[Federal Register Volume 72, Number 210 (Wednesday, October 31, 2007)]
[Rules and Regulations]
[Pages 61540-61545]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 07-5400]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 488

[CMS-2278-IFC]
RIN 0938-AP22


Revisit User Fee Program for Medicare Survey and Certification 
Activities

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Interim final rule with comment period.

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

SUMMARY: This interim final rule with comment period implements the 
continuation of the revisit user fee program for Medicare Survey and 
Certification activities, in accordance with the statutory authority in 
the Continuing Appropriations Resolution (``Continuing Resolution'') 
budget legislation passed by the Congress and signed by the President 
on September 29, 2007. On September 19, 2007, we published a final rule 
that established a system of revisit user fees applicable to health 
care facilities that have been cited for deficiencies during initial 
certification, recertification or substantiated complaint surveys and 
require a revisit to confirm that

[[Page 61541]]

corrections to previously-identified deficiencies have been corrected.

DATES: Effective date: These regulations are effective October 1, 2007.
    Comment date: To be assured consideration, comments must be 
received at one of the addresses provided below, no later than 5 p.m. 
on December 31, 2007.

ADDRESSES: In commenting, please refer to file code CMS-2278-IFC. 
Because of staff and resource limitations, we cannot accept comments by 
facsimile (Fax) transmission.
    You may submit comments in one of four ways (no duplicates, 
please):
    1. Electronically. You may submit electronic comments on specific 
issues in this regulation to http://www.cms.hhs.gov/eRulemaking. Click 
on the link ``Submit electronic comments on CMS regulations with an 
open comment period.'' (Attachments should be in Microsoft Word, 
WordPerfect, or Excel; however, we prefer Microsoft Word.)
    2. By regular mail. You may mail written comments (one original and 
two copies) to the following address only: Centers for Medicare & 
Medicaid Services, Department of Health and Human Services, Attention: 
CMS-2278-IFC, P.O. Box 8010, Baltimore, MD 21244-8016.
    Please allow sufficient time for mailed comments to be received 
before the close of the comment period.
    3. By express or overnight mail. You may send written comments (one 
original and two copies) to the following address only: Centers for 
Medicare & Medicaid Services, Department of Health and Human Services, 
Attention: CMS-2278-IFC, Mail Stop C4-26-05, 7500 Security Boulevard, 
Baltimore, MD 21244-1850.
    4. By hand or courier. If you prefer, you may deliver (by hand or 
courier) your written comments (one original and two copies) before the 
close of the comment period to one of the following addresses. If you 
intend to deliver your comments to the Baltimore address, please call 
telephone number (410) 786-7195 in advance to schedule your arrival 
with one of our staff members. Room 445-G, Hubert H. Humphrey Building, 
200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security 
Boulevard, Baltimore, MD 21244-1850.
    (Because access to the interior of the HHH Building is not readily 
available to persons without Federal Government identification, 
commenters are encouraged to leave their comments in the CMS drop slots 
located in the main lobby of the building. A stamp-in clock is 
available for persons wishing to retain a proof of filing by stamping 
in and retaining an extra copy of the comments being filed.)
    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and received after the comment 
period.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Kathryn Linstromberg, (410) 786-8279.

SUPPLEMENTARY INFORMATION:
    Submitting Comments: As the public was provided an opportunity to 
comment on the substance of the rule during the comment period prior to 
the publication of the September 19, 2007 final rule, and as the 
substance of the rule is not changed by this interim final rule with 
comment period, we are accepting comments only to the extent that they 
pertain to the applicability of the new authority for the rule. You can 
assist us by referencing the file code CMS-2278-IFC.
    Inspection of Public Comments: All comments received before the 
close of the comment period are available for viewing by the public, 
including any personally identifiable or confidential business 
information that is included in a comment. We post all comments 
received before the close of the comment period on the following Web 
site as soon as possible after they have been received: http://www.cms.hhs.gov/eRulemaking. Click on the link ``Electronic Comments on 
CMS Regulations'' on that Web site to view public comments.
    Comments received timely will be also available for public 
inspection as they are received, generally beginning approximately 
three weeks after publication of a document, at the headquarters of the 
Centers for Medicare & Medicaid Services, 7500 Security Boulevard, 
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 
a.m. to 4 p.m. To schedule an appointment to view public comments, 
phone 1-800-743-3951.

