[Federal Register Volume 60, Number 188 (Thursday, September 28, 1995)]
[Rules and Regulations]
[Pages 50115-50120]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-23780]



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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 431, 440, 442, 488, 489, and 498

[HSQ-156-CN]
RIN 0938-AD94


Medicare and Medicaid Programs; Survey, Certification and 
Enforcement of Skilled Nursing Facilities and Nursing Facilities

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Final rule and correction to final regulations.

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SUMMARY: In the November 10, 1994 issue of the Federal Register (FR 
Doc. 94-27703) (59 FR 56116), we established rules for survey of 
skilled nursing facilities that participate in the Medicare program, 
and nursing facilities that participate in the Medicaid program. We 
also established remedies that we impose on facilities that do not 
comply with Federal participation requirements, as alternatives to 
program termination. This document corrects errors made in that 
document.

EFFECTIVE DATE: This correction and amendments to Secs. 493.53 and 
493.90 are effective on July 1, 1995.

FOR FURTHER INFORMATION CONTACT: Deborah Kaplan Schoenemann (410) 786-
6771.

SUPPLEMENTARY INFORMATION: On November 10, 1994, we published in the 
Federal Register, at 59 FR 56116, a final rule which established 
significant revisions to the process we use to survey skilled nursing 
facilities that participate in the Medicare program, and nursing 
facilities that participate in the Medicaid program. The rule also 
established remedies that we impose on facilities that do not comply 
with the Federal participation requirements, as alternatives to program 
termination. This notice corrects both typographical and technical 
errors made in that document.

I. Technical Corrections

    In Sec. 431.153(a), we are correcting an inadvertent error in 
terminology. Paragraph (a) states that, for actions specified in 
Sec. 431.151, the ``Medicaid agency'' must give a provider the 
opportunity for a full evidentiary hearing. This change in reference 
was unintentional since we never intended to limit the latitude that 
States have had for many years under the existing regulation. The 
existing regulation provided only that the ``State'' had the hearing 
responsibility thereby leaving it to the discretion of each State how 
best to organize its hearing system. Some States chose to have the 
Medicaid agency conduct hearings, while others have left this 
responsibility to the survey agencies. We are correcting this 
regulation by restoring the original language as intended.
    In Secs. 442.13 and 489.13, we inadvertently carried forward 
provisions pertaining to the effective date of a provider agreement 
that we have had for many years, and that are inconsistent with other 
provisions of the November 10, 1994 rule. Sections 442.13 and 489.13, 
which cut across provider types, specify that a provider agreement is 
effective on the date that the provider meets all requirements or the 
date on which it meets condition level requirements with an acceptable 
plan of correction for lower level standard requirements, whichever is 
earlier. Because there are no longer standard level requirements for 
nursing homes, and because the definition of substantial compliance has 
been significantly redrawn, we need to conform these sections to 
reflect the new standard of compliance for nursing homes.
    Under the rule published on November 10, 1994, a nursing home may 
continue to participate in the Medicare or Medicaid programs if it is 
in substantial compliance with Federal requirements. Because this 
standard is stricter than its predecessor, we now realize that once a 
nursing home achieves substantial compliance, it has made a sufficient 
demonstration to participate, and we do not require a plan of 
correction before the provider agreement is effective. Thus, if a 
nursing home is in substantial compliance on the date of the survey, 
its provider agreement is effective on the date of the survey. However, 
we still require that it submit an acceptable plan of correction at a 
later date for requirements that it does not fully meet. This is 
consistent with Sec. 488.402(d), which provides that facility with 
deficiencies in program requirements must submit a plan of correction 
for approval except when the deficiencies are isolated and have a 
potential for minimal harm, but no actual harm has occurred. Therefore, 
we are removing the requirement in Secs. 442.13(c)(3)(ii) and 
489.13(b)(3)(ii) that a provider that is in substantial 

