[Federal Register Volume 83, Number 192 (Wednesday, October 3, 2018)]
[Rules and Regulations]
[Pages 49836-49856]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-21500]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 412, 413, 424, and 495

[CMS-1694-CN2]
RIN 0938-AT27


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 2019 Rates; Quality 
Reporting Requirements for Specific Providers; Medicare and Medicaid 
Electronic Health Record (EHR) Incentive Programs (Promoting 
Interoperability Programs) Requirements for Eligible Hospitals, 
Critical Access Hospitals, and Eligible Professionals; Medicare Cost 
Reporting Requirements; and Physician Certification and Recertification 
of Claims; Correction

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

ACTION: Final rule; correction.

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SUMMARY: This document corrects technical and typographical errors in 
the final rule that appeared in the August 17, 2018 issue of the 
Federal Register titled ``Medicare Program; Hospital Inpatient 
Prospective Payment Systems for Acute Care Hospitals and the Long Term 
Care Hospital Prospective Payment System and Policy Changes and Fiscal 
Year 2019 Rates; Quality Reporting Requirements for Specific Providers; 
Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs 
(Promoting Interoperability Programs) Requirements for Eligible 
Hospitals, Critical Access Hospitals, and Eligible Professionals; 
Medicare Cost Reporting Requirements; and Physician Certification and 
Recertification of Claims''.

DATES: The corrections in this document are effective October 1, 2018.

FOR FURTHER INFORMATION CONTACT: Donald Thompson and Michele Hudson, 
(410) 786-4487.

SUPPLEMENTARY INFORMATION: 

I. Background

    In FR Doc. 2018-16766 of August 17, 2018 (83 FR 41144) there were a 
number of technical and typographical errors that are identified and 
corrected by the Correction of Errors section of this correcting 
document. The provisions in this correcting document are effective as 
if they had been included in the document that appeared in the August 
17, 2018 Federal Register. Accordingly, the corrections are effective 
October 1, 2018.

II. Summary of Errors

A. Summary of Errors in the Preamble

    On page 41144, under  FOR FURTHER INFORMATION CONTACT section, we 
are correcting the names of the contacts for Medicare Promoting 
Interoperability Program issues.
    On page 41151, in our discussion regarding Changes to the Hospital 
Readmissions Reduction Program under ``Summary of Cost and Benefits'', 
we made errors in the impact figures.
    On pages 41200, 41219, 41236, and 41313, we made a technical error 
in using the term ``primary'' rather than ``principal'' when in 
describing certain diagnosis codes or conditions.
    On page 41254, we inadvertently omitted a base MS-DRG group to 
which the listed thoracoscopic procedures of pericardium and pleura may 
be assigned. Specifically, we are correcting the list of MS-DRGs on 
page 41254 to include MS-DRGs 166, 167, and 168 (Other Respiratory 
System O.R. Procedures with MCC, with CC, and without CC/MCC, 
respectively) in MDC 4 (Diseases and Disorders of the Respiratory 
System), consistent with the MS-DRGs to which other approaches for 
procedures involving drainage or extirpation of matter from the pleura 
are assigned.
    On page 41299, we made a technical error in describing which ICD-
10-PCS procedure codes will be used to identify cases involving the use 
of KYMRIAH and YESCARTA that are eligible for new technology add-on 
payments in FY 2019. Specifically, cases involving the use of KYMRIAH 
and YESCARTA that are eligible for new technology add-on payments will 
be identified by either of

[[Page 49837]]

the ICD-10-PCS procedure codes listed in the final rule (XW033C3 or 
XW043C3) rather than requiring the combination of both ICD-10-PCS 
procedure codes.
    On page 41311, we made a typographical error in describing which 
National Drug Code (NDC) will be used to identify cases involving 
VABOMERETM that are eligible for new technology add-on 
payments in FY 2019. Specifically, we are correcting the NDC code of 
65293-0009-01, which erroneously was missing an extra digit. In 
addition, we were made aware after the final rule that NDC 70842-0120-
01 can also be used to identify cases of VABOMERETM. 
Therefore, cases involving the use of VABOMERETM that are 
eligible for new technology add-on payments in FY 2019 will be 
identified with either of the following NDCs: 65293-0009-01 and 70842-
0120-01.
    On page 41320, we made a typographical error in describing which 
ICD-10-PCS procedure codes will be used to identify cases involving the 
remed[emacr][reg] SystemTM that are eligible for new 
technology add-on payments in FY 2019. Specifically, we are correcting 
the ICD-10-PCS procedure code 05H43MZ (Insertion of neurostimulator 
lead into left innominate vein, percutaneous approach), which had 
erroneously contained an extra digit.
    On page 41334, we made a technical error in describing which ICD-
10-PCS procedure codes will be used to identify cases involving 
ZEMDRITM that are eligible for new technology add-on 
payments in FY 2019. Specifically, cases involving the use of 
ZEMDRITM that are eligible for new technology add-on 
payments will be identified by either of the ICD-10-PCS procedure codes 
listed in the final rule (XW033G4 or XW043G4) rather than requiring the 
combination of both ICD-10-PCS procedure codes.
    On page 41342, we made a technical error in describing which ICD-
10-PCS procedure codes will be used to identify cases involving 
GIAPREZATM that are eligible for new technology add-on 
payments in FY 2019. Specifically, cases involving the use of 
GIAPREZATM that are eligible for new technology add-on 
payments will be identified by either of the ICD-10-PCS procedure codes 
listed in the final rule (XW033H4 or XW043H4) rather than requiring the 
combination of both ICD-10-PCS procedure codes.
    On page 41348, we made a typographical error in stating the 
applicant's estimated cost of the Sentinel[reg] Cerebral Protection 
System. Specifically, we stated that the applicant estimated the cost 
is $2,400, when we should have stated the cost is $2,800.
    On page 41362, we made a technical error in describing which ICD-
10-PCS procedure codes will be used to identify cases involving 
AndexXaTM that are eligible for new technology add-on 
payments in FY 2019. Specifically, cases involving the use of 
AndexXaTM that are eligible for new technology add-on 
payments will be identified by either of the ICD-10-PCS procedure codes 
listed in the final rule (XW03372 or XW04372) rather than requiring the 
combination of both ICD-10-PCS procedure codes.
    On pages 41364, 41365, 41368, and 41375, in our discussion of the 
wage indexes, we are correcting the number of hospitals with critical 
access hospital (CAH) status removed from the FY 2019 wage index, the 
number of hospitals used for the FY 2019 wage index, the number of 
hospital occupational mix surveys used for the FY 2019 wage index, and 
the values for the FY 2019 national average hourly wage (unadjusted for 
occupational mix), the FY 2019 occupational mix adjusted national 
average hourly wage, and the FY 2019 national average hourly wages for 
the occupational mix nursing subcategories, due to inadvertent errors 
related to the following:
     The inclusion of a CAH in the wage data (CMS Certification 
Number (CCN) 060016).
     Wage data collected from the Medicare cost reports of one 
hospital (CCN 100044).
     Occupational Mix data collected from one hospital (CCN 
010001).
    On page 41406, we are correcting a typographical error in our 
reference to the discussion of the comments received on the proposed 
methodology for Factor 3.
    On page 41415, in our discussion regarding Methodology for 
Calculating Factor 3 for FY 2019, we are correcting a technical error 
in the calculation of the CCR ceilings for FY 2014 and FY 2015 and the 
number of hospitals above the ceiling in each of those years.
    On page 41432, in our discussion regarding Regulatory Background of 
Hospital Readmissions Reduction Program, we made a typographical error 
in referencing the fiscal year in which the calculation of the 
proportion of ``dually eligible'' Medicare beneficiaries used to 
stratify hospitals into peer groups will begin.
    On page 41436, in our discussion regarding Identification of 
Aggregate Payments for Each Condition/Procedure and All Discharges, we 
inadvertently omitted language regarding which MedPAR data is included 
in the program calculations.
    On page 41446, we made a technical error in the heading for section 
IV.I.2.c. by inadvertently stating the incorrect number of measure 
removal proposals that we were finalizing in the FY 2019 IPPS/LTCH PPS 
final rule for the Hospital Value-Based Purchasing (VBP) Program.
    On page 41452, we made an error in the date of publication of a 
reference.
    On page 41469, in the table entitled ``Previously Adopted and Newly 
Displayed Performance Standards for the FY 2021 Program Year: Safety, 
Clinical Outcomes, and Efficiency and Cost Reduction Domains,'' we 
inadvertently did not display several of the numbers in the benchmark 
column to 3 decimal places.
    On page 41488, in our discussion regarding analysis of Hospital-
Acquired Condition Reduction Program, we made a technical error in 
referencing hospital's National Healthcare Safety Network (NHSN) 
Healthcare-Associated Infection (HAI) measures.
    On pages 41528 and 41529, we corrected the MS-LTC-DRG budget 
neutrality factor due to an error in the MS-LTC-DRG weights resulting 
from the inadvertent inclusion of an all-inclusive rate provider.
    On pages 41536 and 41537, due to the changes in the MS-LTC-DRG 
weights resulting from the correction to the MS-LTC-DRG budget 
neutrality factor (described previously) and the corrections in the 
LTCH PPS wage index referenced above and discussed in greater detail 
below, we made conforming changes to the budget neutrality adjustment 
factor for the cost of the elimination of the 25-percent threshold 
policy for FY 2019 and the area wage budget neutrality factor.
    On page 41556, in our discussion regarding claims-based-readmission 
measures, the National Quality Forum (NQF) number for the MORT-30-CABG 
measure was inadvertently listed as NQF #2515, which is the NQF number 
for the READM-30-CABG measure.
    On page 41558, in our discussion finalizing our proposals to remove 
the mortality measures, we inadvertently referenced the FY 2020 payment 
determination twice.
    On page 41576, in the table entitled ``Summary of Hospital IQR 
Program Measures Newly Finalized for Removal,'' an entry under 
``Claims-Based Coordination of Care Measures'' inadvertently included 
an ``A'' in the short name for the Pneumonia Readmission measure.
    On page 41579, in the table entitled ``Measures for the FY 2021 
Payment

[[Page 49838]]

Determination,'' we inadvertently omitted the entry for the FY 2021 
payment determination for MORT-30-CABG. In the same table, we made a 
typographical error by inadvertently including an asterisk at the end 
of Hospital 30-Day, All-Cause, Risk-Standardized Mortality Rate 
Following Acute Ischemic Stroke (MORT-30-STK). In the same table, we 
made a typographical error by inadvertently listing the incorrect NQF 
number for STK-06, Discharged on Statin Medication measure. In the same 
table, we inadvertently excluded the word ``Venous'' from the full 
measure name of VTE-2, Intensive Care Unit Venous Thromboembolism 
Prophylaxis.
    On page 41599, in our discussion of Social Risk Factors in the 
Hospital Inpatient Quality Reporting (IQR) Program, we inadvertently 
used the term ``measures'' instead of ``methods''.
    On page 41672, in our discussion regarding the electronic reporting 
of electronic clinical quality measures (eCQMs) for CY 2019, we 
incorrectly referred to the Spring 2017 version of the CQM electronic 
specifications as the most recent version. A more recent version of the 
specifications was issued after the proposed rule was published, which 
is the 2018 eCQM specifications update (published in May 2018).

B. Summary of Errors in the Addendum

    As discussed in section II.D. of this correcting document, we made 
several technical errors with regard to the calculation of Factor 3 of 
the uncompensated care payment methodology. Factor 3 is used to 
determine the total amount of the uncompensated care payment a hospital 
is eligible to receive for a fiscal year. This amount is then used to 
calculate the amount of the interim uncompensated care payments a 
hospital receives per discharge. Per discharge uncompensated care 
payments are included when determining total payments for purposes of 
all of the budget neutrality factors and the final outlier threshold. 
As a result, the revisions made to address these technical errors 
regarding the calculation of Factor 3 directly affected the calculation 
of total payments and required the recalculation of all the budget 
neutrality factors and the final outlier threshold.
    Because of the errors related to the wage data for the three 
hospitals (CCNs 010001, 060016 and 100044) as discussed in section 
II.A. of this correcting document, we recalculated the FY 2019 national 
average hourly wages unadjusted for occupational mix and adjusted for 
occupational mix which resulted in the recalculation of the final FY 
2019 IPPS wage indexes and the geographic adjustment factors (GAFs) 
(which are computed from the wage index). The final FY 2019 IPPS wage 
data are used in the calculation of the wage index budget neutrality 
adjustment when comparing total payments using the final FY 2018 IPPS 
wage index data to total payments using the final FY 2019 IPPS wage 
index data. Additionally, the final FY 2019 IPPS wage index data are 
used when determining total payments for purposes of the rest of the 
budget neutrality factors (except for the MS-DRG reclassification and 
recalibration budget neutrality factor) and the final outlier 
threshold. In addition, the final FY 2019 IPPS wage index data are used 
to calculate the FY 2019 LTCH PPS wage index values, certain budget 
neutrality factors, and the LTCH PPS standard Federal payment rate in 
the FY 2019 IPPS/LTCH PPS final rule.
    We also made inadvertent errors related to the status of four 
providers reclassified from urban to rural under section 1886(d)(8)(E) 
of the Act (codified in the regulations under Sec.  412.103 and 
hereinafter referred to as Sec.  412.103). Specifically, the 
reclassification status in the FY 2019 IPPS/LTCH PPS final rule did not 
properly reflect the application of urban to rural reclassification 
under Sec.  412.103 for four providers (CCNs 050025, 050573, 120001 and 
120002). We note, provider 050573 was approved by the MGCRB for 
reclassification (as already reflected in the FY 2019 IPPS/LTCH final 
rule) in addition to its urban to rural reclassification under Sec.  
412.103. Additionally, the final FY 2019 IPPS wage index with 
reclassification is used when determining total payments for purposes 
of all budget neutrality factors (except for the MS-DRG 
reclassification and recalibration budget neutrality factor and the 
wage index budget neutrality adjustment factor) and the final outlier 
threshold.
    Due to the correction of the combination of errors listed 
previously (revisions to Factor 3 of the uncompensated care payment 
methodology, the correction to the final FY 2019 IPPS wage index data 
adjusted for occupational mix and the correction to the geographic 
reclassification status of four hospitals), we recalculated all IPPS 
budget neutrality adjustment factors, the fixed-loss cost threshold, 
the final wage indexes (and GAFs), and the national operating 
standardized amounts and capital Federal rate. (We note there was no 
change to the rural community hospital demonstration program budget 
neutrality adjustment or the operating outlier adjustment factor 
resulting from the correction of this combination of errors.) 
Therefore, we made conforming changes to the following:
     On pages 41715 and 41727, the MS-DRG reclassification and 
recalibration budget neutrality adjustment factor.
     On page 41716, the following budget neutrality 
adjustments:
    ++ Wage index budget neutrality adjustment.
    ++ Reclassification hospital budget neutrality adjustment.
    ++ Rural floor budget neutrality adjustment.
     On page 41723, the calculation of the outlier fixed-loss 
cost threshold, total operating Federal payments, total operating 
outlier payments, and the outlier adjustment to the capital Federal 
rate.
     On pages 41724 through 41725, the table titled ``Changes 
From FY 2018 Standardized Amounts to the FY 2019 Standardized 
Amounts''.
    On page 41722, we are also correcting inadvertent technical errors 
in the figures reported for the covered charges and cases by quarter in 
the periods used to calculate the charge inflation factor. 
Specifically, we erroneously presented figures based on total charges 
for the applicable periods listed in the table rather than the covered 
charges and the case counts were not correctly aligned with the 
corresponding quarter. We note that although there were technical 
errors in the figures as presented in the table and the corresponding 
discussion on page 41722, the correct figures were used for the outlier 
calculations in the final rule. In addition, on page 41723, we are 
correcting technical errors in the description of the formula showing 
total outlier payments as a percentage of total operating Federal 
payments.
    On pages 41727 through 41729, in our discussion of the 
determination of the Federal hospital inpatient capital-related 
prospective payment rate update, due to the recalculation of the GAFs, 
we have made conforming corrections to the increase in the capital 
Federal rate, the GAF/DRG budget neutrality adjustment factors, the 
capital Federal rate, and the outlier threshold (as discussed 
previously), along with certain statistical figures (for example, 
percent change) in the accompanying discussions. Also, as a result of 
these errors we have made conforming corrections in the tables showing 
the comparison of factors and adjustments for the FY 2018 capital 
Federal rate and FY 2019 capital Federal rate and the proposed FY 2019 
capital Federal rate and final FY 2019 capital Federal rate.

