[Federal Register Volume 77, Number 205 (Tuesday, October 23, 2012)]
[Rules and Regulations]
[Pages 64755-64758]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-25975]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 412, 413, and 495

[CMS-0044-CN2]
RIN-0938-AQ84


Medicare and Medicaid Programs; Electronic Health Record 
Incentive Program--Stage 2; Corrections

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

ACTION: Final rule; correction.

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SUMMARY: This document corrects technical errors and typographical 
errors in the final rule entitled ``Medicare and Medicaid Programs; 
Electronic Health Record Incentive Program--Stage 2'' which appeared in 
the September 4, 2012 issue of the Federal Register.

DATES: Effective Date: This document is effective on November 12, 2012, 
except that the correction to instruction 8.NN (77 FR 54149) is 
effective October 23, 2012.

FOR FURTHER INFORMATION CONTACT: Travis Broome, (214) 767-4450.

SUPPLEMENTARY INFORMATION:

I. Background

    In FR Doc. 2012-21050 of September 4, 2012 (77 FR 53968), the final 
rule entitled ``Medicare and Medicaid Programs; Electronic Health 
Record Incentive Program--Stage 2'' there were a number of technical 
errors and typographical errors that are identified in the Summary of 
Errors section and corrected in the Correction of Errors section.

II. Summary of Errors

A. Summary of Errors in the Preamble

    On page 54041 in our response to a public comment regarding the 
meaningful use objective ``provide structured electronic lab results to 
eligible professionals,'' we inadvertently did not replace a 
placeholder ``ONC reference once available'' with the reference when it 
became available.
    On page 54051, in our discussion of the submission period for 
electronic submissions, we inadvertently omitted references to the 
applicable provider or supplier (that is, eligible professional (EP), 
eligible hospital, and critical access hospital) that has to meet the 
calendar year or fiscal year submission period requirements. Also on 
this page in the footnote following Table 5, we made errors in our 
description of the providers and suppliers that are in the first year 
of demonstrating meaningful use for purposes of avoiding a payment 
adjustment.
    On page 54052 in our response to public comments regarding the 
transition to electronic health record (EHR) technology certified to 
the 2014 Edition EHR certification criteria, we inadvertently omitted 
certain CQMs that we included in the Stage 1 final rule but are not 
finalizing in the Stage 2 final rule for reporting beginning in CY 2014 
after consideration of the public comments. Also on this page, in 
another response to public comments regarding 2011 Edition of EHR 
certification criteria, we made a grammatical error.
    On page 54053, we inadvertently omitted certain CQMs that would be 
excluded from an EP's option of reporting in the Stage 1 final rule.
    On pages 54044, 54055, 54056, 54058, 54068, 54079, 54081, and 
54120, we made inadvertent errors in the numbering and referencing of 
several tables.
    On page 54056, we made inadvertent errors in specifying the 
providers and suppliers that would receive the annual fiscal or 
calendar year updates to the clinical quality measure (CQM) 
specifications.
    On pages 54069, 54072, and 54073, in Table 8--CQMs Finalized for 
Medicare and Medicaid EPs Beginning with CY 2014, we made several 
typographical and technical errors in the titles/descriptions of 
several CQMs. We also made typographical errors in referencing the 
footnotes for CQM 0418.

B. Summary of Errors in the Regulations Text

    On page 54149, we made a technical error in an amendatory statement 
(NN)

[[Page 64756]]

for Sec.  495.6. In the amendatory statement, we erroneously stated 
that we were adding paragraphs (f)(1)(ii)(B) and (C) instead of stating 
that we were adding paragraph (f)(1)(ii)(B).
    On pages 54155 and 54157, we made technical errors by omitting 
qualifying language in Sec.  495.6(l)(6)(ii) and Sec.  495.6(m)(4)(ii).
    On page 54153 (in Sec.  495.6(j)(14)(ii)(C)(1)), we made a 
typographical error in the regulatory citation.

