Medicare Program; Final Waivers in Connection With the Shared Savings Program; Continuation of Effectiveness and Extension of Timeline for Publication of Final Rule, 62356-62358 [2014-24663]

Download as PDF mstockstill on DSK4VPTVN1PROD with RULES 62356 Federal Register / Vol. 79, No. 201 / Friday, October 17, 2014 / Rules and Regulations • Is not subject to requirements of Section 12(d) of the National Technology Transfer and Advancement Act of 1995 (15 U.S.C. 272 note) because application of those requirements would be inconsistent with the CAA; and • Does not provide EPA with the discretionary authority to address, as appropriate, disproportionate human health or environmental effects, using practicable and legally permissible methods, under Executive Order 12898 (59 FR 7629, February 16, 1994). This rule is not approved to apply on any Indian reservation land or in any other area where EPA or an Indian tribe has demonstrated that a tribe has jurisdiction. In those areas of Indian country, the rule does not have tribal implications as specified by Executive Order 13175, nor will it impose substantial direct costs on tribal governments or preempt tribal law. The Congressional Review Act, 5 U.S.C. 801 et seq., as added by the Small Business Regulatory Enforcement Fairness Act of 1996, generally provides that before a rule may take effect, the agency promulgating the rule must submit a rule report, which includes a copy of the rule, to each House of the Congress and to the Comptroller General of the United States. EPA will submit a report containing this action and other required information to the U.S. Senate, the U.S. House of Representatives, and the Comptroller General of the United States prior to publication of the rule in the Federal Register. A major rule cannot take effect until 60 days after it is published in the Federal Register. This action is not a ‘‘major rule’’ as defined by 5 U.S.C. 804(2). Under section 307(b)(1) of the CAA, petitions for judicial review of this action must be filed in the United States Court of Appeals for the appropriate circuit by December 16, 2014. Filing a petition for reconsideration by the Administrator of this final rule does not affect the finality of this action for the purposes of judicial review nor does it extend the time within which a petition for judicial review may be filed, and shall not postpone the effectiveness of such rule or action. Parties with objections to this direct final rule are encouraged to file a comment in response to the parallel notice of proposed rulemaking for this action published in the proposed rules section of this Federal Register, rather than file an immediate petition for judicial review of this direct final rule, so that EPA can withdraw this direct final rule and address the comment in the proposed rulemaking. This action may not be challenged later in proceedings to VerDate Sep<11>2014 21:55 Oct 16, 2014 Jkt 235001 enforce its requirements. (See section 307(b)(2).) List of Subjects in 40 CFR Part 52 Environmental protection, Air pollution control, Incorporation by reference, Oxides of nitrogen, Ozone, Volatile organic compounds. Dated: September 24, 2014. Susan Hedman, Regional Administrator, Region 5. 40 CFR part 52 is amended as follows: Stationary Sources, Part 219: Organic Material Emission Standards and Limitations for the Metro East Area, Subpart A: General Provisions, Sections 219.105 ‘‘Test Methods and Procedures’’ and 219.112 ‘‘Incorporations by Reference’’, and Subpart Y: Gasoline Distribution, Section 219.583 ‘‘Gasoline Dispensing Operations—Storage Tank Filling Operations’’, effective December 23, 2013. [FR Doc. 2014–24462 Filed 10–16–14; 8:45 am] BILLING CODE 6560–50–P PART 52—APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS 1. The authority citation for part 52 continues to read as follows: ■ Authority: 42 U.S.C. 7401 et seq. 2. Section 52.720 is amended by adding paragraph (c)(202) to read as follows: ■ § 52.720 Identification of plan. * * * * * (c) * * * (202) On January 17, 2013, the Illinois Environmental Protection Agency submitted a request to phase out Stage II vapor