Federal Register, Volume 84 Issue 195 (Tuesday, October 8, 2019)

[Federal Register Volume 84, Number 195 (Tuesday, October 8, 2019)]
[Rules and Regulations]
[Pages 53603-53630]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-21865]

[[Page 53603]]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 412, 413, and 495

[CMS-1716-CN2]
RIN 0938-AT73

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 2020 Rates; Quality
Reporting Requirements for Specific Providers; Medicare and Medicaid
Promoting Interoperability Programs Requirements for Eligible Hospitals
and Critical Access Hospitals; Correction

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

ACTION: Final rule; correction.

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SUMMARY: This document corrects technical and typographical errors in
the final rule that appeared in the August 16, 2019 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 2020 Rates; Quality Reporting Requirements for Specific Providers;
Medicare and Medicaid Promoting Interoperability Programs Requirements
for Eligible Hospitals and Critical Access Hospitals.''

DATES: Effective date: This correcting document is effective on October
7, 2019.
Applicability date: The corrections in this correcting document are
applicable to discharges occurring on or after October 1, 2019.

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

SUPPLEMENTARY INFORMATION:

I. Background

In FR Doc. 2019-16762 of August 16, 2019 (84 FR 42044) 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 corrections in this correcting document are applicable to
discharges occurring on or after October 1, 2019 as if they had been
included in the document that appeared in the August 16, 2019 Federal
Register.

II. Summary of Errors

A. Summary of Errors in the Preamble

On page 42190, we inadvertently omitted information about the
change in the manufacturer of ZEMDRI\TM\ (Plazomicin).
On page 42191, we made a typographical error in the maximum new
technology add-on payment for a case involving the use of GIAPREZA\TM\.
On pages 42208, we made typographical errors in the discussion
regarding the substantial clinical improvement criterion and
CABLIVI[supreg].
On pages 42264 through 42265, we are correcting technical errors
that have come to our attention in the description of certain data
relating to the GammaTile\TM\ technology, based on information provided
by the applicant.
On page 42338, due to conforming changes discussed in section II.B.
of this correcting document, we are correcting the transition budget
neutrality factor for the transition wage index policy.
On page 42372, we inadvertently omitted the final Factor 3 of the
uncompensated care payment methodology's cost-to-charge ratio (CCR)
``ceiling'' and the number of hospitals trimmed.
On page 42426, we made a typographical error in the discussion of
the change related to critical access hospital (CAH) payment for
ambulance services.
On pages 42459, 42466, 42472, 42474, and 42504, in the discussion
of the Hospital Inpatient Quality Reporting (IQR) Program, we made
typographical and technical errors in website and website-related
information.

B. Summary of Errors in the Addendum

We are correcting an error in the version 37 ICD-10 MS-DRG
assignment for some cases in the historical claims data in the FY 2018
MedPAR files used in the ratesetting for the FY 2020 IPPS/LTCH PPS
final rule, which resulted in inadvertent errors in the MS-DRG relative
weights (and associated average length-of-stay (LOS)). Additionally,
the version 37 MS-DRG assignment and relative weights are used when
determining total payments for purposes of all of the budget neutrality
factors and the final outlier threshold. As a result, the corrections
to the MS-DRG assignment under the ICD-10 MS-DRG Grouper version 37 for
some cases in the historical claims data in the FY 2018 MedPAR files
and the recalculation of the relative weights directly affected the
calculation of total payments and required the recalculation of all the
budget neutrality factors and the final outlier threshold.
In addition, as discussed in section II.D. of this correcting
document, we made certain 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 in 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.
We made an inadvertent error in the Medicare Geographic
Classification Review Board (MGCRB) reclassification status of one
hospital in the FY 2020 IPPS/LTCH PPS final rule. Specifically, one
hospital (CCN 330273) was treated as being reclassified under section
1886(d)(10) of the Act; however, its MGCRB reclassification had been
withdrawn. In addition, we made an inadvertent error in the application
of the rural floor to one hospital (CCN 220016), in that we assigned
this hospital the rural wage index rather than the rural floor (Note:
As finalized in the FY 2020 IPPS/LTCH PPS final rule (84 FR 42332
through 42336) the calculation of the rural floor does not include the
wage data of urban hospitals reclassified as rural under section
1886(d)(8)(E) of the Act (as implemented at Sec. 412.103).) We also
made inadvertent errors related to the application of the out-migration
adjustment under section 1886(d)(13) of the Act. Specifically, in the
FY 2020 IPPS/LTCH PPS final rule, we inadvertently applied the out-
migration adjustment to hospitals that received an MGCRB
reclassification to their home area. Additionally, the final FY 2020
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 (corrections to the MS-DRG assignment for some cases in the
historical claims data and the resulting recalculation of

[[Page 53604]]

the relative weights and average length of stay, revisions to Factor 3
of the uncompensated care payment methodology, the correction to the
MGCRB reclassification status of one hospital, correction of the
application of the rural floor to one hospital, and the correction in
the application of the out-migration adjustment to certain hospitals
with a geographic reclassification), we recalculated all IPPS budget
neutrality adjustment factors, the fixed-loss cost threshold, the final
wage indexes (and geographic adjustment factors (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 resulting from the correction of
this combination of errors.) Therefore, we made conforming changes to
the following:
On pages 42621 and 42636, the MS-DRG reclassification and
recalibration budget neutrality adjustment factor.
On page 42621, the reclassification hospital budget
neutrality adjustment. (We note that although we recalculated the
updated wage index budget neutrality adjustment, that factor did not
change as a result of the recalculation.)
On page 42622, the rural floor budget neutrality
adjustment and the lowest quartile wage index budget neutrality
adjustment.
On page 42623, the transition budget neutrality
adjustment.
On page 42625, the calculation of the estimated percentage
of FY 2020 capital outlier payments, the estimated total Federal
capital payments and the estimated capital outlier payments.
On page 42630, the calculation of the outlier fixed-loss
cost threshold, total operating Federal payments, total operating
outlier payments, the estimated percentage of capital outlier payments,
the outlier adjustment to the capital Federal rate and the related
discussion of the percentage estimates of operating and capital outlier
payments.
On pages 42632 through 42634, the table titled ``Changes
from FY 2019 Standardized Amounts to the FY 2020 Standardized
Amounts''.
On page 42624, we inadvertently omitted the discussion of
incorporating a projection of operating outlier payment reconciliations
for the FY 2020 outlier threshold calculation.
On page 42632, in the table titled ``Changes from FY 2019
Standardized Amounts to the FY 2020 Standardized Amounts'', we are also
correcting the typographical errors in the Nonlabor percentage (If Wage
Index is Greater Than 1.0000) and in the FY 2020 Update factor.
On pages 42637 through 42640, 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 adjustment to 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 table showing the comparison of
factors and adjustments for the FY 2019 capital Federal rate and FY
2020 capital Federal rate.
On page 42641, we made typographical errors in the LTCH standard
Federal payment rate.
On page 42648, we are making conforming changes to the fixed-loss
amount for FY 2020 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 42651 and 42652, we are making conforming corrections to
the 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 previously described.
On page 42652, we made a typographical error in the LTCH PPS
standard Federal payment rate (reduced update) in Table 1E.

