[Federal Register Volume 80, Number 164 (Tuesday, August 25, 2015)]
[Proposed Rules]
[Pages 51504-51506]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2015-20994]


=======================================================================
-----------------------------------------------------------------------

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Part 510

[CMS-5516-CN]
RIN 0938-AS64


Medicare Program; Comprehensive Care for Joint Replacement 
Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint 
Replacement Services; Corrections

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

ACTION: Proposed rule; correction.

-----------------------------------------------------------------------

SUMMARY: This document corrects technical and typographical errors that 
appeared in the proposed rule published in the July 14, 2015 Federal 
Register entitled ``Medicare Program; Comprehensive Care for Joint 
Replacement Payment Model for Acute Care Hospitals Furnishing Lower 
Extremity Joint Replacement Services.''

DATES: The comment due date for the proposed rule published in the 
Federal Register on July 14, 2015 (80 FR 41198) remains September 8, 
2015.

FOR FURTHER INFORMATION CONTACT:
    Claire Schreiber, [email protected], (410) 786-8939.
    Gabriel Scott, [email protected], (410) 786-3928.

SUPPLEMENTARY INFORMATION:

I. Background

    In FR Doc. 2015-17190 of July 14, 2015 (80 FR 41198), there were a 
number of technical and typographical errors that are identified and 
corrected in the Correction of Errors section of this document.

II. Summary of Errors

    On page 41210, in our discussion of the factors considered but not 
used in creating proposed strata, we inadvertently omitted a term and 
used an incorrect term.
    On pages 41212 and 41269, we made errors in referencing the name of 
the Comprehensive Care for Joint Replacement (CCJR) model.
    On pages 41223 and 41224, in our discussion of the proposed pricing 
adjustment for high payment episodes, we made errors in describing the 
distribution model presented in Figure 2.
    On page 41234, in our discussion of the proposed combination of 
CCJR episodes anchored by Medical Severity Diagnosis-Related Groups 
(MS-DRGs) 469 and 470, we made an error in the unpooled hospital-
specific historical average payments calculation for MS-DRG 469 
anchored target prices.
    On pages 41235 and 41236, in our discussion of the proposed 
approach to combine pricing features, we made an error in the placement 
and the language of a sentence that was part of the bulleted text.
    On page 41240, in the discussion of the criteria for applicable 
hospitals and performance scoring, we made errors in stating the 
percentage of eligible elective primary total hip arthroplasty/total 
knee arthoplasty (THA/TKA) patients for which hospitals must submit 
data and the timeframe for the submission of data.
    On pages 41241 and 41242, we made errors in stating a National 
Quality Forum (NQF) measure number.
    On page 41250, in the discussion of the accounting for CCJR 
reconciliation payments and repayments in other models and programs, we 
inadvertently omitted a word.
    On page 41251, in the discussion of the accounting for per 
beneficiary per month (PBPM) payments in the episode definition, we 
made an error in stating the total number of models with PBPMs.
    On pages 41268, 41270, and 41278, we made typographical errors in 
footnotes 42, 43, and 55, respectively. These errors include omitting 
the title of the article that was referenced, omitting the text of the 
footnote, and inadvertently adding a reference to a footnote.
    On page 41283, in the discussion of ``Case Mix Adjustment,'' we 
inadvertently omitted a term.
    On pages 41242, 41281, and 41284, we made technical and 
typographical errors in using the acronyms ``CCJR-,'' ``HCAHPS,'' and 
``THA''.
    On page 41285, in our discussion of pre-operative assessments, we 
made errors in our designation of several bulleted paragraphs.
    On pages 41287 and 41288, Table 16, we made errors in the table 
formatting and omitted language that would identify the entries 
pertaining to the duration of the performance period.

III. Correction of Errors

    In FR Doc. 2015-17190 of July 14, 2015 (80 FR 41198), make the 
following corrections:
    1. On page 41210, first column, fifth full paragraph, lines 1 
through 3, the phrase ``these measures are proposed to be part of the 
selection stratus'' is corrected to read ``these measures are not 
proposed to be part of the selection strata''.