recovery standards at 35 Ill. Adm. Code 218.586 and to make other related revisions to 35 Ill. Adm. Code Parts 201, 218, and 219. (i) Incorporation by reference. (A) Illinois Administrative Code, Title 35: Environmental Protection, Subtitle B: Air Pollution, Chapter I: Pollution Control Board, Subchapter a: Permits and General Provisions, Part 201: Permits and General Provisions, Subpart C: Prohibitions, Section 201.146 ‘‘Exemptions from State Permit Requirements’’ and Subpart K: Records and Reports, Section 201.302 ‘‘Reports’’, effective December 23, 2013. (B) Illinois Administrative Code, Title 35: Environmental Protection, Subtitle B: Air Pollution, Chapter I: Pollution Control Board, Subchapter C: Emissions Standards And Limitations For Stationary Sources, Part 218: Organic Material Emission Standards and Limitations For the Chicago Area, Subpart A: General Provisions, Section 218.112 ‘‘Incorporations By Reference’’ and Subpart Y: Gasoline Distribution, Sections 218.583 ‘‘Gasoline Dispensing Operations—Storage Tank Filling Operations’’ and 218.586 ‘‘Gasoline Dispensing Operations—Motor Vehicle Fueling Operations’’, effective December 23, 2013. (C) Illinois Administrative Code, Title 35: Environmental Protection, Subtitle B: Air Pollution, Chapter I: Pollution Control Board, Subchapter c: Emission Standards and Limitations for PO 00000 Frm 00032 Fmt 4700 Sfmt 4700 DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Chapter IV Office of Inspector General 42 CFR Chapter V [CMS–1439–RCN] RIN 0938–AR30 Medicare Program; Final Waivers in Connection With the Shared Savings Program; Continuation of Effectiveness and Extension of Timeline for Publication of Final Rule Centers for Medicare & Medicaid Services (CMS) and Office of Inspector General (OIG), HHS. ACTION: Interim final rule; continuation of effectiveness and extension of timeline for publication of final rule. AGENCY: This document announces the continuation of effectiveness of an interim final rule and the extension of the timeline for publication of the final rule. This document is issued in accordance with section 1871(a)(3)(C) of the Social Security Act (the Act), which allows an interim final rule to remain in effect after the expiration of the timeline specified in section 1871(a)(3)(B) of the Act if the Secretary publishes a notice of continuation prior to the expiration of the timeline. DATES: This document is effective on October 17, 2014. FOR FURTHER INFORMATION CONTACT: Catherine Bernstein (410) 786–6887 or Lisa Ohrin (410) 786–8852, for general issues and issues related to the Physician Self-Referral Law. Patrice Drew (202) 619–1368, for general issues and issues related to the Federal anti-kickback statute or civil monetary penalties law. SUPPLEMENTARY INFORMATION: SUMMARY: E:\FR\FM\17OCR1.SGM 17OCR1 Federal Register / Vol. 79, No. 201 / Friday, October 17, 2014 / Rules and Regulations I. Background Section 1871(a)(3)(A) of the Social Security Act (the Act) sets forth certain procedures for promulgating regulations necessary to carry out the administration of the insurance programs under Title XVIII of the Act. Section 1871(a)(3)(A) of the Act requires the Secretary, in consultation with the Director of the Office of Management and Budget (OMB), to establish a regular timeline for the publication of a final rule based on the previous publication of a proposed rule or an interim final rule. In accordance with section 1871(a)(3)(B) of the Act, such regular timeline may vary among different final rules, based on the complexity of the rule, the number and scope of the comments received, and other relevant factors. The timeline for publishing the final rule, however, cannot exceed 3 years from the date of publication of the proposed or interim final rule, unless there are exceptional circumstances. After consultation with the Director of OMB, the Department, through CMS, published a notice in the December 30, 2004 Federal Register (69 FR 78442) establishing a general 3-year timeline for publishing Medicare final rules after the publication of a proposed or interim final rule. Section 1871(a)(3)(C) of the Act states that