[Federal Register Volume 81, Number 193 (Wednesday, October 5, 2016)]
[Rules and Regulations]
[Pages 68947-68963]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-24042]
[[Page 68947]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 405, 412, 413, and 489
[CMS-1655-F; CMS-1664-F; CMS-1632-F2]
RIN 0938-AS77; 0938-AS88; 0938-AS41
Medicare Program; Hospital Inpatient Prospective Payment Systems
for Acute Care Hospitals and the Long-Term Care Hospital Prospective
Payment System and Policy Changes and Fiscal Year 2017 Rates; Quality
Reporting Requirements for Specific Providers; Graduate Medical
Education; Hospital Notification Procedures Applicable to Beneficiaries
Receiving Observation Services; Technical Changes Relating to Costs to
Organizations and Medicare Cost Reports; Finalization of Interim Final
Rules With Comment Period on LTCH PPS Payments for Severe Wounds,
Modifications of Limitations on Redesignation by the Medicare
Geographic Classification Review Board, and Extensions of Payments to
MDHs and Low-Volume Hospitals; 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, 2016 Federal Register
titled ``Medicare Program; Hospital Inpatient Prospective Payment
Systems for Acute Care Hospitals and the Long-Term Care Hospital
Prospective Payment System and Policy Changes and Fiscal Year 2017
Rates; Quality Reporting Requirements for Specific Providers; Graduate
Medical Education; Hospital Notification Procedures Applicable to
Beneficiaries Receiving Observation Services; Technical Changes
Relating to Costs to Organizations and Medicare Cost Reports;
Finalization of Interim Final Rules With Comment Period on LTCH PPS
Payments for Severe Wounds, Modifications of Limitations on
Redesignation by the Medicare Geographic Classification Review Board,
and Extensions of Payments to MDHs and Low-Volume Hospitals.''
DATES: This correction is effective October 1, 2016.
FOR FURTHER INFORMATION CONTACT: Donald Thompson, (410) 786-4487.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2016-18476 of August 22, 2016 (81 FR 56761) there were a
number of technical and typographical errors identified and corrected
in the Correction of Errors section of this correcting document. The
provisions in this correcting document are effective as if they had
been included in the document that appeared in the August 22, 2016
Federal Register. Accordingly, the corrections are effective October 1,
2016.
II. Summary of Errors
A. Summary of Errors in the Preamble
On page 56775, we made a typographical error in stating the cost
reduction.
On page 56796, we are correcting errors and inadvertent omissions
in the summary and response to a comment on the assignment of 18
additional diagnosis codes.
On page 56797, we erroneously referred to the wrong table.
On page 56801, we are correcting errors and inadvertent omissions
in our response to comments on our proposal to redesignate four ICD-10-
PCS procedure codes.
On page 56803 and in the table on page 56804 describing ICD-10-PCS
Endovascular Thrombectomy Procedure Codes Reassigned to MS-DRGs 270,
271, and 272 for FY 2017, we are correcting technical errors in our
discussion in response to comments to remove 34 ICD-10-PCS procedure
codes describing endovascular thrombectomy of non-lower limbs from the
proposed list of codes to be reassigned to MS-DRGs 270, 271 and 272. In
this response, we erroneously referred to 34 procedure codes describing
non-lower limb procedures (as included in the list submitted by the
commenter) rather than 32 non-lower limb procedure codes. Two of the 34
procedure codes identified by the commenter, ICD-10-PCS procedure codes
04CT3ZZ (Extirpation of matter from right peroneal artery, percutaneous
approach) and 04CU3ZZ (Extirpation of matter from left peroneal artery,
percutaneous approach), describe endovascular thrombectomy of lower
limbs. These codes are assigned to MS-DRGs 270, 271 and 272, accurately
replicating the logic of ICD-9-CM MS-DRGs Version 32 and supporting
clinical and resource use homogeneity as originally proposed and in
accordance with the finalized policy to add procedures describing
endovascular thrombectomy of lower limbs to ICD-10 Version 34 MS-DRGS
270, 271 and 272.
On page 56804, as a result of our correction of the MS-DRG
assignment in Table 6B--New Procedure Codes for 13 ICD-10-PCS procedure
codes that describe endovascular thrombectomy procedures of the lower
limb, as described in section II.D. of this correction document, we are
making additional conforming corrections to the table describing ICD-
10-PCS Endovascular Thrombectomy Procedure Codes Reassigned to MS-DRGs
270, 271, and 272 for FY 2017.
On pages 56821 and 56823, we erroneously stated there were 58
additional combination codes for removal and replacement of knee
joints. There were 57 additional combination codes.
On pages 56822 and 56823, we erroneously listed the code number for
(Replacement of Left Knee Joint, Femoral Surface with Synthetic
Substitute, Cemented, Open Approach) as code 0SRU0JA three times within
the table. The correct code number should be 0SRU0J9 (Replacement of
Left Knee Joint, Femoral Surface with Synthetic Substitute, Cemented,
Open Approach).
As a result of the corrections to pages 56803, 56804, 56821, 56822,
and 56823, we have made conforming changes to the ICD-10 MS-DRG
Definitions Manual Version 34 and ICD-10 MS-DRG Grouper Software
Version 34 for FY 2017.
On page 56858, we erroneously omitted MS-DRG 265 from the table of
MS-DRGs subject to the policy for replaced devices offered without cost
or with a credit.
On pages 56895 and 56897, we inadvertently made an error to the
title of ICD-10-PCS procedure code XW03331 and omitted an additional
procedure code that describes Idarucizumab. Cases involving
Idarucizumab that are eligible for new technology add-on payments will
be identified by ICD-10-PCS procedure codes XW03331 (Introduction of
Idarucizumab, Dabigatran reversal agent into peripheral vein,
percutaneous approach, New Technology Group 1) and XW04331
(Introduction of Idarucizumab, Dabigatran reversal agent into central
vein, percutaneous approach, New Technology Group 1).
On page 56927, as a result of the correction of the technical
errors described in section II.B of this correction document, we have
made conforming changes to the following: The number of hospitals
approved for wage index reclassifications by the Medicare Geographic
Classification Review Board (MGCRB) starting in FY 2017 and the number
of hospitals in a
[[Page 68948]]
MGCRB reclassification status for FY 2017.
On page 57002 in the table titled, ``Previously Adopted and Newly
Finalized Baseline and Performance Periods for the FY 2021 Program
Year'' we erroneously repeated the same information three times, and in
the first instance provided incorrect performance period years for the
Mortality (MORT-30-AMI, MORT-30-HF, MORT-30-COPD) and THA/TKA measures.
On page 57033, we made a typographical error and omitted a dash
within the web link address creating a non-functional link.
On pages 57195, 57196, 57199, 57211, 57213, 57218, and 57220
through 57223 we inadvertently made technical and typographical errors
to the Long-Term Care Hospital Quality Reporting Program section and
have corrected those errors for clarification.
B. Summary of Errors in the Addendum
As discussed in section II.D. of this correcting document, we made
technical errors with regard to the calculation of Factor 3 of the
uncompensated care payment methodology. The revisions made to address
some of these errors directly affected and required the recalculation
of all the budget neutrality factors and final outlier threshold.
Factor 3 is used to determine the amount of total uncompensated care
payment a hospital is eligible to receive as well as the amount of the
uncompensated care payment a hospital receives per discharge. Per
discharge uncompensated care payments are then included when
determining total payments for purposes of all of the budget neutrality
factors and the final outlier threshold. Therefore, we made conforming
changes to pages 57278 through 57280, 57286, and 57291 to take into
account the updated per-discharge uncompensated care payments
determined using revised Factor 3 amounts. We made further conforming
corrections to the national outlier adjustment factors on page 57286
and the table on page 57288 as a result of these changes. Finally, we
made conforming corrections to the national operating standardized
amounts.
We made inadvertent errors related to the MGCRB reclassification
status of one provider as well as the status of three providers
reclassified as urban to rural under section 1886(d)(8)(E) of the Act
(codified in the regulations under Sec. 412.103 and hereinafter
referred to as Sec. 412.103).
Specifically, the reclassification status in the FY 2017 IPPS/LTCH
PPS final rule did not properly reflect the following:
Withdrawal of a MGCRB reclassification for FY 2017 for one
provider.
Application of urban to rural reclassification under Sec.
412.103 for three providers.
Therefore, on page 57279, we recalculated the reclassification
hospital budget neutrality adjustment.
The reclassification errors also required the recalculation of
additional budget neutrality adjustment factors, the fixed-loss cost
threshold, the final wage indexes, and the national operating
standardized amounts. Therefore, we made conforming changes to the
following:
On page 57280, the rural floor budget neutrality
adjustment and the wage index transition budget neutrality adjustment.
On page 57286, the calculation of the outlier fixed-loss
cost threshold and the national outlier adjustment factors.
On page 57288, the table titled ``Change of FY 2016
Standardized Amounts to the FY 2017 Standardized Amounts''.
On pages 57291 and 57293 through 57295, in our discussion of the
determination of the Federal hospital inpatient capital related
prospective payment rate update, we have made conforming corrections to
the increase in the capital Federal rate, the incremental and
cumulative budget neutrality adjustment factors for changes in the GAFs
and the MS-DRG relative weights, the GAF/MS-DRG budget neutrality
adjustment factor (due to the errors in our calculation of the GAFs,
which are computed from the wage index), the capital Federal rate, and
the outlier threshold (as discussed previously).
Also, as a result of these errors, on pages 57294 and 57295, we
have made conforming corrections in the tables showing the comparison
of factors and adjustments for the FY 2016 capital Federal rate and FY
2017 capital Federal rate and the proposed FY 2017 capital Federal rate
and final FY 2017 capital Federal rate.
On page 57307, we are making conforming corrections the fixed-loss
amount for site neutral discharges due to corrections in the IPPS rates
and factors discussed previously.
On page 57312, we have made conforming corrections to the national
operating standardized amounts and capital standard Federal payment
rate (which also include the rates payable to hospitals located in
Puerto Rico) in Tables 1A, 1B, 1C, and 1D as a result of the conforming
corrections to certain budget neutrality factors and the outlier
threshold (as described previously).
