[Federal Register Volume 61, Number 245 (Thursday, December 19, 1996)]
[Rules and Regulations]
[Pages 66919-66923]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 96-32094]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
42 CFR Parts 412, 413, and 489
[BPD-847-FCN]
RIN 0938-AH34
Medicare Program; Changes to the Hospital Inpatient Prospective
Payment Systems and Fiscal Year 1997 Rates; Corrections
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Final rule; correction.
-----------------------------------------------------------------------
SUMMARY: In the August 30, 1996 issue of the Federal Register (61 FR
46166), we published a final rule revising the Medicare hospital
inpatient prospective payment systems for operating costs and capital-
related costs to implement necessary changes arising from our
continuing experience with the system. In the addendum to that final
rule, we announced the amounts and factors for determining prospective
payment rates for Medicare hospital inpatient services for operating
costs and capital-related costs applicable to discharges occurring on
or after October 1, 1996, and set forth rate-of-increase limits for
hospitals and hospital units excluded from the prospective payment
systems. This document corrects errors made in that document.
EFFECTIVE DATE: October 1, 1996.
FOR FURTHER INFORMATION CONTACT: Stephen Phillips, (410) 786-4548.
SUPPLEMENTARY INFORMATION: In publishing Table 3C of the Addendum to
the August 30, 1996 final rule (61 FR 46166), we inadvertently failed
to incorporate a number of wage data revisions that had been
transmitted to the Hospital Cost Report Information System (HCRIS)
before mid-August 1996 as part of the process for verifying wage data.
This document corrects the published average hourly wages for affected
hospitals. Also, in the final rule, we indicated that if a hospital
believes its wage index value was incorrect as a result of an
intermediary or HCFA error that the hospital could not have known about
before reviewing data made available in mid-August, the hospital must
notify the intermediary and HCFA in writing, to be received no later
than September 16, 1996 (see 61 FR 46179). As a result of this process,
we have corrected the wage data for seven hospitals. Accordingly, the
wage index values for several areas have changed and are corrected in
this document.
The August 30, 1996 final rule also contained other technical and
typographical errors. Therefore, we are making the following
corrections to the final rule:
[[Page 66920]]
1. On page 46236, third column, last paragraph, the date
``October 1, 1994'' is corrected to read ``October 1, 1993''.
2. On page 46240, the title ``Table 3C--Hospital Case Mix
Indexes for Discharges Occurring in Federal Fiscal Year 1995'' is
corrected to read ``Table 3C--Hospital Case Mix Indexes for
Discharges Occurring in Federal Fiscal Year 1995 and Hospital
Average Hourly Wages for Federal Fiscal Year 1997 Wage Index''.
3. On pages 46240 through 46255, in Table 3C the column heading
``Avg. hour wage'' is corrected to read ``Avg. hourly wage''.
4. On pages 46240 through 46255, in Table 3C the average hourly
wage for specified providers is corrected to read as follows:
------------------------------------------------------------------------
Corrected avg.
Provider Case mix index Avg. hourly wage hourly wage
------------------------------------------------------------------------
050021........... 01.4226 23.40 23.75
050080........... 01.2370 16.56 22.05
050093........... 01.5911 22.35 22.40
050136........... 01.3787 21.89 22.75
050263........... 01.2879 24.44 24.24
050469........... 01.0927 17.33 17.36
050591........... 01.2961 22.97 27.01
050630........... 01.3492 21.26 22.00
050701........... 01.3067 27.13 27.42
060042........... 01.0563 15.65 18.09
060057........... 01.0526 21.45 21.11
100049........... 01.3205 18.04 18.04
100092........... 01.4493 16.91 16.20
100129........... 01.2547 17.45 17.49
100179........... 01.6547 19.03 18.61
100183........... 01.3672 19.33 19.24
100209........... 01.6581 22.39 .................
