[Federal Register Volume 67, Number 126 (Monday, July 1, 2002)]
[Rules and Regulations]
[Pages 44073-44077]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-16476]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 412 and 413

[CMS-1069-F2]
RIN -0938-AL40


Medicare Program; Prospective Payment System for Inpatient 
Rehabilitation Facilities; Correcting Amendment

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Final rule; correcting amendment.

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SUMMARY: In the August 7, 2001 issue of the Federal Register (66 FR 
41316), we published a final rule establishing a prospective payment 
system (PPS) for Medicare payment of inpatient hospital services 
provided by a rehabilitation hospital or rehabilitation unit of a 
hospital. The effective date was January 1, 2002. This correcting 
amendment corrects a limited number of technical and typographical 
errors identified in the August 7, 2001 final rule. It also corrects an 
example related to the Inpatient Rehabilitation Facility Patient 
Assessment Instrument contained within the final rule.

EFFECTIVE DATE: This correcting amendment is effective July 31, 2002.

FOR FURTHER INFORMATION CONTACT: Robert Kuhl, (410) 786-4597.

SUPPLEMENTARY INFORMATION:

Need for Corrections

    In our August 7, 2001 final rule (66 FR 41316), referred to as the 
final rule throughout this correcting amendment, we provided an 
extensive discussion of the inpatient rehabilitation facility (IRF) 
patient assessment instrument and its implementation that employed 
various examples to illustrate essential points of the patient 
assessment process. A number of those examples contain technical 
errors. In addition, we are making technical corrections to the 
regulations text where the regulations text inadvertently fails to 
reflect the policies set forth in the preamble of the final rule.

Summary of Technical Corrections to the Preamble to the August 7, 2001 
Final Rule

    In section IV of the final rule, we describe the process of using 
the IRF patient assessment instrument to collect patient data that are 
the basis of payments made under the IRF prospective payment system. 
Beginning on page 41330 of the final rule, we describe the schedule for 
completing, encoding (computerizing), and transmitting data contained 
in the IRF patient assessment instrument. The rules associated with the 
assessment schedule are codified at Secs. 412.610 and 412.614.

Interruption of the Stay During the Admission Assessment

    After the patient is admitted, the IRF has a time period to observe 
the patient's functional status/clinical condition that is then 
recorded on the patient assessment instrument. This time period is 
referred to in the final rule as the admission assessment time period. 
Section 412.610(b) states that ``The first day that the Medicare Part A 
fee-for-service inpatient is furnished Medicare-covered services during 
his or her current inpatient rehabilitation facility hospital stay is 
counted as day one of the patient assessment schedule.'' Section 
412.610(c)(1)(i) specifies the general rule that the admission 
assessment time period is a span of time that covers calendar days 1 
through 3 of the patient's current Medicare Part A fee-for-service 
hospitalization. The patient's IRF admission day is the first day of 
the admission assessment time period. For example, Chart 1 on page 
41330 illustrates the assessment schedule for an inpatient stay in an 
IRF; the admission assessment time period is the first 3 days of the 
patient's IRF hospitalization, with day 3 being the admission 
assessment reference date, day 4 being the admission assessment 
completion date, and day 10 being the encoded by date. Chart 2 on page 
41331 illustrates the application of the general rule for a patient who 
is admitted on July 3, 2002. The admission assessment

[[Page 44074]]

