[Federal Register Volume 82, Number 191 (Wednesday, October 4, 2017)]
[Rules and Regulations]
[Pages 46163-46170]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-21327]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 409, 411, 413, 424, and 488
[CMS-1679-CN]
RIN 0938-AS96
Medicare Program; Prospective Payment System and Consolidated
Billing for Skilled Nursing Facilities for FY 2018, SNF Value-Based
Purchasing Program, SNF Quality Reporting Program, Survey Team
Composition, and Correction of the Performance Period for the NHSN HCP
Influenza Vaccination Immunization Reporting Measure in the ESRD QIP
for PY 2020; Correction
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final rule; correction.
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SUMMARY: This document corrects technical errors in the final rule that
appeared in the August 4, 2017 Federal Register, which will update the
payment rates used under the prospective payment system (PPS) for
skilled nursing facilities (SNFs) for fiscal year (FY) 2018.
DATES: This correction is effective October 1, 2017.
FOR FURTHER INFORMATION CONTACT: John Kane, (410) 786-0557.
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2017-16256 (82 FR 36530), the final rule entitled
``Medicare Program; Prospective Payment System and Consolidated Billing
for Skilled Nursing Facilities for FY 2018, SNF Value-Based Purchasing
Program, SNF Quality Reporting Program, Survey Team Composition, and
Correction of the Performance Period for the NHSN HCP Influenza
Vaccination Immunization Reporting Measure in the ESRD QIP for PY
2020'', there were a number of technical errors that are identified and
corrected in section IV., Correction of Errors. The provisions in this
correcting document are effective as if they had been included in the
document that appeared in the August 4, 2017, Federal Register
(hereinafter referred to as the FY 2018 SNF PPS final rule).
Accordingly, the corrections are effective October 1, 2017.
II. Summary of Errors
A. Summary of Errors in the Preamble
As discussed in the FY 2018 SNF PPS final rule (82 FR 36539), in
developing the wage index to be applied to skilled nursing facilities
(SNFs) under the SNF prospective payment system (PPS), we use the
updated, pre-reclassified hospital inpatient prospective payment system
(IPPS) wage data, exclusive of the occupational mix adjustment. For FY
2018, the updated, unadjusted, pre-reclassified IPPS wage data used
under the SNF PPS are for hospital cost reporting periods beginning on
or after October 1, 2013, and before October 1, 2014 (FY 2014 cost
report data), as discussed in the FY 2018 IPPS final rule (82 FR
38130). In calculating the wage index under the FY 2018 IPPS final
rule, we made inadvertent errors related to the wage data collected
from the Medicare cost reports of six hospitals which are located in
CBSAs 24860 and 40340. Specifically, we used incorrect wage data for
these six hospitals to calculate the final FY 2018 IPPS wage indexes,
the geographic adjustment factor (GAF) (which is computed from the wage
index), as well as certain other IPPS factors and adjustments.
These errors are identified, discussed and corrected in the
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 2018 Rates; Quality
Reporting Requirements for Specific Providers; Medicare and Medicaid
Electronic Health Record (EHR) Incentive Program Requirements for
Eligible Hospitals, Critical Access Hospitals, and Eligible
Professionals; Provider-Based Status of Indian Health Services and
Tribal Facilities and Organizations; Cost Reporting and Provider
Requirements; Agreement Termination Notices; Correction (CMS-1677-CN)
that appears elsewhere in this issue of the Federal Register.
As discussed above, we use the updated, pre-reclassified,
unadjusted IPPS wage data in developing the wage index used under the
SNF PPS. Due to the technical errors described above, the published FY
2018 SNF PPS wage indexes were incorrect. Thus, the use of the
corrected wage data for the six hospitals required the recalculation of
the final FY 2018 SNF PPS wage indexes. Additionally, as discussed on
page 36543 of the FY 2018 SNF PPS final rule, section 1888(e)(4)(G)(ii)
of the Act requires that we apply the wage index in a manner that does
not result in aggregate payments under the SNF PPS that are greater or
less than would otherwise be made if the wage index adjustment had not
been made. To achieve this, we apply a budget neutrality factor to the
unadjusted SNF PPS federal per diem base rates. Due to the
recalculation and subsequent revision of the final FY 2018 SNF PPS wage
indexes, it was necessary to recalculate the FY 2018 SNF PPS wage index
budget neutrality factor as well. Revising the wage index budget
neutrality factor causes a change in the unadjusted SNF PPS federal per
diem rates (provided in Tables 2 and 3 of the FY 2018 SNF PPS final
rule (82 FR 36535)), which then causes changes in the case-mix adjusted
SNF PPS rates (provided in Tables 4 and 5 in the FY 2018 SNF PPS final
rule (82 FR 36537 through 36538), as well as the labor adjusted SNF PPS
rates (provided in Tables 6 and 7 of the FY 2018 SNF PPS final rule (82
FR 36541 through 36543). Finally, due to the recalculated wage indexes,
we recalculated the impact analysis provided in Table 26 of the FY 2018
SNF PPS final rule (82 FR 36629). The corrections to these errors are
found in section IV. of this document.
