United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2006_register executive 2010-09-22 article Part II Rules and Regulations D09002ee1c80ef589 D09002ee1c80ef6a6 United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Centers for Medicare & Medicaid Services originator org United States Government Agency or Subagency We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs to implement changes arising from our continuing experience with these systems, and to implement a number of changes made by the Deficit Reduction Act of 2005 (Pub. L. 109-171). In addition, in the Addendum to this final rule, we describe the changes to the amounts and factors used to determine the rates for Medicare hospital inpatient services for operating costs and capital-related costs. We also are setting forth rate-of-increase limits as well as policy changes for hospitals and hospital units excluded from the IPPS that are paid in full or in part on a reasonable cost basis subject to these limits. These changes are applicable to discharges occurring on or after October 1, 2006. In this final rule, we discuss public comments we received on our proposals to refine the diagnosis-related group (DRG) system under the IPPS to better recognize severity of illness among patients--to use a hospital-specific relative value (HSRV) cost center weighting methodology to adjust DRG relative weights; and to implement consolidated severity-adjusted DRGs or alternative severity adjustment methods. Among the other policy changes that we are making are those changes related to: limited revisions of the reclassification of cases to DRGs; the long-term care (LTC)-DRGs and relative weights; the wage data, including the occupational mix data, used to compute the wage index; applications for new technologies and medical services add-on payments; payments to hospitals for the direct and indirect costs of graduate medical education; submission of hospital quality data; payments to sole community hospitals and Medicare-dependent, small rural hospitals; and provisions governing emergency services under the Emergency Medical Treatment and Labor Act of 1986 (EMTALA). We are responding to requested public comments on a number of other issues that include performance-based hospital payments for services and health information technology, as well as how to improve health data transparency for consumers. In addition, we are responding to public comments received on a proposed rule issued in the Federal Register on May 17, 2006 that proposed to revise the methodology for calculating the occupational mix adjustment to the wage index for the FY 2007 hospital inpatient prospective payment system by applying an adjustment to 100 percent of the wage index using new 2006 occupational mix survey data collected from hospitals. We are finalizing two policy documents published in the Federal Register relating to the implementation of the Health Care Infrastructure Improvement Program, a hospital loan program for cancer research, established under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. This final rule also revises the definition of the term "unit" to specify the exclusion of units of drugs sold to approved Medicare Competitive Acquisition Program (CAP) vendors for use under the CAP from average sales price (ASP) calculations for a period of up to 3 years, at which time we will reevaluate our policy. 71 FR 47870 https://www.govinfo.gov/app/details/FR-2006-08-18/06-6692 06-6692 fr18au06-21 4120-01-P CMS-1488-F CMS-1287-F CMS-1320-F and CMS-1325-IFC4 https://www.govinfo.gov/app/details/FR-2006-08-18/06-6692 https://www.govinfo.gov/content/pkg/FR-2006-08-18/html/06-6692.htm https://www.govinfo.gov/content/pkg/FR-2006-08-18/pdf/06-6692.pdf Health Facilities Medicare Health Facilities Health Professions Kidney Diseases Laboratories Rural Areas X-Rays Administrative Practice and Procedure Puerto Rico Reporting and Recordkeeping Requirements Emergency Medical Services Grant Programs-Health Medicaid Loan Programs Infrastructure Improvement Program Reporting and Recordkeeping 482 p. 47870 48351 71 FR 47870 Title 42 Part 409 42 CFR Part 409 Title 42 Part 410 42 CFR Part 410 Title 42 Part 412 42 CFR Part 412 Title 42 Part 413 42 CFR Part 413 Title 42 Part 414 42 CFR Part 414 Title 42 Part 424 42 CFR Part 424 Title 42 Part 485 42 CFR Part 485 Title 42 Part 489 42 CFR Part 489 Title 42 Part 505 42 CFR Part 505 Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates; Fiscal Year 2007 Occupational Mix Adjustment to Wage Index; Health Care Infrastructure Improvement Program; Selection Criteria of Loan Program for Qualifying Hospitals Engaged in Cancer-Related Health Care and Forgiveness of Indebtedness; and Exclusion of Vendor Purchases Made Under the Competitive Acquisition Program (CAP) for Outpatient Drugs and Biologicals Under Part B for the Purpose of Calculating the Average Sales Price (ASP); Federal Register Vol. 71, Issue RULE 06-6692 II DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 2006-10-01 2006-08-01 CMS-1488-F CMS-1287-F CMS-1320-F and CMS-1325-IFC4 4120-01-P 06-6692 Final rules and interim final rule with comment period.

