Medicare Program: Approval for an Exception to the Prohibition on Expansion of Facility Capacity Under the Hospital Ownership and Rural Provider Exceptions to the Physician Self-Referral Prohibition
| Published date | 11 March 2021 |
| Citation | 86 FR 13901 |
| Record Number | 2021-05095 |
| Section | Notices |
| Court | Centers For Medicare & Medicaid Services |
13901
Federal Register / Vol. 86, No. 46 / Thursday, March 11, 2021 / Notices
assets or the ownership of, control of, or
the power to vote shares of a bank or
bank holding company and all of the
banks and nonbanking companies
owned by the bank holding company,
including the companies listed below.
The public portions of the
applications listed below, as well as
other related filings required by the
Board, if any, are available for
immediate inspection at the Federal
Reserve Bank(s) indicated below and at
the offices of the Board of Governors.
This information may also be obtained
on an expedited basis, upon request, by
contacting the appropriate Federal
Reserve Bank and from the Board’s
Freedom of Information Office at
https://www.federalreserve.gov/foia/
request.htm. Interested persons may
express their views in writing on the
standards enumerated in the BHC Act
(12 U.S.C. 1842(c)).
Comments regarding each of these
applications must be received at the
Reserve Bank indicated or the offices of
the Board of Governors, Ann E.
Misback, Secretary of the Board, 20th
Street and Constitution Avenue NW,
Washington DC 20551–0001, not later
than April 12, 2021.
A. Federal Reserve Bank of
Minneapolis (Chris P. Wangen,
Assistant Vice President), 90 Hennepin
Avenue, Minneapolis, Minnesota
55480–0291:
1. American Bancor, Ltd., Dickinson,
North Dakota; to acquire voting shares
of The Citizens State Bank of Finley,
Finley, North Dakota.
Board of Governors of the Federal Reserve
System, March 8, 2021.
Michele Taylor Fennell,
Deputy Associate Secretary of the Board.
[FR Doc. 2021–05081 Filed 3–10–21; 8:45 am]
BILLING CODE P
FEDERAL RESERVE SYSTEM
Change in Bank Control Notices;
Acquisitions of Shares of a Bank or
Bank Holding Company
The notificants listed below have
applied under the Change in Bank
Control Act (Act) (12 U.S.C. 1817(j)) and
§ 225.41 of the Board’s Regulation Y (12
CFR 225.41) to acquire shares of a bank
or bank holding company. The factors
that are considered in acting on the
applications are set forth in paragraph 7
of the Act (12 U.S.C. 1817(j)(7)).
The public portions of the
applications listed below, as well as
other related filings required by the
Board, if any, are available for
immediate inspection at the Federal
Reserve Bank(s) indicated below and at
the offices of the Board of Governors.
This information may also be obtained
on an expedited basis, upon request, by
contacting the appropriate Federal
Reserve Bank and from the Board’s
Freedom of Information Office at
https://www.federalreserve.gov/foia/
request.htm. Interested persons may
express their views in writing on the
standards enumerated in paragraph 7 of
the Act.
Comments regarding each of these
applications must be received at the
Reserve Bank indicated or the offices of
the Board of Governors, Ann E.
Misback, Secretary of the Board, 20th
Street and Constitution Avenue NW,
Washington DC 20551–0001, not later
than March 26, 2021.
A. Federal Reserve Bank of St. Louis
(David L. Hubbard, Senior Manager)
P.O. Box 442, St. Louis, Missouri
63166–2034. Comments can also be sent
electronically to
Comments.applications@stls.frb.org:
1. Travis Brown; the Angela J. McLane
Revocable Trust; Angela J. McLane,
individually and as trustee of the
Angela J. McLane Revocable Trust; and
David Rowland, all of Poplar Bluff,
Missouri; to become members of the
McLane Family Control Group, a group
acting concert, by retaining voting
shares of Midwest Bancorporation, Inc.,
Poplar Bluff, Missouri, and thereby
retaining voting shares of First Midwest
Bank of Dexter, Dexter, Missouri, First
Midwest Bank of Poplar Bluff, Poplar
Bluff, Missouri, and First Midwest Bank
of the Ozarks, Piedmont, Missouri.