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.
    In our view, this correcting document does not constitute a 
rulemaking that would be subject to the APA notice and comment or 
delayed effective date requirements. This correcting document corrects 
technical and typographical errors in the preamble and regulations text 
of the September 4, 2012 final rule and does not make substantive 
changes to the policies that were adopted. As a result, this correcting 
document is intended to ensure that the final rule accurately reflects 
the policies adopted in that rule.
    In addition, even if this were a rulemaking to which the notice and 
comment and delayed effective date requirements applied, we find that 
there is good cause to waive such requirements. Undertaking further 
notice and comment procedures to incorporate the corrections in this 
document into the final rule or delaying the effective date would be 
contrary to the public interest. Furthermore, such procedures would be 
unnecessary, as we are not altering the policies that were already 
subject to comment and finalized in our final rule. Therefore, we 
believe we have good cause to waive the notice and comment and 
effective date requirements.

IV. Correction of Errors

    In FR Doc. 2012-21050 of September 4, 2012 (77 FR 53968), make the 
following corrections:

A. Correction of Errors in the Preamble

    1. On page 54041, second column, third paragraph, line 17, the 
phrase ``criteria at (ONC reference once available)'' is corrected to 
read ``criteria at 45 CFR 170.314(b)(6)''.
    2. On page 54044, lower half of the page, in the table heading for 
Table B5--Stage 2 Objectives and Measures, the table number ``Table 
B5'' is corrected to read ``Table 4A''.
    3. On page 54051--
    a. Top quarter of the page, second column, first full paragraph, 
line 4, the phrase ``CY or FY respectively.'' is corrected to read ``CY 
or FY for EPs, eligible hospitals, and CAHs, respectively.''.
    b. Second quarter of the page, in Table 5 Reporting and Submission 
Periods for EPs, Eligible Hospitals and CAHs in Their First Year of 
Meaningful Use Submitting CQMs Via Attestation Beginning With CY/FY 
2014, the footnote following the table, line 1, the phrase ``Medicare 
EPs and eligible hospitals'' is corrected to read ``EPs, eligible 
hospitals, and CAHs in the Medicare EHR Incentive Program''.
    4. On page 54052, third column--
    a. First partial paragraph, line 1, the phrase ``0013, 0027, 
0084).'' is corrected to read ``0013, 0027, 0084) as well as 9 CQMs 
that we included in the Stage 1 final rule but are not finalizing in 
this Stage 2 final rule for reporting beginning in CY 2014 (NQF 0001, 
0012, 0014, 0047, 0061, 0067, 0073, 0074, 0575)).''.
    b. Last paragraph, lines 2 and 3, the phrase ``EHR technology 
should based'' is corrected to read ``EHR technology should be based''.
    5. On page 54053, first column, last bulleted paragraph, line 9, 
the phrase ``reporting NQF 0013, 0027, 0084'' is corrected to read 
``reporting NQF 0013, 0027, 0084, 0001, 0012, 0014, 0047, 0061, 0067, 
0073, 0074, 0575''.
    6. On page 54055, first column, first full paragraph, lines 22 and 
23, the phrase ``MAP in Tables 7 (EPs) and 8 (eligible hospitals and 
CAHs)'' is corrected to read ``MAP in Tables 8 (EPs) (77 FR 13749 
through 13757 and 9 (eligible hospitals and CAHs) (77 FR 13760 through 
13763)''.
    7. On page 54056, second column, fourth full paragraph--
    a. Line 7, the phrase ``FY/CY for hospitals and EPs respectively.'' 
is corrected to read ``FY and CY for eligible hospitals and CAHs, and 
EPs, respectively.''.
    b. Line 29, the reference ``Table 7'' is corrected to read ``Table 
8''.
    c. Line 32, the reference ``Table 8'' is corrected to read ``Table 
10''.
    8. On page 54058--
    a. Second column, fourth full paragraph, line 4, the reference 
``Table 7'' is corrected to read ``Table 8''.
    b. Third column, first partial paragraph, line 2, the reference 
``Table 7'' is corrected to read ``Table 8''.
    9. On page 54068,
    a. First column, first full paragraph--
    (1) Line 5, the reference ``Table 7'' is corrected to read ``Table 
8''.
    (2) Line 7, the reference ``Table 7'' is corrected to read ``Table 
8 ``.
    (b) First column, second full paragraph, line 3, ``Table 7'' is 
corrected to read ``Table 8''.
    c. Third column, first full paragraph, line 3, the reference 
``Table 7'' is corrected to read ``Table 8''.
    10. On pages 54069 through 54075, in Table 8--CQMs Finalized for 
Medicare and Medicaid EPs Beginning with CY 2014, we make the following 
corrections:
    a. Column 2 (CQM title and description) is corrected for the 
following entries:

