[Federal Register Volume 73, Number 193 (Friday, October 3, 2008)]
[Rules and Regulations]
[Pages 57541-57543]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-23082]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 411, 412, 413, 422, and 489
[CMS-1390-CN; CMS-1531-CN; CMS-1385-CN2]
RIN 0938-AP15; RIN 0938-AO35; RIN 0938-AO65
Medicare Program; Changes to the Hospital Inpatient Prospective
Payment Systems and Fiscal Year 2009 Rates; Payments for Graduate
Medical Education in Certain Emergency Situations; Changes to
Disclosure of Physician Ownership in Hospitals and Physician Self-
Referral Rules; Updates to the Long-Term Care Prospective Payment
System; Updates to Certain IPPS-Excluded Hospitals; and Collection of
Information Regarding Financial Relationships Between Hospitals;
Correction
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Correction of final rules.
-----------------------------------------------------------------------
SUMMARY: This document corrects technical and typographical errors that
appeared in the final rule published in the Federal Register on August
19, 2008, entitled ``Medicare Program; Changes to the Hospital
Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates;
Payments for Graduate Medical Education in Certain Emergency
Situations; Changes to Disclosure of Physician Ownership in Hospitals
and Physician Self-Referral Rules; Updates to the Long-Term Care
Prospective Payment System; Updates to Certain IPPS-Excluded Hospitals;
and Collection of Information Regarding Financial Relationships Between
Hospitals.''
DATES: Effective Date: Except for the items listed in section IV.B.3.a.
through e. of this notice, the items listed in this correction notice
are effective on October 1, 2008. The items listed in section IV.B.3.a.
through e. of this notice are effective on October 1, 2009.
FOR FURTHER INFORMATION CONTACT: Tzvi Hefter (410) 786-4487,
Corrections to the preamble and addendum. Donald Romano, (410) 786-1401
or Lisa Ohrin, (410) 786-4565, Corrections to the regulations text for
part 411.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. E8-17914 of August 19, 2008 (73 FR 48434), the final
rule entitled Medicare Program; Changes to the Hospital Inpatient
Prospective Payment Systems and Fiscal Year 2009 Rates; Payments for
Graduate Medical Education in Certain Emergency Situations; Changes to
Disclosure of Physician Ownership in Hospitals and Physician Self-
Referral Rules; Updates to the Long-Term Care Prospective Payment
System; Updates to Certain IPPS-Excluded Hospitals; and Collection of
Information Regarding Financial Relationships Between Hospitals''
(hereinafter referred to as the FY 2009 IPPS final rule) there were a
number of technical and typographical errors that are identified and
corrected in the Correction of Errors section below. We note that the
FY 2009 IPPS final rule had several effective dates (see 73 FR 48343);
and therefore, we are conforming the effective dates of the items
listed in this notice with the effective dates specified in the FY 2009
IPPS final rule.
II. Summary of Errors
A. Errors in the Preamble
On page 48434, in the effective dates section of the final rule, we
specified that Sec. 411.357(p)(1)(i)(A) and (B) are effective on
October 1, 2009. However, we made a technical error in codifying these
paragraphs (see sections II.B. and IV.B.3.e.(B). of this notice). To
ensure that the cross-reference is consistent with the regulations in
Sec. 411.357(p), we are correcting the cross-reference in section
IV.A.1 of this notice.
On pages 48491, 48497, and 48773, we made inadvertent typographical
errors in two figures and a date. We correct these errors in section
IV.A.2, 3, and 8 of this notice.
On page 48509, we stated that we were finalizing several codes and
that these codes will be added to the MCE edit for males only. However,
through an inadvertent error the codes were not included in the final
FY 2009 MCE edits. Therefore, in section IV.A.4. of this notice, we
correct this discussion by adding language to note that the codes for
MCE edit for males only will be added to the MCE codes for FY 2010.
On page 48566, we discuss the analysis conducted by Acumen
comparing MedPAC's recommended wage indices to the current CMS wage
index. In section IV.A.5 of this notice, we correct this discussion by
adding a parenthetical statement to clarify that the wage index data
that we provided did not include the effects of sections 505 and 508 of
the Medicare Prescription Drug, Improvement, and Modernization Act of
2003 (MMA).
On page 48646, we discuss the deadline for submission of emergency
Medicare graduate medical education (GME) affiliation agreements. In
our example, we incorrectly stated the date by which hospitals are
permitted to submit an emergency Medicare GME Affiliation agreement for
the period from March 1, 2009, to June 30, 2009, and the period from
July 1, 2009, to June 30, 2010. The dates referenced were August 28,
2009, and August 28, 2010, respectively. In section IV.A.6 of this
correction notice, we corrected these inadvertent errors.
