[Federal Register Volume 89, Number 191 (Wednesday, October 2, 2024)]
[Rules and Regulations]
[Pages 80095-80098]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-22496]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 412
[CMS-1806-CN]
RIN 0938-AV32
Medicare Program; FY 2025 Inpatient Psychiatric Facilities
Prospective Payment System--Rate Update; Correction
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Final action; correction.
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SUMMARY: This document corrects technical errors in the final action
that appeared in the August 7, 2024 Federal Register titled ``Medicare
Program; FY 2025 Inpatient Psychiatric Facilities Prospective Payment
System--Rate Update''.
DATES: This correction is effective October 1, 2024.
FOR FURTHER INFORMATION CONTACT:
The IPF Payment Policy mailbox at [email protected] for
information regarding the IPF wage index.
Nick Brock (410) 786-5148, for general information regarding the
inpatient psychiatric facilities prospective payment system (IPF PPS).
SUPPLEMENTARY INFORMATION:
I. Background
In FR Doc. 2024-16909 of August 7, 2024, the fiscal year (FY) 2025
Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS)
final rule (89 FR 64582), there were technical errors that are
identified and corrected in this correcting document. These corrections
are effective as if they had been included in the FY 2025 IPF PPS final
rule. Accordingly, the corrections are effective October 1, 2024.
II. Summary of Errors
A. Summary of Errors in the Preamble
There was a technical error in the calculation of the final FY 2025
IPF PPS wage indexes, which impacted several calculations. There is an
impact to the
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wage index for twelve providers in Core-Based Statistical Area (CBSA)
26 for rural Missouri due to the recalculated wage indexes, and thus we
recalculated the impact analysis provided in Table 24 of the FY 2025
IPF PPS final rule (89 FR 64670 through 64671). Therefore, changes are
needed to the published values in Table 24. We also recalculated the
wage index budget neutrality factor; however, after recalculating,
there are no changes needed to the published wage index budget
neutrality factor because the difference between the previously
published factor and the newly calculated factor is within the margin
of error for rounding. This means that the recalculated wage index
budget neutrality factor remained 0.9996 and the IPF federal per diem
base rate remained $876.53.
On pages 64670 and 64671, Table 24 reflects the impact to providers
based on the inaccurate calculation of the FY 2025 IPF PPS wage index;
therefore, Table 24 should be updated to reflect the correct
calculations.
On page 64672, the payment percent increase for rural areas of
``3.8 percent'' is incorrect; therefore, ``3.8 percent'' should be
replaced with ``3.9 percent''.
B. Summary of Errors in and Corrections to the Tables Posted on the CMS
website for the IPF PPS Wage Index
As discussed in the FY 2025 IPF PPS final rule (89 FR 64582), we
used the concurrent pre-floor, pre-reclassified Inpatient Prospective
Payment System (IPPS) hospital wage index as the basis for the IPF wage
index. For FY 2025, concurrent pre-floor, pre-reclassified IPPS
hospital wage data used under the IPF PPS are for cost reporting
periods beginning on or after October 1, 2020 and before October 1,
2021 (FY 2021 cost report data), as discussed in the final rule titled,
``Medicare and Medicaid Programs and the Children's Health Insurance
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 2025 Rates; Quality Programs
Requirements; and Other Policy Changes'' (89 FR 68986) (hereinafter
referred to as the FY 2025 IPPS final rule). In calculating the wage
index under the FY 2025 IPPS final rule, we made an inadvertent error
related to the calculation of the wage index. This error is identified,
discussed, and corrected in the correction notice titled, ``Medicare
and Medicaid Programs and the Children's Health Insurance 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 2025 Rates; Quality Programs Requirements; and
Other Policy Changes; Correction'', published elsewhere in this issue
of the Federal Register.
