Medicare and Medicaid Programs; Reform of Requirements for Long-Term Care Facilities, 32256-32260 [2017-14646]
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Federal Register / Vol. 82, No. 133 / Thursday, July 13, 2017 / Rules and Regulations
K. How does today’s action affect
Indian Country (18 U.S.C. 1151) in
Louisiana?
Louisiana is not authorized to carry
out its Hazardous Waste Program in
Indian Country within the State. This
authority remains with EPA. Therefore,
this action has no effect in Indian
Country.
L. What is codification and is the EPA
codifying Louisiana’s hazardous waste
program as authorized in this rule?
Codification is the process of placing
the State’s statutes and regulations that
comprise the State’s authorized
hazardous waste program into the CFR.
We do this by referencing the
authorized State rules in 40 CFR part
272. We reserve the amendment of 40
CFR part 272 subpart T for this
authorization of Louisiana’s program
changes until a later date. In this
authorization application, the EPA is
not codifying the rules documented in
this Federal Register notice.
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M. Administrative Requirements
The Office of Management and Budget
(OMB) has exempted this action (RCRA
State Authorization) from the
requirements of Executive Order 12866
(58 FR 51735, October 4, 1993) and
13563 (76 FR 3821, January 21, 2011).
Therefore, this action is not subject to
review by OMB. This action authorizes
State requirements for the purpose of
RCRA 3006 and imposes no additional
requirements beyond those imposed by
State law. Accordingly, this action will
not have a significant economic impact
on a substantial number of small entities
under the Regulatory Flexibility Act (5
U.S.C. 601 et seq.). Because this action
authorizes pre-existing requirements
under State law and does not impose
any additional enforceable duty beyond
that required by State law, it does not
contain any unfunded mandate or
significantly or uniquely affect small
governments, as described in the
Unfunded Mandates Reform Act of 1995
(Pub. L. 104–4). For the same reason,
this action also does not significantly or
uniquely affect the communities of
Tribal governments, as specified by
Executive Order 13175 (65 FR 67249,
November 9, 2000). This action will not
have substantial direct effects on the
States, on the relationship between the
national government and the States, or
on the distribution of power and
responsibilities among the various
levels of government, as specified in
Executive Order 13132 (64 FR 43255,
August 10, 1999), because it merely
authorizes State requirements as part of
the State RCRA hazardous waste
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program without altering the
relationship or the distribution of power
and responsibilities established by
RCRA. This action also is not subject to
Executive Order 13045 (62 FR 19885,
April 23, 1997), because it is not
economically significant and it does not
make decisions based on environmental
health or safety risks. This rule is not
subject to Executive Order 13211,
‘‘Actions Concerning Regulations That
Significantly Affect Energy Supply,
Distribution, or Use’’ (66 FR 28355 May
22, 2001), because it is not a significant
regulatory action under Executive Order
12866.
Under RCRA 3006(b), the EPA grants
a State’s application for authorization,
as long as the State meets the criteria
required by RCRA. It would thus be
inconsistent with applicable law for the
EPA, when it reviews a State
authorization application, to require the
use of any particular voluntary
consensus standard in place of another
standard that otherwise satisfies the
requirements of RCRA. Thus, the
requirements of section 12(d) of the
National Technology Transfer and
Advancement Act of 1995 (15 U.S.C.
272 note) do not apply. As required by
section 3 of Executive Order 12988 (61
FR 4729, February 7, 1996), in issuing
this rule, the EPA has taken the
necessary steps to eliminate drafting
errors and ambiguity, minimize
potential litigation, and provide a clear
legal standard for affected conduct. The
EPA has complied with Executive Order
12630 (53 FR 8859, March 15, 1988) by
examining the takings implications of
the rule in accordance with the
‘‘Attorney General’s Supplemental
Guidelines for the Evaluation of Risk
and Avoidance of Unanticipated
Takings’’ issued under the Executive
Order. This rule does not impose an
information collection burden under the
provisions of the Paperwork Reduction
Act of 1995 (44 U.S.C. 3501 et seq.).
Executive Order 12898 (59 FR 7629,
February 16, 1994) establishes federal
executive policy on environmental
justice. It’s main provision directs
federal agencies, to the greatest extent
practicable and permitted by law, to
make environmental justice part of their
mission by identifying and addressing,
as appropriate, disproportionately high
and adverse human health or
environmental effects of their programs,
policies, and activities on minority
populations and low-income
populations in the United States.
Because this rule authorizes pre-existing
State rules which are at least equivalent
to, and no less stringent than existing
federal requirements, and impose no
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additional requirements beyond those
imposed by State law, and there are no
anticipated significant adverse human
health or environmental effects, the rule
is not subject to Executive Order 12898.
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. The EPA will
submit a report containing this
document 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 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). This action
nevertheless will be effective September
11, 2017.
List of Subjects in 40 CFR Part 271
Environmental protection,
Administrative practice and procedure,
Confidential business information,
Hazardous waste, Hazardous waste
transportation, Indian lands,
Intergovernmental relations, Penalties,
Reporting and recordkeeping
requirements.
Authority: This action is issued under the
authority of sections 2002(a), 3006, and
7004(b) of the Solid Waste Disposal Act as
amended 42 U.S.C. 6912(a), 6926, 6974(b).
Dated: April 24, 2017.
Samuel Coleman,
Acting Regional Administrator, Region 6.
[FR Doc. 2017–14766 Filed 7–12–17; 8:45 am]
BILLING CODE 6560–50–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
42 CFR Parts 405, 409, 431, 447, 482,
483, 485, 488, and 489
[CMS–3260–F2]
RIN–0938–AR61
Medicare and Medicaid Programs;
Reform of Requirements for LongTerm Care Facilities
Centers for Medicare &
Medicaid Services (CMS), HHS.
AGENCY:
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Federal Register / Vol. 82, No. 133 / Thursday, July 13, 2017 / Rules and Regulations
Final rule; correction and
correcting amendment.
ACTION:
In the October 4, 2016 issue
of the Federal Register, we published a
final rule revising the requirements that
Long-Term Care (LTC) facilities must
meet to participate in the Medicare and
Medicaid programs. The effective date
was November 28, 2016. This document
corrects technical and typographical
errors identified in the October 4, 2016
final rule.
DATES: This document is effective July
13, 2017.
FOR FURTHER INFORMATION CONTACT:
Ronisha Blackstone, (410) 786–6882.
SUPPLEMENTARY INFORMATION:
SUMMARY:
I. Background
In FR Doc. 2016–23503 which
appeared in the October 4, 2016 Federal
Register (81 FR 68688), entitled
‘‘Reform of Requirements for Long-Term
Care Facilities,’’ there were technical
and typographical errors that are
identified and corrected in the
Implementation Timeframe table of the
preamble and in the regulations text of
this document.
II. Summary of Errors
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A. Summary of Errors in the Preamble
We inadvertently made technical and
typographical errors in the preamble as
follows:
On page 68725, fourth full paragraph
of the second column, we inadvertently
referenced proposed § 482.11 instead of
proposed § 483.11.
On page 68729, second paragraph of
the third column, we inadvertently
referenced § 482.15(a) instead of
§ 483.15(a).
On page 68736, second full paragraph
of the second column, we inadvertently
referenced § 482.20(k)(4) instead of
§ 483.20(k)(4).
