[Federal Register Volume 82, Number 133 (Thursday, July 13, 2017)]
[Rules and Regulations]
[Pages 32256-32260]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-14646]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 405, 409, 431, 447, 482, 483, 485, 488, and 489

[CMS-3260-F2]
RIN-0938-AR61


Medicare and Medicaid Programs; Reform of Requirements for Long-
Term Care Facilities

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

[[Page 32257]]


ACTION: Final rule; correction and correcting amendment.

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SUMMARY: In the October 4, 2016 issue of the Federal Register, we 
published a final rule revising the requirements that Long-Term Care 
(LTC) facilities must meet to participate in the Medicare and Medicaid 
programs. The effective date was November 28, 2016. This document 
corrects technical and typographical errors identified in the October 
4, 2016 final rule.

DATES: This document is effective July 13, 2017.

FOR FURTHER INFORMATION CONTACT: Ronisha Blackstone, (410) 786-6882.

SUPPLEMENTARY INFORMATION: 

I. Background

    In FR Doc. 2016-23503 which appeared in the October 4, 2016 Federal 
Register (81 FR 68688), entitled ``Reform of Requirements for Long-Term 
Care Facilities,'' there were technical and typographical errors that 
are identified and corrected in the Implementation Timeframe table of 
the preamble and in the regulations text of this document.

II. Summary of Errors

A. Summary of Errors in the Preamble

    We inadvertently made technical and typographical errors in the 
preamble as follows:
    On page 68725, fourth full paragraph of the second column, we 
inadvertently referenced proposed Sec.  482.11 instead of proposed 
Sec.  483.11.
    On page 68729, second paragraph of the third column, we 
inadvertently referenced Sec.  482.15(a) instead of Sec.  483.15(a).
    On page 68736, second full paragraph of the second column, we 
inadvertently referenced Sec.  482.20(k)(4) instead of Sec.  
483.20(k)(4).
    Under the Implementation Timeframe table we made technical and 
typographical errors as follows:
    On page 68696, under Sec.  483.12, we inadvertently referenced the 
``Coordination with QAPI Plan'' instead of the ``Coordination with QAPI 
Program.'' We are correcting this error to clarify that the 
Coordination with QAPI Program will be implemented in Phase 3.
    On page 68697, we inadvertently designated existing requirements at 
Sec.  483.45(e)(1) and (2) to be implemented in the second phase of the 
implementation schedule. Requirements at Sec.  483.45(e)(1) and (2) are 
redesignations and do not reflect a change in policy. We indicated in 
the final rule (81 FR 68696) that the first phase of implementation 
will include those requirements that were unchanged or received only 
minor modification. Therefore, we are correcting the exceptions to the 
Phase 1 implementation deadlines to specify that the requirements at 
Sec.  483.45(e)(3), (4), and (5) Psychotropic drugs will be implemented 
in Phase 2.
    On page 68697, we inadvertently designated existing requirements at 
Sec.  483.75(g)(2)(i) and (ii) to be implemented in the third phase of 
the implementation schedule. Requirements at Sec.  483.75(g)(2)(i) and 
(ii) are redesignations and do not reflect a change in policy. We 
indicated in the final rule (81 FR 68696) that the first phase of 
implementation will include those requirements that were unchanged or 
received only minor modification. Therefore, we are correcting the 
exceptions to the Phase 3 implementation deadlines under ``Sec.  
483.75--Quality assurance and performance improvement'' by replacing 
the paragraph designation (g)(1) with (g), subparagraph designation 
(iv) with (g)(1)(iv), and clarifying that (g)(2)(iii) will also be 
implemented in Phase 3. Also, we are correcting the acronym ``ICPO'' to 
read ``IP.''

