Safety Act of 2005 (the Act), among Secretary for Communications and Information,
other things, authorized NTIA to create Before the Committee on Commerce, Science and
a Digital-to-Analog Converter Box Transportation, United States Senate (Oct. 17, 2007)
Coupon Program (Coupon Program) to (recognizing seniors as a targeted group that
depends on over-the-air television to a greater
assist consumers who wish to continue extent than the general population), available at
receiving broadcast programming over http://www.ntia.doc.gov/ntiahome/congress/2007/
the air using analog-only televisions not KneuerlSenateCommercel101707.htm.
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Federal Register / Vol. 73, No. 80 / Thursday, April 24, 2008 / Proposed Rules 22121
circumstances. However, NTIA must be Home). NTIA seeks comments on how to eligible households. Specifically,
assured that coupons are distributed to it should define eligible nursing homes NTIA proposes to permit coupon
verifiable residents of these facilities for the purpose of the proposed waiver. applications to be submitted by, or on
and that the Coupon Program is There are databases available to assist behalf of, a resident of an Eligible
administered effectively within the NTIA in identifying Eligible Nursing Nursing Home using any of the
existing resources Congress has made Homes. For example, the U.S. following three methods, provided that
available and in a manner that Department of Health and Human only one application may be submitted
minimizes waste, fraud and abuse. Services (HHS) Center for Medicare and for any individual:
NTIA requests comments on its Medicaid Services (CMS) determines a 1. Individual: An individual residing
proposal to waive its eligibility nursing facility’s eligibility to in an Eligible Nursing Home (Nursing
requirements for nursing home participate in the Medicare program Home Resident) may apply for one (1)
residents. based on a state’s certification of coupon on his own behalf. In such
The addition of nursing home compliance and a facility’s compliance circumstances, the coupon applicant
residents to the program presents with civil rights requirements.4 CMS would be required to include: (i) his or
particular administrative challenges. maintains an Online Survey, her name, date of birth, and Social
NTIA is concerned about whether Certification and Reporting (OSCAR), in Security Number (SSN); (ii) the name
information is readily available that cooperation with the state long-term and address of the Eligible Nursing
would allow the agency to confirm that care surveying agencies.5 NTIA Home; and (iii) a certification from the
the individual making the coupon proposes to use a facility’s inclusion in Nursing Home Resident as to whether
request (or on whose behalf the request the CMS OSCAR database as a baseline he or she receives television exclusively
is made) actually resides in a nursing criterion to establish the eligibility of a over the air or through cable, satellite or
home. NTIA seeks comments on ways to facility for the waiver proposed here. other pay television service. In
address these and other administrative However, NTIA recognizes that not all accordance with the Privacy Act of
challenges. nursing homes in the United States are 1974, disclosure of an individual’s SSN
In addition, information the agency included within the OSCAR database. for purposes of this waiver process is
has gathered from organizations Accordingly, NTIA solicits comments voluntary; however additional
representing both residents and on ways to ensure that all appropriate information to verify the resident’s
operators of senior care facilities facilities not otherwise in the OSCAR identity will be solicited if the
indicates that the majority of residents database are identified and included in individual chooses not to disclose the
of such facilities face cognitive, our waiver standards. To that extent, SSN.6 Such additional process may
mobility, and economic barriers to NTIA requests that nursing home delay the resident’s receipt of a coupon.