[[Page 49839]]

    On pages 41730 through 41731, 41733, 41736 and 41737, due to 
corrections in the LTCH PPS wage index discussed previously, we are 
making conforming corrections to the following:
     The area wage level adjustment budget neutrality factor.
     The fixed-loss amount for FY 2019 LTCH PPS standard 
Federal payment rate discharges and the high-cost outlier (HCO) 
threshold.
     The budget neutrality adjustment factor for the cost of 
the elimination of the 25-percent threshold policy for FY 2019 and the 
FY 2019 LTCH PPS standard Federal payment rate.
     The fixed-loss amount for FY 2019 site neutral payment 
rate discharges and the high-cost outlier (HCO) threshold (based on the 
corrections to the IPPS fixed-loss amount discussed previously).
    On pages 41738 and 41739, we are making conforming corrections to 
the figures used in the example of computing the adjusted LTCH PPS 
Federal prospective payment for FY 2019.
    On pages 41740 and 41741, we are making conforming corrections to 
the following:
     National adjusted operating standardized amounts and 
capital standard Federal payment rate (which also include the rates 
payable to hospitals located in Puerto Rico) in Tables 1A, 1B, 1C, and 
1D as a result of the conforming corrections to certain budget 
neutrality factors and the outlier threshold (as described previously). 
We are also correcting a typographical error in the update factor 
presented in the column heading for a hospital that submitted quality 
data and is a meaningful EHR user.
     LTCH PPS standard Federal payment rate in Table 1E as a 
result of the correction to the LTCH PPS wage index values (as 
discussed previously).

C. Summary of Errors in the Appendices

    On pages 41742, 41744 through 41751, and 41763 through 41765 in our 
regulatory impact analyses, we made conforming corrections to the 
factors, values, and tables and accompanying discussion of the changes 
in operating and capital IPPS payments for FY 2019 and the effects of 
certain IPPS budget neutrality factors as a result of the technical 
errors that lead to conforming changes in our calculation of the 
operating and capital IPPS budget neutrality factors, outlier 
threshold, final wage indexes, operating standardized amounts, and 
capital Federal rate (as described in sections II.A. and II.B. of this 
correcting document).
    In particular, we made changes to the following tables:
     On pages 41744 through 41746, the table titled ``Table I--
Impact Analysis of Changes to the IPPS for Operating Costs for FY 
2019''.
     On pages 41748 through 41749, the table titled ``FY 2019 
IPPS Estimated Payments Due To Rural Floor With National Budget 
Neutrality''.
     On pages 41750 through 41751, the table titled ``Table 
II--Impact Analysis of Changes for FY 2019 Acute Care Hospital 
Operating Prospective Payment System [Payments per discharge]''.
     On pages 41764 through 41765, the table titled ``Table 
III--Comparison of Total Payments per Case [FY 2018 payments compared 
to FY 2019 payments]''.
    On pages 41753 through 41755, we are correcting the discussion of 
the ``Effects of the Changes to Medicare DSH and Uncompensated Care 
Payments for FY 2019'' for purposes of the Regulatory Impact Analysis 
in Appendix A of the FY 2019 IPPS/LTCH PPS final rule, including the 
table titled ``MODELED UNCOMPENSATED CARE PAYMENTS FOR ESTIMATED FY 
2019 DSHs BY HOSPITAL TYPE: MODEL UCP $ (IN MILLIONS) * FROM FY 2018 to 
FY 2019'' on pages 41753 and 41754, in light of the corrections 
discussed in section II.D. of this correcting document.
    On page 41756, in our discussion of the effects of changes under 
the FY 2019 Hospital Value-Based Purchasing (VBP) Program that appears 
in Appendix A, we are correcting an inadvertent reference to the word 
``proposed'' in the heading for section I.H.6.a in the first column at 
the bottom of the page and in line 1 of the last paragraph of the 
second column at the bottom of the page.
    On pages 41758 through 41759, in table entitled ``Estimated 
Proportion of Hospitals in the Worst-Performing Quartile (>75th 
Percentile) of the Total HAC Scores for the FY 2019 HAC Reduction 
Program'', we inadvertently included incorrect data.
    On pages 41766 and 41768 through 41769, we made conforming 
corrections to the LTCH PPS area wage level budget neutrality factor, 
the budget neutrality adjustment factor for the cost of the elimination 
of the 25-percent threshold policy for FY 2019, and the LTCH PPS 
standard Federal payment rate as described in section II.B. of this 
correcting document.
    On pages 41768 through 41770, we are making conforming corrections 
to ``Table IV--Impact of Payment Rate and Policy Changes to LTCH PPS 
Payments for Standard Payment Rate Cases for FY 2019'' and the 
corresponding summary text. We are also correcting the inadvertent 
mislabeling of the Pacific and Mountain rows in that table.

D. Summary of Errors in and Corrections to Files and Tables Posted on 
the CMS Website

    We are correcting the errors in the following IPPS tables that are 
listed on pages 41739 through 41740 of the FY 2019 IPPS/LTCH PPS final 
rule and are available on the internet on the CMS website at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2019-IPPS-Final-Rule-Home-Page.html. The tables 
that are available on the internet have been updated to reflect the 
revisions discussed in this correcting document.
    Table 2--Case-Mix Index and Wage Index Table by CCN-FY 2019. The 
wage data errors (as discussed in section II.A. of this correcting 
document) related to the three hospitals (CCNs 010001, 060016, and 
100044) required the recalculation of the FY 2019 national average 
hourly wages unadjusted for occupational mix and adjusted for 
occupational mix which resulted in recalculating the FY 2019 wage 
indexes. Additionally, for the four providers (CCNs 050025, 050573, 
120001, and 120002) for which we are applying urban to rural 
reclassification under Sec.  412.103 (as discussed in section II.B. of 
this correcting document), we are correcting the values where 
applicable in the columns titled ``FY 2019 Wage Index'', 
``Reclassified/Redesignated CBSA'', ``Hospital Reclassified as Rural 
Under Section 1886(d)(8)(E) of the Act (Sec.  412.103)'' and ``Dual 
Status 412.103 and MGCRB/LUGAR''. Also, the revisions to Factor 3 of 
the uncompensated care payment methodology and recalculation of the FY 
2019 wage index necessitated the recalculation of the rural floor 
budget neutrality factor (as discussed in section II.B. of this 
correcting document). Therefore, we are correcting the values in the 
column titled ``FY 2019 Wage Index'' for all hospitals. Additionally, 
for the two hospitals (CCNs 010001 and 100044) for which we 
inadvertently used the incorrect wage and occupational mix data (as 
discussed in section II.A. of this correcting document), we are 
correcting the average hourly wages in the columns titled ``Average 
Hourly Wage FY 2019'' and ``3-Year Average Hourly Wage (2017, 2018, 
2019)''. Furthermore, we are deleting provider 060016 from the wage 
index and Table 2 since it is a CAH (as discussed in section II.A. of 
this correcting document).

[[Page 49840]]

    Table 3.--Wage Index Table by CBSA--FY 2019. The correction of the 
wage data errors (as discussed in section II.A. of this correcting 
document) related to the three hospitals (CCNs 010001, 060016, and 
100044) required the recalculation of the FY 2019 national average 
hourly wage adjusted for occupational mix which resulted in 
recalculating the FY 2019 wage indexes. Also, the revisions to Factor 3 
of the uncompensated care payment methodology, recalculation of the FY 
2019 wage index, and correction of the reclassification errors 
discussed in section II.B. of this correcting document necessitated the 
recalculation of the rural floor budget neutrality factor (as discussed 
in section II.B. of this correcting document). Therefore, we are making 
corresponding changes to the wage indexes and GAFs of all CBSAs listed 
in Table 3. Specifically, we are correcting the values and flags in the 
columns titled ``Wage Index'', ``Reclassified Wage Index'', ``GAF'', 
``Reclassified GAF'', ``Pre-Frontier and/or Pre-Rural Floor Wage 
Index'' and ``Eligible for Rural Floor Wage Index''. Also, we are 
making changes to reflect the application of urban to rural 
reclassification under Sec.  412.103 for the four providers (CCNs 
050025, 050573, 120001 and 120002) discussed in section II.B. of this 
correcting document. Specifically, we are correcting the values and 
flags in the columns titled ``Wage Index'', ``Reclassified Wage 
Index'', ``GAF'', ``Reclassified GAF'', ``Pre-Frontier and/or Pre-Rural 
Floor Wage Index'' and ``Eligible for Rural Floor Wage Index''. 
Additionally, for the 3 CBSAs (06, 20020, and 38940) where the three 
hospitals (CCNs 010001, 060016, and 100044) for which there were wage 
data errors are located (as discussed in section II.A. of this 
correcting document), we are correcting the average hourly wages in the 
columns titled ``FY 2019 Average Hourly Wage'' and ``3-Year Average 
Hourly Wage (2017, 2018, 2019)''.
    Table 4.--List of Counties Eligible for the Out-Migration 
Adjustment under Section 1886(d)(13) of the Act--FY 2019. The 
correction of the wage data errors related to the three hospitals (CCNs 
010001, 060016, and 100044), as discussed in section II.A. of this 
correcting document, required the recalculation of the FY 2019 national 
average hourly wage adjusted for occupational mix which resulted in 
recalculating the FY 2019 wage indexes. Also, the revisions to Factor 3 
of the uncompensated care payment methodology, recalculation of the FY 
2019 wage indexes, and correction of the reclassification errors 
discussed in section II.B. of this correcting document necessitated the 
recalculation of the rural floor budget neutrality factor (as discussed 
in section II.B. of this correcting document). Also, we are making 
changes to reflect the application of urban to rural reclassification 
under Sec.  412.103 for the four providers (CCNs 050025, 050573, 120001 
and 120002), as discussed in section II.B. of this correcting document. 
Therefore, we are making corresponding changes to the eligible counties 
and out migration values listed in Table 4. Specifically, we are 
correcting the list of counties and values in the columns titled ``FIPS 
County Code'', ``County Name'', ``State'', ``State Code'', ``Fiscal 
Year Begin of Adjustment'' and ``FY 2019 Out Migration''.
    Table 18.--FY 2019 Medicare DSH Uncompensated Care Payment Factor 
3. We are correcting this table to reflect revisions to the Factor 3 
calculations for purposes of determining uncompensated care payments 
for the FY 2019 IPPS/LTCH PPS final rule for the following reasons:
     To reflect mergers where data for the merged hospital were 
not combined with the data for the surviving hospital.
     To correct the projected DSH eligibility for a SCH that 
now has CAH status, and therefore is no longer included in Table 18.
     To correct a provider's Factor 3 that was inadvertently 
calculated using the methodology for all-inclusive rate providers.
     To correct the Factor 3s that were computed for hospitals 
whose FY 2014 or FY 2015 cost report in the June 2018 extract of 
Healthcare Cost Report Information System (HCRIS) inadvertently omitted 
amended uncompensated care cost data that had been reported by the 
hospital on an amended Worksheet S-10 in a timely manner per Change 
Request (CR) 10378 issued on December 1, 2017, or where the FY 2014 or 
FY 2015 cost report for a DSH eligible hospital had inadvertently been 
uploaded into HCRIS without making the calculation modifications 
described in Transmittal 11, and to reflect the cost-to-charge ratio 
(CCR) trim changes resulting from the inclusion of the inadvertently 
omitted data.
    We are revising Factor 3 for all hospitals to correct these errors. 
We are also revising the amount of the total uncompensated care payment 
calculated for each DSH-eligible hospital. The total uncompensated care 
payment that a hospital receives is used to calculate the amount of the 
interim uncompensated care payments the hospital receives per 
discharge. We also corrected the per discharge interim uncompensated 
care payment for all hospitals to reflect the 2017 discharges as shown 
on the FY 2019 IPPS Impact File. We also corrected the per discharge 
interim uncompensated care payment calculated for a merged hospital to 
reflect the discharges for the subsumed hospital. Per discharge 
uncompensated care payments are included when determining total 
payments for purposes of all of the budget neutrality factors and the 
final outlier threshold. As a result, these corrections to the 
uncompensated care payments impacted the calculation of all the budget 
neutrality factors as well as the outlier fixed-loss cost threshold. 
These corrections will be reflected in Table 18 and the Medicare DSH 
Supplemental Data File. In section IV.C. of this correcting document, 
we have made corresponding revisions to the discussion of the ``Effects 
of the Changes to Medicare DSH and Uncompensated Care Payments for FY 
2019'' for purposes of the Regulatory Impact Analysis in Appendix A of 
the FY 2019 IPPS/LTCH PPS final rule to reflect the corrections 
discussed previously.
    We are also correcting the errors in the following LTCH PPS tables 
that are listed on 41739 through 41740 of the FY 2019 IPPS/LTCH PPS 
final rule and are available on the internet on the CMS website at 
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCareHospitalPPS/index.html under the list item for regulation 
number CMS-1694-F. The tables that are available on the internet have 
been updated to reflect the revisions discussed in this correcting 
document.
    Table 11.--MS-LTC-DRGs, Relative Weights, Geometric Average Length 
of Stay, Short-Stay Outlier (SSO) Threshold for Discharges Occurring 
from October 1, 2018 through September 30, 2019 under the LTCH PPS. We 
are correcting this table to reflect the revisions to the MS-LTC-DRG 
relative weights, geometric average length-of-stay, and short-stay 
outlier threshold due to the inadvertent inclusion of an all-inclusive 
rate provider as discussed in section II.A. of this correcting 
document.
    Table 12A.--LTCH PPS Wage Index for Urban Areas for Discharges 
Occurring from October 1, 2018 through September 30, 2019. We are 
correcting this table to reflect the revisions to the LTCH PPS wage 
index values discussed in section II.A. of this correcting document.
    Table 12B.--LTCH PPS Wage Index for Rural Areas for Discharges 
Occurring