B. Summary of Errors in and Corrections to Tables Posted on the CMS Web
Site
We are correcting the wage indexes in Tables A and B setting forth
the wage indexes for urban (Table A) and non-urban (Table B) areas
based on CBSA labor market areas, which are available exclusively on
the CMS Web site at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex.html. These tables have been updated
to reflect the revisions discussed in this correcting document.
We are republishing the wage indexes in Tables A and B accordingly
on the CMS Web site at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex.html.
III. Waiver of Proposed Rulemaking and Delayed Effective Date
We ordinarily publish a notice of proposed rulemaking in the
Federal Register to provide a period for public comment before the
provisions of a rule take effect in accordance with section 553(b) of
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However,
[[Page 46164]]
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 therefor in the notice.
Section 553(d) of the APA ordinarily requires a 30-day delay in
effective date of final rules after the date of their publication in
the Federal Register. This 30-day delay in effective date can be
waived, however, if an agency finds for good cause that the delay is
impracticable, unnecessary, or contrary to the public interest, and the
agency incorporates a statement of the findings and its reasons in the
rule issued.
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. The document corrects technical errors in
the FY 2018 SNF PPS final rule and in the tables referenced in the
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 2018 SNF PPS final rule accurately reflects the policies adopted
in that final rule.
In addition, even if this were a rule to which the notice and
comment procedures and delayed effective date requirements applied, we
find that there is good cause to waive such requirements. Undertaking
further notice and comment procedures to incorporate the corrections in
this document into the final rule or delaying the effective date would
be contrary to the public interest because it is in the public's
interest for providers to receive appropriate payments in as timely a
manner as possible, and to ensure that the FY 2018 SNF PPS final rule
and the tables referenced in the final rule accurately reflect our
methodologies, payment rates, and policies. Furthermore, such
procedures would be unnecessary, as we are not making substantive
changes to our payment methodologies or policies, but rather, we are
simply implementing correctly the methodologies and policies that we
previously proposed, requested comment on, and subsequently finalized.
This correcting document is intended solely to ensure that the FY 2018
SNF PPS final rule and the tables referenced in the final rule
accurately reflect these methodologies and policies. Therefore, we
believe we have good cause to waive the notice and comment and
effective date requirements.
Correction of Errors
In FR Doc. 2017-16256 of August 4, 2017 (82 FR 36530), make the
following corrections:
1. On page 36535, TABLE 2--FY 2018 UNADJUSTED FEDERAL RATE PER DIEM
URBAN is corrected to read as follows:
Table 2--FY 2018 Unadjusted Federal Rate Per Diem Urban
----------------------------------------------------------------------------------------------------------------
Nursing--case- Therapy--case- Therapy--non-
Rate component mix mix case-mix Non-case-mix
----------------------------------------------------------------------------------------------------------------
Per Diem Amount............................. $177.21 $133.48 $17.58 $90.44
----------------------------------------------------------------------------------------------------------------
2. On page 36535, TABLE 3--FY 2018 UNADJUSTED FEDERAL RATE PER DIEM
RURAL is corrected to read as follows:
Table 3--FY 2018 Unadjusted Federal Rate Per Diem Rural
----------------------------------------------------------------------------------------------------------------
Nursing--case- Therapy--case- Therapy--non-
Rate component mix mix case-mix Non-case-mix
----------------------------------------------------------------------------------------------------------------
Per Diem Amount............................. $169.29 $153.92 $18.78 $92.11
----------------------------------------------------------------------------------------------------------------
3. On page 36536, third column, first full paragraph,
a. Line 21, the figure ``$443.08'' is corrected to read
``$442.95''.
b. Line 26, the figure ``$1,010.22.'' is corrected to read
``$1,009.93.''.