requesting and using coupons. Many associations, state certifying agencies, 2. Person Designated to Act on a
nursing home residents would therefore and other senior care groups provide as Nursing Home Resident’s Behalf:
likely require the assistance of another much information as possible to enable Alternately, a person designated to act
person to order a coupon, purchase the NTIA to ensure that the Program reaches on behalf of a Nursing Home Resident
box for them using the coupon, and nursing homes with residents that may request one (1) coupon for that
install the converter box. NTIA seeks would benefit from the Coupon resident. In that case, the coupon
comment on how best to address the Program. NTIA also seeks information application would be required to
role of such assistive personnel in our on the number of nursing home include all of the information specified
waiver process while still protecting residents that would actually need in Option 1 above, and, in addition, the
against the potential increased risk of coupons to purchase converter boxes in person requesting the coupon on the
waste, fraud, or abuse. order to continue receiving broadcast Nursing Home Resident’s behalf must
programming over the air using analog- supply: (i) his own name, address,
A. Identification of Nursing Homes or
only televisions not connected to cable, Social Security Number, and date of
Other Senior Care Facilities
satellite, or other pay television service, birth; and (ii) evidence that he is
In order to plan and administer the empowered to act on the behalf of the
and the impact on the cost of
Coupon Program effectively and resident (e.g., power of attorney or birth
administering the program.
efficiently, NTIA must be able to certificate indicating familial
determine how many additional coupon B. Administration of Coupon Program relationship).
requests will be added by operation of for Nursing Home Residents 3. An Administrator of a Nursing
the proposed waiver. Moreover, NTIA To mitigate risks associated with the Home or Other Senior Care Facility:
must be able to ensure to the extent lack of readily available information to Finally, provided that an application
possible that such requests are being authenticate requests from or on behalf has not already been submitted under
made by or on behalf of, and coupons of nursing home residents, NTIA either of the foregoing options, an
are being issued to, legitimately proposes an exception to our existing administrator of an Eligible Nursing
qualified individuals who need coupon eligibility and application Home may also request one (1) coupon
converter boxes. NTIA recognizes that requirements that would enable on behalf of a Nursing Home Resident
the terms ‘‘nursing home’’ and ‘‘senior residents of Eligible Nursing Homes to of his facility. As in Option 2, the
care facility’’ are somewhat generic. apply for and receive coupons subject to administrator would be required to
There are many facilities that care for certain additional information provide for each resident for whom the
elderly residents that may be considered requirements not otherwise applicable request is being made all of the
nursing homes in the general sense. information specified in Option 1 above.
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These include assisted living facilities, 4 See generally 42 CFR Part 403. In addition, the administrator would
continuing care retirement 5 OSCAR is a compilation of all the data elements
communities, and convalescent rest collected by surveyors during the inspection survey 6 The Privacy Act of 1974 provides that it ‘‘shall
homes. For these reasons, NTIA believes conducted at nursing facilities for the purpose of be unlawful for any Federal, State or local
certification for participation in the Medicare and government agency to deny to any individual any
it is necessary to define in some way the Medicaid programs. The institutional files are right, benefit, or privilege provided by law because
scope of facilities whose residents will available at http://www.cms.hhs.gov/HealthPlanRep of such individual’s refusal to disclose his social
qualify for the waiver (Eligible Nursing FileData/05lInst.asp. security number.’’ 5 U.S.C. 552a.