C. Summary of Errors in the Appendices

On pages 42657 through 42662, 42664 through 42669, and 42684
through 42686 in our regulatory impact analyses, we have made
conforming corrections to the factors, values, and tables and
accompanying discussion of the changes in operating and capital IPPS
payments for FY 2020 and the effects of certain IPPS budget neutrality
factors as a result of the technical errors that lead to changes in our
calculation of the operating and capital IPPS budget neutrality
factors, outlier threshold, final wage indexes, operating standardized
amounts, and capital Federal rate (as described in section II.B. of
this correcting document).
These conforming corrections include changes to the following
tables:
On pages 42657 through 42660, the table titled ``Table I--
Impact Analysis of Changes to the IPPS for Operating Costs for FY
2020''.
On pages 42664 through 42666, the table titled
``Comparison of FY 2019 and FY 2020 IPPS Estimated Payments Due to
Rural Floor with National Budget Neutrality''.
On pages 42668 through 42669, the table titled ``Table
II--Impact Analysis of Changes for FY 2020 Acute Care Hospital
Operating Prospective Payment System (Payments per discharge)''.
On pages 42685 through 42686, the table titled ``Table
III--Comparison of Total Payments per Case [FY 2019 payments compared
to FY 2020 payments]''.
On pages 42671 through 42675, we are correcting the discussion of
the ``Effects of the Changes to Medicare DSH and Uncompensated Care
Payments for FY 2020'' for purposes of the Regulatory Impact Analysis
in Appendix A of the FY 2020 IPPS/LTCH PPS final rule, including the
table titled ``Modeled Uncompensated Care Payments for Estimated FY
2020 DSHs by Hospital Type: Model Uncompensated Care Payments ($ in
Millions)--from FY 2019 to FY 2020'' on pages 42672 through 42674, in
light of the corrections discussed in section II.D. of this correcting
document.

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 page 42651 of the FY 2020 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/index.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 2020. The
correction of the error (as discussed in section II.B. of this
correcting document) related to one hospital's MGCRB reclassification
status, the correction of the application of the rural floor to one
hospital, and the correction of the application of the out-migration
adjustment to hospitals that reclassified to their home area
necessitated the recalculation of the FY 2020 wage indexes. Also, the
corrections to the version 37 MS-DRG assignment for some cases in the
historical claims data and the resulting recalculation of the

[[Page 53605]]

