[Federal Register Volume 82, Number 247 (Wednesday, December 27, 2017)]
[Rules and Regulations]
[Pages 61184-61190]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-27949]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 414, 416, and 419

[CMS-1678-CN]
RIN 0938-AT03


Medicare Program: Hospital Outpatient Prospective Payment and 
Ambulatory Surgical Center Payment Systems and Quality Reporting 
Programs; Correction

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

ACTION: Final rule; correction.

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

SUMMARY: This document corrects technical errors that appeared in the 
final rule with comment period published in the Federal Register on 
December 14, 2017 entitled ``Hospital Outpatient Prospective Payment 
and Ambulatory Surgical Center Payment Systems and Quality Reporting 
Programs.''

DATES: Effective Date: January 1, 2018.

FOR FURTHER INFORMATION CONTACT: Lela Strong (410) 786-3213.

SUPPLEMENTARY INFORMATION: 

I. Background

    In FR Doc. R1-2017-23932 of December 14, 2017 (82 FR 59216), titled 
``Medicare Program: Hospital Outpatient Prospective Payment and 
Ambulatory Surgical Center Payment Systems and Quality Reporting 
Programs'' (hereinafter referred to as the CY 2018 OPPS/ASC final 
rule), there were a number of technical errors that are identified and 
corrected in the Correction of Errors section below. The provisions in 
this correction document are effective as if they had been included in 
the document published December 14, 2017. Accordingly, the corrections 
are effective January 1, 2018.
    We note that the CY 2018 OPPS/ASC final rule was originally 
published on pages 52356 through 52637 in the issue of Monday, November 
13, 2017. In that publication, a section of the document was omitted 
due to a printing error. Therefore, on December 14, 2017, the CY 2018 
OPPS/ASC final rule was republished in its entirety. Accordingly, any 
corrections made in this document are made to the December 14, 2017 
republished version.

II. Summary of Errors

A. Errors in the Preamble

1. Hospital Outpatient Prospective Payment System (OPPS) Corrections
    On page 59256, we are correcting the OPPS weight scalar based on 
the conforming policy correction to the Ambulatory Payment 
Classification (APC) assignment of Healthcare Common Procedure Coding 
System (HCPCS) code 93880 in APC 5522 (Level 2 Imaging without 
Contrast) to APC 5523 (Level 3 Imaging without Contrast).
    On page 59262, we are correcting language related to hospital-
specific Cost-to-Charge Ratios (CCRs) and their application on payments 
for pass-through devices.
    On pages 59269 through 59271, we use the payment rates available in 
Addenda A and B to display calculation of adjusted payment and 
copayment. Due to the correction of OPPS payment rates as a result of 
the corrected OPPS weight scalar, we are also correcting the payment 
and copayment numbers used in the example.
    On page 59277, due to the corrected OPPS APC geometric mean cost as 
a result of the conforming policy correction to the imaging without 
contrast APCs, we are correcting the list of APCs excepted from the 2 
times rule for calendar year (CY) 2018. Specifically, we are revising 
Table 14 to

[[Page 61185]]