4. On page 36537, TABLE 4--RUG-IV CASE-MIX ADJUSTED FEDERAL RATES
AND ASSOCIATED INDEXES--URBAN is corrected to read as follows:
Table 4--RUG-IV Case-Mix Adjusted Federal Rates and Associated Indexes--Urban
--------------------------------------------------------------------------------------------------------------------------------------------------------
Nursing Therapy Non-case mix Non-case mix
RUG-IV category Nursing index Therapy index component component therapy comp component Total rate
--------------------------------------------------------------------------------------------------------------------------------------------------------
RUX..................................... 2.67 1.87 $473.15 $249.61 .............. $90.44 $813.20
RUL..................................... 2.57 1.87 455.43 249.61 .............. 90.44 795.48
RVX..................................... 2.61 1.28 462.52 170.85 .............. 90.44 723.81
RVL..................................... 2.19 1.28 388.09 170.85 .............. 90.44 649.38
RHX..................................... 2.55 0.85 451.89 113.46 .............. 90.44 655.79
RHL..................................... 2.15 0.85 381.00 113.46 .............. 90.44 584.90
RMX..................................... 2.47 0.55 437.71 73.41 .............. 90.44 601.56
RML..................................... 2.19 0.55 388.09 73.41 .............. 90.44 551.94
RLX..................................... 2.26 0.28 400.49 37.37 .............. 90.44 528.30
RUC..................................... 1.56 1.87 276.45 249.61 .............. 90.44 616.50
RUB..................................... 1.56 1.87 276.45 249.61 .............. 90.44 616.50
RUA..................................... 0.99 1.87 175.44 249.61 .............. 90.44 515.49
RVC..................................... 1.51 1.28 267.59 170.85 .............. 90.44 528.88
RVB..................................... 1.11 1.28 196.70 170.85 .............. 90.44 457.99
RVA..................................... 1.10 1.28 194.93 170.85 .............. 90.44 456.22
[[Page 46165]]
RHC..................................... 1.45 0.85 256.95 113.46 .............. 90.44 460.85
RHB..................................... 1.19 0.85 210.88 113.46 .............. 90.44 414.78
RHA..................................... 0.91 0.85 161.26 113.46 .............. 90.44 365.16
RMC..................................... 1.36 0.55 241.01 73.41 .............. 90.44 404.86
RMB..................................... 1.22 0.55 216.20 73.41 .............. 90.44 380.05
RMA..................................... 0.84 0.55 148.86 73.41 .............. 90.44 312.71
RLB..................................... 1.50 0.28 265.82 37.37 .............. 90.44 393.63
RLA..................................... 0.71 0.28 125.82 37.37 .............. 90.44 253.63
ES3..................................... 3.58 .............. 634.41 .............. 17.58 90.44 742.43
ES2..................................... 2.67 .............. 473.15 .............. 17.58 90.44 581.17
ES1..................................... 2.32 .............. 411.13 .............. 17.58 90.44 519.15
HE2..................................... 2.22 .............. 393.41 .............. 17.58 90.44 501.43
HE1..................................... 1.74 .............. 308.35 .............. 17.58 90.44 416.37
HD2..................................... 2.04 .............. 361.51 .............. 17.58 90.44 469.53
HD1..................................... 1.60 .............. 283.54 .............. 17.58 90.44 391.56
HC2..................................... 1.89 .............. 334.93 .............. 17.58 90.44 442.95
HC1..................................... 1.48 .............. 262.27 .............. 17.58 90.44 370.29
HB2..................................... 1.86 .............. 329.61 .............. 17.58 90.44 437.63
HB1..................................... 1.46 .............. 258.73 .............. 17.58 90.44 366.75
LE2..................................... 1.96 .............. 347.33 .............. 17.58 90.44 455.35
LE1..................................... 1.54 .............. 272.90 .............. 17.58 90.44 380.92
LD2..................................... 1.86 .............. 329.61 .............. 17.58 90.44 437.63
LD1..................................... 1.46 .............. 258.73 .............. 17.58 90.44 366.75
LC2..................................... 1.56 .............. 276.45 .............. 17.58 90.44 384.47
LC1..................................... 1.22 .............. 216.20 .............. 17.58 90.44 324.22
LB2..................................... 1.45 .............. 256.95 .............. 17.58 90.44 364.97
LB1..................................... 1.14 .............. 202.02 .............. 17.58 90.44 310.04
CE2..................................... 1.68 .............. 297.71 .............. 17.58 90.44 405.73
CE1..................................... 1.50 .............. 265.82 .............. 17.58 90.44 373.84
CD2..................................... 1.56 .............. 276.45 .............. 17.58 90.44 384.47
CD1..................................... 1.38 .............. 244.55 .............. 17.58 90.44 352.57
CC2..................................... 1.29 .............. 228.60 .............. 17.58 90.44 336.62
CC1..................................... 1.15 .............. 203.79 .............. 17.58 90.44 311.81
CB2..................................... 1.15 .............. 203.79 .............. 17.58 90.44 311.81
CB1..................................... 1.02 .............. 180.75 .............. 17.58 90.44 288.77