relative weights and ALOS (as discussed in section II.B. of this
correcting document), corrections to Factor 3 of the uncompensated care
payment methodology, and recalculation of the FY 2020 wage indexes
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 for all hospitals in the
columns titled ``FY 2020 Wage Index Prior to Quartile and Transition'',
``FY 2020 Wage Index With Quartile'', and ``FY 2020 Wage Index With
Quartile and Cap''.
For the hospital (CCN 330273) for which we are correcting its MGCRB
reclassification status (as discussed in section II.B. of this
correcting document), we are also correcting the columns titled
``Reclassified/Redesignated CBSA'' and ``MGCRB Reclass''. For the
hospitals that reclassified to their home area for which we
inadvertently applied the out-migration adjustment, as discussed in
section II.B. of this correcting document), we are also correcting the
column titled ``Out-Migration Adjustment''.
Table 3.--Wage Index Table by CBSA--FY 2020. Corrections to the
version 37 MS-DRG assignment for some cases in the historical claims
data and the resulting recalculation of the relative weights and ALOS,
corrections to Factor 3 of the uncompensated care payment methodology,
and the correction of the reclassification, rural floor application and
outmigration adjustment errors (discussed in section II.B. of this
correcting document) necessitated the recalculation of the rural floor
budget neutrality factor and the FY 2020 wage indexes (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'', ``GAF'', ``Reclassified Wage Index'',
``Reclassified GAF'', ``State Rural Floor'', ``Eligible for Rural Floor
Wage Index'', ``Pre-Frontier and/or Pre-Rural Floor Wage Index'',
``Reclassified Wage Index Eligible for Frontier Wage Index'',
``Reclassified Wage Index Eligible for Rural Floor Wage Index'', and
``Reclassified Wage Index Pre-Frontier and/or Pre-Rural Floor''.
Additionally, some of the labels for the area names of the rural
CBSAs were displayed incorrectly (the area name did not correspond to
the CBSA code in the column titled ``CBSA''). Therefore, we are
correcting the column titled ``Area Name'' for the affected CBSAs.
Also, there were technical errors in the calculation of the FY 2020
average hourly wage and 3-year average hourly wage for some CBSAs, and
therefore, we are correcting the columns titled ``FY 2020 Average
Hourly Wage'' and ``3-Year Average Hourly Wage (2018, 2019, 2020)'' for
the affected CBSAs. Specifically, we inadvertently counted the salaries
and hours of multicampus hospitals twice when calculating the FY 2020
average hourly wage and 3-year average hourly wage for the CBSAs that
include those hospitals, and some providers were inadvertently not
assigned to a CBSA when we calculated the 3-year average hourly wage.
We also inadvertently did not display the wage index of 1.0000 in the
state rural floor for some states that are eligible for the Frontier
wage index. Therefore, we are correcting the column titled ``State
Rural Floor'' for the affected CBSAs. (Note: As stated in the FY 2020
IPPS/LTCH PPS Final Rule (84 FR 42312), section 10324 of Public Law
111-148 requires that hospitals in frontier States cannot be assigned a
wage index of less than 1.0000.)
Table 5.--List of Medicare Severity Diagnosis-Related Groups (MS-
DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean
Length of Stay--FY 2020. We are correcting this table to reflect the
recalculation of the relative weights, geometric average length-of-stay
(LOS), and arithmetic mean LOS as a result of the corrections to the
version 37 MS-DRG assignment for some cases in the historical claims
data used in the calculations (as discussed in section II.B. of this
correcting document).
Table 7B.--Medicare Prospective Payment System Selected Percentile
Lengths of Stay: FY 2018 MedPAR Update--March 2019 GROUPER Version 37
MS-DRGs. We are correcting this table to reflect the recalculation of
the relative weights, geometric average length-of-stay (LOS), and
arithmetic mean LOS as a result of the corrections to the version 37
MS-DRG assignment for some cases in the historical claims data used in
the calculations (as discussed in section II.B. of this correcting
document).
Table 18.--FY 2020 Medicare DSH Uncompensated Care Payment Factor
3. We are correcting this table to reflect corrections to the Factor 3
calculations for purposes of determining uncompensated care payments
for the FY 2020 IPPS/LTCH PPS final rule for the following reasons:
To correct the Factor 3s that were computed for hospitals
where a MAC had accepted an amended report, reopened a report, and/or
adjusted uncompensated care cost data on a report, but the corrected
uncompensated care data were inadvertently omitted from the June 30,
2019 extract of the Healthcare Cost Report Information System (HCRIS).
To correct for the inadvertent inclusion of terminated
hospitals in the Factor 3 calculations.
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; accordingly, we have also revised these amounts for all DSH-
eligible hospitals. 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 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 2020'' for purposes of the
Regulatory Impact Analysis in Appendix A of the FY 2020 IPPS/LTCH PPS
final rule to reflect the corrections discussed previously.
We also are correcting the errors in the IPPS files described below
that are available on the internet on the CMS website at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software.html. The files
that are available on the internet have been updated to reflect the
corrections discussed in this correcting document.
We are correcting the erroneous designation of the following ten
ICD-10-CM diagnosis codes as a HAC within HAC 05: Falls and Trauma for
FY 2020 in the ICD-10 MS-DRG Definitions Manual Version 37 Appendix I
Hospital Acquired Conditions (HACs) List and the ICD-10 MS-DRG Grouper
Mainframe Software Version 37: S02.121K (Fracture of orbital roof,
right side, subsequent encounter for fracture with nonunion); S02.122K
(Fracture of orbital roof, left side, subsequent encounter for fracture
with nonunion); S02.129K (Fracture of orbital roof,

[[Page 53606]]

unspecified side, subsequent encounter for fracture with nonunion);
S02.831K (Fracture of medial orbital wall, right side, subsequent
encounter for fracture with nonunion); S02.832K (Fracture of medial
orbital wall, left side, subsequent encounter for fracture with
nonunion); S02.839K (Fracture of medial orbital wall, unspecified side,
subsequent encounter for fracture with nonunion); S02.841K (Fracture of
lateral orbital wall, right side, subsequent encounter for fracture
with nonunion); S02.842K (Fracture of lateral orbital wall, left side,
subsequent encounter for fracture with nonunion); S02.849K (Fracture of
lateral orbital wall, unspecified side, subsequent encounter for
fracture with nonunion) and S02.85XK (Fracture of orbit, unspecified,
subsequent encounter for fracture with nonunion). We have corrected the
ICD-10 MS-DRG Definitions Manual Version 37 and the ICD-10 MS-DRG
Grouper Mainframe Software Version 37 to correctly reflect that these
diagnosis codes are not defined as HACs for MS-DRG assignment for FY
2020.

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. This document corrects technical and typographical
errors in the preamble, addendum, payment rates, tables, and appendices
included or referenced in the FY 2020 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 2020 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 2020 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 2020
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. 2019-16762 of August 16, 2019 (84 FR 42044), we are
making the following corrections:

A. Corrections of Errors in the Preamble

1. On page 42190, second column, second full paragraph, lines 1
through 4, the sentence ``Achaogen, Inc. submitted an application for
new technology add-on payments for ZEMDRI\TM\ (Plazomicin) for FY
2019.'' is corrected to read ``Achaogen, Inc. submitted an application
for new technology add-on payments for ZEMDRI\TM\ (Plazomicin) for FY
2019 (we note that Cipla USA Inc. has since acquired
ZEMDRI^TM (Plazomicin) from Achaogen Inc.)''
2. On page 42191, third column, first partial paragraph, line 2,
the figure ``$4,083.75'' is corrected to read ``$1,950.''
3. On page 42208,
a. First column, second full paragraph, line 18 (last line), the
term ``comparing'' is corrected to read ``compared''.
b. Second column, fifth full paragraph, line 1, the phrase ``all
the'' is corrected to read ``all of the''.
4. On page 42264, third column, first full paragraph, lines 12
through 16, the sentence ``The applicant stated that they collaborated
with a biostatistics firm to advise to ensure the analysis of their
data meets the highest standards.'' is corrected to read ``The
applicant stated that they collaborated with a biostatistics firm to
ensure the analysis of their data meets the highest standards.''.
5. On page 42265,
a. First column,
i. First full paragraph,
A. Line 8, the phrase ``performed on 79 patients'' is corrected to
read ``performed on 74 patients with 79 tumors''.
B. Lines 30 through 33, the sentence ``Based on the data, there was
no statistically significant difference between the control arm
treatment and GammaTile\TM\ treatment.'' is corrected to read ``There
was a statistically significant difference between the control arm
treatment and GammaTile\TM\ treatment for patients with recurrent
meningioma and brain metastases and no statistically significant
difference between the control arm treatment and GammaTile\TM\
treatment for patients with recurrent high-grade glioma.''.
ii. Second paragraph, lines 2 and 3, the phrase ``the initial 20 of
79 patients'' is corrected to read ``the initial 19 patients (with 20
tumors) of the 74 patients''.
b. Second column, first partial paragraph, lines 17 through 33, the
sentences ``While we acknowledge the difficulty in establishing
randomized control groups in studies involving recurrent brain tumors,
after careful review of all data received to date, we find the data did
not show a statistically significant difference between the time to
first recurrence in the control arm in comparison to the time to second
recurrence in the GammaTile\TM\ treatment arm. Based on the information
stated above, we are unable to make a determination that GammaTile\TM\
technology represents a substantial