100255........... 01.3326 19.11 19.00
110036........... 01.6813 ................ 22.81
110183........... 01.3677 17.07 19.70
140024........... 01.0188 13.59 13.73
140082........... 01.5017 22.10 21.20
140252........... 01.4282 21.53 21.25
140253........... 01.4398 ................ 16.57
150038........... 01.2712 16.65 16.27
150066........... 01.0006 12.89 13.75
150114........... 01.0253 13.44 13.37
160080........... 01.2094 15.46 15.50
160082........... 01.7526 17.09 17.17
160093........... 01.1433 15.20 13.86
160098........... 01.0813 13.90 13.78
170004........... 01.0839 13.18 12.65
170017........... 01.1668 16.76 15.46
170024........... 01.1563 12.71 12.32
170108........... 01.9468 10.88 10.46
170109........... 01.0494 14.67 14.50
170124........... 01.9495 12.10 11.92
170144........... 01.6225 18.74 15.14
180001........... 01.2298 16.16 16.24
180015........... 01.2422 14.91 15.01
180018........... 01.2225 15.73 14.16
180058........... 01.0125 12.85 12.59
190001........... 00.9354 16.67 16.35
190006........... 01.2839 14.07 14.50
190010........... 01.1104 15.31 14.69
190011........... 01.1162 14.08 14.05
190029........... 01.1364 14.09 13.50
190036........... 01.6581 21.15 19.08
190046........... 01.4846 16.87 17.16
190079........... 01.2606 13.61 14.76
190081........... 00.8818 9.70 9.89
190122........... 01.2732 12.96 13.85
190183........... 01.1310 13.81 13.43
190197........... 01.2631 19.05 18.80
190208........... 00.8210 10.20 10.36
220046........... 01.3991 21.48 21.50
230015........... 01.1305 18.28 19.53
230106........... 01.1730 18.07 18.31
230230........... 01.5400 20.38 20.45
260042........... 01.4179 15.65 15.82
260062........... 01.1677 19.89 17.72
260066........... 01.0907 12.78 13.19
260074........... 01.2444 11.49 14.81
260085........... 01.5653 18.92 18.57
260105........... 01.8722 19.18 19.47
260123........... 01.0309 11.17 11.56
270011........... 01.1240 16.46 16.06
270028........... 01.0735 14.91 15.41
270040........... 01.0819 17.60 16.77
270049........... 01.8369 18.19 18.17
280030........... 01.7482 23.06 23.13
310005........... 01.2257 19.20 19.96
310006........... 01.2209 19.02 20.36
310010........... 01.2966 21.05 21.06
310019........... 01.6444 20.84 21.05
310038........... 01.9189 22.82 23.48
310070........... 01.3980 22.16 22.21
310075........... 01.2933 21.67 21.71
310076........... 01.3854 28.16 28.51
310084........... 01.2622 20.43 20.61
310090........... 01.1884 22.86 22.97
310108........... 01.3940 21.08 21.14
310111........... 01.2536 19.70 19.78
310115........... 01.1954 19.78 20.03
330006........... 01.3128 24.11 24.15
330080........... 01.4167 24.95 24.92
330127........... 01.3974 25.01 25.99
330128........... 01.3390 25.26 25.74
330136........... 01.2620 20.45 20.56
330195........... 01.6272 29.02 28.90
330196........... 01.3367 25.53 25.57
330199........... 01.4635 24.80 24.33
330202........... 01.4872 25.07 26.80
330204........... 01.4236 24.90 25.19
330209........... 01.1871 21.17 21.15
330222........... 01.2611 15.28 16.35
330231........... 01.1364 27.57 27.55
330234........... 02.1947 24.17 28.46
330240........... 01.3472 26.47 25.60
330385........... 01.1735 29.27 29.06
330396........... 01.2740 25.30 26.13
340047........... 01.9028 17.98 18.09
350011........... 01.9090 17.37 17.35
360147........... 01.2662 ................ 15.55
360176........... 01.1811 15.62 15.53
370011........... 01.0616 12.47 12.51
370012........... 00.8457 10.05 9.22
370042........... 00.8626 11.22 10.56
370048........... 01.1790 13.46 13.39
370049........... 01.3544 16.07 15.77
370083........... 00.9505 10.95 10.91
370084........... 01.0351 8.88 8.95
390012........... 01.1943 19.15 19.13
400031........... 01.1362 8.00 8.10
400048........... 01.1349 7.30 7.35
400061........... 01.6729 11.80 12.62
400087........... 01.3682 7.87 8.18
400110........... 01.1163 7.65 7.69
400112........... 01.2541 6.01 6.52
410007........... 01.6598 20.37 20.96
420018........... 01.7297 18.63 18.94
420049........... 01.1758 14.55 14.60
430004........... 01.0941 17.25 16.64
430009........... 01.0881 11.86 12.21
450450........... 01.0892 16.43 .................