B. Federal Reserve Bank of
Minneapolis (Chris P. Wangen,
Assistant Vice President), 90 Hennepin
Avenue, Minneapolis, Minnesota
55480–0291:
1. The Nancy B. Miller Trust dated
July 1, 2020, and the Win R. Miller Trust
dated July 1, 2020, Nancy B. Miller and
Win R. Miller as trustees, and the Mary
A. Walquist Trust dated June 5, 2020,
Mary A. Walquist as trustee, all of
Marine on St. Croix, Minnesota, to
become members of the Walquist/Miller
Family Control Group, a group acting in
concert, by acquiring voting shares of
Marine Bancshares, Inc., and thereby
indirectly acquiring voting shares of
Security State Bank of Marine, both of
Marine on St. Croix, Minnesota.
2. Jerome M. Bauer and Susanne M.
Bauer, both of Durand, Wisconsin; to
acquire voting shares of Security
Financial Services Corporation, and
thereby indirectly acquire voting shares
of Security Financial Bank, both of
Durand, Wisconsin, and Jackson County
Bank, Black River Falls, Wisconsin.
In addition, Jerome M. Bauer,
Susanne M. Bauer, Tad M. Bauer, Jodi
N. Bauer, Timothy A. Hoffman, Julie M.
Hoffman, Janice M. Spindler, and
Steven R. Spindler, all of Durand,
Wisconsin; the Chad W. and Amanda S.
Smith Revocable Grantor Trust,
Amanda S. Smith, both of Eau Galle,
Washington, individually, and together
with Chad W. Smith, as co-trustees,
Durand Washington; the James M. and
Linda M. Bauer Revocable Grantor
Trust, James M. Bauer and Linda M.
Bauer, as co-trustees, the John J. and
Mary Jane Brantner Revocable Grantor
Trust, John J. Brantner and Mary Jane
Brantner, as co-trustees, and the Larry J.
and Marcia J. Weber Revocable Grantor
Trust, Larry J. Weber, as trustee, all of
Durand, Wisconsin; as a group acting in
concert, to retain voting shares of
Security Financial Services Corporation,
and thereby indirectly retain voting
shares of Security Financial Bank and
Jackson County Bank.
Board of Governors of the Federal Reserve
System, March 8, 2021.
Michele Taylor Fennell,
Deputy Associate Secretary of the Board.
[FR Doc. 2021–05082 Filed 3–10–21; 8:45 am]
BILLING CODE P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[CMS–1758–FN]
Medicare Program: Approval for an
Exception to the Prohibition on
Expansion of Facility Capacity Under
the Hospital Ownership and Rural
Provider Exceptions to the Physician
Self-Referral Prohibition
AGENCY
: Centers for Medicare &
Medicaid Services (CMS), HHS.
ACTION
: Final notice.
SUMMARY
: This final notice announces
our decision to approve the request from
Solutions Medical Consulting, LLC d/b/
a Serenity Springs Hospital for an
exception to the prohibition on
expansion of facility capacity.
DATES
: This decision is applicable
beginning March 11, 2021.
FOR FURTHER INFORMATION CONTACT
:
POH-ExceptionRequests@
cms.hhs.gov.
Joi Hosley, (410) 786–2194.
Patricia Taft, (410) 786–4561.
SUPPLEMENTARY INFORMATION
:
I. Background
Section 1877 of the Social Security
Act (the Act), also known as the
physician self-referral law—(1) prohibits
VerDate Sep<11>2014 16:53 Mar 10, 2021 Jkt 253001 PO 00000 Frm 00028 Fmt 4703 Sfmt 4703 E:\FR\FM\11MRN1.SGM 11MRN1
khammond on DSKJM1Z7X2PROD with NOTICES
13902
Federal Register / Vol. 86, No. 46 / Thursday, March 11, 2021 / Notices
1
When approving an expansion exception
request, we are required to follow the regulations
in effect as of the date the request is filed. The
regulations at 42 CFR 411.362(c)(6) were modified
effective January 1, 2021 (85 FR 85866; https://
www.federalregister.gov/documents/2020/12/29/
2020-26819/medicare-program-hospital-outpatient-
prospective-payment-and-ambulatory-surgical-
center-payment.