CA2..................................... 0.88 .............. 155.94 .............. 17.58 90.44 263.96
CA1..................................... 0.78 .............. 138.22 .............. 17.58 90.44 246.24
BB2..................................... 0.97 .............. 171.89 .............. 17.58 90.44 279.91
BB1..................................... 0.90 .............. 159.49 .............. 17.58 90.44 267.51
BA2..................................... 0.70 .............. 124.05 .............. 17.58 90.44 232.07
BA1..................................... 0.64 .............. 113.41 .............. 17.58 90.44 221.43
PE2..................................... 1.50 .............. 265.82 .............. 17.58 90.44 373.84
PE1..................................... 1.40 .............. 248.09 .............. 17.58 90.44 356.11
PD2..................................... 1.38 .............. 244.55 .............. 17.58 90.44 352.57
PD1..................................... 1.28 .............. 226.83 .............. 17.58 90.44 334.85
PC2..................................... 1.10 .............. 194.93 .............. 17.58 90.44 302.95
PC1..................................... 1.02 .............. 180.75 .............. 17.58 90.44 288.77
PB2..................................... 0.84 .............. 148.86 .............. 17.58 90.44 256.88
PB1..................................... 0.78 .............. 138.22 .............. 17.58 90.44 246.24
PA2..................................... 0.59 .............. 104.55 .............. 17.58 90.44 212.57
PA1..................................... 0.54 .............. 95.69 .............. 17.58 90.44 203.71
--------------------------------------------------------------------------------------------------------------------------------------------------------
5. On page 36538, TABLE 5--RUG-IV CASE-MIX ADJUSTED FEDERAL RATES
AND ASSOCIATED INDEXES--RURAL is corrected to read as follows:
Table 5--RUG-IV Case-Mix Adjusted Federal Rates and Associated Indexes--Rural
--------------------------------------------------------------------------------------------------------------------------------------------------------
Nursing Therapy Non-case mix Non-case mix
RUG-IV Category Nursing index Therapy index component component therapy comp component Total rate
--------------------------------------------------------------------------------------------------------------------------------------------------------
RUX..................................... 2.67 1.87 $452.00 $287.83 .............. $92.11 $831.94
RUL..................................... 2.57 1.87 435.08 287.83 .............. 92.11 815.02
RVX..................................... 2.61 1.28 441.85 197.02 .............. 92.11 730.98
RVL..................................... 2.19 1.28 370.75 197.02 .............. 92.11 659.88
RHX..................................... 2.55 0.85 431.69 130.83 .............. 92.11 654.63
RHL..................................... 2.15 0.85 363.97 130.83 .............. 92.11 586.91
RMX..................................... 2.47 0.55 418.15 84.66 .............. 92.11 594.92
RML..................................... 2.19 0.55 370.75 84.66 .............. 92.11 547.52
RLX..................................... 2.26 0.28 382.60 43.10 .............. 92.11 517.81
[[Page 46166]]
RUC..................................... 1.56 1.87 264.09 287.83 .............. 92.11 644.03
RUB..................................... 1.56 1.87 264.09 287.83 .............. 92.11 644.03
RUA..................................... 0.99 1.87 167.60 287.83 .............. 92.11 547.54
RVC..................................... 1.51 1.28 255.63 197.02 .............. 92.11 544.76
RVB..................................... 1.11 1.28 187.91 197.02 .............. 92.11 477.04
RVA..................................... 1.10 1.28 186.22 197.02 .............. 92.11 475.35
RHC..................................... 1.45 0.85 245.47 130.83 .............. 92.11 468.41
RHB..................................... 1.19 0.85 201.46 130.83 .............. 92.11 424.40
RHA..................................... 0.91 0.85 154.05 130.83 .............. 92.11 376.99
RMC..................................... 1.36 0.55 230.23 84.66 .............. 92.11 407.00
RMB..................................... 1.22 0.55 206.53 84.66 .............. 92.11 383.30
RMA..................................... 0.84 0.55 142.20 84.66 .............. 92.11 318.97
RLB..................................... 1.50 0.28 253.94 43.10 .............. 92.11 389.15
RLA..................................... 0.71 0.28 120.20 43.10 .............. 92.11 255.41
ES3..................................... 3.58 .............. 606.06 .............. 18.78 92.11 716.95
ES2..................................... 2.67 .............. 452.00 .............. 18.78 92.11 562.89
ES1..................................... 2.32 .............. 392.75 .............. 18.78 92.11 503.64
HE2..................................... 2.22 .............. 375.82 .............. 18.78 92.11 486.71
HE1..................................... 1.74 .............. 294.56 .............. 18.78 92.11 405.45
HD2..................................... 2.04 .............. 345.35 .............. 18.78 92.11 456.24
HD1..................................... 1.60 .............. 270.86 .............. 18.78 92.11 381.75
HC2..................................... 1.89 .............. 319.96 .............. 18.78 92.11 430.85
HC1..................................... 1.48 .............. 250.55 .............. 18.78 92.11 361.44