[[Page 53607]]

clinical improvement over existing therapies.'' are corrected to read
``While we acknowledge the difficulty in establishing randomized
control groups in studies involving recurrent brain tumors, based on
the information stated above, we are unable to make a determination
that GammaTile\TM\ technology represents a substantial clinical
improvement over existing therapies.''.
6. On page 42338, second column, first full paragraph, line 14, the
figure ``0.998838'' is corrected to read ``0.998835''.
7. On page 42379, second column, first full paragraph, the last
line is corrected by adding the parenthetical sentence ``(For the final
rule, this trim removed 5 hospitals that have a CCR above the
calculated ceiling of 1.082 for FY 2015 cost reports.)''.
8. On page 42426, second column, first full paragraph, line 9, the
phrase ``its community'' is corrected to read ``its community.''.
9. On page 42459, first column, footnote paragraph (footnote 395),
the website ``https://ecqi.healthit.gov/ecqi-tools-key-resources/content/vsac)'' is corrected to read ``https://ecqi.healthit.gov/tool/
vsac''.
10. On page 42466, second column, footnote paragraph (footnote
447), the website title ``2015 Considerations for Implementing Measures
in Federal Programs: Hospitals'' is corrected to read ``Spreadsheet of
MAP 2015 Final Recommendations''.
11. On page 42472, third column, footnote paragraph (footnote 473),
the published date ``2013'' is corrected to read ``2015''.
12. On page 42474, second column, footnote paragraph (footnote
478), the website title ``2015 Considerations for Implementing Measures
in Federal Programs: Hospitals'' is corrected to read ``Spreadsheet of
MAP 2015 Final Recommendations''.
13. On page 42504, third column, footnote paragraph (footnote 663),
the website ``https://ecqi.healthit.gov/content/about-ecqi'' is
corrected to read ``https://ecqi.healthit.gov/about-ecqi.''.

B. Correction of Errors in the Addendum

1. On page 42621,
a. First column, last bulleted paragraph, line 17 and line 22, the
figure ``0.997649'' is corrected to read ``0.996859''.
b. Third column, last paragraph, line 11, the figure ``0.985425''
is corrected to read ``0.985447''.
2. On page 42622,
a. First column, last full paragraph, line 3, the figure
``0.997081'' is corrected to read ``0.997073''.
b. Third column, first bullet, last line, the figure ``0.997987''
is corrected to read ``0.997984''.
3. On page 42623, first column, first full paragraph, line 5, the
figure ``0.998838'' is corrected to read ``0. 998835''.
4. On page 42624, second column,
a. Second full paragraph (immediately under the section heading
``(a) Incorporating a Projection of Outlier Payment Reconciliations for
the FY 2020 Outlier Threshold Calculation''), the sentence ``We
proposed the following methodology to incorporate a projection of
outlier payment reconciliations for the FY 2020 outlier threshold
calculation.'' is corrected to read ``We proposed the following
methodology to incorporate a projection of operating outlier payment
reconciliations for the FY 2020 outlier threshold calculation.''.
b. Before the second partial paragraph which begins with the phrase
``Step 1.'' the language is corrected by adding the following
paragraphs to read as follows:
``Step 1.--Use the Federal FY 2014 cost reports for hospitals paid
under the IPPS from the most recent publicly available quarterly HCRIS
extract available at the time of development of the proposed rule and
final rules, and exclude sole community hospitals (SCHs) that were paid
under their hospital-specific rate (that is, if Worksheet E, Part A,
Line 48 is greater than Line 47 in the applicable columns.) In the
proposed rule, we stated that we used the December 2018 HCRIS extract
for the proposed rule and that we expected to use the March 2019 HCRIS
extract for the FY 2020 final rule.
Step 2.--Calculate the aggregate amount of historical total of
operating outlier reconciliation dollars (Worksheet E, Part A, Line
2.01) using the Federal FY 2014 cost reports from Step 1.
Step 3.--Calculate the aggregate amount of total Federal operating
payments using the Federal FY 2014 cost reports from Step 1. The total
Federal operating payments consist of the Federal payments (Worksheet
E, Part A, Line 1.01 and Line 1.02, plus Line 1.03 and Line 1.04),
outlier payments (Worksheet E, Part A, Line 2 and Line 2.02), and the
outlier reconciliation payments (Worksheet E, Part A, Line 2.01). We
note that a negative amount on Worksheet E, Part A, Line 2.01 for
outlier reconciliation indicates an amount that was owed by the
hospital, and a positive amount indicates this amount was paid to the
hospital.
Step 4.--Divide the amount from Step 2 by the amount from Step 3
and multiply the resulting amount by 100 to produce the percentage of
total operating outlier reconciliation dollars to total Federal
operating payments for FY 2014. This percentage amount would be used to
adjust the outlier target for FY 2020 as described in Step 5.
Step 5.--Because the outlier reconciliation dollars are only
available on the cost reports, and not in the Medicare claims data in
the MedPAR file used to model the outlier threshold, we proposed to
target 5.1 percent minus the percentage determined in Step 4 in
determining the outlier threshold. Using the FY 2014 cost reports based
on the December 2018 HCRIS extract (as used for the proposed rule),
because the aggregate outlier reconciliation dollars from Step 2 are
negative, we targeted an amount higher than 5.1 percent for outlier
payments for FY 2020 under our proposed methodology.
For the FY 2020 proposed rule, based on December 2018 HCRIS, 16
hospitals had an outlier reconciliation amount recorded on Worksheet E,
Part A, Line 2.01 for total operating outlier reconciliation dollars of
negative $24,433,087 (Step 2). The total Federal operating payments
based on the December 2018 HCRIS was $82,969,541,296 (Step 3). The
ratio (Step 4) was a negative 0.029448 percent, which, when rounded to
the second digit, was negative 0.03 percent. Therefore, for FY 2020, we
proposed to incorporate a projection of outlier reconciliation dollars
by targeting an outlier threshold at 5.13 percent [5.1 percent-(-0.03
percent)]. When the percentage of operating outlier reconciliation
dollars to total Federal operating payments is negative (such is the
case when the aggregate amount of outlier reconciliation is negative),
the effect is a decrease to the outlier threshold compared to an
outlier threshold that is calculated without including this estimate of
operating outlier reconciliation dollars. In section II.A.4.i.(2) of
the Addendum to the proposed rule, we provided the FY 2020 outlier
threshold as calculated for the proposed rule both with and without
including this proposed percentage estimate of operating outlier
reconciliation.
As explained earlier, we stated in the proposed rule that we
believe this is an appropriate method to include outlier reconciliation
dollars in the outlier model because it uses the total outlier
reconciliation dollars based on historic data rather than predicting
which specific hospitals will have outlier payments reconciled for FY
2020. However, we stated we would continue to use a 5.1 percent target
(or an outlier offset factor of 0.949) in calculating the outlier
offset to the standardized