In the FY 2025 Hospital Inpatient Prospective Payment Systems and
Long-Term Care Hospital Prospective Payment System (IPPS/LTCH PPS)
final rule (89 FR 68986), we finalized a policy to exclude hospitals
that have subsequently converted to rural emergency hospitals (REHs)
from the wage index. Specifically, we stated that any hospital that is
designated as a REH by 7 days prior to the publication of the
preliminary wage index public use file (PUF) is excluded from the
calculation of the wage index. We inadvertently treated a current IPPS
hospital as a hospital that had converted to REH status, thereby
erroneously excluding its data from the wage index (CMS Certification
Number (CCN) 26-0163). Therefore, we restored the wage data for this
hospital to be included in the wage index.
This error affects the unadjusted, pre-reclassified, pre-rural
floor IPPS wage data and thereby affects the IPF PPS wage data for CBSA
26 for rural Missouri.
We are correcting the wage index for CBSA 26 rural Missouri in
Table B setting forth the wage indexes for rural areas based on CBSA
labor market areas and Table C setting forth the wage indexes for urban
and rural areas without counties, which are available exclusively on
the CMS website at https://www.cms.gov/medicare/medicare-fee-for-service-payment/inpatientpsychfacilpps/wageindex.
The omitted wage data for the one hospital in CBSA 26 required the
recalculation of the final FY 2025 IPF PPS wage indexes. Additionally,
as discussed in the FY 2025 IPF PPS final rule (89 FR 64582), changes
to the wage index are made in a budget neutral manner so that updates
do not increase expenditures. Due to the recalculation and subsequent
revision of the final FY 2025 IPF PPS wage indexes, it was necessary to
recalculate the FY 2025 IPF PPS wage index budget neutrality factor.
However, as discussed above, no changes are needed to the published
wage index budget neutrality factor since the difference between the
previously published factor and the newly calculated factor is within
the margin of error for rounding. This means that the recalculated wage
index budget neutrality factor remained 0.9996 and the IPF federal per
diem base rate remained $876.53.
III. Waiver of Proposed Rulemaking
We ordinarily publish a notice of proposed rulemaking in the
Federal Register to provide a period for public comment before the
provisions of a rule take effect in accordance with section 553(b) of
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we
can waive this notice and comment procedure if the Secretary finds, for
good cause, that the notice and comment process is impracticable,
unnecessary, or contrary to the public interest, and incorporates a
statement of the finding and the reasons therefore in the notice.
Section 553(d) of the APA ordinarily requires a 30-day delay in
effective date of final rules after the date of their publication in
the Federal Register. This 30-day delay in effective date can be
waived, however, if an agency finds for good cause that the delay is
impracticable, unnecessary, or contrary to the public interest, and the
agency incorporates a statement of the findings and its reasons in the
rule issued.
We believe that this correcting document does not constitute a rule
that would be subject to the notice and comment or delayed effective
date requirements. This document corrects technical errors in the
preamble of the FY 2025 IPF PPS final rule, as well as two tables on
the Centers for Medicare & Medicaid Services (CMS) website, 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 2025 IPF
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 IPFs to receive appropriate payments in a timely manner to
ensure that the FY 2025 IPF PPS final rule accurately reflects our
policies as of the date they take effect and are applicable.
Furthermore, such procedures would be unnecessary, as we are not
altering our payment methodologies or policies, but rather, we are
simply correctly implementing the policies that we previously
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proposed, received comment on, and subsequently finalized. This
correcting document is intended solely to ensure that the FY 2025 IPF
PPS final rule accurately reflects these payment methodologies and
policies. For these reasons, we believe we have good cause to waive the
notice and comment and effective date requirements.
