Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates, 24680-25135 [07-1920]

Download as PDF 24680 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 411, 412, 413, and 489 [CMS–1533–P] RIN 0938–AO70 Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2008 Rates Centers for Medicare and Medicaid Services (CMS), HHS. ACTION: Proposed rule. mmaher on DSK3CLS3C1PROD with $$_JOB AGENCY: SUMMARY: We are proposing to revise 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 certain provisions made by the Deficit Reduction Act of 2005 (Pub. L. 109–171), the Medicare Improvements and Extension Act under Division B, Title I of the Tax Relief and Health Care Act of 2006 (Pub. L. 109– 432), and the Pandemic and All-Hazards Preparedness Act (Pub. L. 109–417). In addition, in the Addendum to this proposed rule, we describe the proposed 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 proposed rate-ofincrease limits for certain 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 or that have a portion of a prospective payment system payment based on reasonable cost principles. These proposed changes would be applicable to discharges occurring on or after October 1, 2007. In this proposed rule, we discuss our proposals to further refine the diagnosisrelated group (DRG) system under the IPPS to better recognize severity of illness among patients—for FY 2008, we are proposing to adopt a Medicare Severity DRG (MS–DRG) classification system for the IPPS. We are also proposing to use the structure of the proposed MS–DRG system for the LTCH prospective payment system (referred to as MS–LTC–DRGs) for FY 2008. Among the other policy changes that we are proposing to make are changes related to: Limited revisions of the reclassification of cases to proposed MS–DRGs, the proposed relative weights for the proposed MS–LTC– VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 DRGs; the wage data, including the occupational mix data, used to compute the wage index; applications for new technologies and medical services addon payments; payments to hospitals for the indirect costs of graduate medical education; submission of hospital quality data; provisions governing application of sanctions relating to the Emergency Medical Treatment and Labor Act of 1986 (EMTALA); provisions governing disclosure of physician ownership in hospitals and patient safety measures; and provisions relating to services furnished to beneficiaries in custody of penal authorities. DATES: To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on June 12, 2007. ADDRESSES: In commenting, please refer to file code CMS–1533–P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. You may submit comments in one of three ways (no duplicates, please): 1. Electronically. You may submit electronic comments on specific issues in this regulation to https:// www.cms.hhs.gov/eRulemaking. Click on the link ‘‘Submit electronic comments on CMS regulations with an open comment period’’. (Attachments should be in Microsoft Word, WordPerfect, or Excel; however, we prefer Microsoft Word.) 2. By regular mail. You may mail written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–1533– P, P.O. Box 8011, Baltimore, MD 21244– 1850. Please allow sufficient time for mailed comments to be received before the close of the comment period. 3. By express or overnight mail. You may send written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–1533–P, Mail Stop C4–26–05, 7500 Security Boulevard, Baltimore, MD 21244–1850. 4. By hand or courier. If you prefer, you may deliver (by hand or courier) your written comments (one original and two copies) before the close of the comment period to one of the following addresses. If you intend to deliver your comments to the Baltimore address, please call telephone number (410) 786– 7195 in advance to schedule your arrival with one of our staff members. PO 00000 Frm 00002 Fmt 4701 Sfmt 4702 Room 445–G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201, or 7500 Security Boulevard, Baltimore, MD 21244–1850. (Because access to the interior of the Hubert H. Humphrey Building is not readily available to persons without Federal Government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain proof of filing by stamping in and retaining an extra copy of the comments being filed.) Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period. Submission of comments on paperwork requirements. You may submit comments on this document’s paperwork requirements by mailing your comments to the addresses provided at the end of the ‘‘Collection of Information Requirements’’ section in this document. For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section. FOR FURTHER INFORMATION CONTACT: Marc Hartstein, (410) 786–4548, Operating Prospective Payment, Diagnosis-Related Groups (DRGs), Wage Index, New Medical Services and Technology Add-On Payments, and Hospital Geographic Reclassifications Issues Tzvi Hefter, (410) 786–4487, Capital Prospective Payment, Excluded Hospitals, Graduate Medical Education, Critical Access Hospitals, and Long-Term Care (LTC)–DRG 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 Jacqueline Proctor, (410) 786–8852, Disclosure of Physician Ownership in Hospitals and Patient Safety Measures Issues Fred Grabau, (410) 786–0206, Services to Beneficiaries in Custody of Penal Authorities Issues SUPPLEMENTARY INFORMATION: Submitting Comments: We welcome comments from the public on all issues set forth in this rule to assist us in fully considering issues and developing policies. You can assist us by referencing the file code CMS–1533–P E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules and the specific ‘‘issue identifier’’ that precedes the section on which you choose to comment. Inspection of Public Comments: All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following Web site as soon as possible after they have been received: https://www.cms.hhs.gov/ eRulemaking. Click on the link ‘‘Electronic Comments on CMS Regulations’’ on that Web site to view public comments. Comments received timely will also be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, phone 1–800–743–3951. Electronic Access This Federal Register document is also available from the Federal Register online database through GPO Access, a service of the U.S. Government Printing Office. Free public access is available on a Wide Area Information Server (WAIS) through the Internet and via asynchronous dial-in. Internet users can access the database by using the World Wide Web; the Superintendent of Documents’ home page address is https://www.gpoaccess.gov/, by using local WAIS client software, or by telnet to swais.access.gpo.gov, then login as guest (no password required). Dial-in users should use communications software and modem to call (202) 512– 1661; type swais, then login as guest (no password required). mmaher on DSK3CLS3C1PROD with $$_JOB Acronyms AHA American Hospital Association AHIMA American Health Information Management Association AHRQ Agency for Health Care Research and Quality AMI Acute myocardial infarction AOA American Osteopathic Association APR DRG All Patient Refined Diagnosis Related Group System ASC Ambulatory surgical center ASP Average sales price AWP Average wholesale price BBA Balanced Budget Act of 1997, Pub. L. 105–33 BBRA Medicare, Medicaid, and SCHIP [State Children’s Health Insurance Program] Balanced Budget Refinement Act of 1999, Pub. L. 106–113 VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 BIPA Medicare, Medicaid, and SCHIP [State Children’s Health Insurance Program] Benefits Improvement and Protection Act of 2000, Pub. L. 106–554 BLS Bureau of Labor Statistics CAH Critical access hospital CART CMS Abstraction & Reporting Tool CBSAs Core-based statistical areas CC Complication or comorbidity CCR Cost-to-charge ratio CDAC Clinical Data Abstraction Center CIPI Capital input price index CPI Consumer price index CMI Case-mix index CMS Centers for Medicare & Medicaid Services CMSA Consolidated Metropolitan Statistical Area COBRA Consolidated Omnibus Reconciliation Act of 1985, Pub. L. 99– 272 CPI Consumer price index CY Calendar year DRA Deficit Reduction Act of 2005, Pub. L. 109–171 DRG Diagnosis-related group DSH Disproportionate share hospital ECI Employment cost index EMR Electronic medical record EMTALA Emergency Medical Treatment and Labor Act of 1986, Pub. L. 99–272 FDA Food and Drug Administration FFY Federal fiscal year FIPS Federal information processing standards FQHC Federally qualified health center FTE Full-time equivalent FY Fiscal year GAAP Generally Accepted Accounting Principles GAF Geographic Adjustment Factor GME Graduate medical education HCAHPS Hospital Consumer Assessment of Healthcare Providers and Systems HCFA Health Care Financing Administration HCRIS Hospital Cost Report Information System HHA Home health agency HHS Department of Health and Human Services HIC Health insurance card HIPAA Health Insurance Portability and Accountability Act of 1996, Pub. L. 104– 191 HIPC Health Information Policy Council HIS Health information system HIT Health information technology HMO Health maintenance organization HSA Health savings account HSCRC Maryland Health Services Cost Review Commission HSRV Hospital-specific relative value HSRVcc Hospital-specific relative value cost center HQA Hospital Quality Alliance HQI Hospital Quality Initiative ICD–9–CM International Classification of Diseases, Ninth Revision, Clinical Modification ICD–10–PCS International Classification of Diseases, Tenth Edition, Procedure Coding System IHS Indian Health Service IME Indirect medical education IOM Institute of Medicine IPF Inpatient psychiatric facility PO 00000 Frm 00003 Fmt 4701 Sfmt 4702 24681 IPPS Acute care hospital inpatient prospective payment system IRF Inpatient rehabilitation facility JCAHO Joint Commission on Accreditation of Healthcare Organizations LAMCs Large area metropolitan counties LTC–DRG Long-term care diagnosis-related group LTCH Long-term care hospital MAC Medicare Administrative Contractor MCC Major complication or comorbidity MCE Medicare Code Editor MCO Managed care organization MCV Major cardiovascular condition MDC Major diagnostic category MDH Medicare-dependent, small rural hospital MedPAC Medicare Payment Advisory Commission MedPAR Medicare Provider Analysis and Review File MEI Medicare Economic Index MGCRB Medicare Geographic Classification Review Board MIEA–TRHCA Medicare Improvements and Extension Act, Division B of the Tax Relief and Health Care Act of 2006, Pub. L. 109–432 MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Pub. L. 108–173 MPN Medicare provider number MRHFP Medicare Rural Hospital Flexibility Program MSA Metropolitan Statistical Area NAICS North American Industrial Classification System NCD National coverage determination NCHS National Center for Health Statistics NCQA National Committee for Quality Assurance NCVHS National Committee on Vital and Health Statistics NECMA New England County Metropolitan Areas NQF National Quality Forum NTIS National Technical Information Service NVHRI National Voluntary Hospital Reporting Initiative OES Occupational employment statistics OIG Office of the Inspector General OMB Executive Office of Management and Budget O.R. Operating room OSCAR Online Survey Certification and Reporting (System) PRM Provider Reimbursement Manual PPI Producer price index PMSAs Primary metropolitan statistical areas PPS Prospective payment system PRA Per resident amount ProPAC Prospective Payment Assessment Commission PRRB Provider Reimbursement Review Board PS&R Provider Statistical and Reimbursement (System) QIG Quality Improvement Group, CMS QIO Quality Improvement Organization RHC Rural health clinic RHQDAPU Reporting hospital quality data for annual payment update RNHCI Religious nonmedical health care institution E:\FEDREG\03MYP2.LOC 03MYP2 24682 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB RRC Rural referral center RUCAs Rural-urban commuting area codes RY Rate year SAF Standard Analytic File SCH Sole community hospital SFY State fiscal year SIC Standard Industrial Classification SNF Skilled nursing facility SOCs Standard occupational classifications SOM State Operations Manual SSA Social Security Administration SSI Supplemental Security Income TEFRA Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97–248 UHDDS Uniform hospital discharge data set VBP Value-based purchasing Table of Contents I. Background A. Summary 1. Acute Care Hospital Inpatient Prospective Payment System (IPPS) 2. Hospitals and Hospital Units Excluded From the IPPS a. Inpatient Rehabilitation Facilities (IRFs) b. Long-Term Care Hospitals (LTCHs) c. Inpatient Psychiatric Facilities (IPFs) 3. Critical Access Hospitals (CAHs) 4. Payments for Graduate Medical Education (GME) B. Provisions of the Deficit Reduction Act of 2005 (DRA) C. Provisions of the Medicare Improvements and Extension Act Under Division B of the Tax Relief and Health Care Act of 2006 D. Provisions of the Pandemic and AllHazards Preparedness Act E. Major Contents of this Proposed Rule 1. Proposed DRG Reclassifications and Recalibrations of Relative Weights 2. Proposed Changes to the Hospital Wage Index 3. Other Decisions and Proposed Changes to the IPPS for Operating Costs and GME Costs 4. Proposed Changes to the IPPS for Capital-Related Costs 5. Proposed Changes to the Payment Rate for Excluded Hospitals and Hospital Units: Rate-of-Increase Percentages 6. Services Furnished to Beneficiaries in Custody of Penal Authorities 7. Determining Proposed Prospective Payment Operating and Capital Rates and Rate-of-Increase Limits 8. Impact Analysis 9. Recommendation of Update Factors for Operating Cost Rates of Payment for Inpatient Hospital Services 10. Discussion of Medicare Payment Advisory Commission Recommendations II. Proposed Changes to DRG Classifications and Relative Weights A. Background B. DRG Reclassifications 1. General 2. Yearly Review for Making DRG Changes C. MedPAC Recommendations for Revisions to the IPPS DRG System D. Refinement of DRGs Based on Severity of Illness 1. Evaluation of Alternative SeverityAdjusted DRG Systems a. Overview of Alternative DRG Classification Systems VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 b. Comparative Performance in Explaining Variation in Resource Use c. Payment Accuracy and Case-Mix Impact d. Issues for Future Consideration 2. Development of Proposed Medicare Severity DRGs (MS–DRGs) a. Comprehensive Review of the CC List b. Chronic Diagnosis Codes c. Acute Diagnosis Codes d. Prior Research on Subdivisions of CCs Into Multiple Categories e. Proposed Medicare Severity DRGs (MS– DRGs) 3. Dividing Proposed MS–DRGs on the Basis of the CCs and MCCs 4. Conclusion 5. Impact of the Proposed MS–DRGs 6. Changes to Case-Mix Index (CMI) from the Proposed MS–DRGs 7. Effect of the Proposed MS–DRGs on the Outlier Threshold 8. Effect of the Proposed MS–DRGs on the Postacute Care Transfer Policy E. Refinement of the Relative Weight Calculation 1. Summary of RTI’s Report on Charge Compression 2. RTI Recommendations a. Short-Term Recommendations b. Medium-Term Recommendations c. Long-Term Recommendations F. Hospital-Acquired Conditions, Including Infections 1. General 2. Legislative Requirements 3. Public Input 4. Collaborative Effort 5. Criteria for Selection of the HospitalAcquired Conditions 6. Proposed Selection of Hospital-Acquired Conditions 7. Other Issues G. Proposed Changes to the Specific DRG Classifications 1. Pre-MDC: Intestinal Transplantations 2. MDC 1 (Diseases and Disorders of the Nervous System) a. Implantable Neurostimulators b. Intracranial Stents 3. MDC 3 (Diseases and Disorders of the Ear, Nose, Mouth, and Throat)—Cochler Implants 4. MDC 8 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue) a. Hip and Knee Replacements b. Spinal Fusions c. Spinal Disc Devices d. Other Spinal DRGs 5. MDC 17 (Myeloproliferative Diseases and Disorders, Poorly Differentiated Neoplasm): Endoscopic Procedures 6. Medicare Code Editor (MCE) Changes a. Non-Covered Procedure Edit: Code 00.62 (Percutaneous Angioplasty or Atherectomy of Intracranial Vessel(s)) b. Non-Specific Principal Diagnosis Edit 7 and Non-Specific O.R. Procedures Edit 10 c. Limited Coverage Edit 17 7. Surgical Hierarchies 8. CC Exclusion List Proposed for FY 2008 a. Background b. Proposed CC Exclusions List for FY 2008 9. Review of Procedure Codes in CMS DRGs 468, 476, and 477 Frm 00004 Fmt 4701 Sfmt 4702 a. Moving Procedure Codes From CMS DRG 468 (Proposed MS–DRGs 981 Through 983) or CMS DRG 477 (Proposed MS–DRGs 987 Through 989) to MDCs b. Reassignment of Procedures Among CMS DRGs 468, 476, and 477 (Proposed MS–DRG 981 Through 983, 984 Through 986, and 987 Through 989) c. Adding Diagnosis or Procedure Codes to MDCs 10. Changes to the ICD–9–CM Coding System 11. Other Issues a. Seizures and Headaches b. Devices That Are Replaced Without Cost or Where Credit for a Replaced Device Is Furnished to the Hospital H. Recalibration of DRG Weights I. Proposed MS–LTC–DRG Reclassifications and Relative Weights for LTCHs for FY 2008 1. Background 2. Proposed Changes in the LTC–DRG Classifications a. Background b. Patient Classifications Into DRGs 3. Development of the Proposed FY 2008 MS–LTC–DRG Relative Weights a. General Overview of Development of the Proposed MS–LTC–DRG Relative Weights b. Data c. Hospital-Specific Relative Value Methodology d. Proposed Treatment of Severity Levels in Developing Relative Weights e. Proposed Low-Volume MS–LTC–DRGs 4. Steps for Determining the Proposed FY 2008 MS–LTC–DRG Relative Weights J. Proposed Add-On Payments for New Services and Technologies 1. Background 2. Public Input Before Publication of a Notice of Proposed Rulemaking on AddOn Payments 3. FY 2008 Status of Technologies Approved for FY 2007 Add-On Payments a. Endovascular Graft Repair of the Thoracic Aorta b. Restore[reg] Rechargeable Implantable Neurostimulators c. X STOP Interspinous Process Decompression System 4. FY 2008 Application for New Technology Add-On Payments 5. Technical Correction III. Proposed Changes to the Hospital Wage Index A. Background B. Core-Based Statistical Areas for the Hospital Wage Index C. Proposed Occupational Mix Adjustment to the Proposed FY 2008 Wage Index 1. Development of Data for the Proposed FY 2008 Occupational Mix Adjustment 2. Timeline for the Collection, Review, and Correction of the Occupational Mix Data 3. Calculation of the Proposed Occupational Mix Adjustment for FY 2008 4. Proposed 2007–2008 Occupational Mix Survey for the FY 2010 Wage Index D. Worksheet S–3 Wage Data for the Proposed FY 2008 Wage Index 1. Included Categories of Costs E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 2. Contract Labor for Indirect Patient Care Services 3. Excluded Categories of Costs 4. Use of Wage Index Data by Providers Other Than Acute Care Hospitals Under the IPPS E. Verification of Worksheet S–3 Wage Data F. Wage Index for Multicampus Hospitals G. Computation of the Proposed FY 2008 Unadjusted Wage Index 1. Method for Computing the Proposed FY 2008 Unadjusted Wage Index 2. Expiration of the Imputed Floor 3. CAHs Reverting Back to IPPS Hospitals and Raising the Rural Floor 4. Application of Rural Floor Budget Neutrality H. Analysis and Implementation of the Proposed Occupational Mix Adjustment and the Proposed FY 2008 Occupational Mix Adjusted Wage Index I. Revisions to the Proposed Wage Index Based on Hospital Redesignations 1. General 2. Effects of Reclassification/Redesignation 3. FY 2008 MGCRB Reclassifications 4. Hospitals That Applied for Reclassification Effective in FY 2008 and Reinstating Reclassifications in FY 2008 5. Clarification of Policy on Reinstating Reclassifications 6. ‘‘Fallback’’ Reclassifications 7. Geographic Reclassification Issues for Multicampus Hospitals 8. Redesignations of Hospitals under Section 1886(d)(8)(B) of the Act 9. Reclassifications Under Section 1886(d)(8)(B) of the Act 10. New England Deemed Counties 11. Reclassifications under Section 508 of Pub. L. 108–173 12. Other Issues J. Proposed FY 2008 Wage Index Adjustment Based on Commuting Patterns of Hospital Employees K. Process for Requests for Wage Index Data Corrections L. Labor-Related Share for the Proposed Wage Index for FY 2008 M. Wage Index Study Required Under Pub. L. 109–432 N. Proxy for the Hospital Market Basket IV. Other Decisions and Proposed Changes to the IPPS for Operating Costs and GME Costs A. Reporting of Hospital Quality Data for Annual Hospital Payment Update 1. Background 2. FY 2008 Quality Measures 3. New Quality Measures and Data Submission Requirements for FY 2009 and Subsequent Years a. Proposed New Quality Measures for FY 2009 and Subsequent Years b. Data Submission 4. Retiring or Modifying RHQDAPU Program Quality Measures 5. Procedures for the RHQDAPU Program for FY 2008 and FY 2009 a. Procedures for Participating in the RHQDAPU Program b. Chart Validation Requirements c. Data Validation and Attestation d. Public Display e. Reconsideration and Appeal Procedures VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 f. RHQDAPU Program Withdrawal Requirements 6. Electronic Medical Records 7. New Hospitals B. Development of the Medicare Hospital Value-Based Purchasing Plan C. Rural Referral Centers (RRCs) 1. Proposed Annual Update of RRC Status Criteria a. Case-Mix Index b. Discharges 2. Acquired Rural Status of RRCs D. Indirect Medical Education (IME) Adjustment 1. Background 2. IME Adjustment Factor for FY 2008 3. Time Spent by Residents on Vacation or Sick Leave and in Orientation a. Background b. Vacation and Sick Leave Time c. Orientation Activities d. Proposed Regulation Changes E. Hospital Emergency Services Under EMTALA 1. Background 2. Recent Legislation Affecting EMTALA Implementation a. Secretary’s Authority to Waive Requirements During National Emergencies b. Provisions of the Pandemic and AllHazards Preparedness Act c. Proposed Revisions to the EMTALA Regulations F. Disclosure of Physician Ownership in Hospitals and Patient Safety Measures 1. Disclosure of Physician Ownership in Hospitals 2. Patient Safety Measures G. Rural Community Hospital Demonstration Program V. Proposed Changes to the IPPS for CapitalRelated Costs A. Background B. Proposed Policy Change VI. Proposed Changes for Hospitals and Hospital Units Excluded From the IPPS A. Payments to Existing and New Excluded Hospitals and Hospital Units B. Separate PPS for IRFs C. Separate PPS for LTCHs D. Separate PPS for IPFs E. Determining Proposed LTCH Cost-toCharge Ratios (CCRs) Under the LTCH PPS VII. Services Furnished to Beneficiaries in Custody of Penal Authorities VIII. MedPAC Recommendations IX. Other Required Information A. Requests for Data From the Public B. Collection of Information Requirements C. Response to Public Comments Regulation Text Addendum—Proposed Schedule of Standardized Amounts, Update Factors, and Rate-of-Increase Percentages