[[Page 49841]]

from October 1, 2018 through September 30, 2019. We are correcting this 
table to reflect the revisions to the LTCH PPS wage index values 
discussed in section II.A. of this correcting document.

III. Waiver of Proposed Rulemaking, 60-Day Comment Period, and Delay in 
Effective Date

    Under 5 U.S.C. 553(b) of the Administrative Procedure Act (APA), 
the agency is required to publish a notice of the proposed rulemaking 
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 rulemaking 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) of 
the Act 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 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 are 
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 rule 
that would be subject to the notice and comment or delayed effective 
date requirements. The document corrects technical and typographical 
errors in the preamble, addendum, payment rates, tables, and appendices 
included or referenced in the FY 2019 IPPS/LTCH PPS final rule, but 
does not make substantive changes to the policies or payment 
methodologies that were adopted in the final rule. As a result, this 
correcting document is intended to ensure that the information in the 
FY 2019 IPPS/LTCH PPS final rule accurately reflects the policies 
adopted in that document.
    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 2019 IPPS/LTCH PPS final 
rule accurately reflects our methodologies and policies. Furthermore, 
such procedures would be unnecessary, as we are not making substantive 
changes to our 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 2019 
IPPS/LTCH PPS final rule accurately reflects these methodologies and 
policies. Therefore, we believe we have good cause to waive the notice 
and comment and effective date requirements.

IV. Correction of Errors

    In FR Rule Doc. 2018-16766 of August 17, 2018 (83 FR 41144), we are 
making the following corrections:

A. Corrections of Errors in the Preamble

    1. On page 41144, third column, sixth and seventh full paragraph, 
the contact information ``Elizabeth Holland, (410) 786-1309, Promoting 
Interoperability Programs. Clinical Quality Measure Related Issues. 
Kathleen Johnson, (410) 786-3295 and Steven Johnson (410) 786-3332, 
Promoting Interoperability Programs Nonclinical Quality Measure Related 
Issues.'' is corrected to read ``Jessica Wright, (410) 786-3838, 
Medicare Promoting Interoperability Program''.
    2. On page 41151, second column, second bulleted paragraph,
    a. Line 13, the figure ``2,610'' is corrected to read ``2,599''.
    b. Line 19, the figure ``$566'' is corrected to read ``$550''.
    3. On page 41200, between the untitled tables, first column, first 
full paragraph, line 27, the phrase ``primary and secondary diagnoses'' 
is corrected to read ``principal and secondary diagnoses''.
    4. On page 41219, middle of the page, third column, partial 
paragraph, line 13, the phrase ``primary and secondary diagnoses'' is 
corrected to read ``principal and secondary diagnoses''.
    5. On page 41236, lower half of the page, third column, first 
partial paragraph, line 2, the phrase ``primary diagnosis'' is 
corrected to read ``principal diagnosis''.
    6. On page 41254, lower two-thirds of the page, first column, 
partial paragraph, lines 12 through 17, the phrase ``MS-DRGs 163, 164, 
and 165 (Major Chest Procedures with MCC, with CC, and without CC/MCC, 
respectively) in MDC 4 (Diseases and Disorders of the Respiratory 
System);'' to read ``MS-DRGs 163, 164, and 165 (Major Chest Procedures 
with MCC, with CC, and without CC/MCC, respectively) and MS-DRGs 166, 
167, and 168 (Other Respiratory System O.R. Procedures with MCC, with 
CC, and without CC/MCC, respectively) in MDC 4 (Diseases and Disorders 
of the Respiratory System);''.
    7. On page 41299, second column, first partial paragraph, lines 2 
through 7, the sentence ``Cases involving KYMRIAH and YESCARTA that are 
eligible for new technology add-on payments will be identified by ICD-
10-PCS procedure codes XW033C3 and XW043C3.'' is corrected to read 
``Cases involving KYMRIAH and YESCARTA that are eligible for new 
technology add-on payments will be identified by either of the 
following ICD-10-PCS procedure codes: XW033C3 (Introduction of 
engineered autologous chimeric antigen receptor T-cell immunotherapy 
into peripheral vein, percutaneous approach, new technology group 3) or 
XW043C3 (Introduction of engineered autologous chimeric antigen 
receptor T-cell immunotherapy into central vein, percutaneous approach, 
new technology group 3).''
    8. On page 41311, second column, first partial paragraph, lines 46 
through 51, the phrase ``FY 2019 cases involving the use of 
VABOMERE\TM\ that are eligible for the FY 2019 new technology add-on 
payments will be identified by the NDC of 65293-009-01 (VABOMERE\TM\ 
Meropenem-Vaborbactam Vial).'' is corrected to read ``FY 2019 cases 
involving the use of VABOMERE\TM\ that are eligible for the FY 2019 new 
technology add-on payments will be identified by the NDC of 65293-0009-
01 (VABOMERE\TM\ Meropenem-Vaborbactam Vial).''
    9. On page 41313, first column, first partial paragraph, line 8, 
the phrase ``primary diagnosis'' is corrected to read ``principal 
diagnosis''.
    10. On page 41320, second column, first partial paragraph, line 15, 
the code ``05H043MZ'' is corrected to read ``05H43MZ''.
    11. On page 41334, second column, first full paragraph, lines 20 
through 24,

[[Page 49842]]

the sentence ``Cases involving ZEMDRITM that are eligible 
for new technology add-on payments will be identified by ICD-10-PCS 
procedure codes XW033G4 and XW043G4.'' is corrected to read ``Cases 
involving ZEMDRITM that are eligible for new technology add-
on payments will be identified by either of the following ICD-10-PCS 
procedure codes: XW033G4 (Introduction of Plazomicin anti-infective 
into peripheral vein, percutaneous approach, new technology group 4) or 
XW043G4 (Introduction of Plazomicin anti-infective into central vein, 
percutaneous approach, new technology group 4).''
    12. On page 41342, second column, first partial paragraph, lines 3 
and 4, the phrase ``identified by ICD-10-PCS procedure codes XW033H4 
and XW043H4.'' is corrected to read ``identified by either of the 
following ICD-10-PCS procedure codes: XW033H4 (Introduction of 
synthetic human angiotensin II into peripheral vein, percutaneous 
approach, new technology group 4) or XW043H4 (Introduction of synthetic 
human angiotensin II into central vein, percutaneous approach, new 
technology group 4).''
    13. On page 41348, second column, first full paragraph, line 17, 
the figure ``$2,400'' is corrected to read ``$2,800''.
    14. On page 41362, first column, first partial paragraph, lines 4 
through 7, the phrase ``eligible for new technology add-on payments 
will be identified by ICD-10-PCS procedure codes XW03372 and XW04372.'' 
is corrected to read ``eligible for new technology add-on payments will 
be identified by either of the following ICD-10-PCS procedure codes: 
XW03372 (Introduction of Andexanet alfa, factor Xa inhibitor reversal 
agent into peripheral vein, percutaneous approach, new technology group 
2) or XW04372 (Introduction of Andexanet alfa, factor Xa inhibitor 
reversal agent into central vein, percutaneous approach, new technology 
group 2).''
    15. On page 41364, third column, first partial paragraph--
    a. Line 10, the figure ``3'' is corrected to read ``4''.
    b. Line 18, the figure ``11'' is corrected to read ``12''.
    c. Line 21, the figure ``3'' is corrected to read ``4''.
    d. Line 23, the figure ``3,283'' is corrected to read ``3,282''.
    e. Lines 23 through 24, the figure ``(3,260 + 28 - 2 - 3 = 3,283)'' 
is corrected to read ``(3,260 + 28 - 2 - 4 = 3,282)''.
    16. On page 41365--
    a. Second column, third full paragraph, last line, the figure 
``$42.997789358'' is corrected to read ``$42.998002633''.
    b. Third column, first partial paragraph, line 32, the figure 
``$42.997789358'' is corrected to read ``$42.998002633''.
    17. On page 41368, third column, first partial paragraph, line 21, 
the figure ``3,283'' is corrected to read ``3,282''.
    18. On page 41375--
    a. Second column--
    i. First partial paragraph--
    A. Line 2, the figure ``3,283'' is corrected to read ``3,282''.
    B. Line 3, the figure ``3,114'' is corrected to read ``3,113''.
    C. Lines 6 and 7, the parenthetical figures ``(3,114/3,283)'' are 
corrected to read ``(3,113/3,282)''.
    D. Last line, the figure ``$42.955567020'' is corrected to read 
``$42.955981146''.
    ii. Following the first full paragraph the untitled table is 
corrected to read as follows:

------------------------------------------------------------------------
 Final unadjusted national average     Final occupational mix adjusted
            hourly wage                  national average hourly wage
------------------------------------------------------------------------
              $42.998002633                        $42.955981146
------------------------------------------------------------------------

    b. Third column,
    i. Top of the column (before the first full paragraph), the 
untitled table is corrected to read as follows:

------------------------------------------------------------------------
                                                          Average hourly
          Occupational mix nursing subcategory                 wage
------------------------------------------------------------------------
National RN.............................................    $41.65745883
National LPN and Surgical Technician....................     24.73751208
National Nurse Aide, Orderly, and Attendant.............     16.96596364
National Medical Assistant..............................     18.13187187
National Nurse Category.................................     35.03615689
------------------------------------------------------------------------

    ii. First full paragraph, line 4, the figure ``$35.04005228'' is 
corrected to read ``$35.03615689''.
    19. On page 41406, second column, first full paragraph, line 30, 
the term ``Facto'' is corrected to read ``Factor''.
    20. On page 41415, third column--
    a. Second full paragraph,
    i. Line 26, the phrase ``5 hospitals'' is corrected to read ``16 
hospitals''.
    ii. Line 28, the figure ``1.031'' is corrected to read ``1.032''.
    iii. Line 30, the figure ``0.93'' is corrected to read ``0.929''.
    b. Fourth full paragraph, line 10, the phrase ``14 hospitals'' is 
corrected to read ``25 hospitals''.
    21. On page 41432, first column, first partial paragraph, lines 2 
and 3, the phrase ``FY 2018'' is corrected to read ``FY 2019''.
    22. On page 41436, second column, last bulleted paragraph, the 
sentence, ``March 2018 update of the FY 2017 MedPAR files to identify 
claims within FY 2017'' is corrected to read ``March 2018 update of the 
FY 2017 MedPAR file to identify claims within FY 2017 with discharge 
dates that are on or before June 30, 2017.''
    23. On page 41446, third column, section heading ``c. Removal of 
Ten Measures From the Hospital VBP Program'' is corrected to read ``c. 
Removal of Four Measures From the Hospital VBP Program''.
    24. On page 41452, third column, footnote paragraph (footnote 241), 
the date ``(August 20, 2017)'' is corrected to read ``(August 30, 
2017)''.
    25. On page 41469, table titled ``Previously Adopted and Newly 
Displayed Performance Standards for the FY 2021 Program Year: Safety, 
Clinical Outcomes, and Efficiency and Cost Reduction Domains'', under 
``Safety Domain'', the entries in the ``Benchmark'' column for the 
CAUTI, CLABSI, MRSA Bacteremia, and Colon and Abdominal Hysterectomy 
SSI measures are corrected to read to three decimal places as follows:

------------------------------------------------------------------------
                                            Achievement
           Measure short name                threshold       Benchmark
------------------------------------------------------------------------
                              Safety Domain
------------------------------------------------------------------------
CAUTI...................................           0.774           0.000
CLABSI..................................           0.687           0.000
CDI.....................................           0.748           0.067
MRSA Bacteremia.........................           0.763           0.000

[[Page 49843]]