Under the Implementation Timeframe
table we made technical and
typographical errors as follows:
On page 68696, under § 483.12, we
inadvertently referenced the
‘‘Coordination with QAPI Plan’’ instead
of the ‘‘Coordination with QAPI
Program.’’ We are correcting this error to
clarify that the Coordination with QAPI
Program will be implemented in Phase
3.
On page 68697, we inadvertently
designated existing requirements at
§ 483.45(e)(1) and (2) to be implemented
in the second phase of the
implementation schedule. Requirements
at § 483.45(e)(1) and (2) are
redesignations and do not reflect a
change in policy. We indicated in the
final rule (81 FR 68696) that the first
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phase of implementation will include
those requirements that were unchanged
or received only minor modification.
Therefore, we are correcting the
exceptions to the Phase 1
implementation deadlines to specify
that the requirements at § 483.45(e)(3),
(4), and (5) Psychotropic drugs will be
implemented in Phase 2.
On page 68697, we inadvertently
designated existing requirements at
§ 483.75(g)(2)(i) and (ii) to be
implemented in the third phase of the
implementation schedule. Requirements
at § 483.75(g)(2)(i) and (ii) are
redesignations and do not reflect a
change in policy. We indicated in the
final rule (81 FR 68696) that the first
phase of implementation will include
those requirements that were unchanged
or received only minor modification.
Therefore, we are correcting the
exceptions to the Phase 3
implementation deadlines under
‘‘§ 483.75—Quality assurance and
performance improvement’’ by
replacing the paragraph designation
(g)(1) with (g), subparagraph designation
(iv) with (g)(1)(iv), and clarifying that
(g)(2)(iii) will also be implemented in
Phase 3. Also, we are correcting the
acronym ‘‘ICPO’’ to read ‘‘IP.’’
B. Summary of Errors in the Regulations
Text
On page 68847, we inadvertently
omitted a conforming change to revise
cross-references to part 483 found in
part 409. Sections 409.20 and 409.26
include incorrect cross-references to
§ 483.75(n). We inadvertently did not
update these cross-references.
Therefore, we are revising § 409.20 and
§ 409.26 to correct the cross-reference by
replacing § 483.75(n) with § 483.70(j).
On page 68847, we made technical
errors in the regulations text for
§ 482.58. We inadvertently used the
cross-references from the proposed rule
‘‘Medicare and Medicaid Programs;
Reform of Requirements for Long-Term
Care Facilities’’ (80 FR 42246) rather
than the final rule. We are revising
§ 482.58 to correct the cross-references.
As we noted in the proposed rule, the
revised citations correspond to crossreferences previously set out at § 482.58
and make no substantive policy
changes.
On page 68848, we made technical
errors in the regulations text of § 483.5.
We inadvertently omitted a conforming
change to revise cross-references in the
definitions of ‘‘composite distinct part’’
and ‘‘distinct part.’’ We are revising the
definition of ‘‘composite distinct part’’
and the definition for ‘‘distinct part.’’
We made no substantive changes.
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On page 68854, we inadvertently
designated a cross-reference at
§ 483.10(i)(4), and on pages 68856 and
68857, we inadvertently designated
cross-references at § 483.15(a) through
(d).
On page 68856, we made a technical
error in the regulations text of
§ 483.15(c)(2)(iii)(F). We inadvertently
omitted the apostrophe from the word
‘‘resident’s.’’
On page 68863, we made a technical
error in the amendatory instruction for
§ 483.45. We set out the regulatory text
for paragraph (c)(5) but inadvertently
omitted the instruction to add paragraph
(c)(5) as a new paragraph. We are
revising § 483.45 by adding an
instruction to add paragraph (c)(5).
On page 68863, we made a technical
error in the regulations text of
§ 483.50(a)(2)(iii). We inadvertently
misspelled the word ‘‘assistance.’’
On page 68865, we made a technical
error in the amendatory instruction for
§ 483.70(i), in which we inadvertently
omitted the instruction to revise the
paragraph heading for paragraph (i). We
are inserting this instruction in this final
rule.
On page 68868, we made a technical
error in the regulations text for
§ 483.75(g)(1)(iv). In the preamble of the
final rule (81 FR 68812), we indicated
that in § 483.80(b) we were changing our
use of ‘‘infection control and prevention
officer (ICPO)’’ to ‘‘infection
preventionist (IP).’’ Section
483.75(g)(1)(iv) also uses the term
‘‘infection control and prevention
officer.’’ We are revising
§ 483.75(g)(1)(iv) by replacing the
phrase ‘‘infection control and
prevention officer’’ with ‘‘infection
preventionist.’’
On page 68869, we made a technical
error in the regulations text for
§ 483.85(b). We incorrectly indicated
that the operating organization for each
facility must have in operation a
compliance and ethics program by
November 28, 2017. In the final rule (81
FR 68697) we indicated that all the
requirements in § 483.85 would be
implemented in Phase 3 (November 28,
2019). Therefore, we are revising
paragraph § 483.85(b) to accurately
indicate that the operating organization
for each facility must have in operation
a compliance and ethics program by
November 28, 2019 and removing the
reference to November 28, 2017.
On page 68870, we made technical
errors in the regulations text for
§ 483.90. We incorrectly designated
paragraph § 483.90(d) as (c), which
resulted in the omission of existing
requirements at § 483.90(c) in the Code
of Federal Regulations (CFR). We are
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revising § 483.90 to correctly designate
the paragraphs in this section and add
the omitted requirements.
On page 68871, we made a technical
error in the amendatory instruction for
§ 485.635. We incorrectly revised the
cross-reference to § 483.25(i) in
§ 485.635(a)(3)(vii). We are revising
§ 485.635 to correct the cross-reference
by replacing the reference to
‘‘§ 483.25(d)(8)’’ with ‘‘§ 483.25(g.)’’
On page 68871, we made technical
errors in the regulations text for
§ 485.645. We inadvertently used the
cross-references from the proposed rule
‘‘Medicare and Medicaid Programs;
Reform of Requirements for Long-Term
Care Facilities (80 FR 42269) rather than
the final rule. We are revising § 485.645
to correct the cross-references. As we
noted in the proposed rule, the revised
citations correspond to cross-references
previously set out at § 485.645 and make
no substantive policy changes.
On page 68871, we made a technical
error in the regulations text for § 488.56.
Section 488.56(b) and (b)(2) include
incorrect cross-references to § 488.75(i).
We inadvertently did not update these
cross-references. Therefore, we are
revising § 488.56 to correct the crossreference by replacing § 488.75(i) with
§ 483.70(h).
III. Waiver of Proposed Rulemaking
and Delay in Effective Date
We ordinarily publish a notice of
proposed rulemaking in the Federal
Register to provide a period for public
comment before the provisions of a rule
take effect in accordance with section
553(b) of the Administrative Procedure
Act (APA) (5 U.S.C. 553(b)). However,
we can waive this notice and comment
procedure if the Secretary finds, for
good cause, that the notice and
comment process is impracticable,
unnecessary, or contrary to the public
interest, and incorporates a statement of
the finding and the reasons therefore in
the rule.
Section 553(d) of the APA ordinarily
requires a 30-day delay in effective date
of final rules after the date of their
publication in the Federal Register.