time period would be July 3, 4, and 5, the admission assessment 
reference date July 5, the admission assessment completion date July 6, 
and the admission assessment encoded by date July 12, 2002.
    The preamble also explains the admission assessment time period, 
admission assessment reference date, the admission assessment 
completion date, and the admission assessment encoded by date for the 
case in which the beneficiary has an interrupted stay during the 
admission assessment time period. As defined in Sec. 412.602, an 
interrupted stay means a stay at an inpatient rehabilitation facility 
during which a Medicare inpatient is discharged from the inpatient 
rehabilitation facility and returns to the same inpatient 
rehabilitation facility within three consecutive calendar days. The 
duration of the interruption of the stay of three consecutive calendar 
days begins with the day of discharge from the inpatient rehabilitation 
facility and ends on midnight of the third day. However, the August 7, 
2001, final rule contains some technical errors in illustrating the 
assessment process for a patient who has an interruption in a stay 
which occurs during the admission assessment time period.
    On page 41331 of the preamble of the final rule, we describe the 
process of shifting the dates associated with the admission assessment 
schedule when an inpatient rehabilitation stay has been interrupted. In 
the example on page 41331, the patient's stay begins with an admission 
to the IRF on July 3, 2002. However, the stay is interrupted on July 4, 
2002, and the patient returns to the IRF before midnight of July 6, 
2002. The example on page 41331 incorrectly states that, due to this 
interruption in the hospital stay, the admission assessment time period 
would be shifted to July 6, 7, and 8. The example is incorrect because 
the three calendar days to observe the patient during the admission 
assessment time period must include July 3, because July 3 is the day 
of admission to the IRF. As stated previously, the day of admission to 
the IRF is the first day of the admission assessment time period. 
Because July 3 is day 1 of the admission assessment time period, then 
July 6, the date when the patient returns to the IRF after the 
interruption in the stay, is day 2 of the admission assessment time 
period. Accordingly, July 7 is day 3 of the admission assessment time 
period.
    The admission assessment reference date, completion date, and 
encoded by date are based upon the admission assessment time period. 
Because the final rule example regarding the shifting of the admission 
assessment time period is incorrect, it follows that the admission 
assessment reference date of July 8, the admission assessment 
completion date of July 9, and the encoded by date of July 15, 2002 
included in the example are also incorrect. The correct admission 
assessment time period, as a result of an interruption in the stay as 
described in the final rule example, is July 3, 6, and 7, with July 7 
being the assessment reference date, July 8 the completion date, and 
July 14, 2002, the encoded by date.
    If, for example, the patient was admitted to the IRF on July 3, but 
the stay is interrupted on July 5, 2002, and the patient returns to the 
IRF before midnight of July 7, 2002, the admission assessment time 
period dates would be July 3, 4, and 7. In this case, the admission 
assessment reference date would be July 7, the completion date would be 
July 8, and the encoded by date would be July 14, 2002.

Discharge Assessment

    Section 412.610, ``Assessment schedule,'' specifies the general 
rules for the admission assessment and the discharge assessment. As 
stated previously, the admission assessment time period is a span of 
time that covers calendar days 1 through 3 of the patient's current 
Medicare Part A fee-for-service hospitalization. The first day of the 
patient's IRF stay is counted as day 1 of the patient assessment 
schedule, with day 3 of the hospitalization being the admission 
assessment reference date. Section 412.610 specifies the general rule 
that the discharge assessment reference date is the day the first of 
the following two events occurs: (1) The patient is discharged from the 
IRF; or (2) the patient stops being furnished Medicare Part A fee-for-
service IRF services. The discharge assessment time period includes the 
discharge assessment reference date and the two calendar days prior to 
the discharge assessment reference date.
    Applying the admission assessment general rule means that a patient 
admitted on October 1, 2002, and discharged on October 4, 2002, would 
have an admission assessment time period of October 1, 2, and 3 (the 
first three days of the current Medicare Part A IRF hospitalization), 
with October 3 being the admission assessment reference date. Applying 
the discharge assessment general rule means that October 4, 2002 (the 
day the patient is discharged from the IRF) is the discharge assessment 
reference date, with October 2 and 3 (the two calendar days prior to 
the discharge assessment reference date) being part of the discharge 
assessment time period.
    In this situation, the admission assessment time period and the 
discharge assessment time period both include October 2 and 3. However, 
on page 41327, we incorrectly stated that ``In addition, for the 
discharge assessment, in no case will the discharge assessment time 
period include a calendar day(s) prior to the admission assessment 
reference calendar date or the admission assessment reference calendar 
date itself.'' That statement is incorrect because there will be 
situations, such as when a patient's IRF stay is only 4 days in length, 
when it would be impossible to apply the admission assessment and 
discharge assessment general rules and not include the admission 
assessment reference date itself, or another day of the admission 
assessment time period, as part of the discharge assessment time 
period. Consequently, a patient who has a very short IRF stay may have 
a discharge assessment time period that includes (that is, overlaps) a 
calendar day(s) prior to the admission assessment reference calendar 
date or the admission assessment reference calendar date itself.
    In order to correct for this overly broad statement, previously 
quoted from page 41327, that makes application of both the admission 
assessment and discharge assessment general rules impossible when a 
short stay causes the time periods for the admission and discharge 
assessments to overlap, we are adding, after the word ``itself'', the 
phrase, ``, unless a patient's IRF length of stay causes these 
assessment periods to overlap.''