SUPPLEMENTARY INFORMATION: 

I. Background

    In the June 29, 2007 Federal Register (72 FR 35673), we published 
the proposed rule entitled, ``Establishment of Revisit User Fee Program 
for Medicare Survey and Certification Activities'' and provided for a 
60-day comment period. In the September 19, 2007 Federal Register (72 
FR 53628) we published the Revisit User Fee Program final rule. That 
final rule set forth final requirements and a final fee schedule for 
providers and suppliers who require a revisit survey as a result of 
deficiencies cited during an initial certification, recertification, or 
substantiated complaint survey.
    The Centers for Medicare & Medicaid Services (CMS) has in place an 
outcome-oriented survey process that is designed to determine whether 
existing Medicare-certified providers and suppliers or providers and 
suppliers seeking initial Medicare certification are actually meeting 
statutory and regulatory requirements, conditions of participation, or 
conditions for coverage. These health and safety requirements apply to 
the environments of care and the delivery of services to residents or 
patients served by these facilities and agencies. The Secretary of the 
Department of Health and Human Services (HHS) has designated CMS to 
enforce the conditions of participation/coverage and other requirements 
of the Medicare program. The revisit user fee will be assessed for 
revisits conducted in order to determine whether deficiencies cited as 
a result of failing to satisfy federal quality of care requirements 
have been corrected.
    Pursuant to the requirements of the Continuing Appropriations 
Resolution budget bill for fiscal year (FY) 2007, which was passed by 
the Congress and signed by the President, we were directed by the 
Secretary to implement the revisit user fees for FY 2007 for certain 
providers and suppliers for which a revisit was required to confirm 
that previously-identified failures to meet federal quality of care 
requirements had been remedied. The fees recover the costs associated 
with the Medicare Survey and Certification program's revisit surveys. 
The primary purpose for implementing the revisit user fees is to ensure 
the continuance of CMS Survey and Certification quality assurance 
functions that improve patient care and safety. The fees became 
effective upon publication September 19, 2007, when the final rule was 
published.

II. Provisions of the Interim Final Rule

    The current Continuing Resolution (Pub. L. 110-92, H. J. Res. 52 
Sec. Sec.  101 & 106(2007)) authorizes HHS to continue the revisit user 
fees until November 16, 2007, as follows:
    * * *
    Sec. 101. Such amounts as may be necessary, at a rate for 
operations as provided in the applicable appropriations Acts for 
fiscal year 2007 and under the authority and conditions provided in 
such Acts, for continuing projects or activities (including the 
costs of direct loans and loan guarantees) that are not otherwise 
specifically provided for in this joint resolution, that were

[[Page 61542]]

conducted in fiscal year 2007, and for which appropriations, funds, 
or other authority were made available in the following 
appropriations Acts:
    * * *
    (3) The Continuing Appropriations Resolution, 2007 (division B 
of Public Law 109-289, as amended by Pub. L. 110-5). (H.J. Res. 20, 
Sec.  101(2007)).
    Sec. 106. Unless otherwise provided for in this joint resolution 
or in the applicable appropriations Act for fiscal year 2008, 
appropriations and funds made available and authority granted 
pursuant to this joint resolution shall be available until whichever 
of the following first occurs:

    * * *
    (3) November 16, 2007.
    As directed by the Secretary, in the September 19, 2007 Federal 
Register (72 FR 53628), we established revisit user fees for revisit 
surveys and put forth in regulation the definitions, criteria for 
determining the fee, the fee schedule, collection of fees, 
reconsideration process for revisit user fees, enforcement and 
regulatory language addressing enrollment and billing privileges, and 
provider agreements. In the September 19, 2007 final rule, cost 
projections were based on FY 2006 actual data and were expected to 
amount to $37.3 million on an annual basis for FY 2007. These 
calculations were included in section IV of the final rule (72 FR 
53642).
    We stated in the final rule that, ``if authority for the revisit 
user fee is continued, we will use the current fee schedule in [the 
final rule] for the assessment of such fees until such time as a new 
fee schedule notice is proposed and published in final form.'' (72 FR 
53628). The current Continuing Resolution continues the authority of 
the FY 2007 Continuing Resolution from October 1, 2007 through November 
16, 2007. Accordingly, the revisit fees will continue to be assessed 
for the entire time period authorized by the current Continuing 
Resolution.