This 30-day delay in effective date can
be waived, however, if an agency finds
for good cause that the delay is
impracticable, unnecessary, or contrary
to the public interest, and the agency
incorporates a statement of the findings
and its reasons in the rule issued.
Our revisions to the requirements for
Long-Term Care (LTC) facilities found
in part 483 subpart B have previously
been subjected to notice and comment
procedures. These corrections are
consistent with the discussion of the
policy in the October 2016 final rule
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and do not make substantive changes to
this policy. This correcting amendment
merely corrects technical errors in the
regulations text of the October 2016
final rule and makes no substantive
policy changes. As a result, this
correcting amendment is intended to
ensure that the October 2016 final rule
accurately reflects the policy adopted in
the final rule. Therefore, we find that
undertaking further notice and comment
procedures to incorporate these
corrections into the final rule is
unnecessary and contrary to the public
interest.
For the same reasons, we are also
waiving the 30-day delay in effective
date for this correcting amendment. We
believe that it is in the public interest
to ensure that the October 2016 final
rule accurately reflect our revisions to
the requirements for LTC facilities.
Delaying the effective date of these
corrections would be contrary to the
public interest. Therefore, we also find
good cause to waive the 30-day delay in
effective date.
IV. Correction of Errors in the Preamble
a. On page 68725, in second column;
in the fourth paragraph, line 21 remove
‘‘482.11’’ and add in its place ‘‘483.11’’.
b. On page 68729, in the third
column; in the second paragraph, line
11 remove ‘‘482.15(a)’’ and add in its
place ‘‘483.15(a)’’.
c. On page 68736, in the second
column; in the second paragraph, line
58 remove ’’ 482.20(k)(4)’’ and add in its
place ‘‘483.20(k)(4)’’.
d. On page 68696, in the table under
the ‘‘Implementation deadline’’ heading,
second column, in the second bullet,
after the word ‘‘QAPI,’’ remove the word
‘‘Plan’’ and add ‘‘Program’’ in its place.
e. On page 68697, in the table under
the ‘‘Implementation deadline’’ heading,
second column—
1. In the sixth bullet, remove the
phrase ‘‘(e) Psychotropic drugs—
Implemented in Phase 2’’ and add
‘‘(e)(3), (4), and (5) Psychotropic drugs—
Implemented in Phase 2’’ in its place.
2. In the sixteenth bullet—
A. Remove the reference to ‘‘(g)(1)’’
and add ‘‘(g)’’ in its place.
B. Remove the phrase ‘‘with the
exception of subparagraph (iv), the
addition of the ICPO, which will be
implemented in Phase 3’’ and add ‘‘with
the exception of aragraphs (g)(1)(iv) (the
addition of the IP) and (g)(2)(iii)
(regarding the use of QAPI data), which
will be implemented in Phase 3’’.
C. Remove the acronym ‘‘ICPO’’ and
add ‘‘IP’’ in its place.
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List of Subjects
42 CFR Part 409
Health facilities, Medicare.
42 CFR Part 482
Grant programs—health, Hospitals,
Medicaid, Medicare, Reporting and
recordkeeping requirements.
42 CFR Part 483
Grant programs—health, Health
facilities, Health professions, Health
records, Medicaid, Medicare, Nursing
homes, Nutrition, Reporting and
recordkeeping requirements, Safety.
42 CFR Part 485
Grant programs—health, Health
facilities, Medicaid, Medicare, Privacy,
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 amends 42 CFR
chapter IV as set forth below:
PART 409—HOSPITAL INSURANCE
BENEFITS
1. The authority citation for part 409
continues to read as follows:
■
Authority: Secs. 1102 and 1871 of the
Social Security Act (42 U.S.C. 1302 and
1395hh).
§ 409.20
[Amended]
2. In § 409.20, amend paragraph (a)(6)
by removing the cross-reference
‘‘§ 483.75(n)’’ and adding in its place
‘‘§ 483.70(j)’’.
■
§ 409.26
[Amended]
3. In § 409.26, amend paragraph (a)(1)
by removing the cross-reference
‘‘§ 483.75(n)’’ and adding in its place
‘‘§ 483.70(j)’’.
■
PART 482—CONDITIONS OF
PARTICIPATION FOR HOSPITALS
4. The authority citation for part 482
continues to read as follows:
■
Authority: Secs. 1102, 1871 and 1881 of
the Social Security Act (42 U.S.C. 1302,
1395hh, and 1395rr), unless otherwise noted.
5. In § 482.58 revise paragraph (b) to
read as follows:
■
§ 482.58 Special requirements for hospital
providers of long-term care services
(‘‘swing-beds’’)
*
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Federal Register / Vol. 82, No. 133 / Thursday, July 13, 2017 / Rules and Regulations
(b) Skilled nursing facility services.
The facility is substantially in
compliance with the following skilled
nursing facility requirements contained
in subpart B of part 483 of this chapter.
(1) Resident rights (§ 483.10(b)(7),
(c)(1), (c)(2)(iii), (c)(6), (d), (e)(2), (e)(4),
(f)(4)(ii), (f)(4)(iii), (f)(9), (h), (g)(8),
(g)(17), and (g)(18) introductory text.
(2) Admission, transfer, and discharge
rights (§ 483.5 definition of transfer and
discharge, § 483.15(c)(1), (c)(2)(i),
(c)(2)(ii), (c)(3), (c)(4), (c)(5), and (c)(7)).
(3) Freedom from abuse, neglect, and
exploitation (§ 483.12(a)(1), (a)(2),
(a)(3)(i), (a)(3)(ii), (a)(4), (b)(1), (b)(2),
(c)).
(4) Patient activities (§ 483.24(c)).
(5) Social services (§ 483.40(d) and
483.70(p)).
(6) Discharge planning (§ 483.20(e)).
(7) Specialized rehabilitative services
(§ 483.65).
(8) Dental services (§ 483.55).
PART 483—REQUIREMENTS FOR
STATES AND LONG TERM CARE
FACILITIES
6. The authority citation for part 483
continues to read as follows:
■
Authority: Secs. 1102, 1128I and 1871 of
the Social Security Act (42 U.S.C. 1302,
1320a–7j, 1395hh and 1396r).
7. In § 483.5, amend the definition of
‘‘Composite distinct part’’ by revising
paragraph (2) introductory text and
amend the definition of ‘‘Distinct part’’
by revising paragraph (1) to read as
follows:
■
§ 483.5
Definitions.
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*
*
*
*
*
Composite distinct part—* * *
(2) Requirements. In addition to
meeting the requirements of specified in
the definition of ‘‘distinct part’’ of this
section, a composite distinct part must
meet all of the following requirements:
*
*
*
*
*
Distinct part—(1) Definition. A
distinct part SNF or NF is physically
distinguishable from the larger
institution or institutional complex that
houses it, meets the requirements of this
paragraph and of paragraph (2) of this
definition, and meets the applicable
statutory requirements for SNFs or NFs
in sections 1819 or 1919 of the Act,
respectively. A distinct part SNF or NF
may comprise one or more buildings or
designated parts of buildings (that is,
wings, wards, or floors) that are: In the
same physical area immediately
adjacent to the institution’s main
buildings; other areas and structures
that are not strictly contiguous with the
main buildings but are located within
close proximity to the main buildings;
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and any other areas that CMS
determines on an individual basis, to be
part of the institution’s campus. A
distinct part must include all of the beds
within the designated area, and cannot
consist of a random collection of
individual rooms or beds that are
scattered throughout the physical plant.