Transmission of Assessment Data

    Under Sec. 412.610, patient data are collected on the same IRF 
patient assessment instrument two times. The first time is during the 
admission assessment time period, and the second time is during the 
discharge assessment time period. Under Sec. 412.614(c), we require 
that both the admission and discharge assessment data be transmitted 
together only one time after the patient is discharged. Because the 
discharge date is the sole basis for determining when the transmission 
of the data must occur, an event, such as an interruption of a stay, 
that occurs before the actual day of discharge will not affect any of 
the discharge assessment schedule dates, including the date to transmit 
the data. However, on page 41331 of the preamble and in Sec. 412.618(c) 
on page 41390, we incorrectly stated that if an interruption

[[Page 44075]]

of a stay occurred for (that is, during) the admission assessment time 
period, the patient assessment instrument transmitted by date would be 
shifted forward. We are correcting the statement on page 41331 by 
removing the phrase ``and patient assessment instrument transmitted by 
date'', because an interruption of the stay, which occurs before the 
discharge date, has no effect on the ``transmitted by date.'' A 
corresponding correction to the regulations text at Sec. 412.618(c) 
will be addressed in the next section of this correcting amendment.

Definition of a Discharge

    As stated on page 41331 and Sec. 412.602 of the final rule, a 
discharge of a Medicare patient occurs when--(1) the patient is 
formally released; (2) the patient stops receiving Medicare-covered 
Part A inpatient rehabilitation services; or (3) the patient dies in 
the inpatient rehabilitation facility. However, in defining a 
discharge, we inadvertently failed to account for situations where a 
patient stops receiving Medicare-covered Part A inpatient 
rehabilitation services, but meets the condition, under Sec. 424.13(b), 
for continued hospitalization. Specifically, under Sec. 424.13(b), a 
physician may certify or recertify the need for continued 
hospitalization if the physician finds that the patient could receive 
proper treatment in a skilled nursing facility (SNF) but no bed is 
available in a participating SNF. To account for situations where a 
patient meets the requirement at Sec. 424.13(b) in our definition of a 
discharge, on page 41331, we are correcting the condition ``(2) the day 
on which the patient ceases to receive Medicare-covered Part A 
inpatient rehabilitation services'' by adding ``unless the patient 
qualifies for continued hospitalization under Sec. 424.13(b) of the 
regulations.'' A corresponding correction to the regulations text at 
Sec. 412.602 will be addressed in the next section of this correcting 
amendment.

Example of Computing a Facility's Federal Prospective Payment

    The example on page 41367 of the preamble reflects an incorrect 
amount ($20,033.81) for the Federal Prospective Payment amounts 
associated with CMG 0111 (without comorbidities). Inserting the correct 
amount from Table 2 of the final rule ($19,071.89), the corrected 
adjusted payment for Facility A will be $24,133.91 and the corrected 
adjusted payment for Facility B will be $24,990.08. In addition, the 
line after the subtotal is incorrectly labeled as ``DSH adjustment'' 
and should be labeled ``LIP adjustment'' to indicate an adjustment for 
low-income patients as referred to throughout the final rule.
    We also found and corrected other typographical errors.