Effective With Cost Reporting Periods Beginning On or After October 1, 2007 I. Summary and Background II. Proposed Changes to the Prospective Payment Rates for Hospital Inpatient Operating Costs for FY 2008 A. Calculation of the Proposed Adjusted Standardized Amount PO 00000 Frm 00005 Fmt 4701 Sfmt 4702 24683 1. Standardization of Base-Year Costs or Target Amounts 2. Computing the Proposed Average Standardized Amount 3. Updating the Proposed Average Standardized Amount 4. Other Adjustments to the Average Standardized Amount a. Proposed Recalibration of DRG Weights and Updated Wage Index—Budget Neutrality Adjustment b. Reclassified Hospitals—Budget Neutrality Adjustment c. Case-Mix Budget Neutrality Adjustment d. Outliers e. Proposed Rural Community Hospital Demonstration Program Adjustment (Section 410A of Pub. L. 108–173) 5. Proposed FY 2008 Standardized Amount B. Proposed Adjustments for Area Wage Levels and Cost-of-Living 1. Proposed Adjustment for Area Wage Levels 2. Proposed Adjustment for Cost-of-Living in Alaska and Hawaii C. Proposed DRG Relative Weights D. Calculation of the Proposed Prospective Payment Rates for FY 2008 1. Federal Rate 2. Hospital-Specific Rate (Applicable Only to SCHs and MDHs) a. Calculation of Hospital-Specific Rate b. Updating the FY 1982, FY 1987, FY 1996, and FY 2002 Hospital-Specific Rates for FY 2008 3. General Formula for Calculation of Proposed Prospective Payment Rates for Hospitals Located in Puerto Rico Beginning On or After October 1, 2007 and Before October 1, 2008 a. Puerto Rico Rate b. National Rate III. Proposed Changes to Payment Rates for Acute Care Hospital Inpatient CapitalRelated Costs for FY 2008 A. Determination of Proposed Federal Hospital Inpatient Capital-Related Prospective Payment Rate Update 1. Projected Capital Standard Federal Rate Update a. Description of the Update Framework b. Comparison of CMS and MedPAC Update Recommendation 2. Proposed Outlier Payment Adjustment Factor 3. Proposed Budget Neutrality Adjustment Factor for Changes in DRG Classifications and Weights and the GAF 4. Proposed Exceptions Payment Adjustment Factor 5. Proposed Capital Standard Federal Rate for FY 2008 6. Proposed Special Capital Rate for Puerto Rico Hospitals B. Calculation of the Proposed Inpatient Capital-Related Prospective Payments for FY 2008 C. Capital Input Price Index 1. Background 2. Forecast of the CIPI for FY 2008 IV. Proposed Changes to Payment Rates for Excluded Hospitals and Hospital Units: Rate-of-Increase Percentages A. Payments to Existing Excluded Hospitals and Units B. New Excluded Hospitals and Units E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24684 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules V. Tables Table 1A—National Adjusted Operating Standardized Amounts, Labor/Nonlabor (69.7 Percent Labor Share/30.3 Percent Nonlabor Share If Wage Index Is Greater Than 1) 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) Table 1C—Adjusted Operating Standardized Amounts for Puerto Rico, Labor/Nonlabor Table 1D—Capital Standard Federal Payment Rate Table 2—Hospital Case-Mix Indexes for Discharges Occurring in Federal Fiscal Year 2006; Hospital Wage Indexes for Federal Fiscal Year 2008; Hospital Average Hourly Wages for Federal Fiscal Years 2006 (2002 Wage Data), 2007 (2003 Wage Data), and 2008 (2004 Wage Data); and 3-Year Average of Hospital Average Hourly Wages Table 3A—FY 2008 and 3-Year Average Hourly Wage for Urban Areas by CBSA Table 3B—FY 2008 and 3-Year Average Hourly Wage for Rural Areas by CBSA Table 4A—Wage Index and Capital Geographic Adjustment Factor (GAF) for Urban Areas by CBSA—FY 2008 Table 4B—Wage Index and Capital Geographic Adjustment Factor (GAF) for Rural Areas by CBSA—FY 2008 Table 4C—Wage Index and Capital Geographic Adjustment Factor (GAF) for Hospitals That Are Reclassified by CBSA—FY 2008 Table 4F—Puerto Rico Wage Index and Capital Geographic Adjustment Factor (GAF) by CBSA—FY 2008 Table 4J—Out-Migration Wage Adjustment—FY 2008 Table 5—List of Proposed Medicare Severity Diagnosis-Related Groups (MS– DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay Table 6A—New Diagnosis Codes Table 6B—New Procedure Codes Table 6C—Invalid Diagnosis Codes Table 6D—Invalid Procedure Codes Table 6E—Revised Diagnosis Code Titles Table 6F—Revised Procedure Code Titles Table 6G—Additions to the CC Exclusion List (Available only through the Internet on the CMS Web site at: https:// www.cms.hhs.gov/AcuteInpatientPPS/) Table 6H—Deletions from the CC Exclusion List (Available only through the Internet on the CMS Web site at: https://www.cms.hhs.gov/ AcuteInpatientPPS/) Table 6I—Complete List of Complication and Comorbidity (CC) Exclusions (Available only through the Internet on the CMS Web site at: https:// www.cms.hhs.gov/AcuteInpatientPPS/) Table 6J—Major Complication and Comorbidity (MCC) List Table 6K—Complications and Comorbidity (CC) List Table 7A—Medicare Prospective Payment System Selected Percentile Lengths of Stay: FY 2006 MedPAR Update— VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 December 2006 GROUPER V24.0 CMS– DRGs Table 7B—Medicare Prospective Payment System Selected Percentile Lengths of Stay: FY 2006 MedPAR Update— December 2006 GROUPER V25.0 CMS DRGs Table 8A—Proposed Statewide Average Operating Cost-to-Charge Ratios—March 2007 Table 8B—Proposed Statewide Average Capital Cost-to-Charge Ratios—March 2007 Table 8C—Proposed Statewide Average Total Cost-to-Charge Ratios for LTCHs— March 2007 Table 9A—Hospital Reclassifications and Redesignations—FY 2008 Table 9C—Hospitals Redesignated as Rural under Section 1886(d)(8)(E) of the Act— FY 2008 Table 10—Geometric Mean Plus the Lesser of .75 of the National Adjusted Operating Standardized Payment Amount (Increased to Reflect the Difference Between Costs and Charges) or .75 of One Standard Deviation of Mean Charges by Proposed Medicare Severity Diagnosis-Related Groups (MS–DRGs)— March 2007 Table 11—Proposed FY 2008 MS–LTC– DRGs, Relative Weights, Geometric Average Length of Stay, and 5/6ths of the Geometric Average Length of Stay Appendix A—Regulatory Impact Analysis I. Overall Impact II. Objectives III. Limitations on Our Analysis IV. Hospitals Included In and Excluded From the IPPS V. Effects on Excluded Hospitals and Hospital Units VI. Quantitative Effects of the Proposed Policy Changes Under the IPPS for Operating Costs A. Basis and Methodology of Estimates B. Analysis of Table I C. Effects of the Proposed Changes to the DRG Reclassifications and Relative CostBased Weights (Column 2) D. Effects of Proposed Wage Index Changes (Column 3) E. Combined Effects of Proposed DRG and Wage Index Changes (Column 4) F. Effects of the Expiration of the 3-Year Provision Allowing Urban Hospitals That Were Converted to Rural as a Result of the FY 2005 Labor Market Area Changes to Maintain the Wage Index of the Urban Labor Market Area in Which They Were Formerly Located (Column 5) G. Effects of MGCRB Reclassifications (Column 6) H. Effects of the Adjustment to the Application of the Rural Floor (Column 7) I. Effects of Expiration of the Imputed Rural Floor (Column 8) J. Effects of the Expiration of Section 508 of Pub. L. 108–173 (Column 9) K. Effects of the Proposed Wage Index Adjustment for Out-Migration (Column 10) L. Effects of All Proposed Changes With CMI Adjustment Prior to Assumed Growth (Column 11) PO 00000 Frm 00006 Fmt 4701 Sfmt 4702 M. Effects of All Proposed Changes With CMI Adjustment and Assumed Growth (Column 12) N. Effects of Proposed Policy on Payment Adjustment for Low-Volume Hospitals O. Impact Analysis of Table II VII. Effects of Other Proposed Policy Changes A. Effects of Proposed Policy on HospitalAcquired Conditions, Including Infections B. Effects of Proposed MS–LTC–DRG Reclassifications and Relative Weights for LTCHs C. Effects of Proposed New Technology Add-On Payments D. Effects of Requirements for Hospital Reporting of Quality Data for Annual Hospital Payment Update E. Effects of Proposed Policy on Cancellation of Classification of Acquired Rural Status and Rural Referral Centers F. Effects of Proposed Policy Change on Payment for Indirect Graduate Medical Education G. Effects of Proposed Policy Changes Relating to Emergency Services Under EMTALA H. Effects of Proposed Policy on Disclosure of Physician Ownership in Hospitals and Patient Safety Measures I. Effects of Implementation of Rural Community Hospital Demonstration Program J. Effects of Proposed Policy Changes on Services Furnished to Beneficiaries in Custody of Penal Authorities VIII. Effects of Proposed Changes in the Capital IPPS A. General Considerations B. Results IX. Alternatives Considered X. Overall Conclusion XI. Accounting Statement XII. Executive Order 12866 Appendix B—Recommendation of Update Factors for Operating Cost Rates of Payment for Inpatient Hospital Services I. Background II. Inpatient Hospital Update for FY 2008 III. Secretary’s Recommendation IV. MedPAC Recommendation for Assessing Payment Adequacy and Updating Payments in Traditional Medicare I. Background A. Summary 1. Acute Care Hospital Inpatient Prospective Payment System (IPPS) Section 1886(d) of the Social Security Act (the Act) sets forth a system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (Hospital Insurance) based on prospectively set rates. Section 1886(g) of the Act requires the Secretary to pay for the capital-related costs of hospital inpatient stays under a prospective payment system (PPS). Under these PPSs, Medicare payment for hospital inpatient operating and capital-related costs is made at E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules predetermined, specific rates for each hospital discharge. Discharges are classified according to a list of diagnosis-related groups (DRGs). The base payment rate is comprised of a standardized amount that is divided into a labor-related share and a nonlabor-related share. The laborrelated share is adjusted by the wage index applicable to the area where the hospital is located; and if the hospital is located in Alaska or Hawaii, the nonlabor-related share is adjusted by a cost-of-living adjustment factor. This base payment rate is multiplied by the DRG relative weight. If the hospital treats a high percentage of low-income patients, it receives a percentage add-on payment applied to the DRG-adjusted base payment rate. This add-on payment, known as the disproportionate share hospital (DSH) adjustment, provides for a percentage increase in Medicare payments to hospitals that qualify under either of two statutory formulas designed to identify hospitals that serve a disproportionate share of low-income patients. For qualifying hospitals, the amount of this adjustment may vary based on the outcome of the statutory calculations. If the hospital is an approved teaching hospital, it receives a percentage add-on payment for each case paid under the IPPS, known as the indirect medical education (IME) adjustment. This percentage varies, depending on the ratio of residents to beds. Additional payments may be made for cases that involve new technologies or medical services that have been approved for special add-on payments. To qualify, a new technology or medical service must demonstrate that it is a substantial clinical improvement over technologies or services otherwise available, and that, absent an add-on payment, it would be inadequately paid under the regular DRG payment. The costs incurred by the hospital for a case are evaluated to determine whether the hospital is eligible for an additional payment as an outlier case. This additional payment is designed to protect the hospital from large financial losses due to unusually expensive cases. Any outlier payment due is added to the DRG-adjusted base payment rate, plus any DSH, IME, and new technology or medical service add-on adjustments. Although payments to most hospitals under the IPPS are made on the basis of the standardized amounts, some categories of hospitals are paid the higher of a hospital-specific rate based on their costs in a base year (the higher of FY 1982, FY 1987, FY 1996, or FY 2002) or the IPPS rate based on the VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 standardized amount. For example, sole community hospitals (SCHs) are the sole source of care in their areas, and Medicare-dependent, small rural hospitals (MDHs) are a major source of care for Medicare beneficiaries in their areas. Both of these categories of hospitals are afforded this special payment protection in order to maintain access to services for beneficiaries. (Until FY 2007, an MDH has received the IPPS rate plus 50 percent of the difference between the IPPS rate and its hospital-specific rate if the hospitalspecific rate is higher than the IPPS rate. In addition, an MDH does not have the option of using FY 1996 as the base year for its hospital-specific rate. As discussed below, for discharges occurring on or after October 1, 2007, but before October 1, 2011, an MDH will receive the IPPS rate plus 75 percent of the difference between the IPPS rate and its hospital-specific rate, if the hospitalspecific rate is higher than the IPPS rate.) Section 1886(g) of the Act requires the Secretary to pay for the capital-related costs of inpatient hospital services ‘‘in accordance with a prospective payment system established by the Secretary.’’ The basic methodology for determining capital prospective payments is set forth in our regulations at 42 CFR 412.308 and 412.312. Under the capital IPPS, payments are adjusted by the same DRG for the case as they are under the operating IPPS. Capital IPPS payments are also adjusted for IME and DSH, similar to the adjustments made under the operating IPPS. In addition, hospitals may receive outlier payments for those cases that have unusually high costs. The existing regulations governing payments to hospitals under the IPPS are located in 42 CFR part 412, subparts A through M. 2. Hospitals and Hospital Units Excluded From the IPPS Under section 1886(d)(1)(B) of the Act, as amended, certain specialty hospitals and hospital units are excluded from the IPPS. These hospitals and units are: rehabilitation hospitals and units; long-term care hospitals (LTCHs); psychiatric hospitals and units; children’s hospitals; and cancer hospitals. Religious nonmedical health care institutions (RNHCIs) are also excluded from the IPPS. Various sections of the Balanced Budget Act of 1997 (Pub. L. 105–33), the Medicare, Medicaid and SCHIP [State Children’s Health Insurance Program] Balanced Budget Refinement Act of 1999 (Pub. L. 106–113), and the Medicare, Medicaid, and SCHIP Benefits Improvement and PO 00000 Frm 00007 Fmt 4701 Sfmt 4702 24685 Protection Act of 2000 (Pub. L. 106–554) provide for the implementation of PPSs for rehabilitation hospitals and units (referred to as inpatient rehabilitation facilities (IRFs)), LTCHs, and psychiatric hospitals and units (referred to as inpatient psychiatric facilities (IPFs)), as discussed below. Children’s hospitals, cancer hospitals, and RNHCIs continue to be paid solely under a reasonable cost-based system. The existing regulations governing payments to excluded hospitals and hospital units are located in 42 CFR parts 412 and 413. a. Inpatient Rehabilitation Facilities (IRFs) Under section 1886(j) of the Act, as amended, rehabilitation hospitals and units (IRFs) have been transitioned from payment based on a blend of reasonable cost reimbursement subject to a hospital-specific annual limit under section 1886(b) of the Act and the adjusted facility Federal prospective payment rate for cost reporting periods beginning on or after January 1, 2002 through September 30, 2002, to payment at 100 percent of the Federal rate effective for cost reporting periods beginning on or after October 1, 2002. IRFs subject to the blend were also permitted to elect payment based on 100 percent of the Federal rate. The existing regulations governing payments under the IRF PPS are located in 42 CFR part 412, subpart P. b. Long-Term Care Hospitals (LTCHs) Under the authority of sections 123(a) and (c) of Pub. L. 106–113 and section 307(b)(1) of Pub. L. 106–554, the LTCH PPS was effective for a LTCH’s first cost reporting period beginning on or after October 1, 2002. LTCHs that do not meet the definition of ‘‘new’’ under § 412.23(e)(4) are paid, during a 5-year transition period, a LTCH prospective payment that is comprised of an increasing proportion of the LTCH Federal rate and a decreasing proportion based on reasonable cost principles. Those LTCHs that did not meet the definition of ‘‘new’’ could elect to be paid based on 100 percent of the Federal prospective payment rate instead of a blended payment in any year during the 5-year transition. For cost reporting periods beginning on or after October 1, 2006, all LTCHs are paid 100 percent of the Federal rate. The existing regulations governing payment under the LTCH PPS are located in 42 CFR part 412, subpart O. c. Inpatient Psychiatric Facilities (IPFs) Under the authority of sections 124(a) and (c) of Pub. L. 106–113, inpatient E:\FEDREG\03MYP2.LOC 03MYP2 24686 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules psychiatric facilities (IPFs) (formerly psychiatric hospitals and psychiatric units of acute care hospitals) are paid under the IPF PPS. Under the IPF PPS, some IPFs are transitioning from being paid for inpatient hospital services based on a blend of reasonable costbased payment and a Federal per diem payment rate, effective for cost reporting periods beginning on or after January 1, 2005. For cost reporting periods beginning on or after January 1, 2008, all IPFs will be paid 100 percent of the Federal per diem payment amount. The existing regulations governing payment under the IPF PPS are located in 42 CFR 412, subpart N. 3. Critical Access Hospitals (CAHs) Under sections 1814, 1820, and 1834(g) of the Act, payments are made to critical access hospitals (CAHs) (that is, rural hospitals or facilities that meet certain statutory requirements) for inpatient and outpatient services based on 101 percent of reasonable cost. Reasonable cost is determined under the provisions of section 1861(v)(1)(A) of the Act and existing regulations under 42 CFR parts 413 and 415. mmaher on DSK3CLS3C1PROD with $$_JOB 4. Payments for Graduate Medical Education (GME) Under section 1886(a)(4) of the Act, costs of approved educational activities are excluded from the operating costs of inpatient hospital services. Hospitals with approved graduate medical education (GME) programs are paid for the direct costs of GME in accordance with section 1886(h) of the Act; the amount of payment for direct GME costs for a cost reporting period is based on the hospital’s number of residents in that period and the hospital’s costs per resident in a base year. The existing regulations governing payments to the various types of hospitals are located in 42 CFR part 413. B. Provisions of the Deficit Reduction Act of 2005 (DRA) The Deficit Reduction Act of 2005 (DRA), Pub. L. 109–171, made a number of changes to the Act relating to prospective payments to hospitals and other providers for inpatient services. This proposed rule would implement amendments made by (1) section 5001(a), which, effective for FY 2007 and subsequent years, expands the requirements for hospital quality data reporting; and (2) section 5001(c), which requires the Secretary to select, by October 1, 2007, at least two hospitalacquired conditions that meet certain specified criteria that will be subject to a quality adjustment in DRG payments during FY 2008. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 In this proposed rule, we also discuss our development of a plan to implement, beginning with FY 2009, a value-based purchasing plan for section 1886(d) hospitals, in accordance with the requirements of section 5001(b) of Pub. L. 109–171. C. Provisions of the Medicare Improvements and Extension Act Under Division B of the Tax Relief and Health Care Act of 2006 In this proposed rule, we discuss the provisions of section 106(b)(1) of the Medicare Improvements and Extensions Act under Division B, Title I of the Tax Relief and Health Care Act of 2006 (MIEA–TRHCA), Pub. L. 109–432, which requires MedPAC to submit to Congress, not later than June 30, 2007, a report on the Medicare wage index classification system applied under the Medicare Prospective Payment System. Section 106(b) of the MIEA–TRHCA requires the report to include any alternatives that MedPAC recommends to the method to compute the wage index under section 1886(d)(3)(E) of the Act. In addition, we discuss the provisions of section 106(b)(2) of the MIEA– TRHCA, which instructs the Secretary of Health and Human Services, taking into account MedPAC’s recommendations on the Medicare wage index classification system, to include in the FY 2009 IPPS proposed rule one or more proposals to revise the wage index adjustment applied under section 1886(d)(3)(E) of the Act for purposes of the IPPS. We note that we published a notice in the Federal Register on March 23, 2007 (72 FR 13799) that addressed the provisions of section 106(a) of the MIEA–TRHCA relating to the extension of geographic reclassifications of hospitals under section 508 of Pub. L. 108–173 (that expired on March 31, 2007) through September 30, 2007. D. Provisions of the Pandemic and AllHazards Preparedness Act On December 19, 2006, Congress enacted the Pandemic and All-Hazards Preparedness Act, Pub. L. 109–417. Section 302(b) of Pub. L. 109–417 makes two specific changes that affect EMTALA implementation in emergency areas during an emergency period. Specifically section 302(b)(1)(A) of Pub. L. 109–417 amended section 1135(b)(3)(B) of the Act to state that sanctions may be waived for the direction or relocation of an individual for screening where, in the case of a public health emergency that involves a pandemic infections disease, that direction or relocation occurs pursuant PO 00000 Frm 00008 Fmt 4701 Sfmt 4702 to a State pandemic preparedness plan. In addition, sections 302(b)(1)(B) and (b)(1)(C) of Pub. L. 109–417 amended section 1135(b)(3)(B) of the Act to state that, if a public health emergency involves a pandemic infectious disease (such as pandemic influenza), the duration of a waiver or modification under section 1135(b)(3) of the Act (relating to EMTALA) shall be determined in accordance with section 1135(e) of the Act as that subsection applies to public health emergencies. In this proposed rule, we are proposing to make changes to the EMTALA regulations to conform them to the sanction waiver provisions of section 302(b) of Pub. L. 109–417. E. Major Contents of This Proposed Rule In this proposed rule, we are setting forth proposed changes to the Medicare IPPS for operating costs and for capitalrelated costs in FY 2008. We also are setting forth proposed changes relating to payments for IME costs and payments to certain hospitals and units that continue to be excluded from the IPPS and paid on a reasonable cost basis. The changes being proposed would be effective for discharges occurring on or after October 1, 2007, unless otherwise noted. The following is a summary of the major changes that we are proposing to make: 1. Proposed DRG Reclassifications and Recalibrations of Relative Weights We are proposing to adopt a Medicare Severity DRG (MS–DRG) classification system for the IPPS to better recognize severity of illness. We present the methodology we used to establish the proposed MS–DRGs and discuss our efforts to further analyze alternative severity-adjusted DRG systems and to refine the relative weight calculations for DRGs. We present a proposed listing and discussion of hospital-acquired conditions, including infections, which we have evaluated and are considering for selection to be subject to the statutorily required quality adjustment in DRG payments for FY 2008. We are proposing limited annual revisions to the DRG classification system in the following areas: intestinal transplants, neurostimulators, intracranial stents, cochlear implants, knee and hip replacements, spinal fusions and spinal disc devices, and endoscopic procedures. We are presenting our reevaluation of certain FY 2007 applicants for add-on payments for high-cost new medical services and technologies, and our analysis of the FY 2008 applicant E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules (including public input, as directed by Pub. L. 108–173, obtained in a town hall meeting). We are proposing the annual update of the long-term care diagnosis-related group (LTC–DRG) classifications and relative weights for use under the LTCH PPS for FY 2008. We are proposing that the LTC–DRGs would be revised to mirror the proposed MS–DRGs for the IPPS. mmaher on DSK3CLS3C1PROD with $$_JOB 2. Proposed Changes to the Hospital Wage Index In section III. of the preamble to this proposed rule, we are proposing revisions to the wage index and the annual update of the wage data. Specific issues addressed include the following: <bullet≤ The FY 2008 wage index update, using wage data from cost reporting periods that began during FY 2004. <bullet≤ Analysis and implementation of the proposed FY 2008 occupational mix adjustment to the wage index. <bullet≤ Proposed changes relating to expiration of the imputed floor for the wage index and application of budget neutrality for the rural floor. <bullet≤ Proposed changes in determining the wage index for multicampus hospitals. <bullet≤ The proposed revisions to the wage index based on hospital redesignations and reclassifications, including reclassifications for multicampus hospitals. <bullet≤ The proposed adjustment to the wage index for FY 2008 based on commuting patterns of hospital employees who reside in a county and work in a different area with a higher wage index. <bullet≤ The timetable for reviewing and verifying the wage data that will be in effect for the proposed FY 2008 wage index. <bullet≤ The labor-related share for the FY 2008 wage index, including the labor-related share for Puerto Rico. 3. Other Decisions and Proposed Changes to the IPPS for Operating Costs and GME Costs In section IV. of the preamble to this proposed rule, we discuss a number of provisions of the regulations in 42 CFR Parts 412, 413, and 489, including the following: <bullet≤ The reporting of hospital quality data as a condition for receiving the full annual payment update increase. <bullet≤ Development of the Medicare value-based purchasing plan and scheduled ‘‘listening sessions.’’ <bullet≤ The proposed updated national and regional case-mix values and discharges for purposes of VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 determining RRC status and a proposed policy change relating to the acquired rural status of RRCs. <bullet≤ The statutorily-required IME adjustment factor for FY 2008 and a proposed policy change relating to determining counts of residents on vacation or sick leave and in orientation for IME and direct GME purposes. <bullet≤ Proposed changes relating to waiver of sanctions for requirements for emergency services for hospitals under EMTALA during national emergency. <bullet≤ Proposed policy changes relating to disclosure to patients of physician ownership of hospitals and patient safety measures. <bullet≤ Discussion of the fourth year of implementation of the Rural Community Hospital Demonstration Program. 4. Proposed Changes to the IPPS for Capital-Related Costs In section V. of the preamble to this proposed rule, we discuss the payment policy requirements for capital-related costs and capital payments to hospitals and propose changes relating to adjustments to the Federal capital rate to address continuous large positive margins. 5. Proposed Changes to the Payment Rates for Excluded Hospitals and Hospital Units: Rate-of-Increase Percentages In section VI. of the preamble to this proposed rule, we discuss payments to excluded hospitals and hospital units, and proposed changes for determining LTCH CCRs under the LTCH PPS. 6. Services Furnished to Beneficiaries in Custody of Penal Authorities In section VII. of the preamble to this proposed rule, we clarify when individuals are considered to be in ‘‘custody’’ for purposes of Medicare payment for services furnished to beneficiaries who are under penal authorities. 7. Determining Proposed Prospective Payment Operating and Capital Rates and Rate-of-Increase Limits In the Addendum to this proposed rule, we set forth proposed changes to the amounts and factors for determining the FY 2008 prospective payment rates for operating costs and capital-related costs. We also establish the proposed threshold amounts for outlier cases. In addition, we address the proposed update factors for determining the rateof-increase limits for cost reporting periods beginning in FY 2008 for hospitals and hospital units excluded from the PPS. PO 00000 Frm 00009 Fmt 4701 Sfmt 4702 24687 8. Impact Analysis In Appendix A of this proposed rule, we set forth an analysis of the impact that the proposed changes would have on affected hospitals. 9. Recommendation of Update Factors for Operating Cost Rates of Payment for Inpatient Hospital Services In Appendix B of this proposed rule, as required by sections 1886(e)(4) and (e)(5) of the Act, we provided our recommendations of the appropriate percentage changes for FY 2008 for the following: <bullet≤ A single average standardized amount for all areas for hospital inpatient services paid under the IPPS for operating costs (and hospital-specific rates applicable to SCHs and MDHs). <bullet≤ Target rate-of-increase limits to the allowable operating costs of hospital inpatient services furnished by hospitals and hospital units excluded from the IPPS. 10. Discussion of Medicare Payment Advisory Commission Recommendations Under section 1805(b) of the Act, MedPAC is required to submit a report to Congress, no later than March 1 of each year, in which MedPAC reviews and makes recommendations on Medicare payment policies. MedPAC’s March 2007 recommendation concerning hospital inpatient payment policies addressed the update factor for inpatient hospital operating costs and capital-related costs under the IPPS and for hospitals and distinct part hospital units excluded from the IPPS. This recommendation is addressed in Appendix B of this proposed rule. For further information relating specifically to the MedPAC March 2007 reports or to obtain a copy of the reports, contact MedPAC at (202) 220–3700 or visit MedPAC’s Web site at: https:// www.medpac.gov. II. Proposed Changes to DRG Classifications and Relative Weights (If you choose to comment on issues in this section, please include the caption ‘‘DRG Reclassifications’’ at the beginning of your comment.) A. Background Section 1886(d) of the Act specifies that the Secretary shall establish a classification system (referred to as DRGs) for inpatient discharges and adjust payments under the IPPS based on appropriate weighting factors assigned to each DRG. Therefore, under the IPPS, we pay for inpatient hospital services on a rate per discharge basis that varies according to the DRG to E:\FEDREG\03MYP2.LOC 03MYP2 24688 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules which a beneficiary’s stay is assigned. The formula used to calculate payment for a specific case multiplies an individual hospital’s payment rate per case by the weight of the DRG to which the case is assigned. Each DRG weight represents the average resources required to care for cases in that particular DRG, relative to the average resources used to treat cases in all DRGs. Congress recognized that it would be necessary to recalculate the DRG relative weights periodically to account for changes in resource consumption. Accordingly, section 1886(d)(4)(C) of the Act requires that the Secretary adjust the DRG classifications and relative weights at least annually. These adjustments are made to reflect changes in treatment patterns, technology, and any other factors that may change the relative use of hospital resources. B. DRG Reclassifications 1. General As discussed in the preamble to the FY 2007 IPPS final rule (71 FR 47881 through 47971), we are focusing our efforts in FY 2008 on making significant reforms to the IPPS consistent with the recommendations made by MedPAC in its ‘‘Report to the Congress, PhysicianOwned Specialty Hospitals’’ in March 2005. MedPAC recommended that the Secretary refine the entire DRG system by taking into account severity of illness and applying hospital-specific relative value (HSRV) weights to DRGs.1 We began this reform process by adopting cost-based weights over a 3-year transition period beginning in FY 2007 and making interim changes to the DRG system for FY 2007 by creating 20 new CMS DRGs and modifying 32 others across 13 different clinical areas involving nearly 1.7 million cases. As described below in more detail, these refinements are intermediate steps towards comprehensive reform of both the relative weights and the DRG system that is occurring as we undertake further study. Currently, cases are classified into CMS DRGs for payment under the IPPS based on the principal diagnosis, up to eight additional diagnoses, and up to six procedures performed during the stay. In a small number of DRGs, classification is also based on the age, sex, and discharge status of the patient. The diagnosis and procedure information is reported by the hospital using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9– CM). The process of forming the DRGs was begun by dividing all possible principal diagnoses into mutually exclusive principal diagnosis areas, referred to as Major Diagnostic Categories (MDCs). The MDCs were formed by physician panels as the first step toward ensuring that the DRGs would be clinically coherent. The diagnoses in each MDC correspond to a single organ system or etiology and, in general, are associated with a particular medical specialty. Thus, in order to maintain the requirement of clinical coherence, no final DRG could contain patients in different MDCs. Most MDCs are based on a particular organ system of the body. For example, MDC 6 is Diseases and Disorders of the Digestive System. This approach is used because clinical care is generally organized in accordance with the organ system affected. However, some MDCs are not constructed on this basis because they involve multiple organ systems (for example, MDC 22 (Burns)). For FY 2007, cases are assigned to one of 538 DRGs in 25 MDCs. The table below lists the 25 MDCs. MAJOR DIAGNOSTIC CATEGORIES (MDCS) mmaher on DSK3CLS3C1PROD with $$_JOB 1 ...... 2 ...... 3 ...... 4 ...... 5 ...... 6 ...... 7 ...... 8 ...... 9 ...... 10 .... 11 .... 12 .... 13 .... 14 .... 15 .... 16 .... 17 .... 18 .... 19 .... 20 .... 21 .... 22 .... 23 .... 24 .... 25 .... Diseases and Disorders of the Nervous System. Diseases and Disorders of the Eye. Diseases and Disorders of the Ear, Nose, Mouth, and Throat. Diseases and Disorders of the Respiratory System. Diseases and Disorders of the Circulatory System. Diseases and Disorders of the Digestive System. Diseases and Disorders of the Hepatobiliary System and Pancreas. Diseases and Disorders of the Musculoskeletal System and Connective Tissue. Diseases and Disorders of the Skin, Subcutaneous Tissue and Breast. Endocrine, Nutritional and Metabolic Diseases and Disorders. Diseases and Disorders of the Kidney and Urinary Tract. Diseases and Disorders of the Male Reproductive System. Diseases and Disorders of the Female Reproductive System. Pregnancy, Childbirth, and the Puerperium. Newborns and Other Neonates with Conditions Originating in the Perinatal Period. Diseases and Disorders of the Blood and Blood Forming Organs and Immunological Disorders. Myeloproliferative Diseases and Disorders and Poorly Differentiated Neoplasms. Infectious and Parasitic Diseases (Systemic or Unspecified Sites). Mental Diseases and Disorders. Alcohol/Drug Use and Alcohol/Drug Induced Organic Mental Disorders. Injuries, Poisonings, and Toxic Effects of Drugs. Burns. Factors Influencing Health Status and Other Contacts with Health Services. Multiple Significant Trauma. Human Immunodeficiency Virus Infections. In general, cases are assigned to an MDC based on the patient’s principal diagnosis before assignment to a DRG. However, for FY 2007, there are 9 DRGs to which cases are directly assigned on the basis of ICD–9–CM procedure codes. These DRGs are for heart transplant or implant of heart assist systems, liver and/or intestinal transplants, bone marrow transplants, lung transplants, simultaneous pancreas/kidney transplants, pancreas transplants, and 1 Medicare Payment Advisory Commission: Report to the Congress, Physician-Owned Specialty Hospitals, March 2005, page viii. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00010 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules for tracheostomies. Cases are assigned to these DRGs before they are classified to 24689 an MDC. The table below lists the nine current pre-MDCs. PRE-MAJOR DIAGNOSTIC CATEGORIES (PRE-MDCS) DRG DRG DRG DRG DRG DRG DRG DRG 103 480 481 482 495 512 513 541 mmaher on DSK3CLS3C1PROD with $$_JOB DRG 542 Heart Transplant or Implant of Heart Assist System. Liver Transplant and/or Intestinal Transplant. Bone Marrow Transplant. Tracheostomy for Face, Mouth, and Neck Diagnoses. Lung Transplant. Simultaneous Pancreas/Kidney Transplant. Pancreas Transplant. ECMO or Tracheostomy with Mechanical Ventilation 96+ Hours or Principal Diagnosis Except for Face, Mouth, and Neck Diagnosis with Major O.R. Tracheostomy with Mechanical Ventilation 96+ Hours or Principal Diagnosis Except for Face, Mouth, and Neck Diagnosis without Major O.R. Once the MDCs were defined, each MDC was evaluated to identify those additional patient characteristics that would have a consistent effect on the consumption of hospital resources. Because the presence of a surgical procedure that required the use of the operating room would have a significant effect on the type of hospital resources used by a patient, most MDCs were initially divided into surgical DRGs and medical DRGs. Surgical DRGs are based on a hierarchy that orders operating room (O.R.) procedures or groups of O.R. procedures by resource intensity. Medical DRGs generally are differentiated on the basis of diagnosis and age (0 to 17 years of age or greater than 17 years of age). Some surgical and medical DRGs are further differentiated based on the presence or absence of a complication or comorbidity (CC). Generally, nonsurgical procedures and minor surgical procedures that are not usually performed in an operating room are not treated as O.R. procedures. However, there are a few non-O.R. procedures that do affect DRG assignment for certain principal diagnoses. An example is extracorporeal shock wave lithotripsy for patients with a principal diagnosis of urinary stones. Once the medical and surgical classes for an MDC were formed, each diagnosis class was evaluated to determine if complications, comorbidities, or the patient’s age would consistently affect the consumption of hospital resources. Physician panels classified each diagnosis code based on whether the diagnosis, when present as a secondary condition, would be considered a substantial CC. A substantial CC was defined as a condition which, because of its presence with a specific principal diagnosis, would cause an increase in the length of stay by at least one day in at least 75 percent of the patients. Each medical and surgical class within an MDC was tested to determine if the presence of any substantial CC would VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 consistently affect the consumption of hospital resources. A patient’s diagnosis, procedure, discharge status, and demographic information is entered into the Medicare claims processing systems and subjected to a series of automated screens called the Medicare Code Editor (MCE). The MCE screens are designed to identify cases that require further review before classification into a DRG. After patient information is screened through the MCE and any further development of the claim is conducted, the cases are classified into the appropriate DRG by the Medicare GROUPER software program. The GROUPER program was developed as a means of classifying each case into a DRG on the basis of the diagnosis and procedure codes and, for a limited number of DRGs, demographic information (that is, sex, age, and discharge status). After cases are screened through the MCE and assigned to a DRG by the GROUPER, the PRICER software calculates a base DRG payment. The PRICER calculates the payment for each case covered by the IPPS based on the DRG relative weight and additional factors associated with each hospital, such as IME and DSH adjustments. These additional factors increase the payment amount to hospitals above the base DRG payment. The records for all Medicare hospital inpatient discharges are maintained in the Medicare Provider Analysis and Review (MedPAR) file. The data in this file are used to evaluate possible DRG classification changes and to recalibrate the DRG weights. However, in the FY 2000 IPPS final rule (64 FR 41500), we discussed a process for considering nonMedPAR data in the recalibration process. In order for us to consider using particular non-MedPAR data, we must have sufficient time to evaluate and test the data. The time necessary to do so depends upon the nature and PO 00000 Frm 00011 Fmt 4701 Sfmt 4702 quality of the non-MedPAR data submitted. Generally, however, a significant sample of the non-MedPAR data should be submitted by midOctober for consideration in conjunction with the next year’s proposed rule. This date allows us time to test the data and make a preliminary assessment as to the feasibility of using the data. Subsequently, a complete database should be submitted by early December for consideration in conjunction with the next year’s proposed rule. In this IPPS proposed rule for FY 2008, we are proposing to adopt significant changes to the current DRGs. As described in detail below, we are proposing significant improvement in the DRG system to recognize severity of illness and resource usage by proposing to adopt Medicare Severity DRGs (MS– DRGs). The changes we are proposing in this proposed rule would be reflected in the FY 2008 GROUPER, Version 25.0, and would be effective for discharges occurring on or after October 1, 2007. Unless otherwise noted in this proposed rule, our DRG analysis is based on data from the December 2006 update of the FY 2006 MedPAR file, which contains hospital bills received through December 31, 2006, for discharges occurring in FY 2006. 