The term ‘‘distinct part’’ also includes a
composite distinct part that meets the
additional requirements specified in the
definition of ‘‘composite distinct part’’
of this section.
*
*
*
*
*
§ 483.10
[Amended]
8. In § 483.10, amend paragraph (i)(4)
by removing the reference
‘‘§ 483.90(d)(2)(iv)’’ and adding in its
place ‘‘§ 483.90(e)(2)(iv)’’.
■
§ 483.15
[Amended]
9. In § 483.15—
a. Amend paragraph (a)(7) by
removing the reference ‘‘paragraph
(b)(10)’’ and adding in its place
‘‘paragraph (c)(9)’’.
■ b. Amend paragraph (b)(2) by
removing the reference to
‘‘§ 483.10(g)(3)’’ and adding in its place
‘‘§ 483.10(g)(18)(i)’’.
■ c. Amend paragraph (c)(2)(ii)(B) by
removing the reference ‘‘paragraph
(b)(1)(i)(C) or (D)’’ and adding in its
place ‘‘paragraph (c)(1)(i)(C) or (D)’’.
■ d. Amend paragraph (c)(2)(iii)(F) by
removing the word ‘‘residents’’ and
adding in its place ‘‘resident’s’’.
■ e. Amend paragraph (c)(3)(iii) by
removing the reference to ‘‘paragraph
(b)(5)’’ and adding in its place
‘‘paragraph (c)(5)’’.
■ f. Amend paragraph (c)(4)(i) by
removing the reference ‘‘paragraphs
(b)(4)(ii) and (b)(8)’’ and adding in its
place ‘‘paragraphs (c)(4)(ii) and (8)’’.
■ g. Amend paragraph (c)(4)(ii)(A) by
removing the reference to ‘‘paragraph
(b)(1)(ii)(C)’’ and adding in its place
‘‘paragraph (c)(1)(i)(C)’’.
■ h. Amend paragraph (c)(4)(ii)(B) by
removing the reference to ‘‘paragraph
(b)(1)(ii)(D)’’ and adding in its place
‘‘paragraph (c)(1)(i)(D)’’.
■ i. Amend paragraph (c)(4)(ii)(C) by
removing the reference ‘‘paragraph
(b)(1)(ii)(B)’’ and adding in its place
‘‘paragraph (c)(1)(i)(B)’’.
■ j. Amend paragraph (c)(4)(ii)(D) by
removing the reference ‘‘paragraph
(b)(1)(ii)(A)’’ and adding in its place
‘‘paragraph (c)(1)(i)(A)’’.
■ k. Amend paragraph (c)(5)
introductory text by removing the
reference ‘‘paragraph (b)(3)’’ and adding
in its place ‘‘paragraph (c)(3)’’.
■ l. Amend paragraph (d)(1)(iii) by
removing the reference ‘‘paragraph
■
■
PO 00000
Frm 00033
Fmt 4700
Sfmt 4700
32259
(c)(3)’’ and adding in its place
‘‘paragraph (e)(1)’’.
■ m. Amend paragraph (d)(1)(iv) by
removing the reference ‘‘paragraph
(c)(3)’’ and adding in its place
‘‘paragraph (e)(1)’’.
■ n. Amend paragraph (d)(2) by
removing the reference ‘‘paragraph
(c)(1)’’ and adding in its place
‘‘paragraph (d)(1)’’.
■ 10. In § 483.45 add paragraph (c)(5) to
read as follows:
§ 483.45
Pharmacy services.
*
*
*
*
*
(c) * * *
(5) The facility must develop and
maintain policies and procedures for the
monthly drug regimen review that
include, but are not limited to, time
frames for the different steps in the
process and steps the pharmacist must
take when he or she identifies an
irregularity that requires urgent action
to protect the resident.
*
*
*
*
*
§ 483.50
[Amended]
11. In § 483.50, amend paragraph
(a)(2)(iii) by removing the word
‘‘asistance’’ and adding in its place
‘‘assistance’’.
■ 12. In § 483.70 revise the heading to
paragraph (i) to read as follows:
■
§ 483.70
Administration.
*
*
*
*
*
(i) Medical records. * * *
*
*
*
*
*
§ 483.75
[Amended]
13. In § 483.75, amend paragraph
(g)(1)(iv) by removing the phrase
‘‘infection control and prevention
officer’’ and adding in its place
‘‘infection preventionist’’.
■ 14. In § 483.85 revise paragraph (b) to
read as follows:
■
§ 483.85
Compliance and ethics program.
*
*
*
*
*
(b) General rule. Beginning November
28, 2019, the operating organization for
each facility must have in operation a
compliance and ethics program (as
defined in paragraph (a) of this section)
that meets the requirements of this
section.
*
*
*
*
*
■ 15. In § 483.90 revise paragraph (c) to
read as follows:
§ 483.90
Physical environment.
*
*
*
*
*
(c) Emergency power. (1) An
emergency electrical power system must
supply power adequate at least for
lighting all entrances and exits;
E:\FR\FM\13JYR1.SGM
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32260
Federal Register / Vol. 82, No. 133 / Thursday, July 13, 2017 / Rules and Regulations
16. The authority citation for part 485
continues to read as follows:
(5) Social services (§ 483.40(d) and
§ 483.70(p) of this chapter).
(6) Comprehensive assessment,
comprehensive care plan, and discharge
planning (§ 483.20(b), and § 483.21(b)
and (c)(2) of this chapter), except that
the CAH is not required to use the
resident assessment instrument (RAI)
specified by the State that is required
under § 483.20(b), or to comply with the
requirements for frequency, scope, and
number of assessments prescribed in
§ 413.343(b) of this chapter).
(7) Specialized rehabilitative services
(§ 483.65 of this chapter).
(8) Dental services (§ 483.55 of this
chapter).
(9) Nutrition (§ 483.25(g)(1) and (g)(2)
of this chapter).
Authority: Secs. 1102 and 1871 of the
Social Security Act (42 U.S.C. 1302 and
1395(hh)).
PART 488—SURVEY, CERTIFICATION,
AND ENFORCEMENT PROCEDURES
§ 485.635
■
equipment to maintain the fire
detection, alarm, and extinguishing
systems; and life support systems in the
event the normal electrical supply is
interrupted.
(2) When life support systems are
used, the facility must provide
emergency electrical power with an
emergency generator (as defined in
NFPA 99, Health Care Facilities) that is
located on the premises.
*
*
*
*
*
PART 485—CONDITIONS OF
PARTICIPATION: SPECIALIZED
PROVIDERS
■
[Amended]
17. In § 485.635, amend paragraph
(a)(3)(vii) by removing the reference to
‘‘§ 483.25(d)(8)’’ and adding in its place
‘‘§ 483.25(g)’’.
■ 18. In § 485.645—
■ a. Revise paragraph (d)(1).
■ b. Remove paragraph (d)(2).
■ c. Redesignate paragraphs (d)(3)
through (10) as paragraphs (d)(2)
through (9), respectively.
■ d. Revise newly redesignated
paragraphs (d)(2) through (9).
The revisions read as follows:
■
19. The authority citation for part 488
continues to read as follows:
Authority: Secs. 1102, 1128l, 1864, 1865,
1871 and 1875 of the Social Security Act,
unless otherwise noted (42 U.S.C 1302,
1320a–7j, 1395aa, 1395bb, 1395hh) and
1395ll.
