Section 488.442 (d) and (e) concerns the disposition of civil money
penalties and interest collected from long term care facilities. It was
brought to our attention that the law specifically requires that, for
Medicare-participating facilities, we deposit the funds as
miscellaneous receipts of the U.S. Treasury (rather than ``return them
to the Medicare Trust Fund''), and, for Medicaid-participating
facilities, that we return the funds to the State. Section 488.442(e)
concerns disposition of civil money penalties and interest collected
from facilities that participate in both Medicare and Medicaid programs
(dually participating facilities). Again, we believe it is more correct
legally to refer not to the Medicare Trust Fund, but to ``miscellaneous
receipts of the U.S. Treasury.'' Therefore, we have made these changes
to Sec. 488.442 (d) and (e). In addition, in Sec. 488.442(f), we are
making an editorial change by revising the term ``deficient'' with
regard to facilities to ``noncompliant.''
In Sec. 488.454, regarding the duration of remedies, paragraph (d)
provides that, if the facility can supply documentation acceptable to
us or the State that it was in substantial compliance, and was capable
of remaining in substantial compliance, if necessary, on a date
preceding that of the revisit, the remedies terminate on the date that
we or the State can verify that the facility achieved substantial
compliance. We inadvertently left off at the end of the sentence ``the
facility demonstrated that it could maintain substantial compliance, if
necessary.''
In Sec. 489.3, we are correcting an error in the definition of
immediate jeopardy, which is inconsistent with the definition of
immediate jeopardy in Sec. 488.301. As corrected, ``immediate
jeopardy'' means a situation in which the provider's noncompliance with
one or more requirements of participation has caused, or is likely to
cause, serious injury, harm, impairment, or death to a resident. We are
removing the phrase, ``immediate corrective action is necessary
because''.
In Sec. 489.53, we removed the entire paragraph (b) in error, and
should have removed only paragraph (b)(2) because it is no longer
applicable. Paragraph (b)(1), which concerns termination of a provider
agreement for a hospital or rural primary care hospital that has an
emergency department, was inadvertently removed. Consequently, we are
correcting this by reinstating the content of paragraph (b)(1) as
paragraph (b).
Finally, we are correcting an error, which inadvertently gave the
impression (by our not changing part 498) that judicial review of a
civil money penalty was available to a facility in the United States
District Courts. In fact, through the incorporation of parts of section
1128A of the Social Security Act (the Act) in sections 1819(h) and
1919(h) of the Act, judicial review of such actions may occur only in
the appropriate United States Court of Appeals. Therefore, we are
revising Sec. 498.90 to reflect this fact. In addition, we are revising
Sec. 498.90 to make it conform to Sec. 498.1(h), which makes it clear
that Appeals Council decisions on civil money penalty cases are final
once the Appeals Council makes a decision, regardless of whether
judicial review occurs.
II. Other Corrections
In this document, we are making numerous corrections resulting from
typographical errors, errors in cross references, omissions and
conflicts within the November 10, 1994 rule.
III. Corrections to the Regulations Text of the November 10, 1994 Final
Rule (59 FR 56116)
PART 431--[CORRECTED]
1. On page 56232, column three, Sec. 431.153(a), line two,
``Medicaid agency'' is corrected to read ``State''.
PART 440--[CORRECTED]
Sec. 440.40 [Corrected]
2. On page 56234, column one, Sec. 440.40(a)(2), line one,
``includes'' is corrected to read ``include''.
PART 442--[CORRECTED]
3. We make the following corrections to Sec. 442.13:
a. On page 56235, column three, Sec. 442.13(b), in the sixth line,
``survey'' is corrected to read ``survey,''.
b. On page 56235, column three, Sec. 442.13(c)(3)(ii) is corrected
to read as follows:
Sec. 442.13 Effective date of agreement.
* * * * *
(c) * * *
(3) * * *
(ii) Submits, if applicable, an approvable waiver request.
* * * * *
Sec. 442.30 [Corrected]
4. On page 56235, column three, in the amendatory language to item
10, the word ``and is inserted before ``(a)(4)'' in line two, and the
words ``introductory paragraph of'' are inserted before ``(a)(7)'' in
line three.
[[Page 50118]]
PART 488--[CORRECTED]
5. On page 56239, column one, Sec. 488.303(d) is corrected to read
as follows:
Sec. 488.303 State plan requirement.
* * * * *
(d) Required remedies for a non-State operated NF. A State must
establish, in addition to termination of the provider agreement, the
following remedies or an approved alternative to the following remedies
for imposition against a non-State operated NF:
(1) Temporary management.
(2) Denial of payment for new admissions.
(3) Civil money penalties.
(4) Transfer of residents.