include APC 5523 (Level 3 Imaging without Contrast) to this list, for a 
total of 12 APCs.
    On page 59295, we inadvertently excluded a summary of a comment and 
our response to that comment. We are revising the discussion to include 
the comment and response.
    On page 59311, due to the correction in OPPS APC geometric mean 
cost as a result of the conforming policy correction to the imaging 
without contrast APCs in Addendum A and Addendum B, we are also 
correcting the CY 2018 APC geometric mean cost for APC 5522 (Level 2 
Imaging without Contrast) and APC 5523 (Level 3 Imaging without 
Contrast) in Table 54 as well as in the OPPS Addenda A and B.
    On page 59323, we incorrectly listed the HCPCS code that describes 
Lung biopsy plug with delivery system as C2623 instead of C2613.
    On page 59369, we inadvertently omitted vaccines assigned to OPPS 
status indicator ``F'' from the 340B payment adjustment exclusion. 
Specifically, we stated in the preamble that ``We remind readers that 
our 340B payment policy applies to only OPPS separately payable drugs 
(status indicator ``K'') and does not apply to vaccines (status 
indicator ``L'' or ``M''), or drugs with transitional pass-through 
payment status (status indicator ``G'').'' We are correcting this 
statement to read ``We remind readers that our 340B payment policy 
applies to only OPPS separately payable drugs (status indicator ``K'') 
and does not apply to vaccines (status indicator ``F'', ``L'' or 
``M''), or drugs with transitional pass-through payment status (status 
indicator ``G'').'' In addition, we are also correcting the statement 
on page 59369 that reads ``Part B drugs or biologicals excluded from 
the 340B payment adjustment include vaccines (assigned status indicator 
``L'' or ``M'') and drugs with OPPS transitional pass-through payment 
status (assigned status indicator ``G'')'' to correctly state our final 
policy that ``Part B drugs or biologicals excluded from the 340B 
payment adjustment include vaccines (assigned status indicator ``F'', 
``L'' or ``M'') and drugs with OPPS transitional pass-through payment 
status (assigned status indicator ``G'').''
    On pages 59412 through 59413, we are correcting a typographical 
error in the title of Table 87.
    On pages 59482 through 59483, we are correcting the count of 
excepted Rural Sole Community Hospitals as well as the count of other 
providers that were listed in regards to the 340B Program.
    On pages 59486 through 59488, we provided and described Table 88--
Estimated Impact of the CY 2018 Changes for the Hospital Outpatient 
Prospective Payment System, based on rates which applied an incorrect 
scalar. We have updated Table 88 and the description of the table to 
reflect the corrections to the scalar as a result of the corrections to 
geometric mean costs in APCs 5522 and 5523.
2. Ambulatory Surgical Center (ASC) Payment System Corrections
    On page 59413, the discussion of ASC Payment for Covered Ancillary 
Services for CY 2018 was inadvertently omitted. We are including that 
discussion in this correcting document.
    On page 59422, we inadvertently published an incorrect ASC 
conversion factor of $44.663 for ASCs that do not meet the quality 
reporting requirements. With the correct application of our established 
policy, the corrected 2018 ASC conversion factor for ASCs that do not 
meet the quality reporting requirements is $44.674.
3. Partial Hospitalization Program Corrections
    On page 59375, the text states: ``We proposed to apply our 
established methodologies in developing the CY 2018 geometric mean per 
diem costs and payment rates, including the application of a 2 standard deviation trim on costs per day for CMHCs and a CCR<=5 
hospital service day trim for hospital-based PHP providers.'' The less 
than or equal to sign that appears in this sentence is incorrect and 
misstates our trim policy. Therefore, we are correcting ``CCR<=5'' to 
read ``CCR>5.''

B. Summary of Errors and Corrections to the OPPS and ASC Addenda Posted 
on the CMS Website

1. OPPS Addenda Posted on the CMS Website
    The payment and copayment rates in Addendum A (Final OPPS APCs for 
CY 2018), Addendum B (Final OPPS Payment by HCPCS Code for CY 2018), 
Addendum C (Final HCPCS Codes Payable Under the 2018 OPPS by APC), and 
the payment rates in the 2018 OPPS APC Offset File and the 2018 OPPS 
HCPCS Device Offset File that were published on the CMS website in 
conjunction with the CY 2018 OPPS/ASC final rule are corrected to 
reflect the corrected assignment of HCPCS code 93880 to APC 5522 (Level 
2 Imaging without Contrast) and APC 5523 (Level 3 Imaging without 
Contrast).
    In addition, in Addendum B, 17 HCPCS codes were incorrectly 
assigned to OPPS status indicator ``Q4'' when they should have been 
assigned to status indicator ``A.'' We are correcting the mistake by 
assigning status indicator ``A'' to these codes as shown in the chart 
that follows.

------------------------------------------------------------------------
     HCPCS code       Short descriptor         CI               SI
------------------------------------------------------------------------
81105..............  Hpa-1 genotyping.               NC               A
81106..............  Hpa-2 genotyping.               NC               A
81107..............  Hpa-3 genotyping.               NC               A
81108..............  Hpa-4 genotyping.               NC               A
81109..............  Hpa-5 genotyping.               NC               A
81110..............  Hpa-6 genotyping.               NC               A
81111..............  Hpa-9 genotyping.               NC               A
81112..............  Hpa-15 genotyping               NC               A
81120..............  Idh1 common                     NC               A
                      variants.
81121..............  Idh2 common                     NC               A
                      variants.
81175..............  Asxl1 full gene                 NC               A
                      sequence.
81176..............  Asxl1 gene target               NC               A
                      seq alys.
81448..............  Hrdtry perph                    NC               A
                      neurphy panel.
81520..............  Onc breast mrna                 NC               A
                      58 genes.
81521..............  Onc breast mrna                 NC               A
                      70 genes.
81541..............  Onc prostate mrna               NC               A
                      46 genes.
81551..............  Onc prostate 3                  NC               A
                      genes.
------------------------------------------------------------------------