[[Page 64757]]



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                                                                                         Other quality
                                                                Measure steward &       measure programs
              CQM No.                CQM title & description   contact information     that use the same           New CQM                 Domain
                                                                                            CQM ***
--------------------------------------------------------------------------------------------------------------------------------------------------------
NQF 0018 *.........................  Title: Controlling High  NCQA.................  EHR PQRS, ACO, Group   .....................  Clinical Process/
                                      Blood Pressure.         Contact Information:    Reporting PQRS, UDS.                          Effectiveness.
                                     Description: Percentage   www.ncqa.org..
                                      of patients 18[dash]85
                                      years of age who had a
                                      diagnosis of
                                      hypertension and whose
                                      blood pressure was
                                      adequately controlled
                                      (<140/90mmHg) during
                                      the measurement period.
NQF 0385...........................  Title: Colon Cancer:     AMA-PCPI.............  EHR PQRS.............  .....................  Clinical Process/
                                      Chemotherapy for AJCC   Contact Information:                                                  Effectiveness.
                                      Stage III Colon Cancer   cpe@ama[dash]assn.or
                                      Patients.                g;.
                                     Description: Percentage   American Society of
                                      of patients aged 18      Clinical Oncology
                                      through 80 years with    (ASCO):
                                      AJCC Stage III colon     www.asco.org;.
                                      cancer who are           National
                                      referred for adjuvant    Comprehensive Cancer
                                      chemotherapy,            Network (NCCN):
                                      prescribed adjuvant      www.nccn.org..
                                      chemotherapy, or have
                                      previously received
                                      adjuvant chemotherapy
                                      within the
                                      12[dash]month
                                      reporting period.
NQF 0403...........................  Title: HIV/AIDS:         AMA-PCPI.............  .....................  New..................  Clinical Process/
                                      Medical Visit.          Contact Information:.                                                 Effectiveness.
                                     Description: Percentage   cpe@ama[dash]assn.or
                                      of patients,             g;.
                                      regardless of age,       NCQA................
                                      with a diagnosis of     Contact Information:
                                      HIV/AIDS with at least   www.ncqa.org..
                                      two medical visits
                                      during the measurement
                                      year with a minimum of
                                      90 days between each
                                      visit.
TBD (proposed as NQF 0407).........  Title: HIV/AIDS: RNA     NCQA.................  PQRS.................  New..................  Clinical Process/
                                      control for Patients    Contact Information:                                                  Effectiveness.
                                      with HIV.                www.ncqa.org..
                                     Description: Percentage
                                      of patients aged 13
                                      years and older with a
                                      diagnosis of HIV/AIDS,
                                      with at least two
                                      visits during the
                                      measurement year, with
                                      at least 90 days
                                      between each visit,
                                      whose most recent HIV
                                      RNA level is <200
                                      copies/mL.
NQF 0421 *.........................  Title: Preventive Care   Centers for Medicare   EHR PQRS, ACO, Group   .....................  Population/Public
                                      and Screening: Body      and Medicaid           Reporting PQRS, UDS.                          Health.
                                      Mass Index (BMI)         Services (CMS), 1-
                                      Screening and            888-734-6433 or
                                      Follow[dash]Up.          http://
                                     Description: Percentage   questions.cms.hhs.go
                                      of patients aged 18      v/app/ask/p/
                                      years and older with     21,26,1139;
                                      an encounter during     QIP..................
                                      the reporting period    Contact Information:
                                      with a documented        www.usqualitymeasure
                                      calculated BMI during    s.org..
                                      the encounter or
                                      during the previous
                                      six months AND when
                                      the BMI is outside of
                                      normal parameters,
                                      follow[dash]up plan is
                                      documented during the
                                      encounter or during
                                      the previous 6 months
                                      of the encounter with
                                      the BMI outside of
                                      normal parameters.
                                     Normal Parameters: Age
                                      65 years and older BMI
                                      >= 23 and < 30.
                                     Age 18[dash]64 years
                                      BMI >= 18.5 and < 25.
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[[Page 64758]]