C. Summary of Errors in the Appendices
On pages 57312, 57315 through 57317, 57319 through 57323, 57330
through 57332 in our regulatory impact analyses, we made conforming
corrections to the factors, values, and tables and accompanying
discussion of the changes in operating and capital IPPS payments for FY
2017 and the effects of certain budget neutrality factors as a result
of the technical errors that lead to conforming changes in our
calculation of the operating and capital IPPS budget neutrality
factors, outlier threshold, final wage indexes, operating standardized
amounts, and capital Federal rate (as described in section II.B. of
this correction document).
On pages 57324 through 57326, in the table titled ``Modeled
Disproportionate Share Hospital Payments for Estimated FY 2017 DSHs by
Hospital Type: Model DSH $ (In Millions) From FY 2016 To FY 2017'' and
the accompanying discussion, we made corrections to address technical
and formatting errors in the estimated impacts resulting from
inadvertent errors in the calculation of Factor 3 for certain
hospitals.
On pages 57331 through 57332, we made conforming corrections to
Table III--Comparison of Total Payments Per Case [FY 2016 Payments
Compared to FY 2017 Payments].
On page 57342, we made conforming corrections to the discussion of
the estimated changes in operating and capital IPPS payments and the
accounting statement and table for acute care hospitals that arose from
the corrections of errors and conforming changes as described in
sections II.B. and II.D. of this correcting document.
D. Summary of Errors in and Corrections to Files and Tables Posted on
the CMS Web Site
We are correcting the errors in the following IPPS tables that are
listed on page 57311 of the FY 2017 IPPS/LTCH PPS final rule and are
available on the Internet on the CMS Web site at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2017-IPPS-Final-Rule-Home-Page.html. The tables that are available on the
Internet have been updated to reflect the revisions discussed in this
correcting document.
Table 2--Case-Mix Index and Wage Index Table--FY 2017. Because the
uncompensated care and reclassification errors discussed in section
II.B. of this correction document required that we recalculate the
rural and imputed floor budget neutrality factor, we are
[[Page 68949]]
correcting the values in the column titled FY 2017 Wage Index for all
providers. For the three providers for which we are applying urban to
rural reclassification under Sec. 412.103, we are correcting the
values in the column titled ``FY 2017 Wage Index'', inserting the rural
reclassified CBSA in the column titled ``Reclassified/Redesignated
CBSA'', and inserting a ``Y'' in the column titled ``Hospital
Reclassified as Rural Under Section 1886(d)(8)(E) of the Act (Sec.
412.103)''. For the provider that withdrew its MGCRB reclassification
for FY 2017, we are revising the wage index in the column titled FY
2017 Wage Index, and we are removing the MGCRB flag in the column
titled MGCRB Reclass.
Table 3--Wage Index Table by CBSA--FY 2017. Because the
uncompensated care and reclassification errors discussed in section
II.B. of this correction document required that we recalculate the
rural and imputed floor budget neutrality factor, we are making
corresponding changes to the wage indexes and GAFs of all CBSAs listed
in Table 3. Specifically, we are correcting the values and flags in the
columns titled ``Wage Index'', ``Reclassified Wage Index'', ``GAF'',
``Reclassified GAF'', ``Pre-Frontier and/or Pre-Rural Floor Wage
Index'' and ``Eligible for Rural Floor Wage Index''.
Table 6B--New Procedure Codes for FY 2017. In Table 6B--New
Procedure Codes, we inadvertently listed the incorrect MS-DRG
assignment for 13 ICD-10-PCS procedure codes that describe endovascular
thrombectomy procedures of the lower limb involving a bifurcation. We
are correcting the MS-DRG assignment of these 13 ICD-10-PCS codes in
Table 6B.
Table 10--New Technology Add-On Payment Thresholds for Applications
for FY 2018. We are correcting the thresholds in this table as a result
of the corrections to the operating standardized amounts discussed in
section II.B. of this correcting document.
Table 18--FY 2017 Medicare DSH Uncompensated Care Payment Factor 3
and Projected DSH Eligibility. For the FY 2017 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 2017. We also
published, in the Supplemental Medicare DSH File located in the FY 2017
IPPS/LTCH PPS final rule data files page at https://www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/AcuteInpatientPPS/FY2017-IPPS-FinalRule-Home-Page-Items/FY2017-IPPSFinal-Rule-Data-Files.html, the
data used to calculate each hospital's Factor 3, total uncompensated
care payment, and estimated uncompensated care payment per discharge.
Shortly after the publication of the FY2017 IPPS/LTCH PPS final
rule, we discovered that, in calculating Factor 3 of the uncompensated
care payment methodology, we had understated the low-income insured
days of hospitals that merged after 2011 with one surviving provider
number because we inadvertently excluded the low income insured days of
acquired hospitals from the low income insured days used in the Factor
3 calculation of surviving hospitals that were projected to receive
Medicare DSH in FY 2017. In addition, we discovered that we had
calculated a Factor 3 for hospitals that have ceased operations and
erroneously calculated Factor 3 using Medicaid days reported on
Worksheet S-3 instead of Worksheet S-2 of certain hospitals' FY 2013
cost reports. We are revising Factor 3 for all hospitals to correct
these errors. These corrections to the uncompensated care payments
impacted the calculation of all the budget neutrality factors as well
as the outlier fixed-loss cost threshold for outlier payments.
In addition, we discovered that we had inadvertently excluded the
Medicaid days from the 2011 cost report for a provider as well as the
Medicaid days from the 2012 cost report for another provider from the
calculation of Factor 3. Due to technical errors by our Medicare
Administrative Contractors the Medicaid days from these cost reports
were not included in the March 2016 update of HCRIS. We projected that
both providers would be eligible to receive Medicare DSH in FY 2017.
Accordingly, we are revising Factor 3 for all hospitals to reflect
these Medicaid days; however, the impact of these revisions is too
small to affect other aspects of the IPPS ratesetting, such as the
calculation of the fixed-loss threshold for outlier payments.
We are also correcting the errors in the following LTCH PPS table
that is listed on page 57311 of the FY 2017 IPPS/LTCH PPS final rule
and is available on the Internet on the CMS Web site at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCareHospitalPPS/index.html under the list item for regulation
number CMS-1655-F. The table that is available on the Internet has been
updated to reflect the revisions discussed in this correcting document.
Table 11--MS-LTC-DRGs, Relative Weights, Geometric Average Length
of Stay, Short Stay Outlier (SSO) Threshold, and ``IPPS Comparable
Threshold'' for LTCH PPS Discharges Occurring from October 1, 2016
through September 30, 2017. We are correcting this table by correcting
typographical errors for MS-LTC-DRGs 627 and 658 in the columns titled
``Relative Weight,'' ``Geometric Average Length of Stay,'' ``Short-Stay
Outlier (SSO) Threshold,'' and ``IPPS Comparable Threshold.''
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 the
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.
We believe that 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, addendum, payment
rates, tables, and appendices included or referenced in the FY 2017
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 2017 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
[[Page 68950]]
appropriate payments in as timely a manner as possible, and to ensure
that the FY 2017 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 2017 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. 2016-18476 of August 22, 2016 (81 FR 56761), we are
making the following corrections:
A. Corrections of Errors in the Preamble
1. On page 56775, third column, second bulleted paragraph, line 25,
the figure ``$50.4 million'' is corrected to read ``$56.4 million''.
2. On page 56796--
a. Top half of the page, third column, third full paragraph,
(1) Lines 4 and 5, the phrase ``describing similar conditions'' is
corrected to read ``displayed in Table 6A--New Diagnosis Codes
associated with the proposed rule (which is available via the Internet
on the CMS Web site at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html) that describe similar
conditions''.
(2) Lines 9 and 10, the phrase, ``18 ICD-10-CN diagnosis codes in
the following table be reassigned'' is corrected to read ``18 ICD-10-CM
diagnosis codes in the following table also be reassigned''.
b. Lower half of the page, first column, last paragraph--
(1) Lines 6 and 7, the phrase ``describing procedures performed
on'' is corrected to read ``describing conditions affecting''.
(2) Line 14, the phrase ``MS DRGs 091, 092 and 093.'' is corrected
to read ``MS-DRGs 091, 092, and 093 because they are also nervous
system codes.''
3. On page 56797, first column, first paragraph, lines 15 and 16,
the phrase ``These 18 codes also are reflected in Table 6E'' is
corrected to read ``These 18 codes are reflected in Table 6A''.
4. On page 56801, second column, second full paragraph--
a. Lines 11 and 12, the phrase ``performing such procedures because
loop'' is corrected to read ``performing such procedures because, as
noted in the FY 2017 IPPS/LTCH PPS proposed rule, loop''.
b. Lines 25 and 26, the phrase ``were not able to finalize that
specific request.'' is corrected to read ``were not able to replicate
that specific request in the ICD-9-CM based MS-DRGs.''.
c. Lines 26 through 29, the sentence ``Rather, we finalized an
alternative option, which was to change the designation for four of the
six codes requested.'' is corrected to read ``Rather, we proposed an
alternative option, which was to change the designation for four of the
six codes requested, because we believed that if we limited the change
in designation to these four codes, the change would not have any
impact.''.
d. Lines 40 through 41, the phrase ``not finalizing the proposal to
change the two'' is corrected to read ``not changing the designation of
the two''.
5. On page 56803, bottom of the page--
a. First column, last paragraph, lines 7 and 8, the phrase
``removing the 34 codes'' is corrected to read ``removing 32 of the 34
codes''.
b. Second column, first partial paragraph--
(1) Lines 5 and 6, the phrase ``34 non-lower'' is corrected to read
``32 non-lower''.
(2) Lines 8 and 9, the phrase ``These 34 non-lower'' is corrected
to read ``These 32 non-lower''.
(3) Line 13, after the phrase ``for FY 2017.'' the paragraph is
corrected by adding sentences to read as follows:
``Two of the procedure codes identified by the commenter, ICD-10-
PCS procedure codes 04CT3ZZ (Extirpation of matter from right peroneal
artery, percutaneous approach) and 04CU3ZZ (Extirpation of matter from
left peroneal artery, percutaneous approach) describe endovascular
thrombectomy of lower limbs and are not non-lower limb procedure
codes.''.
c. Third column, first full paragraph, line 11, the phrase ``34
procedure'' is corrected to read ``32 procedure''.