[[Page 53608]]

amount. In the past, the outlier offset was six decimals because we
targeted and set the threshold at 5.1 percent by adjusting the
standardized amount by the outlier offset until operating outlier
payments divided by total operating Federal payments plus operating
outlier payments equaled approximately 5.1 percent (this approximation
resulted in an offset beyond three decimals). However, we stated that
under our proposed methodology, we believed a three decimal offset of
0.949 reflecting 5.1 percent is appropriate rather than the unrounded
six decimal offset that we have calculated for prior fiscal years.
Specifically, as discussed in section II.A.5. of the Addendum in the
proposed rule, we proposed to determine an outlier adjustment by
applying a factor to the standardized amount that accounts for the
projected proportion of total estimated FY 2020 operating Federal
payments paid as outliers. Our proposed modification to the outlier
threshold methodology was designed to adjust the total estimated
outlier payments for FY 2020 by incorporating the projection of
negative outlier reconciliation. That is, under our proposal, total
estimated outlier payments for FY 2020 would be the sum of the
estimated FY 2020 outlier payments based on the claims data from the
outlier model and the estimated FY 2020 total operating outlier
reconciliation dollars. We stated that we believe the proposed
methodology would more accurately estimate the outlier adjustment to
the standardized amount by increasing the accuracy of the calculation
of the total estimated FY 2020 operating Federal payments paid as
outliers. We stated that in other words, the net effect of our outlier
proposal to incorporate a projection for outlier reconciliation dollars
into the threshold methodology would be that FY 2020 outlier payments
(which include the estimated recoupment percentage for FY 2020
calculated for the proposed rule of 0.03 percent) would be 5.1 percent
of total operating Federal payments plus total outlier payments.
Therefore, we stated the operating outlier offset to the standardized
amount is 0.949 (1-0.051).
In the FY 2020 IPPS/LTCH PPS proposed rule, we stated that,
although we were not making any proposals with respect to the
methodology for FY 2021 and subsequent fiscal years, the above-
described proposed methodology could advance by 1 year the cost reports
used to determine the historical outlier reconciliation (for example,
for FY 2021, the FY 2015 outlier reconciliations would be expected to
be complete). We stated that we were considering additional options in
order to have available more recent estimates of outlier reconciliation
for future rulemaking.
We invited public comment on our proposed methodology for
projecting the estimate of outlier reconciliation and incorporating
that estimate into the modeling for the fixed-loss cost outlier
threshold.
Comment: Some commenters supported the methodology and stated that
they were able to replicate the CMS calculation of the adjustment based
on the outlier reconciliations reported in the cost reports. A
commenter requested that CMS confirm the steps taken in calculating the
reconciliation amount included the following steps: (1) Exclude
Maryland hospitals from the analysis; (2) base the list of IPPS
providers on all Medicare participating providers in FY 2014 and do not
restrict consideration to only current IPPS providers; (3) if a
provider has multiple cost reports, use all of them; and (4) if there
were multiple columns for the line in the cost report, only the first
column should be used. The commenter also requested that CMS describe
any other steps it took in the analysis.
Some commenters raised concerns with the completeness of outlier
reconciliations and/or finalized cost reports. The commenters
recommended that an earlier cost report year (FY 2012 or FY 2013) be
used instead of the FY 2014 cost report year as proposed. One commenter
stated that in their review of FY 2012 through FY 2014 cost reports for
completeness, there were no changes in HCRIS to the FY 2012 cost
reports during the last year, yet their analysis of FY 2013 cost report
showed several changes in 2019. The commenter was concerned that the FY
2014 reconciliations in the cost report are still subject to change and
suggested CMS use FY 2012 data for purposes of the FY 2020 outlier
threshold calculation. Another commenter that recommended CMS use FY
2013 cost reports stated that FY 2013 cost reports likely provided more
audited cost reports, even though they were less current.
Response: We thank the commenters for their support and input on
the proposed methodology.
Regarding the commenter who requested clarification on specific
methodology steps, as noted in the proposed rule, in Step 1, we used
the Federal FY 2014 cost reports for hospitals paid under the IPPS, and
therefore excluded hospitals not paid under the IPPS, such as Maryland
hospitals and cancer hospitals. Also, we did not restrict the data
included to only current IPPS providers; specifically, we used all cost
reports with a begin date in the Federal fiscal year 2014 including if
a hospital had multiple cost reports during the fiscal year. For the
request for clarification on multiple columns for a line in the cost
report, when there were multiple columns available and the provider was
paid under the IPPS for that period of the cost report, then we believe
it is appropriate to use multiple columns, as the multiple columns are
needed to fully represent the relevant IPPS payment amounts. For
example, where there were geographic reclassifications in different
periods of the cost report and/or SCH/MDH status in different periods
of the cost report, which are two of the reasons for multiple columns,
we believe all such columns should be used to determine the IPPS
payment amounts. We note the proposed rule calculation inadvertently
did not incorporate the multiple columns, however these multiple
columns have been used in projecting the estimated outlier
reconciliation for this final rule.
Regarding the comments on using an earlier cost report year instead
of the proposed FY 2014, we note that the proposed rule used data from
16 hospitals and the final rule is using data from 22 hospitals. As
stated above, we believe that many of the reasons aside from outlier
reconciliation that resulted in a delay in the cost reports being final
settled have now been resolved. Additionally, as stated above, we
believe that the updated FY 2014 cost reports for the final rule
provide the most recent and complete available data to project the
estimate of operating outlier reconciliation, while the commenters'
recommended approach would use data for earlier years. We also note
that the March 2019 HCRIS, includes approximately 92 percent of
finalized FY 2014 cost reports while the March 2019 HCRIS for FY 2013
includes approximately 95 percent of finalized FY 2013 cost reports.
Given the very small percentage variance in finalized cost reports from
FY 2013 to 2014 in the March 2019 HCRIS, we believe it would be more
accurate to use the more recent data based on FY 2014 cost reports.
Given the amount of time that has passed since FY 2012 cost reports,
which is 8 years prior to the upcoming fiscal year, we believe any
additional incremental increase in the percentage of finalized cost
reports for FY 2012 is outweighed by using the more recent FY 2014 cost
reports because they would more accurately project the estimate of
operating outlier reconciliation.