Correction of Errors in the Preamble of the August 7, 2001 Final Rule

    1. On page 41327, third column; third full paragraph, in line 17 
from the bottom of the page, after the word ``itself'' add the 
following text: ``, unless a patient's IRF length of stay causes these 
assessment periods to overlap.''
    2. On page 41331, in the first column, in the next to last line add 
the word ``and'' before the word ``patient''.
    3. On page 41331 in the first column, in the last line, and 
continuing in the second column, first and second lines, remove the 
following text, ``and patient assessment instrument transmitted by 
date''.
    4. On page 41331, in the second column, line 19, the date ``July 
6'' is corrected to read ``July 3''.
    5. On page 41331, second column, line 20, the date ``July 7'' is 
corrected to read ``July 6'' and the date ``July 8'' is corrected to 
read ``July 7''.
    6. On page 41331, second column, line 27, the date ``July 8'' is 
corrected to read ``July 7''.
    7. On page 41331, second column, lines 29 to 30, the date ``July 
9'' is corrected to read ``July 8''.
    8. On page 41331, second column, lines 32 to 33, the date ``July 
15, 2002'' is corrected to read ``July 14, 2002''.
    9. On page 41331, third column, line 7, after the phrase ``(2) the 
day on which the patient ceases to receive Medicare-covered Part A 
inpatient rehabilitation services'', add the phrase, ``unless the 
patient qualifies for continued hospitalization under Sec. 424.13(b) of 
the regulations''.
    10. On page 41350, third column, line two, remove the number 
``191''.
    11. On page 41367, replace the label ``DSH Adjustment'' with ``LIP 
Adjustment'' and replace the values in the table labeled ``Examples of 
Computing a Facility's Federal Prospective Payment'' with the 
following:

------------------------------------------------------------------------
                                            Facility A      Facility B
------------------------------------------------------------------------
Federal Prospective Payment.............   $19,971.89      $19,971.89
Labor Share.............................        x .72395        x .72395
                                         -------------------------------
Labor Portion of Federal Payment........   $14,458.65      $14,458.65
Wage Index..............................       x 0.987         x 1.234
                                         -------------------------------
Wage Adjusted Amount....................   $14,270.69      $17,841.97
Non-Labor Amount........................   + 5,513.24      + 5,513.24
                                         -------------------------------
Wage Adjusted Federal Payment...........   $19,783.93      $23,355.21
Rural Adjustment........................       x 1.1914        x 1.0000
                                         -------------------------------
Subtotal................................   $23,570.57      $23,355.21
LIP Adjustment..........................       x 1.0239        x 1.070
                                         -------------------------------
    Total Adjusted Federal Prospective     $24,133.91      $24,990.08
     Payment............................
------------------------------------------------------------------------

    12. On page 41367, first column, second paragraph from the bottom, 
the dollar amount of ``$24,208.73'' is corrected to read ``$24,133.91'' 
and the dollar amount of ``$25,067.56'' is corrected to read 
``$24,990.08''.

Summary of Technical Corrections to the Regulations Text of the August 
7, 2001 Final Rule

Definition of a Discharge

    As stated in the previous section of this correcting amendment, we 
inadvertently failed to account for a patient that stops receiving 
Medicare-covered Part A inpatient rehabilitation services, but meets 
the condition, under Sec. 424.13(b), for continued hospitalization in 
defining a discharge in Sec. 412.602 of the final rule.