6. On page 56804, top of page, the table titled ``ICD-10-PCS
ENDOVASCULAR THROMBECTOMY PROCEDURE CODES REASSIGNED TO MS-DRGs 270,
271, AND 272 FOR FY 2017'' is corrected by adding the following
entries:
------------------------------------------------------------------------
------------------------------------------------------------------------
04CK3Z6........................... Extirpation of Matter from Right
Femoral Artery, Bifurcation,
Percutaneous Approach.
04CL3Z6........................... Extirpation of Matter from Left
Femoral Artery, Bifurcation,
Percutaneous Approach.
04CM3Z6........................... Extirpation of Matter from Right
Popliteal Artery, Bifurcation,
Percutaneous Approach.
04CN3Z6........................... Extirpation of Matter from Left
Popliteal Artery, Bifurcation,
Percutaneous Approach.
04CP3Z6........................... Extirpation of Matter from Right
Anterior Tibial Artery,
Bifurcation, Percutaneous Approach.
04CQ3Z6........................... Extirpation of Matter from Left
Anterior Tibial Artery,
Bifurcation, Percutaneous Approach.
04CR3Z6........................... Extirpation of Matter from Right
Posterior Tibial Artery,
Bifurcation, Percutaneous Approach.
04CS3Z6........................... Extirpation of Matter from Left
Posterior Tibial Artery,
Bifurcation, Percutaneous Approach.
04CT3Z6........................... Extirpation of Matter from Right
Peroneal Artery, Bifurcation,
Percutaneous Approach.
04CT3ZZ........................... Extirpation of Matter from Right
Peroneal Artery, Percutaneous
Approach.
04CU3Z6........................... Extirpation of Matter from Left
Peroneal Artery, Bifurcation,
Percutaneous Approach.
04CU3ZZ........................... Extirpation of Matter from Left
Peroneal Artery, Percutaneous
Approach.
04CV3Z6........................... Extirpation of Matter from Right
Foot Artery, Bifurcation,
Percutaneous Approach.
04CW3Z6........................... Extirpation of Matter from Left Foot
Artery, Bifurcation, Percutaneous
Approach.
04CY3Z6........................... Extirpation of Matter from Lower
Artery, Bifurcation, Percutaneous
Approach.
------------------------------------------------------------------------
7. On page 56821, middle of the page--
a. Second column, first partial paragraph, line 2, the phrase
``identified 58'' is corrected to read ``identified 57''.
b. Third column, first partial paragraph, line 3, the phrase
``following 58'' is corrected to read ``following 57''.
8. On pages 56821 through 56823, in the table titled ``ICD-10-PCS
CODE PAIRS PROPOSED TO BE ADDED TO VERSION 34 ICD-10 MS-DRGs 466, 467,
and 468: PROPOSED NEW KNEE REVISION ICD-10-PCS COMBINATIONS'', the
codes (in the 4th column) for the following entries are corrected to
read as follows:
[[Page 68951]]
ICD-10-PCS Code Pairs Proposed To Be Added to Version 34 ICD-10 MS-DRGs 466, 467, and 468: Proposed New Knee
Revision ICD-10-PCS Combinations
----------------------------------------------------------------------------------------------------------------
Code Code description Code Code description
----------------------------------------------------------------------------------------------------------------
0SPD08Z.................. Removal of Spacer from and 0SRU0J9.................. Replacement of Left Knee
Left Knee Joint, Open Joint, Femoral Surface
Approach. with Synthetic
Substitute, Cemented,
Open Approach.
0SPD38Z.................. Removal of Spacer from and 0SRU0J9.................. Replacement of Left Knee
Left Knee Joint, Joint, Femoral Surface
Percutaneous Approach. with Synthetic
Substitute, Cemented,
Open Approach.
0SPD48Z.................. Removal of Spacer from and 0SRU0J9.................. Replacement of Left Knee
Left Knee Joint, Joint, Femoral Surface
Percutaneous Endoscopic with Synthetic
Approach. Substitute, Cemented,
Open Approach.
----------------------------------------------------------------------------------------------------------------
9. On page 56823, lower half of the page--
a. First column, second paragraph, line 10, the phrase ``58 new''
is corrected to read ``57 new''.
b. Second column--
(1) First partial paragraph, line 11, the phrase ``58 new'' is
corrected to read `` new''.
(2) First full paragraph, lines 3 and 4, the phrase ``58 new'' is
corrected to read ``57 new''.
10. On page 56858, top of the page, the untitled table is corrected
by adding the following entry after line 34 (which is the entry for MDC
5, MS-DRG 262):
------------------------------------------------------------------------
MDC MS-DRG MS-DRG Title
------------------------------------------------------------------------
5 265 AICD Lead Procedures.
------------------------------------------------------------------------
11. On page 56895, third column, first partial paragraph--
a. Lines 8 and 9, the phrase ``a unique ICD-10-PCS procedure code''
is corrected to read ``two unique ICD-10-PCS procedure codes''.
b. Lines 10 through 15, the sentence ``The approved procedure code
is XW0331 (Introduction of Idarucizumab, Dabigatran reversal agent into
central vein, percutaneous approach, New Technology Group 1).'' is
corrected to read ``The approved procedure codes are XW0331
(Introduction of Idarucizumab, Dabigatran reversal agent into
peripheral vein, percutaneous approach, New Technology Group 1) and
XW04331 (Introduction of Idarucizumab, Dabigatran reversal agent into
central vein, percutaneous approach, New Technology Group 1).''.
12. On page 56897, third column, third full paragraph, line 11, the
phrase ``procedure code XW03331.'' is corrected to read ``procedure
codes XW03331 and XW04331.''.
13. On page 56927--
a. Second column, last partial paragraph, line 5 the phrase ``265
hospitals'' is corrected to read ``264 hospitals''.
b. Third column, first partial paragraph, line 12, the phrase ``817
hospitals'' is corrected to read ``816 hospitals''.
14. On page 57002, bottom of the page, the table titled
``PREVIOUSLY ADOPTED AND NEWLY FINALIZED BASELINE AND PERFORMANCE
PERIODS FOR THE FY 2021 PROGRAM YEAR'' is corrected to read as follows:
Previously Adopted and Newly Finalized Baseline and Performance Periods
for the FY 2021 Program Year
------------------------------------------------------------------------
Domain Baseline period Performance period
------------------------------------------------------------------------
Clinical Care
Mortality (MORT-30-AMI, July 1, July 1,
MORT-30-HF, MORT-30-COPD) * 2011-June 30, 2016-June 30,
2014. 2019
THA/TKA *.............. April 1, April 1,
2011-March 31, 2016-March 31,
2014. 2019
MORT-30-PN (updated July 1, September
cohort). 2012-June 30, 1, 2017-June 30,
2015. 2019
Efficiency and Cost Reduction
MSPB................... January January
1, 2017-December 1, 2019-December
31, 2017. 31, 2019
Payment (AMI Payment July 1, July 1,
and HF Payment). 2012-June 30, 2017-June 30,
2015. 2019
------------------------------------------------------------------------
* Previously adopted baseline and performance periods that remain
unchanged (80 FR 49562 through 49563).
15. On page 57033, first column, last paragraph, lines 2 through 4,
the web link ``http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/AcuteInpatientPPS/dgme.html'' is corrected to read
``http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/dgme.html.''
16. On page 57195--
a. First column, last partial paragraph, lines 4 and 5, the phrase
``it recommended'' is corrected to read ``the commenters recommended''.
b. Third column, third full paragraph--
(1). Line 14, the phrase ``This measure'' is corrected to read
``The Drug Regimen Review Conducted with Follow-Up for Identified
Issues-PAC LTCH QRP quality measure''.
(2) Lines 23 through 25, the phrase `` and Potentially Preventable
30-Day Post-Discharge Readmission Measure for LTCH QRP,'' is corrected
to read ``, Potentially Preventable 30-Day Post-Discharge Readmission
Measure for LTCH QRP and Medicare Spending Per Beneficiary-PAC LTCH
QRP,''.
17. On page 57196, third column, first full paragraph, lines 13
through 16, the phrase ``with information more frequently, such as
unadjusted counts of potentially preventable readmissions (PPRs) and
discharge data.'' is corrected to read ``with information, such as
unadjusted counts of potentially preventable readmissions (PPRs) and
discharge data, more frequently.''
18. On page 57199, first column, second full paragraph, lines 3 and
4, the phrase ``SES or SDS status.'' is corrected to read ``SES or
SDS.''
19. On page 57211, third column, second full paragraph, line 16,
the phrase ``to discharge'' is corrected to read ``to be discharged''.
20. On page 57213--
a. Second column, last partial paragraph, lines 6 through 8, the
phrase
[[Page 68952]]
``and a SNF stay within a 30-day window, the SNF stay is a candidate to
for'' is corrected to read ``and then a SNF stay within a 30-day
window, the SNF stay is a candidate for''.
b. Third column, after the last paragraph, Footnote 280, lines 1
and 2, the measure name ``Hospital-Wide All-Cause Readmission Measure
(HWR) (CMS/Yale).'' is corrected to read ``Hospital-Wide All-Cause
Unplanned Readmission Measure (HWR) (CMS/Yale).''
21. On page 57218, third column, first full paragraph, lines 4 and
5, the phrase ``The commenter was correct in its interpretation of'' is
corrected to read ``The commenter's interpretation was correct
regarding''.
22. On page 57220, second column, second footnoted full paragraph
(Footnote 311), lines 1 through 6, the footnote ``\311\Greenwald, J.L.,
Halasyamani, L., Greene, J., LaCivita, C., et al. (2010). Making
inpatient medication reconciliation patient centered, clinically
relevant and implementable: A consensus statement on key principles and
necessary first steps. Journal of Hospital Medicine, 5(8), 477-485.''
is corrected to read ``\311\Institute of Medicine. Preventing
Medication Errors. Washington, DC: National Academies Press; 2006.''
23. On page 57221, second column, second full paragraph, lines 3
and 4, the phrase ``cross-setting and quality measure'' is corrected to
read ``cross-setting quality measure''.
24. On page 57222--
a. Second column, first full paragraph, lines 11 and 12, the phrase
``however, the adoption of the measure'' is corrected to read
``however, the measure''.
b. Third column, first full paragraph--
(1) Line 4, the word ``facilities'' is corrected to read
``facility's''.