(5) Closure of the facility and transfer of residents.
(6) State monitoring.
* * * * *
Sec. 488.314 [Corrected]
6. On page 56240, column one, Sec. 488.314(a)(4)(iii), line four,
``paragraphs (a)(2)(i) or (ii)'' is corrected to read ``paragraph
(a)(4)(i) or paragraph (a)(4)(ii)''.
Sec. 488.325 [Corrected]
7. We make the following corrections to Sec. 488.325:
a. On page 56241, column one, Sec. 488.325(f)(2), line two,
``Sec. 488.206'' is corrected to read ``Sec. 488.406''.
b. On page 56241, column two, Sec. 488.325(i), line eight, ``part
1002, subpart C,'' is corrected to read ``part 1007''.
Sec. 488.330 [Corrected]
8. On page 56241, column three, Sec. 488.330(e)(1)(ii), line two,
``the pendency of any hearing'' is corrected to read ``any pending
hearing''.
Sec. 488.335 [Corrected]
9. We make the following corrections to Sec. 488.335:
a. On page 56242, column three, Sec. 488.335(b), line three,
``their'' is corrected to read ``the''.
b. On page 56242, column three, Sec. 488.335(c)(3)(iv), line one,
``Survey agency's intent'' is corrected to read ``Intent''.
c. On page 56242, column three, Sec. 488.335(c)(3)(v), line four,
``the survey agency'' is removed.
d. On page 56243, column one, Sec. 488.335(f), beginning on line
six, ``survey agency, which may not delegate this responsibility,'' is
removed.
e. On page 56243, column one, Sec. 488.335(f)(5) is corrected to
read as follows:
Sec. 488.335 Action on complaints of resident neglect and abuse, and
misappropriation of resident property.
* * * * *
(f) * * *
(5) The nurse aide registry for nurse aides. Only the State survey
agency may report the findings to the nurse aide registry, and this
must be done within 10 working days of the findings, in accordance with
Sec. 483.156(c) of this chapter. The State survey agency may not
delegate this responsibility.
* * * * *
Sec. 488.401 [Corrected]
10. On page 56243, column three, Sec. 488.401, in the definition of
Plan of correction, line three, ``the certifying agency which'' is
corrected to read ``HCFA or the survey agency that''.
Sec. 488.402 [Corrected]
11. We make the following corrections to Sec. 488.402:
a. On page 56243, column three, Sec. 488.402(f)(1), beginning on
line one, the paragraph heading is removed.
b. On page 56243, column three, Sec. 488.402(f)(1), beginning on
line five, ``HCFA'' is corrected to read ``HCFA or the State (as
authorized by HCFA)''.
c. On page 56243, column three, Sec. 488.402(f)(2), line one, the
paragraph heading is removed.
d. On page 56244, column one, Sec. 488.402(f)(7), line one, the
paragraph heading ``State monitoring--immediate jeopardy.'' is
corrected to read ``State monitoring.''
e. On page 56244, column one, Sec. 488.402(f)(7), beginning on line
two, ``imposed when there is immediate jeopardy'' is removed.
12. On page 56244, column two, Sec. 488.406(a) and (b) are
corrected to read as follows:
Sec. 488.406 Available remedies.
(a) General. In addition to the remedy of termination of the
provider agreement, the following remedies are available:
(1) Temporary management.
(2) Denial of payment including--
(i) Denial of payment for all individuals, imposed by HCFA, to a--
(A) Skilled nursing facility, for Medicare;
(B) State, for Medicaid; or
(ii) Denial of payment for all new admissions.
(3) Civil money penalties.
(4) State monitoring.
(5) Transfer of residents.
(6) Closure of the facility and transfer of residents.
(7) Directed plan of correction.
(8) Directed in-service training.
(9) Alternative or additional State remedies approved by HCFA.
(b) Remedies that must be established. At a minimum, and in
addition to termination of the provider agreement, the State must
establish the following remedies or approved alternatives to the
following remedies:
(1) Temporary management.
(2) Denial of payment for new admissions.
(3) Civil money penalties.
(4) Transfer of residents.
(5) Closure of the facility and transfer of residents.
(6) State monitoring.
* * * * *
13. We make the following corrections to Sec. 488.408:
a. On page 56244, column three, Sec. 488.408(b), line 10, ``set
forth'' is corrected to read ``set forth in''.
b. On page 56244, column three, Sec. 488.408(c)(2), line one,
``HCFA or'' is corrected to read ``HCFA does or''.
c. On page 56244, column three, Sec. 488.408(d)(3), is corrected to
read as follows:
Sec. 488.408 Selection of remedies.