[[Page 44076]]

Specifically, under Sec. 424.13(b), a physician may certify or 
recertify the need for continued hospitalization if the physician finds 
that the patient could receive proper treatment in a skilled nursing 
facility (SNF) but no bed is available in a participating SNF. To 
account for a patient who meets the requirement at Sec. 424.13(b), we 
are correcting the second definition of a discharge on page 41388 under 
Sec. 412.602 to read as follows: ``The patient stops receiving 
Medicare-covered Part A inpatient rehabilitation services, unless the 
patient qualifies for continued hospitalization under Sec. 424.13(b) of 
this chapter''. This correction does not affect the criteria, under 
Sec. 412.610(c)(2)(ii), to determine the discharge assessment reference 
date.

Criteria To Be Classified as an IRF

    Our clearly stated intention in the preambles of both the November 
3, 2000 proposed rule (65 FR 66304) and the final rule, was not to 
change the existing general criteria to be excluded from the acute care 
hospital prospective payment system (Sec. 412.22), or the specific 
criteria to be classified as an excluded rehabilitation hospital or 
rehabilitation unit (Secs. 412.23, 412.25, 412.29, and 412.30) under 
subpart B of part 412 of the regulation. In Sec. 412.604(b) on page 
41388, we inadvertently failed to include reference to the general 
exclusion criteria under Sec. 412.22 as a condition to be paid under 
the IRF PPS. In this document, we are correcting Sec. 412.604(b) to 
state that subject to the special payment provisions of Sec. 412.22(c), 
an inpatient rehabilitation facility must meet the general criteria of 
Sec. 412.22 and the criteria to be classified as a rehabilitation 
hospital or rehabilitation unit set forth in Secs. 412.23(b), 412.25, 
and 412.29 for exclusion from the inpatient hospital prospective 
payment systems specified in Sec. 412.1(a)(1).

Assessment Process for Interrupted Stays

    We are making several technical corrections to Sec. 412.618(c), on 
pages 41390 to 41391, which describes the ``Revised assessment 
schedule'' when an interruption of a stay occurs. The corrections we 
are making to Sec. 412.618(c) conform the policies regarding the 
assessment process for interrupted stays to those stated in the 
corrected preamble to the regulation text.
    Section 412.618(c)(1) of the final rule states that, ``If the 
interruption in the stay occurs before the admission assessment, the 
assessment reference date, completion dates, encoding dates, and data 
transmission dates for the admission and discharge assessments are 
advanced by the same number of calendar days as the length of the 
patient's interruption in the stay.'' The phrase ``occurs before the 
admission assessment'' is incorrect because an interruption of a stay 
affects the admission assessment schedule only if the interruption 
occurs during, not before, the admission assessment time period. 
Specifically, an interruption of a stay that occurs ``during the 
admission assessment time period'' results in a shifting of the 
relevant assessment schedule dates. We are correcting the phrase 
``occurs before the admission assessment'' to read ``occurs during the 
admission assessment time period'' to accurately reflect when an 
interruption in a stay affects the assessment schedule as indicated in 
our policy described in the corrected preamble. In addition, the phrase 
``data transmission dates'' in Sec. 412.618(c)(1) of the final rule is 
incorrect because, as discussed earlier in this correcting amendment, 
an interruption of a stay does not affect the date of transmitting the 
assessment data. Specifically, the date to transmit admission and 
discharge assessment data together is based solely on the day that the 
patient is discharged. Thus, an interruption of a stay will not impact 
the data transmission date. We are correcting Sec. 412.618(c)(1) to 
remove the reference to the ``data transmission dates'' and, thus, 
conform the regulations text to the corrected preamble.
    Section 412.618(c)(2) of the final rule states that, ``If the 
interruption of the stay occurs after the admission assessment and 
before the discharge assessment, the completion date, encoding date, 
and data transmission date for the admission assessment are advanced by 
the same number of calendar days as the length of the patient's 
interruption in the stay.'' Under Sec. 412.610(c)(1), the admission 
assessment schedule can only be established after the admission 
assessment time period is known. If an interruption of a stay occurs 
after the admission assessment time period (and before the discharge 
assessment), the admission assessment schedule, which has already been 
established, cannot be revised, contrary to what was incorrectly 
indicated in Sec. 412.618(c)(2) of the final rule. Since the situation 
specified in Sec. 412.618(c)(2) would never result in a revised 
assessment schedule, we are correcting Sec. 412.618 by eliminating 
Sec. 412.618(c)(2).
    In summary, to conform the regulations text to the policy in the 
corrected preamble, Sec. 412.618(c)(2) is removed, and the regulations 
text in formerly designated paragraph (c)(1) becomes paragraph (c), 
``Revised assessment schedule.'' The corrected text of Sec. 412.618(c) 
reads, ``If the interruption in the stay occurs during the admission 
assessment time period, the assessment reference date, completion date, 
and encoding date for the admission assessment are advanced by the same 
number of calendar days as the length of the patient's interruption in 
the stay.''