[[Page 50116]]
compliance with Federal requirements submit a plan of correction before 
the provider agreement is effective.
    In Secs. 488.303(d) and 488.406(a) and (b), we are reordering the 
list of remedies to separate ``transfer of residents'' from ``closure 
of the facility in emergency situations or transfer of residents, or 
both.'' We are making this change to avoid any misunderstanding that 
might otherwise occur that would lead to a conclusion that in order for 
there to be a transfer of residents there must be a facility closure. A 
transfer of residents may occur when there is no facility closure, as 
would be the case when a facility's provider agreement is terminated. 
While we believe that the regulations provided the necessary separation 
of these two events, we are correcting the text to make certain that 
there is no chance for ambiguity.
    In Secs. 488.303(d) and 488.406(b), in reference to the remedies 
that the State must establish, we are clarifying that, ``in addition to 
termination of the provider agreement,'' the State must establish 
certain remedies or approved alternatives to these remedies. The reason 
for this clarification is that termination is a remedy that States must 
establish, but it is unlike the other remedies listed, because there 
are circumstances in which termination is the only option available.
    In Sec. 488.330(e)(1)(ii), we are replacing the phrase, ``the 
pendency of any hearing'' with ``any pending hearing'' because it is 
simpler, more easily understood, and consistent with paragraph 
(e)(2)(ii).
    In Sec. 488.335(f), regarding the report of findings that an 
individual has neglected or abused a resident or misappropriated 
resident property, we are correcting an unintentional error in the 
text, which resulted in the implication that it is always the State 
survey agency that must report the findings. In a particular State, an 
agency other than the State survey agency may be responsible for 
reporting the findings, except for reporting to the nurse aide 
registry. Only the State survey agency may report the findings to the 
nurse aide registry, and it may not delegate this responsibility, in 
accordance with Sec. 483.156(b)(2). Therefore, we are revising 
Sec. 488.335(f) to make this distinction clear. In 
Secs. 488.335(c)(3)(iv) and 488.335(c)(3)(v), we are making conforming 
changes by removing references to the survey agency.
    In Sec. 488.401, in the definition of ``plan of correction,'' we 
are replacing the term, ``certifying agency'' with ``HCFA or the survey 
agency'' to make clearer the identity of the certifying agency.
    Section 488.402(f)(1), regarding notification requirements for all 
facilities other than non-State operated NFs, provides that HCFA gives 
the provider notice of the remedy. As currently written, the regulation 
does not acknowledge that, while we impose all remedies on facilities 
other than non-State operated NFs, we permit States to send notices of 
adverse actions in certain cases of minimal noncompliance, but only as 
we direct. Leaving the regulation in its current published form would 
give the erroneous impression that HCFA must be the sole entity to 
provide such notice, which would not comport with program practice 
under these regulations. Therefore, we are revising Sec. 488.402(f)(1) 
to specify that, except when the State is taking action against a non-
State operated NF, HCFA ``or the State (as authorized by HCFA)'' gives 
the provider notice of the remedy.
    In Sec. 488.402(f)(7), regarding State monitoring, we are removing 
an incorrect reference to immediate jeopardy. We do not give a facility 
notice before we impose State monitoring, even when there is immediate 
jeopardy. We discussed this in the preamble (59 FR 56171, column two) 
and failed to correct this error in the text of the regulations.
