[Federal Register Volume 79, Number 192 (Friday, October 3, 2014)]
[Rules and Regulations]
[Pages 59675-59692]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2014-23630]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 405, 412, 413, 415, 422, 424, 485, and 488
[CMS-1607-CN]
RINs 0938-AS11; 0938-AR12; and 0938-AR53
Medicare Program; Hospital Inpatient Prospective Payment Systems
for Acute Care Hospitals and the Long-Term Care Hospital Prospective
Payment System and Fiscal Year 2015 Rates; Quality Reporting
Requirements for Specific Providers; Reasonable Compensation
Equivalents for Physician Services in Excluded Hospitals and Certain
Teaching Hospitals; Provider Administrative Appeals and Judicial
Review; Enforcement Provisions for Organ Transplant Centers; and
Electronic Health Record (EHR) Incentive Program; Correction
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final rule; correction.
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SUMMARY: This document corrects technical and typographical errors in
the final rule that appeared in the August 22, 2014 Federal Register
titled ``Medicare Program; Hospital Inpatient Prospective Payment
Systems for Acute Care Hospitals and the Long-Term Care Hospital
Prospective Payment System and Fiscal Year 2015 Rates; Quality
Reporting Requirements for Specific Providers; Reasonable Compensation
Equivalents for Physician Services in Excluded Hospitals and Certain
Teaching Hospitals; Provider Administrative Appeals and Judicial
Review; Enforcement Provisions for Organ Transplant Centers; and
Electronic Health Record (EHR) Incentive Program.''
DATES: Effective date: This document is effective October 1, 2014.
FOR FURTHER INFORMATION CONTACT: Ing Jye Cheng, (410) 786-4487,
Operating Prospective Payment, Capital Prospective Payment, and New
Medical Service and Technology Add-On Payment Corrections.
Donald Thompson, (410) 786-6504, Operating Prospective Payment,
Wage Index, and Capital Prospective Payment Corrections.
James Poyer, (410) 786-2261, PPS-Exempt Cancer Hospital Quality
Reporting and Hospital Inpatient Quality Reporting Corrections.
Mary Pratt, (410) 786-2261, Long-term Care Hospital Quality Data
Reporting Corrections.
Kellie Shannon, (410) 786-0416, Administrative Appeals by Providers
and Judicial Review Corrections.
Thomas Hamilton, (410) 786-6763, Organ Transplant Center
Corrections.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2014-18545 which appeared in the August 22, 2014 Federal
Register (79 FR 49853), titled ``Medicare Program; Hospital Inpatient
Prospective Payment Systems for Acute Care Hospitals and the Long-Term
Care Hospital Prospective Payment System and Fiscal Year 2015 Rates;
Quality Reporting Requirements for Specific Providers; Reasonable
Compensation Equivalents for Physician Services in Excluded Hospitals
and Certain Teaching Hospitals; Provider Administrative Appeals and
Judicial Review; Enforcement Provisions for Organ Transplant Centers;
and Electronic Health Record (EHR) Incentive Program'' (hereinafter
referred to as the FY 2015 IPPS/LTCH PPS final rule), there were a
number of technical errors that are identified and corrected in section
IV. of this correcting document. The provisions in this correction
document are effective as if they had been included in the FY 2015
IPPS/LTCH PPS final rule that appeared in the August 22, 2014 Federal
Register. Accordingly, the corrections are effective October 1, 2014.
II. Summary of Errors and Corrections to Tables Posted on the CMS Web
Site
A. Summary of Errors in the Preamble
On page 49865, in our discussion of the summary of costs and
benefits of the payment adjustment of the Hospital-Acquired Condition
(HAC) Reduction Program for FY 2015, we made a technical error in the
amount by which overall payments would decrease.
On page 49918, in our discussion of new technology add-on payments,
we made an error in the amount of the maximum add-on payment for
Voraxaze[supreg].
On page 49940, we made an error in our discussion of the FY 2015
new technology add-on payment for the
[[Page 59676]]
CardioMEMSTM HF (Heart Failure) Monitoring System.
On pages 50246 through 50249, in the table titled ``Previously
Adopted Hospital IQR Program Measures And Measures Newly Finalized in
this Final Rule for the FY 2017 Payment Determination and Subsequent
Years,'' we inadvertently listed VTE-3 as a ``voluntary electronic
clinical quality measure'' only and inadvertently omitted PN-6 from the
table, which should have been listed as a voluntary electronic clinical
quality measure.
On pages 50279 and 52084, in our discussion of the PPS-exempt
Cancer Hospital Quality Reporting Program (PCHQR), we provided a Web
site link that is not functional due to a typographical error, and made
other typographical and technical errors.
On pages 50298, 50302, and 50306, we made typographical and
technical errors in our discussion of the Long-Term Care Hospital
Quality Reporting (LTCHQR) Program.
On page 50335, we made typographical and technical errors in our
discussion of organ transplant centers.
B. Summary of Errors in the Regulations Text
On page 50350, in the regulations text at Sec. 405.1811(c) and
Sec. 405.1835(c), we made technical errors in specifying the
requirements regarding a provider's right to contractor or Board
hearings resulting from untimely contractor determinations.
C. Summary of Errors in the Addendum
In calculating the final FY 2015 IPPS operating and capital rates
and impacts, we made two technical errors.
First, there was a technical error in our determination of payments
under the postacute care transfer policy for certain MS-DRGs within the
ratesetting process. Specifically, we inadvertently did not treat those
MS-DRGs that qualified for a special payment under the postacute care
transfer policy (see Sec. 412.4(f)(6)) in FY 2015 as MS-DRGs subject
to the postacute care transfer policy. Consequently, the FY 2015
transfer-adjusted case-mix indexes and cases used to model IPPS
payments in the ratesetting process were incorrect, and resulted in a
miscalculation of the operating and capital IPPS budget neutrality
factors, outlier threshold, operating standardized amounts, capital
Federal rates, and impacts for the FY 2015 IPPS/LTCH PPS final rule. To
conform with our established methodology, we are recalculating the FY
2015 transfer-adjusted case-mix indexes and cases used to model IPPS
payments in the ratesetting process after properly treating those MS-
DRGs that qualified for a special payment under the postacute care
transfer policy in FY 2015 as MS-DRGs subject to the postacute care
transfer policy. Therefore, we are recalculating the operating and
capital IPPS budget neutrality factors, outlier threshold, operating
standardized amounts, capital Federal rates, and impacts for FY 2015
using our established methodology.
The second error was the inadvertent error in identifying claims
for indirect medical education (IME) payments for Medicare Advantage
(MA) beneficiaries (MA IME claims) in the ratesetting process for the
FY 2015 IPPS/LTCH PPS final rule. Per the methodology established in
the FY 2011 IPPS/LTCH PPS final rule (75 FR 50422 through 50433), in
order to identify IME MA claims, we first search the MedPAR file for
all claims with an IME payment greater than zero. Then, we filter these
claims for a subset of claims with a group health organization (GHO)
paid indicator with a value of ``1'' or with the IME payment field
equal to the DRG payment field. For the reasons described later in this
section, in applying this methodology for the FY 2015 IPPS/LTCH PPS
final rule, we did not identify certain MA IME claims using the filter
for claims where the IME payment field is equal to the DRG payment
field.
The Budget Control Act of 2011 requires mandatory across-the-board
reductions in Federal spending, also known as sequestration. The
American Taxpayer Relief Act of 2012 postponed sequestration for 2
months. As required by law, President Obama issued a sequestration
order on March 1, 2013.
For FY 2015, we used claims from the FY 2013 MedPAR in our
ratesetting process to determine the operating and capital IPPS budget
neutrality factors, outlier threshold, operating standardized amounts,
capital Federal rates, and the IPPS impact analyses presented in the FY
2015 IPPS/LTCH PPS final rule. Claims for discharges occurring on or
after April 1, 2013 had the 2-percent reduction for sequestration
applied to the DRG payment field. As a result, in applying the
methodology described previously for the FY 2015 IPPS/LTCH PPS final
rule, we inadvertently did not properly identify certain claims for IME
MA payments because the DRG payment field reflected the 2-percent
reduction for sequestration (and therefore, the IME payment field did
not equal the DRG payment field for those claims). As discussed in the
FY 2015 IPPS/LTCH PPS final rule (79 FR 50364 and 50365), under our
established methodology, payments for MA IME claims are used in our
operating IPPS budget neutrality calculations. Therefore, the
inadvertent omission of these MA IME claims resulted in a
miscalculation of the operating budget neutrality calculations. (We
note this error did not affect the calculation of the outlier threshold
or the MS-DRG relative weights because, under our established
methodology for the respective calculations of these IPPS payment
factors, we only include claims with a ``Claim Type'' of 60, and the
claims that were not properly identified as MA IME claims did not have
a ``Claim Type'' of 60.) We are recalculating the operating budget
neutrality factors that are used to determine the standardized amounts
for FY 2015 to conform with our established methodology as stated in
the FY 2015 IPPS/LTCH PPS final rule. Specifically, for this correcting
document, we are restoring the 2-percent reduction for sequestration to
the DRG payment field in order to ensure that we properly identify all
claims where the IME payment field is equal to the DRG payment field
consistent with our established methodology.