B. Summary of Errors in the Regulations Text

    On page 68847, we inadvertently omitted a conforming change to 
revise cross-references to part 483 found in part 409. Sections 409.20 
and 409.26 include incorrect cross-references to Sec.  483.75(n). We 
inadvertently did not update these cross-references. Therefore, we are 
revising Sec.  409.20 and Sec.  409.26 to correct the cross-reference 
by replacing Sec.  483.75(n) with Sec.  483.70(j).
    On page 68847, we made technical errors in the regulations text for 
Sec.  482.58. We inadvertently used the cross-references from the 
proposed rule ``Medicare and Medicaid Programs; Reform of Requirements 
for Long-Term Care Facilities'' (80 FR 42246) rather than the final 
rule. We are revising Sec.  482.58 to correct the cross-references. As 
we noted in the proposed rule, the revised citations correspond to 
cross-references previously set out at Sec.  482.58 and make no 
substantive policy changes.
    On page 68848, we made technical errors in the regulations text of 
Sec.  483.5. We inadvertently omitted a conforming change to revise 
cross-references in the definitions of ``composite distinct part'' and 
``distinct part.'' We are revising the definition of ``composite 
distinct part'' and the definition for ``distinct part.'' We made no 
substantive changes.
    On page 68854, we inadvertently designated a cross-reference at 
Sec.  483.10(i)(4), and on pages 68856 and 68857, we inadvertently 
designated cross-references at Sec.  483.15(a) through (d).
    On page 68856, we made a technical error in the regulations text of 
Sec.  483.15(c)(2)(iii)(F). We inadvertently omitted the apostrophe 
from the word ``resident's.''
    On page 68863, we made a technical error in the amendatory 
instruction for Sec.  483.45. We set out the regulatory text for 
paragraph (c)(5) but inadvertently omitted the instruction to add 
paragraph (c)(5) as a new paragraph. We are revising Sec.  483.45 by 
adding an instruction to add paragraph (c)(5).
    On page 68863, we made a technical error in the regulations text of 
Sec.  483.50(a)(2)(iii). We inadvertently misspelled the word 
``assistance.''
    On page 68865, we made a technical error in the amendatory 
instruction for Sec.  483.70(i), in which we inadvertently omitted the 
instruction to revise the paragraph heading for paragraph (i). We are 
inserting this instruction in this final rule.
    On page 68868, we made a technical error in the regulations text 
for Sec.  483.75(g)(1)(iv). In the preamble of the final rule (81 FR 
68812), we indicated that in Sec.  483.80(b) we were changing our use 
of ``infection control and prevention officer (ICPO)'' to ``infection 
preventionist (IP).'' Section 483.75(g)(1)(iv) also uses the term 
``infection control and prevention officer.'' We are revising Sec.  
483.75(g)(1)(iv) by replacing the phrase ``infection control and 
prevention officer'' with ``infection preventionist.''
    On page 68869, we made a technical error in the regulations text 
for Sec.  483.85(b). We incorrectly indicated that the operating 
organization for each facility must have in operation a compliance and 
ethics program by November 28, 2017. In the final rule (81 FR 68697) we 
indicated that all the requirements in Sec.  483.85 would be 
implemented in Phase 3 (November 28, 2019). Therefore, we are revising 
paragraph Sec.  483.85(b) to accurately indicate that the operating 
organization for each facility must have in operation a compliance and 
ethics program by November 28, 2019 and removing the reference to 
November 28, 2017.
    On page 68870, we made technical errors in the regulations text for 
Sec.  483.90. We incorrectly designated paragraph Sec.  483.90(d) as 
(c), which resulted in the omission of existing requirements at Sec.  
483.90(c) in the Code of Federal Regulations (CFR). We are

[[Page 32258]]

revising Sec.  483.90 to correctly designate the paragraphs in this 
section and add the omitted requirements.
    On page 68871, we made a technical error in the amendatory 
instruction for Sec.  485.635. We incorrectly revised the cross-
reference to Sec.  483.25(i) in Sec.  485.635(a)(3)(vii). We are 
revising Sec.  485.635 to correct the cross-reference by replacing the 
reference to ``Sec.  483.25(d)(8)'' with ``Sec.  483.25(g.)''
    On page 68871, we made technical errors in the regulations text for 
Sec.  485.645. We inadvertently used the cross-references from the 
proposed rule ``Medicare and Medicaid Programs; Reform of Requirements 
for Long-Term Care Facilities (80 FR 42269) rather than the final rule. 
We are revising Sec.  485.645 to correct the cross-references. As we 
noted in the proposed rule, the revised citations correspond to cross-
references previously set out at Sec.  485.645 and make no substantive 
policy changes.
    On page 68871, we made a technical error in the regulations text 
for Sec.  488.56. Section 488.56(b) and (b)(2) include incorrect cross-
references to Sec.  488.75(i). We inadvertently did not update these 
cross-references. Therefore, we are revising Sec.  488.56 to correct 
the cross-reference by replacing Sec.  488.75(i) with Sec.  483.70(h).