    Section 488.408(d)(3) concerns our option and a State's option to 
apply remedies in Category 2 to any deficiency. We are correcting an 
omission by clarifying that HCFA or the State may apply one or more of 
the remedies in Category 2 to any deficiency except when the facility 
is in substantial compliance, or when HCFA or the State imposes a civil 
money penalty for a deficiency that constitutes immediate jeopardy, in 
which case, the penalty must be in the upper range of penalty amounts, 
as specified in Sec. 488.438(a).
    In Sec. 488.410(c)(2), we are correcting an inadvertent error. 
Paragraph (c)(2) provides that when a facility has deficiencies that 
pose immediate jeopardy, we will or the State must take immediate 
action to remove the jeopardy and correct the noncompliance through 
temporary management or terminate the facility's participation under 
the State plan (and we will terminate the facility's Medicare 
participation if it is a dually-participating facility).
    In Sec. 488.412(a)(2), we are changing ``State survey agency'' to 
``State'' because we inadvertently failed to recognize that, in fact, 
the submission of plans and timetables for corrective action are as 
likely to be generated by agencies other than the State survey agency 
and it was not our intent to limit States' discretion. We are also 
changing ``plan of correction'' to ``plan and timetable for corrective 
action'' for consistency with terminology used in Sec. 488.450.
    In Sec. 488.417(c)(1) and (c)(2), with regard to resumption of 
payments when a facility has repeated instances of substandard quality 
of care, we clarify that, when the facility is a State-operated NF 
participating in the Medicaid program, HCFA, rather than the State, 
makes the determination that the facility has achieved substantial 
compliance and is capable of remaining in substantial compliance. To 
permit a State to make this determination for a facility that the State 
itself operates, would be an obvious conflict of interest and 
inconsistent with the law's directive that the Secretary be the 
certifying entity for these facilities. We are also clarifying that 
HCFA makes the determination for all facilities except non-State 
operated NFs against which HCFA is imposing no remedies, and the State 
makes the determination for non-State operated NFs against which HCFA 
is imposing no remedies.
    Section 488.422(c)(1) provides that State monitoring is 
discontinued when the facility demonstrates that it is in substantial 
compliance with the requirements, and it will remain in compliance for 
a period of time specified by HCFA or the State, or until termination 
procedures are complete. We are correcting an inadvertent error in the 
text by clarifying that the facility only has to demonstrate that it 
will remain in compliance, in addition to demonstrating that it has 
achieved substantial compliance, if the remedy was imposed for repeated 
instances of substandard quality of care.
    In Sec. 488.426, we are rewording the section title to remove the 
erroneous implication that closure of a facility can occur without 
transfer of residents. In paragraph (a), we are revising the heading to 
more accurately reflect the content of the paragraph. In paragraph (b), 
we are revising the heading to reflect the content, which is transfer 
of residents when HCFA or the State terminates the facility's provider 
agreement, and we are removing the reference to ``immediate jeopardy'' 
because we inadvertently failed to recognize in the final rule that 
provider agreement terminations cause residents to be transferred 
regardless of whether immediate jeopardy exists. We are also removing 
paragraph (c) because it would be redundant after the change to 
paragraph (b).
    Section 488.432(a)(1)(i), regarding when a civil money penalty is 
collected after a facility requests a hearing, 