§ 488.56
[Amended]
20. In § 488.56 amend paragraphs (b)
introductory text and (b)(2) by removing
the reference ‘‘§ 488.75(i)’’ and adding
in its place ‘‘§ 483.70(h)’’.
■
Dated: June 30, 2017.
Thomas E. Price
Secretary, Department of Health and Human
Services.
*
jstallworth on DSK7TPTVN1PROD with RULES
§ 485.645 Special requirements for CAH
providers of long-term care services
(‘‘swing-beds’’)
[FR Doc. 2017–14646 Filed 7–12–17; 8:45 am]
*
*
*
*
(d) * * *
(1) Resident rights (§ 483.10(b)(7),
(c)(1), (c)(2)(iii), (c)(6), (d), (e)(2), (e)(4),
(f)(4)(ii), (f)(4)(iii), (f)(9), (g)(8), (g)(17),
(g)(18) introductory text, (h) of this
chapter).
(2) Admission, transfer, and discharge
rights (§ 483.5 definition of transfer &
discharge, § 483.15(c)(1), (c)(2), (c)(3),
(c)(4), (c)(5), (c)(7), (c)(8), and (c)(9) of
this chapter).
(3) Freedom from abuse, neglect and
exploitation (§ 483.12(a)(1), (a)(2),
(a)(3)(i), (a)(3)(ii), (a)(4), (b)(1), (b)(2),
(c)(1), (c)(2), (c)(3), and (c)(4) of this
chapter).
(4) Patient activities (§ 483.24(c) of
this chapter), except that the services
may be directed either by a qualified
professional meeting the requirements
of § 483.24(c)(2), or by an individual on
the facility staff who is designated as the
activities director and who serves in
consultation with a therapeutic
recreation specialist, occupational
therapist, or other professional with
experience or education in recreational
therapy.
VerDate Sep<11>2014
14:16 Jul 12, 2017
Jkt 241001
BILLING CODE 4120–01–P
FEDERAL COMMUNICATIONS
COMMISSION
47 CFR Parts 1, 25, 73, and 74
[GN Docket No. 15–236; DA 17–562]
Review of Foreign Ownership Policies
for Broadcast, Common Carrier and
Aeronautical Radio Licensees
Federal Communications
Commission.
ACTION: Final rule; dismissal of petition
for reconsideration.
AGENCY:
In this Order on
Reconsideration, the Federal
Communications Commission
(Commission) dismisses a petition for
reconsideration filed in this rulemaking
proceeding by William J. Kirsch. This
action was taken on delegated authority
jointly by the Acting Chief, International
Bureau, and the Chief, Media Bureau.
DATES: July 13, 2017.
SUMMARY:
PO 00000
Frm 00034
Fmt 4700
Sfmt 4700
FOR FURTHER INFORMATION CONTACT:
Gabrielle Kim or Francis Gutierrez,
Telecommunications and Analysis
Division, International Bureau, FCC,
(202) 418–1480 or via email to
Gabrielle.Kim@fcc.gov,
Francis.Gutierrez@fcc.gov.
SUPPLEMENTARY INFORMATION: This is a
summary of the Commission’s Order on
Reconsideration in GN Docket No. 15–
236, DA 17–562, adopted and released
on June 8, 2017. The full text of the
Order on Reconsideration is available
for inspection and copying during
normal business hours in the FCC
Reference Center, 445 12th Street SW.,
Room CY–A257, Washington, DC 20554.
To request materials in accessible
formats for people with disabilities,
send an email to FCC504@fcc.gov or call
the Consumer & Governmental Affairs
Bureau at 202–418–0530 (voice), 202–
418–0432 (TTY). The document also is
available for download over the Internet
at https://transition.fcc.gov/Daily_
Releases/Daily_Business/2017/db0608/
DA-17-562A1.pdf.
Synopsis
1. In the 2016 Foreign Ownership
Report and Order, 81 FR 86586, the
Commission modified the foreign
ownership filing and review process for
broadcast licensees by extending the
streamlined procedures developed for
foreign ownership reviews for common
carrier and certain aeronautical
licensees under section 310(b)(4) of the
Communications Act of 1934, as
amended (the ‘‘Act’’), to the broadcast
context with certain limited exceptions.
The Commission also reformed the
methodology used by both common
carrier and broadcast licensees that are,
or are controlled by, U.S. public
companies to assess compliance with
the foreign ownership restrictions in
section 310(b)(3) and 310(b)(4) of the
Act, respectively. In response, a petition
for reconsideration (Petition) was filed
by William J. Kirsch (Petitioner)
asserting that the Commission did not
address the concerns he had raised
earlier in the proceeding in response to
the 2015 Foreign Ownership NPRM, 80
FR 68815.
2. The Order on Reconsideration
dismisses the Petition because it does
not meet the requirements of section
1.429 of the Commission’s rules and
plainly does not warrant consideration
by the Commission. More specifically,
the Petition fails to state with
particularity the respects in which the
Petitioner believes the action taken by
the Commission in the 2016 Foreign
Ownership Report and Order should be
changed; relies on arguments that the
E:\FR\FM\13JYR1.SGM
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Agencies
[Federal Register Volume 82, Number 133 (Thursday, July 13, 2017)]
[Rules and Regulations]
[Pages 32256-32260]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-14646]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 405, 409, 431, 447, 482, 483, 485, 488, and 489
[CMS-3260-F2]
RIN-0938-AR61
Medicare and Medicaid Programs; Reform of Requirements for Long-
Term Care Facilities
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
[[Page 32257]]
ACTION: Final rule; correction and correcting amendment.
-----------------------------------------------------------------------
SUMMARY: In the October 4, 2016 issue of the Federal Register, we
published a final rule revising the requirements that Long-Term Care
(LTC) facilities must meet to participate in the Medicare and Medicaid
programs. The effective date was November 28, 2016. This document
corrects technical and typographical errors identified in the October
4, 2016 final rule.
DATES: This document is effective July 13, 2017.
FOR FURTHER INFORMATION CONTACT: Ronisha Blackstone, (410) 786-6882.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2016-23503 which appeared in the October 4, 2016 Federal
Register (81 FR 68688), entitled ``Reform of Requirements for Long-Term
Care Facilities,'' there were technical and typographical errors that
are identified and corrected in the Implementation Timeframe table of
the preamble and in the regulations text of this document.
II. Summary of Errors
A. Summary of Errors in the Preamble
We inadvertently made technical and typographical errors in the
preamble as follows:
On page 68725, fourth full paragraph of the second column, we
inadvertently referenced proposed Sec. 482.11 instead of proposed
Sec. 483.11.
On page 68729, second paragraph of the third column, we
inadvertently referenced Sec. 482.15(a) instead of Sec. 483.15(a).
On page 68736, second full paragraph of the second column, we
inadvertently referenced Sec. 482.20(k)(4) instead of Sec.
483.20(k)(4).
Under the Implementation Timeframe table we made technical and
typographical errors as follows:
On page 68696, under Sec. 483.12, we inadvertently referenced the
``Coordination with QAPI Plan'' instead of the ``Coordination with QAPI
Program.'' We are correcting this error to clarify that the
Coordination with QAPI Program will be implemented in Phase 3.
