Medical Devices; Exemptions From Premarket Notification: Class II Devices, 25910-25915 [2018-11879]

Download as PDF 25910 Federal Register / Vol. 83, No. 108 / Tuesday, June 5, 2018 / Rules and Regulations number of small entities under the criteria of the Regulatory Flexibility Act. List of Subjects in 14 CFR Part 97 Air traffic control, Airports, Incorporation by reference, Navigation (air). Issued in Washington, DC, on May 18, 2018. John S. Duncan, Executive Director, Flight Standards Service. Adoption of the Amendment Accordingly, pursuant to the authority delegated to me, Title 14, Code of Federal Regulations, part 97 (14 CFR part 97) is amended by establishing, amending, suspending, or removing Standard Instrument Approach Procedures and/or Takeoff Minimums and Obstacle Departure Procedures effective at 0901 UTC on the dates specified, as follows: PART 97—STANDARD INSTRUMENT APPROACH PROCEDURES 1. The authority citation for part 97 continues to read as follows: ■ Authority: 49 U.S.C. 106(f), 106(g), 40103, 40106, 40113, 40114, 40120, 44502, 44514, 44701, 44719, 44721–44722. 2. Part 97 is amended to read as follows: ■ amozie on DSK3GDR082PROD with RULES Effective 21 June 2018 Fort Madison, IA, Fort Madison Muni, RNAV (GPS) RWY 17, Amdt 1A Big Rapids, MI, Roben-Hood, Takeoff Minimums and Obstacle DP, Amdt 6A Detroit, MI, Detroit Metropolitan Wayne County, ILS OR LOC RWY 22L, ILS RWY 22L SA CAT I, Amdt 32A Detroit, MI, Detroit Metropolitan Wayne County, RNAV (RNP) W RWY 22R, OrigA Detroit, MI, Detroit Metropolitan Wayne County, RNAV (RNP) X RWY 3R, Orig-A Detroit, MI, Detroit Metropolitan Wayne County, RNAV (RNP) X RWY 21L, Orig-A St Paul, MN, St Paul Downtown Holman Fld, ILS OR LOC RWY 32, Amdt 6A Omaha, NE, Eppley Airfield, RNAV (GPS) Y RWY 18, Amdt 4A Saranac Lake, NY, Adirondack Rgnl, Takeoff Minimums and Obstacle DP, Amdt 8 Cleveland, OH, Cleveland-Hopkins Intl, RNAV (GPS) Y RWY 6L, Amdt 2A Ottawa, OH, Putnam County, VOR RWY 27, Amdt 2C Effective 19 July 2018 Manley Hot Springs, AK, Manley Hot Springs, RNAV (GPS) RWY 18, Orig Manley Hot Springs, AK, Manley Hot Springs, RNAV (GPS) RWY 36, Orig Manley Hot Springs, AK, Manley Hot Springs, Takeoff Minimums and Obstacle DP, Orig Fayetteville/Springdale/Rogers, AR, Northwest Arkansas Rgnl, ILS OR LOC RWY 34, Amdt 4 VerDate Sep<11>2014 16:50 Jun 04, 2018 Jkt 244001 Auburn, CA, Auburn Muni, RNAV (GPS) RWY 7, Orig-B Long Beach, CA, Long Beach/Daugherty Field/, ILS OR LOC RWY 30, Amdt 34 Long Beach, CA, Long Beach/Daugherty Field/, RNAV (RNP) RWY 26R, Amdt 1A Long Beach, CA, Long Beach/Daugherty Field/, Takeoff Minimums and Obstacle DP, Amdt 6A Long Beach, CA, Long Beach/Daugherty Field/, VOR OR TACAN RWY 30, Amdt 9 Oakland, CA, Metropolitan Oakland Intl, RNAV (RNP) Z RWY 12, Amdt 2 Palm Springs, CA, Jacqueline Cochran Rgnl, RNAV (GPS) RWY 30, Amdt 1 Palm Springs, CA, Jacqueline Cochran Rgnl, VOR RWY 30, Amdt 2 Palm Springs, CA, Jacqueline Cochran Rgnl, VOR–A, Amdt 1 Panama City, FL, Northwest Florida Beaches Intl, ILS OR LOC RWY 16, ILS RWY 16 SA CAT I, ILS RWY 16 SA CAT II, Amdt 3 Douglas, GA, Douglas Muni, ILS OR LOC RWY 4, Amdt 2C Kahului, HI, Kahului, ILS OR LOC RWY 2, Amdt 25A Springfield, IL, Abraham Lincoln Capital, VOR RWY 4, Orig-C Sterling/Rockfalls, IL, Whiteside Co Arpt-Jos H Bittorf Fld, ILS OR LOC RWY 25, Amdt 11 Sterling/Rockfalls, IL, Whiteside Co Arpt-Jos H Bittorf Fld, LOC BC RWY 7, Amdt 6 Sterling/Rockfalls, IL, Whiteside Co Arpt-Jos H Bittorf Fld, NDB RWY 7, Amdt 6, CANCELED Sterling/Rockfalls, IL, Whiteside Co Arpt-Jos H Bittorf Fld, RNAV (GPS) RWY 7, Amdt 1 Sterling/Rockfalls, IL, Whiteside Co Arpt-Jos H Bittorf Fld, RNAV (GPS) RWY 25, Amdt 1 Howell, MI, Livingston County Spencer J Hardy, RNAV (GPS) RWY 31, Amdt 1B Howell, MI, Livingston County Spencer J Hardy, VOR RWY 31, Amdt 11A, CANCELED Menominee, MI, Menominee Rgnl, ILS OR LOC RWY 3, Amdt 3 Menominee, MI, Menominee Rgnl, RNAV (GPS) RWY 3, Orig-A Menominee, MI, Menominee Rgnl, RNAV (GPS) RWY 21, Orig-C Menominee, MI, Menominee Rgnl, RNAV (GPS) RWY 32, Amdt 1C Menominee, MI, Menominee Rgnl, Takeoff Minimums and Obstacle DP, Amdt 3A Menominee, MI, Menominee Rgnl, VOR–A, Amdt 3C Cabool, MO, Cabool Memorial, RNAV (GPS) RWY 21, Orig-B Cabool, MO, Cabool Memorial, VOR/DME RWY 21, Amdt 2A, CANCELED Ithaca, NY, Ithaca Tompkins Rgnl, ILS OR LOC RWY 32, Amdt 7 Ithaca, NY, Ithaca Tompkins Rgnl, RNAV (GPS) RWY 32, Orig-B Ithaca, NY, Ithaca Tompkins Rgnl, VOR RWY 14, Amdt 14A, CANCELED Ogdensburg, NY, Ogdensburg Intl, RNAV (GPS) RWY 9, Amdt 1 Watertown, NY, Watertown Intl, Takeoff Minimums and Obstacle DP, Amdt 3 Tiffin, OH, Seneca County, NDB RWY 24, Amdt 7D Tiffin, OH, Seneca County, RNAV (GPS) RWY 6, Orig-B PO 00000 Frm 00030 Fmt 4700 Sfmt 4700 Tiffin, OH, Seneca County, RNAV (GPS) RWY 24, Amdt 1C Tiffin, OH, Seneca County, VOR RWY 6, Amdt 9B Anderson, SC, Anderson Rgnl, RNAV (GPS) RWY 23, Amdt 2 Weslaco, TX, Mid Valley, RNAV (GPS) RWY 14, Orig-A Weslaco, TX, Mid Valley, VOR–A, Orig-B Eastsound, WA, Orcas Island, RNAV (GPS) RWY 16, Amdt 2 Port Angeles, WA, William R Fairchild Intl, ILS OR LOC RWY 8, Amdt 3A Port Angeles, WA, William R Fairchild Intl, RNAV (GPS) RWY 8, Amdt 1A Port Angeles, WA, William R Fairchild Intl, RNAV (GPS) RWY 26, Amdt 1B Port Angeles, WA, William R Fairchild Intl, Takeoff Minimums and Obstacle DP, Amdt 3A Port Angeles, WA, William R Fairchild Intl, WATTR SEVEN, Graphic DP New Holstein, WI, New Holstein Muni, RNAV (GPS) RWY 14, Orig-B [FR Doc. 2018–11836 Filed 6–4–18; 8:45 am] BILLING CODE 4910–13–P DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration 21 CFR Parts 862, 866, 876, 880, and 884 [Docket No. FDA–2017–N–1129] Medical Devices; Exemptions From Premarket Notification: Class II Devices AGENCY: Food and Drug Administration, HHS. ACTION: Final order. The Food and Drug Administration (FDA or the Agency) is publishing an order to exempt a list of class II devices from premarket notification (510(k)) requirements, subject to certain limitations. This exemption from 510(k), subject to certain limitations, is immediately in effect for the listed class II devices. This exemption will decrease regulatory burdens on the medical device industry and will eliminate private costs and expenditures required to comply with certain Federal regulations. FDA is also amending the codified language for the listed class II devices to reflect this final determination. FDA is publishing this order in accordance with the section of the Federal Food, Drug, and Cosmetic Act (FD&C Act) permitting the exemption of a device from the requirement to submit a 510(k). DATES: This order is effective June 5, 2018. FOR FURTHER INFORMATION CONTACT: Scott McFarland, Center for Devices and SUMMARY: E:\FR\FM\05JNR1.SGM 05JNR1 Federal Register / Vol. 83, No. 108 / Tuesday, June 5, 2018 / Rules and Regulations Radiological Health (CDRH), Food and Drug Administration, 10903 New Hampshire Ave, Bldg. 66, Rm. 4676, Silver Spring, MD 20993–0002, 301– 796–6217. SUPPLEMENTARY INFORMATION: amozie on DSK3GDR082PROD with RULES I. Statutory Background Section 510(k) of the FD&C Act (21 U.S.C. 360(k)) and the implementing regulations, 21 CFR part 807, subpart E, require persons who intend to market a new device to submit and obtain clearance of a premarket notification (510(k)) containing information that allows FDA to determine whether the new device is ‘‘substantially equivalent’’ within the meaning of section 513(i) of the FD&C Act (21 U.S.C. 360c(i)) to a legally marketed device that does not require premarket approval. On December 13, 2016, the 21st Century Cures Act (Cures Act) (Pub. L. 114–255) was signed into law. Section 3054 of the Cures Act amended section 510(m) of the FD&C Act. As amended, section 510(m)(2) provides that, 1 calendar day after the date of publication of the final list under section 510(1)(B), FDA may exempt a class II device from the requirement to submit a report under section 510(k) of the FD&C Act, upon its own initiative or a petition of an interested person, if FDA determines that a 510(k) is not necessary to provide reasonable assurance of the safety and effectiveness of the device. This section requires FDA to publish in the Federal Register a notice of intent to exempt a device, or of the petition, and provide a 60calendar-day comment period. Within 120 days of publication of such notice, FDA shall publish an order in the Federal Register that sets forth its final determination regarding the exemption of the device that was the subject of the notice. II. Criteria for Exemption There are a number of factors FDA may consider to determine whether a 510(k) is necessary to provide reasonable assurance of the safety and effectiveness of a class II device. These factors are discussed in the January 21, 1998, Federal Register notice (63 FR 3142) and subsequently in the guidance the Agency issued on February 19, 1998, entitled ‘‘Procedures for Class II Device Exemptions from Premarket Notification, Guidance for Industry and CDRH Staff’’ (‘‘Class II 510(k) Exemption Guidance’’). That guidance can be obtained through the internet at https://www.fda.gov/downloads/ MedicalDevices/ DeviceRegulationandGuidance/ GuidanceDocuments/UCM080199.pdf VerDate Sep<11>2014 16:50 Jun 04, 2018 Jkt 244001 or by sending an email request to CDRHGuidance@fda.hhs.gov to receive a copy of the document. Please use the document number 159 to identify the guidance you are requesting. Accordingly, FDA generally considers the following factors to determine whether premarket notification is necessary for class II devices: (1) The device does not have a significant history of false or misleading claims or of risks associated with inherent characteristics of the device; (2) characteristics of the device necessary for its safe and effective performance are well established; (3) changes in the device that could affect safety and effectiveness will either (a) be readily detectable by users by visual examination or other means such as routine testing, before causing harm, or (b) not materially increase the risk of injury, incorrect diagnosis, or ineffective treatment; and (4) any changes to the device would not be likely to result in a change in the device’s classification. FDA may also consider that, even when exempting devices, these devices would still be subject to the limitations