(2) Line 22, the phrase ``collected admission'' is corrected to
read ``collected at admission''.
25. On page 57223--
a. First column, second paragraph--
(1) Lines 1 through 4, the phrase ``Since the time of the MAP
consideration, with our measure contractor, we tested this measure in a
pilot test involving twelve PAC facilities,'' is corrected to read
``Since the time of the NQF-convened MAP consideration we have further
tested this measure in a pilot test involving twelve PAC facilities''.
(2) Lines 7 and 8, the phrase, ``record collection system'' is
corrected to read ``records system''.
b. Second column, third full paragraph, lines 9 and 10, the phrase
``PAC facility.'' is corrected to read ``PAC facility. We appreciate
MedPAC and other commenters' recommendation for a quality measure that
assesses post-discharge medication communication with primary care
providers for patients discharged to home.''
B. Correction of Errors in the Addendum
1. On page 57278, third column, fifth full paragraph,
a. Line 3, the figure ``0.999079'' is corrected to read
``0.999078''.
b. Line 9, the figure ``0.999079'' is corrected to read
``0.999078''.
2. On page 57279--
a. Second column, first full paragraph, line 9, the figure
``1.000209'' is corrected to read ``1.00021''.
b. Third column, third full paragraph, line 12, the figure
``0.988224'' is corrected to read ``0.988136''.
3. On page 57280--
a. First column, fifth full paragraph, line 4, the figure
``0.993200'' is corrected to read ``0.991987''.
b. Third column, second full paragraph,
(1) Line 3, the figure ``0.999994'' is corrected to read
``0.999997''.
(2) Line 6, the figure ``0.999994'' is corrected to read
``0.999997''.
4. On page 57286--
a. Second column, last paragraph--
(1) Line 6, the figure ``$23,570'' is corrected to read
``$23,573''.
(2) Line 8, the figure ``$83,347,416,971'' is corrected to read
``$83,364,479,923''.
(3) Line 9, the figure ``$4,479,256,519'' is corrected to read
``$4,479,256,368''.
b. Third column--
(1) First partial paragraph, line 11, the figure ``$23,570'' is
corrected to read ``$23,573''.
(2) Following the third full paragraph, the untitled table is
corrected to read as follows:
------------------------------------------------------------------------
Operating
standardized Capital
amounts Federal rate
------------------------------------------------------------------------
National................................ 0.948998 0.938602
------------------------------------------------------------------------
5. On page 57288, middle of the page, the table titled ``CHANGE OF
FY 2016 STANDARDIZED AMOUNTS TO THE FY 2017 STANDARDIZED AMOUNTS'', is
corrected to read as follows:
Change of FY 2016 Standardized Amounts to the FY 2017 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 2016 Base Rate after If Wage Index is If Wage Index is If Wage Index is If Wage Index is
removing: Greater Than Greater Than Greater Than Greater Than
1. FY 2016 Geographic 1.0000: 1.0000: 1.0000: 1.0000:
Reclassification Budget Labor (69.6 Labor (69.6 Labor (69.6 Labor (69.6
Neutrality (0.988169). percent): percent): percent): percent):
2. FY 2016 Rural Community $4,394.09.. $4,394.09.. $4,394.09.. $4,394.09.
Hospital Demonstration Program Nonlabor (30.4 Nonlabor (30.4 Nonlabor (30.4 Nonlabor (30.4
Budget Neutrality (0.999837). percent): percent): percent): percent):
$1,919.26.. $1,919.26.. $1,919.26.. $1,919.26.
[[Page 68953]]
3. Cumulative FY 2008, FY 2009, If Wage Index is If Wage Index is If Wage Index is If Wage Index is
FY 2012, FY 2013, FY 2014, FY less Than or less Than or less Than or less Than or
2015 and FY 2016 Documentation Equal to 1.0000: Equal to 1.0000: Equal to 1.0000: Equal to 1.0000:
and Coding Adjustments as Labor (62 Labor (62 Labor (62 Labor (62
Required under Sections percent): percent): percent): percent):
7(b)(1)(A) and 7(b)(1)(B) of $3,914.28.. $3,914.28.. $3,914.28.. $3,914.28.
Public Law 110-90 and Nonlabor (38 Nonlabor (38 Nonlabor (38 Nonlabor (38
Documentation and Coding percent): percent): percent): percent):
Recoupment Adjustment as $2,399.07.. $2,399.07.. $2,399.07.. $2,399.07.
required under Section 631 of
the American Taxpayer Relief
Act of 2012 (0.9255).
4. FY 2016 Operating Outlier
Offset (0.948998).
5. FY 2016 New Labor Market
Delineation Wage Index
Transition Budget Neutrality
Factor (0.999998).
6. FY 2017 2-Midnight Rule
Permanent Adjustment (1/0.998).
FY 2017 Update Factor........... 1.0165............ 0.99625........... 1.00975........... 0.9895.
FY 2017 MS[dash]DRG 0.999078.......... 0.999078.......... 0.999078.......... 0.999078.
Recalibration Budget Neutrality
Factor.
FY 2017 Wage Index Budget 1.00021........... 1.00021........... 1.00021........... 1.00021.
Neutrality Factor.
FY 2017 Reclassification Budget 0.988136.......... 0.988136.......... 0.988136.......... 0.988136.
Neutrality Factor.
FY 2017 Operating Outlier Factor 0.948998.......... 0.948998.......... 0.948998.......... 0.98998.
Cumulative Factor: FY 2008, FY 0.9118............ 0.9118............ 0.9118............ 0.9118.
2009, FY 2012, FY 2013, FY
2014, FY 2015, FY 2016 and FY
2017 Documentation and Coding
Adjustment as Required under
Sections 7(b)(1)(A) and
7(b)(1)(B) of Public Law 110-90
and Documentation and Coding
Recoupment Adjustment as
required under Section 631 of
the American Taxpayer Relief
Act of 2012.
FY 2017 New Labor Market 0.999997.......... 0.999997.......... 0.999997.......... 0.999997.
Delineation Wage Index 3-Year
Hold Harmless Transition Budget
Neutrality Factor.
FY 2017 2[dash]Midnight Rule One- 1.006............. 1.006............. 1.006............. 1.006.
Time Prospective Increase.
National Standardized Amount for Labor: $3,839.23.. Labor: $3,762.75.. Labor: $3,8143.74. Labor: $3,737.25.
FY 2017 if Wage Index is Nonlabor: Nonlabor: Nonlabor: Nonlabor:
Greater Than 1.0000; Labor/Non- $1,676.91. $1,643.50. $1,665.77. $1,632.37.
Labor Share Percentage (69.6/
30.4).
[[Page 68954]]
National Standardized Amount for Labor: $3,420.01.. Labor: $3,351.88.. Labor: $3,397.30.. Labor: $3,329.16.
FY 2017 if Wage Index is less Nonlabor: Nonlabor: Nonlabor: Nonlabor:
Than or Equal to 1.0000; Labor/ $2,096.13. $2,054.37. $2,082.21. $2,040.46.
Non-Labor Share Percentage (62/
38).
----------------------------------------------------------------------------------------------------------------
6. On page 57291--
a. First column, second full paragraph, line 15, the figure
``0.999079'' is corrected to read ``0.999078''.
b. Third column, first full paragraph line 6, the figure ``1.84''
is corrected to read ``1.83''.
7. On page 57293, third column--
a. First partial paragraph--
(1) Line 1, the figure ``0.9995'' is corrected to read ``0.9994''.
(2) Line 4, ``0.9855'' is corrected to read ``0.9854''.
b. First full paragraph, line 16, the figure ``0.9851'' is
corrected to read ``0.9850''.
c. Last paragraph--
(1) Line 2, the figure ``0.9991''is corrected to read ``0.9990''.
(2) Line 4, ``0.9995'' is corrected to read ``0.9994''.
8. On page 57294--
a. Top of the page--
(1) Second column--
(a) First full paragraph, line 17, the figure ``$446.81'' is
corrected to read ``$446.79''.
(b) Second bulleted paragraph, line 6, the figure ``0.9991'' is
corrected to read ``0.9990''.
(2) Third column, second full paragraph--
(a) Line 13, the figure, ``0.09'' is corrected to read ``0.10''.
(b) Line 26, the figure, ``1.84'' is corrected to read ``1.832''.
b. Bottom of the page, the table titled ``COMPARISON OF FACTORS AND
ADJUSTMENTS: FY 2016 CAPITAL FEDERAL RATE AND FY 2017 CAPITAL FEDERAL
RATE'' is corrected to read as follows:
Comparison of Factors and Adjustments: FY 2016 Capital Federal Rate and FY 2017 Capital Federal Rate
----------------------------------------------------------------------------------------------------------------
Percent change
FY 2016 FY 2017 Change \3\
----------------------------------------------------------------------------------------------------------------
Update Factor \1\............................... 1.0130 1.009 1.009 0.9
GAF/DRG Adjustment Factor \1\................... 0.9976 0.9990 0.9990 -0.10
Outlier Adjustment Factor \2\................... 0.9365 0.9386 1.0022 0.22
Permanent 2-midnight Policy Adjustment Factor... N/A 1.002 1.002 0.2
One-Time 2-midnight Policy Adjustment Factor.... N/A 1.006 1.006 0.6
Capital Federal Rate............................ $438.75 $446.79 1.0183 1.83
----------------------------------------------------------------------------------------------------------------
\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 2016 to FY 2017 resulting from the
application of the 0.9990 GAF/DRG budget neutrality adjustment factor for FY 2017 is a net change of 0.9990
(or -0.10 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 2017 outlier adjustment factor is 0.9386/0.9365, or 1.0022 (or 0.22 percent).
\3\ Sum of individual changes may not match percent change in capital rate due to rounding.