III. Waiver of Proposed Rulemaking and Delay in Effective Date

    We ordinarily publish a notice of proposed rulemaking in the 
Federal Register to provide a period for public comment before the 
provisions of a rule take effect in accordance with section 553(b) of 
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we 
can waive this notice and comment procedure if the Secretary finds, for 
good cause, that the notice and comment process is impracticable, 
unnecessary, or contrary to the public interest, and incorporates a 
statement of the finding and the reasons therefore in the rule.
    Section 553(d) of the APA ordinarily requires a 30-day delay in 
effective date of final rules after the date of their publication in 
the Federal Register. This 30-day delay in effective date can be 
waived, however, if an agency finds for good cause that the delay is 
impracticable, unnecessary, or contrary to the public interest, and the 
agency incorporates a statement of the findings and its reasons in the 
rule issued.
    Our revisions to the requirements for Long-Term Care (LTC) 
facilities found in part 483 subpart B have previously been subjected 
to notice and comment procedures. These corrections are consistent with 
the discussion of the policy in the October 2016 final rule and do not 
make substantive changes to this policy. This correcting amendment 
merely corrects technical errors in the regulations text of the October 
2016 final rule and makes no substantive policy changes. As a result, 
this correcting amendment is intended to ensure that the October 2016 
final rule accurately reflects the policy adopted in the final rule. 
Therefore, we find that undertaking further notice and comment 
procedures to incorporate these corrections into the final rule is 
unnecessary and contrary to the public interest.
    For the same reasons, we are also waiving the 30-day delay in 
effective date for this correcting amendment. We believe that it is in 
the public interest to ensure that the October 2016 final rule 
accurately reflect our revisions to the requirements for LTC 
facilities. Delaying the effective date of these corrections would be 
contrary to the public interest. Therefore, we also find good cause to 
waive the 30-day delay in effective date.

IV. Correction of Errors in the Preamble

    a. On page 68725, in second column; in the fourth paragraph, line 
21 remove ``482.11'' and add in its place ``483.11''.
    b. On page 68729, in the third column; in the second paragraph, 
line 11 remove ``482.15(a)'' and add in its place ``483.15(a)''.
    c. On page 68736, in the second column; in the second paragraph, 
line 58 remove '' 482.20(k)(4)'' and add in its place ``483.20(k)(4)''.
    d. On page 68696, in the table under the ``Implementation 
deadline'' heading, second column, in the second bullet, after the word 
``QAPI,'' remove the word ``Plan'' and add ``Program'' in its place.
    e. On page 68697, in the table under the ``Implementation 
deadline'' heading, second column--
    1. In the sixth bullet, remove the phrase ``(e) Psychotropic 
drugs--Implemented in Phase 2'' and add ``(e)(3), (4), and (5) 
Psychotropic drugs--Implemented in Phase 2'' in its place.
    2. In the sixteenth bullet--
    A. Remove the reference to ``(g)(1)'' and add ``(g)'' in its place.
    B. Remove the phrase ``with the exception of subparagraph (iv), the 
addition of the ICPO, which will be implemented in Phase 3'' and add 
``with the exception of aragraphs (g)(1)(iv) (the addition of the IP) 
and (g)(2)(iii) (regarding the use of QAPI data), which will be 
implemented in Phase 3''.
    C. Remove the acronym ``ICPO'' and add ``IP'' in its place.

List of Subjects

42 CFR Part 409

    Health facilities, Medicare.

42 CFR Part 482

    Grant programs--health, Hospitals, Medicaid, Medicare, Reporting 
and recordkeeping requirements.

42 CFR Part 483

    Grant programs--health, Health facilities, Health professions, 
Health records, Medicaid, Medicare, Nursing homes, Nutrition, Reporting 
and recordkeeping requirements, Safety.

42 CFR Part 485

    Grant programs--health, Health facilities, Medicaid, Medicare, 
Privacy, Reporting and recordkeeping requirements.