[[Page 61186]]

    In Addendum M, we inadvertently excluded Current Procedural 
Terminology (CPT) codes 71045 (Radiologic examination, chest; single 
view) and 71046 (Radiologic examination, chest; 2 views). The revised 
Addendum M includes these codes. CPT codes 71045 and 71046 replaced CPT 
codes 71010 (Radiologic examination, chest; single view, frontal) and 
71020 (Radiologic examination, chest, 2 views, frontal and lateral; 
with apical lordotic procedure) effective January 1, 2018. Since the 
predecessor codes were assigned to composite APC 5041 (Critical Care) 
and APC 5045 (Trauma Response with Critical Care) before January 1, 
2018, the replacement codes are assigned to the same composite APCs 
effective January 1, 2018.
    In Addendum P, we inadvertently excluded the following 7 CPT codes:
     0409T (Insertion or replacement of permanent cardiac 
contractility modulation system, including contractility evaluation 
when performed, and programming of sensing and therapeutic parameters; 
pulse generator only);
     0410T (Insertion or replacement of permanent cardiac 
contractility modulation system, including contractility evaluation 
when performed, and programming of sensing and therapeutic parameters; 
atrial electrode only);
     0411T (Insertion or replacement of permanent cardiac 
contractility modulation system, including contractility evaluation 
when performed, and programming of sensing and therapeutic parameters; 
ventricular electrode only);
     0414T (Removal and replacement of permanent cardiac 
contractility modulation system pulse generator only);
     0446T (Creation of subcutaneous pocket with insertion of 
implantable interstitial glucose sensor, including system activation 
and patient training);
     0449T (Insertion of aqueous drainage device, without 
extraocular reservoir, internal approach, into the subconjunctival 
space; initial device); and
     28291 (Hallux rigidus correction with cheilectomy, 
debridement and capsular release of the first metatarsophalangeal 
joint; with implant).
    CPT codes 0409T, 0410T, 0411T, 0414T, 0446T, 0449T represent 
procedures requiring the implantation of medical devices that do not 
have yet have associated claims data and therefore have been granted 
device-intensive status with a default device offset percentage of 41 
percent, per our current policy outlined in the CY 2017 OPPS/ASC final 
rule with comment (81 FR 79658). CPT code 28291 replaced CPT code 28293 
(Correction, hallux valgus (bunion), with or without sesamoidectomy; 
resection of joint with implant) which previously held the device-
intensive designation with a device offset percentage of 43.78 percent. 
Since the predecessor code was device-intensive, CPT code 28291 is also 
device-intensive status and a device offset percentage of 43.78 percent 
based on the offset from the predecessor code.
    To view the corrected CY 2018 OPPS status indicator, payment and 
copayment rates, that result from these technical corrections as well 
as CPT codes that were inadvertently excluded, we refer readers to the 
Addenda and supporting files that are posted on the CMS website at: 
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html. Select ``CMS-1678-CN'' from the list 
of regulations. All corrected Addenda for this correcting document are 
contained in the zipped folder titled ``2018 OPPS Final Rule Addenda'' 
at the bottom of the page for CMS-1678-CN.
2. ASC Payment System Addenda Posted on the CMS Website
    As a result of the technical corrections described in Section II.A. 
and II.B.1. of this correction notice, we have updated Addenda AA and 
BB to reflect the final corrected payment rates and indicators for CY 
2018 for ASC covered surgical procedures and covered ancillary 
services. In addition, in addendum BB, we inadvertently included HCPCS 
code Q2040 (Tisagenlecleucel, up to 250 million car-positive viable t 
cells, including leukapheresis and dose preparation procedures, per 
infusion) as a separately payable drug when furnished in the ASC 
setting. Because the complement of services required to furnish the 
drug described by HCPCS code Q2040 are not all covered ASC surgical 
procedures, we are correcting the error by removing HCPCS code Q2040 
from Addendum BB.
    To view the corrected final CY 2018 ASC payment rates and 
indicators that result from these technical corrections, we refer 
readers to the Addenda and supporting files on the CMS website at: 
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Regulations-and-Notices.html. Select ``CMS-1678-CN'' 
from the list of regulations. All corrected ASC addenda for this 
correcting document are contained in the zipped folder entitled 
``Addendum AA, BB, DD1, DD2, and EE'' at the bottom of the page for 
CMS-1678-CN.
    In addition, we inadvertently excluded the below nine codes from 
the file labeled ``CY 2018 ASC Procedures to which the No Cost/Full 
Credit and Partial Credit Device Adjustment Policy Applies''. These 
nine codes were included as ASC device-intensive procedures to which 
the no cost/full credit and partial credit device adjustment policy 
applies in the CY 2017 final rule, and we did not intend any changes to 
them for CY 2018.
     0409T (Insertion or replacement of permanent cardiac 
contractility modulation system, including contractility evaluation 
when performed, and programming of sensing and therapeutic parameters; 
pulse generator only);
     0410T (Insertion or replacement of permanent cardiac 
contractility modulation system, including contractility evaluation 
when performed, and programming of sensing and therapeutic parameters; 
atrial electrode only);
     0411T (Insertion or replacement of permanent cardiac 
contractility modulation system, including contractility evaluation 
when performed, and programming of sensing and therapeutic parameters; 
ventricular electrode only);
     0414T (Removal and replacement of permanent cardiac 
contractility modulation system pulse generator only);
     0446T (Creation of subcutaneous pocket with insertion of 
implantable interstitial glucose sensor, including system activation 
and patient training);
     0449T (Insertion of aqueous drainage device, without 
extraocular reservoir, internal approach, into the subconjunctival 
space; initial device);
     22867 (Insertion of interlaminar/interspinous process 
stabilization/distraction device, without fusion, including image 
guidance when performed, with open decompression, lumbar; single 
level);
     22869 (Insertion of interlaminar/interspinous process 
stabilization/distraction device, without open decompression or fusion, 
including image guidance when performed, lumbar; single level); and
     28291 (Hallux rigidus correction with cheilectomy, 
debridement and capsular release of the first metatarsophalangeal 
joint; with implant).
    To view the revised version of the ``CY 2018 ASC Procedures to 
which the No Cost/Full Credit and Partial Credit Device Adjustment 
Policy Applies,'' we refer readers to the CMS website at:

[[Page 61187]]

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/ASC-Policy-Files.html.

III. Waiver of Proposed Rulemaking

    Under 5 U.S.C. 553(b) of the Administrative Procedure Act (APA), 
the agency is required to publish a notice of the proposed rule in the 
Federal Register before the provisions of a rule take effect. 
Similarly, section 1871(b)(1) of the Act requires the Secretary to 
provide for notice of the proposed rule in the Federal Register and 
provide a period of not less than 60 days for public comment. In 
addition, section 553(d) of the APA, and section 1871(e)(1)(B)(i) 
mandate a 30-day delay in effective date after issuance or publication 
of a rule. Sections 553(b)(B) and 553(d)(3) of the APA provide for 
exceptions from the notice and comment and delay in effective date of 
the APA requirements; in cases in which these exceptions apply, 
sections 1871(b)(2)(C) and 1871(e)(1)(B)(ii) of the Act provide 
exceptions from the notice and 60-day comment period and delay in 
effective date requirements of the Act as well. Section 553(b)(B) of 
the APA and section 1871(b)(2)(C) of the Act authorize an agency to 
dispense with normal rulemaking requirements for good cause if the 
agency makes a finding that the notice and comment process is 
impracticable, unnecessary, or contrary to the public interest. In 
addition, both section 553(d)(3) of the APA and section 
1871(e)(1)(B)(ii) of the Act allow the agency to avoid the 30-day delay 
in effective date where such delay is contrary to the public interest 
and an agency includes a statement of support.
    We believe that this correcting document does not constitute a 
rulemaking that would be subject to these requirements. This correcting 
document corrects technical and typographic errors in the preamble, 
addenda, payment rates, tables, and appendices included or referenced 
in the CY 2018 OPPS/ASC final rule but does not make substantive 
changes to the policies or payment methodologies that were adopted in 
the final rule. As a result, the corrections made through this 
correcting document are intended to ensure that the information in the 
CY 2018 OPPS/ASC final rule accurately reflects the policies adopted in 
that rule.
    In addition, even if this were a rulemaking 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 CY 2018 OPPS/ASC final rule 
accurately reflects our policies as of the date they take effect and 
are applicable.
    Furthermore, such procedures would be unnecessary, as we are not 
altering our payment methodologies or policies, but rather, we are 
simply correctly implementing the policies that we previously proposed, 
received comment on, and subsequently finalized. This correcting 
document is intended solely to ensure that the CY 2018 OPPS/ASC final 
rule accurately reflects these payment methodologies and policies. For 
these reasons, we believe we have good cause to waive the notice and 
comment and effective date requirements.