9. On page 57295--
a. The top of the page, the table titled ``COMPARISON OF FACTORS
AND ADJUSTMENTS: PROPOSED FY 2017 CAPITAL FEDERAL RATE AND FINAL FY
2017 CAPITAL FEDERAL RATE'' is corrected to read as follows:
Comparison of Factors and Adjustments: Proposed FY 2017 Capital Federal Rate and Final FY 2017 Capital Federal
Rate
----------------------------------------------------------------------------------------------------------------
Proposed FY
2017 Final FY 2017 Change Percent change
----------------------------------------------------------------------------------------------------------------
Update Factor \1\............................... 1.0090 1.0090 1.0000 0.00
GAF/DRG Adjustment Factor \1\................... 0.9993 0.9990 0.9997 -0.03
Outlier Adjustment Factor \2\................... 0.9374 0.9386 1.0013 0.13
Permanent 2-midnight Policy Adjustment Factor... 1.002 1.002 1.000 0.00
One-Time 2-midnight Policy Adjustment Factor.... 1.006 1.006 1.000 0.00
Capital Federal Rate............................ $446.35 $446.79 1.0010 0.10
----------------------------------------------------------------------------------------------------------------
b. Lower three-fourths of the page, first column, second paragraph,
line 21, the figure, ``$23,570.'' is corrected to read ``$23,573.''
10. On page 57307, second column, first full paragraph--
a. Line 15, the figure ``$23,570'' is corrected to read
``$23,573''.
b. Line 35, the figure ``$23,570'' is corrected to read
``$23,573''.
11. On page 57312--
a. Top of the page--
[[Page 68955]]
(1) Table 1A titled ``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 2017'' 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 2017
--------------------------------------------------------------------------------------------------------------------------------------------------------
Hospital submitted quality data and is Hospital submitted quality data and Hospital did NOT submit quality data Hospital did NOT submit quality data
a meaningful EHR user (update = 1.65 is NOT a meaningful EHR user and is a meaningful EHR user and is NOT a meaningful EHR user
percent) (update = -0.375 percent) (update = 0.975 percent) (update = -1.05 percent)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Labor Nonlabor Labor Nonlabor Labor Nonlabor Labor Nonlabor
--------------------------------------------------------------------------------------------------------------------------------------------------------
$3,839.23 $1,677.91 $3,762.75 $1,643.50 $3,813.74 $1,665.77 $3,737.25 $1,632.37
--------------------------------------------------------------------------------------------------------------------------------------------------------
(2) Table 1B titled ``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 2017'' 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 2017
--------------------------------------------------------------------------------------------------------------------------------------------------------
Hospital submitted quality data and is Hospital submitted quality data and Hospital did NOT submit quality data Hospital did NOT submit quality data
a meaningful EHR user (update = 1.65 is NOT a meaningful EHR user (update and is a meaningful EHR user (update and is NOT a meaningful EHR user
percent) = -0.375 percent) = 0.975 percent) (update = -1.05 percent)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Labor Nonlabor Labor Nonlabor Labor Nonlabor Labor Nonlabor
--------------------------------------------------------------------------------------------------------------------------------------------------------
$3,420.01 $2,096.13 $3,351.88 $2,054.37 $3,397.30 $2,082.21 $3,329.16 $2,040.46
--------------------------------------------------------------------------------------------------------------------------------------------------------
b. Middle of the page--
(1) Table 1C titled ``ADJUSTED OPERATING STANDARDIZED AMOUNTS FOR
HOSPITALS IN PUERTO RICO, LABOR/NONLABOR (NATIONAL: 62 PERCENT LABOR
SHARE/38 PERCENT NONLABOR SHARE BECAUSE WAGE INDEX IS LESS THAN OR
EQUAL TO 1);--FY 2017'' is corrected to read as follows:
Table 1C--Adjusted Operating Standardized Amounts for Hospitals in Puerto Rico, Labor/Nonlabor (National: 62
Percent Labor Share/38 Percent Nonlabor Share Because Wage Index Is Less Than or Equal to 1)--FY 2017
----------------------------------------------------------------------------------------------------------------
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...... $3,420.01 $2,096.13
----------------------------------------------------------------------------------------------------------------
\1\ For FY 2017, there are no CBSAs in Puerto Rico with a national wage index greater than 1.
(2) Table 1D titled ``CAPITAL STANDARD FEDERAL PAYMENT RATE--FY
2017'' is corrected as follows:
Table 1D--Capital Standard Federal Payment Rate--FY 2017
------------------------------------------------------------------------
Rate
------------------------------------------------------------------------
National............................................... $446.79
------------------------------------------------------------------------
C. Corrections of Errors in the Appendices
1. On page 57312, bottom of the page, third column, first partial
paragraph,
a. Line 8, the figure ``$987'' is corrected to read ``$990''.
b. Line 10, the figure ``$66'' is corrected to read ``$72''.
2. On page 57315, upper three-fourths of the page--
a. Second column, third full paragraph,
(1) Line 7, the figure ``1,380'' is corrected to read ``1,369''.
(2) Line 9, the figure ``1,135'' is corrected to read ``1,146''.
b. Third column, first full paragraph, line 13--
(1) The figure ``1,372'' is corrected to read ``1,369''.
(2) The figure ``1,150'' is corrected to read ``1,153''.
3. On pages 57315 through 57317, the table titled ``TABLE I--IMPACT
ANALYSIS OF CHANGES TO THE IPPS FOR OPERATING COSTS FOR FY 2017'' is
corrected to read as follows:
[[Page 68956]]
Table I--Impact Analysis of Changes to the IPPS for Operating Costs for FY 2017
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
FY 2017 FY 2017 Wage Rural and
weights and data under new imputed floor
Hospital rate DRG changes CBSA with Application of the
Number of update and with designations FY 2017 MGCRB application of frontier wage All FY 2017
hospitals documentation application of with reclassifications national rural index and changes
\1\ and coding recalibration application of and imputed out[dash]migration
adjustment budget wage budget floor budget adjustment
neutrality neutrality neutrality
........... (1) \2\ (2) \3\ (3) \4\ (4) \5\ (5) \6\ (6) \7\ (7) \8\
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
All Hospitals.................................................. 3,330 1.0 0.0 0.0 0.0 0.0 0.1 0.9
By Geographic Location:
Urban hospitals................................................ 2,515 0.9 0.0 0.0 -0.1 0.0 0.1 0.9
Large urban areas.......................................... 1,369 0.9 0.1 0.0 -0.3 -0.1 0.0 0.9
Other urban areas.......................................... 1,146 1.0 0.0 0.0 0.1 0.2 0.2 1.0
Rural hospitals................................................ 815 1.6 -0.4 0.1 1.3 -0.2 0.1 1.2
Bed Size (Urban):
0-99 beds.................................................. 659 0.9 -0.2 0.2 -0.5 0.1 0.2 0.9
100-199 beds............................................... 767 1.0 -0.1 0.0 0.0 0.3 0.2 0.7
200-299 beds............................................... 446 1.0 -0.1 -0.1 0.1 0.0 0.1 0.8
300-499 beds............................................... 431 1.0 0.1 0.0 -0.2 0.1 0.2 0.9
500 or more beds........................................... 212 0.9 0.2 0.0 -0.2 -0.2 0.0 1.1
Bed Size (Rural):
0-49 beds.................................................. 317 1.5 -0.5 0.1 0.2 -0.2 0.3 1.0
50-99 beds................................................. 292 1.8 -0.6 0.1 0.8 -0.2 0.1 1.2
100-149 beds............................................... 120 1.6 -0.4 0.0 1.5 -0.2 0.2 1.0
150-199 beds............................................... 46 1.7 -0.2 0.2 1.7 -0.3 0.0 1.3
200 or more beds........................................... 40 1.6 -0.1 0.2 2.5 -0.3 0.0 1.5
Urban by Region:
New England................................................ 116 0.8 0.0 -0.5 1.1 0.9 0.1 -0.4
Middle Atlantic............................................ 315 0.9 0.1 -0.1 0.8 -0.2 0.1 0.9
South Atlantic............................................. 407 1.0 0.0 -0.2 -0.5 -0.3 0.1 0.9
East North Central......................................... 390 0.9 0.0 -0.1 -0.2 -0.4 0.0 1.0
East South Central......................................... 147 1.0 0.0 -0.1 -0.4 -0.3 0.0 1.2
West North Central......................................... 163 1.1 0.1 -0.1 -0.8 -0.4 0.7 1.0
West South Central......................................... 385 0.9 0.0 0.2 -0.5 -0.4 0.0 1.2
Mountain................................................... 163 1.1 0.0 0.1 -0.3 1.2 0.2 2.2
Pacific.................................................... 378 0.9 0.0 0.4 -0.4 1.0 0.1 0.5
Puerto Rico................................................ 51 0.9 0.1 -0.5 -1.0 0.1 0.1 0.3
Rural by Region:
New England................................................ 21 1.3 -0.2 0.3 1.4 -0.3 0.2 1.6
Middle Atlantic............................................ 54 1.7 -0.4 0.1 0.8 -0.2 0.1 1.6
South Atlantic............................................. 128 1.7 -0.5 -0.1 2.3 -0.3 0.1 1.0
East North Central......................................... 115 1.7 -0.4 0.0 1.0 -0.2 0.1 1.2
East South Central......................................... 155 1.1 -0.3 0.4 2.2 -0.4 0.1 1.0
West North Central......................................... 98 2.2 -0.4 0.0 0.2 -0.1 0.3 1.5
West South Central......................................... 160 1.5 -0.4 0.4 1.3 -0.3 0.1 1.2
Mountain................................................... 60 1.7 -0.4 0.1 0.2 -0.1 0.2 1.3
Pacific.................................................... 24 1.9 -0.4 -0.3 1.3 -0.1 0.0 1.3
By Payment Classification: 0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Urban hospitals............................................ 2,522 0.9 0.0 0.0 -0.1 0.0 0.1 0.9
Large urban areas.......................................... 1,369 0.9 0.1 0.0 -0.3 -0.1 0.0 0.9
Other urban areas.......................................... 1,153 1.0 0.0 0.0 0.1 0.2 0.2 1.0
Rural areas................................................ 808 1.6 -0.4 0.1 1.4 -0.2 0.1 1.2
Teaching Status:
Nonteaching................................................ 2,266 1.1 -0.2 0.0 0.1 0.2 0.1 0.8
Fewer than 100 residents................................... 815 1.0 0.0 0.0 -0.1 0.0 0.2 0.9
100 or more residents...................................... 249 0.9 0.2 0.0 -0.1 -0.2 0.0 1.1
Urban DSH:
Non-DSH.................................................... 589 0.9 -0.1 -0.2 0.2 0.0 0.2 0.8
100 or more beds........................................... 1,642 0.9 0.1 0.0 -0.1 0.0 0.1 0.9
Less than 100 beds......................................... 363 1.0 -0.3 0.0 -0.5 0.1 0.1 0.7
Rural DSH:
SCH........................................................ 240 2.0 -0.6 0.1 0.1 -0.1 0.0 1.4
