[Federal Register Volume 63, Number 44 (Friday, March 6, 1998)]
[Rules and Regulations]
[Pages 11147-11159]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-5384]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 400, 409, 410, 411, 412, 413, 424, 440, 485, 488, 489 
and 498

[BPD-878-CN]
RIN 0938-AH55


Medicare Program; Changes to the Hospital Inpatient Prospective 
Payment Systems and Fiscal Year 1998 Rates; Corrections

AGENCY: Health Care Financing Administration (HCFA), HHS.

ACTION: Final rule with comment period; correction notice.

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SUMMARY: In the August 29, 1997, issue of the Federal Register (62 FR 
45966), we published a final rule with comment period revising the 
Medicare hospital inpatient prospective payment systems for operating 
costs and capital-related costs to implement necessary changes 
resulting from the Balanced Budget Act of 1997, Pub. L. 105-33, and 
changes arising from our continuing experience with the system. This 
document corrects errors made in that document.

EFFECTIVE DATE: October 1, 1997.

FOR FURTHER INFORMATION CONTACT: Nancy Edwards, (410) 786-4531.

SUPPLEMENTARY INFORMATION: In the preamble of the August 29, 1997 final 
rule with comment period, we indicated that if a hospital believed 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 had to notify the 
intermediary and HCFA in writing, no later than September 15, 1997 (see 
62 FR 45989). As a result of this process, we have corrected the wage 
data for 10 hospitals and included the wage data for 2 hospitals that 
were erroneously omitted. In addition, the Balanced Budget Act of 1997, 
Public Law 105-33, allowed hospitals meeting specific criteria to be 
reclassified for fiscal year (FY) 1998 and subsequent years. Because 
these reclassification decisions were made after publication of the 
final rule with comment period, the impact on their area wage indexes 
are reflected below. Accordingly, the wage index values for several 
areas have changed and are corrected in this document.
    The August 29, 1997 final rule with comment period also contained 
technical and typographic errors. Therefore, we are making the 
following corrections to the final rule with comment period:

[[Page 11148]]

    1. On page 45967, third column, fourth full paragraph, fourth line, 
the phrase ``are (MDH) for FY 1998 or 1999 will'' is corrected to read 
``are not designated as Medicare-dependent small rural hospitals (MDHs) 
for FY 1998 or 1999 will''.
    2. On page 45968, second column, fifth full paragraph, first and 
second lines, the phrase ``For cost reporting periods beginning on or 
after'' is corrected to read ``For discharges on or after''.
    3. On page 45997, third column, first paragraph, fourth through 
sixth lines, the phrase ``uses the fixed loss outlier threshold of 
$7,600 from the proposed rule'' is corrected to read ``uses a fixed 
loss outlier threshold of $9,700''.
    4. On page 46005, third column, first full paragraph, seventh line, 
the phrase ``December 31, 1990'' is corrected to read ``December 31, 
1998''.
    5. On page 46019, first column, first paragraph, the table is 
replaced with the following:


(1) Psychiatric hospital and units............................   $10,534
(2) Rehabilitation hospitals and units........................    19,104
(3) Long-term care hospitals..................................    37,688
                                                                        

    6. On page 46020, second column, third full paragraph, the table is 
replaced with the following:


(1) Psychiatric hospital and units............................    $8,482
(2) Rehabilitation hospitals and units........................    16,677
(3) Long-term care hospitals..................................    18,947
                                                                        

    The changes in item numbers 6 and 7 reflect an update of 3.4 
percent that was not included in the data published in the August 29, 
1997 final rule with comment period. These changes were made through 
Program Memorandum A-97-13 on September 29, 1997 and were effective 
October 1, 1997.
    7. On page 46042, second column, in the Table of Cost-of-Living 
Adjustment Factors, Alaska and Hawaii Hospitals, the cost-of-living 
adjustment for the County of Hawaii is corrected to read as follows:


County of Hawaii.............................................       1.15
                                                                        

    8. On pages 46054 through 46069, in Table 3C--Hospital Case Mix 
Indexes for Discharges Occurring in Federal Fiscal Year 1996; Hospital 
Average Hourly Wages for Federal Fiscal Year 1998 Wage Index, the 
average hourly wages for specified providers are corrected to read as 
follows:

----------------------------------------------------------------------------------------------------------------
                                                                                    Avg. hourly   Corrected avg.
                            Provider                              Case mix index       wage         hourly wage 
----------------------------------------------------------------------------------------------------------------
09-0003.........................................................         01.3454           20.56           24.76
09-0007.........................................................         01.2828           20.38           21.23
14-0067.........................................................         01.7828           18.84           18.79
16-0029.........................................................         01.5134           18.14           18.32
22-0071.........................................................         01.9236           21.67           23.15
22-0077.........................................................         01.7917           22.92           23.28
33-0196.........................................................         01.3114            0.34           28.36
33-0385.........................................................         01.1776           -2.89           26.83
33-0396.........................................................         01.3520           24.91           31.58
39-0132.........................................................         01.3448           15.42           19.77
40-0029.........................................................         01.1383  ..............            9.92
40-0048.........................................................         01.2251  ..............            7.12
----------------------------------------------------------------------------------------------------------------

