[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