[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