[[Page 50117]]
provides that a facility must request a hearing within the time 
specified in Sec. 498.40 for a SNF, a dually participating facility, or 
State-operated NF. We inadvertently omitted from the list, ``non-State 
operated NF against which HCFA is imposing remedies.'' Similarly, in 
Sec. 488.432(a)(1)(ii), we are correcting an error by clarifying that a 
facility must request a hearing on the determination of noncompliance 
that is the basis for imposition of the civil money penalty within the 
time specified in Sec. 431.153 for a non-State operated NF ``that is 
not subject to imposition of remedies by HCFA.''
    In Sec. 488.434, with regard to written notice of our intent to 
impose a civil money penalty, we are removing the phrase, ``intent to 
impose.'' The proposed rule provided that the effective date of a civil 
money penalty would be the 10th day after the last day of the survey in 
immediate jeopardy situations, and the 20th day after the last day of 
the survey in non-immediate jeopardy situations.
    Consequently, the proposed rule referred to ``the intent'' to 
impose a civil money penalty because a provider always had a window of 
opportunity in which to correct the noncompliance and avoid the 
imposition of the civil money penalty. (If a facility corrected the 
deficiency before the 10th or 20th day, we would not impose a civil 
money penalty.) However, on page 56200 of the preamble to the final 
rule, we noted that a notice of imposition of the penalty is not 
required before a civil money penalty can begin to accrue, since the 
Act permits the imposition of a civil money penalty for past violations 
that have been corrected, and the civil money penalty may start 
accruing as early as the date that the facility was first out of 
compliance, as determined by HCFA or the State. For these reasons, we 
are removing the phrase, ``intent to impose,'' (the civil money 
penalty) in Sec. 488.434.
    In Sec. 488.442(c)(2), we correct an inadvertent error regarding 
the Medicare rate of interest assessed on the unpaid balance of a civil 
money penalty. Paragraph (c)(2) should have specified that the Medicare 
rate of interest is ``the higher of'' the rate fixed by the Secretary 
of the Treasury after taking into consideration private consumer rates 
of interest prevailing on the date of the notice of the penalty amount 
due (published quarterly in the Federal Register by HHS under 45 CFR 
30.13(a)), or the current value of funds (published annually in the 
Federal Register by the Secretary of the Treasury, subject to quarterly 
revisions). Our intention to use ``the higher of'' the two amounts is 
indicated in the discussion of Sec. 488.442(c) on page 56209 of the 
preamble.
    Section 488.442 (d) and (e) concerns the disposition of civil money 
penalties and interest collected from long term care facilities. It was 
brought to our attention that the law specifically requires that, for 
Medicare-participating facilities, we deposit the funds as 
miscellaneous receipts of the U.S. Treasury (rather than ``return them 
to the Medicare Trust Fund''), and, for Medicaid-participating 
facilities, that we return the funds to the State. Section 488.442(e) 
concerns disposition of civil money penalties and interest collected 
from facilities that participate in both Medicare and Medicaid programs 
(dually participating facilities). Again, we believe it is more correct 
legally to refer not to the Medicare Trust Fund, but to ``miscellaneous 
receipts of the U.S. Treasury.'' Therefore, we have made these changes 
to Sec. 488.442 (d) and (e). In addition, in Sec. 488.442(f), we are 
making an editorial change by revising the term ``deficient'' with 
regard to facilities to ``noncompliant.''
    In Sec. 488.454, regarding the duration of remedies, paragraph (d) 
provides that, if the facility can supply documentation acceptable to 
us or the State that it was in substantial compliance, and was capable 
of remaining in substantial compliance, if necessary, on a date 
preceding that of the revisit, the remedies terminate on the date that 
we or the State can verify that the facility achieved substantial 
compliance. We inadvertently left off at the end of the sentence ``the 
facility demonstrated that it could maintain substantial compliance, if 
necessary.''
    In Sec. 489.3, we are correcting an error in the definition of 
immediate jeopardy, which is inconsistent with the definition of 
immediate jeopardy in Sec. 488.301. As corrected, ``immediate 
jeopardy'' means a situation in which the provider's noncompliance with 
one or more requirements of participation has caused, or is likely to 
cause, serious injury, harm, impairment, or death to a resident. We are 
removing the phrase, ``immediate corrective action is necessary 
because''.
    In Sec. 489.53, we removed the entire paragraph (b) in error, and 
should have removed only paragraph (b)(2) because it is no longer 
applicable. Paragraph (b)(1), which concerns termination of a provider 
agreement for a hospital or rural primary care hospital that has an 
emergency department, was inadvertently removed. Consequently, we are 
correcting this by reinstating the content of paragraph (b)(1) as 
paragraph (b).
    Finally, we are correcting an error, which inadvertently gave the 
impression (by our not changing part 498) that judicial review of a 
civil money penalty was available to a facility in the United States 
District Courts. In fact, through the incorporation of parts of section 
1128A of the Social Security Act (the Act) in sections 1819(h) and 
1919(h) of the Act, judicial review of such actions may occur only in 
the appropriate United States Court of Appeals. Therefore, we are 
revising Sec. 498.90 to reflect this fact. In addition, we are revising 
Sec. 498.90 to make it conform to Sec. 498.1(h), which makes it clear 
that Appeals Council decisions on civil money penalty cases are final 
once the Appeals Council makes a decision, regardless of whether 
judicial review occurs.