HB2..................................... 1.86 .............. 314.88 .............. 18.78 92.11 425.77
HB1..................................... 1.46 .............. 247.16 .............. 18.78 92.11 358.05
LE2..................................... 1.96 .............. 331.81 .............. 18.78 92.11 442.70
LE1..................................... 1.54 .............. 260.71 .............. 18.78 92.11 371.60
LD2..................................... 1.86 .............. 314.88 .............. 18.78 92.11 425.77
LD1..................................... 1.46 .............. 247.16 .............. 18.78 92.11 358.05
LC2..................................... 1.56 .............. 264.09 .............. 18.78 92.11 374.98
LC1..................................... 1.22 .............. 206.53 .............. 18.78 92.11 317.42
LB2..................................... 1.45 .............. 245.47 .............. 18.78 92.11 356.36
LB1..................................... 1.14 .............. 192.99 .............. 18.78 92.11 303.88
CE2..................................... 1.68 .............. 284.41 .............. 18.78 92.11 395.30
CE1..................................... 1.50 .............. 253.94 .............. 18.78 92.11 364.83
CD2..................................... 1.56 .............. 264.09 .............. 18.78 92.11 374.98
CD1..................................... 1.38 .............. 233.62 .............. 18.78 92.11 344.51
CC2..................................... 1.29 .............. 218.38 .............. 18.78 92.11 329.27
CC1..................................... 1.15 .............. 194.68 .............. 18.78 92.11 305.57
CB2..................................... 1.15 .............. 194.68 .............. 18.78 92.11 305.57
CB1..................................... 1.02 .............. 172.68 .............. 18.78 92.11 283.57
CA2..................................... 0.88 .............. 148.98 .............. 18.78 92.11 259.87
CA1..................................... 0.78 .............. 132.05 .............. 18.78 92.11 242.94
BB2..................................... 0.97 .............. 164.21 .............. 18.78 92.11 275.10
BB1..................................... 0.90 .............. 152.36 .............. 18.78 92.11 263.25
BA2..................................... 0.70 .............. 118.50 .............. 18.78 92.11 229.39
BA1..................................... 0.64 .............. 108.35 .............. 18.78 92.11 219.24
PE2..................................... 1.50 .............. 253.94 .............. 18.78 92.11 364.83
PE1..................................... 1.40 .............. 237.01 .............. 18.78 92.11 347.90
PD2..................................... 1.38 .............. 233.62 .............. 18.78 92.11 344.51
PD1..................................... 1.28 .............. 216.69 .............. 18.78 92.11 327.58
PC2..................................... 1.10 .............. 186.22 .............. 18.78 92.11 297.11
PC1..................................... 1.02 .............. 172.68 .............. 18.78 92.11 283.57
PB2..................................... 0.84 .............. 142.20 .............. 18.78 92.11 253.09
PB1..................................... 0.78 .............. 132.05 .............. 18.78 92.11 242.94
PA2..................................... 0.59 .............. 99.88 .............. 18.78 92.11 210.77
PA1..................................... 0.54 .............. 91.42 .............. 18.78 92.11 202.31
--------------------------------------------------------------------------------------------------------------------------------------------------------
6. On pages 36541 through 36542, TABLE 6--RUG-IV CASE-MIX ADJUSTED
FEDERAL RATES FOR URBAN SNFS BY LABOR AND NON-LABOR COMPONENT is
corrected to read as follows:
Table 6--RUG-IV Case-Mix Adjusted Federal Rates for Urban SNFS by Labor and Non-Labor Component
----------------------------------------------------------------------------------------------------------------
Non-labor
RUG-IV category Total rate Labor portion portion
----------------------------------------------------------------------------------------------------------------
RUX............................................................. $813.20 $575.75 $237.45
RUL............................................................. 795.48 563.20 232.28
RVX............................................................. 723.81 512.46 211.35
[[Page 46167]]
RVL............................................................. 649.38 459.76 189.62
RHX............................................................. 655.79 464.30 191.49
RHL............................................................. 584.90 414.11 170.79
RMX............................................................. 601.56 425.90 175.66
RML............................................................. 551.94 390.77 161.17
RLX............................................................. 528.30 374.04 154.26
RUC............................................................. 616.50 436.48 180.02
RUB............................................................. 616.50 436.48 180.02
RUA............................................................. 515.49 364.97 150.52
RVC............................................................. 528.88 374.45 154.43
RVB............................................................. 457.99 324.26 133.73
RVA............................................................. 456.22 323.00 133.22
