[Federal Register Volume 68, Number 45 (Friday, March 7, 2003)]
[Rules and Regulations]
[Pages 10987-10988]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-5360]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 412

[CMS-1177-F2]
RIN 0938-AK69


Medicare Program; Prospective Payment System for Long-Term Care 
Hospitals: Implementation and FY 2003 Rates; Correcting Amendment

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

ACTION: Final rule; correcting amendment.

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SUMMARY: In the August 30, 2002 issue of the Federal Register (67 FR 
55954), we published a final rule for the Prospective Payment System 
for Long Term Care Hospitals. The effective date was October 1, 2002. 
This correcting amendment corrects a limited number of technical and 
typographical errors identified in the August 30, 2002 final rule.

EFFECTIVE DATE: This correcting amendment is effective March 7, 2003.

FOR FURTHER INFORMATION CONTACT: Tzvi Hefter, (410) 786-4487.

SUPPLEMENTARY INFORMATION:

Need for Corrections

    1. We redesignated Sec.  412.23(e)(2) as Sec.  412.23(e)(2)(ii) in 
the August 30, 2002 final rule, but failed to make a conforming change 
to existing Sec.  412.22(h)(3)(ii) of the Code of Federal Regulations 
(CFR) which contains a cite to Sec.  412.23(e)(2) instead of Sec.  
412.23(e)(2)(ii). This incorrect cite, if left uncorrected, would 
change our policy concerning satellite hospitals. In order to avoid 
this result, we are revising Sec.  412.22(h)(3)(ii), to reference Sec.  
412.23(e)(2)(ii).
    2. When we added Sec.  412.541(d)(1), we inadvertently omitted 
information on outlier payments. The regulation on interim payments for 
hospitals not receiving periodic interim payments under the long-term 
care hospital prospective payment system (LTCH PPS) was designed to 
conform with the interim payment regulation at Sec.  412.116(d) under 
the inpatient prospective payment system (IPPS). As it now reads, the 
paragraph misrepresents CMS outlier policy for the LTCH PPS by 
prohibiting LTCHs from including outliers on interim bills. As revised, 
instead of prohibiting appropriate outlier payments for Medicare 
patients with unusually long lengths of stay, this regulation will now 
conform to the regulation at Sec.  412.116(d) and allow appropriate 
outlier payments. Section 412.541(d)(1) is revised by deleting the last 
sentence and replacing it with the following: ``Payment for the interim 
bill is determined as if the bill were a final discharge bill and 
includes any outlier payment determined as of the last day for which 
services have been billed.''
    3. In the August 30, 2002 final rule, we incorrectly stated two 
wage index amounts for MSA 3810 in Table 1 on page 56065 of the rule. 
On page 56065 in the third column (Full wage index) of Table 1, the 
figure 0.8513 is corrected to read 0.9794. On page 56065 in the fourth 
column (\1/5\ wage index) of Table 1, the figure 0.9703 is corrected to 
read 0.9959. We established in the August 30, 2002 final rule (67 FR 
56018) for the LTCH PPS that the wage data used in calculations for the 
wage index would be computed based on the same data used by inpatient 
acute care hospital prospective payment system (IPPS). Wage index 
values published in the IPPS final rule on August 1, 2002 (67 FR 50155, 
50199, and 50217) have been determined to be incorrect. On September 
30, 2002, a program memorandum (Transmittal A-02-092) set forth the 
correct values and presently a correction notice is being prepared for 
publication for the IPPS wage index values. Since the IPPS data upon 
which the LTCH wage index for MSA 810 is based has been corrected, this 
data change would necessarily require a correction in the LTCH wage 
index for MSA 3810. Publishing this correction provides the accurate 
wage index adjustment factor under the LTCH PPS that will disclose to 
providers in this metropolitan statistical area (MSA) how this 
adjustment will affect their payments.

Correction of Errors in the Preamble of August 30, 2002 Final Rule

    1. On page 56065 in the third column (Full wage index) of Table 1, 
the figure 0.8513 is corrected to read 0.9794.
    2. On page 56065 in the fourth column (\1/5\ wage index) of Table 
1, the figure 0.9703 is corrected to read 0.9959.

Summary of Technical Corrections to the Regulations Text of the August 
30, 2002 Final Rule

    1. In the August 30, 2002 final rule, we redesignated Sec.  
412.23(e)(2) as Sec.  412.23(e)(2)(ii), but did not make a conforming 
change to Sec.  412.22(h)(3)(ii). Presently, Sec.  412.22(h)(3)(ii) 
cites Sec.  412.23(e)(2) instead of Sec.  412.23(e)(2)(ii). This error, 
which appears to change our policy concerning satellite hospitals, is 
corrected by revising Sec.  412.22(h)(3)(ii), to reference Sec.  
412.23(e)(2)(ii).
    2. In the August 30, 2002 final rule (67 FR 56055), we 
inadvertently omitted part of a sentence in Sec.  412.541(d)(1). 
Presently, the sentence reads as ``Payment for the interim bill is 
determined as if the bill were a final discharge bill'' but does not 
address outlier payments. This regulation was designed to conform with 
the policy on billing for outliers on an interim bill of the IPPS, in 
Sec.  412.116(d). The last sentence of Sec.  412.541(d)(1) is revised 
to read as follows: ``Payment for the interim bill is determined as if 
the bill were a final discharge bill and includes any outlier payment 
determined as of the last day for which services have been billed.''

Waiver of Proposed Rulemaking and Effective Date

    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 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 30, 2002 final rule 
(67 FR 55954). Therefore, for good cause, we waive notice and public 
comment procedures under 5 U.S.C. 553(b)(B). In

[[Page 10988]]

addition, since these corrections make no substantive policy changes, 
LTCHs would not require additional time to prepare to implement these 
items. Therefore, for good cause, we find it unnecessary to delay the 
effective date for the changes in this correcting amendment. 
Consequently, we waive the 30-day delay in effective date for this 
correcting amendment.

List of Subjects in 42 CFR Part 412

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

    42 CFR chapter IV part 412 is amended as set forth below:

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).


    2. Section 412.22 is amended by revising paragraph (h)(3)(ii) to 
read as follows:


Sec.  412.22  [Amended]

* * * * *
    (h) Satellite facilities. * * *
    (3) * * *
    (ii) Any hospital excluded from the prospective payment systems 
under Sec.  412.23(e)(2)(ii).
* * * * *


Sec.  412.541  [Amended]

    3. Section 412.541 is amended by revising the the final sentence of 
paragraph (d)(1) to read as follows:
* * * * *
    (d) * * *
    (1) * * * Payment for the interim bill is determined as if the bill 
were a final discharge bill and includes any outlier payment determined 
as of the last day for which services have been billed.
* * * * *

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

    Dated: March 3, 2003.
Ann Agnew,
Executive Secretary to the Department.
[FR Doc. 03-5360 Filed 3-6-03; 8:45 am]
BILLING CODE 4120-01-P