III. Response to Comments

    Because of the large number of public comments we normally receive 
on Federal Register documents, we are not able to acknowledge or 
respond to them individually. We will consider all comments we receive 
by the date and time specified in the DATES section of this preamble, 
and, when we proceed with a subsequent document, we will respond to the 
comments in the preamble to that document.

IV. Waiver of Proposed Rulemaking and Delay in Effective Date

    We ordinarily publish a notice of proposed rulemaking in the 
Federal Register and invite public comment on the proposed rule in 
accordance with 5 U.S.C. section 553(b) of the Administrative Procedure 
Act (APA). The notice of proposed rulemaking includes a reference to 
the legal authority under which the rule is proposed, and the terms and 
substances of the proposed rule or a description of the subjects and 
issues involved. This procedure can be waived, however, if an agency 
finds good cause that a notice-and-comment procedure is impracticable, 
unnecessary, or contrary to the public interest and incorporates a 
statement of the finding and its reasons in the rule issued. We find 
that the notice-and-comment procedure is unnecessary in this 
circumstance because providers and suppliers have already been provided 
notice and an opportunity to comment on the substance of this rule. 
This interim final rule with comment merely updates the Congressional 
authority under which the rule operates.
    Therefore, we find good cause to waive the notice of proposed 
rulemaking and to issue this final rule on an interim basis. We are 
providing a 60-day public comment period.
    We ordinarily provide a 30-day delay in the effective date of the 
provisions of a rule in accordance with the Administrative Procedure 
Act (APA) 5 U.S.C. 553(d). However, the delay in the effective date may 
be waived as, in pertinent part, ``provided by the agency for good 
cause found and published with the rule'' 5 U.S.C. 553(d)(3). The 
Secretary finds that good cause exists to waive the 30-day effective 
date delay.
    The good cause exception to the 30 day effective date delay 
provision of section 553(d) of the APA is read to be broader than the 
good cause exception to the notice and comment provision of section 
553(b)of the APA.
    The legislative history of the APA indicates that the purpose for 
deferring the effectiveness of a rule under section 553(d) was to 
``afford persons affected a reasonable time to prepare for the 
effective date of a rule or rules or to take other action which the 
issuance may prompt.'' S. Rep. No. 752, 79th Cong., 1st Sess. 15 
(1946); H.R. Rep. No. 1980, 79th Cong. 2d Sess. 25 (1946). In this 
case, affected parties do not need time to adjust their behavior before 
this rule takes effect. This rule merely updates the authority under 
which the revisit fee is assessed and does not provide any additional 
requirements for the affected parties. Moreover, with or without a 
revisit fee, a provider or supplier must be found to have corrected 
significant deficiencies in order to avoid termination. Additionally, 
the application of a fee for the revisit does not place appreciable 
administrative burdens on the affected providers or suppliers. We do 
not expect appreciable cost to State survey agencies because we are 
undertaking the billing and collection of the revisit user fee.
    We identified in the proposed rule the immediacy of this revisit 
user fee program and the limited nature of FY 2007, Continuing 
Resolution Appropriation (Pub. L. 110-5). Specifically, the Continuing 
Resolution required us to implement the revisit fee program in FY 2007. 
Accordingly, providers and suppliers have been on notice for some time 
that these fees will be imposed, and do not need additional time to be 
prepared to comply with the requirements of this regulation. We believe 
that given the short timeframe that we have to collect fees before the 
statutory authority of the current Continuing Resolution expires, there 
is good cause to waive the 30-day effective date.