As described previously, one or both of these two technical errors
resulted in errors to our calculation of the operating and capital IPPS
budget neutrality factors, outlier threshold, operating standardized
amounts, capital Federal rates, and impacts. As a result of these
technical errors we are correcting the following errors:
In the operating and capital budget neutrality factors,
outlier threshold, operating standardized amounts, capital Federal
rates, and capital IPPS payment estimates that appear on the following
pages of the Addendum of the FY 2015 IPPS/LTCH PPS final rule: 50367
through 50370, 50373 and 50374, 50380 through 50383, 50385 and 50386,
50388 through 50390, and 50404 (Tables 1A through 1D).
In the data presented in the tables referred to in the FY
2015 IPPS/LTCH PPS final rule and available via the Internet on the CMS
Web site (see section II.D. of this correcting document).
In the operating and capital impacts that appear in the
following pages of the Appendices of the FY 2015 IPPS/LTCH PPS final
rule: 50405, 50407, 50409 through 50418, 50420 through 50429, 50435 and
50436, and 50446.
The errors described previously also affect the calculation of the
Hospital Readmissions Reduction Program payment adjustment factors and
the Hospital Value-Based Purchasing (VBP)
[[Page 59677]]
Program payment adjustment factors for FY 2015. The readmissions
payment adjustment factor is based in part on a ratio of a hospital's
``aggregate payment for excess readmissions'' and its ``aggregate
payments for all discharges.'' We use Medicare Part A inpatient claims
from the MedPAR file as our data source for determining aggregate
payments for excess readmissions and aggregate payments for all
discharges. For FY 2015, we use MedPAR claims with discharge dates on
or after July 1, 2010 and no later than June 30, 2013 to calculate the
ratio used in determining the readmissions payment adjustment factors.
Under the Hospital VBP Program, the Secretary reduces the base
operating DRG payment amount for an eligible hospital for each
discharge in a fiscal year by an applicable percent. The sum total of
these reductions in a fiscal year must equal the total amount available
for value-based incentive payments for all eligible hospitals for the
fiscal year, as estimated by the Secretary. We use a linear exchange
function to translate this estimated amount available into a value-
based incentive payment percentage for each hospital, based on its
total performance score (TPS). We then calculate the value-based
incentive payment adjustment factor for each hospital and apply that
factor to the base-operating DRG payment amount for each discharge
occurring at that hospital in FY 2015 on a per claim basis. We
finalized the methodology for using base operating DRG payment amounts
derived from the MedPAR file in the calculation of the value-based
incentive payment adjustment factors in the FY 2013 IPPS/LTCH PPS final
rule (77 FR 53574 and 53575). In the FY 2015 IPPS/LTCH PPS final rule
(79 FR 50049), based on the March 2014 update of the FY 2013 MedPAR
file (that is, MedPAR Part A claims with discharge dates on or after
October 1, 2012 and on or before September 30, 2013), we estimated that
the amount available for value-based incentive payments for FY 2015 is
$1.4 billion (the applicable percent for the FY 2015 Hospital VBP
Program is 1.50 percent).
We use the same methodology described previously to identify only
Medicare Part A claims in the MedPAR file and to remove IME MA claims
when calculating the Hospital Readmissions Reduction Program and the
Hospital VBP Program payment adjustment factors. In addition, we use
the claims in the MedPAR file to determine the base operating DRG
payment amounts used in the calculation of these payment adjustment
factors. Consequently, in determining the base-operating DRG payment
amounts used in our calculation of the proxy readmissions adjustment
factors (Table 15A) and the updated proxy Hospital VBP payment
adjustment factors (Table 16A) for the FY 2015 IPPS/LTCH PPS final
rule, we inadvertently failed to properly exclude all of the IME MA
claims, and also inadvertently included the 2-percent sequestration
reduction for claims in the FY 2013 MedPAR with a discharge date after
April 1, 2013. Therefore, to properly account for how sequestration is
reflected in the FY 2013 MedPAR data in the calculation of these
payment adjustment factors, we restored the 2-percent sequestration
reduction to the DRG payment field on the MedPAR claim (as described
previously). This correction ensures that we identify and remove all
IME MA claims when the IME payment field is equal to the DRG payment
field and correctly determine the base-operating DRG payment amount
used in the calculation of the readmission and Hospital VBP payment
adjustment factors for FY 2015.
At the time of the issuance of the FY 2015 IPPS/LTCH PPS final
rule, under the Hospital Readmissions Reduction Program, applicable
hospitals had not yet had the opportunity to review and correct data
from the FY 2015 applicable period before they were made public under
our policy regarding the reporting of hospital-specific information.
Therefore, in Table 15A listed in the Addendum of the FY 2015 IPPS/LTCH
PPS final rule, we provided proxy FY 2015 readmission payment
adjustment factors, and stated that we expected to publish the final FY
2015 readmissions payment adjustment factors in Table 15B on the CMS
IPPS Web site by October 2014, and would use those final factors for
determining payments for discharges occurring on or after October 1,
2014 (79 FR 50048). Similarly, in the final rule, we provided updated
proxy value-based incentive payment adjustment factors for FY 2015 in
Table 16A listed in the Addendum of that final rule to reflect changes
based on the March 2014 update to the FY 2013 MedPAR file. These
updated proxy value-based incentive payment adjustment factors for FY
2015 were based on historic FY 2014 Program TPSs because hospitals had
not been given the opportunity to review and correct their actual TPSs
for the FY 2015 Hospital VBP Program at the time we issued that final
rule. We stated that after hospitals had been given an opportunity to
review and correct their actual TPSs for FY 2015, we would publish
Table 16B to display the actual value-based incentive payment
adjustment factors, and that we expected Table 16B to be posted on the
CMS Web site in October 2014 (79 FR 50049).
The review and corrections period for the data from the FY 2015
applicable period under the Hospital Readmissions Reduction Program
resulted in no changes to the proxy adjustment factors shown in Table
15A. However, the calculation of the FY 2015 readmissions payment
adjustment factors was affected by the inadvertent errors resulting
from our use of claims in the FY 2013 MedPAR with a discharge date
after April 1, 2013 without properly accounting for how sequestration
was reflected in those data. Because we use claims data from July 1,
2010 to June 30, 2013 to calculate the FY 2015 readmissions payment
adjustment factors, only a portion of that data (that is, the claims
between April 1, 2013 and June 30, 2013) was impacted by the errors
described previously. As a result of the correction of those errors,
the FY 2015 readmissions payment adjustment factors have changed for 60
hospitals. The final FY 2015 readmissions payment adjustment factors,
which were calculated after correcting the errors discussed previously,
are posted in Table 15B on the CMS Web site at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html.
(Click on the link on the left side of the screen titled, ''FY 2015
IPPS Final Rule Home Page'' or ''Acute Inpatient--Files for
Download''.) As noted previously, the final FY 2015 readmissions
payment adjustment factors in Table 15B will be used for determining
payments for discharges occurring on or after October 1, 2014. After
accounting for these corrections in determination of the FY 2015
readmissions payment adjustment factors, we are revising the estimated
savings under the Hospital Readmissions Reduction Program to $428
million, from $424 million in the FY 2015 IPPS/LTCH PPS final rule (79
FR 50425).
We note that we are not correcting the proxy FY 2015 readmissions
payment adjustment factors for FY 2015 shown in Table 15A or the
updated proxy value-based incentive payment adjustment factors for FY
2015 shown in Table 16A. However, consistent with the methodology for
calculating the operating budget neutrality factors for the FY 2015
IPPS/LTCH PPS final rule (79 FR 50366), we used corrected proxy payment
adjustment factors in the recalculation of the IPPS rates for this
correcting document. These factors can be found in the IPPS Impact File
that
[[Page 59678]]
corresponds to this correcting document which is available on the CMS
Web site. (We note that the description of the methodology for
calculating the operating budget neutrality factors contained errors
that are summarized later in the section and corrected in section
IV.C.1. of this correcting document). The proxy factors in Table 15A
were provided for informational purposes and they are not used for
payment adjustment purposes and the final FY 2015 readmissions payment
adjustment factors in Table 15B will be used for determining payments
for discharges occurring on or after October 1, 2014 (79 FR 50048).
Similarly, the proxy factors in Table 16A were provided for
informational purposes, according to the methodology finalized in the
FY 2013 IPPS/LTCH final rule (77 FR 53576), and they are not used for
payment adjustment purposes. As stated in the FY 2015 IPPS/LTCH PPS
final rule, we intend to post the actual Hospital VBP Program payment
adjustment factors, as Table 16B, in October of 2014, after hospitals
have had an opportunity to review and correct their TPSs.
On page 50366, we made an error in the description of our budget
neutrality methodology with respect to the readmissions payment
adjustment factors that we used for the purpose of modeling aggregate
payments when determining all budget neutrality factors. As we
discussed in the FY 2015 IPPS/LTCH PPS final rule (79 FR 50048), for
that final rule we determined proxy FY 2015 readmission payment
adjustment factors (shown in Table 15A), which were calculated based on
data from the FY 2015 applicable period of July 1, 2010 to June 30,
2013.