2. Yearly Review for Making DRG Changes Many of the changes to the DRG classifications we make annually are the result of specific issues brought to our attention by interested parties. We encourage individuals with concerns about DRG classifications to bring those concerns to our attention in a timely manner so they can be carefully considered for possible inclusion in the annual proposed rule and, if included, may be subjected to public review and comment. Therefore, similar to the timetable for interested parties to submit non-MedPAR data for consideration in E:\FEDREG\03MYP2.LOC 03MYP2 24690 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB the DRG recalibration process, concerns about DRG classification issues should be brought to our attention no later than early December in order to be considered and possibly included in the next annual proposed rule updating the IPPS. The actual process of forming the DRGs was, and will likely continue to be, highly iterative, involving a combination of statistical results from test data combined with clinical judgment. We describe in detail below the process we used to develop the proposed MS–DRGs. In addition, in deciding whether to make further modification to the proposed MS–DRGs for particular circumstances brought to our attention, we would consider whether the resource consumption and clinical characteristics of the patients with a given set of conditions are significantly different than the remaining patients in the proposed MS– DRG. We would evaluate patient care costs using average charges and lengths of stay as proxies for costs and rely on the judgment of our medical officers to decide whether patients are clinically distinct or similar to other patients in the MS–DRG. In evaluating resource costs, we would consider both the absolute and percentage differences in average charges between the cases we would select for review and the remainder of cases in the MS–DRG. We also would consider variation in charges within these groups; that is, whether observed average differences were consistent across patients or attributable to cases that were extreme in terms of charges or length of stay, or both. Further, we also would consider the number of patients who will have a given set of characteristics and generally would prefer not to create a new DRG unless it would include a substantial number of cases. C. MedPAC Recommendations for Revisions to the IPPS DRG System In the FY 2006 and FY 2007 IPPS final rules, we discussed a number of recommendations made by MedPAC regarding revisions to the DRG system used under the IPPS (70 FR 47473 through 47482 and 71 FR 47881 through 47939). In Recommendations 1–3 in the 2005 Report to Congress on Physician-Owned Specialty Hospitals, MedPAC recommended that CMS: <bullet≤ Refine the current DRGs to more fully capture differences in severity of illness among patients. <bullet≤ Base the DRG relative weights on the estimated cost of providing care. <bullet≤ Base the weights on the national average of the hospital-specific VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 relative values (HSRVs) for each DRG (using hospital-specific costs to derive the HSRVs). <bullet≤ Adjust the DRG relative weights to account for differences in the prevalence of high-cost outlier cases. <bullet≤ Implement the case-mix measurement and outlier policies over a transitional period. As we noted in the FY 2006 IPPS final rule, we had insufficient time to complete a thorough evaluation of these recommendations for full implementation in FY 2006. However, we did adopt severity-weighted cardiac DRGs in FY 2006 to address public comments on this issue and the specific concerns of MedPAC regarding cardiac surgery DRGs. We also indicated that we planned to further consider all of MedPAC’s recommendations and thoroughly analyze options and their impacts on the various types of hospitals in the FY 2007 IPPS proposed rule. For FY 2007, we began this process. In the FY 2007 IPPS proposed rule, we proposed to adopt Consolidated Severity DRGs (CS DRGs) for FY 2008 (if not earlier). However, based on public comments received on the FY 2007 IPPS proposed rule, we decided not to adopt the CS DRGs. Rather, we decided to make interim changes to the existing DRGs for FY 2007 by creating 20 new DRGs involving 13 different clinical areas that would significantly improve the CMS DRG system’s recognition of severity of illness. We also modified 32 DRGs to better capture differences in severity. The new and revised DRGs were selected from 40 existing CMS DRGs that contain 1,666,476 cases and represent a number of body systems. In creating these 20 new DRGs, we deleted 8 and modified 32 existing DRGs. We indicated that these interim steps for FY 2007 were being taken as a prelude to more comprehensive changes to better account for severity in the DRG system by FY 2008. In the FY 2007 IPPS final rule, we indicated our intent to pursue further DRG reform through two initiatives. First, we announced that we were in the process of engaging a contractor to assist us with evaluating alternative DRG systems that were raised as potential alternatives to the CS DRGs in the public comments. Second, we indicated our intent to review over 13,000 ICD–9–CM diagnosis codes as part of making further refinements to the current CMS DRGs to better recognize severity of illness based on the work that CMS (then HCFA) did in the mid-1990’s to adopt severity DRGs. We describe in detail below the progress we have made on these two initiatives, our proposed actions for FY 2008, and our plans for continued analysis of PO 00000 Frm 00012 Fmt 4701 Sfmt 4702 reform of the DRG system for FY 2009. We note that revising the DRGs to better recognize severity of illness has implications for the outlier threshold, the application of the postacute care transfer policy, the measurement of real case-mix versus apparent case-mix, and the IME and the DSH adjustments. We discuss these implications in more detail in the following sections. In the FY 2007 IPPS proposed rule, we discussed MedPAC’s recommendations to move to a costbased HSRV weighting methodology beginning with the FY 2007 IPPS proposed rule. Although we proposed to adopt HSRV weights for FY 2007, we decided not to adopt the proposed methodology in the final rule after considering the public comments. Instead, in the FY 2007 IPPS final rule, we adopted a cost-based weighting methodology without the hospitalspecific portion of the methodology. The cost weights are being adopted over a 3-year transition period in 1/3 increments between FY 2007 and FY 2009. In addition, in the FY 2007 IPPS final rule, we indicated our intent to further study the hospital-specific methodology as well as other issues brought to our attention with respect to the cost weights. There was significant concern in the public comments that we account for charge compression or the practice of applying a higher charge markup over costs to lower cost than higher cost items and services, if we are to develop relative weights based on cost. Further, public commenters expressed concern about potential inconsistencies between how costs and charges are reported on the Medicare cost reports and charges on the Medicare claims. In the FY 2007 IPPS final rule, we used costs and charges from the cost report to determine departmental level cost-to-charge ratios (CCRs) to apply to charges on the Medicare claims to determine the cost weights. The commenters were concerned about potential distortions to the cost weights that would result from inconsistent reporting between the cost reports and the Medicare claims. After publication of the FY 2007 IPPS final rule, we entered into a contract with RTI International to study both charge compression and to what extent our methodology for calculating DRG relative weights is affected by inconsistencies between how hospitals report costs and charges on the cost report and how hospitals report charges on individual claims. Further, as part of its study of alternative DRG systems, the E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules RAND Corporation is analyzing the HSRV cost-weighting methodology. As we present below, we believe that revisions to the DRG system to better recognize severity of illness and changes to the relative weights based on costs rather than charges are improving the accuracy of the payment rates in the IPPS. We agree with MedPAC that these refinements should be pursued. Although we continue to caution that any system that groups cases will always present some opportunities for providers to specialize in cases they believe to have higher margins, we believe that the changes we have adopted and the continuing reforms we are proposing to adopt for FY 2008 will improve payment accuracy and reduce financial incentives to create specialty hospitals. mmaher on DSK3CLS3C1PROD with $$_JOB D. Refinement of DRGs Based on Severity of Illness (If you choose to comment on issues in this section, please include the caption ‘‘DRG Reform and Proposed MS–DRGs’’ at the beginning of your comment.) For purposes of the following discussions, the term ‘‘CMS DRGs’’ means the DRG system we currently use under the IPPS; the term ‘‘MedicareSeverity DRGs (MS–DRGs)’’ means the revisions that we are proposing to make to the current CMS DRGs to better recognize severity of illness and resource use based on case complexity. Although we have found the terms ‘‘CMS DRGs’’ and ‘‘MS–DRGs’’ useful to distinguish the current DRG system from the DRGs that we are proposing to adopt for FY 2008, we are interested in public comments on how to best refer to both the current DRGs and the proposed DRGs to avoid confusion and improve clarity. 1. Evaluation of Alternative SeverityAdjusted DRG Systems In the FY 2007 IPPS final rule, we stated our intent to engage a contractor to assist us with an evaluation of alternative DRG systems that may better recognize severity than the current CMS DRGs. We noted it was possible that some of the alternative systems would better recognize severity of illness and are based on the current CMS DRGs. We further stated that if we were to develop a clinical severity concept using the current CMS DRGs as the starting point, it was possible that several of the issues raised by commenters (in response to the CS DRGs, which, in the FY 2007 IPPS proposed rule, we proposed to adopt for FY 2008 or earlier) would no longer be a concern. We noted that if we were to propose adoption of severity DRGs for FY 2008, we would consider VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 the issues raised by commenters on last year’s proposed rule as we continued to make further refinements to account for complexity as well as severity to better reflect relative resource use. We stated that we believed it was likely that at least one of several alternative severityadjusted DRG systems suggested for review (or potentially a system we would develop ourselves) would be suitable to achieve our goal of improving payment accuracy beginning in FY 2008. On September 1, 2006, we awarded a contract to the RAND Corporation to perform an evaluation of alternative severity-adjusted DRG classification systems. RAND is evaluating several alternative DRG systems based on how well they are suited to classifying and making payments for inpatient hospital services provided to Medicare patients. Each system is being assessed on its ability to differentiate among severity of illness. A final report is due on or before September 1, 2007. RAND’s draft interim report focused on the following criteria: <bullet≤ Severity-adjusted DRG classification systems: —How well does each classification system explain variation in resource use? —How would the classification system affect a hospital’s patient mix? —Are the groupings manageable, administratively feasible and understandable? <bullet≤ Payment accuracy—What are the payment implications of selected models? In response to our request, several vendors of DRG systems submitted their products for evaluation. The following products are currently being evaluated by RAND: 3M/Health Information Systems (HIS) <bullet≤ CMS DRGs modified for AP– DRG Logic (CMS + AP–DRGs) <bullet≤ Consolidated SeverityAdjusted DRGs (CS DRGs) Health Systems Consultants (HSC) <bullet≤ Refined DRGs (HSC–DRGs) HSS/Ingenix <bullet≤ All-Payer Severity DRGs with Medicare modifications (MM– APS–DRGs) Solucient <bullet≤ Solucient Refined DRGs (Sol–DRGs) Vendors submitted their commercial (off-the-shelf) software to RAND in late September 2006. The five systems were compared to the CMS DRGs that were in effect as of October 1, 2006 (FY 2007). RAND assigned FY 2004 and FY 2005 Medicare discharges from acute care hospitals to the FY 2007 CMS DRGs and to each of the alternative severityadjusted DRG systems. RAND’s initial analysis provided an overview of each PO 00000 Frm 00013 Fmt 4701 Sfmt 4702 24691 alternative DRG classification system, their comparative performance in explaining variation in resource use, differences in DRG grouping logic, and case-mix change. A Technical Expert Panel comprised of individuals representing academic institutions, hospital associations, and MedPAC was formed in October 2006. The members received the preliminary draft report of RAND’s alternative severity-adjusted DRG systems evaluation in early January 2007. The panel met with RAND and CMS on January 18, 2007, to discuss the preliminary draft report and to provide additional comments. RAND incorporated items raised by the panel into its preliminary draft report and submitted a revised interim report to CMS in mid-March 2007. CMS posted RAND’s interim report on the CMS Web site in late March 2007. Interested individuals can view RAND’s interim report on the CMS Web site at: https:// www.cms.hhs.gov/Reports/downloads/ Wynn0307.pdf. At this time, RAND has not completed its final evaluation. RAND’s interim report reflects its preliminary evaluation of the alternative DRG systems using the criteria described above. In the project’s second phase, RAND will continue to evaluate alternative DRG systems as well as to compare performance using HSRVs. As RAND has not completed its evaluation of alternative DRG systems, we are not ready at this time to propose use of one of the alternative DRG systems being evaluated for Medicare in FY 2008. Further, even if RAND had completed its evaluation, we would need to explore whether any transition issues would need to be resolved before we are ready to propose adopting an alternative DRG system. Among other issues, we would need to evaluate the legal and contractual issues associated with adopting a proprietary DRG product. Although vendors for four of the five systems have indicated a willingness to make their products available in the public domain, we believe it is likely there would need to be some discussion as to whether there would be any limitations (such as the source code as well as the DRG logic) on the availability of the DRG systems to hospitals or competing vendors. Further, we would need to resolve contractual issues for updates and maintenance of an alternative DRG system and consider how they interact with our current ongoing contract to maintain the CMS DRGs. There may be further system conversion issues that we have not yet considered. The RAND E:\FEDREG\03MYP2.LOC 03MYP2 24692 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules contract will be complete by September 1, 2007. Once RAND completes its work, we believe we will be in a better position to evaluate whether it would be appropriate to propose to adopt one of the five alternative DRG systems for purposes of the IPPS. As discussed later in this proposed rule, we are proposing to adopt MS– DRGs beginning with FY 2008. The MS– DRGs are the result of modifications to the CMS DRGs to better account for severity. While we are proposing to implement the MS–DRGs on October 1, 2007, we believe the MS–DRGs should be evaluated by RAND. We have instructed RAND to evaluate the proposed MS–DRGs using the same criteria that it is applying to the other DRG systems. As described below, we believe the proposed MS–DRGs represent a substantial improvement in the recognition of severity of illness and resource consumption. For this reason, we are proposing to adopt MS–DRGs for FY 2008. As stated earlier, a final report is expected from RAND by September 1, 2007. This report will include further analysis of the five alternative DRG systems and the additional evaluation of the MS–DRGs. We look forward to reviewing RAND’s final report that will provide a comprehensive evaluation of each severity DRG system that has been examined. We anticipate that after this process is completed, we will have the necessary information to decide our next steps in the reform of the IPPS. Meanwhile, we are proposing to adopt the MS–DRGs for FY 2008 and are providing the following update on RAND’s progress in evaluating alternative DRG systems. We invite public comment regarding RAND’s preliminary analysis of each vendor-supplied alternative severityadjusted DRG system described below. a. Overview of Alternative DRG Classification Systems Analysis of how each of the five severity-adjusted DRG systems performs began by using the current CMS DRGs as a baseline. Two of the five systems (CS DRGs and MM–APS–DRGs) are derivatives of all-patient severityadjusted DRG systems that have been modified by their developers for the Medicare population and two of the systems (HSC–DRGs and Sol–DRGs) are all-patient systems that incorporate severity levels into the CMS DRGs. The CMS–AP–DRGs are a combination of CMS DRGs and a modification for the Medicare population of the major CC severity groupings used in the AP–DRG system. (The AP–DRG system was developed by 3M/HIS specifically for the State of New York to capture the non-Medicare population.) Table A below shows how each of the five alternative severity-adjusted systems classifies patients into base DRGs and their corresponding severity levels. TABLE A.—LOGIC OF CMS AND ALTERNATIVE DRG SYSTEMS CMS DRG CMS+AP–DRG HSC–DRG Sol–-DRG MM–APS–DRG Number of MDCs .............. Number of Pre-MDC base DRGs. Number of base DRGs ..... Total number of Pre-MDC DRGs. Total number of DRGs ..... Number of CC (severity) subclasses. CC subclasses .................. 25 ...................... 9 ........................ 25 ...................... 9 ........................ 25 ...................... 9 ........................ 25 ...................... 9 ........................ 25 ...................... 9 ........................ 25 7 379 .................... 9 ........................ 379 .................... 9 ........................ 215 ADRGs ....... 30 ...................... 248 ADRGs ....... 27 ...................... 361 .................... 27 ...................... 379 9 538 .................... 2 ........................ 602 .................... 3 ........................ 859 4 Without CC, with CC with MCC with some collapsing at base DRG level. Minor, moderate, major, severe with some collapsing at DRG level. No ...................... Without CC With CC for selected base DRGs and With MCC across DRGs within MDC. No ...................... 1,261 ................. 3 (medical) or 4 (surgical). Minor/no substantial CCs, moderate CCs, MCCs, catastrophic CCs (surgical only). 915 .................... 3 ........................ With CC without CC for selected base DRGs. 1,274 ................. 3 (medical) or 4 (surgical). No CC, Class C CC, Class B CC, Class A CC (surgical only). Multiple CCs recognized .. No ...................... No ...................... Mostly no ........... Mostly no ........... Mostly no ........... Mostly no ........... Yes (in computation of weights. No ...................... Yes. CC assignment specific to base DRG. Logic of CC subdivision .... Presence/absence. Principal diagnosis. Presence/absence. Principal diagnosis. Presence/absence. Principal diagnosis. Presence/absence. Principal diagnosis. Presence/absence. Principal diagnosis. 18-step process. Logic of MDC assignment Death used in DRG assignment. Yes (in selected DRGs). Yes (in selected DRGs). Yes .................... Yes .................... Yes (includes ‘‘early death’’ DRGs). Yes .................... Yes (includes ‘‘early death’’ DRGs). Yes .................... Yes (in selected DRGs). Complications of care are CCs. mmaher on DSK3CLS3C1PROD with $$_JOB Classification element RAND’s preliminary evaluation of the logic for each system demonstrated the following: VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 <bullet≤ Four systems add severity levels to the base CMS DRGs; the CS DRGs add severity levels to base APR– DRGs, which are comparable but not PO 00000 Frm 00014 Fmt 4701 Sfmt 4702 Yes, when recognized as a CC No, when CC represents ‘‘poor medical care’’. Con–APR–DRG Yes. Principal diagnosis with rerouting. No. Few. identical to the base CMS DRGs. Both the CS DRGs and MM–APS–DRGs collapse some base DRGs with low Medicare volume. E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB <bullet≤ The HSC–DRGs and the Sol– DRGs use uniform severity levels for each base DRG (three for medical and four for surgical). The general structure of the MM–APS–DRG logic includes three severity levels for each base DRG, but some severity levels for the same base DRG are consolidated to address Medicare low-volume DRGs and monotonicity issues. Monotonicity is when the average costs for a severity group consistently rise as the severity level of the group increases. For example, in a monotonic system, if within a base DRG there are three severity groups and level 1 severity is less than level 2 severity and level 2 severity is less than level 3 severity, the average costs for a level 3 case would be greater than the average costs for a level 2 case, which would be greater than the average costs for a level 1 case. The general structure of the CS DRGs includes four severity levels for each base DRG. However, severity level consolidations occur to address Medicare low-volume DRGs and monotonicity. The CS DRGs consolidate both adjacent severity levels for the same base DRG and the same severity level across multiple base DRGs (especially for severity level 4). <bullet≤ Under the CMS+AP–DRGs and MM–APS–DRGs, each diagnosis is assigned a uniform CC-severity level across all base DRGs (other than CCs on the exclusion list for specific principal diagnoses). The remaining systems assign diagnoses to CC-severity level classifications by groups of DRGs. <bullet≤ Under the grouping logic used by all systems other than the CS DRGs, each discharge is assigned to the highest severity level of any secondary diagnosis. The CS DRGs adjust the initial severity level assignment based on other factors, including the presence of additional CCs. None of the other systems adjust the severity level classification for additional factors or CCs. However, the MM–APS–DRG system handles additional CCs through an enhanced relative weight. <bullet≤ The HSC–DRGs and the Sol– DRGs have a medical ‘‘early death’’ DRG within each MDC. <bullet≤ The CS DRGs do not use death in the grouping logic. In addition, most complications of care do not affect the DRG assignment. b. Comparative Performance in Explaining Variation in Resource Use In evaluating the comparative performance of each alternative DRG system, RAND used MedPAR data from FY 2004 and FY 2005. RAND excluded data from CAHs, Indian Health Service (IHS) hospitals, and hospitals that have VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 all-inclusive rate charging practices. Consistent with CMS practice, RAND did not exclude data from Maryland hospitals, which operate under an IPPS waiver. Records that failed edits for data consistency or that had missing variables that were needed to determine standardized costs were also excluded. RAND reported that evaluation of each alternative severity-adjusted DRG system is a complex process due to differences in how each of the severity levels are applied, the number of severity-adjusted DRGs in each system, and the average number of discharges assigned to each DRG. In addition, the manner in which the DRGs for patients 0–17 years of age are assigned in the severity-adjusted systems affects the number of low-volume DRGs using Medicare discharges. Low-volume, severity-adjusted DRGs can affect the relative performance of a classification system. However, the percentage of Medicare discharges assigned to these DRGs is small— approximately 0.7 percent in the HSC– DRG and Sol–DRG systems compared to 0.1 percent in the CMS DRGs. In determining how much withinDRG variation exists for each alternative severity-adjusted DRG system, RAND calculated the mean standardized cost, standard deviation, and coefficient of variation for each DRG among the systems. The coefficient of variation (CV) is the standard deviation divided by the mean. The CV allowed RAND to compare the variation of populations that contain significantly different mean values. Preliminary results of the comparison demonstrate that all five severity-adjusted systems reduce the amount of variation within DRGs. The HSC–DRGs and Sol–DRGs have a slightly higher proportion of patients assigned to DRGs with a CV<76 percent but also have a higher proportion of patients assigned to DRGs with a CV≤=100 percent. The CS DRGs had a slightly lower percentage of patients assigned to DRGs with a CV<76 percent than the other severity-adjusted systems. The MM–APS–DRGs, CS DRGs, and CMS+AP–DRGs all have fewer than 2 percent of patients assigned to DRGs with a CV≤=100 percent. RAND utilized a general linear regression model to evaluate how well each severity-adjusted DRG system explains variation in costs per case. The initial results demonstrate that all five severity-adjusted DRG systems predict cost better than the CMS DRGs. The CS DRGs have higher adjusted R2 values (explanatory power) than the other severity-adjusted systems in nearly every MDC. In general, the