[Federal Register Volume 74, Number 189 (Thursday, October 1, 2009)]
[Rules and Regulations]
[Pages 50712-50713]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-23708]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 412

[CMS-1538-CN]
RIN 0938-AP56


Medicare Program; Inpatient Rehabilitation Facility Prospective 
Payment System for Federal Fiscal Year 2010; Correction

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

ACTION: Correction of final rule.

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SUMMARY: This document corrects technical errors that appeared in the 
final rule published in the Federal Register on August 7, 2009 entitled 
``Inpatient Rehabilitation Facility Prospective Payment System for 
Federal Fiscal Year 2010'' (74 FR 39762).

DATES: Effective Date. The correction to the average length of stay 
value for CMG 0501, tier 2, in Table 1 on page 39768 of the final rule 
(74 FR 39762) is effective October 1, 2009. The correction to the 
preamble text at the top of the middle column of page 39791 of the 
final rule (74 FR 39762) is effective January 1, 2010.

FOR FURTHER INFORMATION CONTACT: Susanne Seagrave, (410) 786-0044.

SUPPLEMENTARY INFORMATION:

I. Background

    In FR Doc. E9-18616 of August 7, 2009 (74 FR 39762), there are 
technical errors that we are identifying and correcting in the 
Correction of Errors section below. The corrections in this notice are 
effective as if they were included in the final rule published on 
August 7, 2009. Accordingly, the correction to the average length of 
stay value for CMG 0501, tier 2, in Table 1 on page 39768 of the final 
rule (74 FR 39762) is effective October 1, 2009. This change is 
applicable for IRF discharges occurring on or after October 1, 2009 and 
on or before September 30, 2010 (FY 2010). The correction to the 
preamble text at the top of the middle column of page 39791 of the 
final rule is effective January 1, 2010.

II. Summary of Errors

    In the August 7, 2009 final rule (74 FR 39762), the average length 
of stay value for CMG 0501, tier 2, in Table 1 on page 39768 should 
have been listed as 10, but was inadvertently listed as 0. In the FY 
2010 IRF PPS proposed rule (74 FR 21052 at 21057), we proposed the 
average length of stay value for CMG 0501, tier 2, as 10. The proposal 
was based on FY 2007 IRF claims data, which was the most recent 
available data we had at the time. The updated FY 2008 data that we 
used for the final rule contained no IRF cases for CMG 0501, tier 2. 
When there are not enough cases in a particular CMG and tier (referred 
to herein as a ``payment group'') to calculate an average length of 
stay, we combine the cases in that payment group with the next highest-
paying payment group to calculate an average length of stay value. 
Accordingly, for the final rule, we used the average length of stay 
value of 10 from CMG 0501, tier 1 for CMG 0501, tier 2, but in Table 1 
we inadvertently indicated a value of 0 instead of 10. Thus, we are 
correcting Table 1 to show the average length of stay value for CMG 
0501, tier 2, is 10.
    In addition, we are correcting certain language in the preamble 
that could be misread, resulting in confusion with the regulatory 
requirements that must be met with respect to the preadmission 
screening required under Sec.  412.622(a)(4)(A). Section 
412.622(a)(4)(A) requires that the comprehensive preadmission screening 
be conducted by a licensed or certified clinician(s) designated by the 
rehabilitation physician described in Sec.  412.622(a)(3(iv) within 48 
hours immediately preceding the IRF admission. Our policy is that the 
IRF personnel conducting the screening must be a clinician or group of 
clinicians who are appropriately trained and qualified to assess the 
patient's medical and functional status, assess the risk for clinical 
and rehabilitation complications, and assess other aspects of the 
patient's condition both medically and functionally. As we stated in 
the final rule, we do not believe that non-clinical personnel can 
adequately perform these assessments. In the final rule (74 FR 39791), 
we stated that, ``* * * we believe that the IRF personnel involved in 
collecting the information for the preadmission screening must be 
appropriately trained and qualified to assess the patient's medical and 
functional status, assess the risk for clinical and rehabilitation 
complications, and assess other aspects of the patient's condition both 
medically and functionally'' (emphasis added). As the discussion in 
which this sentence was embedded only pertained to clinical staff 
assessments under Sec.  412.622(a)(4)(A), we should have utilized 
terminology that referenced ``clinical staff'' and ``assessment,'' not 
``IRF personnel'' and ``collecting.'' Consistent with the discussion in 
which the statement appears, we meant to convey that the IRF clinical 
staff conducting the preadmission screening must be trained and 
qualified to make the appropriate assessments. The appropriate use of 
non-clinical staff in the collection of the information that is used in 
the Sec.  412.622(a)(4)(A) assessment is beyond the scope of the 
preamble discussion. Therefore, to eliminate any confusion, we are 
revising the sentence in the middle column at the top of page 39791 of 
the final rule to read, ``* * * we believe that the clinician(s) 
conducting the preadmission screening must be appropriately trained and 
qualified to assess the patient's medical and functional status, assess 
the risk for clinical and rehabilitation

[[Page 50713]]

complications, and assess other aspects of the patient's condition both 
medically and functionally.''

III. Correction of Errors

    In FR Doc. E9-18616 of August 7, 2009 (74 FR 39762), make the 
following corrections:

0
1. On page 39768, in Table 1, in CMG 0501, under ``Average length of 
stay,'' tier 2, the value ``0'' is corrected to read ``10.''
0
2. On page 39791, in column 2, in line 7 from the top, the phrase ``IRF 
personnel involved in collecting the information for,'' is corrected to 
read, ``clinician(s) conducting.''

IV. Waiver of Proposed Rulemaking and Delayed 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)). We also 
ordinarily provide a 30-day delay in the effective date of the 
provisions of a rule in accordance with section 553(d) of the APA (5 
U.S.C. 553(d)). However, we can waive both notice and comment 
procedures and the 30-day delay in effective date if the Secretary 
finds, for good cause, that such procedures are impracticable, 
unnecessary, or contrary to the public interest, and incorporates a 
statement of the finding and the reasons into the notice.
    The policies and payment methodology expressed in the FY 2010 IRF 
PPS final rule (74 FR 39762) have previously been subjected to notice 
and comment procedures. This correction notice provides technical 
corrections to the FY 2010 final rule that was promulgated through 
notice and comment rulemaking, and does not make substantive changes to 
the policies or payment methodologies that were expressed in the final 
rule. Therefore, we find it unnecessary to undertake further notice and 
comment procedures with respect to this correction notice. We also 
believe that it is in the public interest (and would be contrary to the 
public interest to do otherwise) to waive notice and comment procedures 
and the 30-day delay in effective date for this notice. This correction 
notice is intended to ensure that the FY 2010 final rule accurately 
reflects the policies expressed in the final rule, and that the correct 
information is made available to the public prior to the effective 
dates of the final rule. Therefore, we find good cause to waive notice 
and comment procedures and the 30-day delay in the effective date for 
this correction notice.

(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, 2009.
Dawn L. Smalls,
Executive Secretary to the Department.
[FR Doc. E9-23708 Filed 9-30-09; 8:45 am]
BILLING CODE 4120-01-P