Special Payment Provision for Interrupted Stays

    On page 41356 of the preamble of the final rule, we responded to a 
request to clarify how services during an interrupted stay would be 
paid if a beneficiary is discharged from the IRF to an acute care 
hospital. In our response to this comment, we stated that, under 
Sec. 412.624(g), there would be no separate diagnostic related group 
(DRG) payment to the acute care hospital when the beneficiary is 
``discharged and returns to the same IRF on the same day''. However, 
Sec. 412.624(g)(1) incorrectly states that this provision applies to a 
patient with an ``interruption of one day or less''. Therefore, in 
order to conform the regulations text to the policy as stated in the 
preamble, we are correcting Sec. 412.624(g)(1) to apply to a patient 
who is discharged and returns to the same IRF on the same day. 
Additionally, in our response to this comment, we correctly stated the 
policy in the preamble that if a beneficiary receives inpatient acute 
care hospital services, the acute care hospital can receive a DRG 
payment if the beneficiary is ``discharged from the IRF and does not 
return to that IRF by the end of that same day''. However, 
Sec. 412.624(g)(2) in the final rule incorrectly states that this 
provision applies to a patient with an ``interruption of more than one 
day''. To conform the regulation text to the correction to 
Sec. 412.624(g)(1) above and to the policy as stated in the preamble, 
we are correcting Sec. 412.624(g)(2) to apply to a patient who is 
discharged and does not return to the same IRF on the same day.

Waiver of Proposed Rulemaking

    We ordinarily publish a correcting amendment of proposed rulemaking 
in the Federal Register to provide a period for public comment before 
the provisions of a correcting amendment such as this can take effect. 
We can waive this procedure, however, if we find good cause that a 
notice and comment procedure is impracticable, unnecessary, or contrary 
to the public interest and incorporate a statement of

[[Page 44077]]

finding and its reasons in the correcting amendment issued.
    We find for good cause that it is unnecessary to undertake notice 
and public comment procedures because this correcting amendment does 
not make any substantive policy changes. This document makes technical 
corrections and conforming changes to the August 7, 2001 final rule. 
Therefore, for good cause, we waive notice and public comment 
procedures under 5 U.S.C. 553(b)(B).

List of Subjects

42 CFR Part 412

    Administrative practice and procedure, Health facilities, Medicare, 
Puerto Rico, Reporting and recordkeeping requirements.

42 CFR Part 413

    Health facilities, Kidney diseases, Medicare, Puerto Rico, 
Reporting and recordkeeping requirements.

    Accordingly, 42 CFR chapter IV is corrected by making the following 
correcting amendments:

PART 412--PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL 
SERVICES

    1. The authority citation for part 412 continues to read as 
follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh).


Sec. 412.602  [Amended]

    2. In Sec. 412.602, make the following corrections:
    a. In the introductory text of the definition of ``Discharge,'' 
correct the phrase ``a inpatient'' to read ``an inpatient''.
    b. In the definition of ``Discharge'', paragraph (2) is revised to 
read as follows:


Sec. 412.602  Definitions.