[[Page 51505]]

    2. On page 41212, lower half of the page, second column, first 
paragraph, lines 1 and 2, the phrase ``Coordinated Quality Care-Joint 
Replacement'' is corrected to read ``Comprehensive Care for Joint 
Replacement''.
    3. On page 41223, third column, last paragraph, lines 7 through 12, 
the sentence ``Similarly, we believe the BPCI distribution of Model 2 
90-day LEJR episode payment amounts as displayed in Figure 1 provides 
information that is relevant to policy development regarding CCJR 
episodes.'' is corrected to read ``Similarly, we believe the 
distribution of 90-day LEJR episode payment amounts utilizing the BPCI 
Model 2 episode definition as displayed in Figure 2 provides 
information that is relevant to policy development regarding CCJR 
episodes.''.
    4. On page 41224, top of the page, in the figure heading (Figure 
2), the heading ``FIGURE 2: ESTIMATED NATIONAL DISTRIBUTION of BPCI 
MODEL 2 LEJR 90-day EPISODE PAYMENT AMOUNTS'' is corrected to read 
``FIGURE 2: ESTIMATED NATIONAL DISTRIBUTION OF LEJR 90-day EPISODE 
PAYMENT AMOUNTS''.
    5. On page 41234, first column, first full paragraph, line 11, the 
phrase ``hospital weight'' is corrected to read ``anchor factor''.
    6. On page 41235, third column--
    a. Sixth bulleted paragraph, last line, the phrase ``the previous 
step.'' is corrected to read ``the previous step. We have posted 
region-specific historical average episode payments on the CCJR 
proposed rule Web site at http://innovation.cms.gov/initiatives/ccjr/
.''.
    b. Last bulleted paragraph, lines 12 through 13, and page 41236, 
first column, first partial paragraph, lines 1 through 3, the sentence, 
``We have posted region-specific pooled historical average episode 
payments on the CCJR proposed rule Web site at http://innovation.cms.gov/initiatives/ccjr/.'' is corrected by removing the 
sentence.
    7. On page 41240--
    a. Second column, last bulleted paragraph, line 3, the figure 
``70'' is corrected to read ``80''.
    b. Third column--
    (1) First full paragraph (bulleted), line 3, the phrase ``12 
month'' is corrected to read ``performance''.
    (2) Second full paragraph, line 30, the figure ``70'' is corrected 
to read ``80''.
    8. On page 41241--
    a. Top of the page, second column, first partial paragraph, line 
27, the parenthetical reference ``(NQF #1661)'' is corrected to read 
``(NQF #0166)''.
    b. Lower third of the page, in the table titled ``TABLE 8--QUALITY 
MEASURE WEIGHTS IN COMPOSITE QUALITY SCORE'', first column of the table 
(Quality measure), line 3, the parenthetical reference ``(NQF #1661)'' 
is corrected to read ``(NQF #0166)''.
    9. On page 41242, top third of the page, third column, first full 
paragraph, line 9--
    a. The acronym ``HCAPHS'' is corrected to read ``HCAHPS''.
    b. The parenthetical reference ``(NQF #1661)'' is corrected to read 
``(NQF #0166)''.
    10. On page 41250, third column, first full paragraph, line 12, the 
phrase ``to be able make'' is corrected to read ``to be able to make''.
    11. On page 41251, second column, first full paragraph, line 2, the 
phrase ``four existing models'' is corrected to read ``active models''.
    12. On page 41268, second column, last paragraph, the footnote 