In addition, we made a typographical error in the March 2013 and
2014 operating national average case weighted cost-to charge ratios
(CCRs) set forth in the FY 2015 IPPS/LTCH PPS final rule. Also, we made
a technical error in the calculation of the capital CCR adjustment
factor that is applied to determine the capital CCRs used in our
ratesetting process. This inadvertent technical error caused a
miscalculation of the capital CCRs used in the determination of the
operating and capital budget neutrality factors and the calculation of
the outlier threshold for the FY 2015 IPPS/LTCH PPS final rule.
Therefore, we are correcting the capital CCR adjustment factor and the
capital CCRs used in our determination of the operating and capital
budget neutrality factors as well as our calculation of the outlier
threshold.
Lastly, we made technical and typographical errors in the table
heading for Table 2-2 which is listed in the Addendum of the FY 2015
IPPS/LTCH PPS final rule as one of the tables that are only available
through the Internet on the CMS Web site (page 50403).
D. Corrections to Tables Posted on the CMS Web Site
The following corrections are being made to the tables listed on
pages 50402 and 50403 of the FY 2015 IPPS/LTCH PPS final rule that are
only available through the Internet on the CMS Web site at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html.
In Table 2-2.--Acute Care Hospitals Case-Mix Indexes for Discharges
Occurring in Federal Fiscal Year 2012; Hospital Wage Indexes for
Federal Fiscal Year 2015; Hospital Average Hourly Wages for Federal
Fiscal Years 2013 (2009 Wage Data), 2014 (2010 Wage Data), and 2015
(2011 Wage Data; Based on FY 2015 CBSA Delineations); and 3-Year
Average of Hospital Average Hourly Wages, we are correcting the table
heading as noted in section II.C. of this correcting document. We are
also correcting the entries in column ``FY 2015 Wage Index'' as a
result of the technical errors discussed in section II.C. of this
correcting document.
We are correcting the following tables in the entirety as a result
of the technical errors discussed in section II.C. of this correcting
document:
Table 4A-1.--Wage Index and Capital Geographic Adjustment
Factor (GAF) for Acute Care Hospitals in Urban Areas by CBSA and by
State--FY 2015; Based on CBSA Delineations Used in FY 2014.
Table 4A-2.--Wage Index and Capital Geographic Adjustment
Factor (GAF) for Acute Care Hospitals in Urban Areas by CBSA and by
State--FY 2015; Based on CBSA Delineations Used in FY 2015.
Table 4B-1.--Wage Index and Capital Geographic Adjustment
Factor (GAF) for Acute Care Hospitals in Rural Areas by CBSA and by
State--FY 2015; Based on CBSA Delineations Used in FY 2014.
Table 4B-2.--Wage Index and Capital Geographic Adjustment
Factor (GAF) for Acute Care Hospitals in Rural Areas by CBSA and by
State--FY 2015; Based on FY 2015 CBSA Delineations.
Table 4C-1.--Wage Index and Capital Geographic Adjustment
Factor (GAF) for Acute Care Hospitals That Are Reclassified by CBSA and
by State--FY 2015; Based on CBSA Delineations Used in FY 2014.
Table 4C-2.--Wage Index and Capital Geographic Adjustment
Factor (GAF) for Acute Care Hospitals That Are Reclassified by CBSA and
by State--FY 2015; Based on CBSA Delineations Used in FY 2015.
Table 4D-1.--States Designated as Frontier, with Acute
Care Hospitals Receiving at a Minimum the Frontier State Floor Wage
Index; Urban Areas with Acute Care Hospitals Receiving the Statewide
Rural Floor or Imputed Floor Wage Index--FY 2015; Based on CBSA
Delineations Used in FY 2014.
Table 4D-2.--States Designated as Frontier, with Acute
Care Hospitals Receiving at a Minimum the Frontier State Floor Wage
Index; Urban Areas with Acute Care Hospitals Receiving the Statewide
Rural Floor or Imputed Floor Wage Index--FY 2015; Based on CBSA
Delineations Used in FY 2015.
Table 4J.--Out-Migration Adjustment for Acute Care
Hospitals--FY 2015
Table 10.--New Technology Add-On Payment Thresholds \1,2\
for Applications for FY 2016.
Table 5.--List of Medicare Severity Diagnosis-Related Groups (MS-
DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean
Length of Stay--FY 2015. We are correcting this table by correcting
typographical and technical errors in the columns titled ``Geometric
Mean LOS'' and ``Arithmetic Mean LOS''.
Table 8B.--FY 2015 Statewide Average Capital Cost-to-Charge Ratios
(CCRs) for Acute Care Hospitals. We are correcting typographical and
technical errors in this table.
Table 18.--FY 2015 Medicare DSH Uncompensated Care Payment Factor 3
and Supplemental Medicare DSH File--FY 2015 Uncompensated Care Payment
Factors. For the FY 2015 IPPS/LTCH PPS final rule, we published a list
of hospitals that we identified to be subsection (d) hospitals and
subsection (d) Puerto Rico hospitals eligible to receive empirically
justified Medicare DSH payment adjustments and uncompensated care
payments for FY 2015. As stated in the FY 2015 IPPS/LTCH PPS final rule
(79 FR 50022), we allowed the public an additional period after the
issuance of the final rule to review and submit comments on the
accuracy of the list of mergers that we identified in the final rule.
Based on the comments received during this additional period, we are
updating Table 18 and the Supplemental Medicare DSH File to reflect the
merger information received in response to the final rule and are also
making one other correction to Table 18 and the Supplemental Medicare
DSH File. We have discovered that in calculating Factor 3 of the
uncompensated care payment methodology, we inadvertently
[[Page 59679]]
excluded the Medicaid days from the most recently available 2012 or
2011 cost report for a certain provider that was projected to receive
Medicare DSH in FY 2015. This provider submitted its Medicare hospital
cost reports to its Medicare contractor prior to the March 2014 update
of HCRIS but due to technical errors the Medicare hospital cost reports
were not included in the March 2014 update of HCRIS. As a result, this
provider had no Medicaid days included in the calculation of Factor 3.
In order to correct this error, we have revised Factor 3 for all
hospitals to incorporate the changes to the data for this provider
whose Medicare hospital cost report data were inadvertently excluded
from the March 2014 update of HCRIS.
E. Summary of Errors in the Appendices
On page 50428, in our discussion of the effects of the new
technology add-on payment policy, we made an error in the costs of the
add-on payments for Voraxaze[supreg] for FY 2015.
On pages 50405, 50407, and 50409 through 50429; we made errors in
the operating impacts as described in section II.C. of this correcting
document.
On pages 50435 through 50437, we made errors in the capital impacts
as described in section II.C. of this correcting document.
On page 50446, we made an error in the estimated expenditures under
the IPPS as a result of the errors described in section II.C. of this
correcting document.
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 rule
that would be subject to the APA notice and comment or delayed
effective date requirements. This correcting document corrects
technical and typographic errors in the preamble, regulation text,
addendum, payment rates, tables, and appendices included or referenced
in the FY 2015 IPPS/LTCH PPS final rule but does not make substantive
changes to the policies or payment methodologies that were adopted in
the final rule. As a result, this correcting document is intended to
ensure that the information in the FY 2015 IPPS/LTCH PPS final rule
accurately reflects the policies adopted in that final rule.
In addition, even if this were a rule to which the notice and
comment procedures 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 because it is in the public's
interest for providers to receive appropriate payments in as timely a
manner as possible, and to ensure that the FY 2015 IPPS/LTCH PPS final
rule accurately reflects our policies. Furthermore, such procedures
would be unnecessary, as we are not altering our payment methodologies
or policies, but rather, we are simply implementing correctly the
policies that we previously proposed, received comment on, and
subsequently finalized. This correcting document is intended solely to
ensure that the FY 2015 IPPS/LTCH PPS final rule accurately reflects
these payment methodologies and policies. Therefore, we believe we have
good cause to waive the notice and comment and effective date
requirements.
IV. Correction of Errors
In FR Doc. 2014-18545 of August 22, 2014 (79 FR 49853), make the
following corrections:
A. Corrections of Errors in the Preamble
1. On page 49865, third column, third bulleted paragraph, line 12,
the figure ``$369'' is corrected to read ``$373''.
2. On page 49918, second column, first partial paragraph:
a. Lines 7 through 12, the sentences ``The cost of Voraxaze[supreg]
is $22,500 per vial. The applicant stated that an average of four vials
is used per Medicare beneficiary. Therefore, the average cost per case
for Voraxaze[supreg] is $90,000 ($22,500 x 4).'' are corrected to read
``Based on the latest data from the manufacturer, the cost of
Voraxaze[supreg] is $23,625 per vial. The applicant stated that an
average of four vials is used per Medicare beneficiary. Therefore, the
average cost per case for Voraxaze[supreg] is $94,500 ($23,625 x 4).''
b. Lines 18 through 20, the sentence ``As a result, the maximum new
technology add-on payment for Voraxaze[supreg] is $45,000 per case.''
is corrected to read ``As a result, based on the latest data from the
manufacturer, the maximum new technology add-on payment for
Voraxaze[supreg] for FY 2015 is $47,250 per case.''