    b. Column 1 (CQM number) is corrected for the following entry:

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                         Other quality
                                                                Measure steward &       measure programs
              CQM No.                CQM title & description   contact information     that use the same           New CQM                 Domain
                                                                                             CQM***
--------------------------------------------------------------------------------------------------------------------------------------------------------
NQF 0418* and **...................  Title: Preventive Care   Centers for Medicare   EHR PQRS, ACO, Group   New..................  Population/Public
                                      and Screening:           and Medicaid           Reporting PQRS.                               Health.
                                      Screening for Clinical   Services (CMS), 1-
                                      Depression and           888-734-6433 or
                                      Follow[dash]Up Plan.     http://
                                     Description: Percentage   questions.cms.hhs.go
                                      of patients aged 12      v/app/ask/p/
                                      years and older          21,26,1139;
                                      screened for clinical   Quality Insights of
                                      depression on the date   Pennsylvania (QIP).
                                      of the encounter using   Contact Information:
                                      an age appropriate       www.usqualitymeasure
                                      standardized             s.org.
                                      depression screening
                                      tool AND if positive,
                                      a follow[dash]up plan
                                      is documented on the
                                      date of the positive
                                      screen.
--------------------------------------------------------------------------------------------------------------------------------------------------------

    11. On page 54079, in the third column, second full paragraph--
    a. Line 3, the reference ``Table 8'' is corrected to read ``Table 
10''.
    b. Line 24, the reference ``Table 8''is corrected to read ``Table 
10''.
    12. On page 54081, first column, second full paragraph, line 2, the 
reference ``Table 8'' is corrected to read ``Table 10''.
    13. On page 54120, middle of the page, in the table heading Table 
E1--Determination of Net Average Allowable Costs for the First Payment 
Year, the table number ``Table E1'' is corrected to read ``Table 19A''.

B. Correction of Errors in the Regulations Text


Sec.  495.6  [Corrected]

    1. On page 54149, third column, lines 60 and 61, the sentence ``NN. 
Adding paragraphs (f)(1)(ii)(B) and (C).'' is corrected to read ``NN. 
Adding paragraph (f)(1)(ii)(B).''
    2. On page 54153, third column, fourth full paragraph (Sec.  
495.6(j)(14)(ii)(C)(1)), line 10, the reference ``CFR 107.314(b)(2)'' 
is corrected to read ``CFR 170.314(b)(2)''.
    3. On page 54155, second column, 14th paragraph (Sec.  
495.6(l)(6)(ii)), line 1, the phrase ``More than 55 percent of'' is 
corrected to read ``Subject to paragraph (c) of this section, more than 
55 percent of''.
    3. On page 54157, first column, seventh paragraph (Sec.  
495.6(m)(4)(ii)), line 1, the phrase ``More than 10 percent of'' is 
corrected to read ``Subject to paragraph (c) of this section, more than 
10 percent of''.

(Catalog of Federal Domestic Assistance Program No. 93.778, Medical 
Assistance Program)

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

    Dated: October 16, 2012.
Oliver Potts,
Deputy Executive Secretary to the Department, Department of Health and 
Human Services.
[FR Doc. 2012-25975 Filed 10-22-12; 8:45 am]
BILLING CODE 4120-01-P