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22122 Federal Register / Vol. 73, No. 80 / Thursday, April 24, 2008 / Proposed Rules
also be required to provide: (i) the name this process may not be connected to program should, at a minimum, require
and address of the residents’ Eligible television sets owned by the nursing that application data be validated
Nursing Home; (ii) the administrator’s home or senior care facility. against other government or third-party
own name, Social Security Number, and The Coupon Program does not intend sources to determine whether an
date of birth; and (iii) a copy of each to reimburse individuals, family applicant has provided accurate
facility’s operating license indicating members, nursing home administrators information on their identity and place
the administrator’s authorization to or others who may be designated to act of residence.8 Specifically, GAO
administer the Eligible Nursing Home. on behalf of residents for any costs these recommended that applicants should be
NTIA intends to audit periodically the individuals may incur in obtaining required to provide their actual
use of coupons obtained through any of coupons or providing other assistance address.9
these methods to ensure that the coupon related to obtaining and installing Accordingly, the current Coupon
was used to provide a converter box for converter boxes. Program regulations require applicants
the resident’s personal use. Due to the NTIA proposes that all other to provide a United States Postal Service
potentially high risk of fraud and lack provisions of the Coupon Program rules mailing address in all but a few
of other identifying information for would apply to Nursing Home instances, such as applicants residing
individuals in this population, NTIA Residents. on Indian reservations, Alaskan Native
proposes to collect the Social Security Villages, and other rural areas to which
Numbers and dates of birth from II. Applicants Utilizing Post Office the U.S. Postal Service does not deliver
nursing home residents and their Boxes for Mail Receipt to residential addresses. Consistent with
representatives. This information As noted above, since NTIA began GAO’s recommendation, the Coupon
provides a unique identifier for each accepting applications for coupons on Program regulations make it clear that
resident. NTIA will only use the Social January 1, 2008, it has received and these applicants may be required to
Security Number for identification, denied applications from a number of provide additional proof of their
verification and tracking purposes for consumers that utilize a post office box physical residence. Moreover, as GAO
the Coupon Program. This information for mail receipt. NTIA has become recommended, the address of each
will be collected and maintained in a aware through the appeals process, applicant is checked by NTIA’s
manner meeting the highest level of however, that many applicants have contractor against a third-party database
security required for personally sound reasons for utilizing a post office to assist in validating eligibility.
identifiable information. The box for mail receipt. For example, a NTIA now proposes to amend section
information collected will be limited to number of consumers appealing denials 301.3(a) of its regulations to permit a
that which is necessary to identify the expressed concerns about the risk of household utilizing a post office box for
individual, and, if necessary, conduct identity theft as a result of stolen mail mail receipt to become eligible to apply
an audit of the Coupon Program or the received via home delivery as the reason for and receive coupons if it can provide
nursing home facility. Similar that they receive mail utilizing a post proof of physical residence as proof of
information is routinely collected from office box. As a consequence, NTIA the application process. NTIA believes
families and legal designees conducting believes it is appropriate to revisit our that requiring proof of physical
business for individuals in senior care regulations concerning the treatment of residence will balance the need for
facilities. applications using post office boxes. preventive controls to protect the
NTIA requests comments on other In developing the Coupon Program Program from waste, fraud, and abuse
methods or information that the agency regulations, NTIA carefully considered with the goal of the Program to provide
can use to verify the legitimacy of mechanisms to deter waste, fraud, and assistance to those consumers that will
requests made by or on behalf of abuse in the Program. In a number of need a converter box to continue
Nursing Home Residents. NTIA also receiving broadcast programming over
studies of government benefit programs,
seeks comments on methods to track the air using analog-only televisions.
most recently in its examination of
and prevent duplicate requests and Specifically, NTIA proposes that an
fraud associated with Hurricane Katrina
identify patterns of fraudulent behavior. applicant that utilizes a post office box
and Rita disaster benefits distributed by
for mail receipt must provide one or
C. Applicability of Other Provisions of the Federal Emergency Management
more of the following documents to
the Coupon Program Rule Agency (FEMA), the Government
satisfy the requirement for proof of
Consistent with section 301.4(d) of Accountability Office (GAO) noted that
physical residence: a valid driver’s
the Coupon Program regulations, NTIA preventive controls are the most
license containing the applicant’s
proposes to send coupons to Nursing effective and efficient means to
physical address; a utility bill (water,
Home Residents via U.S. Postal Service minimize waste, fraud, and abuse.7
gas, electric, oil, cable, or landline
to the address of the Eligible Nursing GAO has specifically cited the misuse of telephone (i.e., not wireless or pager)
Home specified in the application. In post office boxes by applicants for bearing the applicant’s name and
the case of a request from an benefits and recommended that physical address and issued within the
administrator on behalf of a Nursing preventive controls in a benefits sixty (60) days immediately preceding
Home Resident, NTIA proposes to mail 7 Hurricanes Katrina and Rita Disaster Relief:
the date the coupon application is
the coupon directly to the requesting Improper Fraudulent Individual Assistance
administrator at the address provided Payments Estimated to be Between $600 Million 8 GAO 2007 Testimony, supra n. 3, at 4–5. See
for the facility in the application. and $1.4 Billion, Testimony, GAO–06–844T (GAO also Benefit Fraud with Post Office Boxes, Letter to
NTIA proposes that a coupon issued 2006 Testimony) (June 14, 2006); Hurricanes Representative Gallegly, GAO/HEHS–97–54R (Feb.