V. Collection of Information Requirements

    This document does not impose information collection and 
recordkeeping requirements. Consequently, it need not be reviewed by 
the Office of Management and Budget under the authority of the 
Paperwork Reduction Act of 1995.

VI. Regulatory Impact Analysis

A. Overall Impact

    We have examined the impacts of this rule as required by Executive 
Order 12866 (September 1993, Regulatory Planning and Review), the 
Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354), 
section 1102(b) of the Social Security Act, the Unfunded Mandates 
Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
    Executive Order 12866 (as amended by Executive Order 13258, which 
merely reassigns responsibility of duties) directs agencies to assess 
all costs and benefits of available regulatory alternatives and, if 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, distributive impacts, and equity). A 
regulatory impact analysis (RIA) must be prepared for major rules with 
economically significant effects ($100 million or more in any one 
year). This rule is not a major rule. The aggregate costs will total 
approximately $37.3 million in any one year.
    The RFA requires agencies to analyze options for regulatory relief 
of small businesses. For purposes of the RFA,

[[Page 61543]]

small entities include small businesses, nonprofit organizations, and 
small governmental jurisdictions. Individuals and States are not 
included in the definition of a small entity. Small businesses are 
small entities, either by nonprofit status or by having revenues of 
$6.5 million to $31.9 million or less in any one year for purposes of 
the RFA. The September 19, 2007 final rule provided an analysis on the 
impact of small entities (72 FR 53642-3). The analysis published in the 
final rule remains valid. Since this interim final rule with comment 
merely updates the Congressional authority under which the rule 
operates, we have determined, and the Secretary certifies, that this 
rule will not have a significant impact on small entities based on the 
overall effect on revenues.
    Section 1102(b) of the Act requires us to prepare a regulatory 
impact analysis if a rule may have a significant impact on the 
operations of a substantial number of small rural hospitals. This 
analysis must conform to the provisions of section 604 of the RFA. For 
purposes of section 1102(b) of the Act, we define a small rural 
hospital as a hospital that is located outside of a Metropolitan 
statistical Area (superseded by Core Based Statistical Areas) and has 
fewer than 100 beds. This rule affects those small rural hospitals that 
have been cited for a deficiency based on noncompliance with required 
conditions of participation and for which a revisit is needed to make 
sure that the deficiency has been corrected. We identified in the 
September 19, 2007 final rule that for the effective period of that 
rule that less than 3 percent of all hospitals may be assessed a 
revisit user fee and that less than 1 percent of those hospitals would 
be rural hospitals (72 FR 53643). The analysis published in the final 
rule remains valid. Since this interim final rule with comment merely 
updates the Congressional authority under which the rule operates, we 
maintain that given the effective period of this rule, we have 
determined, and the Secretary certifies, that this rule will not have a 
significant impact on small rural hospitals.
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any rule whose mandates require spending in any one year of 
$100 million in 1995 dollars, updated annually for inflation. That 
threshold level is currently approximately $120 million. This interim 
final rule with comment will have no mandated effect on State, local, 
or tribal governments and the impact on the private sector is estimated 
to be less than $120 million and will only affect those Medicare 
providers or suppliers for which a revisit user fee is assessed based 
on the need to conduct a revisit survey to ensure deficient practices 
that were cited have been corrected.
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a proposed rule (and subsequent 
final rule) that imposes substantial direct requirement costs on State 
and local governments, preempts State law, or otherwise has Federalism 
implications. This interim final rule with comment will not 
substantially affect State or local governments. This rule establishes 
user fees for providers and suppliers for which CMS has identified 
deficient practices and requires a revisit to assure that corrections 
have been made. Therefore, we have determined that this interim final 
rule with comment will not have a significant effect on the rights, 
roles, and responsibilities of State or local governments.