IV. Correction of Errors

    In FR Doc. R1-2017-23932 of December 14, 2017 (82 FR 59216), make 
the following corrections:
    1. On page 59256, third column, first paragraph, in line 11, 
correct ``1.4457'' to read ``1.4458''.
    2. On page 59262, second column, second full paragraph, in line 7, 
add the parenthetical phrase ``(in cases where we are unable to use the 
implantable device CCR)'' after the words ``pass-through devices''.
    3. On page 59269,
    a. Third column, last full paragraph,
    (1) In line 17, correct ``$572.81'' to read ``$575.85.''
    (2) In line 21, correct ``$561.35'' to read ``$561.39.''
    b. Third column, last partial paragraph,
    (1) In lines 5 and 6, correct ``$442.53 (.60 * $572.81 * 1.2876).'' 
to read ``$442.56 (.60 * $575.85 * 1.2876).''
    (2) In line 9, correct ``$443.68 (.60 * $561.35 * 1.2876).'' to 
read ``$443.70 (.60 * $561.39 * 1.2876).''
    (3) In line 12, correct ``$229.12 (.40 * $572.81).'' to read 
``$229.14 (.40 * $575.85).''
    4. On page 59270, first column, first partial paragraph,
    a. In line 2, correct ``$224.54 (.40 * $561.35).'' to read 
``$224.56 (.40 * $561.39).''
    b. In lines 6 and 7, correct ``$671.65 ($442.53 + $229.12).'' to 
read ``$671.70 ($442.56 + $229.14).''
    c. In lines 9 and 10, correct ``$658.22 ($433.68 + $224.54).'' to 
read ``$658.26 ($443.70 + $224.56).''
    5. On page 59271, first column, second full paragraph, under ``Step 
1,'' in line 8, correct ``$572.81'' to read ``$575.85.''
    6. On page 59277, Table 14--APC Exceptions to the 2 Times Rule for 
CY 2018, is corrected to read as follows:

                            Table 14--APC Exceptions to the 2 Times Rule for CY 2018
----------------------------------------------------------------------------------------------------------------
                 APC                                               CY 2018 APC title
----------------------------------------------------------------------------------------------------------------
5112................................  Level 2 Musculoskeletal Procedures
5521................................  Level 1 Imaging without Contrast
5522................................  Level 2 Imaging without Contrast
5523................................  Level 3 Imaging without Contrast
5524................................  Level 4 Imaging without Contrast
5571................................  Level 1 Imaging with Contrast
5691................................  Level 1 Drug Administration
5721................................  Level 1 Diagnostic Tests and Related Services
5731................................  Level 1 Minor Procedures
5732................................  Level 2 Minor Procedures
5771................................  Cardiac Rehabilitation
5823................................  Level 3 Health and Behavior Services
----------------------------------------------------------------------------------------------------------------

    7. On page 59295, third column,
    a. After the first partial paragraph, add the following comment and 
response:
    Comment: We received a comment to the CY 2018 OPPS/ASC proposed 
rule