On page 48648, we discuss the rolling average and cap adjustments
for FTE residents. In this discussion, we incorrectly stated that FTE
residents training in new teaching hospitals and in new residency
programs at existing teaching hospitals are excluded from the rolling
average for the minimum accredited length of the program. In section
IV.A.7. of this notice, we have corrected this error by revising this
sentence to clarify that, in accordance with the regulations at Sec.
413.79(d)(5), the exclusion from the rolling average applies for new
programs that qualify for the cap adjustment under Sec. 413.79(e).
[[Page 57542]]
B. Errors in the Regulation Text
On page 48751, in the regulations text for Sec. 411.353(c)(1)(ii)
and (iii) and (g)(1), we made grammatical and typographical errors. We
are correcting these errors in section IV.B.1. of this notice.
On page 48752, in the regulations text for Sec. 411.354(c)(1)(ii),
we inadvertently omitted the quotation marks for the phrase ``stand in
the shoes''. In section IV.B.2. of this notice, we are correcting this
error.
On pages 48752 and 48753, in the regulations text for Sec.
411.357, we note the following errors:
In paragraphs (a)(5)(ii)(B), (b)(4)(ii)(B), (l)(3)(ii),
and (p)(1)(i)(B) regarding rental of office space, rental of equipment,
fair market value compensation, and indirect compensation arrangements,
respectively, we inadvertently included the phrase ``between the
parties'' instead of the phrase ``by the lessor to the lessee''.
Therefore, our regulations text for these paragraphs do not accurately
reflect our policy in the FY 2009 IPPS final rule (see 73 FR 48713
through 48714). We are correcting these errors in section IV.B.3., a.,
c., d., and e.D. of this notice.
In paragraph (b)(4)(ii)(A) regarding rental changes, we
made a grammatical error in using the term ``by'' instead of
``through''. We are correcting this error in section IV.B.3.b. of this
notice.
In paragraph (p)(1)(i), we inadvertently included the last
sentence as part of this paragraph instead of making that sentence the
beginning of paragraph (p)(1)(ii). In section IV.B.3.e.B.., we are
correcting this error by redesignating this language as paragraph
(p)(1)(ii).
In paragraph (p)(1)(i)(A) (redesignated as paragraph
(p)(1)(ii)(A)) (see section IV.B.3.e.C. of this notice) regarding
compensation for the rental of office space or equipment, we
inadvertently omitted the term ``on'' from the phrase ``performed or
business generated through''. We are correcting this omission in
section III.B.3.e.(3). of this notice.
In paragraphs (p)(1)(ii) and (iii), we inadvertently
included regulatory text that also appears in paragraphs (p)(2) and (3)
and is applicable to paragraph (p) in its entirety. In section
IV.B.3.e.A. of this notice, we are correcting these errors by removing
paragraphs (p)(1)(ii) and (iii).
In paragraph (r)(2)(ii) regarding remuneration of
obstetrical malpractice insurance subsidies, we made grammatical errors
when using the term ``payments''. In section IV.B.3.f.A. of this
notice, we are correcting the term to read ``payment''.
In paragraph (r)(3)(ii)(B) regarding the cost of
malpractice insurance premiums, we inadvertently included the phrase
``rural area or'' which does not conform to the policy in the FY 2009
IPPS final rule (see 73 FR 48734). In section IV.B.3.f.B. of this
notice, we are correcting this error by removing the phrase.
C. Errors in the Addendum
On pages 48827 and 48881, in Tables 2 and 3, we had erroneous wage
data for provider number 300005 and rural New Hampshire, respectively.
Therefore, we are correcting these errors in sections IV.C.1. and 2. of
this notice. We note that the corrections to the wage data for the New
Hampshire provider specified in this notice are consistent with our
regulations at 42 CFR 412.64(k)(2)(ii). We also note that wage data
corrections for this provider are also reflected in the FY 2009 final
rates, wage indices, budget neutrality factors and tables included in
the notice subsequent to the FY 2009 IPPS final rule published
elsewhere in this Federal Register.
On pages 49044, 49046, and 49060, we made technical errors in the
MS-LTC-DRG titles for several MS-LTC-DRGs (that is, MS-LTC-DRGs 154
through 156, 250, 251 and 864). We need to correct these titles so that
they are consistent with the MS-DRG titles presented in Table 5 of the
FY 2009 IPPS final rule since the patient classification system
utilized under the LTCH PPS uses the same diagnosis-related groups
(DRGs) as those used under the IPPS. Therefore, we are correcting these
errors in section IV.C.3. of this notice.