on exemptions. III. Comments on the Proposed Exemption and FDA Response In the Federal Register of November 7, 2017 (82 FR 51633), FDA published a notice (‘‘November 2017 notice’’) announcing its intent to exempt, upon its own initiative, certain class II devices listed in table 1 from 510(k) requirements, subject to certain limitations, and provided opportunity for interested persons to submit comments by January 8, 2018. After reviewing comments received, FDA is now providing its final determination on exempting the certain class II devices listed in table 1 from 510(k) requirements, subject to certain limitations as identified in this order. FDA is also amending the codified language for the classification regulations for the certain class II devices listed in table 1 to reflect this final determination. Persons with pending 510(k) submissions for devices that are now exempt from 510(k), subject to the limitations, should withdraw their submissions. In response to the November 2017 notice announcing FDA’s intent to exempt those device types from 510(k) requirements, FDA received a submission from one commenter—a professional organization—opposing an exemption from 510(k) for the genetic health risk assessment test device type. To make it easier to identify comments and our responses, the word ‘‘Comment’’ appears in parentheses PO 00000 Frm 00031 Fmt 4700 Sfmt 4700 25911 before the comment’s description, and the word ‘‘Response’’ in parentheses precedes the response. Specific issues raised by the comment and the Agency’s response follows. (Comment) The commenter recommended FDA not exempt onetime FDA reviewed genetic health risk assessment system devices from the 510(k) requirement because there would be insufficient oversight to ensure the analytical and clinical validity of these tests, consumers would be misled regarding which tests FDA has affirmed are scientifically valid, and concerns that, if one-time FDA reviewed genetic health risk assessment system devices were exempted, consumers would not be assured of being adequately informed about test quality. The commenter believed it is not possible to assess the analytical and clinical validity of all genetic health risks a company might offer by conducting a one-time review of its ‘assessment system’, as proposed by FDA. Such oversight, it is argued, will only allow FDA to assess the analytical and clinical validity, and ‘mitigate the risks of false negatives and positives’, for tests initially proposed by the company during this one-time review. The commenter believed that it does not appear that there will be assessment of the analytical or clinical validity of subsequent tests offered, nor any assessment of the risks to the consumer of an incorrect result. This commenter believed that FDA’s proposal to exempt one-time FDA reviewed genetic health risk assessment system devices will not prevent scientifically invalid tests from being marketed to the public and lacks a comprehensive assessment. Further, the commenter argued that, after undergoing the one-time FDA review for genetic health risk assessment tests, companies would be able to market subsequent tests to the public as part of the same system and declare that the tests meet FDA’s standards. Such tests would not be held to any specific standards of analytical or clinical validity. The public would likely assume (and purveyors would likely advertise) that FDA had reviewed and approved such tests as valid even though they had not been reviewed by the Agency. The commenter also argued that there is a vast range of quality (i.e., scientific merit) of direct-to-consumer (DTC) genetic health risk assessment tests on the market. The commenter argued that the market’s current mixing of entertainment tests, which make claims unsubstantiated by the scientific literature, with those tests which have a clinical utility, are clinically valid, and can be supported by current scientific E:\FR\FM\05JNR1.SGM 05JNR1 25912 Federal Register / Vol. 83, No. 108 / Tuesday, June 5, 2018 / Rules and Regulations amozie on DSK3GDR082PROD with RULES literature, is particularly confusing for the average consumer. (Response) We agree that the concerns raised above are important. These concerns were considered during our review and development of the initial classification regulation for genetic health risk assessment system devices and in our consideration of whether to exempt one-time FDA reviewed genetic health risk assessment system devices from the 510(k) requirement. We believe these concerns have been addressed and accounted for in our determination that the 510(k) requirement is not necessary to provide a reasonable assurance of safety and effectiveness for these devices. We outline our rationale below. Consumer understanding of genetic risk is clearly an important issue that was considered extensively by FDA in the context of genetic health risk assessment system devices. This issue was balanced with the increasing desire from the public to learn more about one’s own genetic makeup and how it affects genetic risk for health conditions. To ensure that the tests and test reports are presented to the lay consumer in a manner that is understandable, we employed several requirements. Consumer understanding of the tests and associated test reports is assured by user comprehension study requirements, specific labeling requirements for these over-the-counter (OTC) tests, and general requirements for devices. The special labeling requirements for these devices under § 866.5950(b) (21 CFR 866.5950(b)) include providing information on the manufacturer’s website about frequently asked questions, available professional guidelines, and how to obtain access to a genetic counselor. A. User Comprehension Study A user comprehension study is required under § 866.5950(b)(3)(iii)(M). The required user comprehension study must assess comprehension of the test process and results by potential users of the test with pre- and post-test user comprehension studies. This study must be conducted on a statistically sufficient sample size of non-trained individuals who represent the demographics of the United States as well as a diverse range of age and educational levels. The study must include directly evaluating a representative sample of the material being presented to the user during use of the test. The test that is given to the participants must be informed by a physician and/or genetic counselor that identifies the appropriate general and variant-specific concepts contained within the material being tested in the user comprehension study to ensure VerDate Sep<11>2014 16:50 Jun 04, 2018 Jkt 244001 that all relevant concepts are incorporated in the study as well as having included the definition of the target condition being tested and related symptoms, explain the intended use and limitations of the test, explain the relevant ethnicities in regard to the variant tested, explain genetic health risks and relevance to the user’s ethnicity, and assess participants’ ability to understand the following comprehension concepts: The test’s limitations, purpose, appropriate action, test results, and other factors that may have an impact on the test results. The outcome of this study has to meet rigorous standards, including meeting predefined primary endpoint criteria, including a minimum of a 90 percent or greater overall comprehension rate (i.e., selection of the correct answer) for each comprehension concept. In addition, the testing must follow a format where users have limited time to complete the studies (such as an onsite survey format and a one-time visit with a cap on the maximum amount of time that a participant has to complete the tests). From our experience with user comprehension studies, the Agency believes that meeting or exceeding these user comprehension study requirements ensures that the materials presented to the user are adequate for OTC use. The information the test provider must provide on its website includes a summary table of comprehension rates regarding comprehension concepts (e.g., purpose of test, test results, test limitations, ethnicity relevance for the test results, etc.) for each study report. B. Frequently Asked Questions The manufacturer’s website must have a frequently asked questions section in the summary and technical information sections under § 866.5950(b)(3)(ii)(C)(3) and (b)(3)(iii)(L)(3). For the frequently asked questions sections, information must be included that is specific for each variant/disease pair that is reported and scientifically valid and supported by corresponding publications. Further information must be included that explains the health condition/disease being tested, the purpose of the test, the information the test will and will not provide, the relevance of race and ethnicity on the test results, information about the population to which the variants in the test is most applicable, the meaning of the result(s), other risks factors that contribute to disease, appropriate followup procedures, how the results of the test may affect the user’s family, including children, and links to resources that provide additional information. PO 00000 Frm 00032 Fmt 4700 Sfmt 4700 C. Resources Likely the test labeling information provided by the test manufacturer will not be the sole source of information that the consumer is seeking or even requires. For this reason, there are requirements under § 866.5950(b)(3)(ii)(C)(2) and (b)(3)(iii)(L)(2) that the manufacturer of the test provide a pre-purchase page in the summary and technical information sections that includes information regarding professional guidelines for testing specific genes and variants. Similar information must be provided in the frequently asked questions section found in the summary and technical information sections on the manufacturer’s website, under § 866.5950(b)(3)(ii)(C)(3) and (b)(3)(iii)(L)(3). These frequently asked questions sections must include a statement about the current professional guidelines for testing these specific gene(s) and variant(s) and, if guidelines do not exist for certain genes or variants being tested for, then this information must be provided as well. Further, to facilitate more personalized support, under § 866.5950(b)(1)(i)(E), test manufacturers are required to