RHC............................................................. 460.85 326.28 134.57
RHB............................................................. 414.78 293.66 121.12
RHA............................................................. 365.16 258.53 106.63
RMC............................................................. 404.86 286.64 118.22
RMB............................................................. 380.05 269.08 110.97
RMA............................................................. 312.71 221.40 91.31
RLB............................................................. 393.63 278.69 114.94
RLA............................................................. 253.63 179.57 74.06
ES3............................................................. 742.43 525.64 216.79
ES2............................................................. 581.17 411.47 169.70
ES1............................................................. 519.15 367.56 151.59
HE2............................................................. 501.43 355.01 146.42
HE1............................................................. 416.37 294.79 121.58
HD2............................................................. 469.53 332.43 137.10
HD1............................................................. 391.56 277.22 114.34
HC2............................................................. 442.95 313.61 129.34
HC1............................................................. 370.29 262.17 108.12
HB2............................................................. 437.63 309.84 127.79
HB1............................................................. 366.75 259.66 107.09
LE2............................................................. 455.35 322.39 132.96
LE1............................................................. 380.92 269.69 111.23
LD2............................................................. 437.63 309.84 127.79
LD1............................................................. 366.75 259.66 107.09
LC2............................................................. 384.47 272.20 112.27
LC1............................................................. 324.22 229.55 94.67
LB2............................................................. 364.97 258.40 106.57
LB1............................................................. 310.04 219.51 90.53
CE2............................................................. 405.73 287.26 118.47
CE1............................................................. 373.84 264.68 109.16
CD2............................................................. 384.47 272.20 112.27
CD1............................................................. 352.57 249.62 102.95
CC2............................................................. 336.62 238.33 98.29
CC1............................................................. 311.81 220.76 91.05
CB2............................................................. 311.81 220.76 91.05
CB1............................................................. 288.77 204.45 84.32
CA2............................................................. 263.96 186.88 77.08
CA1............................................................. 246.24 174.34 71.90
BB2............................................................. 279.91 198.18 81.73
BB1............................................................. 267.51 189.40 78.11
BA2............................................................. 232.07 164.31 67.76
BA1............................................................. 221.43 156.77 64.66
PE2............................................................. 373.84 264.68 109.16
PE1............................................................. 356.11 252.13 103.98
PD2............................................................. 352.57 249.62 102.95
PD1............................................................. 334.85 237.07 97.78
PC2............................................................. 302.95 214.49 88.46
PC1............................................................. 288.77 204.45 84.32
PB2............................................................. 256.88 181.87 75.01
PB1............................................................. 246.24 174.34 71.90
PA2............................................................. 212.57 150.50 62.07
PA1............................................................. 203.71 144.23 59.48
----------------------------------------------------------------------------------------------------------------
7. On pages 36542 through 36543, TABLE 7-RUG-IV CASE-MIX ADJUSTED
FEDERAL RATES FOR RURAL SNFS BY LABOR AND NON-LABOR COMPONENT is
corrected to read as follows:
[[Page 46168]]
Table 7--RUG-IV Case-Mix Adjusted Federal Rates for Rural SNFS by Labor and Non-Labor Component
----------------------------------------------------------------------------------------------------------------
Non-labor
RUG-IV category Total rate Labor portion portion
----------------------------------------------------------------------------------------------------------------
RUX............................................................. $831.94 $589.01 $242.93
RUL............................................................. 815.02 577.03 237.99
RVX............................................................. 730.98 517.53 213.45
RVL............................................................. 659.88 467.20 192.68
RHX............................................................. 654.63 463.48 191.15
RHL............................................................. 586.91 415.53 171.38