On page 68697, we inadvertently designated existing requirements at
Sec. 483.45(e)(1) and (2) to be implemented in the second phase of the
implementation schedule. Requirements at Sec. 483.45(e)(1) and (2) are
redesignations and do not reflect a change in policy. We indicated in
the final rule (81 FR 68696) that the first phase of implementation
will include those requirements that were unchanged or received only
minor modification. Therefore, we are correcting the exceptions to the
Phase 1 implementation deadlines to specify that the requirements at
Sec. 483.45(e)(3), (4), and (5) Psychotropic drugs will be implemented
in Phase 2.
On page 68697, we inadvertently designated existing requirements at
Sec. 483.75(g)(2)(i) and (ii) to be implemented in the third phase of
the implementation schedule. Requirements at Sec. 483.75(g)(2)(i) and
(ii) are redesignations and do not reflect a change in policy. We
indicated in the final rule (81 FR 68696) that the first phase of
implementation will include those requirements that were unchanged or
received only minor modification. Therefore, we are correcting the
exceptions to the Phase 3 implementation deadlines under ``Sec.
483.75--Quality assurance and performance improvement'' by replacing
the paragraph designation (g)(1) with (g), subparagraph designation
(iv) with (g)(1)(iv), and clarifying that (g)(2)(iii) will also be
implemented in Phase 3. Also, we are correcting the acronym ``ICPO'' to
read ``IP.''
B. Summary of Errors in the Regulations Text
On page 68847, we inadvertently omitted a conforming change to
revise cross-references to part 483 found in part 409. Sections 409.20
and 409.26 include incorrect cross-references to Sec. 483.75(n). We
inadvertently did not update these cross-references. Therefore, we are
revising Sec. 409.20 and Sec. 409.26 to correct the cross-reference
by replacing Sec. 483.75(n) with Sec. 483.70(j).
On page 68847, we made technical errors in the regulations text for
Sec. 482.58. We inadvertently used the cross-references from the
proposed rule ``Medicare and Medicaid Programs; Reform of Requirements
for Long-Term Care Facilities'' (80 FR 42246) rather than the final
rule. We are revising Sec. 482.58 to correct the cross-references. As
we noted in the proposed rule, the revised citations correspond to
cross-references previously set out at Sec. 482.58 and make no
substantive policy changes.
On page 68848, we made technical errors in the regulations text of
Sec. 483.5. We inadvertently omitted a conforming change to revise
cross-references in the definitions of ``composite distinct part'' and
``distinct part.'' We are revising the definition of ``composite
distinct part'' and the definition for ``distinct part.'' We made no
substantive changes.
On page 68854, we inadvertently designated a cross-reference at
Sec. 483.10(i)(4), and on pages 68856 and 68857, we inadvertently
designated cross-references at Sec. 483.15(a) through (d).
On page 68856, we made a technical error in the regulations text of
Sec. 483.15(c)(2)(iii)(F). We inadvertently omitted the apostrophe
from the word ``resident's.''
On page 68863, we made a technical error in the amendatory
instruction for Sec. 483.45. We set out the regulatory text for
paragraph (c)(5) but inadvertently omitted the instruction to add
paragraph (c)(5) as a new paragraph. We are revising Sec. 483.45 by
adding an instruction to add paragraph (c)(5).
On page 68863, we made a technical error in the regulations text of
Sec. 483.50(a)(2)(iii). We inadvertently misspelled the word
``assistance.''
On page 68865, we made a technical error in the amendatory
instruction for Sec. 483.70(i), in which we inadvertently omitted the
instruction to revise the paragraph heading for paragraph (i). We are
inserting this instruction in this final rule.
On page 68868, we made a technical error in the regulations text
for Sec. 483.75(g)(1)(iv). In the preamble of the final rule (81 FR
68812), we indicated that in Sec. 483.80(b) we were changing our use
of ``infection control and prevention officer (ICPO)'' to ``infection
preventionist (IP).'' Section 483.75(g)(1)(iv) also uses the term
``infection control and prevention officer.'' We are revising Sec.
483.75(g)(1)(iv) by replacing the phrase ``infection control and
prevention officer'' with ``infection preventionist.''
On page 68869, we made a technical error in the regulations text
for Sec. 483.85(b). We incorrectly indicated that the operating
organization for each facility must have in operation a compliance and
ethics program by November 28, 2017. In the final rule (81 FR 68697) we
indicated that all the requirements in Sec. 483.85 would be
implemented in Phase 3 (November 28, 2019). Therefore, we are revising
paragraph Sec. 483.85(b) to accurately indicate that the operating
organization for each facility must have in operation a compliance and
ethics program by November 28, 2019 and removing the reference to
November 28, 2017.
On page 68870, we made technical errors in the regulations text for
Sec. 483.90. We incorrectly designated paragraph Sec. 483.90(d) as
(c), which resulted in the omission of existing requirements at Sec.
483.90(c) in the Code of Federal Regulations (CFR). We are
[[Page 32258]]
revising Sec. 483.90 to correctly designate the paragraphs in this
section and add the omitted requirements.
On page 68871, we made a technical error in the amendatory
instruction for Sec. 485.635. We incorrectly revised the cross-
reference to Sec. 483.25(i) in Sec. 485.635(a)(3)(vii). We are
revising Sec. 485.635 to correct the cross-reference by replacing the
reference to ``Sec. 483.25(d)(8)'' with ``Sec. 483.25(g.)''
On page 68871, we made technical errors in the regulations text for
Sec. 485.645. We inadvertently used the cross-references from the
proposed rule ``Medicare and Medicaid Programs; Reform of Requirements
for Long-Term Care Facilities (80 FR 42269) rather than the final rule.
We are revising Sec. 485.645 to correct the cross-references. As we
noted in the proposed rule, the revised citations correspond to cross-
references previously set out at Sec. 485.645 and make no substantive
policy changes.
On page 68871, we made a technical error in the regulations text
for Sec. 488.56. Section 488.56(b) and (b)(2) include incorrect cross-
references to Sec. 488.75(i). We inadvertently did not update these
cross-references. Therefore, we are revising Sec. 488.56 to correct
the cross-reference by replacing Sec. 488.75(i) with Sec. 483.70(h).
III. Waiver of Proposed Rulemaking and Delay in Effective Date
We ordinarily publish a notice of proposed rulemaking in the
Federal Register to provide a period for public comment before the
provisions of a rule take effect in accordance with section 553(b) of
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we
can waive this notice and comment procedure if the Secretary finds, for
good cause, that the notice and comment process is impracticable,
unnecessary, or contrary to the public interest, and incorporates a
statement of the finding and the reasons therefore in the rule.
Section 553(d) of the APA ordinarily requires a 30-day delay in
effective date of final rules after the date of their publication in
the Federal Register. This 30-day delay in effective date can be
waived, however, if an agency finds for good cause that the delay is
impracticable, unnecessary, or contrary to the public interest, and the
agency incorporates a statement of the findings and its reasons in the
rule issued.
Our revisions to the requirements for Long-Term Care (LTC)
facilities found in part 483 subpart B have previously been subjected
to notice and comment procedures. These corrections are consistent with
the discussion of the policy in the October 2016 final rule and do not
make substantive changes to this policy. This correcting amendment
merely corrects technical errors in the regulations text of the October
2016 final rule and makes no substantive policy changes. As a result,
this correcting amendment is intended to ensure that the October 2016
final rule accurately reflects the policy adopted in the final rule.