a physician from making referrals for
certain designated health services
payable by Medicare to an entity with
which he or she (or an immediate family
member) has a financial relationship,
unless the requirements of an applicable
exception are satisfied; and (2) prohibits
the entity from filing claims with
Medicare (or billing another individual,
entity, or third party payer) for any
improperly referred designated health
services. A financial relationship may
be an ownership or investment interest
in the entity or a compensation
arrangement with the entity. The statute
establishes a number of specific
exceptions and grants the Secretary of
the Department of Health and Human
Services (the Secretary) the authority to
create regulatory exceptions for
financial relationships that do not pose
a risk of program or patient abuse.
Section 1877(d) of the Act sets forth
exceptions related to ownership or
investment interests held by a physician
(or an immediate family member of a
physician) in an entity that furnishes
designated health services. Section
1877(d)(2) of the Act provides an
exception for ownership or investment
interests in rural providers (the ‘‘rural
provider exception’’). In order to qualify
for the rural provider exception, the
designated health services must be
furnished in a rural area (as defined in
section 1886(d)(2) of the Act) and
substantially all the designated health
services furnished by the entity must be
furnished to individuals residing in a
rural area and, in the case where the
entity is a hospital, the hospital meets
the requirements of section 1877(i)(1) of
the Act no later than September 23,
2011. Section 1877(d)(3) of the Act
provides an exception for ownership or
investment interests in a hospital
located outside of Puerto Rico (the
‘‘whole hospital exception’’). In order to
qualify for the whole hospital exception,
the referring physician must be
authorized to perform services at the
hospital, the ownership or investment
interest must be in the hospital itself
(and not merely in a subdivision of the
hospital), and the hospital meets the
requirements of section 1877(i)(1) of the
Act no later than September 23, 2011.
Section 6001(a)(3) of the Patient
Protection and Affordable Care Act
(Pub. L. 111–148) as amended by the
Health Care and Education
Reconciliation Act of 2010 (Pub. L. 111–
152) (hereafter referred to together as
‘‘the Affordable Care Act’’) amended the
rural provider and hospital ownership
exceptions to the physician self-referral
prohibition to impose additional
restrictions on physician ownership and
investment in hospitals. Since March
23, 2010, a physician-owned hospital
that seeks to avail itself of either
exception is prohibited from expanding
facility capacity unless it qualifies as an
‘‘applicable hospital’’ or ‘‘high Medicaid
facility’’ (as defined in sections
1877(i)(3)(E), (F) of the Act and our
regulations at 42 CFR 411.362(c)(2) and
(3)) and has been granted an exception
to the facility expansion prohibition by
the Secretary. Section 1877(i)(3)(A)(ii) of
the Act provides that individuals and
entities in the community in which the
provider requesting the exception is
located must have an opportunity to
provide input with respect to the
provider’s request for the exception.
Section 1877(i)(3)(H) of the Act states
that the Secretary shall publish in the
Federal Register the final decision with
respect to the request for an exception
to the prohibition against facility
expansion not later than 60 days after
receiving a complete application.
II. Exception Approval Process
On November 30, 2011, we published
a final rule in the Federal Register (76
FR 74122, 74517 through 74525) that,
among other things, finalized
§ 411.362(c), which specified the
process for submitting, commenting on,
and reviewing a request for an exception
to the prohibition on expansion of
facility capacity. We published a
subsequent final rule in the Federal
Register on November 10, 2014 (79 FR
66770) that made certain revisions.
These revisions include, among other
things, permitting the use of data from
an external data source or data from the
Hospital Cost Report Information
System (HCRIS) for specific eligibility
criteria.
Our regulations at § 411.362(c)(5)
require us to solicit community input on
the request for an exception by
publishing a notice of the request in the
Federal Register. Individuals and
entities in the hospital’s community
will have 30 days to submit comments
on the request. Community input must
take the form of written comments and
may include documentation
demonstrating that the physician-owned
hospital requesting the exception does
or does not qualify as an applicable
hospital or high Medicaid facility as
such terms are defined in § 411.362(c)(2)
and (3). In the November 30, 2011 final
rule (76 FR 74522), we gave examples of
community input, such as
documentation demonstrating that the
hospital does not satisfy one or more of
the data criteria or that the hospital
discriminates against beneficiaries of
federal health programs; however, we
noted that these were examples only
and that we will not restrict the type of
community input that may be
submitted. If we receive timely
comments from the community, we will
notify the hospital, and the hospital will
have 30 days after such notice to submit
a rebuttal statement (§ 411.362(c)(5)).