 
Colon and Abdominal Hysterectomy SSI....   0.754   0.000
                                           0.726   0.000
------------------------------------------------------------------------

    26. On page 41488, first column, last paragraph, line 7, the phrase 
``HAI data'' is corrected to read ``HAI measure''.
    27. On page 41528, third column, last paragraph, line 29, the 
figure ``0.9931052'' is corrected to read ``0.9935905''.
    28. On page 41529, first column, first full paragraph, line 7, the 
figure ``0.9931052'' is corrected to read ``0.9935905''.
    29. On page 41536, third column--
    a. First bulleted paragraph, line 2, the figure ``0.990884'' is 
corrected to read ``0.990878''.
    b. Second bulleted paragraph, line 2, the figure ``0.990741'' is 
corrected to read ``0.990737''.
    30. On page 41537--
    a. Second column, last paragraph, last line, the figure 
``0.990741'' is corrected to read ``0.990737''.
    b. Third column, second full paragraph--
    i. Line 6, the figure ``0.990884'' is corrected to read 
``0.990878''.
    ii. Lines 13, the figure ``0.990884'' is corrected to read 
``0.990878''.
    31. On page 41556, third column, last bulleted paragraph, line 4, 
the parenthetical phrase (NQF # 2515) is corrected to read ``(NQF # 
2558)''.
    32. On page 41558, second column, last paragraph, line 7, the 
phrase ``FYs 2020, 2021, and 2020'' is corrected to read ``FYs 2020, 
2021, and 2022''
    33. On page 41576, in the table titled ``SUMMARY OF HOSPITAL IQR 
PROGRAM MEASURES NEWLY FINALIZED FOR REMOVAL,'' under the ``Claims-
Based Coordination of Care Measures'', first column (Short name), the 
fifth entry ``READM-30-PNA'' is corrected to read ``READM-30-PN''.
    34. On page 41579, table titled ``MEASURES FOR THE FY 2021 PAYMENT 
DETERMINATION,'' under ``Claims-Based Mortality Measures'', the 
following entries are corrected by:
    a. Removing the inadvertently included asterisk at the end of the 
full measure name for MORT-30-STK; and
    b. Adding a row to the table to include an entry for MORT-30-CABG, 
which was inadvertently omitted, such that the table will read as 
follows:

------------------------------------------------------------------------
 
------------------------------------------------------------------------
                     Claims-Based Mortality Measures
------------------------------------------------------------------------
MORT-30-CABG...................  Hospital 30-Day, All-              2558
                                  Cause,
                                  Risk[dash]Standardized
                                  Mortality Rate
                                  Following Coronary
                                  Artery Bypass Graft
                                  (CABG) Surgery.
MORT-30-STK....................  Hospital 30-Day, All-               N/A
                                  Cause,
                                  Risk[dash]Standardized
                                  Mortality Rate
                                  Following Acute
                                  Ischemic Stroke.
------------------------------------------------------------------------

    35. On page 41579, table titled ``MEASURES FOR THE FY 2021 PAYMENT 
DETERMINATION,'' under ``EHR-Based Clinical Process of Care Measures 
(that is, Electronic Clinical Quality Measures (eCQMs))'', third column 
(NQF #), line 11, for the entry for STK-06, the NQF number ``0438'' is 
corrected to read ``0439'' as follows:

------------------------------------------------------------------------
 
------------------------------------------------------------------------
STK-06.........................  Discharged on Statin               0439
                                  Medication.
------------------------------------------------------------------------

    36. On page 41579, table titled ``MEASURES FOR THE FY 2021 PAYMENT 
DETERMINATION,'' under ``EHR-Based Clinical Process of Care Measures 
(that is, Electronic Clinical Quality Measures (eCQMs))'', second 
column (Measure Name), the last line down, the measure name for the 
entry for VTE-2 is corrected from ``Intensive Care Unit Thromboembolism 
Prophylaxis'' to reflect the complete measure name ``Intensive Care 
Unit Venous Thromboembolism Prophylaxis.''

------------------------------------------------------------------------
 
------------------------------------------------------------------------
VTE-2..........................  Intensive Care Unit                0372
                                  Venous Thromboembolism
                                  Prophylaxis.
------------------------------------------------------------------------

    37. On page 41599, third column,
    a. Third full paragraph, lines 4 and 5, the phrase ``disparity 
measures'' is corrected to read ``disparity methods''.
    b. Last paragraph, line 9, the phrase ``disparity measures'' is 
corrected to read ``disparity methods''.
    38. On page 41672, first column, fourth paragraph, lines 9 through 
11, the phrase ``Spring 2017 version of the CQM electronic 
specifications'' is corrected to read ``2018 eCQM specifications update 
(published in May 2018)''.

B. Correction of Errors in the Addendum

    1. On page 41715, third column, fourth full paragraph, lines 3 and 
8, the figure ``0.997192'' is corrected to read ``0.997190''.
    2. On page 41716--
    a. First column, fourth full paragraph, line 9, the figure 
``1.000748'' is corrected to read ``1.000746''.
    b. Second column, second full paragraph, line 11, the figure 
``0.985932'' is corrected to read ``0.985335''.
    c. Third column, second full paragraph, line 3, the figure 
``0.993142'' is corrected to read ``0.993911''.
    3. On page 41722--
    a. Middle of the page, the untitled table is corrected to read as 
follows:

[[Page 49844]]



----------------------------------------------------------------------------------------------------------------
                                    Covered charges                         Covered charges
                                    (April 1, 2016,     Cases (April 1,     (April 1, 2017,     Cases (April 1,
             Quarter               through March 31,     2016, through     through March 31,     2017, through
                                         2017)          March 31, 2017)          2018)          March 31, 2018)
----------------------------------------------------------------------------------------------------------------
April-June......................    $135,512,389,540           2,415,120    $141,310,805,358           2,407,887
July-September..................     132,339,957,018           2,356,775     136,951,808,593           2,319,109
October-December................     138,602,493,305           2,413,871     141,939,083,023           2,363,685
January-March...................     150,230,629,335           2,559,371     120,924,791,134           1,983,155
                                 -------------------------------------------------------------------------------
    Total.......................     556,685,469,198           9,745,137     541,126,488,108           9,073,836
----------------------------------------------------------------------------------------------------------------

    b. Bottom of the page, first column,
    i. First paragraph,
    ii. Lines 5, the figures ``$57,448 ($559,839,156,948/9,745,137)'' 
are corrected to read ``$57,124 ($556,685,469,198/9,745,137)''.
    iii. Lines 9 through 10, the figures ``$59,939.96 
($543,885,328,430/9,073,836)'' are corrected to read ``$59,636 
($541,126,488,108/9,073,836)''.
    iv. Lines 13 through 14, the figures ``4.3 percent (1.04338)'' are 
corrected to read ``4.4 percent (1.04396)''.
    v. Line 14, the figures ``8.9 percent (1.08864)'' are corrected to 
read ``9.0 percent (1.08986)''.
    4. On page 41723, first column--
    a. Third full paragraph--
    i. Line 5, the figure ``$25,769'' is corrected to read ``$25,743''.
    ii. Line 7, the figure ``$88,484,589,041'' is corrected to read 
``$88,485,100,546''.
    iii. Line 8, the figure ``$4,755,375,555'' is corrected to read 
``$4,755,311,111''.
    iv. Lines 12 through 13, the parenthetical phrase 
``(($88,484,589,041/$93,239,964,596) x 100 = 5.1 percent)'' is 
corrected to read ``((1 - ($88,485,100,546/$93,240,411,657)) x 100 = 
5.1 percent)''.
    v. Last line, the figure ``$25,769'' is corrected to read 
``$25,743''.
    c. Following the sixth full paragraph, the untitled table is 
corrected to read as follows:

------------------------------------------------------------------------
                                                Operating       Capital
                                               standardized     Federal
                                                 amounts         rate
------------------------------------------------------------------------
National...................................        0.948999    0.949417
------------------------------------------------------------------------

    5. On pages 41724 through 41725, the table titled ``CHANGES FROM FY 
2018 STANDARDIZED AMOUNTS TO THE FY 2019 STANDARDIZED AMOUNTS'', is 
corrected to read as follows:

                  Changes From FY 2018 Standardized Amounts to the FY 2019 Standardized Amounts
----------------------------------------------------------------------------------------------------------------
                                                      Hospital submitted   Hospital did NOT    Hospital did NOT
                                  Hospital submitted   quality data and     submit quality      submit quality
                                   quality data and        is NOT a          data and is a     data and is NOT a
                                    is a meaningful     meaningful EHR      meaningful EHR      meaningful EHR
                                       EHR user              user                user                user
----------------------------------------------------------------------------------------------------------------
FY 2018 Base Rate after           If Wage Index is    If Wage Index is    If Wage Index is    If Wage Index is
 removing:                         Greater Than        Greater Than        Greater Than        Greater Than
1. FY 2018 Geographic              1.0000:             1.0000:             1.0000:             1.0000:
 Reclassification Budget          Labor (68.3%):      Labor (68.3%):      Labor (68.3%):      Labor (68.3%):
 Neutrality (0.987985)             $4,059.36.          $4,059.36.          $4,059.36.          $4,059.36.
2. FY 2018 Operating Outlier      Nonlabor (30.4%):   Nonlabor (30.4%):   Nonlabor (30.4%):   Nonlabor (30.4%):
 Offset (0.948998)                 $1,884.07.          $1,884.07.          $1,884.07.          $1,884.07.
                                  If Wage Index is    If Wage Index is    If Wage Index is    If Wage Index is
                                   less Than or        less Than or        less Than or        less Than or
                                   Equal to 1.0000:    Equal to 1.0000:    Equal to 1.0000:    Equal to 1.0000:
                                  Labor (62%):        Labor (62%):        Labor (62%):        Labor (62%):
                                   $3,684.92.          $3,684.92.          $3,684.92.          $3,684.92.
                                  Nonlabor (38%):     Nonlabor (38%):     Nonlabor (38%):     Nonlabor (38%):
                                   $2,258.50.          $2,258.50.          $2,258.50.          $2,258.50.
FY 2019 Update Factor...........  1.0135............  0.99175...........  1.00625...........  0.9845.
FY 2019 MS-DRG Recalibration      0.99719...........  0.99719...........  0.99719...........  0.99719.
 Budget Neutrality Factor.
FY 2019 Wage Index Budget         1.000746..........  1.000746..........  1.000746..........  1.000746.
 Neutrality Factor.
FY 2019 Reclassification Budget   0.985335..........  0.985335..........  0.985335..........  0.985335.
 Neutrality Factor.
FY 2019 Operating Outlier Factor  0.948999..........  0.948999..........  0.948999..........  0.948999.
FY 2019 Rural Demonstration       0.999467..........  0.999467..........  0.999467..........  0.999467.
 Budget Neutrality Factor.
Adjustment for FY 2019 Required   1.005.............  1.005.............  1.005.............  1.005.
 under Section 414 of Public Law
 114-10 (MACRA).
National Standardized Amount for  Labor: $3,856.27..  Labor: $3,773.51..  Labor: $3,828.68..  Labor: $3,745.93.
 FY 2019 if Wage Index is         Nonlabor:           Nonlabor:           Nonlabor:           Nonlabor:
 Greater Than 1.0000; Labor/Non-   $1,789.81.          $1,751.40.          $1,777.01.          $1,738.60.
 Labor Share Percentage (68.3/
 31.7).
National Standardized Amount for  Labor: $3,500.57..  Labor: $3,425.44..  Labor: $3,475.53..  Labor: $3,400.41.
 FY 2019 if Wage Index is Less    Nonlabor:           Nonlabor:           Nonlabor:           Nonlabor:
 Than or Equal to 1.0000; Labor/   $2,145.51.          $2,099.47.          $2,130.16.          $2,084.12.
 Non-Labor Share Percentage (62/
 38).
----------------------------------------------------------------------------------------------------------------

    6. On page 41727--
    a. First column, second full paragraph, line 13, the figure 
``0.997192'' is corrected to read, ``0.997190''.
    b. Second column, second full paragraph, line 6, the figure ``1.27 
percent'' is corrected to read ``1.20 percent''.
    7. On page 41728, third column--
    a. Second full paragraph, line 12, the figure ``0.9986'' is 
corrected to read ``0.9980''.
    b. Third full paragraph, line 14, the figure ``0.9975'' is 
corrected to read ``0.9969''.
    8. On page 41729--
    a. Top of the page--
    i. First column--
    A. First full paragraph--
    1. Line 2, the figure ``0.9975'' is corrected to read ``0.9969''.