Katrina and Rita: Unprecedented Challenges 21, 1997).
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pursuant to this waiver process may Exposed the Individuals and Households Program 9 GAO stated ‘‘[w]hile not all payments made to
only be used to purchase a CECB to be to Fraud and Abuse; Actions Needed to Reduce post office boxes are improper or potentially
connected to a television set Such Programs in Future, Report to Congressional fraudulent, the number of potentially fraudulent
individually-owned by the Nursing Committees, GAO–06–1013 (Sept. 2006); payments could be substantially reduced if FEMA
Hurricanes Katrina and Rita Disaster Relief: put in place procedures to instruct disaster
Home Resident on whose behalf the Prevention is the Key to Minimizing Fraud, Waste, recipients to provide actual street addresses of
application was made. CECBs and Abuse in Recovery Efforts, Testimony, GAO– damaged property when claiming disaster
purchased with coupons issued under 07–418T (GAO 2007 Testimony) (Jan. 29, 2007). assistance.’’ GAO 2006 Testimony, supra n. 3, at 5.
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22124 Federal Register / Vol. 73, No. 80 / Thursday, April 24, 2008 / Proposed Rules
Executive Order 12630 in the Digital Television Transition and for a coupon on behalf of a resident.
Public Safety Act of 2005 (the Act).11 Although it would take an approximately 30
This rule does not contain policies Specifically, section 3005 of the Act directs minutes to submit the application on the
that have takings implications. NTIA to implement and administer a resident’s behalf, there is no indication that
Executive Order 13132 program through which eligible U.S. this time commitment would a significant
households may obtain a maximum of two
This rule does not contain policies economic impact to nursing care facilities or
coupons, $40 each, to be applied towards the
having federalism implications purchase of a digital-to-analog converter box. homes for the elderly that are considered
requiring preparation of Federalism C. Description and Estimate of the Number ‘‘small entities.’’
Impact Statement. of Small Entities to Which the Proposed The proposed rule provides two
Rules May Apply alternatives to minimize any economic
Authority: The RFA directs agencies to provide a impact on nursing care facilities or homes for
Title III of the Deficit Reduction Act description of and, where feasible, an the elderly. Nursing home residents may
estimate of the number of small entities that apply for coupons directly, thereby
of 2005, Pub. L. 109-171, 120 Stat. 4, 21
may be affected by the proposed rules.12 The eliminating any cost or time by the nursing
(Feb.8, 2005). RFA generally defines the term ‘‘small facility. Alternatively, the proposed rule
Dated: April 18, 2008. entity’’ to include ‘‘small business,’’ ‘‘small
permits a person other than a nursing home
Meredith Attwell Baker, organization,’’ or ‘‘small governmental
jurisdiction.’’13 According to the Small employee acting on behalf of the nursing
Acting Assistant Secretary for home resident to apply for the coupon. This
Communications and Information. Business Administration (SBA), Nursing Care
Facilities and Continuing Care Retirement option would also remove any cost or time
APPENDIX A Communities must have receipts of $12.5 on behalf of a nursing care facility or home
million or less in order to qualify as a small for the elderly.