adjusted R2 PO 00000 Frm 00015 Fmt 4701 Sfmt 4702 24693 value for the CS DRGs is 0.4458, a 13percent improvement over the adjusted R2 value for the CMS DRGs. The HSC– DRGs demonstrate an 11-percent improvement, while the adjusted R2 values for the MM–APS–DRGs and Sol– DRGs are 10.0 percent and 9.7 percent higher respectively, than the CMS DRG R2 value. The CMS+AP–DRGs show the smallest improvement, nearly 8 percent. Another aspect of RAND’s evaluation was to identify the validity of each alternative DRG system as a measurement for resource costs. For a base DRG, the severity levels should be monotonic; that is, the mean cost per discharge should increase simultaneously with an increase in the severity level. A distinction between patient groups and varying treatment costs should be accomplished by the severity levels. RAND studied the percentage differences and absolute differences in cost between the severity levels within the base DRGs for each system under evaluation. For the two systems (CMS+AP–DRGs and CS DRGs) that include several base DRGs, RAND assigned those discharges to the lower severity level base DRG. Following that methodology, RAND was able to calculate how much more costly the discharges assigned to the consolidated or lower severity levels were than the discharges in the base DRG assigned to the next higher severity level. Preliminary results demonstrate that, overall, monotonicity is not a factor across the alternative DRG systems. There are only a small percentage of discharges that are assigned to nonmonotonic DRGs. When a DRG is nonmonotonic, the mean cost in the higher severity level is less than the mean cost in the lower severity level. Using the data from severity of illness levels 1 through 3 (except for the MM– APS–DRGs, which do not have a severity of illness level 3), RAND calculated the discharge-weighted mean cost difference between severity levels and the mean ratio of the cost per discharge for the higher severity level to the adjacent lower severity level. The greatest cost discrimination was present in the higher severity levels versus the lower severity levels across all the systems. The mean cost difference between severity of illness level 1 and severity of illness level 0 was reported to be less than $2,000 for all the severity-adjusted systems. The CMS+AP DRGs have the least amount of cost discrimination between severity levels ($2,117), while the MM–APS–DRG system has the highest mean cost difference ($2,385). The remaining systems demonstrated equivalent percentage cost differences between the E:\FEDREG\03MYP2.LOC 03MYP2 24694 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules severity levels as shown in Table B below. BILLING CODE 4120–01–P In examining whether each of the alternative DRG systems provided stability in the relative weights from year to year, RAND compared the relative weights derived from the MedPAR data in FY 2004 to the relative weights data from FY 2005. RAND’s preliminary results demonstrate that generally, across all the systems, only a small percentage of DRGs had greater than a 5 percent change in relative weights. The HSC–DRGs and Sol–DRGs had a higher proportion of DRGs with a VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 greater than 5 percent change in relative weights than the other systems. Fewer than 10 percent of the DRGs in the remaining systems had relative weight changes greater than 10 percent. In addition to differences in the number of DRGs and the methodology of assigning the severity levels, RAND noted additional factors that may affect the comparative performance of each alternative severity-adjusted DRG system. For further details and discussion, we encourage readers to view RAND’s full interim report on the PO 00000 Frm 00016 Fmt 4701 Sfmt 4702 CMS Web site at: https:// www.cms.hhs.gov/Reports/downloads/ Wynn0307.pdf. c. Payment Accuracy and Case-Mix Impact Similar to how CMS established the relative weights in the FY 2007 IPPS final rule, RAND used standardized costs as determined by the national CCR and the FY 2005 MedPAR data to construct relative weights for each of the DRG systems being evaluated. RAND analyzed the effect of variations in the E:\FEDREG\03MYP2.LOC 03MYP2 EP03MY07.000 mmaher on DSK3CLS3C1PROD with $$_JOB BILLING CODE 4120–01–C 24695 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules explanatory power on the distribution of Medicare payments for each system under evaluation. The preliminary findings indicate payment accuracy is improved by each severity-adjusted system by redistributing payment from lower-cost discharges to higher-cost discharges. However, the total payment redistribution across systems differs and reflects the payment impact of improved explanatory power. Although these findings are estimates, the percent of total payment redistributed was the least under the CMS+AP–DRGs (7.1 percent) and the most under the CS DRGs (11.9 percent). Table C shows changes in case-mix index (CMI) by hospital category across alternative severity-adjusted DRG systems. Preliminary results demonstrate that under the severityadjusted systems, urban hospitals have a higher average CMI than under the CMS DRGs, and rural hospitals have a lower CMI. The analysis suggests that any system adopted to better recognize severity of illness with a budget neutrality constraint will result in payment redistribution that can be expected to benefit urban hospitals at the expense of rural hospitals. This impact occurs because patients treated in urban hospitals are generally more severely ill than patients in rural hospitals and the CMS DRGs are not currently recognizing the full extent of these differences. For purposes of the study, RAND assumed no behavioral changes in coding practice or the types of patients treated. The shift in case-mix (CMI) is greatest with the CS DRGs. The CMI for rural hospitals is 2.4 percent lower than under the CMS DRGs. The CMI for large urban (hospitals located in CBSAs with greater than 1 million population) and other urban hospitals is 0.6 percent and 0.1 percent higher, respectively, for the CS DRGs. The CMI generally increases for larger hospitals and decreases for smaller hospitals. Under the CMS+AP– DRG, HSC–DRG, and Sol–DRG systems, greater than 70 percent of hospitals would experience less than a 2.5 percent change in their CMI. Under the MM–APS–DRG and Con–APR–DRG systems, 65 and 45 percent of hospitals, respectively, would experience less than a 2.5 percent change. The percentage of hospitals experiencing less than a 5 percent change is significant across all of the CMS–based DRG systems. Teaching hospitals commonly treat a higher number of complex cases. However, depending on the severityadjusted DRG system being analyzed, the impact will vary. In the CMS+AP– DRG, HSC–DRG, and MM–APS–DRG systems, facilities with large teaching programs (100 or more residents) demonstrated a larger increase than those facilities with smaller teaching programs. Under the Sol–DRG system, facilities with large teaching programs would experience a 0.1 percent increase, while facilities with the smaller teaching programs would experience a 0.2 percent increase. The CS DRGs showed similar results for hospitals with large teaching programs, but hospitals with the smaller teaching programs would experience an increase of 0.7 percent, relative to the CMS DRGs. RAND found that CMI would decline for nonteaching hospitals from severity adjusted DRGs, from a 0.2 percent decrease under the HSC–DRGs and Sol–DRGs compared to a 0.5 percent decrease under the CS DRGs. TABLE C.—CMI CHANGE IN ALTERNATIVE DRG SYSTEMS RELATIVE TO THE CMS DRG CMI Percentage change from CMS–DRG–CMI mmaher on DSK3CLS3C1PROD with $$_JOB N hospitals ALL ........................................................... By Geographic Location: Large urban areas (pop≤1 million) ... Other urban areas (pop<1 million) ... Rural hospitals .................................. Bed Size (Urban): 0–99 beds ......................................... 100–199 beds ................................... 200–299 beds ................................... 300–499 beds ................................... 500 or more beds ............................. Bed Size (Rural): 0–49 beds ......................................... 50–99 beds ....................................... 100–149 beds ................................... 150–199 beds ................................... 200 or more beds ............................. Urban by Region: New England .................................... Middle Atlantic .................................. South Atlantic .................................... East North Central ............................ East South Central ........................... West North Central ........................... West South Central .......................... Mountain ........................................... Pacific ............................................... Puerto Rico ....................................... Rural by Region: New England .................................... Middle Atlantic .................................. South Atlantic .................................... East North Central ............................ East South Central ........................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 N discharges CMS DRG CMI CMS + AP–DRG HSC– DRG Sol–DRG MM– APS– DRG Con– APR– DRG 3,890 12,165,763 1.00 0.0 0.0 0.0 0.0 0.0 1,485 1,186 1,219 5,715,356 4,578,447 1,871,960 1.02 1.04 0.84 0.5 -0.2 -1.3 0.4 -0.2 -0.9 0.3 -0.1 -1.0 0.6 -0.2 -1.4 0.6 0.1 -2.4 685 875 511 433 167 611,139 2,346,922 2,446,737 2,965,216 1,923,789 0.91 0.93 1.00 1.08 1.17 -1.0 0.0 0.1 0.3 0.6 -1.1 0.1 0.2 0.3 0.3 -1.1 0.0 0.3 0.3 0.2 -1.3 0.1 0.3 0.4 0.4 -1.6 0.0 0.6 0.8 0.4 543 398 160 69 49 330,242 595,599 415,367 260,910 269,842 0.73 0.80 0.85 0.91 0.99 -2.5 -1.4 -1.1 -0.8 -0.6 -2.1 -1.0 -0.7 -0.6 -0.1 -2.2 -1.1 -0.8 -0.7 -0.1 -2.7 -1.6 -1.2 -0.8 -0.6 -5.0 -2.7 -2.0 -1.5 -0.5 129 370 432 410 168 164 369 153 423 53 541,471 1,621,488 2,208,336 1,856,164 696,943 657,322 1,115,411 465,093 1,016,135 115,440 0.99 1.00 1.04 1.03 1.06 1.08 1.05 1.08 1.03 0.87 0.1 0.0 0.5 0.6 -0.2 -0.3 0.1 0.4 0.0 -1.1 -0.2 -0.4 0.7 0.7 -0.2 -0.3 0.0 0.2 -0.2 -1.4 -0.5 -0.5 0.7 0.6 -0.2 0.0 0.1 0.5 -0.1 -0.1 -0.5 -0.3 0.7 0.8 -0.2 -0.3 0.3 0.4 -0.1 -1.2 -0.6 -1.5 1.4 1.5 -0.3 0.3 0.5 1.0 0.2 -5.1 34 68 191 163 201 49,842 139,639 409,116 290,069 328,326 0.90 0.85 0.82 0.87 0.82 -0.6 -1.1 -0.8 -1.1 -1.5 -0.6 -0.7 -0.4 -0.7 -0.9 -0.5 -0.7 -0.5 -0.9 -1.1 -1.1 -1.3 -0.9 -1.3 -1.4 -0.6 -1.5 -1.8 -1.8 -3.2 Frm 00017 Fmt 4701 PO 00000 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 24696 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE C.—CMI CHANGE IN ALTERNATIVE DRG SYSTEMS RELATIVE TO THE CMS DRG CMI—Continued Percentage change from CMS–DRG–CMI N hospitals % mmaher on DSK3CLS3C1PROD with $$_JOB West North Central ........................... West South Central .......................... Mountain ........................................... Pacific ............................................... Teaching Status: Non-teaching ..................................... Fewer than 100 Residents ............... 100 or more Residents ..................... Urban DSH: Non-DSH ........................................... 100 or more beds ............................. Less than 100 beds .......................... Rural DSH: Non-DSH ........................................... SCH .................................................. RRC .................................................. Other Rural: 100 or more beds ............................. Less than 100 beds .......................... Urban teaching and DSH: Both teaching and DSH .................... Teaching and no DSH ...................... No teaching and DSH ....................... No teaching and no DSH ................. Rural Hospital Types: RRC .................................................. SCH .................................................. MDH .................................................. SCH and RRC .................................. MDH and RRC .................................. Other Rural ....................................... 02:00 Aug 26, 2011 Jkt 223001 CMS DRG CMI CMS + AP–DRG HSC– DRG Sol–DRG MM– APS– DRG Con– APR– DRG 184 227 91 60 240,449 266,419 80,219 67,881 0.87 0.80 0.85 0.86 -1.6 -2.1 -1.2 -0.9 -1.2 -1.8 -1.0 -1.0 -1.1 -1.9 -0.4 -1.1 -1.8 -2.0 -1.3 -1.4 -2.5 -4.3 -1.2 -1.6 2,791 853 246 6,115,193 4,061,451 1,989,119 0.92 1.04 1.16 -0.4 0.1 0.8 -0.2 0.2 0.3 -0.2 0.2 0.1 -0.4 0.2 0.5 -0.5 0.7 0.0 778 1,541 352 2,574,640 7,378,095 341,068 1.02 1.05 0.82 -0.1 0.3 -0.9 0.0 0.2 -0.8 0.1 0.2 -1.0 -0.2 0.4 -1.1 0.5 0.4 -2.0 238 402 132 300,747 599,823 466,395 0.87 0.83 0.92 -1.4 -1.3 -0.8 -1.0 -1.0 -0.3 -0.9 -1.0 -0.5 -1.7 -1.4 -0.7 -1.9 -2.4 -1.4 60 387 135,146 369,849 0.80 0.74 -0.9 -2.1 -0.8 -1.6 -1.2 -1.7 -1.3 -2.2 -2.0 -4.3 829 204 1,064 574 4,705,476 1,108,092 3,013,687 1,466,548 1.09 1.06 0.95 1.00 0.5 0.0 -0.1 -0.2 0.3 0.1 0.1 -0.1 0.3 0.0 0.0 0.1 0.5 -0.1 0.1 -0.3 0.5 0.4 0.1 0.5 145 423 180 76 8 387 RAND also noted that changes in coding patterns or behaviors could improve payments with each severity adjusted DRG system. Increases in CMI after adopting the system could be the result of improved coding rather than increases in actual patient severity. Although the State of Maryland’s experience using the APR–DRG system is an indicator, coding behaviors are expected to vary under alternative systems according to RAND. Therefore, the risk of case-mix growth due to improved documentation and coding exists with any system. However, RAND advises that the amount of risk can be assessed based on the logic of the DRG system and result in anticipated changes in coding behavior. RAND found that the CMS+AP–DRG system may have the lowest risk of case-mix increase, while the CS DRGs present the greatest risk. The remaining systems under evaluation demonstrated equivalent risk, based on the DRG logic and other features specific to each system. In section II.D.2.c. of the preamble of this proposed rule, the CMI impact under the proposed MS–DRGs using the State of Maryland’s experience and data is described in detail. RAND’s final VerDate Mar 15 2010 N discharges 519,808 457,119 164,453 266,027 19,746 444,807 0.92 0.79 0.75 0.92 0.85 0.77 -0.8 -1.6 -2.1 -0.9 -1.4 -1.6 -0.4 -1.2 -1.7 -0.7 -0.6 -1.2 -0.5 -1.2 -1.7 -0.7 -0.8 -1.4 -0.7 -1.7 -2.3 -1.1 -1.6 -1.8 -1.4 -3.0 -4.1 -1.3 -1.9 -3.3 report will include a comparison of the CMI impact under the proposed MS– DRG system with the CMI impact of the other alternative severity-adjusted DRG systems. d. Other Issues for Consideration RAND was asked to examine whether each of the alternative severity-adjusted DRG systems under evaluation appear to contain logic that is manageable, administratively feasible, and understandable. Although its evaluation is not yet complete, RAND’s preliminary results describe the extent to which those features are present in the grouping logic of each system. A brief summary of these findings and other discussion points follow. For more complete details of the grouping logic for each system evaluated, we encourage readers to review RAND’s interim report at the following Web site: https:// www.cms.hhs.gov/Reports/downloads/ Wynn0307.pdf. To increase and promote understanding of a DRG classification system, the grouping logic should include a uniform structure. With the exception of the CS DRGs, RAND found that there is uniformity in the PO 00000 Frm 00018 Fmt 4701 Sfmt 4702 hierarchical structure for assigning discharges to MDCs, DRGs, and severity levels for each system evaluated. The CS DRGs utilize a complex rerouting logic and severity of illness level assignment. However, the result is a higher explanatory power that accounts for limitations in the current system. Therefore, due to the complexities associated with that system, it may not easily be understood. However, if the results yield clinically coherent groups of patients with comparable costs, RAND concluded that the system may be worth exploring further. The HSC– DRG and Sol–DRG grouping logic uses a standard number of severity levels for each base DRG, although the result is an increase in the number of low-volume DRGs. The standard severity level structure provides increased understanding, although as mentioned previously, low-volume, severityadjusted DRGs can affect the relative performance of a classification system. The MM–APS–DRGs and CS DRGs use standard DRG severity levels. However, the method of collapsing DRGs varies due to the modifications made for Medicare use. By only collapsing DRGs to determine relative weights, RAND E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules notes it is possible to preserve the underlying DRG structure, which perhaps would lead to a more understandable system. As stated earlier, there are also several transition issues that require attention when evaluating alternative severityadjusted DRG systems. In determining how manageable, administratively feasible, and understandable the systems being evaluated are, consideration should be given to how they crosswalk or map to the current CMS DRGs. Because four of the systems under evaluation are based on the underlying CMS DRG grouping logic to establish their base DRGs (CMS+AP– DRGs, HSC–DRGs, Sol–DRGs, and MM– APS–DRGs), the CMS DRGs are able to crosswalk smoothly to these severityadjusted DRGs. Conversely, crosswalking in reverse or backward mapping from the CMS+AP DRGs to the CMS DRGs is problematic due to the discharges in one severity level of the CMS+AP–DRG system compared to several base CMS DRGs. As expected, the CS DRGs do not crosswalk easily to the CMS DRGs due to the complex grouping logic. The MM–APS–DRGs pose unique complications as well due to the large number (over 1,000) of DRGs. System updates are another important factor that may have serious implications. All of the DRG systems RAND evaluated were reported to make annual updates to reflect ICD–9–CM coding changes. However, the CC severity level assignments for each system have not routinely been reviewed and revised. The review of the CC exclusion list and severity level assignments should be reviewed where appropriate to reflect current patterns of care, according to RAND. Accessibility to each of the severityadjusted DRG system’s logic and software is also a concern. Each system RAND analyzed is currently maintained as a proprietary product. In general, all of the vendors indicated a willingness to place their product in the public domain, under certain terms. As such, we believe it is likely there would need to be discussion as to whether there would be any limitations (such as the source code as well as the DRG logic) on the availability of the DRG systems to hospitals or competing vendors. The intent of each vendor to provide public access to its grouper logic and software is described in further detail in RAND’s interim report. The RAND contract will be complete by September 1, 2007. The final report will include evaluation of the proposed MS–DRGs, with further analysis of the five alternative severity-adjusted DRG VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 classification systems. RAND will also study various approaches to estimating costs and developing relative weights, as well as the payment impacts of alternative methodologies. Again, we invite public comment on RAND’s preliminary analysis of the alternative severity-adjusted DRG systems. The interim report can be viewed on the CMS Web site at: https:// www.cms.hhs.gov/Reports/downloads/ Wynn0307.pdf. 2. Development of Proposed Medicare Severity DRGs (MS–DRGs) As discussed previously, we are committed to continuing our efforts of making refinements to the current CMS DRGs to better recognize severity of illness. In the FY 2007 final rule, we stated that we had begun a comprehensive review of over 13,000 diagnosis codes to determine which codes should be classified as CCs when present as a secondary diagnosis. We stated that we would also build on the severity DRG work we performed in the mid-1990’s. We received a number of public comments on last year’s proposed rule that supported the refinement of the current CMS DRGs so that they better capture severity. We also committed to performing a more broad based analysis of the entire DRG system to better recognize severity of illness. As a result of this broad based analysis, we developed the proposed MS–DRGs. The proposed MS–DRGs represent a comprehensive approach to applying a severity of illness stratification for Medicare patients throughout the DRGs. As discussed in section II.D.5. of the preamble of this proposed rule, the proposed MS–DRGs maintain the significant advancements in identifying medical technology made to the DRGs in past years. At the same time, they greatly improve our ability to identify groups of patients with varying levels of severity using secondary diagnoses. Further, they improve our ability to assign patients to different DRG severity levels based on resource use that is independent of the patient’s secondary diagnosis—referred to in this discussion as ‘‘complexity.’’ We are proposing to adopt the MS–DRGs for FY 2008 and submit the system to RAND as part of its evaluation of alternative DRG systems. We encourage comments on both our proposed methodology as well as on the resulting proposed DRG structure. a. Comprehensive Review of the CC List Our efforts to better recognize severity of illness began with a comprehensive review of the CC list. Currently, 115 DRGs are split based on the presence or PO 00000 Frm 00019 Fmt 4701 Sfmt 4702 24697 absence of a CC. For these DRGs, the presence of a CC assigns the discharge to a higher weighted DRG. The list of diagnoses designated as a CC was initially created at Yale University in 1980–1981 as part of the project to develop an ICD–9–CM version of the DRGs. The researchers at Yale University developed the ICD–9–CM DRGs using national hospital data with diagnoses and procedures coded in ICD–9–CM from the second half of 1979. Because hospitals only began reporting ICD–9–CM codes in 1979, discharge abstracts at that time were much less likely to fully report all secondary diagnoses. As a result, the Yale University researchers developed a liberal definition of a CC as any secondary diagnosis that ‘‘would cause an increase in length of stay by at least 1 day in at least 75 percent of the patients.’’ Because of the likely underreporting of secondary diagnoses in the 1979 data, the Yale University researchers also used age as a surrogate for identifying patients with a CC. The original version of the ICD–9–CM DRGs assigned patients to a CC DRG if they had a secondary diagnosis on the CC list or if the patient was 70 years or older. With the implementation of the IPPS in FY 1984, the coding of secondary diagnoses by hospitals dramatically improved. During the first 4 years of the IPPS, the CC definition included the age 70 criterion. With the improved coding and reporting of diagnoses associated with the implementation of the IPPS, the use of age as a surrogate for CCs was no longer necessary. Thus, beginning in FY 1988, the age 70 criterion was removed from the CC definition and a CC DRG was defined exclusively by the presence of a secondary diagnosis on the CC list. Except for new diagnosis codes that were added to ICD–9–CM after FY 1984 (for example, HIV), the CC list of diagnoses currently used in the CMS DRGs is virtually identical to the CC list created at Yale University. However, there have been dramatic changes not only in the accuracy and completeness of the coding of secondary diagnoses but also in the characteristics of patients admitted to hospitals and the practice patterns within hospitals as well. Since the implementation of the IPPS, Medicare average length of stay has dropped dramatically from 9.8 days in 1983 to 5.7 days in 2005. The economic incentives inherent in DRGs motivated a change in practice patterns to discharge patients earlier from the hospital. These changes were facilitated by the increased availability of postacute care services, such as nursing homes and home health services, which E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24698 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules allowed problems previously requiring continued hospitalization to be effectively treated outside the acute care hospital. Furthermore, there has also been a dramatic shift to outpatient surgery that avoids costly inpatient stays. Many surgical procedures formerly performed in the hospital are now routinely performed on an outpatient basis. As a result, patients admitted to the hospital today are on average more likely to have a CC than when the IPPS was implemented. The net effect of better coding of secondary diagnoses, reductions in hospital length of stay, increased availability of postacute care services, and the shift to outpatient care is that most patients (nearly 80 percent) admitted to a hospital now have a CC. As a result of the changes that have occurred during the 22 years since the implementation of the IPPS, the CC list as currently defined has lost much of its power to discriminate hospital resource use. Currently, 115 CMS DRGs have a CC subdivision. Up until FY 2002, the number of DRGs with a CC subdivision remained essentially unchanged from the original FY 1984 version of the DRGs. As a means of improving the payment accuracy of the DRGs, beginning with the FY 2002 DRG update, each base CMS DRG without a CC subdivision was evaluated to determine if a CC subdivision was warranted. Over the past five DRG updates, only seven base CMS DRGs have had a CC subdivision added. The primary constraint preventing a significant increase in the number of base CMS DRGs with a CC subdivision is the low number of patients that would be assigned to the non-CC group. Thus, the expansion of the number of CMS DRGs subdivided based on a CC is constrained because the vast majority of patients would be assigned to the CC group and few patients would be assigned to the non-CC group. To remedy these problems, we reviewed each of the 13,549 secondary diagnosis codes to evaluate their assignment as a CC or non-CC using statistical information from the Medicare claims data and applying medical judgment based on current clinical practice. We refer to this list in this section as the ‘‘revised CC list.’’ The need for a revised CC list prompted a reexamination of the secondary diagnoses that qualify as a CC. Our intent was to better distinguish cases that are likely to result in increased hospital resource use based on secondary diagnosis. Using a combination of mathematical data and the judgment of our medical officers, we included the condition on the CC list if it could demonstrate that its presence VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 would lead to substantially increased hospital resource use. Diagnoses may require increased hospital resource use because of a need for such services as: <bullet≤ Intensive monitoring (for example, an intensive care unit (ICU) stay). <bullet≤ Expensive and technically complex services (for example, heart transplant). <bullet≤ Extensive care requiring a greater number of caregivers (for example, nursing care for a quadriplegic). There are 3,326 diagnosis codes on the current CC list. Our 2006 review of the CC list reduced the number of diagnosis codes on the CC list to 2,583. Based on the current CC list, 77.6 percent of patients have at least one CC present. Based on the revised CC list from our 2007 review, the percent of patients having at least one CC present would be reduced to 41.24 percent. b. Chronic Diagnosis Codes The 1979 data used in the original formation of the CC list often did not have the manifestations of a chronic disease fully coded. As a result, the CC list included many chronic diseases with a broad range of manifestations. Such chronic illness diagnoses usually do not cause a significant increase in hospital resource use unless there is an acute exacerbation present or there is a significant deterioration in the underlying chronic condition. Therefore, in the revised CC list, we removed chronic diseases without a significant acute manifestation. Recognition of the impact of the chronic disease is accomplished by separately coding the acute manifestation. For example, the mitral valve disease codes (codes 396.0 through 396.9) are assigned to the current CC list. However, unless the mitral valve abnormalities are associated with other diagnoses indicating acute deterioration, such as acute congestive heart failure, acute pulmonary edema, or respiratory failure, they would not be expected to significantly increase hospital resource use. Therefore, the revised CC list did not include the mitral valve codes. Recognition of the contribution of mitral valve disease to the complexity of hospital care would be accomplished by separately coding those diseases on the CC list that are associated with an acute exacerbation or deterioration of the mitral valve disease. The revised CC list applied the criterion that chronic diagnoses having a broad range of manifestations are not assigned to the CC list as long as there are codes available that allow the acute manifestations of the disease to be coded separately. For some diseases, there are ICD–9–CM codes that PO 00000 Frm 00020 Fmt 4701 Sfmt 4702 explicitly include a specification of the acute exacerbation of the underlying disease. For example, for congestive heart failure, the following codes specify an acute exacerbation of the congestive heart failure: <bullet≤ 428.21, Acute systolic heart failure <bullet≤ 428.41, Acute systolic and diastolic heart failure <bullet≤ 428.43, Acute on chronic systolic heart failure <bullet≤ 428.31, Acute diastolic heart failure <bullet≤ 428.33, Acute on chronic diastolic heart failure These congestive heart failure codes are included on the revised CC List. However, the following congestive heart failure codes do not indicate an acute exacerbation and are not included in the revised CC list: <bullet≤ 428.0, Congestive heart failure not otherwise specified <bullet≤ 428.1, Left heart failure <bullet≤ 428.20, Systolic heart failure not otherwise specified <bullet≤ 428.22, Chronic systolic heart failure <bullet≤ 428.32, Chronic diastolic heart failure <bullet≤ 428.40, Systolic and diastolic heart failure <bullet≤ 428.9, Heart failure not otherwise specified As a result of this approach, most chronic diseases were not assigned to the revised CC list. In general, a significant acute manifestation of the chronic disease must be present and coded for the patient to be assigned a CC. We made exceptions for diagnosis codes that indicate a chronic disease in which the underlying illness has reached an advanced stage or is associated with systemic physiologic decompensation and debility. The presence of such advanced chronic diseases, even in the absence of a separately coded acute manifestation, significantly adds to the treatment complexity of the patient. Thus, the presence of the advanced chronic disease inherently makes the reason for admission more difficult to treat. For example, under the revised CC list, stage IV, V, or end-stage chronic renal failure (codes 585.4 through 585.6) are designated as a CC, but stage I through III chronic renal failure (codes 585.1 through 585.3) are not. For obesity, a body mass index over 35 (codes V85.35 through V85.4) is a CC, but a body mass index between 19 and 35 is not. Endstage renal failure and extreme obesity are examples of chronic diseases for which the advanced stage of the disease is clearly specified. However, for most major chronic diseases, the stage of the disease is not clearly specified in the code. These E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules codes were evaluated based on the consistency and intensity of the physiologic decompensation and debility associated with the chronic disease. For example, quadriplegia (codes 344.00 through 344.09) requires extensive care with a substantial increase in nursing services and more intensive monitoring. Therefore, quadriplegia is considered a CC in the revised CC list. c. Acute Diagnosis Codes Examples of acute diseases included on the revised CC list included acute myocardial infarction (AMI), cerebrovascular accident (CVA) or stroke, acute respiratory failure, acute renal failure, pneumonia and septicemia. These six diseases are representative of the types of illnesses we included on the revised CC list. Other acute diseases were designated as a CC if their impact on hospital resource use would be expected to be comparable to these representative acute diseases. For example, acute endocarditis was included on the CC list but urinary tract infection was not. The revised CC list is essentially comprised of significant acute disease, acute exacerbations of significant chronic diseases, advanced or end stage chronic diseases and chronic diseases associated with extensive debility. Compared to the existing CC list, the 24699 revised CC list requires a secondary diagnosis to have a consistently greater impact on hospital resource. The following Table D compares the current CC list and the revised CC list. There are 3,326 diagnosis codes on the current CC list. The CC revisions reduce the number of diagnosis codes on the CC list to 2,583. Based on the current CC list, 77.6 percent of patients have at least one CC present, using FY 2006 MedPAR data. Based on the revised CC list, the percent of patients having at least one CC present is reduced to 40.34 percent. The revised CC list increases the difference in average charges between patients with and without a CC by 56 percent ($15,236 versus $9,743). TABLE D.—COMPARISON OF CURRENT CC LIST AND REVISED CC LIST Current CC list Revised CC list 3,326 77.66 22.34 $24,538 $14,795 2,583 40.34 59.66 $31,451 $16,215 Codes designated as a CC ................................................................................................................................. Percent of patients with one or more CCs .......................................................................................................... Percent of patients with no CC ........................................................................................................................... Average charge of patients with one or more CCs ............................................................................................. Average charge of patients with no CCs ............................................................................................................ The analysis above suggests that merely reviewing and updating the CC list can lead to significant improvements in the ability of the CMS DRGs to recognize severity of illness. Although we could potentially adopt this one change to better recognize severity of illness in the CMS DRGs, we have undertaken additional analyses that further refine secondary diagnoses into MCCs, CCs and non-CCs as described below. mmaher on DSK3CLS3C1PROD with $$_JOB d. Prior Research on Subdivision of CCs into Multiple Categories (1) Refined DRGs During the mid-1980s, CMS (then HCFA) funded a project at Yale University to revise the use of CCs in the CMS DRGs. The Yale University project mapped all secondary diagnoses that were considered a CC in the CMS DRGs into 136 secondary diagnosis groups, each of which was assigned a CC complexity level. For surgical patients, each of the 136 secondary diagnosis groups was assigned to 1 of 4 CC complexity levels (non-CC, moderate CC, MCC, and catastrophic CC). For medical patients, each of the 136 secondary diagnosis groups was assigned to 1 of 3 CC complexity levels (non-CC, moderate/MCC, and catastrophic CC). All age subdivisions and CC subdivisions in the DRGs were eliminated and replaced by the four CC subgroups for surgical patients, or the three CC subgroups for medical patients. The Yale University project did not VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 reevaluate the categorization of secondary diagnosis as a CC versus a non-CC. Only the diagnoses on the standard CC list were used to create the moderate, major, and catastrophic subgroups. All secondary diagnoses in a secondary diagnosis group were assigned the same level, and a patient was assigned to the subgroup corresponding to the highest level secondary diagnosis. The number of secondary diagnoses had no effect on the subgroup assigned to the patient (that is, multiple secondary diagnoses at one level did not cause a patient to be assigned to a higher subgroup). The DRG system developed by the Yale University project demonstrated that a subdivision of the CCs into multiple subclasses would improve the predictability of hospital costs. (2) 1994 Severity DRGs We also examined the work we performed in the mid-1990’s to revise the CMS DRGs to better capture severity. In 1993, we reevaluated the use of CCs within the CMS DRGs. The reevaluation excluded the CMS DRGs associated with pregnancy, newborn, and pediatric patients (MDCs 14 and 15 and DRGs defined based on age 0–17). The major CC list from the AP–DRGs that are used for Medicaid payment by New York and other States was used to identify an initial list of MCCs. Using Medicare data, we reevaluated the categorization of each secondary diagnosis as a non-CC, CC, or an MCC. PO 00000 Frm 00021 Fmt 4701 Sfmt 4702 The end result was that 111 diagnoses that were non-CCs in the standard CMS DRGs were made a CC, 220 diagnoses that were a CC were made a non-CC, and 395 CCs were considered an MCC. All CC splits in the CMS DRGs were eliminated, and an additional 24 DRGs were merged together. The resulting base CMS DRGs were then subdivided into three, two, or no subgroups based on an analysis of Medicare data. The result was 84 DRGs with no subgroups, 124 DRGs with two subgroups, and 85 DRGs with three subgroups. An additional 63 pregnancy, newborn, and pediatric DRGs not evaluated resulted in a total of 652 DRGs. A patient was assigned to the CC subgroup corresponding to the highest level secondary diagnosis. Multiple secondary diagnoses at one level did not cause a patient to be assigned to a higher subgroup. The categorization of a diagnosis as non-CC, CC, or MCC was uniform across the CMS DRGs, and there were no modifications for specific DRGs. As part of the FY 1995 IPPS proposed rule, we made a complete file of the revised DRG descriptions available to the public. However, we never adopted the revised DRGs (55 FR 27756). e. Proposed Medicare Severity DRGs (MS–DRGs) We had several options in developing a refinement to the current CMS DRGs to better recognize increased resource use due to severity of illness. One E:\FEDREG\03MYP2.LOC 03MYP2 24700 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules option would involve simply taking the work performed in 1994 and then updating it with all the code changes that have taken place since then. We were reluctant to do this because of changes in medical practices as well as the substantial change in ICD–9–CM codes since that time. Another option would be to build on current CMS DRGs which include a number of advancements that better identify medical practices and technologies. Many commenters on the FY 2007 IPPS proposed rule urged us to take the latter approach because they believed the current base CMS DRGs clearly differentiate between the complexities of varying surgical procedures and medical devices. Therefore, we chose the option of developing a new severity DRG system based on the current CMS DRGs. The development of the 1994 Severity DRGs involved three steps: <bullet≤ Consolidation of existing DRGs into base DRGs. <bullet≤ Categorization of each diagnosis as an MCC, CC, or non-CC. <bullet≤ Subdivision of each base DRG into subclasses based on CCs. We reviewed and revised each of the three steps and applied them to our current CMS DRGs to develop DRGs that better identify severity of illness among Medicare patients. We refer to this proposed system as the Medicare Severity DRGs (MS–DRGs). The purpose of the proposed MS–DRGs is to more accurately stratify groups of Medicare patients with varying levels of severity. (1) Consolidation of Existing CMS DRGs Into Proposed Base MS–DRGs The first step in our process was the consolidation of existing CMS DRGs into new proposed base MS–DRGs. We combined together the 115 pairs of CMS DRGs that are subdivided based on the presence of a CC. We further consolidated the CMS DRGs that are split on the basis of a major cardiovascular condition, AMI with and without major complication (CMS DRGs 121 and 122), and cardiac catheterization with and without complex diagnoses (CMS DRGs 124 and 125). We also consolidated the three pairs of burn CMS DRGs that were defined based on the presence of a CC or a significant trauma (CMS DRGs 506 and 507; 508 and 509; and 510 and 511). Next, we consolidated the 43 pediatric CMS DRGs that are defined based on age less than or equal to 17. These pediatric CMS DRGs contain a very low volume of Medicare patients. As shown in Table 10 of the FY 2007 IPPS final rule (71 FR 48318), only two of these pediatric CMS DRGs contained more than 100 patients (CMS DRGs 298 and 333). Seventeen of these pediatric DRGs had no patients (CMS DRGs 30, 33, 41, 48, 54, 58, 137, 252, 255, 282, 330, 340, 343, 393, 405, 446, and 448). As we have stated frequently, our primary focus in maintaining the CMS DRGs is to serve the Medicare population. We do not have the data or the expertise to maintain the DRGs in clinical areas that are not relevant to the Medicare population. We continue to encourage users of the CMS DRGs (or MS–DRGs if adopted) to make relevant adaptations if they are being used for a non-Medicare patient population. In addition to the pediatric CMS DRGs defined by the age of the patient, there are a number of CMS DRGs that relate primarily to the pediatric or adult population that have very low volume in the Medicare population, such as male sterilization, tubal interruptions, circumcisions, tonsillectomies, and myringotomies. These CMS DRGs were consolidated into the most clinically similar proposed MS–DRG. Over the past two decades, the site of service for some elective procedures such as carpal tunnel release, cataract extraction, and laparoscopy has shifted from the inpatient to the outpatient setting, resulting in the CMS DRGs associated with these procedures having very low volume. These CMS DRGs were also consolidated into the most clinically similar proposed MS–DRG. In addition, there were some clinically related CMS DRGs that had significant Medicare patient volume but had no significant difference in resource use. For example, thyroid (CMS DRG 290) and parathyroid (CMS DRG 289) procedures were virtually identical in terms of hospital resource use and were, therefore, consolidated. In total, 34 of these CMS DRGs were consolidated. The DRG consolidations are summarized in Table E below. Four pairs of proposed MS–DRGs (223 and 224; 228 and 229; 323 and 324; and 551 and 552) were defined based on the presence of a CC or some other condition. For example, proposed MS– DRG 323 is defined based on the presence of a CC or the performance of extracorporeal shock wave lithotripsy. For these proposed MS–DRGs, the CC condition was removed and the pair of DRGs remains separate but defined based only on the other condition (that is, proposed MS–DRG 323 became urinary stones with extracorporeal shock wave lithotripsy). As was done in the 1994 severity DRG work, we did not consolidate any of the CMS DRGs for maternity or newborn cases. Before proceeding further, we made one additional change to a base DRG assignment after completing these consolidations. We assigned cranialfacial bone procedures to a proposed new base DRG (Cranial/Facial Bone Procedures). These cases were previously assigned to DRGs 52 and 55 through 63. Table E below shows how DRGs in the CMS DRGs (Version 24.0) were consolidated into proposed new base MS–DRGs. We refer readers to section II.D.2. of the preamble of this proposed rule for a detailed discussion of CCs and MCCs under the proposed MS–DRGs. TABLE E.—DRG CONSOLIDATION Proposed 2008 MSDRG DRG description 6 ..................... 7,8 .................. mmaher on DSK3CLS3C1PROD with $$_JOB CMS-DRG Version 24.0 Carpal Tunnel Release .................................................... Peripheral & Cranial Nerve & Other Nervous System Procedure. 40 41 42 36 38 39 42 ................... ................... ................... ................... Retinal Procedures ........................................................... Primary Iris Procedures ................................................... Lens Procedures with or without Vitrectomy ................... Intraocular Procedures Except Retina, Iris & Lens ......... 116 117 Intraocular Procedures with and without CC/MCC. 43 ................... 46,47,48 ......... Hyphema .......................................................................... Other Disorders of the Eye .............................................. 124 125 Other Disorders of the Eye with and without MCC. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00022 Fmt 4701 Sfmt 4702 Proposed new base MS-DRGs description Peripheral & Cranial Nerve & Other Nervous System Procedure with MCC, with CC, and without CC/MCC. E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24701 TABLE E.—DRG CONSOLIDATION—Continued Proposed 2008 MSDRG DRG description 50 ................... 51 ................... Sialoadenectomy .............................................................. Salivary Gland Procedures Except Sialoadenectomy ..... 139 Salivary Gland Procedures. 