(footnote 42), `` \42\ Naylor MD, Brooten D, Campbell R, Jacobsen BS, 
Mezey MD, Pauly MV, Schwartz JS. JAMA. 1999: 281(7): 613-620. doi:10/
1001/jama.281.7.613'' is corrected to read `` \42\ Naylor MD, Brooten 
D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, Schwartz JS. 
Comprehensive discharge planning and home follow-up of hospitalized 
elders: A randomized clinical trial. JAMA. 1999: 281(7): 613-620. 
doi:10/1001/jama.281.7.6136.''.
    13. On page 41269--
    a. Second column, second full paragraph, lines 28 and 29, the 
phrase ``Coordinated quality care-joint replacement model'' is 
corrected to read ``Comprehensive Care for Joint Replacement model''.
    b. Third column, first partial paragraph, lines 5 and 6, the phrase 
``Medicare-approved coordinated quality care-Joint Replacement model)'' 
is corrected to read ``Medicare-approved Comprehensive Care for Joint 
Replacement model)''.
    14. On page 41270, third column, following the last paragraph, is 
corrected by adding the following footnoted paragraph (Footnote 43):
    `` \43\ Telehealth in an Evolving Health Care Environment: Workshop 
Summary (2012). Available at: http://www.ic4n.org/wp-content/uploads/2014/06/IoM-Telehealth-2012-Workshop-Summary.pdf. Accessed on June 7, 
2015.''
    15. On page 41278, second column, third footnoted paragraph 
(Footnote 55) `` \55\ Soohoo NF, Farng E, Lieberman JR, Chambers L, 
Zingmond DS. Factors That Predict Short-term Complication Rates After 
Total Hip Arthroplasty. Clin Orthop Relat Res. Sep 2010; 468(9): 2363-
2371. Cram P, Vaughn-Sarrazin MS, Wolf B, Katz JN, Rosenthal GE. A 
comparison of total hip and knee replacement in specialty and general 
hospitals. J Bone Joint Surg Am. Aug 2007; 89(8): 1675-1684.'' is 
corrected to read `` \55\ Soohoo NF, Farng E, Lieberman JR, Chambers L, 
Zingmond DS. Factors that predict short-term complication rates after 
total hip arthroplasty. Clin Orthop Relat Res. Sep 2010; 468(9): 2363-
2371.''.
    16. On page 41281, second column, last partial paragraph, line 1, 
the phrase ``We note that CCJR--we chose to align'' is corrected to 
read ``We note that we chose to align''.
    17. On page 41283, first column, sixth bulleted paragraph, the 
phrase ``discharge and survey.'' is corrected to read ``discharge and 
survey completion.''.
    18. On page 41284--
    a. First column, first partial paragraph, line 44, the acronym 
``HCAPHS'' is corrected to read ``HCAHPS''.
    b. Second column, first partial paragraph, line 7, the phrase ``THA 
THA/TKA patient-reported'' is corrected to read ``THA/TKA patient-
reported''.
    19. On page 41285, second column, second bulleted paragraph--
    a. Line 17, the phrase ``--PROMIS'' is corrected to read ``++ 
PROMIS''.
    b. Line 29, the phrase ``--American Society'' is corrected to read 
``++ American Society''.
    c. Line 33, the phrase ``--Total painful'' is corrected to read 
``++ Total painful''.
    d. Line 34, the phrase ``--Quantified spinal'' is corrected to read 
``++ Quantified spinal''.
    20. On pages 41287 and 41288, the table titled ``TABLE 16--EXAMPLE 
OF POTENTIAL PERFORMANCE PERIODS FOR PRE- AND POST-OPERATIVE THA/TKA 
VOLUNTARY DATA SUBMISSION'' is corrected to read as follows:

[[Page 51506]]



Table 16--Example of Potential Performance Periods for Pre- and Post-Operative THA/TKA Voluntary Data Submission
----------------------------------------------------------------------------------------------------------------
                                               Duration of
                                                   the           Patient population         Requirements for
   CCJR Model year      Performance period     performance      eligible for THA/TKA       successful THA/TKA
                                                 period      voluntary data submission       voluntary data
                                                (months)                                      submission *
----------------------------------------------------------------------------------------------------------------
2016.................  April 1, 2016                      3  All patients undergoing    Submit
                        through June 30,                      elective primary THA/TKA   PRE[dash]operative data
                        2016.                                 procedures performed       on primary elective THA/
                                                              between April 1, 2016      TKA procedures for
                                                              and June 30, 2016.         >=80% of procedures
                                                                                         performed between April
                                                                                         1, 2016 and June 30,
                                                                                         2016.
2017.................  April 1, 2016                     15  All patients undergoing    Submit
                        through June 30,                      elective primary THA/TKA   POST[dash]operative
                        2016.                                 procedures performed       data on primary
                                                              between April 1, 2016      elective THA/TKA
                                                              and June 30, 2016.         procedures for >=80% of
                                                                                         procedures performed
                                                                                         between April 1, 2016
                                                                                         and June 30, 2016.
2017.................  July 1, 2016 through  ..............  All patients undergoing    Submit
                        June 30, 2017.                        elective primary THA/TKA   PRE[dash]operative data
                                                              procedures performed       on primary elective THA/
                                                              between July 1, 2016 and   TKA procedures for
                                                              June 30, 2017.             >=80% of procedures
                                                                                         performed between July
                                                                                         1, 2016 and June 30,
                                                                                         2017.
2018.................  July 1, 2016 through              24  All patients undergoing    Submit
                        June 30, 2017.                        elective primary THA/TKA   POST[dash]operative
                                                              procedures performed       data on primary
                                                              between July 1, 2016 and   elective THA/TKA
                                                              June 30, 2017.             procedures for >=80% of
                                                                                         procedures performed
                                                                                         between July 1, 2016
                                                                                         and June 30, 2017.
2018.................  July 1, 2017 through  ..............  All patients undergoing    Submit
                        June 30, 2018.                        elective primary THA/TKA   PRE[dash]operative data
                                                              procedures performed       on primary elective THA/
                                                              between July 1, 2017 and   TKA procedures for
                                                              June 30, 2018.             >=80% of procedures
                                                                                         performed between July
                                                                                         1, 2017 and June 30,
                                                                                         2018.
2019.................  July 1, 2017 through              24  All patients undergoing    Submit
                        June 30, 2018.                        elective primary THA/TKA   POST[dash]operative
                                                              procedures performed       data on primary
                                                              between July 1, 2017 and   elective THA/TKA
                                                              June 30, 2018.             procedures for >=80% of
                                                                                         procedures performed
                                                                                         between July 1, 2017
                                                                                         and June 30, 2018.
2019.................  July 1, 2018 through  ..............  All patients undergoing    Submit
                        June 30, 2019.                        elective primary THA/TKA   PRE[dash]operative data
                                                              procedures performed       on primary elective THA/
                                                              between July 1, 2018 and   TKA procedures for
                                                              June 30, 2019.             >=80% of procedures
                                                                                         performed between July
                                                                                         1, 2018 and June 30,
                                                                                         2019.
2020.................  July 1, 2018 through              24  All patients undergoing    Submit
                        June 30, 2019.                        elective primary THA/TKA   POST[dash]operative
                                                              procedures performed       data on primary
                                                              between July 1, 2018 and   elective THA/TKA
                                                              June 30, 2019.             procedures for >=80% of
                                                                                         procedures performed
                                                                                         between July 1, 2018
                                                                                         and June 30, 2019.
2020.................  July 1, 2019 through  ..............  All patients undergoing    Submit PRE-operative
                        June 30, 2020.                        elective primary THA/TKA   data on primary
                                                              procedures performed       elective THA/TKA
                                                              between July 1, 2019 and   procedures for >=80% of
                                                              June 30, 2020.             procedures performed
                                                                                         between July 1, 2019
                                                                                         and June 30, 2020.
----------------------------------------------------------------------------------------------------------------
* Requirements for determining successful submission of THA/TKA voluntary data are located in section
  III.D.3.a.(9). of this proposed rule.


    Dated: August 19, 2015.
Madhura Valverde,
Executive Secretary to the Department, Department of Health and Human 
Services.
[FR Doc. 2015-20994 Filed 8-21-15; 11:15 am]
 BILLING CODE 4120-01-P