II. Other Corrections

    In this document, we are making numerous corrections resulting from 
typographical errors, errors in cross references, omissions and 
conflicts within the November 10, 1994 rule.

III. Corrections to the Regulations Text of the November 10, 1994 Final 
Rule (59 FR 56116)

PART 431--[CORRECTED]

    1. On page 56232, column three, Sec. 431.153(a), line two, 
``Medicaid agency'' is corrected to read ``State''.

PART 440--[CORRECTED]


Sec. 440.40  [Corrected]

    2. On page 56234, column one, Sec. 440.40(a)(2), line one, 
``includes'' is corrected to read ``include''.

PART 442--[CORRECTED]

    3. We make the following corrections to Sec. 442.13:
    a. On page 56235, column three, Sec. 442.13(b), in the sixth line, 
``survey'' is corrected to read ``survey,''.
    b. On page 56235, column three, Sec. 442.13(c)(3)(ii) is corrected 
to read as follows:


Sec. 442.13  Effective date of agreement.

* * * * *
    (c) * * *
    (3) * * *
    (ii) Submits, if applicable, an approvable waiver request.
* * * * *


Sec. 442.30  [Corrected]

    4. On page 56235, column three, in the amendatory language to item 
10, the word ``and is inserted before ``(a)(4)'' in line two, and the 
words ``introductory paragraph of'' are inserted before ``(a)(7)'' in 
line three.

[[Page 50118]]


PART 488--[CORRECTED]

    5. On page 56239, column one, Sec. 488.303(d) is corrected to read 
as follows:


Sec. 488.303  State plan requirement.

* * * * *
    (d) Required remedies for a non-State operated NF. A State must 
establish, in addition to termination of the provider agreement, the 
following remedies or an approved alternative to the following remedies 
for imposition against a non-State operated NF:
    (1) Temporary management.
    (2) Denial of payment for new admissions.
    (3) Civil money penalties.
    (4) Transfer of residents.
    (5) Closure of the facility and transfer of residents.
    (6) State monitoring.
* * * * *


Sec. 488.314  [Corrected]

    6. On page 56240, column one, Sec. 488.314(a)(4)(iii), line four, 
``paragraphs (a)(2)(i) or (ii)'' is corrected to read ``paragraph 
(a)(4)(i) or paragraph (a)(4)(ii)''.


Sec. 488.325  [Corrected]

    7. We make the following corrections to Sec. 488.325:
    a. On page 56241, column one, Sec. 488.325(f)(2), line two, 
``Sec. 488.206'' is corrected to read ``Sec. 488.406''.
    b. On page 56241, column two, Sec. 488.325(i), line eight, ``part 
1002, subpart C,'' is corrected to read ``part 1007''.


Sec. 488.330  [Corrected]

    8. On page 56241, column three, Sec. 488.330(e)(1)(ii), line two, 
``the pendency of any hearing'' is corrected to read ``any pending 
hearing''.


Sec. 488.335  [Corrected]

    9. We make the following corrections to Sec. 488.335:
    a. On page 56242, column three, Sec. 488.335(b), line three, 
``their'' is corrected to read ``the''.
    b. On page 56242, column three, Sec. 488.335(c)(3)(iv), line one, 
``Survey agency's intent'' is corrected to read ``Intent''.
    c. On page 56242, column three, Sec. 488.335(c)(3)(v), line four, 
``the survey agency'' is removed.
    d. On page 56243, column one, Sec. 488.335(f), beginning on line 
six, ``survey agency, which may not delegate this responsibility,'' is 
removed.
    e. On page 56243, column one, Sec. 488.335(f)(5) is corrected to 
read as follows:


Sec. 488.335  Action on complaints of resident neglect and abuse, and 
misappropriation of resident property.

* * * * *
    (f) * * *
    (5) The nurse aide registry for nurse aides. Only the State survey 
agency may report the findings to the nurse aide registry, and this 
must be done within 10 working days of the findings, in accordance with 
Sec. 483.156(c) of this chapter. The State survey agency may not 
delegate this responsibility.
* * * * *


Sec. 488.401  [Corrected]

    10. On page 56243, column three, Sec. 488.401, in the definition of 
Plan of correction, line three, ``the certifying agency which'' is 
corrected to read ``HCFA or the survey agency that''.