provide information in the § 809.10 (21 CFR 809.10) compliant labeling and any prepurchase page and test report generated regarding how a user obtains access to a genetic counselor, board-certified clinical molecular geneticist, or equivalent healthcare professional regarding the results of a user’s test. D. Genetic Health Risk Assessment System Tests The tests that fall under the genetic health risk assessment system regulation are identified in the regulation in § 866.5950(a) as a qualitative in vitro molecular diagnostic system used for detecting variants in genomic deoxyribonucleic acid (DNA) isolated from human specimens that will provide information to users about their genetic risk of developing a disease to inform lifestyle choices and/or conversations with a healthcare professional. This assessment system is for OTC use. This device does not determine the person’s overall risk of developing a disease. The limitations that are most important for lay users to know about the intended use of these tests that fall under this device type are conveyed via the limiting statements required, under § 866.5950(b)(1)(i), to be provided on the § 809.10 compliant labeling and any pre-purchase page and test report generated. One of these limiting statements must explain that this test is E:\FR\FM\05JNR1.SGM 05JNR1 Federal Register / Vol. 83, No. 108 / Tuesday, June 5, 2018 / Rules and Regulations not intended to diagnose a disease, tell you anything about your current state of health, or be used to make medical decisions, including whether or not you should take a medication or how much of a medication you should take. The limitations that are most important for healthcare professionals to know about the intended use of tests that fall under this device type are, under § 866.5950(b)(1)(ii), required to be provided in the § 809.10 labeling and any test report generated. These limitations include that the test is intended to provide users with their genetic information to inform lifestyle decisions and conversations with their doctor or other healthcare professional and that any diagnostic or treatment decisions should be based on testing and/or other information that a healthcare professional determines to be appropriate for a patient. E. Rigorous Validation Requirements FDA believes the analytical validation requirements are sufficiently detailed in the special controls under § 866.5950(b)(3)(iii)(J) that test providers will have no difficulty in appropriately following these requirements. A high accuracy requirement is necessary for tests that are provided under this regulation and accuracy point estimates for all variants is required to be 99 percent or higher under § 866.5950(b)(3)(iii)(J)(1)(vii) or else they cannot be claimed or reported. Once FDA has reviewed one test that demonstrates this level of accuracy, then the test provider has demonstrated an ability to meet the accuracy requirements for additional similar tests offered. amozie on DSK3GDR082PROD with RULES F. Four Important Limitations on the Scope of the Classification Regulation FDA agrees that there are four important express limitations to the types of tests that can be offered under this classification regulation even when these special controls are met. Tests cannot be offered under this classification regulation that are indicated for prenatal testing; predisposition for cancer where the result of the test may lead to prophylactic screening, confirmatory procedures, or treatments that may incur morbidity or mortality to the patient; assessing the presence of genetic variants that impact the metabolism, exposure, response, risk of adverse events, dosing, or mechanisms of prescription or OTC medications; or assessing the presence of deterministic autosomal dominant variants. VerDate Sep<11>2014 16:50 Jun 04, 2018 Jkt 244001 G. False or Misleading Claims It is a prohibited act for devices to have labeling that is false or misleading in any particular manner, and thus FDA would deem such device to be misbranded under section 502(a) of the FD&C Act (21 U.S.C. 352(a)). This prohibition would include prohibiting the manufacturer of a genetic health risk assessment test device from falsely or misleadingly representing a test as having been part of an original FDA cleared device when it was added subsequently to FDA clearance. This prohibition would also include falsely or misleadingly representing the analytical or clinical validity of one of its tests. In addition, under section 502(c) of the FD&C Act, it is a prohibited act and thus FDA would deem a device to be misbranded if any information required on the labeling of a device by FDA by or under the FD&C Act is not placed prominently thereon with such conspicuousness and in such terms, as to render it likely to be read and understood by the ordinary individual under customary conditions of purchase and use. Thus, a genetic health risk assessment test device for which a manufacturer later modified the formerly compliant labeling to make the labeling such that the labeling was not likely to be read and understood by the ordinary individual under customary conditions of purchase and use would be a misbranded device. H. Conclusion In summary, all tests that are marketed under this classification regulation must meet the general controls and the special controls that are specified in the regulation. Ability of a manufacturer to meet these special controls is demonstrated during the onetime review. Even after the one-time review, the general controls and special controls must continue to be met, including for all tests added or modified after the one-time review of a manufacturer’s device. IV. Limitations on Exemptions FDA has determined that 510(k) is not necessary to assure the safety and effectiveness of the class II devices listed in table 1. This determination is based, in part, on the Agency’s knowledge of the device, including past experience and relevant reports or studies on device performance (as appropriate), the applicability of general and special controls, and the Agency’s ability to limit an exemption. A. General Limitations of Exemptions FDA’s exemption from 510(k) for class II devices listed in table 1 applies only PO 00000 Frm 00033 Fmt 4700 Sfmt 4700 25913 to those devices that have existing or reasonably foreseeable characteristics of commercially distributed devices within that generic type, or, in the case of in vitro diagnostic devices, for which a misdiagnosis, as a result of using the device, would not be associated with high morbidity or mortality. A manufacturer of a listed device is still required to submit a 510(k) to FDA before introducing a device or delivering it for introduction into commercial distribution when the device meets any of the conditions described in §§ 862.9 to 892.9 (21 CFR 862.9 to 21 CFR 892.9). B. Partial Limitations of Exemptions In addition to the general limitations, FDA may also partially limit an exemption from 510(k) requirements to specific devices within a listed device type when initial Agency assessment determines that the factors laid out in the Class II 510(k) Exemption Guidance do not weigh in favor of exemption for all devices in a particular group. In such situations where a partial exemption limitation has been identified, FDA has determined that premarket notification is necessary to provide a reasonable assurance of safety and effectiveness for these devices. In table 1, for example, FDA is listing the exemption of the genetic health risk assessment system, but limits the exemption to such devices that have received a first-time FDA marketing authorization (e.g., 510(k) clearance) for the genetic health risk assessment system (a ‘‘one-time FDA reviewed genetic health risk assessment system’’). FDA has determined that a one-time FDA review (e.g., premarket notification) of a genetic health risk assessment system is necessary to provide reasonable assurance of the safety and effectiveness of the device. FDA has determined that a one-time FDA review of a genetic health risk assessment system is necessary to mitigate the risk of false negatives and false positives by ensuring that certain information be submitted to FDA to allow the Agency to assess the safety and effectiveness of the devices as well as to ensure the devices perform to acceptable standards. Exemption from the requirement of 510(k) does not exempt a device from other applicable regulatory controls under the FD&C Act, including the applicable general and special controls. This exemption from 510(k), subject to the limitations described above, is immediately in effect for the device types identified in table 1. This exemption will decrease regulatory burdens on the medical device industry and will eliminate private costs and E:\FR\FM\05JNR1.SGM 05JNR1 25914 Federal Register / Vol. 83, No. 108 / Tuesday, June 5, 2018 / Rules and Regulations expenditures required to comply with Federal regulations. V. List of Class II Devices FDA is identifying the following list of class II devices that will no longer require premarket notification under section 510(k) of the FD&C Act, subject to the general limitations to the exemptions found in §§ 862.9 to 892.9 and any partial exemption limitations identified in table 1: TABLE 1—CLASS II DEVICES Product code 21 CFR section Device type 862.1840 ............. Total 25-hydroxyvitamin D Mass Spectrometry Test System. Genetic Health Risk Assessment System. PSL Endoscope Disinfectant Basin ......... Purifier, Water, Ultraviolet, Medical Vibrator for Therapeutic Use, Genital. PUP KMG KXQ 866.5950 ............. 876.1500 ............. 880.6710 ............. 884.5960 ............. PTA Partial exemption limitation (if applicable) Exemption is limited to a genetic health risk assessment system that has received a first-time FDA marketing authorization (e.g., 510(k) clearance) for the genetic health risk assessment system (a ‘‘one-time FDA reviewed genetic health risk assessment system’’). FDA is revising the name of product code PUP to further clarify the device type that this product code is intended to represent. The device type was previously ‘‘Endoscope Maintenance System.’’ To more accurately reflect the devices which fall within this device type (product code PUP), the device type has been renamed ‘‘Endoscope Disinfectant Basin.’’ Specifically, these devices are described as ‘‘Wall-mounted tube(s) for holding disinfectant solution and endoscope insertion tubes and accessories.’’ This description has not changed since publication of the November 2017 notice. List of Subjects VI. Analysis of Environmental Impact PART 862—CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES The Agency has determined under 21 CFR 25.30(h) that this action is of a type that does not individually or cumulatively have a significant effect on the human environment. Therefore, neither an environmental assessment nor an environmental impact statement is required. amozie on DSK3GDR082PROD with RULES VII. Paperwork Reduction Act of 1995 This final order refers to previously approved collections of information found in other FDA regulations and guidance. These collections of information are subject to review by the Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501–3520). The collections of information in part 807, subpart E, regarding premarket notification submissions, have been approved under OMB control number 0910–0120; and the collections of information in 21 CFR parts 801 and 809, regarding labeling, have been approved under OMB control number 0910–0485. VerDate Sep<11>2014 16:50 Jun 04, 2018 Jkt 244001 4. In § 866.5950, revise paragraph (b) introductory text to read as follows: ■ 21 CFR Part 862 Medical devices. 21 CFR Part 866 Biologics, Laboratories, Medical devices. 21 CFR Parts 876, 880, and 884 Medical devices. Therefore, under the Federal Food, Drug, and Cosmetic Act and under authority delegated to the Commissioner of Food and Drugs, 21 CFR parts 862, 866, 876, 880, and 884 are amended as follows: 1. The authority citation for part 862 continues to read as follows: ■ Authority: 21 U.S.C. 351, 360, 360c, 360e, 360j, 360l, 371. § 866.5950 system. Genetic health risk assessment * * * * * (b) Classification. Class II (special controls). The genetic health risk assessment system device, when it has previously received a first-time FDA marketing authorization (e.g., 510(k) clearance) for the genetic health risk assessment system (a ‘‘one-time FDA reviewed genetic health risk assessment system’’), is exempt from the premarket notification procedures in part 807, subpart E, of this chapter subject to the limitations in § 866.9. The device must comply with the following special controls: * * * * * PART 876—GASTROENTEROLOGY– UROLOGY DEVICES ■ 2. In § 862.1840, revise paragraph (b) introductory text to read as follows: ■ § 862.1840 Total 25-hydroxyvitamin D mass spectrometry test system. Authority: 21 U.S.C. 351, 360, 360c, 360e, 360j, 360l, 371. * ■ * * * * (b) Classification. Class II (special controls). The device is exempt from the premarket notification procedures in part 807, subpart E, of this chapter subject to the limitations in § 862.9. The device must comply with the following special controls: * * * * * PART 866—IMMUNOLOGY AND MICROBIOLOGY DEVICES 3. The authority citation for part 866 continues to read as follows: ■ Authority: 21 U.S.C. 351, 360, 360c, 360e, 360j, 360l, 371. PO 00000 Frm 00034 Fmt 4700 Sfmt 4700 5. The authority citation for part 876 continues to read as follows: 6. In § 876.1500, revise paragraph (b)(1) to read as follows: § 876.1500 Endoscope and accessories. * * * * * (b) * * * (1) Class II (performance standards). The device, when intended as an endoscope disinfectant basin, which consists solely of a container that holds disinfectant and endoscopes and accessories, is exempt from the premarket notification procedures in part 807, subpart E, of this chapter subject to the limitations in § 876.9. * * * * * E:\FR\FM\05JNR1.SGM 05JNR1 Federal Register / Vol. 83, No. 108 / Tuesday, June 5, 2018 / Rules and Regulations PART 880—GENERAL HOSPITAL AND PERSONAL USE DEVICES 7. The authority citation for part 880 continues to read as follows: ■ Authority: 21 U.S.C. 351, 360, 360c, 360e, 360j, 360l, 371. 8. In § 880.6710, revise paragraph (b) to read as follows: ■ § 880.6710 purifier. Medical ultraviolet water * * * * * (b) Classification. Class II (performance standards). The device is exempt from the premarket notification procedures in part 807, subpart E, of this chapter subject to the limitations in § 880.9. PART 884—OBSTETRICAL AND GYNECOLOGICAL DEVICES 9. The authority citation for part 884 continues to read as follows: ■ Authority: 21 U.S.C. 351, 360, 360c, 360e, 360j, 360l, 371. 10 In § 884.5960, revise paragraph (b) to read as follows: ■ § 884.5960 use. Genital vibrator for therapeutic * * * * * (b) Classification. Class II (performance standards). The device is exempt from the premarket notification procedures in part 807, subpart E, of this chapter subject to the limitations in § 884.9. Dated: May 29, 2018. Leslie Kux, Associate Commissioner for Policy. [FR Doc. 2018–11879 Filed 6–1–18; 8:45 am] BILLING CODE 4164–01–P DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900–AQ15 Case Management Services Grant Program Department of Veterans Affairs. Interim final rule. AGENCY: ACTION: The Department of Veterans Affairs (VA) is amending its regulations that govern programs benefitting homeless veterans to implement a new statutory requirement to establish a new grant program that will provide case management services to improve the retention of housing by veterans who were previously homeless and are transitioning to permanent housing and amozie on DSK3GDR082PROD with RULES SUMMARY: VerDate Sep<11>2014 16:50 Jun 04, 2018 Jkt 244001 to veterans who are at risk of becoming homeless. The grant program established by this interim final rule will be an essential part of VA’s attempts to eliminate homelessness among the veteran population. DATES: This final rule is effective June 5, 2018. Comments must be received on or before August 6, 2018. ADDRESSES: Written comments may be submitted through https:// www.Regulations.gov; by mail or handdelivery to: Director, Regulation Policy and Management (00REG), Department of Veterans Affairs, 810 Vermont Ave. NW, Room 1063B, Washington, DC 20420; or by fax to (202) 273–9026. (This is not a toll-free telephone number.) Comments should indicate that they are submitted in response to ‘‘RIN 2900–AQ15—Case Management Services Grant Program.’’ Copies of comments received will be available for public inspection in the Office of Regulation Policy and Management, Room 1063B, between the hours of 8 a.m. and 4:30 p.m., Monday through Friday (except holidays). Please call (202) 461–4902 for an appointment. (This is not a toll-free telephone number.) In addition, during the comment period, comments may be viewed online through the Federal Docket Management System (FDMS) at https://www.Regulations.gov. FOR FURTHER INFORMATION CONTACT: Jeffery Quarles, Director, Grant and Per Diem Program, (10NC1HM), VA National Grant and Per Diem Program Office, 10770 N 46th Street, Suite C– 200, Tampa, FL 33617, (877) 332–0334. (This is a toll-free number.) SUPPLEMENTARY INFORMATION: In an effort to reduce homelessness in the veteran population, Congress has required VA to expand its benefits for homeless veterans by establishing a new grant program to provide funds to organizations within communities that will provide case management services to improve the retention of housing by veterans who were previously homeless and are transitioning to permanent housing and to veterans who are at risk of becoming homeless. See Public Law 114–315, sec. 712 (Dec. 16, 2016) (codified at 38 U.S.C. 2013). This interim final rule adds this new case management program to VA’s Homeless Providers Grant and Per Diem Program regulations by adding a new subpart G to 38 CFR part 61 to accurately reflect these changes in law. The new case management program will mirror existing homeless grant per diem programs as much as possible for ease of administrating and running the new grant program. PO 00000 Frm 00035 Fmt 4700 Sfmt 4700 25915 61.90 Grant for Case Management Services—Program Paragraph (a) of § 61.90 states that non-profit organizations and State, local, and tribal governments are eligible to apply for a grant to provide case management services. (For purposes of this program, the term ‘‘tribal government’’ means an entity described in paragraph (2) of the definition of public entity in 38 CFR 61.1.) To ensure that grant funding is used to provide case management services to as many veterans as possible, this same paragraph provides that case management services grant funds under this program ‘‘may not be used for veterans who are receiving case management services from permanent supportive housing programs (e.g. Housing and Urban Development-VA Supportive Housing) or rapid rehousing/homeless prevention programs (e.g. Supportive Services for Veterans Families (SSVF)).’’ Paragraph (b) identifies examples of case management services that grantees can provide using these grant funds. Such services include, but are not limited to, ‘‘Making home visits by the case manager to monitor housing stability; Providing or coordinating educational activities related to meal planning, tenant responsibilities, the use of public transportation, community resources, financial management, and the development of natural supports; Making referrals to needed services, such as mental health, substance use disorder, medical, and employment services; and Participating in case conferencing with other service providers who are working with the veteran.’’ Paragraph (c) sets a 6-month time limit for veterans to receive case management services. However, VA may approve a request to extend services beyond the 6-month period if an organization submits a request to VA in writing and VA approves it before the 6-month time limit expires. Because in most circumstances case management services are provided to veterans after they have been in receipt of benefits under the Grant and Per Diem Program, VA believes that 6 months would, in most cases, be sufficient time for a veteran to have the necessary tools in place to retain permanent housing. 61.92 Grant for Case Management Services—Application and Rating Criteria For ease of administration and internal consistency between grant programs benefiting homeless veterans, VA will, to the extent applicable and appropriate, adopt standards for the E:\FR\FM\05JNR1.SGM 05JNR1