* * * * *
(d) * * *
(3) HCFA or the State may apply one or more of the remedies in
Category 2 to any deficiency except when--
(i) The facility is in substantial compliance; or
(ii) HCFA or the State imposes a civil money penalty for a
deficiency that constitutes immediate jeopardy, the penalty must be in
the upper range of penalty amounts, as specified in Sec. 488.438(a).
* * * * *
d. On page 56245, column one, Sec. 488.408(f)(1), line two,
``paragraph (F)(2)'' is corrected to read ``paragraph (f)(2)''.
Sec. 488.410 [Corrected]
14. We make the following changes to Sec. 488.410:
a. On page 56245, column two, Sec. 488.410(c)(2), line one,
``must--'' is corrected to read ``must do one or both of the
following:''.
b. On page 56245, column two, Sec. 488.410(c)(2)(i), line four,
``management; or'' is corrected to read ``management.''.
Sec. 488.412 [Corrected]
15. We make the following corrections to Sec. 488.412:
a. On page 56245, column two, Sec. 488.412(a)(2), line one, ``The
State survey agency'' is corrected to read ``The State''.
b. On page 56245, column two, Sec. 488.412(a)(2), line two, ``a
plan of
[[Page 50119]]
correction'' is corrected to read ``a plan and timetable for corrective
action''.
Sec. 488.417 [Corrected]
16. We make the following corrections to Sec. 488.417:
a. On page 56246, column three, Sec. 488.417(c)(1), beginning on
line four, ``HCFA (under Medicare) or the State (under Medicaid)'' is
corrected to read ``HCFA (for all facilities except non-State operated
NFs against which HCFA is imposing no remedies) or the State (for non-
State operated NFs against which HCFA is imposing no remedies)''.
b. On page 56246, column three, Sec. 488.417(c)(2), beginning on
line one, ``HCFA (under Medicare) or the State (under Medicaid)'' is
corrected to read ``HCFA (for all facilities except non-State operated
NFs against which HCFA is imposing no remedies) or the State (for non-
State operated NFs against which HCFA is imposing no remedies)''.
Sec. 488.422 [Corrected]
17. On page 56247, column one, Sec. 488.422(c)(1), line three,
``and it'' is corrected to read ``and, if imposed for repeated
instances of substandard quality of care,''.
Sec. 488.425 [Corrected]
18. On page 56247, column two, Sec. 488.425(b), line six,
``Sec. 488.206'' is corrected to ``Sec. 488.406''.
Sec. 488.426 [Corrected]
19. We make the following corrections to Sec. 488.426:
a. On page 56247, column two, Sec. 488.426, the section heading
``Closure of a facility or transfer of residents, or both.'' is
corrected to read ``Transfer of residents, or closure of the facility
and transfer of residents.''
b. On page 56247, column two, Sec. 488.426(a), the paragraph
heading ``Closure of a facility or transfer of residents, or both.'' is
corrected to read ``Transfer of residents, or closure of the facility
and transfer of residents in an emergency.''
c. On page 56247, column two, Sec. 488.426(b), the paragraph
heading ``Required transfer in immediate jeopardy situations.'' is
corrected to read ``Required transfer when a facility's provider
agreement is terminated.''
d. On page 56247, column two, Sec. 488.426(b), beginning in line
four, ``agreement for a deficiency that constitutes immediate jeopardy,
the'' is corrected to read ``agreement, the''.
e. On page 56247, column two, Sec. 488.426, paragraph (c) is
removed.
Sec. 488.432 [Corrected]
20. We make the following corrections to Sec. 488.432:
a. On page 56247, column two, Sec. 488.432(a)(1), line 5, ``in--''
is corrected to read ``in one of the following sections:''
b. On page 56247, column two, Sec. 488.432(a)(1)(i)(B), ``facility;
or'' is corrected to read ``facility;''.
c. On page 56247, column two, Sec. 488.432(a)(1)(i)(C), ``State-
operated NF.'' is corrected to read ``State-operated NF; or''.
d. On page 56247, column two, Sec. 488.432(a)(1)(i), a new
paragraph (D) is added to read as follows:
``(D) Non-State operated NF against which HCFA is imposing
remedies.''
e. On page 56247, column two, Sec. 488.432(a)(1)(ii), line two,
``NF.'' is corrected to read ``NF that is not subject to imposition of
remedies by HCFA.''
Sec. 488.434 [Corrected]
21. On page 56247, column three, Sec. 488.434(a)(1), beginning on
line two, ``notice of intent to impose the penalty'' is corrected to
read ``notice of the penalty''.