[[Page 49845]]

    2. Line 4, the figure ``0.9986'' is corrected to read ``0.9980''.
    ii. Second column--
    B. First full paragraph--
    1. Line 8, the figure ``$459.72'' is corrected to read ``$459.41''.
    2. Line 17, the figure ``0.9975'' is corrected to read ``0.9969''.
    3. Third column, first paragraph--
    a. Line 14, the figure ``0.25'' is corrected to read ``0.31''.
    b. Line 20, the figure ``1.27'' is corrected to read ``1.20''.
    b. Middle of page,
    i. The table titled ``COMPARISON OF FACTORS AND ADJUSTMENTS: FY 
2018 CAPITAL FEDERAL RATE AND FY 2019 CAPITAL FEDERAL RATE'' is 
corrected to read as follows:

      Comparison of Factors and Adjustments: FY 2018 Capital Federal Rate and FY 2019 Capital Federal Rate
----------------------------------------------------------------------------------------------------------------
                                                      FY 2018         FY 2019         Change      Percent change
----------------------------------------------------------------------------------------------------------------
Update Factor \1\...............................          1.0130          1.0140           1.014            1.40
GAF/DRG Adjustment Factor \1\...................          0.9987          0.9969          0.9969           -0.31
Outlier Adjustment Factor \2\...................          0.9483          0.9494          1.0012            0.12
Capital Federal Rate............................         $453.95         $459.41          1.0120        \3\ 1.20
----------------------------------------------------------------------------------------------------------------
\1\ The update factor and the GAF/DRG budget neutrality adjustment factors are built permanently into the
  capital Federal rates. Thus, for example, the incremental change from FY 2018 to FY 2019 resulting from the
  application of the 0.9969 GAF/DRG budget neutrality adjustment factor for FY 2019 is a net change of 0.9969
  (or -0.31percent).
\2\ The outlier reduction factor is not built permanently into the capital Federal rate; that is, the factor is
  not applied cumulatively in determining the capital Federal rate. Thus, for example, the net change resulting
  from the application of the FY 2019 outlier adjustment factor is 0.9494/0.9483 or 1.0012 (or 0.12 percent).
\3\ Percent change may not sum due to rounding.

    ii. The table titled ``COMPARISON OF FACTORS AND ADJUSTMENTS: 
PROPOSED FY 2019 CAPITAL FEDERAL RATE AND FINAL FY 2019 CAPITAL FEDERAL 
RATE'' is corrected to read as follows:

 Comparison of Factors and Adjustments: Proposed FY 2019 Capital Federal Rate and Final FY 2019 Capital Federal
                                                      Rate
----------------------------------------------------------------------------------------------------------------
                                                    Proposed FY                                   Percent change
                                                       2019        Final FY 2019      Change             *
----------------------------------------------------------------------------------------------------------------
Update Factor...................................          1.0120          1.0140          1.0020            0.20
GAF/DRG Adjustment Factor.......................          0.9997          0.9969          0.9972           -0.28
Outlier Adjustment Factor.......................          0.9494          0.9494          0.0000            0.00
Capital Federal Rate............................         $459.78         $459.41          0.9992         -0.0008
----------------------------------------------------------------------------------------------------------------
* Percent change may not sum due to rounding.

    c. Bottom of page, second column, first partial paragraph, last 
line, the figure, ``$25,769'' is corrected to read ``$25,743''.
    9. On page 41730, third column, last paragraph, line 21, the figure 
``0.999713.'' is corrected to read ``0.999215''.
    10. On page 41731, first column, first partial paragraph--
    a. Line 3, the figure ``0.990884'' is corrected to read 
``0.990878''.
    b. Lines 10 and 11, the mathematical phrase ``$41,579.65 
(calculated as $41,415.11 x 1.0135 x 0.999713x 0.990884)'' is corrected 
to read ``$41,558.68 (calculated as $41,415.11 x 1.0135 x 0.999215 x 0. 
990878)''.
    c. Lines 18 through 20, ``$40,759.12 (calculated as $41,415.11 x 
0.9935 x 0.999713x 0.990884)'' is corrected to read ``$40,738.57 
(calculated as $41,415.11 x 0.9935 x 0.999215 x 0. 990878)''.
    11. On page 41733, second column, last paragraph,
    a. Line 6, the figure ``0.999713'' is corrected to read 
``0.999215''.
    b. Line 11, the figure ``0.999713'' is corrected to read 
``0.999215``.
    12. On page 41736, second column--
    a. Third full paragraph--
    i. Line 26, the figure, ``$27,124'' is corrected to read 
``$27,121''.
    ii. Line 32, the figure, ``$27,124'' is corrected to read 
``$27,121''.
    iii. Last line, the figure, ``$27,124'' is corrected to read 
``$27,121''.
    b. Last partial paragraph, last line, the figure, ``$27,124'' is 
corrected to read ``$27,121''.
    13. On page 41737--
    a. Second column, last paragraph, line 8, the figure, ``$25,769'' 
is corrected to read ``$25,743''.
    b. Third column--
    i. First partial paragraph, last line, the figure, ``$25,769'' is 
corrected to read ``$25,743''.
    ii. Third full paragraph, line 3, the figure, ``$25,769'' is 
corrected to read ``$25,743''.
    14. On page 41738, third column, last paragraph, line 26, the 
figure ``$41,579.65'' is corrected to read ``$41,558.68''.
    15. On page 41739, top of page--
    a. Second column, second partial paragraph, last line, the figure 
``$41,579.65'' is corrected to read ``$41,558.68''.
    b. Third column, first partial paragraph, line 13, the 
parenthetical figure ``($41,189.62)'' is corrected to read 
``($41,190.33)''.
    c. Untitled table, the table is corrected to read as follows:

------------------------------------------------------------------------
 
------------------------------------------------------------------------
Unadjusted LTCH PPS Standard Federal Prospective Payment      $41,558.68
 Rate...................................................
Labor-Related Share.....................................         x 0.660
Labor-Related Portion of the LTCH PPS Standard Federal      = $27,428.73
 Payment Rate...........................................
Wage Index (CBSA 16974).................................          1.0511
Wage-Adjusted Labor Share of LTCH PPS Standard Federal      = $28,830.34
 Payment Rate...........................................
Nonlabor-Related Portion of the LTCH PPS Standard           + $14,129.95
 Federal Payment Rate ($41,558.68 x 0.340)..............

[[Page 49846]]

 
Adjusted LTCH PPS Standard Federal Payment Amount.......    = $42,960.29
MS-LTC-DRG 189 Relative Weight..........................        x 0.9588
Total Adjusted LTCH PPS Standard Federal Prospective        = $41,190.33
 Payment................................................
------------------------------------------------------------------------

    16. On page 41740, bottom of the page, the table titled ``TABLE 
1A-- NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR 
[(68.3 percent labor share/31.7 percent nonlabor share if wage index is 
greater than 1)--FY 2019]'' is corrected to read as follows:

                                       Table 1A--National Adjusted Operating Standardized Amounts, Labor/Nonlabor
                            [(68.3 percent labor share/31.7 percent nonlabor share if wage index is greater than 1)--FY 2019]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Hospital submitted quality data and is   Hospital submitted quality data and  Hospital did NOT submit quality data  Hospital did NOT submit quality data
 a meaningful EHR user (update = 1.35   is NOT a meaningful EHR user (update  and is a meaningful EHR user (update    and is NOT a meaningful EHR user
               percent)                           = -0.825 percent)                     = 0.625 percent)                  (update = -1.55 percent)
--------------------------------------------------------------------------------------------------------------------------------------------------------
       Labor             Nonlabor             Labor             Nonlabor            Labor             Nonlabor            Labor             Nonlabor
--------------------------------------------------------------------------------------------------------------------------------------------------------
       $3,856.27           $1,789.81          $3,773.51          $1,751.40          $3,828.68          $1,777.01          $3,745.93          $1,738.60
--------------------------------------------------------------------------------------------------------------------------------------------------------

    17. On page 41741--
    a. Top of the page--
    i. The table titled ``TABLE 1B--NATIONAL ADJUSTED OPERATING 
STANDARDIZED AMOUNTS, LABOR/NONLABOR [(62 percent labor share/38 
percent nonlabor share if wage index is less than or equal to 1)--FY 
2019]'' is corrected to read as follows:

                                       Table 1B--National Adjusted Operating Standardized Amounts, Labor/Nonlabor
                         [(62 percent labor share/38 percent nonlabor share if wage index is less than or equal to 1)--FY 2019]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Hospital submitted quality data and is   Hospital submitted quality data and  Hospital did NOT submit quality data  Hospital did NOT submit quality data
 a meaningful EHR user (update = 1.35   is NOT a meaningful EHR user (update  and is a meaningful EHR user (update    and is NOT a meaningful EHR user
               percent)                           = -0.825 percent)                     = 0.625 percent)                  (update = -1.55 percent)
--------------------------------------------------------------------------------------------------------------------------------------------------------
       Labor             Nonlabor             Labor             Nonlabor            Labor             Nonlabor            Labor             Nonlabor
--------------------------------------------------------------------------------------------------------------------------------------------------------
       $3,500.57           $2,145.51          $3,425.44          $2,099.47          $3,475.53          $3,475.53          $3,400.41          $2,084.12
--------------------------------------------------------------------------------------------------------------------------------------------------------

    ii. The table titled ``Table 1C--ADJUSTED OPERATING STANDARDIZED 
AMOUNTS FOR HOSPITALS IN PUERTO RICO, LABOR/NONLABOR [(National: 62 
percent labor share/38 percent nonlabor share because wage index is 
less than or equal to 1)--FY 2019]'' is corrected to read as follows:

         Table 1C--Adjusted Operating Standardized Amounts for Hospitals in Puerto Rico, Labor/Nonlabor
 [(National: 62 percent labor share/38 percent nonlabor share because wage index is less than or equal to 1)--FY
                                                      2019]
----------------------------------------------------------------------------------------------------------------
                               Rates if wage index is greater    Rates if wage index is less than or equal to 1
                                           than 1              -------------------------------------------------
     Standardized amount     ----------------------------------
                                   Labor           Nonlabor              Labor                   Nonlabor
----------------------------------------------------------------------------------------------------------------
National \1\................  Not Applicable.  Not Applicable.                $3,500.57                $2,145.51
----------------------------------------------------------------------------------------------------------------
\1\ For FY 2019, there are no CBSAs in Puerto Rico with a national wage index greater than 1.

    b. Middle of the page--
    i. The table titled ``Table 1D--CAPITAL STANDARD FEDERAL PAYMENT 
RATE [FY 2019]'' is corrected to read as follows:

             Table 1D--Capital Standard Federal Payment Rate
                                [FY 2019]
------------------------------------------------------------------------
                                                               Rate
------------------------------------------------------------------------
National...............................................         $459.41
------------------------------------------------------------------------

    ii. The table titled ``Table 1E--LTCH PPS STANDARD FEDERAL PAYMENT 
RATE [FY 2019]'' is corrected to read as follows:

[[Page 49847]]



            Table 1E--LTCH PPS Standard Federal Payment Rate
                                [FY 2019]
------------------------------------------------------------------------
                                   Full update (1.35  Reduced update * (-
                                       percent)          0.65 Percent)
------------------------------------------------------------------------
Standard Federal Rate...........         $41,558.68          $40,738.57
------------------------------------------------------------------------
* For LTCHs that fail to submit quality reporting data for FY 2019 in
  accordance with the LTCH Quality Reporting Program (LTCH QRP), the
  annual update is reduced by 2.0 percentage points as required by
  section 1886(m)(5) of the Act.

C. Corrections of Errors in the Appendices

    1. On page 41742--
    a. Second column, second full paragraph--
    i. Line 1, the figure ``3,256'' is corrected to read ``3,255''.
    ii. Line 7, the figure ``1,398'' is corrected to read ``1,399''.
    2. On pages 41744 through 41746, the table and table notes for the 
table titled ``TABLE I--IMPACT ANALYSIS OF CHANGES TO THE IPPS FOR 
OPERATING COSTS FOR FY 2019'' are corrected to read as follows:

                                                         TABLE I--Impact Analysis of Changes to the IPPS for Operating Costs for FY 2019
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                   FY 2019
                                                                                                 weights and                                        Rural floor
                                                                                Hospital rate    DRG changes    FY 2019 wage                           with       Application of
                                                                  Number of      update and         with          data with      FY 2019 MGCRB    application of   the frontier     All FY 2019
                                                                hospitals \1\    adjustment    application of  application of  reclassifications  national rural  wage index and      changes
                                                                                 under MACRA    recalibration    wage budget                       floor budget    outmigration
                                                                                                   budget        neutrality                         neutrality      adjustment
                                                                                                 neutrality
                                                                      (1) \2\         (2) \3\         (3) \4\         (4) \5\            (5) \6\         (6) \7\         (7) \8\
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
All Hospitals................................................           3,255             1.8               0               0                  0               0             0.1             2.4
By Geographic Location:
    Urban hospitals..........................................           2,483             1.8               0               0               -0.1               0             0.1             2.5
    Large urban areas........................................           1,302             1.8             0.1               0               -0.8               0               0             2.4
    Other urban areas........................................           1,181             1.8               0               0                0.6               0             0.2             2.5
    Rural hospitals..........................................             772             1.5            -0.3            -0.1                1.2            -0.1             0.1             1.2
Bed Size (Urban):
    0-99 beds................................................             644             1.7            -0.5             0.1               -0.8             0.2             0.2             1.7
    100-199 beds.............................................             763             1.8               0               0               -0.1             0.2             0.2             2.2
    200-299 beds.............................................             433             1.8               0               0                0.1               0             0.1             2.3
    300-499 beds.............................................             424             1.8             0.1               0                  0            -0.1             0.1             2.5
    500 or more beds.........................................             219             1.8             0.1               0               -0.2               0               0             2.9
Bed Size (Rural):
    0-49 beds................................................             305             1.4            -0.5               0                0.2            -0.1             0.2             0.9
    50-99 beds...............................................             274             1.3            -0.4               0                0.7            -0.1             0.2             1.1
    100-149 beds.............................................             108             1.6            -0.5            -0.1                0.9            -0.1               0             1.2
    150-199 beds.............................................              45             1.7            -0.1            -0.2                  2            -0.2             0.3             1.4
    200 or more beds.........................................              40             1.7             0.1            -0.2                2.3            -0.2               0             1.5
Urban by Region:
    New England..............................................             113             1.8             0.1            -0.5                2.7             2.4             0.1             4.7
    Middle Atlantic..........................................             310             1.8             0.2               0                0.2            -0.3             0.1             2.3
    South Atlantic...........................................             401             1.8               0            -0.1               -0.6            -0.3               0               2
    East North Central.......................................             386             1.8             0.1            -0.2               -0.5            -0.3             0.1               2
    East South Central.......................................             147             1.8               0               0               -0.5            -0.3               0             2.1
    West North Central.......................................             158             1.8            -0.1               0               -0.9            -0.3             0.6             2.1
    West South Central.......................................             379             1.8               0             0.2               -0.8            -0.3               0             2.3
    Mountain.................................................             164             1.7            -0.1            -0.7                0.4             0.6             0.3             2.2
    Pacific..................................................             374             1.8            -0.1             0.8                0.1             0.2             0.1             3.3
    Puerto Rico..............................................              51             1.8               0            -1.2               -1.3             0.1             0.1             0.7
Rural by Region:
    New England..............................................              20             1.5             0.1            -0.5                1.5            -0.2               0             0.9
    Middle Atlantic..........................................              53             1.5            -0.2            -0.1                0.6            -0.1             0.1             1.4
    South Atlantic...........................................             122             1.6            -0.2            -0.2                1.7            -0.1             0.1             1.2
    East North Central.......................................             114             1.5            -0.3             0.1                0.9            -0.1               0             1.1
    East South Central.......................................             150             1.7            -0.1            -0.2                2.5            -0.3             0.1             1.8
    West North Central.......................................              94             1.3            -0.5               0                0.1               0             0.2             0.9
    West South Central.......................................             145             1.5            -0.3             0.2                1.3            -0.3             0.2             1.5
    Mountain.................................................              51             1.3            -1.1            -0.4               -0.1            -0.1             0.8             0.8
    Pacific..................................................              23             1.4            -0.4            -0.2                0.8            -0.1               0               1
By Payment Classification:
    Urban hospitals..........................................           2,264             1.8               0               0               -0.6             0.1             0.1             2.3
    Large urban areas........................................           1,317             1.8             0.1               0               -0.7               0               0             2.4
    Other urban areas........................................             947             1.8               0               0               -0.4             0.2             0.2             2.1
    Rural areas..............................................             991             1.7            -0.1               0                2.1            -0.2             0.1             2.7
Teaching Status:
    Nonteaching..............................................           2,156             1.7            -0.1               0                0.1             0.1             0.1             2.1
    Fewer than 100 residents.................................             849             1.8               0               0               -0.2            -0.1             0.2             2.2
    100 or more residents....................................             250             1.8             0.2               0                0.1            -0.1               0             3.1
Urban DSH:

[[Page 49848]]

 
    Non-DSH..................................................             520             1.8            -0.3            -0.2               -0.2            -0.1             0.2               2
    100 or more beds.........................................           1,462             1.8             0.1               0               -0.6             0.1             0.1             2.3
    Less than 100 beds.......................................             367             1.7            -0.2             0.3               -0.6             0.2             0.1             1.9
Rural DSH:
    SCH......................................................             255             1.2            -0.6            -0.1                  0               0               0             0.7
    RRC......................................................             382             1.7               0             0.1                2.4            -0.3             0.1             3.1
    100 or more beds.........................................              33             1.8               0            -0.6                1.6            -0.4             0.1             2.9
    Less than 100 beds.......................................             236             1.6            -0.3               0                0.7            -0.2             0.3             1.5
Urban teaching and DSH:
    Both teaching and DSH....................................             805             1.8             0.1               0               -0.7               0             0.1             2.4
    Teaching and no DSH......................................              89             1.9            -0.1            -0.1               -0.5            -0.1               0             2.3
    No teaching and DSH......................................           1,024             1.8               0             0.1               -0.4             0.3             0.1             2.2
    No teaching and no DSH...................................             346             1.8            -0.3            -0.2               -0.6            -0.1             0.2             1.7
Special Hospital Types:
    RRC......................................................             327             1.8               0             0.2                2.7            -0.3             0.2             3.4
    SCH......................................................             311             1.1            -0.5             0.1               -0.1               0               0             0.8
    MDH......................................................             140             1.5            -0.5            -0.1                0.7               0               0             1.2
    SCH and RRC..............................................             134             1.4            -0.2            -0.2                0.3               0             0.1             1.2
    MDH and RRC..............................................              16             1.5            -0.4               0                0.8            -0.1               0             1.1
Type of Ownership:
    Voluntary................................................           1,898             1.8               0               0                0.1               0             0.1             2.4
    Proprietary..............................................             856             1.8               0            -0.1               -0.1               0             0.1             2.1
    Government...............................................             501             1.7               0             0.2               -0.2            -0.1               0             2.5
Medicare Utilization as a Percent of Inpatient Days:
    0-25.....................................................             602             1.8             0.1            -0.1               -0.4            -0.1               0             2.3
    25-50....................................................           2,138             1.8               0               0                  0               0             0.1             2.5
    50-65....................................................             421             1.7            -0.2            -0.1                0.5             0.3             0.1             1.7
    Over 65..................................................              73             1.1             0.5            -0.1               -0.4            -0.2             0.1             2.5
FY 2019 Reclassifications by the Medicare Geographic
 Classification Review Board:
    All Reclassified Hospitals...............................             859             1.8               0             0.1                2.4            -0.3               0             2.8
    Non-Reclassified Hospitals...............................           2,396             1.8               0               0               -1.1             0.1             0.1             2.2
    Urban Hospitals Reclassified.............................             588             1.8               0             0.1                2.5            -0.3               0             3.1
    Urban Non-reclassified Hospitals.........................           1,835             1.8               0               0               -1.2             0.1             0.1             2.3
    Rural Hospitals Reclassified Full Year...................             271             1.5            -0.2            -0.1                2.1            -0.2             0.1             1.5
    Rural Non-reclassified Hospitals Full Year...............             454             1.4            -0.5            -0.1               -0.4            -0.1             0.2             0.8
    All Section 401 Reclassified Hospitals...................             266             1.7               0             0.1                2.5            -0.3             0.1             3.4
    Other Reclassified Hospitals (Section 1886(d)(8)(B)).....              47             1.7            -0.2            -0.1                2.8            -0.3               0             1.5
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Because data necessary to classify some hospitals by category were missing, the total number of hospitals in each category may not equal the national total. Discharge data are from FY
  2017, and hospital cost report data are from reporting periods beginning in FY 2016 and FY 2015.
\2\ This column displays the payment impact of the hospital rate update and other adjustments, including the 1.35 percent adjustment to the national standardized amount and the hospital-
  specific rate (the estimated 2.9 percent market basket update reduced by 0.8 percentage point for the multifactor productivity adjustment and the 0.75 percentage point reduction under the
  Affordable Care Act), and the 0.5 percent adjustment to the national standardized amount required under section 414 of the MACRA.
\3\ This column displays the payment impact of the changes to the Version 36 GROUPER, the changes to the relative weights and the recalibration of the MS-DRG weights based on FY 2017 MedPAR
  data in accordance with section 1886(d)(4)(C)(iii) of the Act. This column displays the application of the recalibration budget neutrality factor of 0.997190 in accordance with section
  1886(d)(4)(C)(iii) of the Act.
\4\ This column displays the payment impact of the update to wage index data using FY 2015 cost report data and the OMB labor market area delineations based on 2010 Decennial Census data. This
  column displays the payment impact of the application of the wage budget neutrality factor, which is calculated separately from the recalibration budget neutrality factor, and is calculated
  in accordance with section 1886(d)(3)(E)(i) of the Act. The wage budget neutrality factor is 1.000746.
\5\ Shown here are the effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB). The effects demonstrate the FY 2019 payment impact of going from
  no reclassifications to the reclassifications scheduled to be in effect for FY 2019. Reclassification for prior years has no bearing on the payment impacts shown here. This column reflects
  the geographic budget neutrality factor of 0.985335.

[[Page 49849]]

 
\6\ This column displays the effects of the rural floor and expiration of the imputed floor. The Affordable Care Act requires the rural floor budget neutrality adjustment to be 100 percent
  national level adjustment. The rural floor budget neutrality factor applied to the wage index is 0.993911.
\7\ This column shows the combined impact of the policy required under section 10324 of the Affordable Care Act that hospitals located in frontier States have a wage index no less than 1.0 and
  of section 1886(d)(13) of the Act, as added by section 505 of Public Law 108-173, which provides for an increase in a hospital's wage index if a threshold percentage of residents of the
  county where the hospital is located commute to work at hospitals in counties with higher wage indexes. These are not budget neutral policies.
\8\ This column shows the estimated change in payments from FY 2018 to FY 2019.

    3. On page 41746, lower half of page, second column, third 
paragraph, line 6, the figure ``0.997192'' is corrected to read 
``0.997190''.
    4. On page 41747--
    a. Top half of page, second column, first partial paragraph, line 
19, the figure ``1.000748'' is corrected to read ``1.000746''.
    b. Lower half of page, third column, first partial paragraph--
    i. First line, the figure ``0.985932'' is corrected to read 
``0.985335''.
    ii. Line 11, ``which will experience no change'' is corrected to 
read, ``which will experience a 0.1 percent decrease''.
    5. On page 41748, top of page--
    a. First column, second full paragraph--
    i. Line 6, the figure ``0.993142'' is corrected to read 
``0.993911''.
    ii. Line 7, the figure ``0.69 percent'' is corrected to read ``0.61 
percent''.
    b. Second column, first full paragraph--
    i. Line 1, the figure ``263'' is corrected to read ``253''.
    ii. Line 5, the figure ``0.993142'' is corrected to read 
``0.993911''.
    iii. Line 7, the figure ``0.2'' is corrected to read ``0.1''.
    iv. Line 22, the figure ``2.5'' is corrected to read ``2.4''.
    v. Line 30, the figure ``$121 million'' is corrected to read ``$123 
million''.
    6. On pages 41748 and 41749, the table titled ``FY 2019 IPPS 
ESTIMATED PAYMENTS DUE TO RURAL FLOOR WITH NATIONAL BUDGET NEUTRALITY'' 
is corrected to read as follows:

               FY 2019 IPPS Estimated Payments Due to Rural Floor With National Budget Neutrality
----------------------------------------------------------------------------------------------------------------
                                                                                  Percent change
                                                                     Number of      in payments
                                                                  hospitals that      due to
                      State                          Number of     would receive  application of  Difference (in
                                                     hospitals       the rural      rural floor     $ millions)
                                                                       floor        with budget
                                                                                    neutrality
                                                             (1)             (2)             (3)             (4)
----------------------------------------------------------------------------------------------------------------
Alabama.........................................              84               2            -0.3             $-5
Alaska..........................................               6               3             0.1               0
Arizona.........................................              56              33             1.3              26
Arkansas........................................              45               0            -0.3              -3
California......................................             297              59             0.4              42
Colorado........................................              45               9             0.7               9
Connecticut.....................................              30               8             1.3              21
Delaware........................................               6               0            -0.3              -2
Washington, DC..................................               7               0            -0.3              -2
Florida.........................................             168               7            -0.3             -20
Georgia.........................................             101               0            -0.3              -8
Hawaii..........................................              12               6            -0.1               0
Idaho...........................................              14               0            -0.3              -1
Illinois........................................             125               2            -0.3             -14
Indiana.........................................              85               0            -0.3              -7
Iowa............................................              34               0            -0.3              -3
Kansas..........................................              51               0            -0.2              -2
Kentucky........................................              64               0            -0.3              -5
Louisiana.......................................              90               0            -0.3              -5
Maine...........................................              17               0            -0.3              -2
Massachusetts...................................              56              29             3.3             123
Michigan........................................              94               0            -0.3             -14
Minnesota.......................................              49               0            -0.2              -6
Mississippi.....................................              59               0            -0.3              -3
Missouri........................................              72               0            -0.2              -6
Montana.........................................              13               1            -0.2              -1
Nebraska........................................              23               0            -0.3              -2
Nevada..........................................              22               3             0.4               3
New Hampshire...................................              13               8             2.4              14
New Jersey......................................              64               0            -0.4             -16
New Mexico......................................              24               2            -0.2              -1
New York........................................             149              16            -0.3             -21
North Carolina..................................              84               0            -0.3              -9
North Dakota....................................               6               3             0.4               1
Ohio............................................             130               7            -0.3             -11
Oklahoma........................................              79               2            -0.3              -4
Oregon..........................................              34               1            -0.2              -2
Pennsylvania....................................             150               3            -0.3             -17
Puerto Rico.....................................              51              11             0.1               0
Rhode Island....................................              11               0            -0.4              -1

[[Page 49850]]

 
South Carolina..................................              54               6            -0.1              -1
South Dakota....................................              17               0            -0.2              -1
Tennessee.......................................              90               6            -0.3              -7
Texas...........................................             310              13            -0.3             -18
Utah............................................              31               0            -0.3              -2
Vermont.........................................               6               0            -0.2               0
Virginia........................................              74               1            -0.2              -6
Washington......................................              48               3            -0.3              -7
West Virginia...................................              29               2            -0.2              -1
Wisconsin.......................................              66               5            -0.3              -5
Wyoming.........................................              10               2               0               0
----------------------------------------------------------------------------------------------------------------

    7. On pages 41750 and 41751, the table titled ``TABLE II--IMPACT 
ANALYSIS OF CHANGES FOR FY 2019 ACUTE CARE HOSPITAL OPERATING 
PROSPECTIVE PAYMENT SYSTEM [Payments per discharge]'' is corrected to 
read as follows:

    Table II--Impact Analysis of Changes for FY 2019 Acute Care Hospital Operating Prospective Payment System
                                            [Payments per discharge]
----------------------------------------------------------------------------------------------------------------
                                                                     Estimated       Estimated
                                                     Number of      average FY      average FY        FY 2019
                                                     hospitals     2018 payment    2019 payment       changes
                                                                   per discharge   per discharge
                                                             (1)             (2)             (3)             (4)
----------------------------------------------------------------------------------------------------------------
All Hospitals...................................           3,255          12,172          12,463             2.4
By Geographic Location:
    Urban hospitals.............................           2,483          12,508          12,819             2.5
    Large urban areas...........................           1,302          12,986          13,302             2.4
    Other urban areas...........................           1,181          12,049          12,355             2.5
    Rural hospitals.............................             772           9,193           9,307             1.2
Bed Size (Urban):
    0-99 beds...................................             644           9,945          10,113             1.7
    100-199 beds................................             763          10,399          10,623             2.2
    200-299 beds................................             433          11,384          11,650             2.3
    300-499 beds................................             424          12,606          12,917             2.5
    500 or more beds............................             219          15,449          15,893             2.9
Bed Size (Rural):
    0-49 beds...................................             305           7,826           7,897             0.9
    50-99 beds..................................             274           8,746           8,843             1.1
    100-149 beds................................             108           9,150           9,256             1.2
    150-199 beds................................              45           9,667           9,805             1.4
    200 or more beds............................              40          10,734          10,899             1.5
Urban by Region:
    New England.................................             113          13,491          14,131             4.7
    Middle Atlantic.............................             310          14,099          14,429             2.3
    South Atlantic..............................             401          11,145          11,372               2
    East North Central..........................             386          11,830          12,072               2
    East South Central..........................             147          10,517          10,742             2.1
    West North Central..........................             158          12,266          12,524             2.1
    West South Central..........................             379          11,310          11,574             2.3
    Mountain....................................             164          12,938          13,218             2.2
    Pacific.....................................             374          15,773          16,289             3.3
    Puerto Rico.................................              51           9,117           9,185             0.7
Rural by Region:
    New England.................................              20          12,613          12,728             0.9
    Middle Atlantic.............................              53           9,137           9,265             1.4
    South Atlantic..............................             122           8,497           8,598             1.2
    East North Central..........................             114           9,444           9,551             1.1