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs to implement changes arising from our continuing experience with these systems, and to implement a number of changes made by the Deficit Reduction Act of 2005 (Pub. L. 109-171). In addition, in the Addendum to this final rule, we describe the changes to the amounts and factors used to determine the rates for Medicare hospital inpatient services for operating costs and capital-related costs. We also are setting forth rate-of-increase limits as well as policy changes for hospitals and hospital units excluded from the IPPS that are paid in full or in part on a reasonable cost basis subject to these limits. These changes are applicable to discharges occurring on or after October 1, 2006. In this final rule, we discuss public comments we received on our proposals to refine the diagnosis-related group (DRG) system under the IPPS to better recognize severity of illness among patients--to use a hospital-specific relative value (HSRV) cost center weighting methodology to adjust DRG relative weights; and to implement consolidated severity-adjusted DRGs or alternative severity adjustment methods. Among the other policy changes that we are making are those changes related to: limited revisions of the reclassification of cases to DRGs; the long-term care (LTC)-DRGs and relative weights; the wage data, including the occupational mix data, used to compute the wage index; applications for new technologies and medical services add-on payments; payments to hospitals for the direct and indirect costs of graduate medical education; submission of hospital quality data; payments to sole community hospitals and Medicare-dependent, small rural hospitals; and provisions governing emergency services under the Emergency Medical Treatment and Labor Act of 1986 (EMTALA). We are responding to requested public comments on a number of other issues that include performance-based hospital payments for services and health information technology, as well as how to improve health data transparency for consumers. In addition, we are responding to public comments received on a proposed rule issued in the Federal Register on May 17, 2006 that proposed to revise the methodology for calculating the occupational mix adjustment to the wage index for the FY 2007 hospital inpatient prospective payment system by applying an adjustment to 100 percent of the wage index using new 2006 occupational mix survey data collected from hospitals. We are finalizing two policy documents published in the Federal Register relating to the implementation of the Health Care Infrastructure Improvement Program, a hospital loan program for cancer research, established under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. This final rule also revises the definition of the term "unit" to specify the exclusion of units of drugs sold to approved Medicare Competitive Acquisition Program (CAP) vendors for use under the CAP from average sales price (ASP) calculations for a period of up to 3 years, at which time we will reevaluate our policy.

Effective Dates: The provisions of these final rules are effective on October 1, 2006, with the exception of the provisions in Sec. 412.8, Sec. 414.802, and the procedures for withdrawing or terminating reclassifications established in section III.H.4. of the preamble. The provisions of Sec. 412.8, Sec. 414.802, and the procedures for withdrawing or terminating reclassifications established in section II.H.4. of the preamble are effective August 18, 2006. This rule is a major rule as defined in 5 U.S.C. 804(2). Pursuant to 5 U.S.C. 801(a)(1)(A), we are submitting a report to the Congress on this rule on August 1, 2006. Marc Hartstein, (410) 786-4548, Operating Prospective Payment, Diagnosis-Related Groups (DRGs), Wage Index, Occupational Mix Adjustment, New Medical Services and Technology Add-On Payments, Hospital Geographic Reclassifications, Sole Community Hospital, Disproportionate Share Hospital, and Medicare-Dependent, Small Rural Hospital Issues. Tzvi Hefter, (410) 786-4487, Capital Prospective Payment, Excluded Hospitals, Graduate Medical Education, Critical Access Hospitals, Long- Term Care (LTC)-DRGs, and Terms of Hospital Loans under Health Care