a Medicare interim final rule shall not continue in effect if the final rule is not published before the expiration of the regular timeline, unless the Secretary publishes at the end of the regular timeline a notice of continuation that includes an explanation of why the regular timeline was not met. Upon publication of such a notice, the timeline for publishing the final rule is extended for 1 year. mstockstill on DSK4VPTVN1PROD with RULES II. Notice of Continuation Section 1899 of the Act establishes the Shared Savings Program to encourage the development of Accountable Care Organizations (ACOs) in Medicare. The Shared Savings Program is one of the first initiatives implemented under the Affordable Care Act aimed specifically at improving value in the Medicare program—that is, both higher quality and lower total expenditures for individual Medicare beneficiaries and the Medicare program. The Shared Savings Program final rule appeared in the November 2, 2011 Federal Register (76 FR 67801), and the first performance year concluded on December 31, 2013. In connection with the Shared Savings Program, section 1899(f) of the Act authorizes the Secretary to waive certain specified fraud and abuse laws. VerDate Sep<11>2014 21:55 Oct 16, 2014 Jkt 235001 Specifically, section 1899(f) of the Act provides that ‘‘[t]he Secretary may waive such requirements of sections 1128A and 1128B and title XVIII of [the] Act as may be necessary to carry out the provisions of [section 1899 of the Act].’’ The Secretary determined that certain waivers were ‘‘necessary,’’ consistent with this statutory standard, and, CMS and OIG jointly published an interim final rule with comment period (hereinafter referred as ‘‘Waiver IFC’’) (76 FR 67992; November 2, 2011) in conjunction with the issuance of the Shared Savings Program final rule.1 The Waiver IFC established waivers of the application of the Federal physician self-referral law (section 1877 of the Act), the Federal anti-kickback statute (section 1128B(b) of the Act), and certain civil monetary penalties (CMP) law provisions (sections 1128A(a)(5), (b)(1), and (b)(2) of the Act) to specified arrangements involving ACOs participating in the Shared Savings Program. Because the Waiver IFC was issued under the authority at section 1899(f) of the Act, it is considered a Medicare rule subject to the conditions of section 1871(a)(3)(C) of the Act. This document extends the timeline for publication of a final rule concerning Shared Savings Program waivers promulgated in the Waiver IFC. In the absence of this continuation notice, the Waiver IFC would expire, creating legal uncertainty for ACOs participating in the Shared Savings Program and potentially disrupting ongoing business plans or operations of some ACOs. Our goal is to ensure that the regulations setting forth waivers of the fraud and abuse laws continue to be closely aligned with the Shared Savings Program regulations. Based on stakeholder feedback and CMS’s experience operating the Shared Savings Program, CMS determined that certain modifications to the Shared Savings Program regulations were necessary. Therefore, CMS is currently developing a proposed rule regarding the Shared Savings Program. In light of the planned issuance of a proposed rule and the importance of final waiver regulations that align with the Shared Savings Program, we believe the prudent course of action at this time is to extend the effectiveness of the Waiver IFC. In addition, we believe that an extension of the Waiver IFC will avoid impediments to the development of innovative care models envisioned by 1 The Waiver IFC was issued as part of a crossagency, coordinated effort by several Federal agencies to issue documents addressing legal issues regarding ACOs participating in the Shared Savings Program. PO 00000 Frm 00033 Fmt 4700 Sfmt 4700 62357 the Shared Savings Program and new approaches to the delivery of health care for beneficiaries (see 76 FR 68008). As noted previously, the Secretary has determined that the waivers are necessary to carry out the Shared Savings Program. Our decision to extend the Waiver IFC, rather than issue