[[Page 49851]]

 
    East South Central..........................             150           8,142           8,285             1.8
    West North Central..........................              94          10,019          10,112             0.9
    West South Central..........................             145           7,844           7,958             1.5
    Mountain....................................              51          11,139          11,226             0.8
    Pacific.....................................              23          12,734          12,858               1
By Payment Classification:
    Urban hospitals.............................           2,264          12,276          12,557             2.3
    Large urban areas...........................           1,317          12,974          13,290             2.4
    Other urban areas...........................             947          11,325          11,559             2.1
    Rural areas.................................             991          11,833          12,155             2.7
Teaching Status:
    Nonteaching.................................           2,156          10,059          10,267             2.1
    Fewer than 100 residents....................             849          11,616          11,866             2.2
    100 or more residents.......................             250          17,680          18,220             3.1
Urban DSH:
    Non-DSH.....................................             520          10,533          10,748               2
    100 or more beds............................           1,462          12,643          12,939             2.3
    Less than 100 beds..........................             367           9,220           9,397             1.9
Rural DSH:
    SCH.........................................             255          10,239          10,313             0.7
    RRC.........................................             382          12,516          12,901             3.1
    100 or more beds............................              33          13,322          13,711             2.9
    Less than 100 beds..........................             236           7,300           7,410             1.5
Urban teaching and DSH:
    Both teaching and DSH.......................             805          13,783          14,112             2.4
    Teaching and no DSH.........................              89          11,402          11,664             2.3
    No teaching and DSH.........................           1,024          10,322          10,549             2.2
    No teaching and no DSH......................             346           9,951          10,125             1.7
Special Hospital Types:
    RRC.........................................             327          12,440          12,863             3.4
    SCH.........................................             311          11,126          11,219             0.8
    MDH.........................................             140           7,958           8,056             1.2
    SCH and RRC.................................             134          11,502          11,640             1.2
    MDH and RRC.................................              16          10,039          10,149             1.1
Type of Ownership:
    Voluntary...................................           1,898          12,323          12,624             2.4
    Proprietary.................................             856          10,658          10,879             2.1
    Government..................................             501          13,378          13,708             2.5
Medicare Utilization as a Percent of Inpatient
 Days:
    0-25........................................             602          14,927          15,266             2.3
    25-50.......................................           2,138          11,996          12,294             2.5
    50-65.......................................             421           9,817           9,985             1.7
    Over 65.....................................              73           7,271           7,450             2.5
FY 2019 Reclassifications by the Medicare
 Geographic Classification Review Board:
    All Reclassified Hospitals..................             859          12,226          12,572             2.8
    Non-Reclassified Hospitals..................           2,396          12,148          12,415             2.2
    Urban Hospitals Reclassified................             588          12,821          13,212             3.1
    Urban Nonreclassified Hospitals.............           1,835          12,349          12,629             2.3
    Rural Hospitals Reclassified Full Year......             271           9,566           9,710             1.5
    Rural Nonreclassified Hospitals Full Year...             454           8,750           8,821             0.8
    All Section 401 Reclassified Hospitals......             266          13,625          14,091             3.4
    Other Reclassified Hospitals (Section                     47           8,609           8,736             1.5
     1886(d)(8)(B)).............................
----------------------------------------------------------------------------------------------------------------

    8. On pages 41753 through 41754 the table titled ``MODELED 
UNCOMPENSATED CARE PAYMENTS FOR ESTIMATED FY 2019 DSHs BY HOSPITAL 
TYPE: MODEL UCP $ (IN MILLIONS) * FROM FY 2018 to FY 2019'' is 
corrected to read as follows:

[[Page 49852]]



  Modeled Uncompensated Care Payments for Estimated FY 2019 DSHs by Hospital Type: Model UCP $ (in Millions) *
                                             From FY 2018 to FY 2019
----------------------------------------------------------------------------------------------------------------
                                                   FY 2018 final
                                                      rule CN      FY 2019 final      Dollar
                                     Number of     estimated UCP  rule estimated  difference: FY  Percent change
                                  estimated DSHs       $ (in         UCP $ (in     2019- FY 2018        **
                                                     millions)       millions)     (in millions)
                                             (1)             (2)             (3)             (4)             (5)
----------------------------------------------------------------------------------------------------------------
Total...........................           2,447          $6,767          $8,273          $1,506           22.26
By Geographic Location:
    Urban Hospitals.............           1,953           6,422           7,802           1,380           21.49
    Large Urban Areas...........           1,046           3,847           4,706             859           22.33
    Other Urban Areas...........             907           2,575           3,096             521           20.22
    Rural Hospitals.............             494             345             471             126           36.64
Bed Size (Urban):
    0 to 99 Beds................             342             177             257              79           44.80
    100 to 249 Beds.............             860           1,519           1,903             384           25.28
    250+ Beds...................             751           4,726           5,642             916           19.39
    Bed Size (Rural):...........
    0 to 99 Beds................             365             164             229              64           39.19
    100 to 249 Beds.............             116             146             200              54           36.66
    250+ Beds...................              13              34              43               8           24.33
Urban by Region:
    New England.................              91             259             279              20            7.76
    Middle Atlantic.............             244           1,004           1,058              55            5.45
    South Atlantic..............             320           1,343           1,769             426           31.69
    East North Central..........             323             864           1,010             146           16.92
    East South Central..........             133             389             477              88           22.71
    West North Central..........             104             312             386              74           23.68
    West South Central..........             254             981           1,423             442           45.03
    Mountain....................             125             313             397              84           26.78
    Pacific.....................             318             874             899              25            2.88
    Puerto Rico.................              41              82             102              20           24.47
Rural by Region:
    New England.................               9              14              17               3           19.24
    Middle Atlantic.............              26              19              22               2           12.43
    South Atlantic..............              88              79             116              37           47.54
    East North Central..........              69              40              56              16           41.12
    East South Central..........             135              93             106              13           13.78
    West North Central..........              29              16              22               6           40.28
    West South Central..........             106              66             102              36           53.62
    Mountain....................              27              14              26              12           84.16
    Pacific.....................               5               4               5               1           24.85
By Payment Classification:
    Urban Hospitals.............           1,866           5,917           7,257           1,340           22.65
    Large Urban Areas...........           1,058           3,855           4,717             862           22.37
    Other Urban Areas...........             808           2,062           2,540             478           23.16
    Rural Hospitals.............             581             850           1,016             166           19.54
Teaching Status:
    Nonteaching.................           1,509           2,020           2,597             578           28.62
    Fewer than 100 residents....             694           2,246           2,744             498           22.17
    100 or more residents.......             244           2,501           2,931             430           17.20
Type of Ownership:
    Voluntary...................           1,447           4,137           4,895             758           18.32
    Proprietary.................             561           1,015           1,259             244           24.05
    Government..................             439           1,615           2,119             504           31.24
Medicare Utilization Percent:
 ***
    0 to 25.....................             472           2,255           2,720             464           20.60
    25 to 50....................           1,674           4,290           5,266             977           22.77
    50 to 65....................             262             215             276              61           28.34
    Greater than 65.............              36               7              11               4           56.55
----------------------------------------------------------------------------------------------------------------
Source: Dobson [verbar] DaVanzo analysis of 2013-2015 Hospital Cost Reports.
* Dollar UCP calculated by [0.75 * estimated section 1886(d)(5)(F) payments * Factor 2 * Factor 3]. When summed
  across all hospitals projected to receive DSH payments, uncompensated care payments are estimated to be $6,767
  million in FY 2018 and $8,273 million in FY 2019.
** Percentage change is determined as the difference between Medicare UCP payments modeled for the FY 2019 IPPS/
  LTCH PPS proposed rule (column 3) and Medicare UCP payments modeled for the FY 2018 IPPS/LTCH PPS final rule
  correction notice (column 2) divided by Medicare UCP payments modeled for the FY 2018 final rule correction
  notice (column 2) times 100 percent.
*** Hospitals with Missing or Unknown Medicare Utilization are not shown in table.

    9. On page 41754,
    a. Second column, first full paragraph,
    i. Line 5, the figure ``36.66'' is corrected to read ``36.64''.
    ii. Line 8, the figure ``21.48'' is corrected to read ``21.49''.

[[Page 49853]]

    b. Third column, first partial paragraph,
    i. Line 2, the figure ``39.52'' is corrected to read ``39.19''.
    ii. Line 5, the figure ``36.35'' is corrected to read ``36.66''
    iii. Line 7, the figure ``24.35'' is corrected to read ``24.33''.
    iv. Line 13, the figure ``44.83'' is corrected to read ``44.80''.
    v. Line 16, the figure ``25.23'' is corrected to read ``25.28''.
    vi. Line 19, the figure ``19.40'' is corrected to read ``19.39''.
    10. On page 41755, first column, second paragraph--
    a. Line 5, the figure ``22.14'' is corrected to read ``22.17''.
    b. Line 9, the figure ``17.23'' is corrected to read ``17.20''.
    c. Line 12, the figure ``31.26'' is corrected to read ``31.24''.
    d. Line 12, the figure ``24.06'' is corrected to read ``24.05''.
    e. Line 15, the figure ``18.30'' is corrected to read ``18.32''.
    11. On page 41756, bottom of the page--
    a. First column, before the first paragraph, the section heading 
``a. Effects of Proposed Changes for FY 2019'' is corrected to read 
``a. Effects of Changes for FY 2019''.
    b. Second column, last paragraph, line 1, the phrase ``The proposed 
estimated impacts'' is corrected to read ``The estimated impacts''.
    12. On pages 41758 through 41759, the table titled ``ESTIMATED 
PROPORTION OF HOSPITALS IN THE WORST-PERFORMING QUARTILE (>75th 
PERCENTILE) OF THE TOTAL HAC SCORES FOR THE FY 2019 HAC REDUCTION 
PROGRAM'' is corrected to read as follows:

  Estimated Proportion of Hospitals in the Worst-Performing Quartile (>75th Percentile) of the Total HAC Scores
                                      for the FY 2019 HAC Reduction Program
                                          [By hospital characteristic]
----------------------------------------------------------------------------------------------------------------
                                                                                     Number of      Percent of
                                                                                   hospitals in    hospitals in
                     Hospital characteristic                         Number of      the worst-      the worst-
                                                                     hospitals      performing      performing
                                                                                   quartile \a\    quartile \b\
----------------------------------------------------------------------------------------------------------------
Total \c\.......................................................           3,219             804            25.0
By Geographic Location (n = 3,201): \d\
    Urban hospitals.............................................           2,416             628            26.0
        1-99 beds...............................................             622             133            21.4
        100-199 beds............................................             728             182            25.0
        200-299 beds............................................             430             119            27.7
        300-399 beds............................................             278              80            28.8
        400-499 beds............................................             145              39            26.9
        500 or more beds........................................             213              75            35.2
    Rural hospitals.............................................             785             165            21.0
        1-49 beds...............................................             304              68            22.4
        50-99 beds..............................................             282              56            19.9
        100-149 beds............................................             116              22            19.0
        150-199 beds............................................              44              10            22.7
        200 or more beds........................................              39               9            23.1
By Safety-Net Status (n = 3,201): \e\
    Non-safety net..............................................           2,555             576            22.5
    Safety-net..................................................             646             217            33.6
By DSH Percent (n = 3,201): \f\
    0-24........................................................           1,313             292            22.2
    25-49.......................................................           1,507             366            24.3
    50-64.......................................................             198              75            37.9
    65 and over.................................................             183              60            32.8
By Teaching Status (n = 3,201): \g\
    Non-teaching................................................           2,121             484            22.8
    Fewer than 100 residents....................................             832             196            23.6
    100 or more residents.......................................             248             113            45.6
By Ownership (n = 3,173):
    Voluntary...................................................           1,868             466            24.9
    Proprietary.................................................             813             175            21.5
    Government..................................................             492             145            29.5
By MCR Percent (n = 3,175): \h\
    0-24........................................................             511             144            28.2
    25-49.......................................................           2,118             505            23.8
    50-64.......................................................             473             117            24.7
    65 and over.................................................              73              15            20.5
By Region (n = 3,217): \i\
    New England.................................................             133              43            32.3
    Mid-Atlantic................................................             364             101            27.7
    South Atlantic..............................................             522             133            25.5
    East North Central..........................................             498             108            21.7
    East South Central..........................................             299              68            22.7
    West North Central..........................................             256              57            22.3
    West South Central..........................................             519             114            22.0
    Mountain....................................................             229              60            26.2

[[Page 49854]]

 
    Pacific.....................................................             397             118            29.7
----------------------------------------------------------------------------------------------------------------
Source: FY 2019 HAC Reduction Program Final Rule Results are based on CMS PSI 90 Composite data from October
  2015 through June 2017 and CDC CLABSI, CAUTI, SSI, CDI, and MRSA results from January 2016 through December
  2017. Hospital Characteristics are based on the FY 2019 Hospital Inpatient Prospective Payment System (IPPS)
  Proposed Rule Impact File.
\a\ This column is the number of non-Maryland hospitals with a Total HAC Score within the corresponding
  characteristic that are estimated to be in the worst-performing quartile.
\b\ This column is the percent of non-Maryland hospitals within each characteristic that are estimated to be in
  the worst-performing quartile. The percentages are calculated by dividing the number of non-Maryland hospitals
  with a Total HAC Score in the worst-performing quartile by the total number of non-Maryland hospitals with a
  Total HAC Score within that characteristic.
\c\ The number of non-Maryland hospitals with a FY 2019 Total HAC Score (N=3,219). Note that not all hospitals
  have data for all hospital characteristics.
\d\ The number of hospitals that had information for geographic location with bed size, Safety-net status,
  Disproportionate Share Hospital (DSH) percent, teaching status, and ownership status (n=3,201).
\e\ A hospital is considered a Safety-net hospital if it is in the top quintile for DSH percent.
\f\ The DSH patient percentage is equal to the sum of (1) the percentage of Medicare inpatient days attributable
  to patients eligible for both Medicare Part A and Supplemental Security Income and (2) the percentage of total
  inpatient days attributable to patients eligible for Medicaid but not Medicare Part A.
\g\ A hospital is considered a teaching hospital if it has an Indirect Medical Education adjustment factor for
  Operation PPS (TCHOP) greater than zero.
\h\ Not all hospitals had data for MCR percent (n=3,175).
\i\ Not all hospitals had data for Region (n=3,217).