INITIAL REGULATORY FLEXIBILITY business concern.14 SBA provided, however, It should be noted that an alternative
ANALYSIS that Homes for the Elderly and Other currently exists which permits seniors living
As required by the Regulatory Flexibility Residential Care Facilities must have receipts in nursing homes to obtain converter boxes
Act (RFA) of 1989, as amended, NTIA has of $6.5 million or less to qualify as a small as a result of the Coupon Program. Family
prepared an Initial Regulatory Flexibility business concern.15 NTIA does not have data members or friends of seniors living in
Analysis (IRFA) addressing the economic on the number of these facilities that would
impact on small entities that might result nursing homes may apply for coupons under
qualify as a small business concern. NTIA
from this Notice of Proposed Rulemaking the current regulations and use those
also does not have data on the number of
(NPRM). NTIA requests written public residents of these small businesses that coupons to purchase converter boxes for
comments on this IRFA. Comments must be would take advantage of the Coupon seniors living in nursing homes. Of course,
identified as responses to the IRFA and must Program. the regulations only permit households to
be filed by the deadlines for comments on the D. Description of Projected Reporting, apply for up to two coupons, and they will
Notice provided above. NTIA will consider Recordkeeping and Other Compliance not be permitted to apply for additional
all timely comments in drafting our final Requirements coupons beyond those permitted under the
Regulatory Flexibility Analysis and in There are no projected reporting, regulations. This alternative, while available
making its decision on a final rule. NTIA will recordkeeping or other compliance
send a copy of the Notice, including this to some, does not address those seniors living
requirements associated with this proposed in nursing homes that do not have family
IRFA, to the Chief Counsel for Advocacy of rule. Nursing facility administrators should
the Small Business Administration. members or friends willing or able to apply
be aware, however, that NTIA intends to
This analysis addresses six issues: (1) a for coupons.
audit periodically the use of coupons
description of the reasons why action by NTIA also considered other options to
obtained to ensure that the coupon was used
NTIA is being considered; (2) the proposed ensure that nursing home residents receive
to provide a converter box for the resident’s
rule’s objectives and legal basis; (3) a converter boxes. For example, NTIA
personal use.
description of and, where feasible, an considered purchasing the boxes directly and
estimate of the number and types of small E. Steps Taken to Minimize Significant
Economic Impact on Small Entities, and distributing them to nursing home residents.
entities affected by the proposed rule; (4) a
description of the projected reporting, record- Significant Alternatives Considered This option, however, would be
keeping and other compliance requirements The proposed rule has no significant administratively difficult to implement.
of the proposed rule, including an estimate economic impact on small entities. NTIA has also approached industry regarding
of the classes of small entities which will be Participation in this program is voluntary, providing assistance to vulnerable groups
subject to the requirement; and (5) the thus any economic impact would not be that may need converter boxes. NTIA will
relevant rules that could duplicate, overlap, caused by the proposed rule as small entities
continue reaching out to industry in this
or conflict with the proposed rule. The are not required to participate in the
program. NTIA also notes that this program regard; however, this approach does not
following sections provide details on each of provide certainty that seniors living in
these issues. may not be attractive to many nursing care
facilities or homes for the elderly, small or nursing homes will receive converter boxes
A. Need for, Objectives of, the Proposed
Rule otherwise, because residents may receive prior to the transition.
This proposed waiver to NTIA’s TV television service through one of the F. Federal Rules That May Duplicate,
Converter Box Coupon Programregulations multichannel video programming Overlap, or Conflict With the Proposed Rules
will permit individuals residing in nursing distributors, such as cable or satellite service. NTIA is not aware of any federal rules that
homes to be eligible to receive coupons for In fact, nursing care facilities or homes for may duplicate, overlap or conflict with the
the purchase of digital-to-analog converter the elderly are only implicated in this proposed rule.
boxes. The proposed rule also permits program if an administrator chooses to apply The preceding analysis indicates that the
households utilizing a post office box for expected burden on small entities to
mail receipt to provide proof of physical 11 Title III of Pub. L. No. 109–171, 120 Stat. 4, 21
implement the proposed rule would be
residence, so that they can become eligible to (2006).
minimal.
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