450758........... 01.2161 13.21 .................
------------------------------------------------------------------------
5. On pages 46256 through 46261, in Table 4A--Wage Index and
Capital Geographic Adjustment Factor (GAF) for Urban Areas, the wage
index values and the GAFs for specified areas are corrected to read as
follows:
----------------------------------------------------------------------------------------------------------------
Corrected Corrected
Urban area Wage index GAF wage index GAF
----------------------------------------------------------------------------------------------------------------
1640...................... *Cincinnati, OH-KY-IN............... 0.9568 0.9702 0.9570 0.9704
2840...................... Fresno, CA.......................... 1.1177 1.0792 1.1183 1.0796
3120...................... *Greensboro-Winston-Salem-High 0.9314 0.9525 0.9332 0.9538
Point, NC.
6580...................... Punta Gorda, FL..................... 0.8353 0.8841 0.8796 0.9159
7320...................... *San Diego, CA...................... 1.2154 1.1429 1.2156 1.1430
7500...................... Santa Rosa, CA...................... 1.2487 1.1643 1.2526 1.1668
----------------------------------------------------------------------------------------------------------------
6. On page 46260, in Table 4A--Wage Index and Capital Geographic
Adjustment Factor (GAF) for Urban Areas, the third set of columns,
first column, the tenth Metropolitan Statistical Area(MSA),
``Providence-Warwick-Pawtucket, RI'' is corrected to read
``*Providence-Warwick-Pawtucket, RI''.
7. On page 46261, in Table 4A--Wage Index and Capital Geographic
Adjustment Factor (GAF) for Urban Areas, the second set of columns,
first column, tenth line, the county ``Andrews, MO'' is corrected to
read ``Andrew, MO''.
8. On page 46262, in Table 4B--Wage Index and Capital Geographic
Adjustment Factor (GAF) for Rural Areas, the wage index value and the
GAF for Iowa are corrected to read as follows:
[[Page 66921]]
----------------------------------------------------------------------------------------------------------------
Corrected Corrected
Nonurban area Wage index GAF wage index GAF
----------------------------------------------------------------------------------------------------------------
Iowa............................................................ 0.7366 0.8111 0.7373 0.8116
----------------------------------------------------------------------------------------------------------------
9. On page 46263, in Table 4C--Wage Index and Capital Geographic
Adjustment Factor (GAF) for Hospitals That Are Reclassified, the wage
index values and the GAFs for Specified areas are corrected to read as
follows:
----------------------------------------------------------------------------------------------------------------
Corrected Corrected
Area reclassified to Wage index GAF wage index GAF
----------------------------------------------------------------------------------------------------------------
Cincinnati, OH-KY-IN............................................ 0.9568 0.9702 0.9570 0.9704
Greensboro-Winston-Salem-High Point, NC......................... 0.9314 0.9525 0.9332 0.9538
San Diego, CA................................................... 1.2154 1.1429 1.2156 1.1430
Santa Rosa, CA.................................................. 1.2363 1.1563 1.2399 1.1586
----------------------------------------------------------------------------------------------------------------
10. On pages 46264 through 46265, in Table 4D--Average Hourly Wage
for Urban Areas, the average hourly wage for specified areas is
corrected to read as follows:
--------------------------------------------------------------------------------------------------------------------------------------------------------
Corrected
Urban area Average hourly average hourly
wage wage
--------------------------------------------------------------------------------------------------------------------------------------------------------
1640................................. Cincinnati, OH-KY-IN............................................................. 18.7085 18.7122
2840................................. Fresno, CA....................................................................... 21.8549 21.8673
3120................................. Greensboro-Winston-Salem-High Point, NC.......................................... 18.2112 18.2468
6580................................. Punta Gorda, FL.................................................................. 16.3323 17.5952
--------------------------------------------------------------------------------------------------------------------------------------------------------
11. On page 46265, in Table 4E--Average Hourly Wage for Rural
Areas, the average hourly wage for Iowa is corrected to read as
follows:
------------------------------------------------------------------------
Corrected
Nonurban area Average hourly average hourly
wage wage
------------------------------------------------------------------------
Iowa.................................... 14.4039 14.4174
------------------------------------------------------------------------
12. On page 46316, Table III--Impact of Final Changes for FY 1997
on Payments per Discharge is corrected to read as follows:
Table III.--Impact of Final Changes for FY 1997 on Payments per Discharge
--------------------------------------------------------------------------------------------------------------------------------------------------------
Adjusted Average Hospital Hold
Number of Discharges Federal Federal specific harmless Exceptions Total Percent
hospitals payment percent payment payment payment payment change
--------------------------------------------------------------------------------------------------------------------------------------------------------
FY 1996 payments per discharge
--------------------------------------------------------------------------------------------------------------------------------------------------------
Low Cost Hospitals....................................... 3,363 6,868,405 $411.84 54.85 $200.68 $15.75 $18.28 $646.55 .......