RRC........................................................ 325 1.7 -0.3 0.1 1.8 -0.2 0.0 1.3
100 or more beds........................................... 29 0.9 -0.4 0.1 2.9 -0.4 0.1 0.5
Less than 100 beds......................................... 142 0.8 -0.4 0.2 1.3 -0.4 0.7 0.2
Urban teaching and DSH:
Both teaching and DSH...................................... 898 0.9 0.1 0.0 -0.2 -0.1 0.1 1.0
Teaching and no DSH........................................ 109 0.9 0.0 -0.1 1.1 0.0 0.0 0.7
No teaching and DSH........................................ 1,107 1.0 -0.1 0.1 -0.1 0.3 0.1 0.8
No teaching and no DSH..................................... 408 0.9 -0.1 -0.2 -0.4 0.0 0.2 0.9
Special Hospital Types:
RRC........................................................ 189 0.8 -0.1 0.1 1.9 0.0 0.5 1.2
SCH........................................................ 324 2.1 -0.3 -0.1 0.0 0.0 0.0 1.7
MDH........................................................ 148 1.7 -0.6 0.0 0.6 -0.1 0.1 1.3
SCH and RRC................................................ 126 2.2 -0.3 0.1 0.4 -0.1 0.0 1.8
MDH and RRC................................................ 12 2.1 -0.6 -0.1 1.3 -0.2 0.0 2.2
Type of Ownership:
Voluntary.................................................. 1,927 1.0 0.0 0.0 0.0 0.0 0.1 0.9
Proprietary................................................ 881 1.0 0.0 0.1 0.0 0.0 0.1 0.9
Government................................................. 522 1.0 0.0 -0.1 -0.2 0.0 0.1 0.9
[[Page 68957]]
Medicare Utilization as a Percent of Inpatient Days:
0-25....................................................... 523 0.8 0.1 0.1 -0.3 0.2 0.0 1.1
25-50...................................................... 2,122 1.0 0.0 0.0 0.0 -0.1 0.1 0.9
50-65...................................................... 545 1.2 -0.2 -0.1 0.6 0.0 0.1 0.9
Over 65.................................................... 89 1.2 -0.3 0.3 -0.4 0.2 0.2 1.0
FY 2017 Reclassifications by the Medicare Geographic
Classification Review Board:
All Reclassified Hospitals................................. 791 1.1 -0.1 0.0 2.3 -0.2 0.0 0.9
Non-Reclassified Hospitals................................. 2,539 1.0 0.0 0.0 -0.8 0.1 0.1 0.9
Urban Hospitals Reclassified............................... 532 1.0 0.0 -0.1 2.3 -0.1 0.0 0.9
Urban Nonreclassified Hospitals............................ 1,936 0.9 0.1 0.0 -0.9 0.1 0.1 0.9
Rural Hospitals Reclassified Full Year..................... 277 1.7 -0.3 0.1 2.2 -0.2 0.0 1.3
Rural Nonreclassified Hospitals Full Year.................. 489 1.6 -0.4 0.2 -0.2 -0.2 0.3 1.1
All Section 401 Reclassified Hospitals:.................... 72 1.7 -0.2 0.0 0.3 -0.1 0.9 1.5
Other Reclassified Hospitals (Section 1886(d)(8)(B))....... 48 1.2 -0.4 0.1 3.1 -0.4 0.0 0.8
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Because data necessary to classify some hospitals by category were missing, the total number of hospitals in each category may not equal the national total. Discharge data are from FY
2015, and hospital cost report data are from reporting periods beginning in FY 2012 and FY 2013.
\2\ This column displays the payment impact of the hospital rate update and other adjustments including the 1.65 percent adjustment to the national standardized amount and hospital-specific
rate (the estimated 2.7 percent market basket update reduced by 0.3 percentage points for the multifactor productivity adjustment and the 0.75 percentage point reduction under the Affordable
Care Act), the -1.5 percent documentation and coding adjustment to the national standardized amount and the adjustment of (1/0.998) to permanently remove the -0.2 percent reduction, and the
1.006 temporary adjustment to address the effects of the 0.2 percent reduction in effect for FYs 2014 through 2016 related to the 2-midnight policy.
\3\ This column displays the payment impact of the changes to the Version 34 GROUPER, the changes to the relative weights and the recalibration of the MS DRG weights based on FY 2015 MedPAR
data in accordance with section 1886(d)(4)(C)(iii) of the Act. This column displays the application of the recalibration budget neutrality factor of 0.999078 in accordance with section
1886(d)(4)(C)(iii) of the Act.
\4\ This column displays the payment impact of the update to wage index data using FY 2013 cost report data and the OMB labor market area delineations based on 2010 Decennial Census data. This
column displays the payment impact of the application of the wage budget neutrality factor, which is calculated separately from the recalibration budget neutrality factor, and is calculated
in accordance with section 1886(d)(3)(E)(i) of the Act. The wage budget neutrality factor is 1.000210.
\5\ Shown here are the effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB) along with the effects of the continued implementation of the new
OMB labor market area delineations on these reclassifications. The effects demonstrate the FY 2017 payment impact of going from no reclassifications to the reclassifications scheduled to be
in effect for FY 2017. Reclassification for prior years has no bearing on the payment impacts shown here. This column reflects the geographic budget neutrality factor of 0.988136.
\6\ This column displays the effects of the rural and imputed floor based on the continued implementation of the new OMB labor market area delineations. The Affordable Care Act requires the
rural floor budget neutrality adjustment to be 100 percent national level adjustment. The rural floor budget neutrality factor (which includes the imputed floor) applied to the wage index is
0.991987. This column also shows the effect of the 3-year transition for hospitals that were located in urban counties that became rural under the new OMB delineations or hospitals deemed
urban where the urban area became rural under the new OMB delineations, with a budget neutrality factor of 0.999997.
\7\ This column shows the combined impact of the policy required under section 10324 of the Affordable Care Act that hospitals located in frontier States have a wage index no less than 1.0 and
of section 1886(d)(13) of the Act, as added by section 505 of Public Law 108-173, which provides for an increase in a hospital's wage index if a threshold percentage of residents of the
county where the hospital is located commute to work at hospitals in counties with higher wage indexes. These are not budget neutral policies.
\8\ This column shows the estimated change in payments from FY 2016 to FY 2017.
4. On page 57319,
a. First column, second full paragraph,
(1) Line 6, the figure ``0.988224'' is corrected to read
``0.988136''.
(2) Line 13, the figure ``1.4'' is corrected to read ``1.3''.
b. Second column--
(1) First full paragraph--
(a) Line 8, the figure ``0.9930'' is corrected to read
``0.991987''.
(b) Line 9, the figure ``0.7'' is corrected to read ``0.8''.
(2) Third full paragraph--
(a) Line 1, the figure ``397'' is corrected to read ``436''.
(b) Line 5--
(1) The figure ``0.9930'' is corrected to read ``0.991987''.
(2) The figure ``0.7'' is corrected to read ``0.8''.
(c) Line 23, the figure ``1.0'' is corrected to read ``0.9''.
(d) Line 31, the figure ``$24'' is corrected to read ``$22''.
(e) Line 33, the figure ``0.7'' is corrected to read ``0.6''.
c. Third column--
(1) First full paragraph,
(a) Line 7, the figure ``$10'' is corrected to read ``$6.4''.
(b) Line 18, the figure ``$17'' is corrected to read ``$18''.
(2) Second full paragraph, line 28, the figure ``0.999994'' is
corrected to read ``0.999997''.
5. On page 57320, the table titled ``FY 2017 IPPS Estimated
Payments Due to Rural Floor and Imputed Floor with National Budget
Neutrality'' is corrected to read as follows:
[[Page 68958]]
FY 2017 IPPS Estimated Payments Due to Rural and Imputed Floor With National Budget Neutrality
----------------------------------------------------------------------------------------------------------------
Percent change in
Number of payments due to
hospitals that application of
State Number of will receive the rural floor and Difference (in $
hospitals rural floor or imputed floor millions)
imputed floor with budget
neutrality
(1) (2) (3) (4)
----------------------------------------------------------------------------------------------------------------
Alabama............................. 83 6 -0.3 -6
Alaska.............................. 6 4 2.1 4
Arizona............................. 57 46 3.5 63
Arkansas............................ 44 0 -0.4 -4
California.......................... 301 186 1.3 131
Colorado............................ 48 3 0.2 3
Connecticut......................... 31 8 0.2 4
Delaware............................ 6 2 0 0
Washington, DC...................... 7 0 -0.4 -1
Florida............................. 171 16 -0.3 -2
Georgia............................. 105 0 -0.4 -18
Hawaii.............................. 12 0 -0.3 -10
Idaho............................... 14 0 -0.3 -1
Illinois............................ 126 3 -0.4 -1
Indiana............................. 89 0 -0.4 -19
Iowa................................ 35 0 -0.4 -11
Kansas.............................. 53 0 -0.3 -4
Kentucky............................ 65 0 -0.4 -3
Louisiana........................... 95 2 -0.4 -6
Maine............................... 18 0 -0.4 -5
Massachusetts....................... 58 15 0.6 -2
Michigan............................ 95 0 -0.4 22
Minnesota........................... 49 0 -0.3 -18
Mississippi......................... 62 0 -0.4 -6
Missouri............................ 74 2 -0.3 -4
Montana............................. 12 4 0.3 -8
Nebraska............................ 26 0 -0.3 1
Nevada.............................. 24 3 -0.2 -2
New Hampshire....................... 13 9 2.2 -2
New Jersey.......................... 64 18 0.2 11
New Mexico.......................... 25 0 -0.3 6
New York............................ 154 21 -0.3 -1
North Carolina...................... 84 1 -0.4 -20
North Dakota........................ 6 1 -0.3 -12
Ohio................................ 130 10 -0.4 -1
Oklahoma............................ 86 2 -0.3 -13
Oregon.............................. 34 2 -0.4 -4
Pennsylvania........................ 151 5 -0.4 -4
Puerto Rico......................... 51 12 0.1 -20
Rhode Island........................ 11 10 4.7 0
South Carolina...................... 57 5 -0.1 18
South Dakota........................ 18 0 -0.2 -2
Tennessee........................... 92 20 -0.3 -1
Texas............................... 320 3 -0.4 -7
Utah................................ 33 1 -0.3 -26
Vermont............................. 6 0 -0.2 -2
Virginia............................ 76 1 -0.3 -1
Washington.......................... 49 6 -0.1 -8
West Virginia....................... 29 3 -0.2 -1
Wisconsin........................... 65 6 -0.3 -5
Wyoming............................. 10 0 -0.1 0
----------------------------------------------------------------------------------------------------------------
6. On page 57321, second column, first partial paragraph --
a Line 1, the figure ``277'' is corrected to read ``278''.
b Line 7, the figure ``1.0'' is corrected to read ``0.9''.