III. Waiver of Proposed Rulemaking and Delay in Effective Date
We ordinarily publish a notice of proposed rulemaking in the
Federal Register to provide a period for public comment before the
provisions of a rule take effect in accordance with section 553(b) of
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we
can waive this notice and comment procedure if the Secretary finds, for
good cause, that the notice and comment process is impracticable,
unnecessary, or contrary to the public interest, and incorporates a
statement of the finding and the reasons therefore in the notice.
Section 553(d) of the APA ordinarily requires a 30-day delay in
effective date of final rules after the date of their publication in
the Federal Register. This 30-day delay in effective date can be
waived, however, if an agency finds for good cause that the delay is
impracticable, unnecessary, or contrary to the public interest, and the
agency incorporates a statement of the findings and its reasons in the
rule issued. Therefore, we are waiving proposed rulemaking and the 30-
day delayed effective date for the technical corrections in this
notice. This notice merely corrects typographical and technical errors
in the preamble, regulations text, and addendum of the FY 2009 IPPS
final rule and does not make substantive changes to the policies or
payment methodologies that were adopted in the final rule. As a result,
this notice is intended to ensure that the FY 2009 IPPS final rule
accurately reflects the policies adopted in the final rule. Therefore,
we find that undertaking further notice and comment procedures to
incorporate these corrections into the final rule or delaying the
effective date of these changes is unnecessary and contrary to the
public interest.
IV. Correction of Errors
In FR Doc. E8-17914 of August 19, 2008 (73 FR 48434), make the
following corrections:
A. Corrections to the Preamble
1. On page 48434, second column, third full paragraph, line 8, the
cross-reference ``(p)(1)(i)(A) and (B)'' is corrected to read
``(p)(1)(ii)''.
2. On page 48491, top half of the page, in the untitled table,
second column (CC/MCC (ICD-9-CM codes)), line 25, the figures ``81.31-
81.83'' are corrected to read ``81.31-81.38''.
3. On page 48497, first column, fourth full paragraph, last line,
the phrase ``October 1, 2009'' is corrected to read ``October 1,
2008''.
4. On page 48509, first column, fifth full paragraph, last line is
corrected by adding the following sentences:
``However, there was an inadvertent omission of these codes from
the MCE product. Therefore, we will add these codes in the MCE for FY
2010.''
5. On page 48566, third column, first full paragraph, line 11,
after the phrase ``FY 2007.'' and before the word ``Acumen's'', the
text is corrected by adding the following parenthetical sentence:
``(Note that the CMS final wage index Acumen analyzed excludes or
removes the effects of sections 505 and 508 of MMA.)''
6. On page 48646, first column, first paragraph
a. Line 36, the date ``August 28, 2009'' is corrected to read
``December 29, 2009''.
b. Line 43, the date ``August 28, 2010'' is corrected to read
``December 29, 2010''.
[[Page 57543]]
7. On page 48648, third column, first paragraph, line 7, the
sentence ``However, FTE residents training in new teaching hospitals
and in new residency programs at existing teaching hospitals are
excluded from the rolling average for the minimum accredited length of
the program (dental and podiatry residents are always exempt from the
rolling average.'' is corrected to read ``However, FTE residents
training in new residency training programs that qualify for cap
adjustments under Sec. 413.79(e) are excluded from the rolling average
for the minimum accredited length of the program.''
8. On page 48773, second column, last paragraph, line 8, the figure
``0.09'' is corrected to read ``0.9''.
B. Corrections to the Regulation Text
Sec. 411.353 [Corrected]
0
1. Section 411.353 is corrected by--
0
a. On page 48751, in the second column, in paragraphs (c)(1)(ii) and
(iii), removing the second and third commas.
0
b. On the same page, in the third column, in paragraph (g)(1)(i),
removing the word ``complied' and adding the word ``complies'' in its
place.
0
c. On same page in the same column, in paragraph (g)(1)(ii)(A),
removing the phrase ``Inadvertent, and the parties obtain the required
signature(s) within 90 consecutive calendar days immediately following
the date on which the compensation arrangement becomes'' and adding the
phrase ``Inadvertent and the parties obtain the required signature(s)
within 90 consecutive calendar days immediately following the date on
which the compensation arrangement became'' in its place.
0
d. On the same page, in the same column, in paragraph (g)(1)(ii)(B),
removing the phrase ``Not inadvertent, and the parties obtain the
required signature(s) within 30 consecutive calendar days immediately
following the date on which the compensation arrangement becomes'' and
adding the phrase ``Not inadvertent and the parties obtain the required
signature(s) within 30 consecutive calendar days immediately following
the date on which the compensation arrangement became'' in its place.