3. On page 49940, third column, last paragraph, fourth line from
the bottom, the phrase ``the maximum payment'' is corrected to read
``the maximum add-on payment''.
4. On pages 50246 through 50249, the table titled ``Previously
Adopted Hospital IQR Program Measures and Measures Newly Finalized in
this Final Rule for the FY 2017 Payment Determination and Subsequent
Years'' is corrected as follows:
a. Adding the following entry (short name VTE-3) immediately
preceding the entry VTE-5:
----------------------------------------------------------------------------------------------------------------
Submission methods
Short name Measure name NQF No. for FY 2017 New for FY 2017
----------------------------------------------------------------------------------------------------------------
VTE-3........... Venous thromboembolism NQF #0373... Electronic clinical .....................
patients with quality measure or
anticoagulation overlap chart-abstracted
therapy. REQUIRED.
----------------------------------------------------------------------------------------------------------------
b. Removing the entry for VTE-3 that follows the entry for Stroke-
10.
c. Adding the following entry for PN-6 immediately preceding the
entry for VTE-4:
[[Page 59680]]
----------------------------------------------------------------------------------------------------------------
Submission methods
Short name Measure name NQF No. for FY 2017 New for FY 2017
----------------------------------------------------------------------------------------------------------------
PN-6............ Initial Antibiotic NQF #0147... Electronic clinical Voluntary electronic
Selection for community- quality measure. clinical quality
acquired pneumonia (CAP) measure.
in Immunocompetent
Patients.
----------------------------------------------------------------------------------------------------------------
5. On 50279, second column, second full paragraph, lines 10 through
13, the hyperlink, ``http://www.Fqualityforum.Forg/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=70374'' is corrected to read
``http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=70374.''
6. On page 50284:
a. Second column, first partial paragraph:
(1) Line 7, the phrase ``However the six'' is corrected to read
``However for the six''.
(2) Line 12, the phrase ``four quarters data'' is corrected to read
``four quarters of data''.
b. Third column, third full paragraph, lines 14 and 15, the
parenthetical phase ``(and not limited to orthopedic surgeries)'' is
corrected to read ``(and are not limited to orthopedic surgeries)''.
7. On page 50298, second column, first partial paragraph, line 6,
the phrase ``the CAM[supreg] Instrument'' is corrected to read ``the
short CAM[supreg] instrument''.
8. On page 50302, third column, second full paragraph, lines 3 and
4, the phrase ``of long-term mechanical ventilation'' is corrected to
read ``with patients on prolonged mechanical ventilation''.
9. On page 50306, lower two-thirds of the page, third column,
partial paragraph, lines 18 and 19, the phrase ``tobacco performance
measure set'' is corrected to read ``tobacco treatment performance
measure set''.
10. On page 50335, first column, first full paragraph:
a. Line 34, the phrase ``that because available'' is corrected to
read ``that became available''.
b. Lines 38 and 39, the phrase ``not enter into an SIA'' is
corrected to read ``not entered into an SIA''.
B. Corrections of Errors in the Regulation Text
Sec. 405.1811 [Corrected]
1. On page 50350, in the first column, in Sec. 405.1811(c)
introductory text, lines 7 and 8, the phrase ``for a cost reporting
period if--'' is corrected to read ``for specific items for a cost
reporting period if--''.
Sec. 405.1835 [Corrected]
2. On page 50350, in the third column, in Sec. 405.1835(c), in
lines 7 through 9, the phrase ``for specific items claimed for a cost
reporting period if--'' is corrected to read ``for specific items for a
cost reporting period if--''.
C. Corrections of Errors in the Addendum
1. On page 50366, first column, first full paragraph the paragraph
beginning with the phrase ``For the purpose of calculating the FY'' and
ending with the phrase ``to the FY 2013 IPPS/LTCH PPS final rule (77 FR
53399 through 53400).)'' is corrected to read as follows:
``For the purpose of calculating the proposed FY 2015 readmissions
payment adjustment factors in the proposed rule, we used excess
readmission ratios and aggregate payments for excess readmissions based
on admissions from the prior fiscal year's applicable period because
hospitals have had the opportunity to review and correct these data
before the data were made public under the policy we adopted regarding
the reporting of hospital-specific readmission rates, consistent with
section 1886(q)(6) of the Act. As discussed in section IV.H.11. of this
preamble, because the review and corrections period will still be
ongoing through August 19, 2014, which extends beyond the issuance of
this FY 2015 IPPS/LTCH PPS final rule, we are calculating proxy FY 2015
readmissions payment adjustment factors using excess readmission ratios
and aggregate payments for excess readmissions based on admissions from
the finalized applicable period for FY 2015. We will determine the
final readmissions payment adjustment factors that will be used for
payments in FY 2015 after the completion of the review and correct
process. (For additional information on our general policy for the
reporting of hospital-specific readmission rates, consistent with
section 1886(q)(6) of the Act, we refer readers to the FY 2013 IPPS/
LTCH PPS final rule (77 FR 53399 through 53400).)''
2. On page 50367, third column, first full paragraph:
a. Line 3, the figure ``0.997543'' is corrected to read
``0.998761''.
b. Line 8, the figure ``0.997543'' is corrected to read
``0.998761''.
3. On page 50368:
a. First column, first partial paragraph, line 19, the figure
``0.997543'' is corrected to read ``0.998761''.
b. Third column:
(1) First partial paragraph, line 11, the figure ``0.997543'' is
corrected to read ``0.998761''.
(2) Last paragraph:
(a) Line 9, the figure ``1.001443'' is corrected to read
``1.001421''.
(b) Line 13, the figure ``0.997543'' is corrected to read
``0.998761''.
(c) Line 15, the figure ``1.001443'' is corrected to read
``1.001421''.
(d) Line 21, the figure ``0.998982'' is corrected to read
``1.000180''.
4. On page 50369, first column, last partial paragraph, line 13,
the figure ``0.990406'' is corrected to read ``0.990429''.
5. On page 50370, first column, second full paragraph:
a. Line 3, the figure ``0.989507'' is corrected to read
``0.989525''.
b. Line 5, the figure ``0.991291'' is corrected to read
``0.991293''.
6. On page 50373:
a. First column, last paragraph, line 3, the figure ``0.998859'' is
corrected to read ``0.998854''.
b. Second column, first partial paragraph, line 1, the figure
``0.998859'' is corrected to read ``0.998854''.
7. On page 50374, second column, second full paragraph, line 5, the
figure ``0.99931'' is corrected to read ``0.999313''.
8. On page 50380:
a. First column:
(1) First paragraph:
(a) Line 4, the figure ``0.292377'' is corrected to read
``0.292376''.
(b) Line 6, the figure ``0.28714'' is corrected to read
``0.287139''.
(2) Second paragraph:
(a) Line 7, the figure ``0.024849'' is corrected to read
``0.024649''.
(b) Line 18, the figure ``0.988307'' is corrected to read
``0.980352''.
c. Third column, second full paragraph, line 9, the figure
``$24,758'' is corrected to read ``$24,626''.
9. On page 50381:
a. First column:
(1) First full paragraph, line 15, the figure ``6.27'' is corrected
to read ``6.18''.
(2) Third full paragraph, the table is corrected to read as
follows:
[[Page 59681]]
------------------------------------------------------------------------
Operating
standardized Capital federal
amounts rate
------------------------------------------------------------------------
National............................ 0.948999 0.938237
Puerto Rico......................... 0.926334 0.916334
------------------------------------------------------------------------
b. Third column, third full paragraph:
(1) Line 4, the figure ``5.71'' is corrected to read ``5.68''.
(2) Line 6, the figure ``0.61'' is corrected to read ``0.58''.
(3) Line 10, the figure ``5.71'' is corrected to read ``5.68''.
10. On pages 50382 and 50383, the table titled, ``Comparison of FY
2014 Standardized Amounts to the FY 2015 Standardized Amounts'' is
corrected to read as follows:
Comparison of FY 2014 Standardized Amounts to the FY 2015 Standardized Amounts
----------------------------------------------------------------------------------------------------------------
Hospital submitted Hospital did NOT Hospital did NOT
Hospital submitted quality data and submit quality submit quality
quality data and is NOT a data and is a data and is NOT a
is a meaningful meaningful EHR meaningful EHR meaningful EHR
EHR user user user user
----------------------------------------------------------------------------------------------------------------
FY 2014 Base Rate after
removing:
1. FY 2014 Geographic If Wage Index is If Wage Index is If Wage Index is If Wage Index is
Reclassification Budget Greater Than Greater Than Greater Than Greater Than
Neutrality (0.990718). 1.0000: Labor 1.0000: Labor 1.0000: Labor 1.0000: Labor
2. FY 2014 Rural Community (69.6%): (69.6%): (69.6%): (69.6%):
Hospital Demonstration $4,230.38 $4,230.38 $4,230.38 $4,230.38
Program Budget Neutrality Nonlabor (30.4%): Nonlabor (30.4%): Nonlabor (30.4%): Nonlabor (30.4%):
(0.999415). $1,847.75. $1,847.75. $1,847.75. $1,847.75.