Fully Prospective...................................... 1,548 3,287,821 375.12 50.00 237.10 ........ 11.40 623.62 .......
Rebase--Fully Prospective.............................. 1,483 2,743,898 371.61 50.00 218.24 ........ 27.88 617.74 .......
Rebase--100% Federal Rate.............................. 228 643,922 793.64 100.00 ........ ........ 0.25 793.89 .......
Rebase--Hold Harmless.................................. 104 192,764 335.30 46.29 ........ 561.32 59.11 955.72 .......
High Cost Hospitals...................................... 1,741 4,288,642 668.50 86.23 ........ 145.12 19.59 833.21 .......
100% Federal Rate...................................... 1,135 3,010,570 785.30 100.00 ........ ........ 2.23 787.53 .......
Hold Harmless.......................................... 606 1,278,072 393.38 52.33 ........ 486.95 60.48 940.81 .......
Total Hospitals...................................... 5,104 11,157,046 510.50 67.15 123.54 65.48 18.78 718.30 .......
--------------------------------------------------------------------------------------------------------------------------------------------------------
FY 1997 payments per discharge
--------------------------------------------------------------------------------------------------------------------------------------------------------
Low Cost Hospitals....................................... 3,363 7,056,653 467.97 63.97 156.10 12.43 40.87 677.38 4.77
Fully Prospective...................................... 1,548 3,377,933 437.83 60.00 184.43 ........ 30.98 653.24 4.75
Rebase--Fully Prospective.............................. 1,483 2,819,103 434.86 60.00 169.76 ........ 55.13 659.76 6.80
Rebase--100% Federal rate.............................. 238 677,500 773.08 100.00 ........ ........ 2.69 775.77 -2.28
Rebase--Hold Harmless.................................. 94 182,117 404.20 56.47 ........ 481.80 145.72 1,031.72 7.95
High Cost Hospitals...................................... 1,741 4,406,184 688.38 89.61 ........ 118.29 50.40 857.07 2.86
100% Federal Rate...................................... 1,167 3,151,900 773.93 100.00 ........ ........ 11.66 785.59 -0.25
Hold Harmless.......................................... 574 1,254,284 473.40 62.81 ........ 415.55 147.74 1,036.69 10.19
Total Hospitals...................................... 5,104 11,462,838 552.69 74.12 96.10 53.13 44.53 746.45 3.92
--------------------------------------------------------------------------------------------------------------------------------------------------------
13. On pages 46317 through 46318, Table IV--Distribution by Method
of Payment (Hold-Harmless/Fully Prospective) of Hospitals Receiving
Capital Payments is corrected to read as follows:
[[Page 66922]]
Table IV.--Distribution by Method of Payment (Hold-Harmless/Fully Prospective) of Hospitals Receiving Capital
Payments
----------------------------------------------------------------------------------------------------------------
(2) Hold-harmless
------------------------ (3)
(1) Total Percentage Percentage Percentage
No. of paid hold- paid fully paid fully
hospitals harmless federal prospective
(A) (B) rate
----------------------------------------------------------------------------------------------------------------
By Geographic Location:
All hospitals.............................................. 5,104 13.1 27.5 59.4
Large urban areas (populations over 1 million)............. 1,584 15.5 34.7 49.9
Other urban areas (populations over 1 million of fewer).... 1,275 16.0 32.7 51.3
Rural areas................................................ 2,245 9.8 19.6 70.7
Urban hospitals............................................ 2,859 15.7 33.8 50.5
0-99 beds.............................................. 697 16.6 27.1 56.2
100-199 beds........................................... 941 19.6 36.6 43.9
200-299 beds........................................... 576 14.4 36.6 49.0
300-499 beds........................................... 478 10.3 34.5 55.2
500 or more beds....................................... 167 10.2 34.1 55.7
Rural hospitals............................................ 2,245 9.8 19.6 70.7
0-49 beds.............................................. 1,175 7.1 14.5 78.5
50-99 beds............................................. 656 12.5 21.6 65.9
100-149 beds........................................... 241 13.7 30.7 55.6
150-199 beds........................................... 98 15.3 22.4 62.2