    9. On pages 46070 through 46076, 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    
----------------------------------------------------------------------------------------------------------------
0060......................  Aguadilla, PR...................       0.4224       0.5542       0.4188       0.5510
0470......................  Arecibo, PR.....................       0.4224       0.5542       0.4218       0.5537
1123......................  Boston-Worcester-Lawrence-Lowell-      1.1436       1.0962       1.1498       1.1003
                             Brockton, MA-NH \1\.                                                               
3500......................  Iowa City, IA...................       0.9401       0.9586       0.9413       0.9594
5600......................  New York, NY \1\................       1.3982       1.2580       1.4449       1.2866
6120......................  Peoria-Pekin, IL................       0.8586       0.9009       0.8571       0.8998
6160......................  Philadelphia, PA-NJ \1\.........       1.1379       1.0925       1.1398       1.0937
7440......................  San Juan-Bayamon, PR \1\........       0.4618       0.5891       0.4625       0.5898
8840......................  Washington, DC-MD-VA-WV \1\.....       1.0780       1.0528       1.0911      1.0615 
----------------------------------------------------------------------------------------------------------------
\1\ Large Urban Area.                                                                                           

    10. On pages 46076 through 46077, in Table 4B--Wage Index and 
Capital Geographic Adjustment Factor (GAF) for Rural Areas, the wage 
index value and the GAF for Puerto Rico are corrected to read as 
follows:

----------------------------------------------------------------------------------------------------------------
                                                                                 Corrected wage                 
                Nonurban area                    Wage index          GAF             index        Corrected GAF 
----------------------------------------------------------------------------------------------------------------
Puerto Rico.................................          0.4224           0.5542           0.3939           0.5283 
----------------------------------------------------------------------------------------------------------------

    11. On pages 46077 through 46078, 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:

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                                                                                  Corrected wage                
              Area reclassified to                  Wage index          GAF            index       Corrected GAF
----------------------------------------------------------------------------------------------------------------
Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH          1.1436          1.0962          1.1498          1.1003
Hartford, CT....................................  ..............  ..............          1.2373          1.1570
Iowa City, IA...................................          0.9198          0.9444          0.9208          0.9451

[[Page 11149]]

                                                                                                                
New York, NY....................................          1.3982          1.2580          1.4449          1.2866
Peoria-Pekin, IL................................          0.8586          0.9009          0.8571          0.8998
Philadelphia, PA-NJ.............................          1.1379          1.0925          1.1398          1.0937
Washington, DC-MD-VA-WV.........................          1.0780          1.0528          1.0911          1.0615
----------------------------------------------------------------------------------------------------------------

    12. On pages 46078 through 46079, in Table 4D--Average Hourly Wage 
for Urban Areas, the average hourly wages for specified areas are 
corrected to read as follows:

------------------------------------------------------------------------
                                                             Corrected  
               Urban area                 Average hourly  average hourly
                                               wage            wage     
------------------------------------------------------------------------
Boston-Worcester-Lawrence-Lowell-                                       
 Brockton, MA-NH........................         22.9992         23.1215
Iowa City, IA...........................         18.8914         18.9163
New York, NY............................         28.1700         29.0344
Peoria-Pekin, IL........................         17.2543         17.2229
Philadelphia, PA-NJ.....................         22.8669         22.9042
San Juan-Bayamon, PR....................          9.2790          9.2933
Springfield, MA.........................         21.4074         21.5827
Washington, DC-MD-VA-WV.................         21.6632         21.9255
------------------------------------------------------------------------

    13. On pages 46079 through 46080, in Table 4E--Average Hourly Wage 
for Rural Areas, the average hourly wage for Puerto Rico is corrected 
to read as follows:

------------------------------------------------------------------------
                                                            Corrected   
             Nonurban area               Average hourly   average hourly
                                              wage             wage     
------------------------------------------------------------------------
Puerto Rico...........................          8.4891           7.9149 
------------------------------------------------------------------------

    14. On page 46080, in Table 4F--Puerto Rico Wage Index and Capital 
Geographic Adjustment Factor (GAF), the wage index values and the GAFs 
for specified areas are corrected to read as follows:

----------------------------------------------------------------------------------------------------------------
                                                                                  Corrected wage                
                      Area                          Wage index          GAF            index       Corrected GAF
----------------------------------------------------------------------------------------------------------------
Aquadilla, PR...................................          0.9291          0.9509          0.9212          0.9453
Arecibo, PR.....................................          0.9291          0.9509          0.9276          0.9498
San Juan-Bayamon, PR............................          1.0156          1.0107          1.0172          1.0117
Rural Puerto Rico...............................          0.9291          0.9509          0.8663          0.9064
----------------------------------------------------------------------------------------------------------------

    15. On pages 46099 through 46105, Table 7A--Medicare Prospective 
Payment System; Selected Percentile Lengths of Stay [FY 96 MEDPAR 
Update 06/97 Grouper V14.0] is corrected by replacing it with the 
following:

BILLING CODE 4120-01-P

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BILLING CODE 4120-01-C
(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: February 23, 1998.
Neil J. Stillman,
Deputy Assistant, Secretary for Information Resource Management.
[FR Doc. 98-5384 Filed 3-5-98; 8:45 am]
BILLING CODE 4120-01-P