Agencies

[Federal Register Volume 83, Number 108 (Tuesday, June 5, 2018)]
[Rules and Regulations]
[Pages 25910-25915]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-11879]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

21 CFR Parts 862, 866, 876, 880, and 884

[Docket No. FDA-2017-N-1129]


Medical Devices; Exemptions From Premarket Notification: Class II 
Devices

AGENCY: Food and Drug Administration, HHS.

ACTION: Final order.

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

SUMMARY: The Food and Drug Administration (FDA or the Agency) is 
publishing an order to exempt a list of class II devices from premarket 
notification (510(k)) requirements, subject to certain limitations. 
This exemption from 510(k), subject to certain limitations, is 
immediately in effect for the listed class II devices. This exemption 
will decrease regulatory burdens on the medical device industry and 
will eliminate private costs and expenditures required to comply with 
certain Federal regulations. FDA is also amending the codified language 
for the listed class II devices to reflect this final determination. 
FDA is publishing this order in accordance with the section of the 
Federal Food, Drug, and Cosmetic Act (FD&C Act) permitting the 
exemption of a device from the requirement to submit a 510(k).

DATES: This order is effective June 5, 2018.

FOR FURTHER INFORMATION CONTACT: Scott McFarland, Center for Devices 
and

[[Page 25911]]

Radiological Health (CDRH), Food and Drug Administration, 10903 New 
Hampshire Ave, Bldg. 66, Rm. 4676, Silver Spring, MD 20993-0002, 301-
796-6217.

SUPPLEMENTARY INFORMATION:

I. Statutory Background

    Section 510(k) of the FD&C Act (21 U.S.C. 360(k)) and the 
implementing regulations, 21 CFR part 807, subpart E, require persons 
who intend to market a new device to submit and obtain clearance of a 
premarket notification (510(k)) containing information that allows FDA 
to determine whether the new device is ``substantially equivalent'' 
within the meaning of section 513(i) of the FD&C Act (21 U.S.C. 
360c(i)) to a legally marketed device that does not require premarket 
approval.
    On December 13, 2016, the 21st Century Cures Act (Cures Act) (Pub. 
L. 114-255) was signed into law. Section 3054 of the Cures Act amended 
section 510(m) of the FD&C Act. As amended, section 510(m)(2) provides 
that, 1 calendar day after the date of publication of the final list 
under section 510(1)(B), FDA may exempt a class II device from the 
requirement to submit a report under section 510(k) of the FD&C Act, 
upon its own initiative or a petition of an interested person, if FDA 
determines that a 510(k) is not necessary to provide reasonable 
assurance of the safety and effectiveness of the device. This section 
requires FDA to publish in the Federal Register a notice of intent to 
exempt a device, or of the petition, and provide a 60-calendar-day 
comment period. Within 120 days of publication of such notice, FDA 
shall publish an order in the Federal Register that sets forth its 
final determination regarding the exemption of the device that was the 
subject of the notice.