Therefore, we find that undertaking further notice and comment
procedures to incorporate these corrections into the final rule is
unnecessary and contrary to the public interest.
For the same reasons, we are also waiving the 30-day delay in
effective date for this correcting amendment. We believe that it is in
the public interest to ensure that the October 2016 final rule
accurately reflect our revisions to the requirements for LTC
facilities. Delaying the effective date of these corrections would be
contrary to the public interest. Therefore, we also find good cause to
waive the 30-day delay in effective date.
IV. Correction of Errors in the Preamble
a. On page 68725, in second column; in the fourth paragraph, line
21 remove ``482.11'' and add in its place ``483.11''.
b. On page 68729, in the third column; in the second paragraph,
line 11 remove ``482.15(a)'' and add in its place ``483.15(a)''.
c. On page 68736, in the second column; in the second paragraph,
line 58 remove '' 482.20(k)(4)'' and add in its place ``483.20(k)(4)''.
d. On page 68696, in the table under the ``Implementation
deadline'' heading, second column, in the second bullet, after the word
``QAPI,'' remove the word ``Plan'' and add ``Program'' in its place.
e. On page 68697, in the table under the ``Implementation
deadline'' heading, second column--
1. In the sixth bullet, remove the phrase ``(e) Psychotropic
drugs--Implemented in Phase 2'' and add ``(e)(3), (4), and (5)
Psychotropic drugs--Implemented in Phase 2'' in its place.
2. In the sixteenth bullet--
A. Remove the reference to ``(g)(1)'' and add ``(g)'' in its place.
B. Remove the phrase ``with the exception of subparagraph (iv), the
addition of the ICPO, which will be implemented in Phase 3'' and add
``with the exception of aragraphs (g)(1)(iv) (the addition of the IP)
and (g)(2)(iii) (regarding the use of QAPI data), which will be
implemented in Phase 3''.
C. Remove the acronym ``ICPO'' and add ``IP'' in its place.
List of Subjects
42 CFR Part 409
Health facilities, Medicare.
42 CFR Part 482
Grant programs--health, Hospitals, Medicaid, Medicare, Reporting
and recordkeeping requirements.
42 CFR Part 483
Grant programs--health, Health facilities, Health professions,
Health records, Medicaid, Medicare, Nursing homes, Nutrition, Reporting
and recordkeeping requirements, Safety.
42 CFR Part 485
Grant programs--health, Health facilities, Medicaid, Medicare,
Privacy, 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 amends 42 CFR chapter IV as set forth below:
PART 409--HOSPITAL INSURANCE BENEFITS
0
1. The authority citation for part 409 continues to read as follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395hh).
Sec. 409.20 [Amended]
0
2. In Sec. 409.20, amend paragraph (a)(6) by removing the cross-
reference ``Sec. 483.75(n)'' and adding in its place ``Sec.
483.70(j)''.
Sec. 409.26 [Amended]
0
3. In Sec. 409.26, amend paragraph (a)(1) by removing the cross-
reference ``Sec. 483.75(n)'' and adding in its place ``Sec.
483.70(j)''.
PART 482--CONDITIONS OF PARTICIPATION FOR HOSPITALS
0
4. The authority citation for part 482 continues to read as follows:
Authority: Secs. 1102, 1871 and 1881 of the Social Security
Act (42 U.S.C. 1302, 1395hh, and 1395rr), unless otherwise noted.
0
5. In Sec. 482.58 revise paragraph (b) to read as follows:
Sec. 482.58 Special requirements for hospital providers of long-term
care services (``swing-beds'')
* * * * *
[[Page 32259]]
(b) Skilled nursing facility services. The facility is
substantially in compliance with the following skilled nursing facility
requirements contained in subpart B of part 483 of this chapter.
(1) Resident rights (Sec. 483.10(b)(7), (c)(1), (c)(2)(iii),
(c)(6), (d), (e)(2), (e)(4), (f)(4)(ii), (f)(4)(iii), (f)(9), (h),
(g)(8), (g)(17), and (g)(18) introductory text.
(2) Admission, transfer, and discharge rights (Sec. 483.5
definition of transfer and discharge, Sec. 483.15(c)(1), (c)(2)(i),
(c)(2)(ii), (c)(3), (c)(4), (c)(5), and (c)(7)).
(3) Freedom from abuse, neglect, and exploitation (Sec.
483.12(a)(1), (a)(2), (a)(3)(i), (a)(3)(ii), (a)(4), (b)(1), (b)(2),
(c)).
(4) Patient activities (Sec. 483.24(c)).
(5) Social services (Sec. 483.40(d) and 483.70(p)).
(6) Discharge planning (Sec. 483.20(e)).
(7) Specialized rehabilitative services (Sec. 483.65).
(8) Dental services (Sec. 483.55).
PART 483--REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES
0
6. The authority citation for part 483 continues to read as follows:
Authority: Secs. 1102, 1128I and 1871 of the Social Security
Act (42 U.S.C. 1302, 1320a-7j, 1395hh and 1396r).
0
7. In Sec. 483.5, amend the definition of ``Composite distinct part''
by revising paragraph (2) introductory text and amend the definition of
``Distinct part'' by revising paragraph (1) to read as follows:
Sec. 483.5 Definitions.
* * * * *
Composite distinct part--* * *
(2) Requirements. In addition to meeting the requirements of
specified in the definition of ``distinct part'' of this section, a
composite distinct part must meet all of the following requirements:
* * * * *
Distinct part--(1) Definition. A distinct part SNF or NF is
physically distinguishable from the larger institution or institutional
complex that houses it, meets the requirements of this paragraph and of
paragraph (2) of this definition, and meets the applicable statutory
requirements for SNFs or NFs in sections 1819 or 1919 of the Act,
respectively. A distinct part SNF or NF may comprise one or more
buildings or designated parts of buildings (that is, wings, wards, or
floors) that are: In the same physical area immediately adjacent to the
institution's main buildings; other areas and structures that are not
strictly contiguous with the main buildings but are located within
close proximity to the main buildings; and any other areas that CMS
determines on an individual basis, to be part of the institution's
campus. A distinct part must include all of the beds within the
designated area, and cannot consist of a random collection of
individual rooms or beds that are scattered throughout the physical
plant. The term ``distinct part'' also includes a composite distinct
part that meets the additional requirements specified in the definition
of ``composite distinct part'' of this section.
* * * * *
Sec. 483.10 [Amended]
0
8. In Sec. 483.10, amend paragraph (i)(4) by removing the reference
``Sec. 483.90(d)(2)(iv)'' and adding in its place ``Sec.
483.90(e)(2)(iv)''.
Sec. 483.15 [Amended]
0
9. In Sec. 483.15--
0
a. Amend paragraph (a)(7) by removing the reference ``paragraph
(b)(10)'' and adding in its place ``paragraph (c)(9)''.
0
b. Amend paragraph (b)(2) by removing the reference to ``Sec.
483.10(g)(3)'' and adding in its place ``Sec. 483.10(g)(18)(i)''.
0
c. Amend paragraph (c)(2)(ii)(B) by removing the reference ``paragraph
(b)(1)(i)(C) or (D)'' and adding in its place ``paragraph (c)(1)(i)(C)
or (D)''.