a final rule at this time, should not be viewed as a diminution of the Department’s commitment to establish waivers ‘‘to foster the success of the Shared Savings Program, the purposes of which are to promote accountability for a Medicare patient population, manage and coordinate care for Medicare fee-forservice beneficiaries, and encourage redesigned care processes to improve quality’’ (76 FR 68008). Our goal remains ‘‘to balance effectively the need for ACO certainty, innovation, and flexibility in the Shared Savings Program with protections for beneficiaries and the Medicare program’’ (76 FR 68008). At this time, we believe we can best achieve this balance by issuing this continuation notice. We also believe that we would benefit from additional input from stakeholders to inform our understanding of —(1) how and to what extent ACOs are using the waivers; (2) whether the existing waivers serve the needs of ACOs and the Medicare program; (3) whether the waivers adequately protect the Medicare program and beneficiaries from the types of harms associated with referral payments or payments to reduce or limit services; and (4) whether there are new or changed considerations that should inform the development of additional notice and comment rulemaking. This document extends the timeline for publication of a final rule through November 2, 2015. In accordance with section 1871(a)(3)(C) of the Act, the Waiver IFC shall remain in effect through November 2, 2015, unless a final waiver rule becomes effective on an earlier date. This document was approved by the Administrator for the Centers for Medicare and Medicaid Services and the Inspector General for the Department of the Health and Human Services as it relates to the authorities that fall within the respective purviews of their offices. This includes, without limitation, section 1877(a) of the Act for the Administrator and sections 1128A(a)(5), (b)(1), and (b)(2) and 1128B(b)(1) and (b)(2) of the Act for the Inspector General. Authority: Section 1871 of the Social Security Act (42 U.S.C. 1395hh). (Catalog of Federal Domestic Assistance Program No. 93.773 Medicare—Hospital E:\FR\FM\17OCR1.SGM 17OCR1 62358 Federal Register / Vol. 79, No. 201 / Friday, October 17, 2014 / Rules and Regulations Insurance Program; and No. 93.774, Medicare—Supplementary Medical Insurance Program) DEPARTMENT OF HOMELAND SECURITY inadvertently duplicated two paragraphs listing standards published by the National Fire Protection Association (NFPA). In addition, the standards had originally appeared in order of the year those particular editions of the standards were published. We intended to reorganize them by identification number instead, but left some of them out of order. This correction deletes the redundant paragraphs and correctly orders the remaining ones. Coast Guard List of Subjects in 46 CFR Part 125 Dated: October 10, 2014. C’Reda Weeden, Executive Secretary to the Department, Department of Health and Human Services. [FR Doc. 2014–24663 Filed 10–16–14; 8:45 am] BILLING CODE 4120–01–P Administrative practice and procedure, Cargo vessels, Hazardous materials transportation, Incorporation by reference, Marine safety, Seamen. 46 CFR Part 125 [Docket No. USCG–2012–0208] RIN 1625–AB62 For the reasons described in the preamble, 46 CFR part 125 is amended by making the following correcting amendment: Offshore Supply Vessels of at Least 6,000 GT ITC Coast Guard, DHS. Interim rule; correction. AGENCY: ACTION: The Coast Guard published an interim rule in the Federal Register on August 18, 2014, to ensure the safe carriage of oil, hazardous substances, and individuals in addition to the crew on U.S.