IV. Correction of Errors in the Preamble
In FR Doc. 2024-16909 of August 7, 2024 (89 FR 64582), make the
following corrections:
1. On pages 64670 and 64671, TABLE 24: FY 2025 IPF PPS PAYMENT
IMPACTS is corrected to read as follows:
Table 24--FY 2025 IPF PPS Payment Systems
[Percent change in columns 3 through 6]
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Refinement of
Number of patient-level Wage index Total percent
Facility by type facilities Outlier adjustments FY25, LRS, and change \1\
and ECT 5% Cap
(1) (2) (3) (4) (5) (6)
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All Facilities.................. 1,419 -0.3 0.0 0.0 2.5
Total Urban................. 1,162 -0.3 0.0 -0.2 2.3
Urban unit.............. 645 -0.4 0.5 -0.6 2.3
Urban hospital.......... 517 -0.1 -0.5 0.2 2.5
Total Rural................. 257 -0.1 -0.3 1.4 3.9
Rural unit.............. 197 -0.1 0.1 1.1 4.0
Rural hospital.......... 60 -0.2 -1.1 2.1 3.6
By Type of Ownership:
Freestanding IPFs:
Urban Psychiatric Hospitals:
Government.......... 119 -0.5 1.1 -0.6 2.7
Non-Profit.......... 97 -0.1 -0.1 -0.3 2.3
For-Profit.......... 301 0.0 -0.9 0.6 2.5
Rural Psychiatric Hospitals:
Government.......... 30 -0.3 1.6 -0.3 3.9
Non-Profit.......... 12 -0.5 -1.5 0.3 1.0
For-Profit.......... 18 0.0 -2.3 3.7 4.2
IPF Units:
Urban:
Government.......... 93 -0.8 0.8 -0.1 2.7
Non-Profit.......... 430 -0.4 0.7 -0.9 2.1
For-Profit.......... 122 -0.2 -0.5 0.1 2.3
Rural:
Government.......... 44 -0.1 -0.1 0.7 3.4
Non-Profit.......... 113 -0.2 0.4 1.2 4.3
For-Profit.......... 40 -0.1 -0.1 1.3 4.0
By Teaching Status:
Non-teaching................ 1,217 -0.2 -0.2 0.3 2.7
Less than 10% interns and 100 -0.5 0.6 -1.1 1.9
residents to beds..........
10% to 30% interns and 76 -0.6 1.2 -1.2 2.2
residents to beds..........
More than 30% interns and 26 -0.7 1.2 -0.1 3.2
residents to beds..........
By Region:
New England................. 99 -0.4 0.9 -1.5 1.8
Mid-Atlantic................ 191 -0.4 0.3 -1.7 0.9
South Atlantic.............. 228 -0.2 0.4 1.3 4.4
East North Central.......... 225 -0.2 0.0 0.5 3.2
East South Central.......... 140 -0.1 -0.2 2.6 5.0
West North Central.......... 95 -0.5 1.1 0.0 3.4
West South Central.......... 213 -0.1 -1.2 1.6 3.2
Mountain.................... 102 -0.2 -0.3 0.8 3.1
Pacific..................... 126 -0.3 -0.5 -1.8 0.1
By Bed Size:
Psychiatric Hospitals:
Beds: 0-24.............. 87 -0.1 -0.9 0.8 2.5
Beds: 25-49............. 86 0.0 -1.3 1.3 2.7
Beds: 50-75............. 91 -0.1 -0.4 0.9 3.2
Beds: 76 +.............. 313 -0.1 -0.3 0.0 2.3
Psychiatric Units:
Beds: 0-24.............. 440 -0.2 0.0 0.3 2.9
Beds: 25-49............. 229 -0.3 0.5 -0.7 2.3
Beds: 50-75............. 103 -0.4 0.7 0.1 3.2
Beds: 76 +.............. 70 -0.7 0.6 -1.2 1.5
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\1\ This column includes the impact of the updates in columns (3) through (6) above, and of the IPF market
basket percentage for FY 2025 of 3.3 percent, reduced by 0.5 percentage point for the productivity adjustment
as required by section 1886(s)(2)(A)(i) of the Act.
[[Page 80098]]
2. On page 64672, in the first column, in the first full paragraph,
in line 6, ``3.8'' is corrected to read ``3.9''.
Elizabeth J. Gramling,
Executive Secretary to the Department, Department of Health and Human
Services.
[FR Doc. 2024-22496 Filed 9-27-24; 4:15 pm]
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