Sec. 488.402  [Corrected]

    11. We make the following corrections to Sec. 488.402:
    a. On page 56243, column three, Sec. 488.402(f)(1), beginning on 
line one, the paragraph heading is removed.
    b. On page 56243, column three, Sec. 488.402(f)(1), beginning on 
line five, ``HCFA'' is corrected to read ``HCFA or the State (as 
authorized by HCFA)''.
    c. On page 56243, column three, Sec. 488.402(f)(2), line one, the 
paragraph heading is removed.
    d. On page 56244, column one, Sec. 488.402(f)(7), line one, the 
paragraph heading ``State monitoring--immediate jeopardy.'' is 
corrected to read ``State monitoring.''
    e. On page 56244, column one, Sec. 488.402(f)(7), beginning on line 
two, ``imposed when there is immediate jeopardy'' is removed.
    12. On page 56244, column two, Sec. 488.406(a) and (b) are 
corrected to read as follows:


Sec. 488.406  Available remedies.

    (a) General. In addition to the remedy of termination of the 
provider agreement, the following remedies are available:
    (1) Temporary management.
    (2) Denial of payment including--
    (i) Denial of payment for all individuals, imposed by HCFA, to a--
    (A) Skilled nursing facility, for Medicare;
    (B) State, for Medicaid; or
    (ii) Denial of payment for all new admissions.
    (3) Civil money penalties.
    (4) State monitoring.
    (5) Transfer of residents.
    (6) Closure of the facility and transfer of residents.
    (7) Directed plan of correction.
    (8) Directed in-service training.
    (9) Alternative or additional State remedies approved by HCFA.
    (b) Remedies that must be established. At a minimum, and in 
addition to termination of the provider agreement, the State must 
establish the following remedies or approved alternatives to the 
following remedies:
    (1) Temporary management.
    (2) Denial of payment for new admissions.
    (3) Civil money penalties.
    (4) Transfer of residents.
    (5) Closure of the facility and transfer of residents.
    (6) State monitoring.
* * * * *
    13. We make the following corrections to Sec. 488.408:
    a. On page 56244, column three, Sec. 488.408(b), line 10, ``set 
forth'' is corrected to read ``set forth in''.
    b. On page 56244, column three, Sec. 488.408(c)(2), line one, 
``HCFA or'' is corrected to read ``HCFA does or''.
    c. On page 56244, column three, Sec. 488.408(d)(3), is corrected to 
read as follows:


Sec. 488.408  Selection of remedies.

* * * * *
    (d) * * *
    (3) HCFA or the State may apply one or more of the remedies in 
Category 2 to any deficiency except when--
    (i) The facility is in substantial compliance; or
    (ii) HCFA or the State imposes a civil money penalty for a 
deficiency that constitutes immediate jeopardy, the penalty must be in 
the upper range of penalty amounts, as specified in Sec. 488.438(a).
* * * * *
    d. On page 56245, column one, Sec. 488.408(f)(1), line two, 
``paragraph (F)(2)'' is corrected to read ``paragraph (f)(2)''.


Sec. 488.410  [Corrected]

    14. We make the following changes to Sec. 488.410:
    a. On page 56245, column two, Sec. 488.410(c)(2), line one, 
``must--'' is corrected to read ``must do one or both of the 
following:''.
    b. On page 56245, column two, Sec. 488.410(c)(2)(i), line four, 
``management; or'' is corrected to read ``management.''.


Sec. 488.412  [Corrected]

    15. We make the following corrections to Sec. 488.412:
    a. On page 56245, column two, Sec. 488.412(a)(2), line one, ``The 
State survey agency'' is corrected to read ``The State''.
    b. On page 56245, column two, Sec. 488.412(a)(2), line two, ``a 
plan of 

[[Page 50119]]
correction'' is corrected to read ``a plan and timetable for corrective 
action''.