7. On pages 57321 through 57323, the table titled ``TABLE II--
IMPACT ANALYSIS OF CHANGES FOR FY 2017 ACUTE CARE HOSPITAL OPERATING
PROSPECTIVE PAYMENT SYSTEM [PAYMENTS PER DISCHARGE]'' is corrected to
read as follows:
[[Page 68959]]
Table II--Impact Analysis of Changes for FY 2017 Acute Care Hospital Operating Prospective Payment System
[Payments per discharge]
----------------------------------------------------------------------------------------------------------------
Estimated Estimated
Number of average FY average FY FY 2017
hospitals 2016 payment 2017 payment changes
per discharge per discharge
(1) (2) (3) (4)
----------------------------------------------------------------------------------------------------------------
All Hospitals................................... 3,330 $11,542 $11,649 0.9
By Geographic Location:
Urban hospitals............................. 2,515 11,890 11,997 0.9
Large urban areas........................... 1,369 12,690 12,799 0.9
Other urban areas........................... 1,146 10,946 11,051 1.0
Rural hospitals............................. 815 8,602 8,707 1.2
Bed Size (Urban):
0-99 beds................................... 659 9,392 9,478 0.9
100-199 beds................................ 767 10,050 10,117 0.7
200-299 beds................................ 446 10,757 10,840 0.8
300-499 beds................................ 431 12,092 12,202 0.9
500 or more beds............................ 212 14,613 14,772 1.1
Bed Size (Rural):
0-49 beds................................... 317 7,208 7,279 1.0
50-99 beds.................................. 292 8,192 8,292 1.2
100-149 beds................................ 120 8,434 8,519 1.0
150-199 beds................................ 46 9,243 9,367 1.3
200 or more beds............................ 40 10,171 10,320 1.5
Urban by Region:
New England................................. 116 12,957 12,901 -0.4
Middle Atlantic............................. 315 13,471 13,593 0.9
South Atlantic.............................. 407 10,498 10,595 0.9
East North Central.......................... 390 11,190 11,303 1.0
East South Central.......................... 147 10,042 10,160 1.2
West North Central.......................... 163 11,578 11,692 1.0
West South Central.......................... 385 10,693 10,820 1.2
Mountain.................................... 163 12,279 12,549 2.2
Pacific..................................... 378 15,372 15,452 0.5
Puerto Rico................................. 51 8,491 8,513 0.3
Rural by Region:
New England................................. 21 11,818 12,009 1.6
Middle Atlantic............................. 54 8,655 8,791 1.6
South Atlantic.............................. 128 8,043 8,122 1.0
East North Central.......................... 115 8,918 9,023 1.2
East South Central.......................... 155 7,639 7,716 1.0
West North Central.......................... 98 9,420 9,560 1.5
West South Central.......................... 160 7,243 7,328 1.2
Mountain.................................... 60 10,100 10,228 1.3
Pacific..................................... 24 12,045 12,197 1.3
By Payment Classification:
Urban hospitals............................. 2,522 11,886 11,993 0.9
Large urban areas........................... 1,369 12,690 12,799 0.9
Other urban areas........................... 1,153 10,940 11,046 1.0
Rural areas................................. 808 8,602 8,706 1.2
Teaching Status:
Nonteaching................................. 2,266 9,600 9,680 0.8
Fewer than 100 residents.................... 815 11,133 11,231 0.9
100 or more residents....................... 249 16,764 16,949 1.1
Urban DSH:
Non-DSH..................................... 589 10,055 10,140 0.8
100 or more beds............................ 1,642 12,247 12,359 0.9
Less than 100 beds.......................... 363 8,853 8,914 0.7
Rural DSH:
SCH......................................... 240 8,584 8,702 1.4
RRC......................................... 325 9,006 9,123 1.3
100 or more beds............................ 29 7,018 7,054 0.5
Less than 100 beds.......................... 142 6,823 6,838 0.2
Urban teaching and DSH:
Both teaching and DSH....................... 898 13,344 13,474 1.0
Teaching and no DSH......................... 109 11,361 11,442 0.7
No teaching and DSH......................... 1,107 10,047 10,124 0.8
No teaching and no DSH...................... 408 9,455 9,539 0.9
Special Hospital Types:
RRC......................................... 189 9,709 9,824 1.2
[[Page 68960]]
SCH......................................... 324 10,344 10,516 1.7
MDH......................................... 148 7,321 7,415 1.3
SCH and RRC................................. 126 10,767 10,957 1.8
MDH and RRC................................. 12 8,822 9,019 2.2
Type of Ownership:
Voluntary................................... 1,927 11,719 11,830 0.9
Proprietary................................. 881 10,130 10,218 0.9
Government.................................. 522 12,485 12,596 0.9
Medicare Utilization as a Percent of Inpatient
Days:
0-25........................................ 523 14,996 15,160 1.1
25-50....................................... 2,122 11,460 11,562 0.9
50-65....................................... 545 9,343 9,431 0.9
Over 65..................................... 89 6,948 7,019 1.0
FY 2017 Reclassifications by the Medicare
Geographic Classification Review Board:
All Reclassified Hospitals.................. 791 11,399 11,507 0.9
Non-Reclassified Hospitals.................. 2,539 11,595 11,701 0.9
Urban Hospitals Reclassified................ 532 12,008 12,115 0.9
Urban Nonreclassified Hospitals............. 1,936 11,849 11,955 0.9
Rural Hospitals Reclassified Full Year...... 277 8,984 9,101 1.3
Rural Nonreclassified Hospitals Full Year... 489 8,173 8,266 1.1
All Section 401 Reclassified Hospitals...... 72 11,307 11,474 1.5
Other Reclassified Hospitals (Section 48 7,889 7,954 0.8
1886(d)(8)(B)).............................
----------------------------------------------------------------------------------------------------------------
7. On page 57324, top of the page, third column, last paragraph,
line 1, the figure ``2,426'' is corrected to read ``2,419''.
8. On pages 57324 and 57325, the table titled ``Modeled
Disproportionate Share Hospital Payments for Estimated FY 2017 DSHs by
Hospital Type: Model DSH $ (In Millions) From FY 2016 to FY 2017'' is
corrected to read as follows:
Modeled Disproportionate Share Hospital Payments for Estimated FY 2017 DSHS by Hospital Type: Model DSH $ (in
Millions) From FY 2016 to FY 2017
----------------------------------------------------------------------------------------------------------------
FY 2016 final FY 2017 final Dollar
Number of rule estimated rule estimated difference: FY Percent change
DSHs (FY 2017) DSH $ * (in DSH $ * (in 2017- FY 2016 **
millions) millions) (in millions)
(1) (2) (3) (4) (5)
----------------------------------------------------------------------------------------------------------------
Total........................... 2,419 $9,767 $9,551 -$216 -2.2
By Geographic Location:
Urban Hospitals............. 1,921 9,294 9,106 -188 -2.0
Large Urban Areas....... 1,045 5,885 5,765 -120 -2.0
Other Urban Areas....... 876 3,408 3,341 -68 -2.0
Rural Hospitals............. 498 473 445 -28 -5.9
Bed Size (Urban):
0 to 99 Beds................ 336 189 185 -4 -2.2
100 to 249 Beds............. 837 2,211 2,154 -57 -2.6
250+ Beds................... 748 6,894 6,767 -127 -1.8
Bed Size (Rural):
0 to 99 Beds................ 368 206 190 -16 -7.8
100 to 249 Beds............. 116 211 199 -12 -5.5
250+ Beds................... 14 56 56 0 -0.2
Urban by Region:
East North Central.......... 322 1,273 1,252 -22 -1.7
East South Central.......... 129 574 566 -8 -1.4
Middle Atlantic............. 232 1,614 1,570 -44 -2.7
Mountain.................... 125 448 448 0 -0.1
New England................. 90 394 385 -9 -2.4
Pacific..................... 312 1,459 1,448 -10 -0.7
Puerto Rico................. 41 104 116 12 11.3
[[Page 68961]]
South Atlantic.............. 314 1,777 1,721 -56 -3.2
West North Central.......... 104 451 439 -11 -2.5
West South Central.......... 252 1,200 1,161 -39 -3.2
Rural by Region:
East North Central.......... 64 49 44 -4 -8.3
East South Central.......... 141 149 141 -8 -5.3
Middle Atlantic............. 28 34 33 -1 -2.4
Mountain.................... 21 16 15 0 -0.2
New England................. 11 15 16 1 7.2
Pacific..................... 7 9 7 -3 -27.4
South Atlantic.............. 86 98 92 -6 -6.4
West North Central.......... 31 20 19 -1 -6.3
West South Central.......... 109 83 78 -6 -7.0
By Payment Classification:
Urban Hospitals............. 1,886 9,243 9,055 -188 -2.0
Large Urban Areas....... 1,043 5,884 5,764 -120 -2.0
Other Urban Areas....... 843 3,359 3,292 -68 -2.0
Rural Hospitals............. 533 523 496 -28 -5.3
Teaching Status:
Nonteaching................. 1,544 3,117 3,053 -64 -2.1
Fewer than 100 residents.... 637 3,213 3,132 -81 -2.5
100 or more residents....... 238 3,437 3,366 -71 -2.1
Type of Ownership:
Voluntary................... 1,405 6,044 5,913 -131 -2.2
Proprietary................. 541 1,672 1,629 -43 -2.6
Government.................. 471 2,023 1,983 -40 -2.0
Unknown..................... 2 27 25 -2 -6.1
Medicare Utilization Percent:
Missing or Unknown.......... 4 1 1 0 0.9
0 to 25..................... 428 3,013 2,974 -39 -1.3
25 to 50.................... 1,617 6,356 6,189 -166 -2.6
50 to 65.................... 319 385 375 -10 -2.5
Greater than 65............. 51 12 11 -1 -8.2
----------------------------------------------------------------------------------------------------------------
Source: Dobson [bond] DaVanzo analysis of 2011-2013 Hospital Cost Reports.