A request for an exception to the
facility expansion prohibition is
considered complete as follows:
•If the request, any written
comments, and any rebuttal statement
include only HCRIS data: (1) The end of
the 30-day comment period if the
Centers for Medicare & Medicaid
Services (CMS) receives no written
comments from the community; or (2)
the end of the 30-day rebuttal period if
CMS receives written comments from
the community, regardless of whether
the physician owned hospital
submitting the request submits a
rebuttal statement (§ 411.362(c)(5)(i)).
•If the request, any written
comments, or any rebuttal statement
include data from an external data
source, no later than: (1) 180 days after
the end of the 30-day comment period
if CMS receives no written comments
from the community; and (2) 180 days
after the end of the 30-day rebuttal
period if CMS receives written
comments from the community,
regardless of whether the physician
owned hospital submitting the request
submits a rebuttal statement
(§ 411.362(c)(5)(ii)).
If we grant the request for an
exception to the prohibition on
expansion of facility capacity, under the
regulations in place at the time the
request was filed, the expansion may
occur only in facilities on the hospital’s
main campus and may not result in the
number of operating rooms, procedure
rooms, and beds for which the hospital
is licensed to exceed 200 percent of the
hospital’s baseline number of operating
rooms, procedure rooms, and beds
(§ 411.362(c)(6)).
1
The CMS decision to
grant or deny a hospital’s request for an
exception to the prohibition on
expansion of facility capacity must be
published in the Federal Register in
accordance with our regulations at
§ 411.362(c)(7).
III. Public Response to Notice With
Comment Period
On December 11, 2020, we published
a notice in the Federal Register (85 FR
VerDate Sep<11>2014 16:53 Mar 10, 2021 Jkt 253001 PO 00000 Frm 00029 Fmt 4703 Sfmt 4703 E:\FR\FM\11MRN1.SGM 11MRN1
khammond on DSKJM1Z7X2PROD with NOTICES
13903
Federal Register / Vol. 86, No. 46 / Thursday, March 11, 2021 / Notices
80111) entitled ‘‘Request for an
Exception to the Prohibition on
Expansion of Facility Capacity Under
the Hospital Ownership and Rural
Provider Exceptions to the Physician
Self-Referral Prohibition.’’ In the
December 2020 notice, we stated that as
permitted by section 1877(i)(3) of the
Act and our regulations at § 411.362(c),
the following physician-owned hospital
requested an exception to the
prohibition on expansion of facility
capacity:
Name of Facility: Solutions Medical
Consulting, LLC d/b/a Serenity Springs
Hospital.
Location: 1495 Frazier Road, Ruston,
Louisiana 71270–1632.
Basis for Exception Request: High
Medicaid Facility.
In the December 2020 notice, we
solicited comments from individuals
and entities in the community in which
Solutions Medical Consulting, LLC d/b/
a Serenity Springs Hospital is located.
During the 30-day public comment
period, we received no public
comments.
IV. Decision
This final notice announces our
decision to approve Solutions Medical
Consulting, LLC d/b/a Serenity Springs
Hospital’s request for an exception to
the prohibition against expansion of
facility capacity. Solutions Medical
Consulting, LLC d/b/a Serenity Springs
Hospital submitted the data and
certifications necessary to demonstrate
that it satisfies the criteria to qualify as
a high Medicaid facility as specified in
the November 30, 2011 final rule. In
accordance with section 1877(i)(3) of
the Act, we are granting Solutions
Medical Consulting, LLC d/b/a Serenity
Springs Hospital’s request for an
exception to the expansion of facility
capacity prohibition based on the
following criteria:
•Solutions Medical Consulting, LLC
d/b/a Serenity Springs Hospital is not
the sole hospital in the county in which
the hospital is located;
•With respect to each of the 3 most
recent 12-month periods for which data
are available as of the date the hospital
submitted its request, Solutions Medical
Consulting, LLC d/b/a Serenity Springs
Hospital had an annual percent of total
inpatient admissions under Medicaid
that is estimated to be greater than such
percent with respect to such admissions
for any other hospital located in the
county in which the hospital is located;
and
•Solutions Medical Consulting, LLC
d/b/a Serenity Springs Hospital certified
that it does not discriminate against
beneficiaries of federal health care
programs and does not permit
physicians practicing at the hospital to
discriminate against such beneficiaries.