[[Page 61188]]

requesting the reassignment of the procedures assigned to APCs 5361 
(Level 1 Laparoscopy and Related Services) and 5362 (Level 2 
Laparoscopy and Related Services) to ensure a more logical distribution 
of procedure costs between these two APCs.
    Response: We appreciate the suggestion and will consider for future 
rulemaking. We note that in the CY 2018 OPPS/ASC proposed rule, there 
was no violation of the 2 times rule for either APC 5361 or APC 5362.
    b. First full paragraph, in line 2, correct ``comment'' to read 
``comments''.
    8. On page 59311, Table 54--Comparison of CY 2017 and CY 2018 
Geometric Mean Costs For The Imaging APCs, is corrected to read as 
follows:

 Table 54-Comparison of CY 2017 and CY 2018 Geometric Mean Costs for the
                              Imaging APCs
------------------------------------------------------------------------
                                            CY 2017 APC     CY 2018 APC
         APC            APC group title   geometric mean  geometric mean
                                               cost            cost
------------------------------------------------------------------------
5521................  Level 1 Imaging             $61.53          $62.08
                       without Contrast.
5522................  Level 2 Imaging             115.88          114.39
                       without Contrast.
5523................  Level 3 Imaging             232.21          232.17
                       without Contrast.
5524................  Level 4 Imaging             462.23          486.38
                       without Contrast.
5571................  Level 1 Imaging             272.40          252.58
                       with Contrast.
5572................  Level 2 Imaging             438.42          456.08
                       with Contrast.
5573................  Level 3 Imaging             675.23          681.45
                       with Contrast.
------------------------------------------------------------------------

    9. On page 59323, second column, second full paragraph, in line 4, 
correct ``C2623'' to read ``C2613''.
    10. On page 59369,
    a. Second column, second full paragraph, in line 5, correct 
``status indicator ``L'' or ``M'''' to read ``status indicator ``F'', 
``L'', or ``M''''.
    b. Third column, first full paragraph, in line 19, correct ``status 
indicator ``L'' or ``M'''' to read ``status indicator ``F'', ``L'', or 
``M''''.
    11. On page 59375, second column, third full paragraph, in line 7, 
correct ``CCR <=5'' to read ``CCR>5''.
    12. On pages 59412 and 59413, in the title for Table 87, correct 
``ASDC'' to read ``ASC''.
    13. On page 59413, second column, after the second full paragraph, 
add the following paragraphs before the section titled, ``D. ASC 
Payment for Covered Surgical Procedures and Covered Ancillary 
Services'':

``2. Covered Ancillary Services

    Consistent with the established ASC payment system policy, in the 
CY 2018 OPPS/ASC proposed rule (82 FR 33662) we proposed to update the 
ASC list of covered ancillary services to reflect the payment status 
for the services under the CY 2018 OPPS. We noted that maintaining 
consistency with the OPPS may result in proposed changes to ASC payment 
indicators for some covered ancillary services because of changes that 
are being finalized under the OPPS for CY 2018. For example, a covered 
ancillary service that was separately paid under the ASC payment system 
in CY 2017 may be proposed for packaged status under the CY 2018 OPPS 
and, therefore, also under the ASC payment system for CY 2018.
    To maintain consistency with the OPPS, we proposed to continue this 
reconciliation of packaged status for the ASC payment system for CY 
2018. Comment indicator ``CH,'' discussed in section XII.F. of the 
proposed rule, was used in Addendum BB to the proposed rule (which is 
available via the internet on the CMS website) to indicate covered 
ancillary services for which we proposed a change in the ASC payment 
indicator to reflect a proposed change in the OPPS treatment of the 
service for CY 2018.
    We included all ASC covered ancillary services and their proposed 
payment indicators for CY 2018 in Addendum BB to the proposed rule. We 
invited public comments on this proposal.
    We did not receive any public comments on these proposals. 
Therefore, we are finalizing, without modification, our proposal to 
update the ASC list of covered ancillary services to reflect the 
payment status for the services under the OPPS. All CY 2018 ASC covered 
ancillary services and their final payment indicators are included in 
Addendum BB to this final rule (which is available via the internet on 
the CMS website).''