* * * * *
    Discharge. * * *
    (2) The patient stops receiving Medicare-covered Part A inpatient 
rehabilitation services, unless the patient qualifies for continued 
hospitalization under Sec. 424.13(b) of this chapter; or
* * * * *


Sec. 412.604  [Amended]

    3. In Sec. 412.604, make the following corrections:
    a. In paragraph (b), add the phrase ``general criteria set forth in 
Sec. 412.22 and the'' before the word ``criteria''.
    b. In paragraph (e)(1)(i), remove the closed parentheses after the 
word ``basis''.
    c. In paragraph (e)(1)(iii), remove the ``s'' from 
``practitioners''.


Sec. 412.610  [Amended]

    4. In Sec. 412.610, in paragraph (c)(2)(ii)(A), remove the 
abbreviation ``IRF'', and in its place, add the phrase ``inpatient 
rehabilitation facility''.


Sec. 412.618  [Amended]

    5. In Sec. 412.618, revise paragraph (c) to read as follows:


Sec. 412.618  Assessment process for interrupted stays.

* * * * *
    (c) If the interruption in the stay occurs during the admission 
assessment time period, the assessment reference date, completion date, 
and encoding date for the admission assessment are advanced by the same 
number of calendar days as the length of the patient's interruption in 
the stay.


Sec. 412.624  [Amended]

    6. In Sec. 412.624, make the following corrections:
    a. In paragraph (a)(1), remove the phrase ``under this subchapter'' 
and in its place, add the phrase ``of this subchapter''.
    b. In paragraph (c)(4), remove the phrase ``is the product'' and in 
its place, add the phrase ``are the product''.
    c. In paragraph (e)(4), in the first sentence, remove the ``s'' 
from the word ``exceeds''.
    d. Revise paragraph (g)(1) and the introductory text of paragraph 
(g)(2) to read as set forth below:


Sec. 412.624  Methodology for calculating the Federal prospective 
payment rates.

* * * * *
    (g) * * *
    (1) Patient is discharged and returns on the same day. Payment for 
a patient who is discharged and returns to the same inpatient 
rehabilitation facility on the same day will be the adjusted Federal 
prospective payment under paragraph (e) of this section that is based 
on the patient assessment data specified in Sec. 412.618(a)(1). Payment 
for a patient who is discharged and returns to the same inpatient 
rehabilitation facility on the same day will only be made to the 
inpatient rehabilitation facility.
    (2) Patient is discharged and does not return by the end of the 
same day. Payment for a patient who is discharged and does not return 
on the same day but does return to the same inpatient rehabilitation 
facility by or on midnight of the third day, defined as an interrupted 
stay under Sec. 412.602, will be--
* * * * *


Sec. 412.626  [Amended]

    7. In Sec. 412.626, make the following corrections:
    (a) In paragraph (b)(1), remove the acronym ``IRF'' and in its 
place, add the phrase ``inpatient rehabilitation facility''.
    (b) In paragraph (b)(2), in the last sentence, remove the word, 
``or'', and in its place, add the phrase, ``timely or is otherwise''.

PART 413--PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR 
END-STAGE RENAL DISEASE SERVICES;

PROSPECTIVELY DETERMINED PAYMENT FOR SKILLED NURSING FACILITIES

    1. The authority citation for part 413 continues to read as 
follows:

    Authority: Secs. 1102, 1812(d), 1814(b), 1815, 1833(a), (i) and 
(n), 1861(v), 1871, 1881, 1883, and 1886 of the Social Security Act 
(42 U.S.C. 1302, 1395d(d), 1395f(b), 1395g, 1395l(a), (i), and (n), 
1395x(v), 1395hh, 1395rr, 1395tt, and 1395ww).


Sec. 413.1  [Amended]

    2. In Sec. 413.1, in paragraph (d)(2)(iv), after the word ``is'', 
add the word ``made''.

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance)

    Dated: June 26, 2002.
Ann Agnew,
Executive Secretary to the Department.
[FR Doc. 02-16476 Filed 6-28-02; 8:45 am]
BILLING CODE 4120-01-P