RMX............................................................. 594.92 421.20 173.72
RML............................................................. 547.52 387.64 159.88
RLX............................................................. 517.81 366.61 151.20
RUC............................................................. 644.03 455.97 188.06
RUB............................................................. 644.03 455.97 188.06
RUA............................................................. 547.54 387.66 159.88
RVC............................................................. 544.76 385.69 159.07
RVB............................................................. 477.04 337.74 139.30
RVA............................................................. 475.35 336.55 138.80
RHC............................................................. 468.41 331.63 136.78
RHB............................................................. 424.40 300.48 123.92
RHA............................................................. 376.99 266.91 110.08
RMC............................................................. 407.00 288.16 118.84
RMB............................................................. 383.30 271.38 111.92
RMA............................................................. 318.97 225.83 93.14
RLB............................................................. 389.15 275.52 113.63
RLA............................................................. 255.41 180.83 74.58
ES3............................................................. 716.95 507.60 209.35
ES2............................................................. 562.89 398.53 164.36
ES1............................................................. 503.64 356.58 147.06
HE2............................................................. 486.71 344.59 142.12
HE1............................................................. 405.45 287.06 118.39
HD2............................................................. 456.24 323.02 133.22
HD1............................................................. 381.75 270.28 111.47
HC2............................................................. 430.85 305.04 125.81
HC1............................................................. 361.44 255.90 105.54
HB2............................................................. 425.77 301.45 124.32
HB1............................................................. 358.05 253.50 104.55
LE2............................................................. 442.70 313.43 129.27
LE1............................................................. 371.60 263.09 108.51
LD2............................................................. 425.77 301.45 124.32
LD1............................................................. 358.05 253.50 104.55
LC2............................................................. 374.98 265.49 109.49
LC1............................................................. 317.42 224.73 92.69
LB2............................................................. 356.36 252.30 104.06
LB1............................................................. 303.88 215.15 88.73
CE2............................................................. 395.30 279.87 115.43
CE1............................................................. 364.83 258.30 106.53
CD2............................................................. 374.98 265.49 109.49
CD1............................................................. 344.51 243.91 100.60
CC2............................................................. 329.27 233.12 96.15
CC1............................................................. 305.57 216.34 89.23
CB2............................................................. 305.57 216.34 89.23
CB1............................................................. 283.57 200.77 82.80
CA2............................................................. 259.87 183.99 75.88
CA1............................................................. 242.94 172.00 70.94
BB2............................................................. 275.10 194.77 80.33
BB1............................................................. 263.25 186.38 76.87
BA2............................................................. 229.39 162.41 66.98
BA1............................................................. 219.24 155.22 64.02
PE2............................................................. 364.83 258.30 106.53
PE1............................................................. 347.90 246.31 101.59
PD2............................................................. 344.51 243.91 100.60
PD1............................................................. 327.58 231.93 95.65
PC2............................................................. 297.11 210.35 86.76
PC1............................................................. 283.57 200.77 82.80
PB2............................................................. 253.09 179.19 73.90
PB1............................................................. 242.94 172.00 70.94
PA2............................................................. 210.77 149.23 61.54
PA1............................................................. 202.31 143.24 59.07
----------------------------------------------------------------------------------------------------------------
[[Page 46169]]
8. On page 36543, under Table 7,
a. Second column, first partial paragraph, line 15, the figure
``1.0013'' is corrected to read ``1.0010''.
b. Third column, first full paragraph, line 16, the figure
``$47,596.42'' is corrected to read ``$47,602.52''.