Infrastructure Improvement Program Issues. Siddhartha Mazumdar, (410) 786-6673, Rural Community Hospital Demonstration Issues. Sheila Blackstock, (410) 786-3502, Quality Data for Annual Payment Update Issues. Thomas Valuck, (410) 786-7479, Hospital Value-Based Purchasing Issues. Frederick Grabau, (410) 786-0206, Services in Foreign Hospitals Issues. Brian Reitz, (410) 786-5001, Obsolete Paper Claims Forms Issues. Melinda Jones, (410) 786-7069, Loan Forgiveness Criteria for Health Care Infrastructure Improvement Program. Corinne Axelrod, (410) 786-5620, Competitive Acquisition Program (CAP) for Part B Drugs Issues. Angela Mason, (410) 786-7452, Payment for Covered Outpatient Drugs and Biologicals Issues. Health Facilities Medicare Health Facilities Health Professions Kidney Diseases Laboratories Rural Areas X-Rays Administrative Practice and Procedure Puerto Rico Reporting and Recordkeeping Requirements Emergency Medical Services Grant Programs-Health Medicaid Loan Programs Infrastructure Improvement Program Reporting and Recordkeeping Medicare: Hospital inpatient prospective payment systems; 2007 FY occupational mix adjustment to wage index; implementation, CMSHOSPITALCAHPS@cms.hhs.gov dfp4@cdc.gov patricia.brooks2@cms.hhs.gov HCAHPSonline.org http://cms.hhs.gov/ICD9ProviderDiagnosticCodes/03_meetings.asp http://rand.org/news.press.05/09.14.html http://www.cdc.gov/nchs/icd9.htm http://www.cms.hhs.gov/AcuteInpatientPPS http://www.cms.hhs.gov/AcuteInpatientPPS/04_outlier.asp#TopOfPage http://www.cms.hhs.gov/AcuteInpatientPPS/08_newtech.asp http://www.cms.hhs.gov/AcuteInpatientPPS/FFD/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=2 http://www.cms.hhs.gov/AcuteInpatientPPS/FFD/list.asp http://www.cms.hhs.gov/AcuteInpatientPPS/FFD/list.asp#TopOfPage http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN/list.asp http://www.cms.hhs.gov/CompetitiveAcquisforBios/ http://www.cms.hhs.gov/eRulemaking http://www.cms.hhs.gov/ESRDGeneralInformation/02_Data.asp#TopOfPage http://www.cms.hhs.gov/HospitalQualityInits/ http://www.cms.hhs.gov/HospitalQualityInits/35_HospitalPremier.asp http://www.cms.hhs.gov/HospitalQualityInits/downloads/HospitalHQA2004_2007200512.pdf http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/03_meetings.asp#TopofPage http://www.cms.hhs.gov/manuals/downloads/ncd103c1_Part1.pdf http://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=170 http://www.cms.hhs.gov/mcd/viewncd.asp:ncd_ http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_ http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/ http://www.cms.hhs.gov/mgcrb/ http://www.cms.hhs.gov/providers/hipps http://www.cms.hhs.gov/transmittals/downloads/R707CP.pdf http://www.gpoaccess.gov/ http://www.hhs.gov/healthit/ahic.html http://www.hospitalcompare.hhs.gov http://www.hospitalcompare.hhs.gov/ http://www.iom.edu/CMS/3809/19805/31310.aspx http://www.medicare.gov/Dialysis http://www.medicare.gov/HHCompare/Home.asp http://www.medicare.gov/NHCompare http://www.medpac.gov/publications/generic_report_display.cfm?report_type_id=1&sid=2&subid=0 http://www.whitehouse.gov/infocus/technology/economic_policy200404/chap3.html http://www.whitehouse.gov/omb/budget/fy2007/ http://www.whitehouse.gov/omb/bulletins/fy04/b04-03.html http://www.whitehousegov/omb/circulars/a004/a-4.pdf QNetExchange.org QualityNet.org QualtyNet.org swais.access.gpo.gov www.cdc.gov/nchs/icd9.htm www.cms.hhs.gov/HospitalQualityInits/downloads/HospitalHCAHPSFactSheet200512.pdf www.cms.hhs.gov/icd9ProviderDiagnosticCodes/01_overview.asp#TopofPage www.cms.hhs.gov/pvrp www.hcahpsonline.org www.hospitalcompare.hhs.gov www.medpac.gov www.qnetexchange.org www.qualitynet.org Vol. 71, no. 160 Office of the Federal Register, National Archives and Records Administration 2006-08-18 continuing daily deposited born digital 760 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2006-08-18 P0b002ee180954ac3 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr18au06 https://www.govinfo.gov/app/details/FR-2006-08-18 https://www.govinfo.gov/content/pkg/FR-2006-08-18/pdf/FR-2006-08-18.pdf https://www.govinfo.gov/content/pkg/FR-2006-08-18/xml/FR-2006-08-18.xml fdlp 47697 48446 DGPO 2010-09-22 2024-06-06 FR-2006-08-18 machine generated eng FR FR-2006-08-18 71 160