[Federal Register Volume 63, Number 192 (Monday, October 5, 1998)]
[Rules and Regulations]
[Pages 53301-53308]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-26596]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Health Care Financing Administration

42 CFR Parts 409, 410, 411, 413, 424, 483 and 489

[HCFA-1913-CN]
RIN 0938-AI47


Medicare Program; Prospective Payment System and Consolidated 
Billing for Skilled Nursing Facilities; Correction

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

ACTION: Correction of interim final rule with comment period.

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SUMMARY: This document corrects technical errors that appeared in the 
interim final rule with comment period published in the Federal 
Register on May 12, 1998 entitled ``Medicare Program; Prospective 
Payment System and Consolidated Billing for Skilled Nursing 
Facilities.''

EFFECTIVE DATE: These corrections are effective July 1, 1998.

FOR FURTHER INFORMATION CONTACT: Bill Ullman, (410) 786-5667.

SUPPLEMENTARY INFORMATION:

Background

    In FR Doc. 98-12208 of May 12, 1998 (63 FR 26252), there were a 
number of technical errors. In the preamble, the errors relate to 
incorrect listings in two tables, technical errors in the discussion of 
one issue, a typographical error in a table, and an incorrect paragraph 
designation. In the regulations text, the errors relate to two 
incorrect paragraph designations, a misspelled word in the heading to a 
section, and a grammatical correction. In addition, we inadvertently 
erased a change made by the regulation titled ``Medicare Program; Scope 
of Medicare Benefits and Application of the Outpatient Mental Health 
Treatment Limitation to Clinical Psychologist and Clinical Social 
Worker Services (HCFA-3706-F)'' published in the Federal Register April 
23, 1998 at 63 FR 20110. That regulation's revision to 42 CFR 
424.32(a)(2) (see 63 FR 20130), regarding basic requirements for 
claims, was inadvertently erased by the interim final rule, which this 
notice corrects, titled ``Medicare Program; Prospective Payment System 
and Consolidated Billing for Skilled Nursing Facilities'' published May 
12, 1998 when it subsequently revised the same section (see 63 FR 
26311). This correction notice incorporates the revisions made by both 
rules. Finally, we are correcting Sec. 483.20 (Resident assessment) 
because we erroneously used a superseded version of regulations text 
when revising that section. The corrections appear in this document 
under the heading ``Correction of Errors.''

Correction of Errors

    In FR Doc. 98-12208 of May 12, 1998 (63 FR 26252), we are making 
the following corrections:

Corrections To Preamble

Page 26262, Table 2.C

    1. The dot lead-in between the ``Category'' column and the ``ADL 
index'' column and between the ``End splits'' column and the ``MDS RUG-
III codes'' column is removed.
    2. First column titled ``Category''
    Under the heading ``IMPAIRED COGNITION,'' the first line is 
corrected to read as follows: ``Score on MDS2.0 Cognitive Performance 
Scale >=3.'' The second and third lines under the heading are retained 
but are blank.
    3. Second column titled ``ADL index''
    After existing line 29, line 30 is added to read ``4-5.''
    Existing line 34 is removed.
    Existing line 37 is removed.
    After existing line 38, line 39 is added to read ``11-15.''
    4. Third column titled ``End splits''
    Line 28 is corrected to read ``Nursing rehabilitation.''
    Line 29 is corrected to read ``Not receiving nursing 
rehabilitation.''
    Line 30 is corrected to read ``Nursing rehabilitation.''
    Line 31 is corrected to read ``Not receiving nursing 
rehabilitation.''
    Line 32 is corrected to read ``Nursing rehabilitation.''
    Line 33 is corrected to read ``Not receiving nursing 
rehabilitation.''
    Line 34 is corrected to read ``Nursing rehabilitation.''
    Line 35 is corrected to read ``Not receiving nursing 
rehabilitation.''