3. Cumulative Factor: FY If Wage Index is If Wage Index is If Wage Index is If Wage Index is
2008, FY 2009, FY 2012, FY less Than or less Than or less Than or less Than or
2013, and FY 2014 Equal to 1.0000: Equal to 1.0000: Equal to 1.0000: Equal to 1.0000:
Documentation and Coding Labor (62%): Labor (62%): Labor (62%): Labor (62%):
Adjustment as Required $3,768.45 $3,768.45 $3,768.45 $3,768.45
under Sections 7(b)(1)(A) Nonlabor (38%): Nonlabor (38%): Nonlabor (38%): Nonlabor (38%):
and 7(b)(1)(B) of Pub. L. $2,309.70. $2,309.70. $2,309.70. $2,309.70.
110-90 and Documentation
and Coding Recoupment
Adjustment as required
under Section 631 of the
American Taxpayer Relief
Act of 2012 (0.9403).
4. FY 2014 Operating Outlier
Offset (0.948995).
FY 2015 Update Factor........... 1.022............. 1.01475........... 1.01475........... 1.0075.
FY 2015 MS[dash]DRG 1.000180.......... 1.000180.......... 1.000180.......... 1.000180.
Recalibration and Wage Index
Budget Neutrality Factor.
FY 2015 Reclassification Budget 0.990429.......... 0.990429.......... 0.990429.......... 0.990429.
Neutrality Factor.
FY 2015 Rural Community 0.999313.......... 0.999313.......... 0.999313.......... 0.999313.
Demonstration Program Budget
Neutrality Factor.
FY 2015 Operating Outlier Factor 0.948999.......... 0.948999.......... 0.948999.......... 0.948999.
Cumulative Factor: FY 2008, FY 0.9329............ 0.9329............ 0.9329............ 0.9329.
2009, FY 2012, FY 2013, FY 2014
and FY 2015 Documentation and
Coding Adjustment as Required
under Sections 7(b)(1)(A) and
7(b)(1)(B) of Pub. L. 110-90
and Documentation and Coding
Recoupment Adjustment as
required under Section 631 of
the American Taxpayer Relief
Act of 2012.
FY 2015 New Labor Market 0.998854.......... 0.998854.......... 0.998854.......... 0.998854.
Delineation Wage Index
Transition Budget Neutrality
Factor.
National Standardized Amount for Labor: $3,784.75 Labor: $3,757.90 Labor: $3,757.90 Labor: $3,731.05
FY 2015 if Wage Index is Nonlabor: Nonlabor: Nonlabor: Nonlabor:
Greater Than 1.0000; Labor/Non- $1,653.10. $1,641.37. $1,641.37. $1,629.65.
Labor Share Percentage (69.6/
30.4).
National Standardized Amount for Labor: $3,371.47 Labor: $3,347.55 Labor: $3,347.55 Labor: $3,323.63
FY 2015 if Wage Index is less Nonlabor: Nonlabor: Nonlabor: Nonlabor:
Than or Equal to 1.0000; Labor/ $2,066.38. $2,051.72. $2,051.72. $2,037.07.
Non-Labor Share Percentage (62/
38).
----------------------------------------------------------------------------------------------------------------
11. On page 50383, the table titled, ``Comparison of FY 2014 Puerto
Rico-Specific Payment Rate to the FY 2015 Puerto Rico-Specific Payment
Rate'' is corrected to read as follows:
[[Page 59682]]
Comparison of FY 2014 Puerto Rico-Specific Payment Rate to the FY 2015
Puerto Rico-Specific Payment Rate
------------------------------------------------------------------------
Update (2.2 Update (2.2
percent); wage index percent); Wage index
is greater than is less than or
1.0000; labor/non- equal to 1.0000;
labor share labor/non[dash]labor
percentage (63.2/ share percentage (62/
36.8) 38)
------------------------------------------------------------------------
FY 2014 Puerto Rico Base
Rate, after removing:
1. FY 2014 Geographic Labor: $1,722.31 Labor: $1,689.61
Reclassification Budget Nonlabor: $1,002.86. Nonlabor:
Neutrality (0.990718). $1,035.56.
2. FY 2014 Rural
Community Hospital
Demonstration Program
Budget Neutrality
(0.999415).
3. FY 2014 Puerto Rico
Operating Outlier
Offset (0.943455).
FY 2015 Update Factor....... 1.022............... 1.022.
FY 2015 MS[dash]DRG 0.998761............ 0.998761.
Recalibration Budget
Neutrality Factor.
FY 2015 Reclassification 0.990429............ 0.990429.
Budget Neutrality Factor.
FY 2015 Rural Community 0.999313............ 0.999313.
Hospital Demonstration
Program Budget Neutrality
Factor.
FY 2015 New Labor Market 0.998854............ 0.998854.
Delineation Wage Index
Transition Budget
Neutrality Factor.
FY 2015 Puerto Rico 0.926334............ 0.926334.
Operating Outlier Factor.
Puerto Rico[dash]Specific Labor: $1,609.97 Labor: $1,579.40
Payment Rate for FY 2015. Nonlabor: $937.45. Nonlabor: $968.02.
------------------------------------------------------------------------
12. On page 50385, lower half of the page, first column, second
paragraph, line 15, the figure ``0.997543'' is corrected to read
``0.998761''.
13. On page 50386, second column, last partial paragraph, line 6,
the figure ``1.2'' is corrected to read ``1.3''.
14. On page 50388:
a. First column:
(1) Second full paragraph:
(a) Line 9, the figure ``6.27'' is corrected to read ``6.18''.
(b) Line 13, the figure ``0.9373'' is corrected to read ``0.9382''
(2) Third full paragraph:
(a) Line 6, the phrase ``0.9373 is a -0.21 percent'' is corrected
to read ``0.9382 is a -0.12 percent''.
(b) Line 11, the mathematical expression ``0.9979 (0.9373/0.9393)''
is corrected to read ``0.9988 (0.9382/0.9393)''.
(c) Line 13, the figure ``0.21 percent'' is corrected to read
``0.12 percent''
b. Second column, second full paragraph:
(1) Line 12, the figure ``0.9987'' is corrected to read''0.9994''.
(2) Line 17, the figure ``0.9877'' is corrected to read ``0.9884''.
(3) Line 18, the figure ``1.0075'' is corrected to read ``1.0082''.
c. Third column:
(1) Third full paragraph, line 9, the figure ``$434.26'' is
corrected to read ``$434.97''.
(2) Fifth full paragraph (second bulleted paragraph), last line,
the figure ``0.9986'' is corrected to read ``0.9993''.
(3) Sixth full paragraph (third bulleted paragraph), last line, the
figure ``0.9373'' is corrected to read ``0.9382''.
15. On page 50389:
a. Top of page, third column, partial paragraph:
(1) Line 1, the figure ``0.14'' is corrected to read ``0.07''.
(2) Line 4, the figure ``0.21''is corrected to read ``0.11''.
(3) Line 7, the figure ``1.15'' is corrected to read ``1.32''.
b. Top half of the page, first table titled, ``Comparison of
Factors and Adjustments: FY 2014 Capital Federal Rate and FY 2015
Capital Federal Rate'' the table and table footnotes are corrected to
read as follows:
Comparison of Factors and Adjustments: FY 2014 Capital Federal Rate and FY 2015 Capital Federal Rate
----------------------------------------------------------------------------------------------------------------
FY 2014 FY 2015 Change Percent change
----------------------------------------------------------------------------------------------------------------
Update Factor \1\............................... 1.0090 1.0150 1.0150 1.50
GAF/DRG Adjustment Factor \1\................... 0.9987 0.9993 0.9993 -0.07
Outlier Adjustment Factor \2\................... 0.9393 0.9382 0.9989 -0.11
Capital Federal Rate............................ 429.31 434.97 1.0132 1.32
----------------------------------------------------------------------------------------------------------------
\1\ The update factor and the GAF/DRG budget neutrality adjustment factors are built permanently into the
capital Federal rates. Thus, for example, the incremental change from FY 2014 to FY 2015 resulting from the
application of the 0.9993 GAF/DRG budget neutrality adjustment factor for FY 2015 is a net change of 0.9993
(or -0.07 percent).
\2\ The outlier reduction factor is not built permanently into the capital Federal rate; that is, the factor is
not applied cumulatively in determining the capital Federal rate. Thus, for example, the net change resulting
from the application of the FY 2015 outlier adjustment factor is 0.9382/0.9393, or 0.9989 (or -0.11 percent).
----c. Middle of the page, second table titled, ``Comparison of
Factors and Adjustments: Proposed FY 2015 Capital Federal Rate and
Final FY 2015 Capital Federal Rate'' is corrected to read as follows:
[[Page 59683]]
Comparison of Factors and Adjustments: Proposed FY 2015 Capital Federal Rate and Final FY 2015 Capital Federal
Rate
----------------------------------------------------------------------------------------------------------------
Proposed Final Change Percent change
----------------------------------------------------------------------------------------------------------------
Update Factor................................... 1.0150 1.0150 1.0000 0.00
GAF/DRG Adjustment Factor....................... 0.9957 0.9993 1.0037 0.37
Outlier Adjustment Factor....................... 0.9374 0.9382 1.0009 0.09
Capital Federal Rate............................ 433.01 434.97 1.0045 0.45
----------------------------------------------------------------------------------------------------------------
d. Bottom half of the page, third column, second full paragraph,
last line, the figure ``$209.10.'' is corrected to read ``$209.45.''