22. We make the following corrections to Sec. 488.442:
a. On page 56249, column two, Sec. 488.442(c)(2), line two,
``interest is--'' is corrected to read ``interest is the higher of--''.
b. On page 56249, column two, Sec. 488.442(c)(2)(i), line one,
``Fixed'' is corrected to read ``The rate fixed''.
c. On page 56249, column two, Sec. 488.442(d) is corrected to read
as follows:
Sec. 488.442 Civil money penalties: Due date for payment of penalty.
* * * * *
(d) Penalties collected by HCFA. Civil money penalties and
corresponding interest collected by HCFA from--
(1) Medicare-participating facilities are deposited as
miscellaneous receipts of the United States Treasury; and
(2) Medicaid-participating facilities are returned to the State.
* * * * *
d. On page 56249, column two, Sec. 488.442(e), beginning on line
four, ``returned to the Medicare Trust Fund and'' is corrected to read
``deposited as miscellaneous receipts of the United States Treasury and
returned to''.
e. On page 56249, column two, Sec. 488.442(f), line six,
``deficient,'' is corrected to read ``noncompliant,''.
Sec. 488.450 [Corrected]
23. On page 56249, column three, Sec. 488.450(b), line five, ``if''
is corrected to read ``of''.
Sec. 488.454 [Corrected]
24. On page 56250, column two, Sec. 488.454(d), the last line,
``achieved.'' is corrected to read ``achieved and the facility
demonstrated that it could maintain substantial compliance, if
necessary.''
PART 489--[CORRECTED]
Sec. 489.3 [Corrected]
25. On page 56250, column three, Sec. 489.3, beginning on line two,
``in which immediate corrective action is necessary because the
provider's'' is corrected to read ``in which the provider's''.
26. On page 56251, column one, Sec. 489.13(b)(3)(ii) is corrected
to read as follows:
Sec. 489.13 Effective date of agreement.
* * * * *
(b) * * *
(3) * * *
(ii) Submits, if applicable, an approvable waiver request.
27. Section 489.53 is amended by adding a new paragraph (b) to read
as follows:
Sec. 489.53 Termination by HCFA
(b) Termination of provider agreement. In the case of a hospital or
rural primary care hospital that has an emergency department, as
defined in Sec. 489.24(b), HCFA may terminate the provider agreement
if--
(1) The hospital fails to comply with the requirements of
Sec. 489.24 (a) through (e), which require the hospital to examine,
treat, or transfer emergency medical condition cases appropriately, and
require that hospitals with specialized capabilities or facilities
accept an appropriate transfer; or
(2) The hospital fails to comply with Sec. 489.20(m), (q), and (r),
which require the hospital to report suspected violations of
Sec. 489.24(d), to post conspicuously in emergency departments or in a
place or places likely to be noticed by all individuals entering the
emergency departments, as well as those individuals waiting for
examination and treatment in areas other than traditional emergency
departments, (that is, entrance, admitting area, waiting room,
treatment area), signs specifying rights of individuals under this
subpart, to post conspicuously information indicating whether or not
the hospital participates in the Medicaid program, and to maintain
medical and other records related to transferred individuals for a
period of 5 years, a list of on-call physicians for individuals with
emergency medical conditions, and a central log on each individual who
comes to the emergency department seeking assistance.
* * * * *
[[Page 50120]]
PART 498--[CORRECTED]
Sec. 498.3 [Corrected]
28. We make the following corrections to Sec. 498.3:
a. On page 56252, column one, Sec. 498.3(b)(12), line two,
``Sec. 498.3(d)(11).'' is corrected to read Sec. 498.3(d)(11)''.
b. On page 56252, column one, Sec. 498.3(d)(10), line seven,
``(b)(14)'' is corrected to read ``(b)(13)''.
c. On page 56252, column two, Sec. 498.3(d)(12), line two,
``(b)(14)'' is corrected to read ``(b)(13)''.
29. Section 498.90 is amended by redesignating existing paragraph
(b) as paragraph (c), and adding a new paragraph (b) to read as
follows:
Sec. 498.90 Effect of Appeals Council decision.
* * * * *
(b)(1) When HCFA imposes a civil money penalty on a SNF or NF, the
decision of the Appeals Council is final upon issuance.
(2) Judicial review of an Appeals Council decision concerning the
imposition of a civil money penalty on a SNF or NF is available in the
appropriate United States Court of Appeals.
Authority: Sections 1819(g), 1819(h), 1919(g), and 1919(h) of
the Social Security Act (42 U.S.C. 1395i-3(g), 1395i-3(h), 1395r(g),
and 1395r(h)).
Dated: September 18, 1995.
Neil J. Stillman,
Deputy Assistant Secretary for Information Resources Management.
[FR Doc. 95-23780 Filed 9-27-95; 8:45 am]
BILLING CODE 4120-01-P