B. Impact on Providers/Suppliers

    There is no change on the impact on providers and suppliers with 
the publication of this interim final rule with comment. The impact 
remains as discussed in the final rule (72 FR 53643).
Final Fee Schedule for Onsite and Offsite Revisit Surveys
    The FY 2007 fee schedule published on September 19, 2007 (72 FR 
53647) in the final rule will be retained. As noted in the final rule, 
the published fee schedule will be utilized by CMS for the assessment 
of such fees until such time as a new fee schedule notice is proposed 
and published in final form. The calculations utilized to determine the 
fee as identified in the final rule will be the same (72 FR 53645-6). 
We will continue to assess a flat fee based on provider or supplier 
type and type of revisit survey conducted. Table A below identifies the 
final fee schedule.

                      Table A.--Final Fee Schedule
------------------------------------------------------------------------
                                                    Fee          Fee
                                                  assessed     assessed
                   Facility                     per offsite   per onsite
                                                  revisit      revisit
                                                   survey       survey
------------------------------------------------------------------------
SNF & NF......................................         $168       $2,072
Hospitals.....................................          168        2,554
HHA...........................................          168        1,613
Hospice.......................................          168        1,736
ASC...........................................          168        1,669
RHC...........................................          168          851
ESRD..........................................          168        1,490
------------------------------------------------------------------------

Costs for All Revisit User Fees Assessed
    We anticipated that the combined costs for all providers and 
suppliers for all revisit surveys in FY 2007 would total approximately 
$37.3 million on an annual basis, with onsite revisit surveys amounting 
to approximately $34.6 million and offsite revisit surveys totaling 
approximately $2.7 million (72 FR 53645). However, actual fees assessed 
in FY 2007 were much less than this annual amount, since CMS did not 
charge for revisits that occurred prior to publication of the final 
regulation. Since we continue to operate under these same annual 
estimates, we provide here estimates of the impact for the period of 
the current continuing resolution as listed below in monthly estimates 
in Tables B and C. For the period of the current continuing resolution, 
we will use the FY 2007 fee schedule established in the final rule for 
the assessment of fees until a new fee schedule notice is proposed and 
published as final.
    In Table B below, we provide the projected costs for the period of 
this continuing resolution based on the fee schedule of the final rule. 
We expect the combined costs for all providers and suppliers for all 
onsite revisit surveys for the period of this continuing resolution to 
total approximately $4.3 million. We first multiplied the total number 
of onsite revisit surveys in one year by the expected revisit user fees 
assessed per revisits as finalized in Table A above, estimated by 
provider or supplier, to obtain the annual cost of revisit surveys. We 
then divided this number by 12 to obtain the monthly cost of onsite 
revisit surveys and multiplied by the effective period of the 
continuing resolution (roughly 1.5 months) to obtain the total costs 
for onsite revisit surveys for the period of the continuing resolution. 
We then totaled all providers and suppliers to achieve the total costs 
for all onsite revisit surveys for the period of this continuing 
resolution.

[[Page 61544]]



                            Table B.--Onsite Revisit Surveys--Estimated Monthly Costs
----------------------------------------------------------------------------------------------------------------
                                                                                                    Total costs
                                                  Monthly number   Fee assessed    Monthly costs    for onsite
                                                     of onsite      per onsite      for onsite        revisit
                    Facility                          revisit         revisit         revisit       surveys for
                                                      surveys     surveys (hrs x     surveys*      period of CR
                                                                       $112)                            **
----------------------------------------------------------------------------------------------------------------
SNF & NF........................................           1,191          $2,072      $2,467,061      $3,700,592
Hospitals.......................................              48           2,554         122,379         183,569
HHA.............................................              89           1,613         143,557         215,336
Hospice.........................................              21           1,736          37,035          55,552
ASC.............................................               8           1,669          13,213          19,819
RHC.............................................              12             851          10,567          15,850
ESRD............................................              58           1,490          86,668         130,003
                                                 ---------------------------------------------------------------
    Total.......................................           1,427  ..............       2,880,480      4,320,721
----------------------------------------------------------------------------------------------------------------
* Monthly costs may differ from the multiple of monthly revisits and fee per revisit due to rounding.
** Monthly costs were multiplied by the effective period of the CR (roughly 1.5 months) Total numbers of onsite
  revisit surveys were rounded up based on FY 2006 actual data presented in the final rule.

