43942 Federal Register / Vol. 68, No. 143 / Friday, July 25, 2003 / Rules and Regulations The RFA requires agencies to analyze List of Subjects (ii) If the liability insurer does not pay options for regulatory relief of small within the 120-day period, the provider 42 CFR Part 411 entities. For purposes of the RFA, small or supplier: entities include small businesses, Kidney diseases, Medicare, Reporting (A) Must withdraw its claim with the nonprofit organizations, and and recordkeeping requirements. liability insurer and/or withdraw its lien against a potential liability settlement. government agencies. Most hospitals 42 CFR Part 485 and most other providers and suppliers (B) May only bill Medicare for are small entities, either by nonprofit Grant programs—health, Health Medicare covered services. (C) May bill the beneficiary only for status or by having revenues of $6 facilities, Medicaid, Medicare, Reporting and recordkeeping applicable Medicare deductible and co- million to $29 million in any 1 year. requirements. insurance amounts plus the amount of Individuals and States are not any charges that may be made to a considered to be small entities. Because ■ For the reasons set forth in the preamble, the Centers for Medicare & beneficiary under 413.35 of this chapter this regulation merely deletes these (when cost limits are applied to these unenforceable provisions from our Medicaid Services amends 42 CFR chapter IV as follows: services) or under 489.32 of this chapter regulations, we have determined and we (when services are partially covered). certify that this final rule will not have PART 411—EXCLUSIONS FROM a significant economic impact on a MEDICARE AND LIMITATIONS ON PART 489—PROVIDER AGREEMENTS substantial number of small entities. MEDICARE PAYMENT AND SUPPLIER APPROVAL Therefore, we are not preparing an ■ analysis for the RFA. ■ 1. The authority citation for part 411 1. The authority citation for part 489 continues to read as follows: continues to read as follows: In addition, section 1102(b) of the Act requires us to prepare a regulatory Authority: Secs. 1102 and 1871 of the Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and Social Security Act (42 U.S.C. 1302 and impact analysis if a rule or notice 1395hh). having the effect of a rule may have a 1395hh). ■ 2. Section 489.20 is amended by significant impact on the operations of ■ 2. Section 411.54 is amended by revising paragraph (g) to read as follows: a substantial number of small rural revising paragraphs (c) and (d) to read as hospitals. This analysis must conform to follows: § 489.20 Basic commitments. the provisions of section 604 of the * * * * * RFA. For purposes of section 1102(b) of § 411.54 Limitation on charges when a (g) To bill other primary payers before the Act, we define a small rural hospital beneficiary has received a liability Medicare. as a hospital that is located outside of insurance payment or has a claim pending against a liability insurer. * * * * * a Metropolitan Statistical Area and has * * * * * Authority: Section 1862(b)(2)(A) of the fewer than 100 beds. We have Social Security Act (42 U.S.C. 1395Y) (c) Itemized bill. A hospital must, determined that this final rule will not (Catalog of Federal Domestic Assistance have a significant effect on the upon request, furnish to the beneficiary or his or her representative an itemized Program No. 93.774, Medicare— operations of a substantial number of Supplementary Medical Insurance Program) bill of the hospital’s charges. small rural hospitals. Therefore, we are Dated: June 6, 2003. not preparing an analysis for section (d) Exception—(1) Prepaid health plans. If the services were furnished Thomas A. Scully, 1102(b) of the Act. through an organization that has a Administrator, Centers for Medicare & Section 202 of the Unfunded contact under section 1876 of the Act Medicaid Services. Mandates Reform Act of 1995 also (that is, an HMO or CMP), or through an Approved: June 30, 2003. requires that agencies assess anticipated organization that is paid under section Tommy G. Thompson, costs and benefits before issuing any 1833(a)(1)(A) of the Act (that is, through rule or notice having the effect of a rule an HCPP) the rules of § 417.528 of this Secretary. that may result in expenditures in any chapter apply. [FR Doc. 03–18509 Filed 7–17–03; 10:06 am] 1 year by State, local, or tribal (2) Special rules for Oregon. For the BILLING CODE 4120–01–P governments, in the aggregate, or by the State of Oregon, because of a court private sector, of $110 million. This decision, and in the absence of a final rule has no consequential effect on reversal on appeal or a statutory FEDERAL COMMUNICATIONS State, local, or tribal governments or on clarification overturning the decision, COMMISSION the private sector. there are the following special rules: 47 CFR Parts 25 and 101 Executive Order 