16. On page 50390, second column, first partial paragraph, last
line, the figure ``$24,758'' is corrected to read ``$24,626''.
17. On page 50403, first column, first paragraph (table heading for
Table 2-2), the heading, ``Table 2-2.--Acute Care Hospitals Case-Mix
Indexes for Discharges Occurring in Federal Fiscal Year 2012; Hospital
Wage Indexes for Federal Fiscal Year 2015; Hospital Average Hourly
Wages for Federal Fiscal Years 2013 (2009 Wage Data), 2014 (2010 Wage
Data), and 2015 (2011 Wage Data; Based on FY 2015 CBSA Delineations);
and 3-Year Average of Hospital Average Hourly Wages'' is corrected to
read ``Table 2-2.--Acute Care Hospitals Case-Mix Indexes for Discharges
Occurring in Federal Fiscal Year 2013; Hospital Wage Indexes for
Federal Fiscal Year 2015; Hospital Average Hourly Wages for Federal
Fiscal Years 2013 (2009 Wage Data; Based on FY 2014 CBSA Delineations),
2014 (2010 Wage Data; Based on FY 2014 CBSA Delineations), and 2015
(2011 Wage Data; Based on FY 2015 CBSA Delineations); and 3-Year
Average of Hospital Average Hourly Wages (Based on FY 2014 and FY 2015
CBSA Delineations)''.
18. On page 50404:
a. Top one-sixth of the page, the first table titled ``Table 1A.--
National Adjusted Operating Standardized Amounts, Labor/Nonlabor (69.6
Percent Labor Share/30.4 Percent Nonlabor Share If Wage Index Is
Greater Than 1)--FY 2015'' is corrected to read as follows:
Table 1A--National Adjusted Operating Standardized Amounts, Labor/Nonlabor (69.6 Percent Labor Share/30.4
Percent Nonlabor Share if Wage Index Is Greater Than 1)--FY 2015
----------------------------------------------------------------------------------------------------------------
Hospital submitted quality Hospital did NOT submit Hospital submitted quality Hospital did NOT submit
data and is a meaningful quality data and is a data and is NOT a quality data and is NOT a
EHR user (update = 2.2 meaningful EHR user meaningful EHR user meaningful EHR user
percent) (update = 1.475 percent) (update = 1.475 percent) (Update = 0.75 percent)
----------------------------------------------------------------------------------------------------------------
Labor Nonlabor Labor Nonlabor Labor Nonlabor Labor Nonlabor
----------------------------------------------------------------------------------------------------------------
$3,784.75 $1,653.10 $3,757.90 $1,641.37 $3,757.90 $1,641.37 $3,731.05 $1,629.65
----------------------------------------------------------------------------------------------------------------
b. Top third of the page, the second table titled ``Table 1B.--
National Adjusted Operating Standardized Amounts, Labor/Nonlabor (62
Percent Labor Share/38 Percent Nonlabor Share If Wage Index Is Less
Than Or Equal To 1)--FY 2015'' is corrected to read as follows:
Table 1B--National Adjusted Operating Standardized Amounts, Labor/Nonlabor (62 Percent Labor Share/38 Percent
Nonlabor Share if Wage Index Is Less Than or Equal to 1)--FY 2015
----------------------------------------------------------------------------------------------------------------
Hospital submitted quality Hospital did NOT submit Hospital submitted quality Hospital did NOT
data and is a meaningful quality data and is a data and is NOT a meaningful submit quality data
EHR user (update = 2.2 meaningful EHR user EHR user (update = 1.475 and is NOT a
percent) (update = 1.475 percent) percent) meaningful EHR user
----------------------------------------------------------------------------------------- (update = 0.75
percent)
Labor Nonlabor Labor Nonlabor Labor Nonlabor -----------------------
Labor Nonlabor
----------------------------------------------------------------------------------------------------------------
$3,371.47 $2,066.38 $3,347.55 $2,051.72 $3,347.55 $2,051.72 $3,323.63 $2,037.0
7
----------------------------------------------------------------------------------------------------------------
c. Middle of the page, the third table titled ``Table 1C.--Adjusted
Operating Standardized Amounts For Puerto Rico, Labor/Nonlabor
(National: 62 Percent Labor Share/38 Percent Nonlabor Share Because
Wage Index Is Less Than Or Equal To 1; Puerto Rico: 63.2 Percent Labor
Share/36.8 Percent Nonlabor Share If Wage Index Is Greater Than 1 Or 62
Percent Labor Share/38 Percent Nonlabor Share If Wage Index Is Less
Than Or Equal To 1--FY 2015'' is corrected to read as follows:
[[Page 59684]]
Table 1C--Adjusted Operating Standardized Amounts for Puerto Rico, Labor/NOnlabor (National: 62 Percent Labor
Share/38 Percent Nonlabor Share Because Wage Index Is Less Than or Equal to 1; Puerto Rico: 63.2 Percent Labor
Share/36.8 Percent Nonlabor Share if Wage Index Is Greater Than 1 or 62 Percent Labor Share/38 Percent Nonlabor
Share if Wage Index Is Less Than or Equal to 1--FY 2015
----------------------------------------------------------------------------------------------------------------
Rates if wage index is greater than 1 Rates if wage index is less
---------------------------------------------- than or equal to 1
Standardized amount -------------------------------
Labor Nonlabor Labor Nonlabor
----------------------------------------------------------------------------------------------------------------
National \1\...................... Not Applicable....... Not Applicable....... $3,371.47 $2,066.38
Puerto Rico....................... $1,609.97............ $937.45.............. 1,579.40 968.02
----------------------------------------------------------------------------------------------------------------
\1\ For FY 2015, there are no CBSAs in Puerto Rico with a national wage index greater than 1.
d. Lower third of the page, the fourth table titled ``Table 1D.--
Capital Standard Federal Payment Rate--FY 2015'' is corrected to read
as follows:
Table 1D--Capital Standard Federal Payment Rate--FY 2015
------------------------------------------------------------------------
Rate
------------------------------------------------------------------------
National................................................ $434.97
Puerto Rico............................................. 209.45
------------------------------------------------------------------------
D. Corrections of Errors in the Appendices
1. On page 50405, first column, first paragraph:
a. Line 10, the figure ``$654'' is corrected to read ``$623''.
b. Line 12, the figure ``$132'' is corrected to read ``$128''.
c. Line 14, the figure ``1.6'' is corrected to read ``1.5''.
2. On page 50407, second column, last partial paragraph, line 3,
the figure ``5.71'' is corrected to read ``5.68''.
3. On pages 50409 through 50419, table titled ``Table I.--Impact
Analysis of Changes to the IPPS For Operating Costs for FY 2015'' the
table and table footnotes are corrected as follows:
BILLING CODE 4120-01-P
[[Page 59685]]
[GRAPHIC] [TIFF OMITTED] TR03OC14.006
[[Page 59686]]
[GRAPHIC] [TIFF OMITTED] TR03OC14.007
[[Page 59687]]
[GRAPHIC] [TIFF OMITTED] TR03OC14.008
BILLING CODE 4120-01-C
4. On page 50420:
a. First column, last partial paragraph, last line, the figure
``0.997543'' is corrected to read ``0.998761''.
b. Second column, first partial paragraph, line 6, the figure
``0.3'' is corrected to read ``0.2''.
c. Third column:
(1) First full paragraph, line 26, the figure ``1.001443'' is
corrected to read ``1.001421''.
[[Page 59688]]
(2) Last partial paragraph, line 6, the phrase ``2 urban hospital''
is corrected to read ``2 urban hospitals''.
5. On page 50421, bottom half of the page:
a. First column, first full paragraph:
(1) Line 9, the figure ``1.001443'' is corrected to read
``1.001421''.
(2) Line 11, the figure ``0.997543'' is corrected to read
``0.998761''.
(3) Line 18, the figures ``0.998982'' and ``0.10'' are corrected to
read ``1.000180'' and ``0.018'', respectively.
b. Second column, second full paragraph:
(1) Line 6, the figure ``0.990406'' is corrected to read
``0.990429''.
(2) Line 13, the figure ``1.5'' is corrected to read ``1.6''.
c. Third column, first full paragraph, line 8, the figure
``0.989507'' is corrected to read ``0.989525''.
6. On page 50422:
a. First column, second partial paragraph:
(1) Line 1, the figure ``422'' is corrected to read ``423''.
(2) Line 3, the figure ``2,974'' is corrected to read ``2,973''.
(3) Line 6, the figure ``0.989507'' is corrected to read
``0.989525''.
b. Second column:
(1) First paragraph, line 23, the phrase, ``this final rule for a
complere'' is corrected to read ``this final rule for a complete''.