    We expect the combined costs for all providers and suppliers for 
all offsite revisit surveys to total $343,875 for the period of the 
current continuing resolution. In Table C below, we first estimated by 
provider or supplier the number of offsite revisit surveys expected for 
an entire fiscal year, and multiplied this number by the expected 
revisit user fee of $168 per offsite revisit survey to obtain the 
annual cost of surveys. We then divided this number by 12 to obtain the 
monthly cost of offsite revisit surveys and multiplied this number by 
the effective period of the continuing resolution (roughly 1.5 months) 
to obtain the total costs for offsite revisit surveys for the period of 
the continuing resolution.

                           Table C.--Offsite Revisit Surveys--Estimated Monthly Costs
----------------------------------------------------------------------------------------------------------------
                                                                                                    Total costs
                                                  Monthly number   Fee assessed    Monthly costs    for offsite
                                                    of offsite      per offsite     for offsite       revisit
                    Facility                          revisit     revisit survey      revisit       surveys for
                                                      surveys       ($112 x 1.5      surveys*      period of CR
                                                                       hrs)                             **
----------------------------------------------------------------------------------------------------------------
SNF & NF........................................           1,262            $168        $211,932        $317,898
Hospitals.......................................              23             168           3,892           5,838
HHA.............................................              43             168           7,238          10,857
Hospice.........................................               4             168             714           1,071
ASC.............................................               8             168           1,302           1,953
RHC.............................................               6             168             938           1,407
ESRD............................................              19             168           3,234           4,851
 
    Total.......................................           1,365  ..............         229,250        343,875
----------------------------------------------------------------------------------------------------------------
* Monthly costs may differ from the multiple of monthly revisits and fee per revisit due to rounding.
** Monthly costs were multiplied by the effective period of the CR (roughly 1.5 months).

    As shown in Table D below, we provide the aggregate costs expected 
as projected for the entire FY 2007, as well as the costs we would 
expect to offset for the period of the current continuing resolution.

 Table D.--Total Costs Combined for All Revisits Surveys per Fiscal Year
                             & Period of CR
------------------------------------------------------------------------
                                              FY 2007     Period of CR *
------------------------------------------------------------------------
Onsite Revisit Surveys..................     $34,565,760      $4,320,512
Offsite Revisit Surveys.................       2,751,000         343,980
                                         -------------------------------
    Total Costs All Revisits............      37,316,760       4,664,492
------------------------------------------------------------------------
* CR period's costs are based on CR period revisit surveys rounded up to
  the nearest whole number as shown in Table B & C.

C. Alternatives Considered

    CMS considered a number of alternatives to the Revisit User Fee. 
Such alternatives were discussed in the final rule published on 
September 19, 2007 (72 FR 53647). We affirm the continuing validity of 
that analysis. The current continuing resolution provides CMS with the 
authority to continue projects or activities as was otherwise provided 
for in FY 2007, and as such CMS is required to publish an interim final 
rule with comment. This interim final rule with comment merely updates 
the Congressional authority under which the rule operates.
    In accordance with Executive Order 12866, this rule has been 
reviewed by the Office of Management and Budget.

List of Subjects in 42 CFR Part 488

    Administrative practice and procedure, Health facilities, Medicare, 
Reporting and recording requirements.


[[Page 61545]]



0
For the reasons set forth in the preamble, the Centers for Medicare & 
Medicaid Services amends 42 CFR chapter IV, part 488 as set forth 
below:

PART 488--SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES

0
1. The authority citation for part 488 is revised to read as follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act, 
unless otherwise noted (42 U.S.C. 1302 and 1395(hh)); Pub. L. 110-
92, H. J. Res. 52 Sec. Sec.  101 & 106 (2007).

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program)

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: October 11, 2007.
Kerry Weems,
Acting Administrator, Centers for Medicare & Medicaid Services.
    Approved: October 25, 2007.
Michael O. Leavitt,
Secretary.
[FR Doc. 07-5400 Filed 10-26-07; 12:02 pm]
BILLING CODE 4120-01-P