9. On page 36543, TABLE 8--ADJUSTED RATE COMPUTATION EXAMPLE SNF
XYZ: LOCATED IN FREDERICK, MD (URBAN CBSA 43524) WAGE INDEX: 0.9863
[See Wage Index in Table A] \1\ is corrected to read as follows:
Table 8--Adjusted Rate Computation Example SNF XYZ: Located in Frederick, MD (Urban CBSA 43524)
[WAGE INDEX: 0.9869 (See Wage Index in Table A)] \1\
--------------------------------------------------------------------------------------------------------------------------------------------------------
Adjusted Adjusted Percent Medicare
RUG-IV group Labor Wage index labor Non-labor rate adjustment days Payment
--------------------------------------------------------------------------------------------------------------------------------------------------------
RVX............................................. $512.46 0.9869 $505.75 $211.35 $717.10 $717.10 14 $10,039.40
ES2............................................. 411.47 0.9869 406.08 169.70 575.78 575.78 30 17,273.40
RHA............................................. 258.53 0.9869 255.14 106.63 361.77 361.77 16 5,788.32
CC2 *........................................... 238.33 0.9869 235.21 98.29 333.50 760.38 10 7,603.80
BA2............................................. 164.31 0.9869 162.16 67.76 229.92 229.92 30 6,897.60
-------------------------------------------------------------------------------------------------------
........... ........... ........... ........... ........... ........... 100 47,602.52
--------------------------------------------------------------------------------------------------------------------------------------------------------
* Reflects a 128 percent adjustment from section 511 of the MMA.
\1\ Available on the CMS Web site at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex.html.
10. On pages 36629, TABLE 26--PROJECTED IMPACT TO THE SNF PPS FOR
FY 2018 is corrected to read as follows:
Table 26--Projected impact to the SNF PPS for FY 2018
----------------------------------------------------------------------------------------------------------------
Number of
facilities FY Update wage Total change
2018 data
----------------------------------------------------------------------------------------------------------------
Group
Total........................................................... 15,468 0.0% 1.0%
Urban........................................................... 11,008 0.1% 1.1%
Rural........................................................... 4,460 -0.6% 0.4%
Hospital-based urban............................................ 518 0.2% 1.2%
Freestanding urban.............................................. 10,490 0.1% 1.1%
Hospital-based rural............................................ 577 -0.7% 0.3%
Freestanding rural.............................................. 3,883 -0.6% 0.4%
Urban by region
New England..................................................... 791 0.2% 1.2%
Middle Atlantic................................................. 1,487 0.4% 1.4%
South Atlantic.................................................. 1,867 -0.2% 0.8%
East North Central.............................................. 2,121 0.0% 1.0%
East South Central.............................................. 551 -0.6% 0.4%
West North Central.............................................. 919 0.4% 1.4%
West South Central.............................................. 1,339 0.1% 1.1%
Mountain........................................................ 511 -0.2% 0.8%
Pacific......................................................... 1,417 0.5% 1.5%
Outlying........................................................ 5 -2.0% -1.0%
Rural by region
New England..................................................... 137 1.5% 2.5%
Middle Atlantic................................................. 215 -0.5% 0.5%
South Atlantic.................................................. 502 -0.7% 0.3%
East North Central.............................................. 937 -1.1% -0.1%
East South Central.............................................. 528 -0.9% 0.1%
West North Central.............................................. 1,076 -0.4% 0.6%
West South Central.............................................. 738 -0.6% 0.4%
Mountain........................................................ 228 -0.3% 0.7%
Pacific......................................................... 99 0.1% 1.1%
Ownership
Profit.......................................................... 1,045 -0.3% 0.7%
Non-profit...................................................... 10,822 0.0% 1.0%
Government...................................................... 3,601 0.0% 1.0%
----------------------------------------------------------------------------------------------------------------
Note: The Total column includes the 1.0 percent market basket increase required by section 1888(e)(5)(B)(iii) of
the Act. Additionally, we found no SNFs in rural outlying areas.
[[Page 46170]]
Dated: September 29, 2017.
Ann C. Agnew,
Executive Secretary to the Department, Department of Health and Human
Services.
[FR Doc. 2017-21327 Filed 9-29-17; 4:15 pm]
BILLING CODE 4120-01-P