    14. On page 59422, first column, first partial paragraph, in line 
1, correct ``44.663'' to read ``44.674''.
    15. On page 59482, third column, second partial paragraph, in line 
43, correct ``270'' to read ``247''.
    16. On page 59483, first column, third partial paragraph, in line 
29, correct ``$199'' to read ``$169''.
    17. On page 59486,
    a. First column, first full paragraph, in line 16, correct ``0.5'' 
to read ``0.6''.
    b. Third column, first full paragraph, in line 6, correct ``1.2'' 
to read ``1.3''.
    18. On page 59487 through 59488, Table 88--Estimated Impact of the 
CY 2018 Changes for the Hospital Outpatient Prospective Payment System, 
is corrected to read as follows:

                        Table 88--Estimated Impact of the CY 2018 Changes for the Hospital Outpatient Prospective Payment System
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                            All budget
                                                                                                                              neutral
                                                                                APC       New wage index                      changes
                                                             Number of     recalibration   and provider        340B       (combined cols    All changes
                                                             hospitals     (all changes)    adjustments     adjustment       2-4) with
                                                                                                                           market basket
                                                                                                                              update
                                                                     (1)             (2)             (3)             (4)             (5)             (6)
--------------------------------------------------------------------------------------------------------------------------------------------------------
ALL PROVIDERS *.........................................           3,878             0.0             0.0             0.0             1.3             1.4

[[Page 61189]]

 
ALL HOSPITALS (excludes hospitals held harmless and                3,765             0.0             0.1            -0.1             1.4             1.5
 CMHCs).................................................
URBAN HOSPITALS.........................................           2,951             0.1             0.1            -0.3             1.3             1.3
    LARGE URBAN (GT 1 MILL.)............................           1,589             0.1             0.0            -0.2             1.2             1.3
    OTHER URBAN (LE 1 MILL.)............................           1,362             0.0             0.2            -0.3             1.3             1.4
RURAL HOSPITALS.........................................             814            -0.3             0.0             1.4             2.5             2.7
    SOLE COMMUNITY......................................             372            -0.2             0.1             2.6             3.9             4.0
    OTHER RURAL.........................................             442            -0.4            -0.2             0.0             0.8             0.9
BEDS (URBAN):
    0-99 BEDS...........................................           1,021             0.0             0.0             1.9             3.3             3.4
    100-199 BEDS........................................             850             0.0             0.2             1.2             2.8             2.9
    200-299 BEDS........................................             468             0.1             0.1             0.5             2.0             2.1
    300-499 BEDS........................................             399             0.1             0.0            -0.4             1.1             1.2
    500 + BEDS..........................................             213             0.0             0.1            -2.2            -0.7            -0.6
BEDS (RURAL):
    0-49 BEDS...........................................             333            -0.6            -0.2             2.1             2.7             2.9
    50-100 BEDS.........................................             297            -0.2            -0.2             1.9             2.8             3.0
    101-149 BEDS........................................              97            -0.3             0.1             1.1             2.3             2.4
    150-199 BEDS........................................              49            -0.2             0.1             0.7             2.0             2.1
    200 + BEDS..........................................              38            -0.3             0.4             0.8             2.4             2.5
REGION (URBAN):
    NEW ENGLAND.........................................             144             0.2             0.4            -0.2             1.7             1.8
    MIDDLE ATLANTIC.....................................             348             0.1            -0.2            -0.1             1.2             1.3
    SOUTH ATLANTIC......................................             463             0.0             0.3            -0.4             1.3             1.4
    EAST NORTH CENT.....................................             471             0.0             0.1            -0.2             1.3             1.4
    EAST SOUTH CENT.....................................             178            -0.1            -0.1            -1.6            -0.4            -0.3
    WEST NORTH CENT.....................................             191             0.1             0.5            -0.6             1.4             1.5
    WEST SOUTH CENT.....................................             513             0.0             0.3             0.9             2.5             2.6
    MOUNTAIN............................................             211             0.3            -0.9            -0.2             0.5             0.7
    PACIFIC.............................................             383             0.1             0.0            -0.6             0.8             0.9
    PUERTO RICO.........................................              49            -0.4             0.2             2.9             4.1             4.2
REGION (RURAL):
    NEW ENGLAND.........................................              21             0.1             1.5             1.2             4.2             4.2
    MIDDLE ATLANTIC.....................................              53            -0.1            -0.5             1.8             2.5             2.7
    SOUTH ATLANTIC......................................             124            -0.4            -0.6             0.7             1.1             1.2
    EAST NORTH CENT.....................................             122            -0.2             0.0             1.5             2.7             2.8
    EAST SOUTH CENT.....................................             155            -0.6            -0.1             0.0             0.7             0.8
    WEST NORTH CENT.....................................              98            -0.1             0.2             2.4             3.9             4.1
    WEST SOUTH CENT.....................................             161            -0.7             0.3             2.6             3.6             3.7
    MOUNTAIN............................................              56             0.0            -0.3             1.9             2.9             3.3
    PACIFIC.............................................              24            -0.2             0.1             1.7             3.0             3.0
TEACHING STATUS:
    NON-TEACHING........................................           2,655            -0.1             0.1             1.3             2.8             2.9
    MINOR...............................................             761             0.1             0.1             0.1             1.6             1.7
    MAJOR...............................................             349             0.1             0.0            -2.4            -1.0            -0.9
DSH PATIENT PERCENT:
    0...................................................              10             0.0             0.2             3.2             4.8             4.9
    GT 0-0.10...........................................             272             0.2            -0.1             2.8             4.4             4.5
    0.10-0.16...........................................             263             0.2             0.0             2.7             4.3             4.4
    0.16-0.23...........................................             572             0.1             0.3             2.6             4.4             4.5
    0.23-0.35...........................................            1132             0.0             0.1            -0.4             1.0             1.2
    GE 0.35.............................................             935             0.0             0.0            -2.2            -0.9            -0.8
    DSH NOT AVAILABLE **................................             581            -2.0             0.1             2.0             1.4             1.6
URBAN TEACHING/DSH:
    TEACHING & DSH......................................           1,002             0.1             0.0            -1.1             0.3             0.4
    NO TEACHING/DSH.....................................           1,386             0.1             0.2             1.3             2.9             3.0
    NO TEACHING/NO DSH..................................              10             0.0             0.2             3.2             4.8             4.9
    DSH NOT AVAILABLE2..................................             553            -1.9             0.1             1.9             1.4             1.6
TYPE OF OWNERSHIP:
    VOLUNTARY...........................................           1,979             0.0             0.0            -0.3             1.2             1.3
    PROPRIETARY.........................................           1,293             0.1             0.1             2.7             4.3             4.5
    GOVERNMENT..........................................             493            -0.1             0.2            -1.6            -0.1             0.0