II. Criteria for Exemption

    There are a number of factors FDA may consider to determine whether 
a 510(k) is necessary to provide reasonable assurance of the safety and 
effectiveness of a class II device. These factors are discussed in the 
January 21, 1998, Federal Register notice (63 FR 3142) and subsequently 
in the guidance the Agency issued on February 19, 1998, entitled 
``Procedures for Class II Device Exemptions from Premarket 
Notification, Guidance for Industry and CDRH Staff'' (``Class II 510(k) 
Exemption Guidance''). That guidance can be obtained through the 
internet at https://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM080199.pdf or by 
sending an email request to [email protected] to receive a copy 
of the document. Please use the document number 159 to identify the 
guidance you are requesting.
    Accordingly, FDA generally considers the following factors to 
determine whether premarket notification is necessary for class II 
devices: (1) The device does not have a significant history of false or 
misleading claims or of risks associated with inherent characteristics 
of the device; (2) characteristics of the device necessary for its safe 
and effective performance are well established; (3) changes in the 
device that could affect safety and effectiveness will either (a) be 
readily detectable by users by visual examination or other means such 
as routine testing, before causing harm, or (b) not materially increase 
the risk of injury, incorrect diagnosis, or ineffective treatment; and 
(4) any changes to the device would not be likely to result in a change 
in the device's classification. FDA may also consider that, even when 
exempting devices, these devices would still be subject to the 
limitations on exemptions.

III. Comments on the Proposed Exemption and FDA Response

    In the Federal Register of November 7, 2017 (82 FR 51633), FDA 
published a notice (``November 2017 notice'') announcing its intent to 
exempt, upon its own initiative, certain class II devices listed in 
table 1 from 510(k) requirements, subject to certain limitations, and 
provided opportunity for interested persons to submit comments by 
January 8, 2018. After reviewing comments received, FDA is now 
providing its final determination on exempting the certain class II 
devices listed in table 1 from 510(k) requirements, subject to certain 
limitations as identified in this order. FDA is also amending the 
codified language for the classification regulations for the certain 
class II devices listed in table 1 to reflect this final determination. 
Persons with pending 510(k) submissions for devices that are now exempt 
from 510(k), subject to the limitations, should withdraw their 
submissions.
    In response to the November 2017 notice announcing FDA's intent to 
exempt those device types from 510(k) requirements, FDA received a 
submission from one commenter--a professional organization--opposing an 
exemption from 510(k) for the genetic health risk assessment test 
device type.
    To make it easier to identify comments and our responses, the word 
``Comment'' appears in parentheses before the comment's description, 
and the word ``Response'' in parentheses precedes the response. 
Specific issues raised by the comment and the Agency's response 
follows.
    (Comment) The commenter recommended FDA not exempt one-time FDA 
reviewed genetic health risk assessment system devices from the 510(k) 
requirement because there would be insufficient oversight to ensure the 
analytical and clinical validity of these tests, consumers would be 
misled regarding which tests FDA has affirmed are scientifically valid, 
and concerns that, if one-time FDA reviewed genetic health risk 
assessment system devices were exempted, consumers would not be assured 
of being adequately informed about test quality. The commenter believed 
it is not possible to assess the analytical and clinical validity of 
all genetic health risks a company might offer by conducting a one-time 
review of its `assessment system', as proposed by FDA. Such oversight, 
it is argued, will only allow FDA to assess the analytical and clinical 
validity, and `mitigate the risks of false negatives and positives', 
for tests initially proposed by the company during this one-time 
review. The commenter believed that it does not appear that there will 
be assessment of the analytical or clinical validity of subsequent 
tests offered, nor any assessment of the risks to the consumer of an 
incorrect result. This commenter believed that FDA's proposal to exempt 
one-time FDA reviewed genetic health risk assessment system devices 
will not prevent scientifically invalid tests from being marketed to 
the public and lacks a comprehensive assessment. Further, the commenter 
argued that, after undergoing the one-time FDA review for genetic 
health risk assessment tests, companies would be able to market 
subsequent tests to the public as part of the same system and declare 
that the tests meet FDA's standards. Such tests would not be held to 
any specific standards of analytical or clinical validity. The public 
would likely assume (and purveyors would likely advertise) that FDA had 
reviewed and approved such tests as valid even though they had not been 
reviewed by the Agency. The commenter also argued that there is a vast 
range of quality (i.e., scientific merit) of direct-to-consumer (DTC) 
genetic health risk assessment tests on the market. The commenter 
argued that the market's current mixing of entertainment tests, which 
make claims unsubstantiated by the scientific literature, with those 
tests which have a clinical utility, are clinically valid, and can be 
supported by current scientific

[[Page 25912]]

literature, is particularly confusing for the average consumer.
    (Response) We agree that the concerns raised above are important. 
These concerns were considered during our review and development of the 
initial classification regulation for genetic health risk assessment 
system devices and in our consideration of whether to exempt one-time 
FDA reviewed genetic health risk assessment system devices from the 
510(k) requirement. We believe these concerns have been addressed and 
accounted for in our determination that the 510(k) requirement is not 
necessary to provide a reasonable assurance of safety and effectiveness 
for these devices. We outline our rationale below.
    Consumer understanding of genetic risk is clearly an important 
issue that was considered extensively by FDA in the context of genetic 
health risk assessment system devices. This issue was balanced with the 
increasing desire from the public to learn more about one's own genetic 
makeup and how it affects genetic risk for health conditions. To ensure 
that the tests and test reports are presented to the lay consumer in a 
manner that is understandable, we employed several requirements. 
Consumer understanding of the tests and associated test reports is 
assured by user comprehension study requirements, specific labeling 
requirements for these over-the-counter (OTC) tests, and general 
requirements for devices. The special labeling requirements for these 
devices under Sec.  866.5950(b) (21 CFR 866.5950(b)) include providing 
information on the manufacturer's website about frequently asked 
questions, available professional guidelines, and how to obtain access 
to a genetic counselor.

A. User Comprehension Study

    A user comprehension study is required under Sec.  
866.5950(b)(3)(iii)(M). The required user comprehension study must 
assess comprehension of the test process and results by potential users 
of the test with pre- and post-test user comprehension studies. This 
study must be conducted on a statistically sufficient sample size of 
non-trained individuals who represent the demographics of the United 
States as well as a diverse range of age and educational levels. The 
study must include directly evaluating a representative sample of the 
material being presented to the user during use of the test. The test 
that is given to the participants must be informed by a physician and/
or genetic counselor that identifies the appropriate general and 
variant-specific concepts contained within the material being tested in 
the user comprehension study to ensure that all relevant concepts are 
incorporated in the study as well as having included the definition of 
the target condition being tested and related symptoms, explain the 
intended use and limitations of the test, explain the relevant 
ethnicities in regard to the variant tested, explain genetic health 
risks and relevance to the user's ethnicity, and assess participants' 
ability to understand the following comprehension concepts: The test's 
limitations, purpose, appropriate action, test results, and other 
factors that may have an impact on the test results. The outcome of 
this study has to meet rigorous standards, including meeting predefined 
primary endpoint criteria, including a minimum of a 90 percent or 
greater overall comprehension rate (i.e., selection of the correct 
answer) for each comprehension concept. In addition, the testing must 
follow a format where users have limited time to complete the studies 
(such as an onsite survey format and a one-time visit with a cap on the 
maximum amount of time that a participant has to complete the tests). 
From our experience with user comprehension studies, the Agency 
believes that meeting or exceeding these user comprehension study 
requirements ensures that the materials presented to the user are 
adequate for OTC use. The information the test provider must provide on 
its website includes a summary table of comprehension rates regarding 
comprehension concepts (e.g., purpose of test, test results, test 
limitations, ethnicity relevance for the test results, etc.) for each 
study report.