(2) Second paragraph, line 8, the figure ``0.991291'' is corrected
to read ``0.991293''.
(3) Last paragraph, line 7, the figure ``1.121'' is corrected to
read ``1.1093''.
(4) Last paragraph, last line, the figure ``$1.9'' is corrected to
read ``$1.8''.
7. On page 50423, the table titled ``FY 2015 IPPS Estimated
Payments Due to Rural Floor and Imputed Floor with National Budget
Neutrality'' is corrected to read as follows:
FY 2015 IPPS Estimated Payments Due to Rural Floor and Imputed Floor With National Budget Neutrality
----------------------------------------------------------------------------------------------------------------
Percent change
in payments
Number of due to
hospitals that application of
State Number of will receive rural floor Difference (in
hospitals the rural and imputed millions)
floor or floor with
imputed floor budget
neutrality
(1) (2) (3) (4)
----------------------------------------------------------------------------------------------------------------
Alabama......................................... 91 2 -0.5 -8.4
Alaska.......................................... 6 4 1.5 2.2
Arizona......................................... 57 9 -0.1 -1.9
Arkansas........................................ 45 0 -0.5 -5.3
California...................................... 309 200 1.9 190.2
Colorado........................................ 47 6 0.2 2.3
Connecticut..................................... 31 8 -0.4 -6.6
Delaware........................................ 6 0 -0.6 -2.4
Washington, D.C................................. 7 0 -0.6 -2.6
Florida......................................... 169 25 -0.3 -18.7
Georgia......................................... 106 0 -0.5 -13.2
Hawaii.......................................... 12 0 -0.4 -1.3
Idaho........................................... 14 0 -0.4 -1.2
Illinois........................................ 127 0 -0.6 -28.0
Indiana......................................... 91 0 -0.6 -13.2
Iowa............................................ 34 0 -0.5 -4.5
Kansas.......................................... 53 0 -0.4 -3.8
Kentucky........................................ 65 1 -0.5 -7.9
Louisiana....................................... 100 0 -0.5 -7.0
Maine........................................... 20 0 -0.5 -2.5
Massachusetts................................... 61 51 4.9 156.4
Michigan........................................ 95 0 -0.5 -23.2
Minnesota....................................... 51 0 -0.5 -10.1
Mississippi..................................... 64 0 -0.5 -5.3
Missouri........................................ 78 0 -0.5 -11.2
Montana......................................... 12 4 -0.3 -0.8
Nebraska........................................ 23 0 -0.4 -2.6
Nevada.......................................... 24 6 0.7 4.7
New Hampshire................................... 13 9 2.2 10.5
New Jersey...................................... 64 15 0.1 2.7
New Mexico...................................... 25 2 -0.3 -1.1
New York........................................ 163 0 -0.6 -48.9
North Carolina.................................. 87 0 -0.5 -15.9
North Dakota.................................... 6 1 -0.3 -0.8
Ohio............................................ 135 10 -0.4 -16.9
Oklahoma........................................ 86 2 -0.5 -5.7
Oregon.......................................... 33 0 -0.5 -4.8
Pennsylvania.................................... 154 10 -0.5 -23.3
Puerto Rico..................................... 52 11 0 -0.1
Rhode Island.................................... 11 4 0.5 1.8
South Carolina.................................. 55 7 -0.3 -5.1
South Dakota.................................... 19 0 -0.3 -1.1
Tennessee....................................... 98 16 -0.2 -5.6
Texas........................................... 324 6 -0.5 -30.1
Utah............................................ 33 2 -0.4 -2.2
[[Page 59689]]
Vermont......................................... 6 0 -0.3 -0.7
Virginia........................................ 79 1 -0.5 -12.0
Washington...................................... 49 8 -0.2 -3.1
West Virginia................................... 30 0 -0.4 -3.2
Wisconsin....................................... 65 2 -0.5 -8.6
Wyoming......................................... 11 1 -0.2 -0.3
----------------------------------------------------------------------------------------------------------------
8. On page 50424:
a. Second column, first partial paragraph, line 9, the figure
``0.998859'' is corrected to read ``0.998854''.
b. Third column, first full paragraph, line 18, the figure ``273''
is corrected to read ``279''.
9. On page 50425:
a. First column, first partial paragraph, last line, the figure
``$424'' is corrected to read ``$428''.
b. Second column, first full paragraph, line 1, the phrase ``Rural
West South'' is corrected to read ``Rural West North''.
c. Third column:
(1) First partial paragraph, line 6, the figure ``5.71'' is
corrected to read ``5.68''.
(2) First full paragraph, line 14, the figure ``0.7'' is corrected
to read ``0.6''.
10. On pages 50426 and 50427, the table titled ``Table II.--Impact
Analysis of Changes for FY 2015 Acute Care Hospital Operating
Prospective Payment System (Payments Per Discharge)'' is corrected to
read as follows:
Table II--Impact Analysis of Changes for FY 2015 Acute Care Hospital Operating Prospective Payment System
[Payments per discharge]
----------------------------------------------------------------------------------------------------------------
Estimated Estimated
Number of average FY average FY All FY 2015
hospitals 2014 payment 2015 payment changes
per discharge per discharge
(1) (2) (3) (4)
----------------------------------------------------------------------------------------------------------------
All Hospitals................................... 3,396 11,249 11,184 -0.6
By Geographic Location:
Urban hospitals............................. 2,549 11,625 11,557 -0.6
Large urban areas........................... 1,401 12,377 12,308 -0.6
Other urban areas........................... 1,148 10,709 10,643 -0.6
Rural hospitals............................. 847 8,240 8,194 -0.6
Bed Size (Urban):
0-99 beds................................... 666 9,088 9,061 -0.3
100-199 beds................................ 787 9,747 9,682 -0.7
200-299 beds................................ 455 10,507 10,489 -0.2
300-499 beds................................ 429 11,951 11,875 -0.6
500 or more beds............................ 212 14,309 14,198 -0.8
Bed Size (Rural):
0-49 beds................................... 328 6,778 6,701 -1.1
50-99 beds.................................. 305 7,803 7,692 -1.4
100-149 beds................................ 125 8,113 8,109 0
150-199 beds................................ 50 8,857 8,819 -0.4
200 or more beds............................ 39 9,988 10,027 0.4
Urban by Region:
New England................................. 120 12,806 12,802 0
Middle Atlantic............................. 324 12,914 12,905 -0.1
South Atlantic.............................. 407 10,453 10,359 -0.9
East North Central.......................... 397 10,849 10,790 -0.5
East South Central.......................... 153 10,052 9,922 -1.3
West North Central.......................... 162 11,355 11,314 -0.4
West South Central.......................... 387 10,677 10,500 -1.7
Mountain.................................... 162 11,935 11,835 -0.8
Pacific..................................... 385 14,691 14,708 0.1
Puerto Rico................................. 52 8,218 7,620 -7.3
Rural by Region:
New England................................. 22 11,207 11,110 -0.9
[[Page 59690]]
Middle Atlantic............................. 57 8,292 8,231 -0.7
South Atlantic.............................. 132 7,836 7,772 -0.8
East North Central.......................... 116 8,475 8,496 0.2
East South Central.......................... 165 7,513 7,409 -1.4
West North Central.......................... 102 8,914 8,941 0.3
West South Central.......................... 168 7,108 6,978 -1.8
Mountain.................................... 61 9,454 9,509 0.6
Pacific..................................... 24 11,083 11,221 1.3
By Payment Classification:
Urban hospitals............................. 2,563 11,609 11,541 -0.6
Large urban areas........................... 1,413 12,366 12,296 -0.6
Other urban areas........................... 1,150 10,677 10,611 -0.6
Rural areas................................. 833 8,457 8,411 -0.5
Teaching Status:
Nonteaching................................. 2,357 9,343 9,300 -0.5
Fewer than 100 residents.................... 795 10,978 10,920 -0.5
100 or more residents....................... 244 16,533 16,399 -0.8
Urban DSH:
Non-DSH..................................... 679 9,836 9,899 0.6
100 or more beds............................ 1,588 12,055 11,960 -0.8
Less than 100 beds.......................... 383 8,434 8,375 -0.7
Rural DSH:
SCH......................................... 373 7,907 7,867 -0.5
RRC......................................... 212 9,194 9,175 -0.2
100 or more beds............................ 24 7,395 7,305 -1.2
Less than 100 beds.......................... 137 6,329 6,253 -1.2
Urban teaching and DSH:
Both teaching and DSH....................... 842 13,277 13,167 -0.8
Teaching and no DSH......................... 133 11,130 11,230 0.9
No teaching and DSH......................... 1,129 9,781 9,713 -0.7
No teaching and no DSH...................... 459 9,223 9,289 0.7
Special Hospital Types:
RRC......................................... 193 9,403 9,350 -0.6
SCH......................................... 325 9,577 9,654 0.8
MDH......................................... 162 7,072 6,706 -5.2
SCH and RRC................................. 124 10,293 10,410 1.1
MDH and RRC................................. 15 9,195 8,458 -8
Type of Ownership:
Voluntary................................... 1,935 11,377 11,334 -0.4
Proprietary................................. 892 10,001 9,919 -0.8
Government.................................. 542 12,283 12,113 -1.4
Medicare Utilization as a Percent of Inpatient
Days:
0-25........................................ 501 14,885 14,544 -2.3
25-50....................................... 2,081 11,359 11,311 -0.4
50-65....................................... 601 9,146 9,145 0
Over 65..................................... 93 8,408 8,353 -0.6
FY 2015 Reclassifications by the Medicare
Geographic Classification Review Board:
All Reclassified Hospitals.................. 719 10,843 10,829 -0.1
Non-Reclassified Hospitals.................. 2,677 11,379 11,298 -0.7
Urban Hospitals Reclassified................ 450 11,514 11,502 -0.1
Urban Nonreclassified Hospitals, FY 2015:... 2,054 11,675 11,593 -0.7
All Rural Hospitals Reclassified FY 2015:... 269 8,734 8,713 -0.2
Rural Nonreclassified Hospitals FY 2015:.... 514 7,667 7,606 -0.8
All Section 401 Reclassified Hospitals:..... 50 10,137 10,025 -1.1
Other Reclassified Hospitals (Section 64 7,814 7,665 -1.9
1886(d)(8)(B)).............................