Sec. 488.417  [Corrected]

    16. We make the following corrections to Sec. 488.417:
    a. On page 56246, column three, Sec. 488.417(c)(1), beginning on 
line four, ``HCFA (under Medicare) or the State (under Medicaid)'' is 
corrected to read ``HCFA (for all facilities except non-State operated 
NFs against which HCFA is imposing no remedies) or the State (for non-
State operated NFs against which HCFA is imposing no remedies)''.
    b. On page 56246, column three, Sec. 488.417(c)(2), beginning on 
line one, ``HCFA (under Medicare) or the State (under Medicaid)'' is 
corrected to read ``HCFA (for all facilities except non-State operated 
NFs against which HCFA is imposing no remedies) or the State (for non-
State operated NFs against which HCFA is imposing no remedies)''.


Sec. 488.422  [Corrected]

    17. On page 56247, column one, Sec. 488.422(c)(1), line three, 
``and it'' is corrected to read ``and, if imposed for repeated 
instances of substandard quality of care,''.


Sec. 488.425  [Corrected]

    18. On page 56247, column two, Sec. 488.425(b), line six, 
``Sec. 488.206'' is corrected to ``Sec. 488.406''.


Sec. 488.426  [Corrected]

    19. We make the following corrections to Sec. 488.426:
    a. On page 56247, column two, Sec. 488.426, the section heading 
``Closure of a facility or transfer of residents, or both.'' is 
corrected to read ``Transfer of residents, or closure of the facility 
and transfer of residents.''
    b. On page 56247, column two, Sec. 488.426(a), the paragraph 
heading ``Closure of a facility or transfer of residents, or both.'' is 
corrected to read ``Transfer of residents, or closure of the facility 
and transfer of residents in an emergency.''
    c. On page 56247, column two, Sec. 488.426(b), the paragraph 
heading ``Required transfer in immediate jeopardy situations.'' is 
corrected to read ``Required transfer when a facility's provider 
agreement is terminated.''
    d. On page 56247, column two, Sec. 488.426(b), beginning in line 
four, ``agreement for a deficiency that constitutes immediate jeopardy, 
the'' is corrected to read ``agreement, the''.
    e. On page 56247, column two, Sec. 488.426, paragraph (c) is 
removed.


Sec. 488.432  [Corrected]

    20. We make the following corrections to Sec. 488.432:
    a. On page 56247, column two, Sec. 488.432(a)(1), line 5, ``in--'' 
is corrected to read ``in one of the following sections:''
    b. On page 56247, column two, Sec. 488.432(a)(1)(i)(B), ``facility; 
or'' is corrected to read ``facility;''.
    c. On page 56247, column two, Sec. 488.432(a)(1)(i)(C), ``State-
operated NF.'' is corrected to read ``State-operated NF; or''.
    d. On page 56247, column two, Sec. 488.432(a)(1)(i), a new 
paragraph (D) is added to read as follows:
    ``(D) Non-State operated NF against which HCFA is imposing 
remedies.''
    e. On page 56247, column two, Sec. 488.432(a)(1)(ii), line two, 
``NF.'' is corrected to read ``NF that is not subject to imposition of 
remedies by HCFA.''


Sec. 488.434  [Corrected]

    21. On page 56247, column three, Sec. 488.434(a)(1), beginning on 
line two, ``notice of intent to impose the penalty'' is corrected to 
read ``notice of the penalty''.
    22. We make the following corrections to Sec. 488.442:
    a. On page 56249, column two, Sec. 488.442(c)(2), line two, 
``interest is--'' is corrected to read ``interest is the higher of--''.
    b. On page 56249, column two, Sec. 488.442(c)(2)(i), line one, 
``Fixed'' is corrected to read ``The rate fixed''.
    c. On page 56249, column two, Sec. 488.442(d) is corrected to read 
as follows:


Sec. 488.442  Civil money penalties: Due date for payment of penalty.

* * * * *
    (d) Penalties collected by HCFA. Civil money penalties and 
corresponding interest collected by HCFA from--
    (1) Medicare-participating facilities are deposited as 
miscellaneous receipts of the United States Treasury; and
    (2) Medicaid-participating facilities are returned to the State.
* * * * *
    d. On page 56249, column two, Sec. 488.442(e), beginning on line 
four, ``returned to the Medicare Trust Fund and'' is corrected to read 
``deposited as miscellaneous receipts of the United States Treasury and 
returned to''.
    e. On page 56249, column two, Sec. 488.442(f), line six, 
``deficient,'' is corrected to read ``noncompliant,''.