B. Frequently Asked Questions

    The manufacturer's website must have a frequently asked questions 
section in the summary and technical information sections under Sec.  
866.5950(b)(3)(ii)(C)(3) and (b)(3)(iii)(L)(3). For the frequently 
asked questions sections, information must be included that is specific 
for each variant/disease pair that is reported and scientifically valid 
and supported by corresponding publications. Further information must 
be included that explains the health condition/disease being tested, 
the purpose of the test, the information the test will and will not 
provide, the relevance of race and ethnicity on the test results, 
information about the population to which the variants in the test is 
most applicable, the meaning of the result(s), other risks factors that 
contribute to disease, appropriate followup procedures, how the results 
of the test may affect the user's family, including children, and links 
to resources that provide additional information.

C. Resources

    Likely the test labeling information provided by the test 
manufacturer will not be the sole source of information that the 
consumer is seeking or even requires. For this reason, there are 
requirements under Sec.  866.5950(b)(3)(ii)(C)(2) and (b)(3)(iii)(L)(2) 
that the manufacturer of the test provide a pre-purchase page in the 
summary and technical information sections that includes information 
regarding professional guidelines for testing specific genes and 
variants. Similar information must be provided in the frequently asked 
questions section found in the summary and technical information 
sections on the manufacturer's website, under Sec.  
866.5950(b)(3)(ii)(C)(3) and (b)(3)(iii)(L)(3). These frequently asked 
questions sections must include a statement about the current 
professional guidelines for testing these specific gene(s) and 
variant(s) and, if guidelines do not exist for certain genes or 
variants being tested for, then this information must be provided as 
well. Further, to facilitate more personalized support, under Sec.  
866.5950(b)(1)(i)(E), test manufacturers are required to provide 
information in the Sec.  809.10 (21 CFR 809.10) compliant labeling and 
any pre-purchase page and test report generated regarding how a user 
obtains access to a genetic counselor, board-certified clinical 
molecular geneticist, or equivalent healthcare professional regarding 
the results of a user's test.

D. Genetic Health Risk Assessment System Tests

    The tests that fall under the genetic health risk assessment system 
regulation are identified in the regulation in Sec.  866.5950(a) as a 
qualitative in vitro molecular diagnostic system used for detecting 
variants in genomic deoxyribonucleic acid (DNA) isolated from human 
specimens that will provide information to users about their genetic 
risk of developing a disease to inform lifestyle choices and/or 
conversations with a healthcare professional. This assessment system is 
for OTC use. This device does not determine the person's overall risk 
of developing a disease.
    The limitations that are most important for lay users to know about 
the intended use of these tests that fall under this device type are 
conveyed via the limiting statements required, under Sec.  
866.5950(b)(1)(i), to be provided on the Sec.  809.10 compliant 
labeling and any pre-purchase page and test report generated. One of 
these limiting statements must explain that this test is

[[Page 25913]]

not intended to diagnose a disease, tell you anything about your 
current state of health, or be used to make medical decisions, 
including whether or not you should take a medication or how much of a 
medication you should take. The limitations that are most important for 
healthcare professionals to know about the intended use of tests that 
fall under this device type are, under Sec.  866.5950(b)(1)(ii), 
required to be provided in the Sec.  809.10 labeling and any test 
report generated. These limitations include that the test is intended 
to provide users with their genetic information to inform lifestyle 
decisions and conversations with their doctor or other healthcare 
professional and that any diagnostic or treatment decisions should be 
based on testing and/or other information that a healthcare 
professional determines to be appropriate for a patient.

E. Rigorous Validation Requirements

    FDA believes the analytical validation requirements are 
sufficiently detailed in the special controls under Sec.  
866.5950(b)(3)(iii)(J) that test providers will have no difficulty in 
appropriately following these requirements. A high accuracy requirement 
is necessary for tests that are provided under this regulation and 
accuracy point estimates for all variants is required to be 99 percent 
or higher under Sec.  866.5950(b)(3)(iii)(J)(1)(vii) or else they 
cannot be claimed or reported. Once FDA has reviewed one test that 
demonstrates this level of accuracy, then the test provider has 
demonstrated an ability to meet the accuracy requirements for 
additional similar tests offered.

F. Four Important Limitations on the Scope of the Classification 
Regulation

    FDA agrees that there are four important express limitations to the 
types of tests that can be offered under this classification regulation 
even when these special controls are met. Tests cannot be offered under 
this classification regulation that are indicated for prenatal testing; 
predisposition for cancer where the result of the test may lead to 
prophylactic screening, confirmatory procedures, or treatments that may 
incur morbidity or mortality to the patient; assessing the presence of 
genetic variants that impact the metabolism, exposure, response, risk 
of adverse events, dosing, or mechanisms of prescription or OTC 
medications; or assessing the presence of deterministic autosomal 
dominant variants.

G. False or Misleading Claims

    It is a prohibited act for devices to have labeling that is false 
or misleading in any particular manner, and thus FDA would deem such 
device to be misbranded under section 502(a) of the FD&C Act (21 U.S.C. 
352(a)). This prohibition would include prohibiting the manufacturer of 
a genetic health risk assessment test device from falsely or 
misleadingly representing a test as having been part of an original FDA 
cleared device when it was added subsequently to FDA clearance. This 
prohibition would also include falsely or misleadingly representing the 
analytical or clinical validity of one of its tests. In addition, under 
section 502(c) of the FD&C Act, it is a prohibited act and thus FDA 
would deem a device to be misbranded if any information required on the 
labeling of a device by FDA by or under the FD&C Act is not placed 
prominently thereon with such conspicuousness and in such terms, as to 
render it likely to be read and understood by the ordinary individual 
under customary conditions of purchase and use. Thus, a genetic health 
risk assessment test device for which a manufacturer later modified the 
formerly compliant labeling to make the labeling such that the labeling 
was not likely to be read and understood by the ordinary individual 
under customary conditions of purchase and use would be a misbranded 
device.

H. Conclusion

    In summary, all tests that are marketed under this classification 
regulation must meet the general controls and the special controls that 
are specified in the regulation. Ability of a manufacturer to meet 
these special controls is demonstrated during the one-time review. Even 
after the one-time review, the general controls and special controls 
must continue to be met, including for all tests added or modified 
after the one-time review of a manufacturer's device.

IV. Limitations on Exemptions

    FDA has determined that 510(k) is not necessary to assure the 
safety and effectiveness of the class II devices listed in table 1. 
This determination is based, in part, on the Agency's knowledge of the 
device, including past experience and relevant reports or studies on 
device performance (as appropriate), the applicability of general and 
special controls, and the Agency's ability to limit an exemption.

A. General Limitations of Exemptions

    FDA's exemption from 510(k) for class II devices listed in table 1 
applies only to those devices that have existing or reasonably 
foreseeable characteristics of commercially distributed devices within 
that generic type, or, in the case of in vitro diagnostic devices, for 
which a misdiagnosis, as a result of using the device, would not be 
associated with high morbidity or mortality. A manufacturer of a listed 
device is still required to submit a 510(k) to FDA before introducing a 
device or delivering it for introduction into commercial distribution 
when the device meets any of the conditions described in Sec. Sec.  
862.9 to 892.9 (21 CFR 862.9 to 21 CFR 892.9).