Specialty Hospitals:
Cardiac specialty Hospitals................. 15 12,303 12,538 1.9
----------------------------------------------------------------------------------------------------------------
11. On page 50428, first column, first paragraph, lines 31 through
35, the sentence ``Based on the applicant's estimate from FY 2013, we
currently estimate that new technology add-on payments for
Voraxaze[supreg] will increase overall FY 2015 payments by
$6,300,000.'' is corrected to read ``Based on the latest data from the
[[Page 59691]]
manufacturer, we currently estimate that new technology add-on payments
for Voraxaze[supreg] will increase overall FY 2015 payments by
$6,615,000.''
12. On page 50429:
a. First column, second paragraph, line 6, the figure ``$5.3'' is
corrected to read ``$8.8''.
b. First column, third paragraph, line 16, the figure ``166'' is
corrected to read ``116''.
c. Second column, first partial paragraph, line 4, the figure
``$70.7'' is corrected to read ``$71''.
13. On page 50435, upper three-fourths of the page:
a. First column, fourth bulleted paragraph:
(1) Line 4, the figure ``0.9986'' is corrected to read ``0.9993''.
(2) Line 5, the figure ``0.9373'' is corrected to read ``0.9382''.
b. Second column, first partial paragraph, line 2, the
figure''1.2'' is corrected to read ``1.3''.
c. Third column:
(1) Second full paragraph, second sentence, is corrected to read,
``The increase in capital payments for voluntary and proprietary
hospitals is estimated at 1.5 percent, and for government hospitals the
increase is estimated to be 1.3 percent.''
(2) Third full paragraph:
(a) Line 20, the figure ``0.7'' is corrected to read ``0.8''.
(b) Line 24, the figure ``(2.2 percent)'' is corrected to read
``(2.3 percent)''.
14. On pages 50435 through 50437, the table titled, ``Table III.
Comparison of Total Payments Per Case'' is corrected to read as
follows:
Table III--Comparison of Total Payments per Case
[FY 2014 payments compared to FY 2015 payments]
----------------------------------------------------------------------------------------------------------------
Average FY Average FY
Number of 2014 payments/ 2015 payments/ Change
hospitals case case
----------------------------------------------------------------------------------------------------------------
By Geographic Location:
All hospitals............................... 3,396 856 869 1.5
Large urban areas (populations over 1 1,401 944 959 1.7
million)...................................
Other urban areas (populations of 1 million 1,148 824 835 1.4
or fewer)..................................
Rural areas................................. 847 583 589 1.0
Urban hospitals............................. 2,549 890 903 1.5
0-99 beds............................... 666 733 740 0.9
100-199 beds............................ 787 772 783 1.5
200-299 beds............................ 455 812 826 1.8
300-499 beds............................ 429 907 922 1.6
500 or more beds........................ 212 1,066 1,081 1.5
Rural hospitals............................. 847 583 589 1.0
0-49 beds............................... 328 474 480 1.2
50-99 beds.............................. 305 542 546 0.8
100-149 beds............................ 125 582 588 1.1
150-199 beds............................ 50 636 643 1.1
200 or more beds........................ 39 709 717 1.1
By Region:
Urban by Region............................. 2,549 890 903 1.5
New England............................. 120 984 1,001 1.7
Middle Atlantic......................... 324 958 977 1.9
South Atlantic.......................... 407 802 812 1.3
East North Central...................... 397 856 867 1.3
East South Central...................... 153 764 772 1.0
West North Central...................... 162 880 892 1.4
West South Central...................... 387 823 831 0.9
Mountain................................ 162 907 918 1.2
Pacific................................. 385 1,120 1,148 2.4
Puerto Rico............................. 52 408 412 1.2
Rural by Region............................. 847 583 589 1.0
New England............................. 22 812 823 1.4
Middle Atlantic......................... 57 566 575 1.7
South Atlantic.......................... 132 555 559 0.7
East North Central...................... 116 607 613 1.1
East South Central...................... 165 534 539 0.9
West North Central...................... 102 619 624 0.9
West South Central...................... 168 515 519 0.8
Mountain................................ 61 653 657 0.5
Pacific................................. 24 749 767 2.4
Puerto Rico............................. 0 0 0 0.0
By Payment Classification:
All hospitals............................... 3,396 856 869 1.5
Large urban areas (populations over 1 1,413 943 959 1.7
million)...................................
Other urban areas (populations of 1 million 1,150 823 835 1.4
or fewer)..................................
Rural areas................................. 833 594 599 0.8
Teaching Status:
Non-teaching............................ 2,357 728 738 1.5
Fewer than 100 Residents................ 795 837 850 1.5
100 or more Residents................... 244 1,210 1,229 1.6
Urban DSH:
100 or more beds.................... 1,588 911 925 1.6
Less than 100 beds.................. 383 649 657 1.1
[[Page 59692]]
Rural DSH:
Sole Community (SCH/EACH)........... 373 530 535 1.1
Referral Center (RRC/EACH).......... 212 656 661 0.8
Other Rural:
100 or more beds................ 24 552 552 0.0
Less than 100 beds.............. 137 465 469 1.0
Urban teaching and DSH:
Both teaching and DSH................... 842 990 1,005 1.5
Teaching and no DSH..................... 133 891 907 1.8
No teaching and DSH..................... 1,129 762 774 1.6
No teaching and no DSH.................. 459 788 799 1.4
Rural Hospital Types:
Non special status hospitals............ 2,575 890 903 1.5
RRC/EACH................................ 193 717 730 1.8
SCH/EACH................................ 325 652 659 1.1
SCH, RRC and EACH....................... 124 711 720 1.3
Hospitals Reclassified by the Medicare
Geographic Classification Review Board:
FY2015 Reclassifications:
All Urban Reclassified.................. 450 886 904 2.1
All Urban Non-Reclassified.............. 2,054 893 906 1.4
All Rural Reclassified.................. 269 621 628 1.0
All Rural Non-Reclassified.............. 514 533 537 0.8
Other Reclassified Hospitals (Section 59 581 595 2.3
1886(d)(8)(B)).........................
Type of Ownership:
Voluntary............................... 1,935 868 882 1.5
Proprietary............................. 892 776 787 1.5
Government.............................. 542 895 907 1.3
Medicare Utilization as a Percent of
Inpatient Days:
0-25.................................... 501 1,022 1,037 1.4
25-50................................... 2,081 871 884 1.5
50-65................................... 601 717 728 1.6
Over 65................................. 93 648 654 1.0
----------------------------------------------------------------------------------------------------------------
a. Upper three-fourths of the page:
(1) Second column, first paragraph:
(a) Line 2, the figure ``$654'' is corrected to read ``$623''.
(b) Line 14, the figure ``$457'' is corrected to read ``$428''.
(c) Line 22, the figure ``$369'' is corrected to read ``$373''.
(d) Line 44, the figure ``$457'' is corrected to read ``$428''.
(e) Line 45, the figure ``$888'' is corrected to read ``$862''.
(f) Line 51, the figure ``$132'' is corrected to read ``$128''.
(g) Line 55, the figure ``$756'' is corrected to read ``$734''.
(2) Third column, last paragraph, last line, the figure ``$756'' is
corrected to read ``$734''.
b. Lower quarter of the page, the table titled ``Table V.--
Accounting Statement: Classification of Estimated Expenditures under
the IPPS from FY 2014 to FY 2015'' is corrected to read as follows:
Table V--Accounting Statement: Classification of Estimated Expenditures
Under the IPPS From FY 2014 to FY 2015
------------------------------------------------------------------------
Category Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers............ -$734 million.
From Whom to Whom......................... Federal Government to IPPS
Medicare Providers.
------------------------------------------------------------------------
Dated: September 30, 2014.
Oliver Potts,
Deputy Executive Secretary to the Department, Department of Health and
Human Services.
[FR Doc. 2014-23630 Filed 10-1-14; 11:15 am]
BILLING CODE 4120-01-P