    13. On page 41763--
    a. Second column, fourth bullet, the figure ``0.9975'' is corrected 
to read ``0.9969''.
    b. Third column, first full paragraph, line 5, the figure ``3,256'' 
is corrected to read ``3,255''.
    14. On page 41764, third column--
    a. Line 12, the figure ``1.0'' is corrected to read ``1.1''.
    b. Line 14, the figure ``3.0'' is corrected to read ``2.9''.
    15. On pages 41764 through 41765, the table titled ``TABLE III--
COMPARISON OF TOTAL PAYMENTS PER CASE [FY 2018 payments compared to FY 
2019 payments]'' is corrected to read as follows:

                                Table III--Comparison of Total Payments per Case
                                 [FY 2018 payments compared to FY 2019 payments]
----------------------------------------------------------------------------------------------------------------
                                                                    Average FY      Average FY
                                                     Number of    2018 payments/  2019 payments/  Percent change
                                                     hospitals         case            case
----------------------------------------------------------------------------------------------------------------
By Geographic Location:
    All hospitals...............................           3,255            $943            $963             2.1
    Large urban areas (populations over 1                  2,483             974             997             2.3
     million)...................................
    Other urban areas (populations of 1 million            1,302           1,011           1,042             3.2
     of fewer)..................................
    Urban hospitals.............................           1,181             939             952             1.4
        0-99 beds...............................             644             789             812             3.0
        100-199 beds............................             763             835             854             2.4
        200-299 beds............................             433             902             922             2.2
        300-499 beds............................             424             981           1,003             2.2
        500 or more beds........................             219           1,170           1,197             2.3
    Rural hospitals.............................             772             666             659            -0.9
        0-49 beds...............................             305             541             556             2.6
        50-99 beds..............................             274             606             621             2.3
        100-149 beds............................             108             677             654            -3.3
        150-199 beds............................              45             729             706            -3.2
        200 or more beds........................              40             808             781            -3.3
By Region:
    Urban by Region.............................           2,483             974             997             2.3
        New England.............................             113           1,068           1,108             3.8
        Middle Atlantic.........................             310           1,069           1,090             2.0
        South Atlantic..........................             401             866             883             2.0
        East North Central......................             386             938             951             1.4
        East South Central......................             147             821             838             2.1
        West North Central......................             158             959             977             1.9
        West South Central......................             379             881             908             3.1
        Mountain................................             164           1,011           1,028             1.5
        Pacific.................................             374           1,238           1,281             3.4
        Puerto Rico.............................              51             447             455             1.7

[[Page 49855]]

 
    Rural by Region.............................             772             666             660            -0.9
        New England.............................              20             922             918            -0.5
        Middle Atlantic.........................              53             639             638            -0.3
        South Atlantic..........................             122             619             610            -1.4
        East North Central......................             114             675             671            -0.6
        East South Central......................             150             623             606            -2.6
        West North Central......................              94             706             704            -0.2
        West South Central......................             145             590             588            -0.3
        Mountain................................              51             742             752             1.2
        Pacific.................................              23             865             864            -0.5
By Payment Classification:
    All hospitals...............................           3,255             943             963             2.1
    Large urban areas (populations over 1                  1,317           1,010           1,042             3.2
     million)...................................
    Other urban areas (populations of 1 million              947             895             919             2.6
     of fewer)..................................
    Rural areas.................................             991             884             875            -1.1
Teaching Status:
    Non-teaching................................           2,156             800             816             1.9
    Fewer than 100 Residents....................             849             909             925             1.8
    100 or more Residents.......................             250           1,308           1,342             2.7
    Urban DSH:
        Non-DSH.................................             520             867             890             2.6
        100 or more beds........................           1,462             984           1,013             3.0
        Less than 100 beds......................             367             720             743             3.1
    Rural DSH:
        Sole Community (SCH/EACH)...............             255             680             681             0.1
        Referral Center (RRC/EACH)..............             382             947             931            -1.6
        Other Rural:
            100 or more beds....................              33           1,068           1,053            -1.4
            Less than 100 beds..................             236             530             543             2.4
    Urban teaching and DSH:
        Both teaching and DSH...................             805           1,055           1,087             3.1
        Teaching and no DSH.....................              89             912             934             2.4
        No teaching and DSH.....................           1,024             833             856             2.8
        No teaching and no DSH..................             346             847             871             2.8
Rural Hospital Types:
    Plain Rural.................................             178             831             831             0.0
    RRC/EACH....................................             327             968             960            -0.7
    SCH/EACH....................................             312             749             752             0.5
    SCH, RRC and EACH...........................             134             807             797            -1.3
Hospitals Reclassified by the Medicare
 Geographic Classification Review Board:
    FY2018 Reclassifications:
        All Urban Reclassified..................             588             995           1,006             1.1
        All Urban Non-Reclassified..............           1,835             966             996             2.9
        All Rural Reclassified..................             271             704             690            -1.8
        All Rural Non-Reclassified..............             454             613             615             0.2
        All Section 401 Reclassified Hospitals..             266           1,033           1,022            -1.1
        Other Reclassified Hospitals (Section                 47             651             661             1.6
         1886(d)(8)(B)).........................
    Type of Ownership:
        Voluntary...............................           1,898             959             976             1.8
        Proprietary.............................             856             851             871             2.3
        Government..............................             501             981           1,011             3.1
    Medicare Utilization as a Percent of
     Inpatient Days:
        0-25....................................             601           1,076           1,104             2.6
        25-50...................................           2,139             942             961             2.1
        50-65...................................             421             774             784             1.3
        Over 65.................................              73             567             582             2.7
----------------------------------------------------------------------------------------------------------------

    16. On page 41766,
    a. First column, last paragraph,
    i. Line 4, the figure ``41,579.65'' is corrected to read 
``$41,558.68''.
    ii. Line 8, the figure ``0.999713'' is corrected to read 
``0.999215''.
    b. Second column,
    i. First partial paragraph,
    A. Line 4, the figure ``0.990884'' is corrected to read 
``0.990878''.
    B. Line 12, the figure ``$40,759.12'' is corrected to read 
``$40,738.57''.
    ii. Second full paragraph, line 14, the figure ``0.999713'' is 
corrected to read ``0.999215''.
    iii. Last paragraph, line 7, the figure ``0.990884'' is corrected 
to read ``0.990878''.
    17. On page 41768, first column,
    a. Line 8, the figure ``41,579.65'' is corrected to read 
``$41,558.68''.
    b. Line 9, the figure ``40,759.12'' is corrected to read 
``$40,738.57''.

[[Page 49856]]

    18. On pages 41768 and 41769, the table entitled ``TABLE IV--IMPACT 
OF PAYMENT RATE AND POLICY CHANGES TO LTCH PPS PAYMENTS FOR LTCH PPS 
STANDARD FEDERAL PAYMENT RATE CASES FOR FY 2019'', is corrected to read 
as follows:

          Table IV--Impact of Payment Rate and Policy Changes to LTCH PPS Payments for LTCH PPS Standard Federal Payment Rate Cases for FY 2019
                                           [Estimated FY 2018 payments compared to estimated FY 2019 payments]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                          Percent change  Percent change
                                                                            Average FY      Average FY     due to change  due to changes  Percent change
                                                          Number of LTCH   2018 LTCH PPS   2019 LTCH PPS   to the annual   to area wage     due to all
           LTCH classification               Number of     PPS standard     payment per     payment per    update to the    adjustment       standard
                                               LTCHS       payment rate      standard        standard        standard        with wage     payment rate
                                                               cases       payment rate    payment rate    federal rate       budget        changes \4\
                                                                                                \1\             \2\       neutrality \3\
(1)                                                  (2)             (3)             (4)             (5)             (6)             (7)             (8)
--------------------------------------------------------------------------------------------------------------------------------------------------------
All Providers...........................             409          75,416         $46,852         $47,334             1.3               0             1.0
By Location:
    Rural...............................              21           2,457          39,339          39,714             1.3            -0.1             1.0
    Urban...............................             388          72,959          47,105          47,591             1.3               0             1.0
        Large...........................             195          40,491          50,164          50,740             1.3               0             1.1
        Other...........................             193          32,468          43,291          43,664             1.3               0             0.9
By Participation Date:
    Before Oct. 1983....................              11           1,923          43,083          43,225             1.3            -0.5             0.3
    Oct. 1983-Sept. 1993................              42           9,632          51,709          52,481             1.3             0.2             1.5
    Oct. 1993-Sept. 2002................             169          31,338          45,565          45,991             1.3               0             0.9
    After October 2002..................             187          32,523          46,877          47,347             1.3               0             1.0
By Ownership Type:
    Voluntary...........................              77          10,614          48,824          49,614             1.3             0.3             1.6
    Proprietary.........................             319          63,040          46,378          46,799             1.3            -0.1             0.9
    Government..........................              13           1,762          51,945          52,739             1.3             0.0             1.5
By Region:
    New England.........................              12           2,707          43,164          43,275             1.3            -0.4             0.3
    Middle Atlantic.....................              24           5,959          50,920          51,553             1.3            -0.1             1.2
    South Atlantic......................              66          13,792          47,641          48,127             1.3            -0.1             1.0
    East North Central..................              68          11,843          46,386          46,711             1.3            -0.3             0.7
    East South Central..................              36           6,385          45,490          45,978             1.3               0             1.1
    West North Central..................              28           4,412          45,951          46,428             1.3            -0.3             1.0
    West South Central..................             120          18,361          41,402          41,785             1.3             0.2             0.9
    Mountain............................              29           4,070          47,897          48,125             1.4            -0.5             0.5
    Pacific.............................              26           7,887          58,121          59,205             1.3             0.7             1.9
By Bed Size:
    Beds: 0-24..........................              43           4,206          44,740          45,008             1.3            -0.4             0.6
    Beds: 25-49.........................             185          26,270          44,623          45,044             1.3               0             0.9
    Beds: 50-74.........................             107          20,178          47,733          48,246             1.3               0             1.1
    Beds: 75-124........................              43          12,086          50,145          50,770             1.3             0.1             1.2
    Beds: 125-199.......................              22           7,709          47,404          47,768             1.3            -0.3             0.8
    Beds: 200+..........................               9           4,967          47,988          48,682             1.3             0.5             1.4
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\1\ Estimated FY 2019 LTCH PPS payments for LTCH PPS standard Federal payment rate criteria based on the payment rate and factor changes applicable to
  such cases presented in the preamble of and the Addendum to this final rule.
\2\ Percent change in estimated payments per discharge for LTCH PPS standard Federal payment rate cases from FY 2018 to FY 2019 for the annual update to
  the LTCH PPS standard Federal payment rate.
\3\ Percent change in estimated payments per discharge for LTCH PPS standard Federal payment rate cases from FY 2018 to FY 2019 for changes to the area
  wage level adjustment under Sec.   412.525(c) (as discussed in section V.B. of the Addendum to this final rule).
\4\ Percent change in estimated payments per discharge for LTCH PPS standard Federal payment rate cases from FY 2018 (shown in Column 4) to FY 2019
  (shown in Column 5), including all of the changes to the rates and factors applicable to such cases presented in the preamble and the Addendum to this
  final rule. We note that this column, which shows the percent change in estimated payments per discharge for all changes, does not equal the sum of
  the percent changes in estimated payments per discharge for the annual update to the LTCH PPS standard Federal payment rate (Column 6) and the changes
  to the area wage level adjustment with budget neutrality (Column 7) due to the effect of estimated changes in estimated payments to aggregate HCO
  payments for LTCH PPS standard Federal payment rate cases (as discussed in this impact analysis), as well as other interactive effects that cannot be
  isolated.

    19. On page 41769, lower two-thirds of the page--
    a. First column, last paragraph, line 13, the figure ``0.999713'' 
is corrected to read ``0.999215''.
    b. Second column,
    i. First partial paragraph, line 1, the figure ``0.999713'' is 
corrected to read ``0.999215''.
    ii. Last paragraph, line 16, the figure ``0.9'' is corrected to 
read ``1.0''.
    c. Third column, second full paragraph, line 5, the figure ``0.4'' 
is corrected to read ``0.3''.
    20. On page 41770, first column,
    a. First full paragraph, line 5, the word ``Pacific'' is corrected 
to read ``Mountain'',
    b. First full paragraph, line 7, the word ``Mountain'' is corrected 
to read ``Pacific'',
    c. First full paragraph, line 9, the figure ``0.4'' is corrected to 
read ``0.5'',
    d. Second full paragraph, line 9, the figure ``1.5'' is corrected 
to read ``1.4''.

    Dated: September 27, 2018.
Wilma M. Robinson,
Deputy Executive Secretary to the Department, Department of Health and 
Human Services.
[FR Doc. 2018-21500 Filed 9-28-18; 4:15 pm]
BILLING CODE 4120-01-P