Sec. 411.354 [Corrected]
0
2. On page 48752, in the first columne, Sec. 411.354(c)(1)(ii)
introductory text is corrected by adding quotation marks to the phrase
``stand in the shoes''.
Sec. 411.357 [Corrected]
0
3. Section 411.357 is corrected by--
0
a. On page 45752, in the third column, in paragraph (a)(5)(ii)(B),
removing the phrase ``between the parties'' and adding the phrase ``by
the lessor to the lessee'' in its place.
0
b. On the same page, in the same column, in paragraph (b)(4)(ii)(A),
removing the word ``by'' and adding the word ``through'' in its place.
0
c. On the same page, in the same column, in paragraph (b)(4)(ii)(B),
removing the phrase ``between the parties'' and adding the phrase ``by
the lessor to the lessee'' in its place.
0
d. On page 48753, in the first column, in paragraph (l)(3)(ii),
removing the phrase ``between the parties'' and adding the phrase ``by
the lessor to the lessee'' in its place.
0
e. On the same page, in the second column, in paragraph (p)(1)--
0
A. Removing paragraphs (p)(1)(ii) and (iii).
0
B. Redesignating the last sentence of paragraph (p)(1)(i) as paragraph
(p)(1)(ii).
0
C. In newly redesignated paragraph (p)(1)(ii)(A), removing the phrase
``performed or business generated through'' and adding the phrase
``performed on or business generated through'' in its place.
0
D. In newly redesignated paragraph (p)(1)(ii)(B), removing the phrase
``between the parties'' and adding the phrase ``by the lessor to the
lessee'' in its place.
0
f. In paragraph (r)--
0
A. On the same page, in the third column, in paragraph (r)(2)(ii),
removing the phrase ``specifies the payments to be made by the
hospital, federally qualified health center, or rural health clinic and
the terms under which the payments are'' and adding the phrase
``specifies the payment to be made by the hospital, federally qualified
health center, or rural health clinic and the terms under which the
payment is'' in its place.
0
B. On page 48754, in the first column, in paragraph (r)(3)(ii)(B),
removing the phrase ``rural area or''.
C. Corrections to the Addendum
1. On page 48827, in Table 2.--Hospital Case-Mix Indexes for
Discharges Occurring in Federal Fiscal Year 2007; Hospital Wage Indexes
for Federal Fiscal Year 2009; Hospital Average Hourly Wages for Federal
Fiscal Years 2007 (2003 Wage Data), 2008 (2004 Wage Data), and 2009
(2005 Wage Data); and 3-Year Average of Hospital Average Hourly Wages,
the FY 2009 average hourly wage and the 3-year average hourly wage for
provider number 300005 are corrected to read as follows:
------------------------------------------------------------------------
Average Average
hourly hourly
Provider No. wage FY wage** (3
2009 \1\ years)
------------------------------------------------------------------------
300005.......................................... 28.2602 28.8266
------------------------------------------------------------------------
2. On page 48881, in Table 3B.--FY 2009 and 3-Year* Average Hourly
Wage for Rural Areas by CBSA, the FY 2009 Average Hourly Wage and 3-
Year Average Hourly wage for the CBSA Code 30 are corrected to read as
follows:
------------------------------------------------------------------------
FY 2009 3-Year
average average
CBSA code Nonurban area hourly hourly
wage wage
------------------------------------------------------------------------
30................. New Hampshire.............. 33.1415 32.7814
------------------------------------------------------------------------
3. On pages 49044, 49046, and 49060, in Table 11.--FY 2009 MS-LTC-
DRGs, Relative Weights, Geometric Average Length of Stay, and Short-
Stay Outlier (SSO) Threshold, the MS-LTC-DRGs titles for the listed MS-
LTC-DRGs are corrected as follows:
------------------------------------------------------------------------
MS-LTC-DRG MS-LTC-DRG Title
------------------------------------------------------------------------
154............................... Other ear, nose, mouth, and throat
diagnoses w MCC.
155............................... Other ear, nose, mouth, and throat
diagnoses w CC.
156............................... Other ear, nose, mouth, and throat
diagnoses w/o CC/MCC.
250............................... Perc cardiovasc proc w/o coronary
artery stent w MCC.
251............................... Perc cardiovasc proc w/o coronary
artery stent w/o MCC.
864............................... Fever.
------------------------------------------------------------------------
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: September 25, 2008.
Ann C. Agnew,
Executive Secretary to the Department.
[FR Doc. E8-23082 Filed 9-29-08; 11:15 am]
BILLING CODE 4120-01-P