0
d. Amend paragraph (c)(2)(iii)(F) by removing the word ``residents''
and adding in its place ``resident's''.
0
e. Amend paragraph (c)(3)(iii) by removing the reference to
``paragraph (b)(5)'' and adding in its place ``paragraph (c)(5)''.
0
f. Amend paragraph (c)(4)(i) by removing the reference ``paragraphs
(b)(4)(ii) and (b)(8)'' and adding in its place ``paragraphs (c)(4)(ii)
and (8)''.
0
g. Amend paragraph (c)(4)(ii)(A) by removing the reference to
``paragraph (b)(1)(ii)(C)'' and adding in its place ``paragraph
(c)(1)(i)(C)''.
0
h. Amend paragraph (c)(4)(ii)(B) by removing the reference to
``paragraph (b)(1)(ii)(D)'' and adding in its place ``paragraph
(c)(1)(i)(D)''.
0
i. Amend paragraph (c)(4)(ii)(C) by removing the reference ``paragraph
(b)(1)(ii)(B)'' and adding in its place ``paragraph (c)(1)(i)(B)''.
0
j. Amend paragraph (c)(4)(ii)(D) by removing the reference ``paragraph
(b)(1)(ii)(A)'' and adding in its place ``paragraph (c)(1)(i)(A)''.
0
k. Amend paragraph (c)(5) introductory text by removing the reference
``paragraph (b)(3)'' and adding in its place ``paragraph (c)(3)''.
0
l. Amend paragraph (d)(1)(iii) by removing the reference ``paragraph
(c)(3)'' and adding in its place ``paragraph (e)(1)''.
0
m. Amend paragraph (d)(1)(iv) by removing the reference ``paragraph
(c)(3)'' and adding in its place ``paragraph (e)(1)''.
0
n. Amend paragraph (d)(2) by removing the reference ``paragraph
(c)(1)'' and adding in its place ``paragraph (d)(1)''.
0
10. In Sec. 483.45 add paragraph (c)(5) to read as follows:
Sec. 483.45 Pharmacy services.
* * * * *
(c) * * *
(5) The facility must develop and maintain policies and procedures
for the monthly drug regimen review that include, but are not limited
to, time frames for the different steps in the process and steps the
pharmacist must take when he or she identifies an irregularity that
requires urgent action to protect the resident.
* * * * *
Sec. 483.50 [Amended]
0
11. In Sec. 483.50, amend paragraph (a)(2)(iii) by removing the word
``asistance'' and adding in its place ``assistance''.
0
12. In Sec. 483.70 revise the heading to paragraph (i) to read as
follows:
Sec. 483.70 Administration.
* * * * *
(i) Medical records. * * *
* * * * *
Sec. 483.75 [Amended]
0
13. In Sec. 483.75, amend paragraph (g)(1)(iv) by removing the phrase
``infection control and prevention officer'' and adding in its place
``infection preventionist''.
0
14. In Sec. 483.85 revise paragraph (b) to read as follows:
Sec. 483.85 Compliance and ethics program.
* * * * *
(b) General rule. Beginning November 28, 2019, the operating
organization for each facility must have in operation a compliance and
ethics program (as defined in paragraph (a) of this section) that meets
the requirements of this section.
* * * * *
0
15. In Sec. 483.90 revise paragraph (c) to read as follows:
Sec. 483.90 Physical environment.
* * * * *
(c) Emergency power. (1) An emergency electrical power system must
supply power adequate at least for lighting all entrances and exits;
[[Page 32260]]
equipment to maintain the fire detection, alarm, and extinguishing
systems; and life support systems in the event the normal electrical
supply is interrupted.
(2) When life support systems are used, the facility must provide
emergency electrical power with an emergency generator (as defined in
NFPA 99, Health Care Facilities) that is located on the premises.
* * * * *
PART 485--CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS
0
16. The authority citation for part 485 continues to read as follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395(hh)).
Sec. 485.635 [Amended]
0
17. In Sec. 485.635, amend paragraph (a)(3)(vii) by removing the
reference to ``Sec. 483.25(d)(8)'' and adding in its place ``Sec.
483.25(g)''.
0
18. In Sec. 485.645--
0
a. Revise paragraph (d)(1).
0
b. Remove paragraph (d)(2).
0
c. Redesignate paragraphs (d)(3) through (10) as paragraphs (d)(2)
through (9), respectively.
0
d. Revise newly redesignated paragraphs (d)(2) through (9).
The revisions read as follows:
Sec. 485.645 Special requirements for CAH providers of long-term care
services (``swing-beds'')
* * * * *
(d) * * *
(1) Resident rights (Sec. 483.10(b)(7), (c)(1), (c)(2)(iii),
(c)(6), (d), (e)(2), (e)(4), (f)(4)(ii), (f)(4)(iii), (f)(9), (g)(8),
(g)(17), (g)(18) introductory text, (h) of this chapter).
(2) Admission, transfer, and discharge rights (Sec. 483.5
definition of transfer & discharge, Sec. 483.15(c)(1), (c)(2), (c)(3),
(c)(4), (c)(5), (c)(7), (c)(8), and (c)(9) of this chapter).
(3) Freedom from abuse, neglect and exploitation (Sec.
483.12(a)(1), (a)(2), (a)(3)(i), (a)(3)(ii), (a)(4), (b)(1), (b)(2),
(c)(1), (c)(2), (c)(3), and (c)(4) of this chapter).
(4) Patient activities (Sec. 483.24(c) of this chapter), except
that the services may be directed either by a qualified professional
meeting the requirements of Sec. 483.24(c)(2), or by an individual on
the facility staff who is designated as the activities director and who
serves in consultation with a therapeutic recreation specialist,
occupational therapist, or other professional with experience or
education in recreational therapy.
(5) Social services (Sec. 483.40(d) and Sec. 483.70(p) of this
chapter).
(6) Comprehensive assessment, comprehensive care plan, and
discharge planning (Sec. 483.20(b), and Sec. 483.21(b) and (c)(2) of
this chapter), except that the CAH is not required to use the resident
assessment instrument (RAI) specified by the State that is required
under Sec. 483.20(b), or to comply with the requirements for
frequency, scope, and number of assessments prescribed in Sec.
413.343(b) of this chapter).
(7) Specialized rehabilitative services (Sec. 483.65 of this
chapter).
(8) Dental services (Sec. 483.55 of this chapter).
(9) Nutrition (Sec. 483.25(g)(1) and (g)(2) of this chapter).
PART 488--SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES
0
19. The authority citation for part 488 continues to read as follows:
Authority: Secs. 1102, 1128l, 1864, 1865, 1871 and 1875 of the
Social Security Act, unless otherwise noted (42 U.S.C 1302, 1320a-
7j, 1395aa, 1395bb, 1395hh) and 1395ll.
Sec. 488.56 [Amended]
0
20. In Sec. 488.56 amend paragraphs (b) introductory text and (b)(2)
by removing the reference ``Sec. 488.75(i)'' and adding in its place
``Sec. 483.70(h)''.
Dated: June 30, 2017.
Thomas E. Price
Secretary, Department of Health and Human Services.
[FR Doc. 2017-14646 Filed 7-12-17; 8:45 am]
BILLING CODE 4120-01-P