42 CFR Part 488

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

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

PART 409--HOSPITAL INSURANCE BENEFITS

0
1. The authority citation for part 409 continues to read as follows:

    Authority:  Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh).

Sec.  409.20  [Amended]

0
 2. In Sec.  409.20, amend paragraph (a)(6) by removing the cross-
reference ``Sec.  483.75(n)'' and adding in its place ``Sec.  
483.70(j)''.


Sec.  409.26  [Amended]

0
3. In Sec.  409.26, amend paragraph (a)(1) by removing the cross-
reference ``Sec.  483.75(n)'' and adding in its place ``Sec.  
483.70(j)''.

PART 482--CONDITIONS OF PARTICIPATION FOR HOSPITALS

0
4. The authority citation for part 482 continues to read as follows:

     Authority:  Secs. 1102, 1871 and 1881 of the Social Security 
Act (42 U.S.C. 1302, 1395hh, and 1395rr), unless otherwise noted.


0
 5. In Sec.  482.58 revise paragraph (b) to read as follows:


Sec.  482.58  Special requirements for hospital providers of long-term 
care services (``swing-beds'')

* * * * *

[[Page 32259]]

    (b) Skilled nursing facility services. The facility is 
substantially in compliance with the following skilled nursing facility 
requirements contained in subpart B of part 483 of this chapter.
    (1) Resident rights (Sec.  483.10(b)(7), (c)(1), (c)(2)(iii), 
(c)(6), (d), (e)(2), (e)(4), (f)(4)(ii), (f)(4)(iii), (f)(9), (h), 
(g)(8), (g)(17), and (g)(18) introductory text.
    (2) Admission, transfer, and discharge rights (Sec.  483.5 
definition of transfer and discharge, Sec.  483.15(c)(1), (c)(2)(i), 
(c)(2)(ii), (c)(3), (c)(4), (c)(5), and (c)(7)).
    (3) Freedom from abuse, neglect, and exploitation (Sec.  
483.12(a)(1), (a)(2), (a)(3)(i), (a)(3)(ii), (a)(4), (b)(1), (b)(2), 
(c)).
    (4) Patient activities (Sec.  483.24(c)).
    (5) Social services (Sec.  483.40(d) and 483.70(p)).
    (6) Discharge planning (Sec.  483.20(e)).
    (7) Specialized rehabilitative services (Sec.  483.65).
    (8) Dental services (Sec.  483.55).

PART 483--REQUIREMENTS FOR STATES AND LONG TERM CARE FACILITIES

0
6. The authority citation for part 483 continues to read as follows:

     Authority:  Secs. 1102, 1128I and 1871 of the Social Security 
Act (42 U.S.C. 1302, 1320a-7j, 1395hh and 1396r).


0
7. In Sec.  483.5, amend the definition of ``Composite distinct part'' 
by revising paragraph (2) introductory text and amend the definition of 
``Distinct part'' by revising paragraph (1) to read as follows:


Sec.  483.5  Definitions.

* * * * *
    Composite distinct part--* * *
    (2) Requirements. In addition to meeting the requirements of 
specified in the definition of ``distinct part'' of this section, a 
composite distinct part must meet all of the following requirements:
* * * * *
    Distinct part--(1) Definition. A distinct part SNF or NF is 
physically distinguishable from the larger institution or institutional 
complex that houses it, meets the requirements of this paragraph and of 
paragraph (2) of this definition, and meets the applicable statutory 
requirements for SNFs or NFs in sections 1819 or 1919 of the Act, 
respectively. A distinct part SNF or NF may comprise one or more 
buildings or designated parts of buildings (that is, wings, wards, or 
floors) that are: In the same physical area immediately adjacent to the 
institution's main buildings; other areas and structures that are not 
strictly contiguous with the main buildings but are located within 
close proximity to the main buildings; and any other areas that CMS 
determines on an individual basis, to be part of the institution's 
campus. A distinct part must include all of the beds within the 
designated area, and cannot consist of a random collection of 
individual rooms or beds that are scattered throughout the physical 
plant. The term ``distinct part'' also includes a composite distinct 
part that meets the additional requirements specified in the definition 
of ``composite distinct part'' of this section.
* * * * *


Sec.  483.10  [Amended]

0
 8. In Sec.  483.10, amend paragraph (i)(4) by removing the reference 
``Sec.  483.90(d)(2)(iv)'' and adding in its place ``Sec.  
483.90(e)(2)(iv)''.