* Dollar DSH calculated by [0.25 * estimated section 1886(d)(5)(F) payments] + [0.75 * estimated section
1886(d)(5)(F) payments * Factor 2 * Factor 3]. When summed across all hospitals projected to receive DSH
payments, DSH payments are estimated to be $9,767 million in FY 2016 and $9,551 million in FY 2017.
** Percentage change is determined as the difference between Medicare DSH payments modeled for the FY 2017 IPPS/
LTCH PPS final rule (column 3) and Medicare DSH payments modeled for the FY 2016 IPPS/LTCH PPS final rule
(column 2) divided by Medicare DSH payments modeled for the FY 2016 final rule (column 2) times 100 percent.
9. On page 57325, bottom of the page, third column, last paragraph,
line 8, the figure ``6.4'' is corrected to read ``5.9''.
10. On page 57326, first column--
a. First partial paragraph--
(1) Line 7 the figure ``5.2'' is corrected to read ``5.5''.
(2) Line 8, the figure ``5.9'' is corrected to read ``0.2''.
b. First full paragraph, line 12, the figure ``11.4'' is corrected
to read ``11.3''.
c. Third full paragraph (last paragraph)--
(1) Line 12, the figure ``11.4'' is corrected to read ``11.3''.
(2) Line 18, the figure ``$9.5 million'' is corrected to read
``$9.4 million''.
11. On page 57330, third column--
a. Fourth bulleted paragraph, line 4, the figure ``0.9991'' is
corrected to read ``0.9990''.
b. Last paragraph, line 6, the figure ``1.84'' is corrected to read
``1.83''.
12. On page 57331, top half of the page--
a. First column--
(1) First partial paragraph--
(a) Line 1, the phrase ``Less than half of the hospitals'' is
corrected to read ``Most of the hospitals''.
(b) Lines 4 through 6, the phrase ``the effects of changes to the
GAFs, while the remainder of these urban area hospitals would
experience no change or a decrease in'' is corrected to read ``the
effects of changes to the GAFs, while hospitals in one urban area are
expected to experience a decrease in''.
(c) Line 11, the phrase ``except for two rural areas where changes
in'' is corrected to read, ``except for one rural area where changes
in''.
(2) Third paragraph, lines 8 and line 9, the phrase ``0.7 percent,
while hospitals in rural areas, on average, are expected to experience
a 0.8'' is corrected to read ``0.7 percent, and hospitals in rural
areas, on average, are also expected to experience a 0.7''.
b. Second column--
(1) First partial paragraph, lines 2 through 6, the sentence ``The
primary factor contributing to the small difference in the projected
increase in capital IPPS payments per case for urban hospitals as
compared to rural hospitals is the changes to the GAFs.'' is corrected
by deleting the sentence.
(2) First full paragraph--
(a) Lines 4 through 8, ``range from a 4.2 percent increase for the
Puerto Rico urban hospitals, and a 1.4 percent
[[Page 68962]]
increase for the West South Central urban region to a 0.7 percent
increase for the Mountain urban region.'' is corrected to read ``range
from a 4.1 percent increase for the Puerto Rico urban hospitals, and a
2.1 percent increase for the Mountain urban region to a 0.7 percent
increase for several other urban regions.''.
(b) Line 13, the figure ``4.2'' is corrected to read ``4.1''.
(c) Line 23, the figure ``1.6'' is corrected to read ``2.1''.
(d) Line 26, the figure ``0.4'' should read ``0.1''.
c. Third column--
(1) First full paragraph, line 9, the figure ``0.7'' is corrected
to read ``0.6''.
(2) Second full paragraph--
(a) Line 13, the figure ``1.0'' is corrected to read ``0.9''.
(b) Line 17, the figure ``1.0'' is corrected to read ``0.9''.
(c) Line 20, the figure ``0.2'' is corrected to read ``0.3''.
13. On pages 57331 and 57332, the table titled ``Table III.--
Comparison of Total Payments Per Case [FY 2016 Payments Compared To FY
2017 Payments]'' is corrected to read as follows:
Table III--Comparison of Total Payments per Case
[FY 2016 payments compared to FY 2017 payments]
----------------------------------------------------------------------------------------------------------------
Average FY Average FY
Number of 2016 payments/ 2017 payments/ Change
hospitals case case
----------------------------------------------------------------------------------------------------------------
By Geographic Location:
All hospitals............................... 3,330 912 920 0.8
Large urban areas (populations over 1 1,369 1,011 1,019 0.7
million)...............................
Other urban areas (populations of 1 1,146 871 879 0.9
million of fewer)......................
Rural areas............................. 815 618 623 0.7
Urban hospitals............................. 2,515 947 955 0.8
0-99 beds............................... 659 768 774 0.8
100-199 beds............................ 767 824 829 0.6
200-299 beds............................ 446 865 871 0.7
300-499 beds............................ 431 958 967 0.9
500 or more beds........................ 212 1,139 1,149 0.9
Rural hospitals............................. 815 618 623 0.7
0-49 beds............................... 317 520 524 0.7
50-99 beds.............................. 292 577 582 0.8
100-149 beds............................ 120 610 614 0.6
150-199 beds............................ 46 669 673 0.6
200 or more beds........................ 40 738 745 0.9
By Region:
Urban by Region............................. 2,515 947 955 0.8
New England............................. 116 1,031 1,024 -0.6
Middle Atlantic......................... 315 1,056 1,064 0.7
South Atlantic.......................... 407 840 847 0.8
East North Central...................... 390 908 915 0.8
East South Central...................... 147 793 804 1.3
West North Central...................... 163 923 930 0.7
West South Central...................... 385 858 868 1.1
Mountain................................ 163 977 998 2.1
Pacific................................. 378 1,219 1,227 0.7
Puerto Rico............................. 51 435 453 4.1
Rural by Region............................. 815 618 623 0.7
New England............................. 21 868 878 1.1
Middle Atlantic......................... 54 591 603 2.1
South Atlantic.......................... 128 584 584 0.0
East North Central...................... 115 638 643 0.9
East South Central...................... 155 562 566 0.9
West North Central...................... 98 666 668 0.4
West South Central...................... 160 536 542 1.2
Mountain................................ 60 718 717 -0.1
Pacific................................. 24 804 812 1.0
By Payment Classification:
All hospitals............................... 3,330 912 920 0.8
Large urban areas (populations over 1 1,369 1,011 1,019 0.7
million)...............................
Other urban areas (populations of 1 1,153 870 878 0.9
million of fewer)......................
Rural areas................................. 808 619 623 0.7
Teaching Status:
Non-teaching............................ 2,266 771 776 0.7
Fewer than 100 Residents................ 815 885 892 0.8
100 or more Residents................... 249 1,287 1,298 0.9
Urban DSH:
100 or more beds.................... 1,642 968 976 0.8
Less than 100 beds.................. 363 696 702 0.8
Rural DSH:
Sole Community (SCH/EACH)........... 240 575 581 1.0
Referral Center (RRC/EACH).......... 325 649 654 0.7
Other Rural:
100 or more beds................ 29 538 540 0.4
[[Page 68963]]
Less than 100 beds.............. 142 526 528 0.3
Urban teaching and DSH:
Both teaching and DSH................... 898 1,043 1,052 0.9
Teaching and no DSH..................... 109 942 948 0.6
No teaching and DSH..................... 1,107 813 820 0.8
No teaching and no DSH.................. 408 815 820 0.6
Rural Hospital Types:
Non special status hospitals............ 2,529 948 955 0.7
RRC/EACH................................ 189 772 782 1.4
SCH/EACH................................ 324 706 716 1.4
SCH, RRC and EACH....................... 126 748 756 1.1
Hospitals Reclassified by the Medicare
Geographic Classification Review Board:
FY2017 Reclassifications:
All Urban Reclassified.................. 532 953 962 0.9
All Urban Non-Reclassified.............. 1,936 948 955 0.7
All Rural Reclassified.................. 277 650 655 0.9
All Rural Non-Reclassified.............. 489 578 580 0.3
Other Reclassified Hospitals (Section 42 599 602 0.5
1886(d)(8)(B)).........................
Type of Ownership:
Voluntary............................... 1,927 926 934 0.8
Proprietary............................. 881 820 827 0.8
Government.............................. 522 963 969 0.6
Medicare Utilization as a Percent of
Inpatient Days:
0-25.................................... 523 1,103 1,114 1.0
25-50................................... 2,122 916 923 0.8
50-65................................... 545 745 750 0.7
Over 65................................. 89 529 531 0.4
----------------------------------------------------------------------------------------------------------------
14. On page 57342--
a. Top of the page--
(1) First column, first full paragraph--
(a) Line 11, the figure ``987'' is corrected to read ``990''.
(b) Line 23, the figure ``809'' is corrected to read ``811''.
(2) Second column, first partial paragraph--
(a) Line 12, the figure ``809'' is corrected to read ``811''.
(b) Line 14, the figure''680'' is corrected to read ``683''.
(c) Line 19, the figure ``66'' is corrected to read ``72''.
(d) Line 23, the figure ``746'' is corrected to read ``755''.
b. Middle of the page, the table titled ``TABLE V--ACCOUNTING
STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES UNDER THE IPPS FROM
FY 2016 TO FY 2017'' is corrected to read as follows:
Table V--Accounting Statement: Classification of Estimated Expenditures
Under the IPPS From FY 2016 to FY 2017
------------------------------------------------------------------------
Category Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers......... $755 million.
From Whom to Whom...................... Federal Government to IPPS
Medicare Providers.
------------------------------------------------------------------------
Dated: September 29, 2016.
Madhura Valverde,
Executive Secretary to the Department, Department of Health and Human
Services.
[FR Doc. 2016-24042 Filed 9-30-16; 11:15 am]
BILLING CODE 4120-01-P