Our decision grants Solutions Medical
Consulting, LLC d/b/a Serenity Springs
Hospital’s request to add a total of 18
operating rooms, procedure rooms, and
beds. Under the regulations in place at
the time the request was filed, the
expansion may occur only in facilities
on the hospital’s main campus and may
not result in the number of operating
rooms, procedure rooms, and beds for
which Solutions Medical Consulting,
LLC d/b/a Serenity Springs Hospital is
licensed to exceed 200 percent of its
baseline number of operating rooms,
procedure rooms, and beds. Solutions
Medical Consulting, LLC d/b/a Serenity
Springs Hospital certified that its
baseline number of operating rooms,
procedure rooms, and beds is 18.
Accordingly, we find that granting an
additional 18 operating rooms,
procedure rooms, and beds will not
exceed the limitation on a permitted
expansion.
V. Collection of Information
Requirements
This document does not impose
information collection requirements,
that is, reporting, recordkeeping or
third-party disclosure requirements.
Consequently, there is no need for
review by the Office of Management and
Budget under the authority of the
Paperwork Reduction Act of 1995 (44
U.S.C. 3501 et seq.).
The Acting Administrator of the
Centers for Medicare & Medicaid
Services (CMS), Elizabeth Richter,
having reviewed and approved this
document, authorizes Lynette Wilson,
who is the Federal Register Liaison, to
electronically sign this document for
purposes of publication in the Federal
Register.
Dated: March 8, 2021.
Lynette Wilson,
Federal Register Liaison, Department of
Health and Human Services.
[FR Doc. 2021–05095 Filed 3–10–21; 8:45 am]
BILLING CODE 4120–01–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Submission for OMB Review; Infant
and Toddler Teacher and Caregiver
Competencies (ITTCC) Study (New
Collection)
AGENCY
: Office of Planning, Research,
and Evaluation, Administration for
Children and Families, HHS.
ACTION
: Request for public comment.
SUMMARY
: This is a primary data
collection request for the Infant and
Toddler Teacher and Caregiver
Competencies (ITTCC) study to
examine, using qualitative case studies,
different approaches to implementing
competency frameworks and assessing
competencies of teachers and caregivers
of infants and toddlers who work in
group early care and education (ECE)
settings (centers and family child care
homes). Each case study will focus on
a specific competency framework used
by states, institutions of higher
education, professional organizations, or
ECE programs. This study aims to
present an internally valid description
of the implementation of competency
frameworks and assessment of
competencies for up to seven
purposively selected cases, not to
promote statistical generalization to
different sites or service populations.
DATES
: Comments due within 30 days of
publication. OMB is required to make a
decision concerning the collection of
information between 30 and 60 days
after publication of this document in the
Federal Register. Therefore, a comment
is best assured of having its full effect
if OMB receives it within 30 days of
publication.
ADDRESSES
: Written comments and
recommendations for the proposed
information collection should be sent
within 30 days of publication of this
notice to www.reginfo.gov/public/do/
PRAMain. Find this particular
information collection by selecting
‘‘Currently under 30-day Review—Open
for Public Comments’’ or by using the
search function.
SUPPLEMENTARY INFORMATION
:
Description: The ITTCC study will
examine implementation and
assessment of competency frameworks
at (1) the system level (that is, among
those charged with creating a structure
for and supporting implementation in
states, institutions of higher education,
and/or professional organizations); and
(2) the program level (that is, in the
center-based settings and family child
VerDate Sep<11>2014 16:53 Mar 10, 2021 Jkt 253001 PO 00000 Frm 00030 Fmt 4703 Sfmt 4703 E:\FR\FM\11MRN1.SGM 11MRN1
khammond on DSKJM1Z7X2PROD with NOTICES