-flagged OSVs of at least 6,000 gross tonnage as measured under the Convention Measurement System. In that interim rule, we revised a paragraph listing consensus standards incorporated by reference. In doing so, we inadvertently duplicated two paragraphs and presented others out of order. This correction resolves that error by removing the doubled paragraphs and reordering the others. DATES: This correction is effective on October 17, 2014. FOR FURTHER INFORMATION CONTACT: If you have questions on this final rule, call or email Justin Staples, Office of Standards Evaluation and Development, Coast Guard; telephone 202–372–1483, email Justin.L.Staples@uscg.mil. If you have questions on viewing material on the docket, call Cheryl Collins, Program Manager, Docket Operations, telephone 202–366–9826. SUPPLEMENTARY INFORMATION: On August 18, 2014, the Coast Guard published an interim rule to ensure the safe carriage of oil, hazardous substances, and individuals in addition to the crew on U.S.-flagged OSVs of at least 6,000 gross tonnage as measured under the Convention Measurement System. 79 FR 48894. In that rule, the Coast Guard revised 46 CFR 125.180 to include a number of new standards to be incorporated by reference. In the process, we SUMMARY: mstockstill on DSK4VPTVN1PROD with RULES PART 125—GENERAL VerDate Sep<11>2014 21:55 Oct 16, 2014 Jkt 235001 1. The authority citation for part 125 continues to read as follows: ■ Authority: 46 U.S.C. 2103, 3306, 3307; 49 U.S.C. App. 1804; sec. 617, Pub. L. 111–281, 124 Stat. 2905; Department of Homeland Security Delegation No. 0170.1. 2. In § 125.180, revise paragraph (i) to read as follows: ■ § 125.180 Incorporation by reference. * * * * * (i) National Fire Protection Association (NFPA), 1 Batterymarch Park, Quincy, MA 02269–9101, 617– 770–3000, http://www.nfpa.org: (1) NFPA 10—Standard for Portable Fire Extinguishers, 1994 Edition, IBR approved for § 132.350. (2) NFPA 70—National Electrical Code, 1993 Edition, IBR approved for §§ 129.320, 129.340, and 129.370. (3) NFPA 302—Fire Protection Standard for Pleasure and Commercial Motor Craft, 1994 Edition, IBR approved for § 129.550. (4) NFPA 306—Control of Gas Hazards on Vessels, 1993 Edition, IBR approved for § 126.160. (5) NFPA 1963—Fire Hose Connections, 1993 Edition, IBR approved for § 132.130. * * * * * K. Cervoni, Chief, Office of Regulations and Administrative Law, U.S. Coast Guard. [FR Doc. 2014–24716 Filed 10–16–14; 8:45 am] BILLING CODE 9110–04–P PO 00000 Frm 00034 Fmt 4700 Sfmt 4700 DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration 50 CFR Part 622 [Docket No. 101206604–1758–02] RIN 0648–XD559 Coastal Migratory Pelagic Resources of the Gulf of Mexico and South Atlantic; 2014–2015 Accountability Measure and Closure for Gulf King Mackerel in Western Zone National Marine Fisheries Service (NMFS), National Oceanic and Atmospheric Administration (NOAA), Commerce. ACTION: Temporary rule; closure. AGENCY: NMFS implements an accountability measure (AM) for commercial king mackerel in the western zone of the Gulf of Mexico (Gulf) exclusive economic zone (EEZ) through this temporary final rule. NMFS has determined that the commercial quota for king mackerel in the western zone of the Gulf EEZ will have been reached by October 17, 2014. Therefore, NMFS closes the western zone of the Gulf to commercial king mackerel fishing in the EEZ. This closure is necessary to protect the Gulf king mackerel resource. DATES: The closure is effective noon, local time, October 17, 2014, until 12:01 a.m., local time, on July 1, 2015. FOR FURTHER INFORMATION CONTACT: Susan Gerhart, 727–824–5305, email: susan.gerhart@noaa.gov. SUPPLEMENTARY INFORMATION: The fishery for coastal migratory pelagic fish (king mackerel, Spanish mackerel, and cobia) is managed under the Fishery Management Plan for the Coastal Migratory Pelagic Resources of the Gulf of Mexico and South Atlantic (FMP). The FMP was prepared by the Gulf of Mexico and South Atlantic Fishery Management Councils (Councils) and is implemented under the authority of the Magnuson-Stevens Fishery Conservation and Management Act (Magnuson-Stevens Act) by regulations at 50 CFR part 622. The commercial quota for the Gulf migratory group king mackerel in the western zone is 1,071,360 lb (485,961 kg) (76 FR 82058, December 29, 2011), for the current fishing year, July 1, 2014, through June 30, 2015. Regulations at 50 CFR 622.388(a)(1) require NMFS to close the commercial sector for Gulf migratory group king mackerel in the western zone when the quota is reached, or is projected to be SUMMARY: E:\FR\FM\17OCR1.SGM 17OCR1