Sec. 488.450  [Corrected]

    23. On page 56249, column three, Sec. 488.450(b), line five, ``if'' 
is corrected to read ``of''.


Sec. 488.454  [Corrected]

    24. On page 56250, column two, Sec. 488.454(d), the last line, 
``achieved.'' is corrected to read ``achieved and the facility 
demonstrated that it could maintain substantial compliance, if 
necessary.''

PART 489--[CORRECTED]


Sec. 489.3  [Corrected]

    25. On page 56250, column three, Sec. 489.3, beginning on line two, 
``in which immediate corrective action is necessary because the 
provider's'' is corrected to read ``in which the provider's''.
    26. On page 56251, column one, Sec. 489.13(b)(3)(ii) is corrected 
to read as follows:


Sec. 489.13  Effective date of agreement.

* * * * *
    (b) * * *
    (3) * * *
    (ii) Submits, if applicable, an approvable waiver request.
    27. Section 489.53 is amended by adding a new paragraph (b) to read 
as follows:


Sec. 489.53  Termination by HCFA

    (b) Termination of provider agreement. In the case of a hospital or 
rural primary care hospital that has an emergency department, as 
defined in Sec. 489.24(b), HCFA may terminate the provider agreement 
if--
    (1) The hospital fails to comply with the requirements of 
Sec. 489.24 (a) through (e), which require the hospital to examine, 
treat, or transfer emergency medical condition cases appropriately, and 
require that hospitals with specialized capabilities or facilities 
accept an appropriate transfer; or
    (2) The hospital fails to comply with Sec. 489.20(m), (q), and (r), 
which require the hospital to report suspected violations of 
Sec. 489.24(d), to post conspicuously in emergency departments or in a 
place or places likely to be noticed by all individuals entering the 
emergency departments, as well as those individuals waiting for 
examination and treatment in areas other than traditional emergency 
departments, (that is, entrance, admitting area, waiting room, 
treatment area), signs specifying rights of individuals under this 
subpart, to post conspicuously information indicating whether or not 
the hospital participates in the Medicaid program, and to maintain 
medical and other records related to transferred individuals for a 
period of 5 years, a list of on-call physicians for individuals with 
emergency medical conditions, and a central log on each individual who 
comes to the emergency department seeking assistance.
* * * * *

[[Page 50120]]


PART 498--[CORRECTED]


Sec. 498.3  [Corrected]

    28. We make the following corrections to Sec. 498.3:
    a. On page 56252, column one, Sec. 498.3(b)(12), line two, 
``Sec. 498.3(d)(11).'' is corrected to read Sec. 498.3(d)(11)''.
    b. On page 56252, column one, Sec. 498.3(d)(10), line seven, 
``(b)(14)'' is corrected to read ``(b)(13)''.
    c. On page 56252, column two, Sec. 498.3(d)(12), line two, 
``(b)(14)'' is corrected to read ``(b)(13)''.
    29. Section 498.90 is amended by redesignating existing paragraph 
(b) as paragraph (c), and adding a new paragraph (b) to read as 
follows:


Sec. 498.90  Effect of Appeals Council decision.

* * * * *
    (b)(1) When HCFA imposes a civil money penalty on a SNF or NF, the 
decision of the Appeals Council is final upon issuance.
    (2) Judicial review of an Appeals Council decision concerning the 
imposition of a civil money penalty on a SNF or NF is available in the 
appropriate United States Court of Appeals.

    Authority: Sections 1819(g), 1819(h), 1919(g), and 1919(h) of 
the Social Security Act (42 U.S.C. 1395i-3(g), 1395i-3(h), 1395r(g), 
and 1395r(h)).

    Dated: September 18, 1995.
Neil J. Stillman,
Deputy Assistant Secretary for Information Resources Management.
[FR Doc. 95-23780 Filed 9-27-95; 8:45 am]
BILLING CODE 4120-01-P