[[Page 53302]]

    Line 37 is corrected to read ``Nursing rehabilitation.''
    Line 38 is corrected to read ``Not receiving nursing 
rehabilitation.''
    Line 39 is corrected to read ``Nursing rehabilitation.''
    Line 40 is corrected to read ``Not receiving nursing 
rehabilitation.''
    Line 43 is corrected to read ``Nursing rehabilitation.''
    Line 44 is corrected to read ``Not receiving nursing 
rehabilitation.''
    Line 45 is corrected to read ``Nursing rehabilitation.''
    Line 46 is corrected to read ``Not receiving nursing 
rehabilitation.''
    5. Fourth column, titled ``MDS RUG III codes''
    Line 35, ``BA1,'' is removed.
    The corrected table is set forth below:

BILLING CODE 4210-01-P-

[[Page 53303]]

[GRAPHIC] [TIFF OMITTED] TR05OC98.034



[[Page 53304]]

[GRAPHIC] [TIFF OMITTED] TR05OC98.035



[[Page 53305]]

[GRAPHIC] [TIFF OMITTED] TR05OC98.036



[[Page 53306]]

[GRAPHIC] [TIFF OMITTED] TR05OC98.037



BILLING CODE 4210-01-C

Page 26260

    In the second column, in lines 7 to 11, the second full sentence is 
corrected to read as follows: ``On average, case-mix values based on 
MDS data are the same as analog-based values for the nursing index and 
29 percent higher for the therapy index.''

Page 26265

    In the third column, in lines 4 to 9, the sentence beginning ``As 
rehabilitation services * * *'' is removed.

Page 26266

    In the third column, in lines 15 to 21, the sentence beginning 
``Although the PPS rules * * *'' is corrected to read as follows: 
``Although the PPS rules allow a 5-day grace period for setting the 
assessment reference date for the Medicare 90-day assessment, the 
Quarterly Review assessment must be completed within 92 days of 
completion of the last comprehensive assessment.''
    In the third column, in lines 21 to 28, the sentence beginning 
``Therefore, if a facility * * *'' is corrected to read as follows: 
``Therefore, if a facility is using the Medicare 90-day assessment to 
also meet the requirement for the Quarterly Review assessment, the 
assessment must be completed within 92 days of completion of the prior 
comprehensive assessment and have an assessment reference date that 
falls within the Medicare 90-day assessment window, days 80 through 89 
(plus grace days, if needed) of the Part A stay.''
    In the third column, in the first full paragraph, in line 19 of 
that paragraph, in the sentence beginning, ``These include * * *,'' the 
phrase ``0 or 1 to 2 or 3'' is corrected to read ``0 to 1 or 2 to 3.''
    In the third column, in the first full paragraph, in line 23, in 
the sentence

[[Page 53307]]

beginning ``As a complement * * *,'' the phrase ``comprehensive 
assessment'' is corrected to read ``full assessment.''
    In the third column, in the first full paragraph, in line 32, in 
the sentence beginning ``For those rare instances * * *,'' the phrase 
``a comprehensive assessment'' is corrected to read ``an assessment.''

Page 26267

    In the first column, in line 7, the word ``comprehensive'' is 
removed.
    In the first column, in line 9, the word ``deemed'' is replaced 
with ``automatically.''
    In the first column, in the first full paragraph, in the first 
sentence, in line 2, after the word ``assessment,'' the clause 
``whichever is chosen to be used as the Initial Admission Assessment'' 
is added.
    In the first column, in the first full paragraph, the second 
sentence is corrected to read as follows: ``As noted above, RAPs also 
must be completed as part of any Significant Change in Status 
assessments.''
    In the first column, in the second full paragraph, in the first 
sentence, in line 3, the words ``be completed'' are replaced with the 
phrase ``have an assessment reference date.''
    In the first column, in the third full paragraph, in the first 
sentence, in line 3, the words ``day 8'' are replaced with the clause 
``the first assessment has been done.''

Page 26267, Table 2.D

    In the third column titled ``Assessment reference date,'' in the 
first line, the phrase ``Days 1-8*'' is replaced with ``Days 1-5*.''
    In the first footnote ``*'' for the table, the phrase ``day 8'' is 
replaced with ``day 5.''
    The second footnote ``**'' for the table is corrected to read as 
follows: ``**RAPs follow Federal rules.''