Sec.  483.15  [Amended]

0
 9. In Sec.  483.15--
0
a. Amend paragraph (a)(7) by removing the reference ``paragraph 
(b)(10)'' and adding in its place ``paragraph (c)(9)''.
0
b. Amend paragraph (b)(2) by removing the reference to ``Sec.  
483.10(g)(3)'' and adding in its place ``Sec.  483.10(g)(18)(i)''.
0
 c. Amend paragraph (c)(2)(ii)(B) by removing the reference ``paragraph 
(b)(1)(i)(C) or (D)'' and adding in its place ``paragraph (c)(1)(i)(C) 
or (D)''.
0
 d. Amend paragraph (c)(2)(iii)(F) by removing the word ``residents'' 
and adding in its place ``resident's''.
0
 e. Amend paragraph (c)(3)(iii) by removing the reference to 
``paragraph (b)(5)'' and adding in its place ``paragraph (c)(5)''.
0
 f. Amend paragraph (c)(4)(i) by removing the reference ``paragraphs 
(b)(4)(ii) and (b)(8)'' and adding in its place ``paragraphs (c)(4)(ii) 
and (8)''.
0
g. Amend paragraph (c)(4)(ii)(A) by removing the reference to 
``paragraph (b)(1)(ii)(C)'' and adding in its place ``paragraph 
(c)(1)(i)(C)''.
0
h. Amend paragraph (c)(4)(ii)(B) by removing the reference to 
``paragraph (b)(1)(ii)(D)'' and adding in its place ``paragraph 
(c)(1)(i)(D)''.
0
i. Amend paragraph (c)(4)(ii)(C) by removing the reference ``paragraph 
(b)(1)(ii)(B)'' and adding in its place ``paragraph (c)(1)(i)(B)''.
0
j. Amend paragraph (c)(4)(ii)(D) by removing the reference ``paragraph 
(b)(1)(ii)(A)'' and adding in its place ``paragraph (c)(1)(i)(A)''.
0
k. Amend paragraph (c)(5) introductory text by removing the reference 
``paragraph (b)(3)'' and adding in its place ``paragraph (c)(3)''.
0
l. Amend paragraph (d)(1)(iii) by removing the reference ``paragraph 
(c)(3)'' and adding in its place ``paragraph (e)(1)''.
0
m. Amend paragraph (d)(1)(iv) by removing the reference ``paragraph 
(c)(3)'' and adding in its place ``paragraph (e)(1)''.
0
n. Amend paragraph (d)(2) by removing the reference ``paragraph 
(c)(1)'' and adding in its place ``paragraph (d)(1)''.

0
10. In Sec.  483.45 add paragraph (c)(5) to read as follows:


Sec.  483.45  Pharmacy services.

* * * * *
    (c) * * *
    (5) The facility must develop and maintain policies and procedures 
for the monthly drug regimen review that include, but are not limited 
to, time frames for the different steps in the process and steps the 
pharmacist must take when he or she identifies an irregularity that 
requires urgent action to protect the resident.
* * * * *


Sec.  483.50  [Amended]

0
11. In Sec.  483.50, amend paragraph (a)(2)(iii) by removing the word 
``asistance'' and adding in its place ``assistance''.

0
12. In Sec.  483.70 revise the heading to paragraph (i) to read as 
follows:


Sec.  483.70  Administration.

* * * * *
    (i) Medical records. * * *
* * * * *


Sec.  483.75  [Amended]

0
13. In Sec.  483.75, amend paragraph (g)(1)(iv) by removing the phrase 
``infection control and prevention officer'' and adding in its place 
``infection preventionist''.

0
14. In Sec.  483.85 revise paragraph (b) to read as follows:


Sec.  483.85  Compliance and ethics program.

* * * * *
    (b) General rule. Beginning November 28, 2019, the operating 
organization for each facility must have in operation a compliance and 
ethics program (as defined in paragraph (a) of this section) that meets 
the requirements of this section.
* * * * *

0
15. In Sec.  483.90 revise paragraph (c) to read as follows:


Sec.  483.90  Physical environment.