B. Partial Limitations of Exemptions

    In addition to the general limitations, FDA may also partially 
limit an exemption from 510(k) requirements to specific devices within 
a listed device type when initial Agency assessment determines that the 
factors laid out in the Class II 510(k) Exemption Guidance do not weigh 
in favor of exemption for all devices in a particular group. In such 
situations where a partial exemption limitation has been identified, 
FDA has determined that premarket notification is necessary to provide 
a reasonable assurance of safety and effectiveness for these devices. 
In table 1, for example, FDA is listing the exemption of the genetic 
health risk assessment system, but limits the exemption to such devices 
that have received a first-time FDA marketing authorization (e.g., 
510(k) clearance) for the genetic health risk assessment system (a 
``one-time FDA reviewed genetic health risk assessment system''). FDA 
has determined that a one-time FDA review (e.g., premarket 
notification) of a genetic health risk assessment system is necessary 
to provide reasonable assurance of the safety and effectiveness of the 
device. FDA has determined that a one-time FDA review of a genetic 
health risk assessment system is necessary to mitigate the risk of 
false negatives and false positives by ensuring that certain 
information be submitted to FDA to allow the Agency to assess the 
safety and effectiveness of the devices as well as to ensure the 
devices perform to acceptable standards.
    Exemption from the requirement of 510(k) does not exempt a device 
from other applicable regulatory controls under the FD&C Act, including 
the applicable general and special controls. This exemption from 
510(k), subject to the limitations described above, is immediately in 
effect for the device types identified in table 1. This exemption will 
decrease regulatory burdens on the medical device industry and will 
eliminate private costs and

[[Page 25914]]

expenditures required to comply with Federal regulations.

V. List of Class II Devices

    FDA is identifying the following list of class II devices that will 
no longer require premarket notification under section 510(k) of the 
FD&C Act, subject to the general limitations to the exemptions found in 
Sec. Sec.  862.9 to 892.9 and any partial exemption limitations 
identified in table 1:

                                            Table 1--Class II Devices
----------------------------------------------------------------------------------------------------------------
                                                                                          Partial exemption
           21 CFR section                   Device type            Product code       limitation (if applicable)
----------------------------------------------------------------------------------------------------------------
862.1840............................  Total 25-hydroxyvitamin  PSL                   ...........................
                                       D Mass Spectrometry
                                       Test System.
866.5950............................  Genetic Health Risk      PTA                   Exemption is limited to a
                                       Assessment System.                             genetic health risk
                                                                                      assessment system that has
                                                                                      received a first-time FDA
                                                                                      marketing authorization
                                                                                      (e.g., 510(k) clearance)
                                                                                      for the genetic health
                                                                                      risk assessment system (a
                                                                                      ``one-time FDA reviewed
                                                                                      genetic health risk
                                                                                      assessment system'').
876.1500............................  Endoscope Disinfectant   PUP                   ...........................
                                       Basin.
880.6710............................  Purifier, Water,         KMG                   ...........................
                                       Ultraviolet, Medical.
884.5960............................  Vibrator for             KXQ                   ...........................
                                       Therapeutic Use,
                                       Genital.
----------------------------------------------------------------------------------------------------------------

    FDA is revising the name of product code PUP to further clarify the 
device type that this product code is intended to represent. The device 
type was previously ``Endoscope Maintenance System.'' To more 
accurately reflect the devices which fall within this device type 
(product code PUP), the device type has been renamed ``Endoscope 
Disinfectant Basin.'' Specifically, these devices are described as 
``Wall-mounted tube(s) for holding disinfectant solution and endoscope 
insertion tubes and accessories.'' This description has not changed 
since publication of the November 2017 notice.

VI. Analysis of Environmental Impact

    The Agency has determined under 21 CFR 25.30(h) that this action is 
of a type that does not individually or cumulatively have a significant 
effect on the human environment. Therefore, neither an environmental 
assessment nor an environmental impact statement is required.

VII. Paperwork Reduction Act of 1995

    This final order refers to previously approved collections of 
information found in other FDA regulations and guidance. These 
collections of information are subject to review by the Office of 
Management and Budget (OMB) under the Paperwork Reduction Act of 1995 
(44 U.S.C. 3501-3520). The collections of information in part 807, 
subpart E, regarding premarket notification submissions, have been 
approved under OMB control number 0910-0120; and the collections of 
information in 21 CFR parts 801 and 809, regarding labeling, have been 
approved under OMB control number 0910-0485.

List of Subjects

21 CFR Part 862

    Medical devices.

21 CFR Part 866

    Biologics, Laboratories, Medical devices.

21 CFR Parts 876, 880, and 884

    Medical devices.
    Therefore, under the Federal Food, Drug, and Cosmetic Act and under 
authority delegated to the Commissioner of Food and Drugs, 21 CFR parts 
862, 866, 876, 880, and 884 are amended as follows:

PART 862--CLINICAL CHEMISTRY AND CLINICAL TOXICOLOGY DEVICES

0
1. The authority citation for part 862 continues to read as follows:

    Authority: 21 U.S.C. 351, 360, 360c, 360e, 360j, 360l, 371.

0
2. In Sec.  862.1840, revise paragraph (b) introductory text to read as 
follows:


Sec.  862.1840  Total 25-hydroxyvitamin D mass spectrometry test 
system.

* * * * *
    (b) Classification. Class II (special controls). The device is 
exempt from the premarket notification procedures in part 807, subpart 
E, of this chapter subject to the limitations in Sec.  862.9. The 
device must comply with the following special controls:
* * * * *

PART 866--IMMUNOLOGY AND MICROBIOLOGY DEVICES

0
3. The authority citation for part 866 continues to read as follows:

    Authority: 21 U.S.C. 351, 360, 360c, 360e, 360j, 360l, 371.

0
4. In Sec.  866.5950, revise paragraph (b) introductory text to read as 
follows:


Sec.  866.5950  Genetic health risk assessment system.

* * * * *
    (b) Classification. Class II (special controls). The genetic health 
risk assessment system device, when it has previously received a first-
time FDA marketing authorization (e.g., 510(k) clearance) for the 
genetic health risk assessment system (a ``one-time FDA reviewed 
genetic health risk assessment system''), is exempt from the premarket 
notification procedures in part 807, subpart E, of this chapter subject 
to the limitations in Sec.  866.9. The device must comply with the 
following special controls:
* * * * *

PART 876--GASTROENTEROLOGY-UROLOGY DEVICES

0
5. The authority citation for part 876 continues to read as follows:

    Authority:  21 U.S.C. 351, 360, 360c, 360e, 360j, 360l, 371.

0
6. In Sec.  876.1500, revise paragraph (b)(1) to read as follows:


Sec.  876.1500  Endoscope and accessories.

* * * * *
    (b) * * *
    (1) Class II (performance standards). The device, when intended as 
an endoscope disinfectant basin, which consists solely of a container 
that holds disinfectant and endoscopes and accessories, is exempt from 
the premarket notification procedures in part 807, subpart E, of this 
chapter subject to the limitations in Sec.  876.9.
* * * * *

[[Page 25915]]

PART 880--GENERAL HOSPITAL AND PERSONAL USE DEVICES

0
7. The authority citation for part 880 continues to read as follows:

    Authority:  21 U.S.C. 351, 360, 360c, 360e, 360j, 360l, 371.


0
8. In Sec.  880.6710, revise paragraph (b) to read as follows:


Sec.  880.6710  Medical ultraviolet water purifier.

* * * * *
    (b) Classification. Class II (performance standards). The device is 
exempt from the premarket notification procedures in part 807, subpart 
E, of this chapter subject to the limitations in Sec.  880.9.

PART 884--OBSTETRICAL AND GYNECOLOGICAL DEVICES

0
9. The authority citation for part 884 continues to read as follows:

    Authority: 21 U.S.C. 351, 360, 360c, 360e, 360j, 360l, 371.


0
10 In Sec.  884.5960, revise paragraph (b) to read as follows:


Sec.  884.5960  Genital vibrator for therapeutic use.

* * * * *
    (b) Classification. Class II (performance standards). The device is 
exempt from the premarket notification procedures in part 807, subpart 
E, of this chapter subject to the limitations in Sec.  884.9.

    Dated: May 29, 2018.
Leslie Kux,
Associate Commissioner for Policy.
[FR Doc. 2018-11879 Filed 6-1-18; 8:45 am]
BILLING CODE 4164-01-P


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