Agencies

[Federal Register Volume 79, Number 201 (Friday, October 17, 2014)]
[Rules and Regulations]
[Pages 62356-62358]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2014-24663]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Chapter IV

Office of Inspector General

42 CFR Chapter V

[CMS-1439-RCN]
RIN 0938-AR30


Medicare Program; Final Waivers in Connection With the Shared 
Savings Program; Continuation of Effectiveness and Extension of 
Timeline for Publication of Final Rule

AGENCY: Centers for Medicare & Medicaid Services (CMS) and Office of 
Inspector General (OIG), HHS.

ACTION: Interim final rule; continuation of effectiveness and extension 
of timeline for publication of final rule.

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

SUMMARY: This document announces the continuation of effectiveness of 
an interim final rule and the extension of the timeline for publication 
of the final rule. This document is issued in accordance with section 
1871(a)(3)(C) of the Social Security Act (the Act), which allows an 
interim final rule to remain in effect after the expiration of the 
timeline specified in section 1871(a)(3)(B) of the Act if the Secretary 
publishes a notice of continuation prior to the expiration of the 
timeline.

DATES: This document is effective on October 17, 2014.

FOR FURTHER INFORMATION CONTACT: 

Catherine Bernstein (410) 786-6887 or Lisa Ohrin (410) 786-8852, for 
general issues and issues related to the Physician Self-Referral Law.
Patrice Drew (202) 619-1368, for general issues and issues related to 
the Federal anti-kickback statute or civil monetary penalties law.

SUPPLEMENTARY INFORMATION:

[[Page 62357]]

I. Background

    Section 1871(a)(3)(A) of the Social Security Act (the Act) sets 
forth certain procedures for promulgating regulations necessary to 
carry out the administration of the insurance programs under Title 
XVIII of the Act. Section 1871(a)(3)(A) of the Act requires the 
Secretary, in consultation with the Director of the Office of 
Management and Budget (OMB), to establish a regular timeline for the 
publication of a final rule based on the previous publication of a 
proposed rule or an interim final rule. In accordance with section 
1871(a)(3)(B) of the Act, such regular timeline may vary among 
different final rules, based on the complexity of the rule, the number 
and scope of the comments received, and other relevant factors. The 
timeline for publishing the final rule, however, cannot exceed 3 years 
from the date of publication of the proposed or interim final rule, 
unless there are exceptional circumstances. After consultation with the 
Director of OMB, the Department, through CMS, published a notice in the 
December 30, 2004 Federal Register (69 FR 78442) establishing a general 
3-year timeline for publishing Medicare final rules after the 
publication of a proposed or interim final rule.
    Section 1871(a)(3)(C) of the Act states that a Medicare interim 
final rule shall not continue in effect if the final rule is not 
published before the expiration of the regular timeline, unless the 
Secretary publishes at the end of the regular timeline a notice of 
continuation that includes an explanation of why the regular timeline 
was not met. Upon publication of such a notice, the timeline for 
publishing the final rule is extended for 1 year.

II. Notice of Continuation

    Section 1899 of the Act establishes the Shared Savings Program to 
encourage the development of Accountable Care Organizations (ACOs) in 
Medicare. The Shared Savings Program is one of the first initiatives 
implemented under the Affordable Care Act aimed specifically at 
improving value in the Medicare program--that is, both higher quality 
and lower total expenditures for individual Medicare beneficiaries and 
the Medicare program. The Shared Savings Program final rule appeared in 
the November 2, 2011 Federal Register (76 FR 67801), and the first 
performance year concluded on December 31, 2013.
    In connection with the Shared Savings Program, section 1899(f) of 
the Act authorizes the Secretary to waive certain specified fraud and 
abuse laws. Specifically, section 1899(f) of the Act provides that 
``[t]he Secretary may waive such requirements of sections 1128A and 
1128B and title XVIII of [the] Act as may be necessary to carry out the 
provisions of [section 1899 of the Act].'' The Secretary determined 
that certain waivers were ``necessary,'' consistent with this statutory 
standard, and, CMS and OIG jointly published an interim final rule with 
comment period (hereinafter referred as ``Waiver IFC'') (76 FR 67992; 
November 2, 2011) in conjunction with the issuance of the Shared 
Savings Program final rule.\1\ The Waiver IFC established waivers of 
the application of the Federal physician self-referral law (section 
1877 of the Act), the Federal anti-kickback statute (section 1128B(b) 
of the Act), and certain civil monetary penalties (CMP) law provisions 
(sections 1128A(a)(5), (b)(1), and (b)(2) of the Act) to specified 
arrangements involving ACOs participating in the Shared Savings 
Program.
---------------------------------------------------------------------------