200 or more beds....................................... 75 8.0 41.3 50.7
By Region:
Urban by Region............................................ 2,859 15.7 33.8 50.5
New England............................................ 160 6.9 25.0 68.1
Middle Atlantic........................................ 434 10.1 29.7 60.1
South Atlantic......................................... 418 20.3 40.0 39.7
East North Central..................................... 480 9.6 30.0 60.4
East South Central..................................... 162 22.8 34.6 42.6
West North Central..................................... 190 18.4 27.4 54.2
West South Centeral.................................... 367 28.1 45.8 26.2
Mountain 5............................................. 126 16.7 41.3 42.1
Pacific................................................ 474 13.1 30.8 56.1
Puerto Rico............................................ 48 10.4 25.0 64.6
Rural by Region............................................ 2,245 9.8 19.6 70.7
New England............................................ 53 7.5 15.1 77.4
Middle Atlantic........................................ 84 10.7 15.5 73.8
South Atlantic......................................... 297 11.8 26.6 62.6
East North Central..................................... 304 10.2 11.8 78.0
East South Central..................................... 278 9.7 31.3 59.0
West North Central..................................... 525 7.2 15.0 77.7
West South Central..................................... 347 9.2 24.8 66.0
Mountain............................................... 211 12.3 15.2 72.5
Pacific................................................ 141 11.3 15.6 73.0
Large urban areas (populations over 100 million)........... 1,779 15.3 34.3 50.4
Other urban areas (populations of 1 million or fewer)...... 1,180 16.1 31.9 51.9
Rural areas................................................ 2,145 9.6 19.4 71.0
Teaching Status:
Non-teaching............................................... 4,019 13.7 26.5 59.8
Few than 100 Residents................................. 850 11.3 32.4 46.4
100 or more Residents.................................. 235 9.4 27.7 63.0
Disproportionate share hospitals (DSH:)
Non-DSH................................................ 3,178 12.4 23.9 63.7
Urban DSH:
100 or more beds....................................... 1,409 15.5 35.9 48.5
Less than 100 beds..................................... 100 17.0 23.0 60.0
Rural DSH:
Sole Community (SCH/EACH).......................... 156 11.5 18.6 69.9
Referral Center (RRC/Each)......................... 27 7.4 37.0 55.6
Other Rural:
100 or more beds............................... 83 8.4 45.8 45.8
Less than 100 beds............................. 151 7.3 25.8 66.9
Urban teaching and DSH:
Both teaching and DSH.................................. 692 11.1 32.2 56.9
Teaching and no DSH.................................... 339 11.2 29.8 59.0
No teaching and DSH.................................... 817 19.5 37.5 43.1
No teaching and no DSH................................. 1,111 16.9 32.3 50.9
Rural Hopital Types:
Non special status hospitals........................... 1,372 7.7 19.5. 72.8
RRC/REACH.............................................. 90 10.0 34.4 55.6
SCH/REach.............................................. 645 13.3 17.2 69.5
[[Page 66923]]
SCh, RRC and Each...................................... 38 13.2 21.1 65.8
Type of Ownership:
Voluntary:
Voluntary.......................................... 2,951 12.4 27.5 60.1
Proprietary........................................ 696 23.7 46.4 29.9
Government......................................... 1,366 8.8 17.5 73.7
Medicare Utilization as a Percent of Inpatient Days:
0-50............................................... 258 15.1 25.2 59.7
25-50.............................................. 1,284 14.6 33.3 52.1
50-65.............................................. 2,097 13.1 27.8 59.1
Over 65............................................ 1,374 10.9 21.5 67.5
----------------------------------------------------------------------------------------------------------------
(Catalog of Federal Domestic Assistance Program No. 93.778, Medical
Assistance Program; No. 93.773 Medicare--Hospital Insurance; and No.
93.774, Medicare--Supplementary Medical Insurance)
Dated: December 11, 1996.
Michael W. Carelton,
Acting Deputy Assistant Secretary for Information Resource Management.
[FR Doc. 96-32094 Filed 12-18-96; 8:45 am]
BILLING CODE 4120-01-M