13132 establishes (i) The provider or supplier may elect certain requirements that an agency to bill a liability insurer or place a lien [ET Docket No. 98–206; RM–9147; RM–9245; FCC 03–97] must meet when it promulgates a rule against the beneficiary’s liability settlement for Medicare covered or notice having the effect of a rule that services, rather than bill only Medicare Order To Deny Petitions for imposes substantial direct requirement for Medicare covered services, if the Reconsideration of MVDDS Technical costs on State and local governments, liability insurer pays within 120 days and Licensing Rules in the 12 GHz preempts State law, or otherwise has after the earlier of the following dates: Band Federalism implications. This final rule (A) The date the provider or supplier AGENCY: Federal Communications will not have a substantial effect on files a claim with the insurer or places State or local governments. Commission. a lien against a potential liability ACTION: Final rule. In accordance with the provisions of settlement. Executive Order 12866, this final rule (B) The date the services were SUMMARY: In this document the was reviewed by the Office of provided or, in the case of inpatient Commission affirms the technical rules Management and Budget. hospital services, the date of discharge. and procedures dealing with sharing of VerDate Jan<31>2003 15:04 Jul 24, 2003 Jkt 200001 PO 00000 Frm 00042 Fmt 4700 Sfmt 4700 E:\FR\FM\25JYR1.SGM 25JYR1 Federal Register / Vol. 68, No. 143 / Friday, July 25, 2003 / Rules and Regulations 43943 spectrum between Multichannel Video to persons with disabilities by developed through the usual notice and Distribution and Data Service (MVDDS) contacting Brian Millin at (202) 418– comment rule making process. and Direct Broadcast Satellite (DBS) and 7426 or TTY (202) 418–7365. File 3. The Commission affirms that the Non-geostationary (NGSO) fixed comments with the Office of the rules and procedures adopted in the satellite service (FSS) in the 12.2–12.7 Secretary, a copy of any comments on Second R&O do not violate other GHz band that the Commission adopted the information collection contained Commission rules or international radio in the Memorandum Opinion and Order herein should be submitted to Les regulations, and are consistent with the and Second Report and Order (Second Smith, Federal Communications regulatory history of DBS and FS R&O). The Commission also affirms the Commission, Room 1–A804, 445 12th allocations in the 12 GHz band because dismissal of the pending license Street, SW., Washington, DC 20554 or MVDDS, unlike previous FS operations, applications to provide terrestrial via the Internet to [email protected], is designed to coexist with DBS and service in the 12.2–12.7 GHz band. The and to Kim A. Johnson, OMB Desk because the adopted rules and Commission takes these actions in the Officer, Room 10236 NEOB, 725 17th procedures will prevent harmful course of addressing the petitions for Street, NW., Washington, DC 20503 or interference to DBS. reconsideration that were filed in via the Internet to Kim 4. The Commission affirms the self- response to the Second R&O in this [email protected]. mitigation responsibilities adopted in proceeding. The Commission amends or the Second R&O for new DBS receivers clarifies certain rule sections, but Summary of the Fourth Memorandum and finds that they are consistent with otherwise denies the petitions for Opinion and Order the primary status of DBS because, due reconsideration. The adoption of the to their modest, effective and 1. DBS Issues. In this Fourth amended rules and the disposition of infrequently required nature, they strike Memorandum Opinion and Order the petitions for reconsideration will an appropriate public interest balance (Fourth MO&O), the Commission facilitate initiation of MVDDS in the that will result in more efficient affirms that the four regional EPFD 12.2–12.7 GHz band. spectrum utilization and will facilitate limits and the 14 dBm EIRP limit DATES: Effective August 25, 2003, except compliance with the non-harmful § 25.146 which contains information adopted for MVDDS operation interference provisions of the statutes collection requirements that have not constitute objective standards that will while allowing initiation of a new been approved by OMB. The Federal prevent harmful interference to DBS as service. defined by § 2.1 of the Commission’s Communications Commission will 5. The Commission finds that publish a document in the Federal rules and will provide certainty that, adequate notice was given for the Register announcing the effective date. along with other reasonable procedures computer model used to derive the Written comments on the new and/or that were adopted, can be discerned and EPFD limits on MVDDS, and that the modified information collection(s) must relied upon by DBS operators.