[[Page 61190]]

 
CMHCs...................................................              49            12.5             0.2             3.2            17.8            17.9
--------------------------------------------------------------------------------------------------------------------------------------------------------
Column (1) shows total hospitals and/or CMHCs.
Column (2) includes all final CY 2018 OPPS policies and compares those to the CY 2017 OPPS.
Column (3) shows the budget neutral impact of updating the wage index by applying the FY 2018 hospital inpatient wage index, including all hold harmless
  policies and transitional wages. The rural adjustment continues our current policy of 7.1 percent so the budget neutrality factor is 1. The budget
  neutrality adjustment for the cancer hospital adjustment is 1.0008 because the target payment-to-cost ratio changes from 0.91 in CY 2017 to 0.89 in CY
  2018 and is further reduced by 1 percentage point to 0.88 in accordance with the 21st Century Cures Act. However, this reduction does not affect the
  budget neutrality adjustment consistent with statute.
Column (4) shows the impact of the 340B drug payment reductions and the corresponding increase in non-drug payments.
Column (5) shows the impact of all budget neutrality adjustments and the addition of the 1.35 percent OPD fee schedule update factor (2.7 percent
  reduced by 0.6 percentage points for the productivity adjustment and further reduced by 0.75 percentage point as required by law).
Column (6) shows the additional adjustments to the conversion factor resulting from the frontier adjustment, a change in the pass-through estimate, and
  adding estimated outlier payments.
These 3,878 providers include children and cancer hospitals, which are held harmless to pre-BBA amounts, and CMHCs.
** Complete DSH numbers are not available for providers that are not paid under IPPS, including rehabilitation, psychiatric, and long-term care
  hospitals.

    19. On page 59488, bottom third of the page,
    a. Second column, first partial paragraph, in line 6, correct 
``17.2'' to read ``17.9''.
    b. Third column, first partial paragraph, in line 10, correct 
``17.2'' to read ``17.9''.

    Dated: December 20, 2017.
Ann C. Agnew,
Executive Secretary to the Department, Department of Health and Human 
Services.
[FR Doc. 2017-27949 Filed 12-22-17; 4:15 pm]
 BILLING CODE 4120-01-P