* * * * *
    (c) Emergency power. (1) An emergency electrical power system must 
supply power adequate at least for lighting all entrances and exits;

[[Page 32260]]

equipment to maintain the fire detection, alarm, and extinguishing 
systems; and life support systems in the event the normal electrical 
supply is interrupted.
    (2) When life support systems are used, the facility must provide 
emergency electrical power with an emergency generator (as defined in 
NFPA 99, Health Care Facilities) that is located on the premises.
* * * * *

PART 485--CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS

0
16. The authority citation for part 485 continues to read as follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395(hh)).


Sec.  485.635  [Amended]

0
17. In Sec.  485.635, amend paragraph (a)(3)(vii) by removing the 
reference to ``Sec.  483.25(d)(8)'' and adding in its place ``Sec.  
483.25(g)''.

0
18. In Sec.  485.645--
0
a. Revise paragraph (d)(1).
0
b. Remove paragraph (d)(2).
0
c. Redesignate paragraphs (d)(3) through (10) as paragraphs (d)(2) 
through (9), respectively.
0
d. Revise newly redesignated paragraphs (d)(2) through (9).
    The revisions read as follows:


Sec.  485.645  Special requirements for CAH providers of long-term care 
services (``swing-beds'')

* * * * *
    (d) * * *
    (1) Resident rights (Sec.  483.10(b)(7), (c)(1), (c)(2)(iii), 
(c)(6), (d), (e)(2), (e)(4), (f)(4)(ii), (f)(4)(iii), (f)(9), (g)(8), 
(g)(17), (g)(18) introductory text, (h) of this chapter).
    (2) Admission, transfer, and discharge rights (Sec.  483.5 
definition of transfer & discharge, Sec.  483.15(c)(1), (c)(2), (c)(3), 
(c)(4), (c)(5), (c)(7), (c)(8), and (c)(9) of this chapter).
    (3) Freedom from abuse, neglect and exploitation (Sec.  
483.12(a)(1), (a)(2), (a)(3)(i), (a)(3)(ii), (a)(4), (b)(1), (b)(2), 
(c)(1), (c)(2), (c)(3), and (c)(4) of this chapter).
    (4) Patient activities (Sec.  483.24(c) of this chapter), except 
that the services may be directed either by a qualified professional 
meeting the requirements of Sec.  483.24(c)(2), or by an individual on 
the facility staff who is designated as the activities director and who 
serves in consultation with a therapeutic recreation specialist, 
occupational therapist, or other professional with experience or 
education in recreational therapy.
    (5) Social services (Sec.  483.40(d) and Sec.  483.70(p) of this 
chapter).
    (6) Comprehensive assessment, comprehensive care plan, and 
discharge planning (Sec.  483.20(b), and Sec.  483.21(b) and (c)(2) of 
this chapter), except that the CAH is not required to use the resident 
assessment instrument (RAI) specified by the State that is required 
under Sec.  483.20(b), or to comply with the requirements for 
frequency, scope, and number of assessments prescribed in Sec.  
413.343(b) of this chapter).
    (7) Specialized rehabilitative services (Sec.  483.65 of this 
chapter).
    (8) Dental services (Sec.  483.55 of this chapter).
    (9) Nutrition (Sec.  483.25(g)(1) and (g)(2) of this chapter).

PART 488--SURVEY, CERTIFICATION, AND ENFORCEMENT PROCEDURES

0
19. The authority citation for part 488 continues to read as follows:

    Authority:  Secs. 1102, 1128l, 1864, 1865, 1871 and 1875 of the 
Social Security Act, unless otherwise noted (42 U.S.C 1302, 1320a-
7j, 1395aa, 1395bb, 1395hh) and 1395ll.


Sec.  488.56  [Amended]

0
20. In Sec.  488.56 amend paragraphs (b) introductory text and (b)(2) 
by removing the reference ``Sec.  488.75(i)'' and adding in its place 
``Sec.  483.70(h)''.

    Dated: June 30, 2017.
Thomas E. Price
Secretary, Department of Health and Human Services.
[FR Doc. 2017-14646 Filed 7-12-17; 8:45 am]
 BILLING CODE 4120-01-P