    \1\ The Waiver IFC was issued as part of a cross-agency, 
coordinated effort by several Federal agencies to issue documents 
addressing legal issues regarding ACOs participating in the Shared 
Savings Program.
---------------------------------------------------------------------------

    Because the Waiver IFC was issued under the authority at section 
1899(f) of the Act, it is considered a Medicare rule subject to the 
conditions of section 1871(a)(3)(C) of the Act. This document extends 
the timeline for publication of a final rule concerning Shared Savings 
Program waivers promulgated in the Waiver IFC. In the absence of this 
continuation notice, the Waiver IFC would expire, creating legal 
uncertainty for ACOs participating in the Shared Savings Program and 
potentially disrupting ongoing business plans or operations of some 
ACOs.
    Our goal is to ensure that the regulations setting forth waivers of 
the fraud and abuse laws continue to be closely aligned with the Shared 
Savings Program regulations.
    Based on stakeholder feedback and CMS's experience operating the 
Shared Savings Program, CMS determined that certain modifications to 
the Shared Savings Program regulations were necessary. Therefore, CMS 
is currently developing a proposed rule regarding the Shared Savings 
Program. In light of the planned issuance of a proposed rule and the 
importance of final waiver regulations that align with the Shared 
Savings Program, we believe the prudent course of action at this time 
is to extend the effectiveness of the Waiver IFC. In addition, we 
believe that an extension of the Waiver IFC will avoid impediments to 
the development of innovative care models envisioned by the Shared 
Savings Program and new approaches to the delivery of health care for 
beneficiaries (see 76 FR 68008). As noted previously, the Secretary has 
determined that the waivers are necessary to carry out the Shared 
Savings Program.
    Our decision to extend the Waiver IFC, rather than issue a final 
rule at this time, should not be viewed as a diminution of the 
Department's commitment to establish waivers ``to foster the success of 
the Shared Savings Program, the purposes of which are to promote 
accountability for a Medicare patient population, manage and coordinate 
care for Medicare fee-for-service beneficiaries, and encourage 
redesigned care processes to improve quality'' (76 FR 68008). Our goal 
remains ``to balance effectively the need for ACO certainty, 
innovation, and flexibility in the Shared Savings Program with 
protections for beneficiaries and the Medicare program'' (76 FR 68008). 
At this time, we believe we can best achieve this balance by issuing 
this continuation notice.
    We also believe that we would benefit from additional input from 
stakeholders to inform our understanding of --(1) how and to what 
extent ACOs are using the waivers; (2) whether the existing waivers 
serve the needs of ACOs and the Medicare program; (3) whether the 
waivers adequately protect the Medicare program and beneficiaries from 
the types of harms associated with referral payments or payments to 
reduce or limit services; and (4) whether there are new or changed 
considerations that should inform the development of additional notice 
and comment rulemaking.
    This document extends the timeline for publication of a final rule 
through November 2, 2015. In accordance with section 1871(a)(3)(C) of 
the Act, the Waiver IFC shall remain in effect through November 2, 
2015, unless a final waiver rule becomes effective on an earlier date.
    This document was approved by the Administrator for the Centers for 
Medicare and Medicaid Services and the Inspector General for the 
Department of the Health and Human Services as it relates to the 
authorities that fall within the respective purviews of their offices. 
This includes, without limitation, section 1877(a) of the Act for the 
Administrator and sections 1128A(a)(5), (b)(1), and (b)(2) and 
1128B(b)(1) and (b)(2) of the Act for the Inspector General.

    Authority:  Section 1871 of the Social Security Act (42 U.S.C. 
1395hh).
(Catalog of Federal Domestic Assistance Program No. 93.773 
Medicare--Hospital

[[Page 62358]]

Insurance Program; and No. 93.774, Medicare--Supplementary Medical 
Insurance Program)

    Dated: October 10, 2014.
C'Reda Weeden,
Executive Secretary to the Department, Department of Health and Human 
Services.
[FR Doc. 2014-24663 Filed 10-16-14; 8:45 am]
BILLING CODE 4120-01-P