[[Page 53609]]

The March 2019 HCRIS contained data for 20 hospitals. While we
proposed to use the March 2019 HCRIS extract to calculate the
reconciliation adjustment for this FY 2020 IPPS final rule, data for
two additional outlier reconciliations were made available to CMS
outside of the March 2019 HCRIS update. We believe including these two
hospitals will lend additional accuracy to project the estimate of
operating outlier reconciliation used in the calculation of the outlier
threshold. Therefore, in order to use the most complete data for FY
2014 cost reports, we are using the March 2019 HCRIS extract,
supplemented by these two additional hospitals' data for this FY 2020
IPPS final rule. We expect to use the March HCRIS for the final rule
for future rulemaking, as we generally expect historical cost reports
for the applicable fiscal year to be available by March. The following
table shows the March 2019 HCRIS with the addition of two hospitals'
outlier reconciliation data for this final rule
[GRAPHIC] [TIFF OMITTED] TR08OC19.000

After consideration of the comments received, and for the reasons
discussed in the proposed rule and in this final rule, we are
finalizing the methodology described above for incorporating the
outlier reconciliation in the outlier threshold calculation. Therefore,
for this final rule we used the same steps described above and in the
proposed rule to incorporate a projection of operating outlier payment
reconciliations for the calculation of the FY 2020 outlier threshold
calculation.
For this FY 2020 final rule, based on the March 2019 HCRIS and
supplemental data for two hospitals, 22 hospitals had an outlier
reconciliation amount recorded on Worksheet E, Part A, Line 2.01 for
total operating outlier reconciliation dollars of negative $35,136,843
(Step 2). The total Federal operating payments based on the March 2019
HCRIS is $84,051,485,178 (Step 3). The ratio (Step 4) is a negative
0.041804 percent, which, when rounded to the second digit, is negative
0.04 percent. Therefore, for FY 2020, using the finalized methodology,
we incorporated a projection of outlier reconciliation dollars by
targeting an outlier threshold at 5.14 percent [5.1 percent-(-.04
percent)]. As noted above, when the percentage of operating outlier
reconciliation dollars to total Federal operating payments is negative
(such is the case when the aggregate amount of outlier reconciliation
is negative), the effect is a decrease to the outlier threshold
compared to an outlier threshold that is calculated without including
this estimate of operating outlier reconciliation dollars. In section
II.A.4.i.(2) of this Addendum of this final rule, we provide the FY
2020 outlier threshold as calculated both with and without including
this percentage estimate of operating outlier reconciliation.
(b) Reducing the FY 2020 Capital Standard Federal Rate by an Adjustment
Factor To Account for the Projected Proportion of Capital IPPS Payments
Paid as Outliers
We establish an outlier threshold that is applicable to both
hospital inpatient operating costs and hospital inpatient capital
related costs (58 FR 46348). Similar to the calculation of the
adjustment to the standardized amount to account for the projected
proportion of operating payments paid as outlier payments, as discussed
in greater detail in section III.A.2. of the Addendum in the proposed
rule and this final rule, we proposed to reduce the FY 2020 capital
standard Federal rate by an adjustment factor to account for the
projected proportion of capital IPPS payments paid as outliers. The
regulations in 42 CFR 412.84(i)(4) state that any outlier
reconciliation at cost report settlement will be based on operating and
capital CCRs calculated based on a ratio of costs to charges computed
from the relevant cost report and charge data determined at the time
the cost report coinciding with the discharge is settled. As such, any
reconciliation also applies to capital outlier payments. As part of our
proposal for FY 2020 to incorporate into the outlier model the total
outlier reconciliation dollars from the most recent and most complete
fiscal year cost report data, we also proposed to adjust our estimate
of FY 2020 capital outlier payments to incorporate a projection of
capital outlier reconciliation payments when determining the adjustment
factor to be applied to the capital standard Federal rate to account
for the projected proportion of capital IPPS payments paid as outliers.
To do so, we proposed to use the following methodology, which generally
parallels the methodology to incorporate a projection of operating
outlier reconciliation payments for the FY 2020 outlier threshold
calculation.''.
5. On page 42625, lower fourth of the page (after the table),
second column, partial paragraph,
a. Line 5, the figure ``5.47'' is corrected to read ``5.45''.
b. Line 7, the figure ``$441,745,478'' is corrected read
``$440,250,855''.
c. Line 8, the figure ``$441,745,478'' is corrected to read
``$440,250,855''.
d. Line 10, the figure ``$8,077,508,094'' is corrected to read
``$8,077,323,420''.
6. On page 42630,
a. Top third of the page,
i. First column, third paragraph, line 11, the figure ``$26,473''
is corrected to read ``$26,552''.
ii. Second column, first partial paragraph,
A. Line 2, the figure ``$91,413,886,336'' is corrected to read
``$91,232,894,870''.
B. Line 3, the figure ``$4,943,282,951'' is corrected to read
``$4,943,522,543''.
C. Line 17, the figure ``$26,662'' is corrected to read
``$26,763''.
D. Line 24, the figure ``$26,473'' is corrected to read
``$26,552''.
iii. Third column, first partial paragraph, lines 8 through 15, the
sentence ``We project that the threshold for FY 2020 of $26,473 (which
reflects our methodology to incorporate an estimate of outlier
reconciliations) will result in outlier payments that will