Page 26268

    In the first column, in the second full paragraph, in lines 3 to 
10, the first sentence after the heading designated ``a.'' is corrected 
to read as follows: ``For a Medicare patient in a Part A covered stay, 
admitted in the 30 days before the SNF became subject to PPS, facility 
staff may choose to use the most recent full MDS assessment (within the 
past 30 days) for RUG-III classification.''
    In the first column, in the second full paragraph, in lines 16 to 
18, the last sentence is corrected, and a new sentence is added after 
it to read as follows: ``The next assessment will be the required 
Medicare 14-day assessment. This assessment must have an assessment 
reference date that is 11 to 14 days after the day the facility became 
subject to SNF PPS.''
    In the third column, in line 5, the word ``completed'' is replaced 
with ``included.''
    In the third column, in lines 9 to 10, the phrase ``admission 
assessment'' is replaced with ``Initial Admission Assessment.''
    In the third column, in line 16, the word ``and'' is removed.
    In the third column, in the second full paragraph, in lines 4 to 
13, the second sentence is corrected, the third and fourth sentences 
are removed, and a new sentence is added after the corrected second 
sentence to read as follows: ``For this reason, when using the 90-day 
assessment as the required quarterly assessment, it must be completed 
accordingly. When the 90-day assessment is not also the quarterly 
assessment, a 5-day grace period is available for setting the 
assessment reference date for this assessment, as for the 30-day and 
60-day assessments.''

Page 26275, Table 2.H

    In the column labeled ``Labor-related'' for the RUGS-III category 
``RMB,'' in line 11, the amount presented contained a typographical 
error. The amount is corrected to read ``$185.78''.

Page 26284

    In the first column, in the second full paragraph, in line 24, the 
phrase ``visits and'' is added before the phrase ``order changes.''
    In the first column, in the second full paragraph, in line 25, the 
phrase ``7 days'' is corrected to read ``14 days.''

Page 26301

    In the first column, in lines 21 and 22, the reference to 
``diagnostic tests (Sec. 410.32(e))'' is corrected to read ``diagnostic 
tests (Sec. 410.32(d)).''

Corrections to Regulatory Text


Sec. 410.32  [Corrected]

    In the third column on page 26307, in the last line, and carrying 
over into the first column on page 26308, in the first line, in 
amendatory instruction number 4 for Sec. 410.32 (Diagnostic X-ray 
tests, diagnostic laboratory tests, and other diagnostic tests: 
Conditions), the reference to ``paragraph (e)'' is corrected to read 
``paragraph (d)'' and the reference to ``paragraph (e)(7)'' is 
corrected to read ``paragraph (d)(7).''
    Also in the first column on page 26308, in the section heading to 
Sec. 410.32, the word ``texts'' is corrected to read ``tests''; and the 
paragraph designation ``(e)'' before the heading ``Diagnostic 
laboratory tests'' is corrected to read ``(d).''


Sec. 413.333  [Corrected]

    In the second column on page 26309, in the definition of ``Resident 
classification system'' that appears in Sec. 413.333 (Definitions), the 
phrase ``as set out in the annual publication'' is corrected to read 
``as set forth in the annual publication.''


Sec. 424.40  [Corrected]

    In the second column on page 26311, in amendatory statement number 
3 for Sec. 424.20 (Requirements for posthospital SNF care), ``paragraph 
(a)'' is corrected to read ``paragraph (a)(1).''


Sec. 424.32  [Corrected]

    In the second column, in Sec. 424.32 (Basic requirements for all 
claims), revised paragraph (a)(2) is corrected to read as follows:
* * * * *
    (2) A claim for physician services, clinical psychologist services, 
or clinical social worker services must include appropriate diagnostic 
coding for those services using ICD-9-CM, and a claim for physician 
services furnished to an SNF resident under Sec. 411.15(p)(2) of this 
chapter must also include the SNF's Medicare provider number.
* * * * *


Sec. 483.20  [Corrected]

    In the third column on page 26311, amendatory instruction number 2 
and the amendment to Sec. 483.20 are removed and a new amendatory 
instruction number 2 and amendment to Sec. 483.20 are added in their 
place to read as follows:

Subpart B--Requirements for Long Term Care Facilities

    2. In Sec. 483.20, the introductory text to paragraph (b)(2) is 
revised to read as follows:


Sec. 483.20  Resident assessment.

* * * * *
    (b) Comprehensive assessments. * * *
    (2) When required. Subject to the timeframes prescribed in 
Sec. 413.343(b) of this chapter, a facility must conduct a 
comprehensive assessment of a resident as follows:
* * * * *
(Authority: Section 1888 of the Social Security Act (42 U.S.C. 
1395yy))

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)


[[Page 53308]]


    Dated: September 29, 1998.
Neil J. Stillman,
Deputy Assistant Secretary for Information Resources Management.
[FR Doc. 98-26596 Filed 9-30-98; 4:28 pm]
BILLING CODE 4120-01-P