[[Page 53610]]

equal 5.1 percent of operating DRG payments and 5.42 percent of capital
payments based on the Federal rate.'' is corrected to read ``We project
that the threshold for FY 2020 of $26,552 (which reflects our
methodology to incorporate an estimate of operating outlier
reconciliations) will result in outlier payments that will equal 5.1
percent of operating DRG payments and we estimate that capital outlier
payments will equal 5.37 percent of capital payments based on the
Federal rate (which reflects our methodology discussed above to
incorporate an estimate of capital outlier reconciliations).
b. Middle of the page, the following the untitled table is
corrected to read as follows:
[GRAPHIC] [TIFF OMITTED] TR08OC19.001

BILLING CODE 4120-01-P
7. On pages 42632 through 42634, the table titled ``CHANGES FROM FY
2019 STANDARDIZED AMOUNTS TO THE FY 2020 STANDARDIZED AMOUNTS'', is
corrected to read as follows:

[[Page 53611]]

[GRAPHIC] [TIFF OMITTED] TR08OC19.002

[[Page 53612]]

[GRAPHIC] [TIFF OMITTED] TR08OC19.003

8. On page 42636, lower third of the page, first column, last
paragraph, line 13, the figure ``0.997649'' is corrected to read
``0.996859''.
9. On page 42637, first column, second full paragraph, line 6, the
figure ``0.70'' is corrected to read ``0.64''.
10. On page 42638, lower two-thirds of the page (after the table),
a. First column, second paragraph,
i. Line 10, the figure ``5.47 '' is corrected to read ``5.45''.
ii. Line 22, the figure ``5.39'' is corrected to read ``5.37''.
b. Second column,
i. First partial paragraph,
A. Line 1, the figure ``5.47'' is corrected to read ``5.45''.
B. Line 5, the figure ``0.9461'' is corrected to read ``0.9463''.
ii. First full paragraph,
A. Lines 5 and 6, the figurative phrase ``0.9461 is a -0.35 percent
change'' is corrected to read ``0.9463 is -0.33 percent change''.
B. Lines 9 through 11, the figurative expression ``0.9965 (0.9461/
0.9494; calculation performed on unrounded numbers)'' is corrected to
read ``0.9967 (0.9463/0.9494; calculation performed on unrounded
numbers)''.
C. Line 13, the figure ``-0.35'' is corrected to read ``-0.33''.
12. On page 42639,
a. First column, second partial paragraph, line 16, the figure
``1.0005'' is corrected to read ``1.0004''.
b. Second column,
i. First partial paragraph, line 8, the figure ``1.0005'' is
corrected to read ``1.0004''.
ii. Second column, first full paragraph,
A. Line 13, the figure ``0.9987'' is corrected to read ``0.9979''.
B. Line 15, the figure ``0.9987'' is corrected to read ``0.9979''.
C. Line 17, the figurative expression ``0.9956 (0.9987 x 0.9968)''
is corrected to read ``0.9948 (0.9979 x 0.9968)''.
c. Third column,
i. First full paragraph,
A. Line 2, the figure ``0.9956'' is corrected to read ``0.9948''.
B. Line 6, the figure ``0.9987'' is corrected to read ``0.9979''.
ii. Second full paragraph,
A. Line 9, the figure ``$462.61'' is corrected to read ``$462.33''.
B. Line 10, the figure ``0.70 percent'' is corrected to read ``0.64
percent''.
iii. Second bulleted paragraph, line 5, the figure ``0.9956'' is
corrected to read ``0.9948''.
iv. Third bulleted paragraph, line 2, the figure ``0.9461'' is
corrected to read ``0.9463''.
v. Last paragraph,
A. Line 12, the figure ``0.44'' is corrected to read ``0.52''.
B. Line 14, the figure ``0.35'' is corrected to read ``0.33''.
C. Line 18, the figure ``0.70'' is corrected to read ``0.64''.
13. On page 42640, the chart titled ``COMPARISON of FACTORS AND
ADJUSTMENTS: FY 2019 CAPITAL FEDERAL RATE AND THE FY 2020 CAPITAL
FEDERAL RATE'' is corrected to read as follows:

[[Page 53613]]

[GRAPHIC] [TIFF OMITTED] TR08OC19.004

14. On page 42641,
a. Second column, third paragraph, line 43, the figure
``$42,677.63'' is corrected to read ``$42,677.64.''
b. Third column, line 5, the figure ``$41,844.89'' is corrected to
read ``$41,844.90''.
15. On page 42648, second column,
a. Third paragraph, line 8, the figure ``$26,473'' is corrected to
read ``$26,552''.
b. Third paragraph, last line, the figure ``$26,473'' is corrected
to read ``$26,552''.
c. Sixth paragraph, line 3, the figure ``$26,473'' is corrected to
read ``$26,552''.
16. On page 42651, 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 2020'' is corrected to read as follows:
[GRAPHIC] [TIFF OMITTED] TR08OC19.005

17. On page 42652--
a. Top of 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 2020'' is
corrected to read as follows:
[GRAPHIC] [TIFF OMITTED] TR08OC19.006

[[Page 53614]]

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 2020'' is corrected to read as follows:
[GRAPHIC] [TIFF OMITTED] TR08OC19.007

b. Middle of the page--
i. The table titled ``TABLE 1D.--CAPITAL STANDARD FEDERAL PAYMENT
RATE--FY 2020'' is corrected to read as follows:
[GRAPHIC] [TIFF OMITTED] TR08OC19.008

c. Bottom of the page, the table ``Table 1E--LTCH PPS STANDARD
FEDERAL PAYMENT RATE FY 2020'' is corrected to read as follows:
BILLING CODE 4120-01-P
[GRAPHIC] [TIFF OMITTED] TR08OC19.009

C. Corrections of Errors in the Appendices

1. On page 42657 through 42660, the table and table notes for the
table titled ``TABLE I--IMPACT ANALYSIS OF CHANGES TO THE IPPS FOR
OPERATING COSTS FOR FY 2020'' are corrected to read as follows:

[[Page 53615]]

[GRAPHIC] [TIFF OMITTED] TR08OC19.010

[[Page 53616]]

[GRAPHIC] [TIFF OMITTED] TR08OC19.011

[[Page 53617]]

[GRAPHIC] [TIFF OMITTED] TR08OC19.012

[[Page 53618]]

[GRAPHIC] [TIFF OMITTED] TR08OC19.013

[[Page 53619]]

2. On page 42661, first column, fourth full paragraph, line 6, the
figure ``0.997649'' is corrected to read ``0.996859''.
3. On page 42662,
a. lower half of the page, first column, third paragraph, line 6,
the figure ``0.985425'' is corrected to read ``0.985447''.
b. lower half of the page, second column, third full paragraph,
line 6, the figure ``0.997081'' is corrected to read ``0.997073''.
c. lower half of the page, third column, first full paragraph, line
16, the figure ``0.997081'' is corrected to read ``0.997073''.
4. On page 42664 through 42666, in the table titled ``Comparison of
FY 2019 and FY 2020 IPPS Estimated Payments Due to Rural Floor with
National Budget Neutrality'' the table is corrected to read as follows:

[[Page 53620]]

[GRAPHIC] [TIFF OMITTED] TR08OC19.014

[[Page 53621]]

[GRAPHIC] [TIFF OMITTED] TR08OC19.015

[[Page 53622]]

[GRAPHIC] [TIFF OMITTED] TR08OC19.016

[[Page 53623]]

5. On page 42667--
a. Second column, first full paragraph--
i. Line 9, the figure ``0.997987'' is corrected to read
``0.997984''.
ii. Line 18, the figure ``0.998838'' is corrected to read
``0.998835''.
6. On page 42668 through 42669, the table titled ``TABLE II.--
IMPACT ANALYSIS OF CHANGES FOR FY 2020 ACUTE CARE HOSPITAL OPERATING
PROSPECTIVE PAYMENT SYSTEM (PAYMENTS PER DISCHARGE)'' is corrected to
read as follows:

[[Page 53624]]

[GRAPHIC] [TIFF OMITTED] TR08OC19.017

[[Page 53625]]

[GRAPHIC] [TIFF OMITTED] TR08OC19.018

7. On page 42672 through 42674 the table titled ``Modeled
Uncompensated Care Payments for Estimated FY 2020 DSHs by Hospital
Type: Model Uncompensated Care Payments ($ in Millions)--from FY 2019
to FY 2020'' is corrected to read as follows:

[[Page 53626]]

[GRAPHIC] [TIFF OMITTED] TR08OC19.019

[[Page 53627]]

[GRAPHIC] [TIFF OMITTED] TR08OC19.020

BILLING CODE 4120-01-C
8. On page 42674,
a. Second column, second full paragraph,
i. Line 5, the figure ``23.00'' is corrected to read ``22.92''.
ii. Line 8, the figure ``7.15'' is corrected to read ``7.23''.
iii. Line 10, the figure ``10.96'' is corrected to read ``11.05''.
b. Third column, first partial paragraph,
i. Line 6, the figure ``14.42'' is corrected to read ``14.20''.
ii. Line 8, the figure ``2.14'' is corrected to read ``2.16''.
iii. Line 11, the figure ``1.24'' is corrected to read ``1.23''.
c. Third column, first full paragraph,
i. Line 10, the phrase ``New England, East North Central'' is
corrected to read: ``New England, Middle Atlantic, East North
Central''.
ii. Line 13 to 16, the phrase ``A smaller than average increase in
uncompensated care payments is projected in the Middle Atlantic Region,
while urban hospitals'' is corrected to read ``Urban hospitals''.
c. Third column, second full paragraph,
i. Line 3, the figure ``2.32'' is corrected to read ``2.29''.
9. On page 42675,
a. First column, first partial paragraph,
i. Line 3, the figure ``4.99'' is corrected to read ``4.95''.
ii. Line 6, the figure ``3.01'' is corrected to read ``3.02''.
iii. Line 8, the figure ``4.17'' is corrected to read ``4.07''.
b. First column, first full paragraph,
i. Line 3, the figure ``3.82'' is corrected to read ``3.89''.
ii. Line 5, the figure ``1.92'' is corrected to read ``1.70''.
iii. Line 8, the figure ``1.27'' is corrected read ``1.00''.
iv. Line 11, the figure ``21.32'' is corrected to read ``20.99''.
v. Line 13, the figure ``1.97'' is corrected to read ``1.80''.
vi. Line 13, the figure ``7.06'' is corrected to read ``6.97''.
10. On page 42684,
a. First column, first partial paragraph,
i. Line 1, the figure ``0.9956'' is corrected to read ``0.9948''.
ii. Line 2, the figure ``0.9461'' is corrected to read ``0.9463''.
b. Second column, third paragraph, line 5, the figure ``2.5
percent'' is corrected to read ``2.6 percent''.
c. Third column, last paragraph, line 14, the figure ``1.2
percent'' is corrected to read ``1.3 percent''.
11. On pages 42685 and 42686, the table titled ``TABLE III.--
COMPARISON OF TOTAL PAYMENTS PER CASE [FY 2019 PAYMENTS COMPARED TO FY
2020 PAYMENTS] is corrected to read as:

[[Page 53628]]

[GRAPHIC] [TIFF OMITTED] TR08OC19.021

[[Page 53629]]

[GRAPHIC] [TIFF OMITTED] TR08OC19.022

[[Page 53630]]

[GRAPHIC] [TIFF OMITTED] TR08OC19.023

Dated: October 1, 2019.
Ann C. Agnew,
Executive Secretary to the Department, Department of Health and Human
Services.
[FR Doc. 2019-21865 Filed 10-7-19; 8:45 am]
BILLING CODE 4120-01-C