52 ................... 55 ................... Cleft Lip & Palate Repair ................................................. Miscellaneous Ear, Nose, Mouth & Throat Procedures .. 133 134 Other Ear, Nose, Mouth & Throat O.R. Procedures with and without CC/MCC. 56 ................... 57,58 .............. 59,60 .............. 61,62 .............. 63 ................... Rhinoplasty ....................................................................... Tonsillectomy & Adenoidectomy Procedure, Except Tonsillectomy &/or Adenoidectomy Only. Tonsillectomy &/or Adenoidectomy Only ......................... Myringotomy with Tube Insertion ..................................... Other Ear, Nose, Mouth & Throat O.R. Procedures ....... Epiglottitis ......................................................................... Otitis Media & Upper Respiratory Infection ..................... Laryngotracheitis .............................................................. 131 132 New DRG—Cranial/Facial Bone Procedures with and without CC/MCC. 67 ................... 68,69,70 ......... 71 ................... 152 153 Otitis Media & Upper Respiratory Infection with and without MCC. 72 ................... 73,74 .............. Nasal, Trauma & Deformity ............................................. Other Ear, Nose, Mouth & Throat Diagnoses ................. 154 155 156 Other Ear, Nose, Mouth & Throat Diagnoses with MCC, with CC, without CC/MCC. 185,186 .......... 187 ................. Dental & Oral Diseases Except Extractions & Restorations. Dental Extractions & Restorations ................................... 157 158 159 Dental & Oral Diseases with MCC, with CC, without CC/ MCC. 199 ................. 200 ................. Hepatobiliary Diagnostic Procedure for Malignancy ........ Hepatobiliary Diagnostic Procedure for Non-Malignancy 420 421 422 Hepatobiliary Diagnostic Procedures with MCC, with CC, without CC/MCC. 244,245 .......... 246 ................. Bone diseases & Specific Arthropathies .......................... Non-Specific Arthropathies .............................................. 553 554 Bone Diseases & Arthropathies with and without MCC. 259,260 .......... 261 ................. 262 ................. Subtotal Mastectomy for Malignancy * ............................ Breast Procedures for Non-Malignancy Except Biopsy & Local Excision. Breast Biopsy & Local Excision for Non-Malignancy ...... 584 585 Breast Biopsy, Local Excision & Other Breast Procedures with and without CC/MCC. 267 ................. 268 ................. 269,270 .......... Perianal & Pilonidal Procedures ...................................... Skin, Subcutaneous Tissue & Breast Plastic Procedures Other Skin, Subcutaneous Tissue & Breast Procedure .. 579 580 581 Other Skin, Subcutaneous Tissue & Breast Procedures with MCC, with CC, without CC/MCC. 289 290 291 294 295 ................. ................. ................. ................. ................. Parathyroid Procedures ................................................... Thyroid Procedures .......................................................... Thyroglossal Procedures ................................................. Diabetes ≤ 35 ................................................................... Diabetes < 35 ................................................................... 625 626 627 637 638 639 Thyroid, Parathyroid & Thyroglossal Procedures with MCC, with CC, without CC/MCC. 338 ................. 339,340 .......... Testes Procedures for Malignancy .................................. Testes Procedures, Non-Malignancy ............................... 711 712 Testes Procedures with and without CC/MCC. 342,343 .......... Circumcision ..................................................................... ................ Procedure 64.0 changed to non-O.R. Cases with only this procedure will go to medical DRGs. 351 ................. 352 ................. Sterilization, Male ............................................................. Other Male Reproductive System Diagnoses .................. 729 730 Other Male Reproductive System Diagnoses with and without CC/MCC. 361 362 363 364 mmaher on DSK3CLS3C1PROD with $$_JOB CMS-DRG Version 24.0 ................. ................. ................. ................. Laparoscopy & Incisional Tubal Interruption ................... Endoscopic Tubal Interruption ......................................... D&C, Conization & Radio-Implant, for Malignancy .......... D&C, Conization Except for Malignancy .......................... History of Malignancy with Endoscopy ............................ 744 745 D&C, Conization, Laparascopy & Tubal Interruption with and without CC/MCC. 411 ................. 412 ................. 413,414 .......... History of Malignancy without Endoscopy ....................... Other Myeloproliferative Disease or Poorly Differentiated Neoplasm Diagnosis. 843 844 845 Other Myeloproliferative Disease or Poorly Differentiated Neoplasm Diagnosis with MCC, with CC, without CC/ MCC. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00023 Fmt 4701 Sfmt 4702 Proposed new base MS-DRGs description Diabetes with MCC, with CC, without CC/MCC. E:\FEDREG\03MYP2.LOC 03MYP2 24702 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE E.—DRG CONSOLIDATION—Continued Proposed 2008 MSDRG CMS-DRG Version 24.0 DRG description 465 ................. 466 ................. Aftercare with History of Malignancy as Secondary Diagnosis. Aftercare without History of Malignancy as Secondary Diagnosis. 949 950 Proposed new base MS-DRGs description Aftercare with and without CC/MCC. *Codes 85.22 and 85.23 in CMS DRGs 259 and 260 were moved to proposed MS-DRG 582 and 583. As summarized in the Table F, the consolidation resulted in the formation of 335 proposed base MS–DRGs. TABLE F.—CONSOLIDATION OF CURRENT CMS DRGS INTO PROPOSED MS–DRGS Number mmaher on DSK3CLS3C1PROD with $$_JOB Current CMS DRGs ...................... Elimination of CC subgroups ........ Elimination of MCC subgroups ..... Elimination of CC complexity subgroups ....................................... Elimination of age 0–17 subgroups ....................................... Consolidation due to volume or resource similarity ..................... New DRG ..................................... Revised Base DRGs .................... Newborn, maternity and error DRGs ........................................ Base DRGs for severity subdivision ............................................ 538 -114 -7 -5 -43 -34 +1 311 +24 335 The end result of the consolidation of the CMS DRGs in the proposed MS– DRGs was similar to the consolidation performed in the 1994 severity DRGs. The 1994 DRG consolidations resulted in 356 base DRGs plus 2 error DRGs. The number of the 1994 base DRGs is different because new CMS DRGs have been added since 1994, the 43 age 0–17 pediatric CMS DRGs were not consolidated, and some of the volume shifts to outpatient care had not yet occurred in 1994. In the 1994 severity DRGs, 24 DRGs were consolidated due to volume or resource similarity. Sixteen of these 1994 DRG consolidations are included in the 34 consolidations done in the 2007 consolidations. However, due to concerns expressed by our physician consultants, 8 of the DRG consolidations from 1994 were not done. For example, interstitial lung disease (DRGs 92 and 93) was not consolidated with simple pneumonia and pleurisy (DRGs 89, 90, 91) as was done in the 1994 consolidations. (2) Categorization of Diagnoses We decided to establish three different levels of CC severity into which we would subdivide the VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 diagnosis codes. The proposed three levels are MCC, CC, and non-CC. Diagnosis codes classified as MCCs reflect the highest level of severity. The next level of severity includes diagnosis codes classified as CCs. The lowest level is for non-CCs. Non-CCs are diagnosis codes that do not significantly affect severity of illness and resource use. Therefore, secondary diagnoses that are non-CCs do not affect the DRG assignment under either the current CMS DRGs or the proposed MS–DRGs. The categorization of diagnoses as an MCC, CC, or non-CC was accomplished using an iterative approach in which each diagnosis was evaluated to determine the extent to which its presence as a secondary diagnosis resulted in increased hospital resource use. In order to begin this iterative process, we started with an initial categorization of each diagnosis as an MCC, CC, or non-CC. As noted previously the 1994 CC revision began by separating CCs into MCC and CC based on the AP–DRG major CCs. One way to begin this iterative process would have been to use the 1994 CC categorization. However, the 1994 CC categorization was based on FY 1992 data and ICD–9–CM diagnosis codes, which now are 15 years old. Since 1992, 1,897 new diagnoses codes have been added, and 346 diagnoses codes have been deleted. Because the revised CC list (explained in section II.C.2.a. of this preamble) was based on current ICD–9– CM codes and used recent data, we decided to utilize the revised CC list rather than the 1994 categorization as our starting point for determining whether each secondary diagnosis should be an MCC, a CC, or a non-CC. The revised CC list categorizes each diagnosis as a CC or a non-CC. We decided to use this list in combination with the categorization under the AP– DRGs and the APR DRGs. The AP–DRGs and the APR–DRGs are updated annually with current codes and provide a good comparison source to use with the revised CC list. We designated as an MCC any diagnosis that was a CC in the revised CC list and was an AP–DRG major CC and was an PO 00000 Frm 00024 Fmt 4701 Sfmt 4702 APR DRG default severity level 3 (major) or 4 (extensive). We designated as a non-CC any diagnosis that was a non-CC in the revised CC list and was an AP–DRG non-CC and was an APR DRG default severity level of 1 (minor). Any diagnoses that did not meet either of the above two criteria was designated as a CC. The only exception to our approach was for diagnoses related to newborns, maternity, and congenital anomalies. These diagnoses are very low volume in the Medicare population and were not reviewed for purposes of creating the revised CC list. We used the APR DRGs to categorize these diagnoses. For newborn, obstetric, and congenital anomaly diagnoses, we designated the APR DRG default severity level 3 (major) and 4 (extreme) diagnoses as an MCC, the APR–DRG default severity level 2 (moderate) diagnoses as a CC, and the APR DRG default severity 1 (minor) diagnoses as a non-CC. Table G summarizes the number of codes in each CC category. TABLE G.—INITIAL CATEGORIZATION OF CC CODES Number of codes MCC .............................................. CC ................................................. Non-CC ......................................... 1,096 4,221 8,232 Total ....................................... 13,549 This initial CC categorization of diagnosis codes was used to begin the iterative process of determining the proposed final CC categorization for each diagnosis code. (3) Additional CC Exclusions For some CMS DRGs, the presence of specific secondary diagnoses affects the base DRG assignment. For example, in MDC 5 (Diseases and Disorders of the Circulatory System), the presence of an AMI code as the principal diagnosis or as a secondary diagnosis will cause the patient to be assigned to the AMI DRGs (CMS DRGs 121 through 123). Therefore, if the AMI code is present as E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules a secondary diagnosis, it should not be used to assign the CC category for a patient because it is redundant within the definition of the base DRG. Similarly, for MDC 24 (Multiple Significant Trauma), specific combinations of significant trauma as principal or secondary diagnosis cause the assignment to the multiple trauma DRGs (CMS DRGs 484 through 487). Therefore, any secondary diagnosis of trauma is redundant with the definition of the multiple trauma DRGs and should not be used to determine the CC category for a patient. Any secondary diagnoses that are used to assign a specific proposed base MS–DRG were excluded from the determination of the CC category for patients assigned to that proposed base MS–DRG. (4) Analysis of Secondary Diagnoses The 311 proposed base MS-DRGs (335 total base DRGs minus the MDC 14, MDC 5, and error DRGs) were subdivided into three CC subgroups. Patients were assigned to the subgroup corresponding to the most extreme CC present). All but four of the proposed base MS-DRGs had strictly monotonically increasing average charges across the three CC subgroups (that is, average charges progressively increased from the non-CC to the CC to 24703 the MCC subgroups). The four proposed MS-DRGs that failed to have monotonically increasing charges all had at least one CC subgroup with very low volume. For example, the non-CC subgroup for the pancreas transplant DRG (CMS DRG 513) had only 2 cases. The overall statistics by CC subgroup for the 311 proposed base MS-DRG is contained in Table H. Patients in the MCC subgroup have average charges that are nearly double the average charge for patients in the CC subgroup. The CC subgroup with the largest number of patients is the non-CC subgroup with 41.1 percent of the patients. TABLE H.—OVERALL STATISTICS FOR PROPOSED MS–DRGS EXCLUDING THOSE IN MDCS 14 AND 15 Number of cases CC subgroup Major ............................................................................................................................................ CC ................................................................................................................................................ Non-CC ........................................................................................................................................ In order to evaluate the initial assignment of secondary diagnoses to the three CC subclasses, we devised a system that determined the impact on resource use of each secondary diagnosis. For each secondary diagnosis, we measured the impact in resource use for the following three subsets of patients: (a) Patients with no other secondary diagnosis or with all other secondary diagnoses that are non-CCs. (b) Patients with at least one other secondary diagnosis that is a CC but none that is an MCC. Meaning 0 .......... Significantly below expected value for the non-CC subgroup. Approximately equal to expected value for the non-CC subgroup. Approximately equal to expected value for the CC subgroup. Approximately equal to expected value for the MCC subgroup. 3 .......... 2,604,696 4,293,744 4,818,411 22.2 36.6 41.1 Meaning 4 .......... Value 2 .......... Average charges Value (c) Patients with at least one other secondary diagnosis that is an MCC. Numerical resource impact values were assigned for each diagnosis as follows: 1 .......... Percent $44,246 24,131 18,435 Significantly above the expected value for the MCC subgroup. Each diagnosis for which Medicare data were available was evaluated to determine its impact on resource use and to determine the most appropriate CC subclass (non-CC, CC, or MCC) assignment. In order to make this determination, the average charge for each subset of cases was compared to the expected charge for cases in that subset. The following format was used to evaluate each diagnosis: ODE mmaher on DSK3CLS3C1PROD with $$_JOB Code Diagnosis Cnt1 Count (Cnt) is the number of patients in each subset and C1, C2, and C3 are a measure of the impact on resource use of patients in each of the subsets. The C1, C2, and C3 values are a measure of the ratio of average charges for patients with these conditions to the expected average charge across all cases. The C1 value reflects a patient with no other secondary diagnosis or with all other secondary diagnoses that are non-CCs. The C2 value reflects a patient with at least one other secondary diagnosis that is a CC but none that is a major CC. The C3 value reflects a patient with at least one other secondary diagnosis that is a major CC. A value close to 1.0 in the C1 field would suggest that the code produces the same expected value as a VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 C1 Cnt2 non-CC diagnosis. That is, average charges for the case are similar to the expected average charges for that subset and the diagnosis is not expected to increase resource usage. A higher value in the C1 (or C2 and C3) field suggests more resource usage is associated with the diagnosis and an increased likelihood that it is more like a CC or major CC than a non-CC. Thus, a value close to 2.0 suggests the condition is more like a CC than a non-CC but not as significant in resource usage as an MCC. A value close to 3.0 suggests the condition is expected to consume resources more similar to an MCC than a CC or non-CC. For example, a C1 value of 1.8 for a secondary diagnosis means that for the subset of patients who have PO 00000 Frm 00025 Fmt 4701 Sfmt 4702 C2 Cnt3 C3 the secondary diagnosis and have either no other secondary diagnosis present, or all the other secondary diagnoses present are non-CCs, the impact on resource use of the secondary diagnoses is greater than the expected value for a non-CC by an amount equal to 80 percent of the difference between the expected value of a CC and a non-CC (that is, the impact on resource use of the secondary diagnosis is closer to a CC than a non-CC). Table I below shows examples of the results. E:\FEDREG\03MYP2.LOC 03MYP2 24704 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE I.—EXAMPLES OF IMPACT ON RESOURCE USE OF SECONDARY DIAGNOSES Code Cnt1 401.1, Benign essential hypertension .............................. 530.81, Esophageal reflux ................................................ 560.1, Paralytic Ileus ........................................................ 491.20, Obstructive chronic bronchitis ............................. 410.71, Subendocardial infarction initial episode ............. 518.81, Acute respiratory failure ...................................... The resource use impact reports were produced for all diagnoses except obstetric, newborn, and congenital anomalies (10,690 diagnoses). These mathematical constructs were used as guides in conjunction with the C1 12,308 294,673 10,651 7,003 1,657 5,332 CntC2 0.955 0.986 1.466 1.416 2.245 2.096 40,113 917,058 87,788 32,276 30,226 118,937 judgment of our clinical staff to classify each secondary diagnosis reviewed as an MCC, CC or non-CC. Our clinical panel reviewed the resource use impact reports and modified 14.9 percent of the initial CC subclass assignments as C2 Cnt3 1.715 1.639 2.320 2.193 2.778 2.936 C3 5,297 122,076 51,303 13,355 42,862 223,054 2.384 2.302 3.226 3.035 3.232 3.337 CC subclass Non-CC. Non-CC CC CC MCC MCC summarized in Table J below. The rows in the table are the initial CC subclass categories and the columns are the final CC subclass categories. TABLE J.—CC SUBCLASS MODIFICATIONS Final CC subclass Initial CC subclass Total MCC CC MCC ............................................................................... CC .................................................................................. Non-CC .......................................................................... 847 542 0 Total ........................................................................ Percent ........................................................................... 1,389 13.0 Of the diagnoses initially designated as an MCC, 6.8 percent were made a CC (62/909), and of the diagnoses initially designated as non-CC, 4.6 percent were made a CC (272/5,923). The major shift occurred in the diagnoses initially assigned to the CC subclass. Fourteen percent of the diagnoses initially designated as a CC were made an MCC (542/3858), and 19.1 percent of the diagnoses initially designated a CC were made a non-CC (737/3,858). In determining the CC subclass assigned to a diagnosis, imprecise codes were, in general, not assigned to the MCC or CC subclass. For example, the congestive heart failure codes have the following CC subclass assignments: mmaher on DSK3CLS3C1PROD with $$_JOB Code 428.21, Acute systolic heart failure. 428.41, Acute systolic & diastolic heart failure. 428.43, Acute on chronic systolic heart failure. 428.31, Acute diastolic heart failure. 428.33, Acute on chronic diastolic heart failure. 428.1, Left heart failure ......... 428.20, Systolic heart failure NOS. 428.22, Chronic systolic heart failure. VerDate Mar 15 2010 02:00 Aug 26, 2011 CC subclass assignment MCC MCC MCC MCC MCC CC CC CC Jkt 223001 62 2,579 272 0 737 5,651 2,913 27.2 6,388 59.8 CC subclass assignment Code 428.32, Chronic diastolic heart failure. 428.40, Systolic & diastolic heart failure. 428.0, Congestive heart failure NOS. 428.9, Heart failure NOS ...... CC CC NonCC Non-CC The acute heart failure codes are MCCs, and the chronic heart failure codes are CCs. However, Not Otherwise Specified (NOS) heart failure codes are non-CCs. Thus, the precise type of heart failure must be specified in order for an MCC or CC to be assigned. There are currently 13,549 ICD–9-CM diagnosis codes. The External Cause of Injury and Poisoning codes (E800— E999) and congenital codes were not included in our current CC review for the proposed MS-DRGs. We excluded the External Cause of Injury and Poisoning codes (E codes) from consideration as an MCC or a CC because they describe how an injury occurred, and not the exact nature of the injury. For instance, if a patient fell on the deck of a boat and fractured his or her skull, one would assign an E code to describe the fall on the boat. A separate diagnosis code would be assigned to describe the exact nature of any resulting injury such as a contusion, fractured bone, or skull fracture and PO 00000 Frm 00026 Fmt 4701 Sfmt 4702 Percent Non-CC 909 3,858 5,923 8.5 36.1 55.4 10,690 ........................ ........................ ........................ concussion. A patient would be assigned to a severity level based on the exact nature of the injury and not the manner in which the injury occurred. Therefore, we decided not to classify any of the E codes as either an MCC or a CC. The congenital codes describe abnormalities when a baby is born. At times, a beneficiary may live with these congenital abnormalities for years without a problem. The congenital abnormalities may later lead to complications that require hospital admissions. Should these congenital abnormalities lead to medical problems that result in a hospital admission for a Medicare beneficiary, the exact nature of the condition being treated would also be assigned a code. This more precise code would be evaluated to determine whether or not it was an MCC or a CC. Therefore, we decided not to classify congenital abnormality codes as an MCC or a CC, but to instead use the other reported diagnosis codes that better describe the reason for the admission. Excluding the external cause of injury codes, we reviewed 10,690 diagnosis codes. As was done in our 1994 severity proposal, diagnoses that were closely associated with patient mortality were assigned different CC subclasses, depending on whether the patient lived or died. These diagnoses are: <bullet≤ 427.41, Ventricular fibrillation E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules <bullet≤ 427.5, Cardiac arrest <bullet≤ 785.51, Cardiogenic shock <bullet≤ 785.59, Other shock without mention of trauma <bullet≤ 799.1, Respiratory arrest Resource use for patients with these diagnoses who were discharged alive was consistent with an MCC. Resource use for patients with these diagnoses who died was consistent with a non-CC. Further, most patients who died could legitimately have one of these diagnoses coded. As a result, these diagnoses are assigned an MCC subclass for patients who lived and a non-CC subclass for patients who died. For some secondary diagnoses assigned to the CC subclass, our medical consultants identified specific clinical situations in which the diagnosis should not be considered a CC. In such clinical situations, the CC exclusion list was used to exclude the secondary diagnosis from consideration in determining the CC subgroup essentially making the secondary diagnosis a non-CC. For example, primary cardiomyopathy (code 425.4) is designated as a CC. However, for patients admitted for congestive heart failure, our medical consultants believed that primary cardiomyopathy should be treated as a non-CC. In order to accomplish that, the congestive heart failure principal diagnoses were added to the CC exclusion list for primary cardiomyopathy as a secondary diagnosis. The list of diagnosis codes that we are proposing to classify as an MCC is included in Table 6J in the Addendum of this proposed rule. The diagnosis codes that we are proposing to classify as a CC are included in Table 6K in the Addendum of this proposed rule. The proposed E-codes, which are diagnosis codes used to classify external causes of injury and poisoning, are not included in this list. All proposed E-codes are designated as non-CCs under the current CMS DRG system and our evaluation supports this non-CC designation as appropriate. 3. Dividing Proposed MS–DRGs on the Basis of the CCs and MCCs In developing the proposed MS– DRGs, two of our major goals were to create DRGs that would more accurately reflect the severity of the cases assigned to them and to create groups that would have sufficient volume so that meaningful and stable payment weights could be developed. As noted above, we excluded the CMS DRGs in MDCs 14 and 15 from consideration because these DRGs are low volume. As stated previously, we do not have the expertise or data to maintain the CMS DRGs for newborns, pediatric, and maternity patients. We continue to maintain MDCs 14 and 15 without modification in order to have MS–DRGs available for these patients in the rare instance where there is a Medicare beneficiary admitted for maternity or newborn care. In designating a proposed MS–DRG as one that will be subdivided into subgroups based on the presence of a CC or MCC, we developed a set of criteria to facilitate our decision-making process. In order to warrant creation of a CC or major CC subgroup within a base MS–DRG, the subgroup had to meet all of the following five criteria: <bullet≤ A reduction in variance of charges of at least 3 percent. <bullet≤ At least 5 percent of the patients in the MS–DRG fall within the CC or MCC subgroup. <bullet≤ At least 500 cases are in the CC or MCC subgroup. <bullet≤ There is at least a 20-percent difference in average charges between subgroups. <bullet≤ There is a $4,000 difference in average charge between subgroups. Our objective in developing these criteria was to create homogeneous subgroups that are significantly different from one another in terms of resource use, that have enough volume to be meaningful, and that improve our ability to explain variance in resource use. These criteria are essentially the same criteria we used in our 1994 severity analysis. To begin our analysis, we subdivided each of the base MS–DRGs into three subgroups: non-CC, CC, and MCC. Each subgroup was then analyzed in relation to the other two subgroups using the volume, charge, and reduction in variance criteria. The criteria were 24705 applied in the following hierarchical manner: <bullet≤ If a three-way subdivision met the criteria, we subdivided the base MS–DRG into three CC subgroups. <bullet≤ If only one type of two-way subdivisions met the criteria, we subdivided the base MS–DRG into two CC subgroups based on the type of twoway subdivision that met the criteria. <bullet≤ If both types of two-way subdivisions met the criteria, we subdivided the base MS–DRG into two CC subgroups based on the type of twoway subdivision with the highest R2 (most explanatory power to explain the difference in average charges). <bullet≤ Otherwise, we did not subdivide the base MS–DRG into CC subgroups. For any given base MS–DRG, our evaluation in some cases showed that a subdivision between a non-CC and a combined CC/MCC subgroup was all that was warranted (that is, there was not a great enough difference between the CC and MCC subgroups to justify separate CC and MCC subgroups). Conversely, in some cases, even though an MCC subgroup was warranted, there was not a sufficient difference between the non-CC and CC subgroups to justify separate non-CC and CC subgroups. Based on this methodology, a base MS–DRG may be subdivided according to the following three alternatives, rather than the current ‘‘with CC’’ and ‘‘without CC’’ division. <bullet≤ DRGs with three subgroups (MCC, CC, and non-CC). <bullet≤ DRGs with two subgroups consisting of an MCC subgroup but with the CC and non-CC subgroups combined. We refer to these groups as ‘‘with MCC’’ and ‘‘without MCC.’’ <bullet≤ DRGs with two subgroups consisting of a non-CC subgroup but with the CC and MCC subgroups combined. We refer to these two groups as ‘‘with CC/MCC’’ and ‘‘without CC/ MCC.’’ As a result of the application of these criteria, 745 proposed MS–DRGs were created as shown in the following table. TABLE K.—NUMBER OF CC SUBGROUPS Number of proposed base MS–DRGs mmaher on DSK3CLS3C1PROD with $$_JOB Subgroups Number of proposed MS– DRGs 53 152 63 43 311 22 53 456 126 86 721 22 No Subgroups .......................................................................................................................................................... Three subgroups ...................................................................................................................................................... Two subgroups: major CC and CC; non-CC .......................................................................................................... Two subgroups: non-CC and CC; major CC .......................................................................................................... Subtotal .................................................................................................................................................................... MDC 14 .................................................................................................................................................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00027 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 24706 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE K.—NUMBER OF CC SUBGROUPS—Continued Number of proposed base MS–DRGs Number of proposed MS– DRGs Error DRGs .............................................................................................................................................................. 2 2 Total .................................................................................................................................................................. 335 745 Subgroups The 745 proposed MS–DRGs represent an increase over the 652 DRGs created in our 1994 CC revision analysis. The increase in the number of DRGs is primarily the result of an increase in the number of proposed base MS–DRGs that are subdivided into three CC subgroups. The distribution of patients across the different types of CC subdivisions is contained in Table L below. The table shows that 51.7 percent of the patients are assigned to base MS–DRGs with three CC subgroups, and only 11.8 percent of the patients are assigned to base MS–DRGs with no CC subgroups. TABLE L.—DISTRIBUTION OF PATIENTS BY TYPE OF CC SUBDIVISION CC subdivision None ................. (MCC and CC), Non-CC ......... MCC, (CC and Non-CC) ........ MCC, CC, and Non-CC ......... Count Percent 1,382,810 11.8 629,639 5.4 3,650,321 31.2 6,054,081 51.7 CMS DRGs, the MS–DRGs with all 311 base MS–DRGs subdivided into 3 CC subgroups, and the MS–DRGs collapsed into 745 DRGs. Table L below shows that the R2 for the proposed MS–DRGs with all 311 base MS–DRGs subdivided into 3 CC subgroups (957 DRGs composed of 311 base MS–DRGs subdivided into 3 CC subgroups plus an additional 22 MDC 14 and MDC 15 DRGs as well as 2 error DRGs) is 10.62 percent higher than the current CMS DRGs. Collapsing the 957 proposed MS– DRGs down to 745 proposed MS–DRGs lowers this increase in R2 slightly to 9.41 percent. Although adopting a 3way split for each base MS–DRG would produce a DRG system with higher explanatory power, the 957 MS–DRGs would not meet the criteria we specified above for subdividing each base DRG. The criteria we specified above would create a monotonic DRG system. We believe that the value of having a monotonic DRG system outweighs the slight decrease in explanatory power. For this reason, we are proposing to adopt the 745 MS–DRGs. Using Medicare charge data (without applying any criteria to remove statistical outlier cases), the reduction in variance (R2) was computed for current TABLE M.—EXPLANATORY POWER (R2) FOR PROPOSED MS–DRGS R2 Current CMS DRG ... 2007 CMS Severity DRGs with 3 CC Subgroups ............. 2007 CMS Severity DRGs Collapsed to 714 DRGs ............. Percent change 36.19 ................ 40.03 10.62 39.59 9.41 4. Conclusion We believe the proposed MS–DRGs represent a substantial improvement over the current CMS DRGs in their ability to differentiate cases based on severity of illness and resource consumption. As developed, the proposed MS–DRGs increase the number of DRGs by 207, while maintaining the reasonable patient volume in each DRG. The proposed MS–DRGs increase the explanation of variance in hospital resource use relative to the current CMS DRGs by 9.41 percent. Further, the data shown below in Table N and Table O illustrate how assignment of cases to different severity of illness subclasses improves in the proposed MS–DRGs relative to the CMS DRGs. TABLE N.—OVERALL STATISTICS FOR CMS DRGS CC subclass—Current CMS DRG Percent One or more CCs .................................................................................................................................................................... Non-CC .................................................................................................................................................................................... 77.66 22.34 Average charges $24,538 14,795 TABLE O.—OVERALL STATISTICS FOR PROPOSED MS–DRGS Number of cases CC subgroup mmaher on DSK3CLS3C1PROD with $$_JOB MCC ................................................................................................................................................................. CC .................................................................................................................................................................... Non-CC ............................................................................................................................................................ Under the current CMS DRGs, 78 percent of cases are assigned to the highest severity levels (CC) and the remaining 22 percent are assigned to the lowest severity level (non-CC). Applying the three severity subclasses to FY 2006 VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 data would result in approximately 22 percent of patients being assigned to the severity subgroup with the highest level of severity (MCC), 41 percent being assigned to the lowest severity subclass (non-CC), and the remaining 37 percent PO 00000 Frm 00028 Fmt 4701 Sfmt 4702 2,607,351 4,298,362 4,826,980 Percent 22.2 36.6 41.1 Average charges $44,219 24,115 18,416 being assigned to the middle severity subclass (CC). Adding the new MCC subgroup greatly enhances our ability to identify and reimburse hospitals for treating patients with high levels of severity. As Table N above shows, the E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules new subgroups also have significantly different resource requirements. The MCC subgroup contains patients with average charges almost twice as large as for those in the CC group ($44,219 compared to $24,115). In addition to resulting in improvements in the DRG system’s recognition of severity of illness, we believe the proposed MS–DRGs are responsive to the public comments that were made on last year’s IPPS proposed rule with respect to how we should undertake further DRG reform. In the FY 2007 IPPS final rule, we identified three major concerns in the public comments about our proposed adoption of CS DRGs: We received comments after the FY 2007 IPPS final rule suggesting that further adjustments are needed to the proposed DRG system. The commenters believed that the CS DRGs did not incorporate many of the changes to the DRG assignments that have been made over the year to the CMS DRGs. There was significant interest in the public comments in either revising the CS DRGs to reflect these changes or using the CMS DRGs at the starting point to better recognize severity. We believe that the proposed MS– DRGs discussed in this proposed rule are responsive to these suggestions. The proposed MS–DRGs use the CMS DRGs as the starting point for revising the DRGs to better recognize resource complexity and severity of illness. We are generally retaining all of the refinements and improvements that have been made to the base DRGs over the years that recognize the significant advancements in medical technology and changes to medical practice. At the same time, the proposed MS–DRGs greatly improve our ability to identify groups of patients with varying levels of severity. They retain all of the improvements made to the DRGs over the years, while providing a more equitable basis for hospital payment. We received many comments about the potential use of a proprietary DRG system. The comments about the CS DRGs raised compelling issues about the potential government use of a proprietary system including concerns about the availability, price, and transparency of the source code, logic and documentation of the DRG system. The commenters noted that CMS makes available these resources in the public domain for purchase through the National Technical Information Service at nominal fees to cover costs. The commenters urged CMS not to adopt a proprietary DRG system that would not be available on the same terms as the current CMS DRGs. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 There are no proprietary issues associated with the proposed MS–DRGs in this proposed rule. The proposed MS–DRGs would be available on the same terms as the current CMS DRGs through the National Technical Information Service. We also received other comments concerning the use of CS DRGs. The commenters stated that no alternatives to CS DRGs had been evaluated. The commenters suggested that alternative DRG systems can better recognize severity than the CS DRGs and should be evaluated before CMS decides which system to adopt. We currently have a contract with the RAND Corporation to evaluate several alternative DRG systems. We believe it is premature to propose adopting one of the systems as RAND has not yet completed its evaluation. However, we believe the proposed MS–DRGs should be part of this process and have asked RAND to evaluate the proposed MS– DRGs with other DRG products that have been submitted for review. Although we are proposing to adopt the MS–DRGs for FY 2008, this decision would not preclude us from adopting any of the systems being evaluated by RAND for FY 2009. As indicated above, we believe the proposed MS–DRGs offer significant improvements to the DRG system without many of the liabilities the public commenters identified with the CS DRGs. Thus, we believe the proposed MS–DRGs offer significant improvements in recognition of severity of illness and complexity of resources and are proposing to adopt them for FY 2008. However, we are continuing our evaluation of alternative DRG systems that can better recognize severity of illness and resource consumption and have submitted the proposed MS–DRGs to RAND for further evaluation. 5. Impact of the Proposed MS–DRGs Unlike the CS DRGs we proposed last year for FY 2008, the payment impacts from the MS–DRGs we are proposing to adopt this year would largely be redistributive within each base MS– DRG. Such a result occurs because we collapse the current CC/non-CC, age and other distinctions that exist in the CMS DRGs and redivide them based on MCCs, CCs, and non-CCs. Thus, within each proposed base MS–DRG, some cases will be paid more and some less, but the base MS–DRGs are retained so there is no redistribution between types of cases as would have occurred under the proposed CS DRGs. We encourage readers to review Table 5 in the Addendum to this proposed rule for a list of the proposed MS–DRGs and the PO 00000 Frm 00029 Fmt 4701 Sfmt 4702 24707 proposed respective relative weight from the revisions we are proposing to better recognize severity of illness to better understand how payment for cases within each base MS–DRG will be affected. As indicated above, all of the severity DRG systems being evaluated by RAND can be expected to result in similar redistributions in case-mix among hospitals. The payment models used by RAND and CMS (and RTI as well) all assume static utilization. That is, payment impact models simulate the effects of a change in policy, assuming no change to Medicare utilization. Any system adopted to better recognize severity of illness with a budget neutrality constraint will result in casemix changes that can be expected to benefit urban hospitals at the expense of rural hospitals. This impact occurs because patients treated in urban hospitals are generally more severely ill than patients in rural hospitals and the CMS DRGs are not currently recognizing the full extent of these differences. Similarly, there will be differential impacts among other categories of hospitals (for example, teaching, disproportionate share, large urban, and other urban hospitals) depending on the mix of cases that each hospital treats. The impact of the proposed MS–DRGs can be expected to have similar effects on case-mix as the DRG systems being analyzed by RAND. In addition, we believe that it is important to note that the MS–DRGs are proposed to be adopted for FY 2008 at the same time that we are phasing in cost weights. In the FY 2007 IPPS final rule, we adopted cost weights over a 3-year transition period in 1⁄3 increments. Thus, the full impact of adopting cost weights will not be incorporated into IPPS payments until FY 2009. Nevertheless, we believe it is important to consider together the effect on case-mix of the fully phasedin cost weights and proposed MS–DRGs to get a complete understanding of how IPPS payment reforms would affect case-mix for different categories of hospitals from FY 2007 through FY 2009. For instance, using cost weights are estimated to increase payments to rural hospitals (see 71 FR 47917). In FY 2007, we are paying hospitals using a blend of 1⁄3 cost and 2⁄3 charge relative weights. In FY 2008, we will pay hospitals using a blend of 2⁄3 cost and 1⁄3 charge relative weights. In FY 2009, we will pay hospitals using 100 percent cost relative weights. Therefore, there will likely be some additional increases in payments to rural hospitals from the final year of the transition to fully implemented cost weights that are not E:\FEDREG\03MYP2.LOC 03MYP2 24708 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules illustrated in the table in the impact section of this proposed rule. mmaher on DSK3CLS3C1PROD with $$_JOB 6. Changes to Case-Mix Index (CMI) From the Proposed MS–DRGs After the 1983 implementation of the IPPS DRG classification system, CMS observed unanticipated growth in inpatient hospital case-mix (the average relative weight of all inpatient hospital cases), which we use as a proxy measurement for severity of illness. We had projected the rate of growth in casemix for the period 1981 to 1984 to be 3.4 percent. The realized rate of growth during this period, which included the introduction of the IPPS, was 8.4 percent, a variance in excess of 1.6 percent per year. The unexpected growth in payments was due to increases in the hospital case-mix index (CMI) beyond the previously projected trend. Hospitals’ CMI values measure the expected treatment cost of the mix of patients treated by a particular hospital. There are three factors that determine changes in a hospital’s CMI: (a) Admitting and treating a more resource intensive patient-mix (due, for example, to technical changes that allow treatment of previously untreatable conditions and/or an aging population); (b) Providing services (such as higher cost surgical treatments, medical devices, and imaging services) on an inpatient basis that previously were more commonly furnished in an outpatient setting; and (c) Changes in documentation (more complete medical records) and coding practice (more accurate and complete coding of the information contained in the medical record). We note that changes in patient-mix and medical practice signal real changes in underlying resource utilization and cost of treatment. While these changes may have occurred in response to incentives from IPPS policies, they represent real changes in resource needs. In contrast, changes in CMI as a result of improved documentation and coding do not represent real increases in underlying resource demands. For the implementation of the IPPS in 1983, improved documentation and coding were found to be the primary cause in the underprojection of CMI increases, accounting for as much as 2 percent in the annual rate of CMI growth observed post-PPS.2 The Medicare Trustees Technical Review Panel 3 has previously 2 Carter, Grace M. and Ginsburg, Paul: The Medicare Case Mix Index Increase, Medical Practice Changes, Aging and DRG Creep, Rand, 1985. 3 Review of Assumptions and Methods of the Medicare Trustees’ Financial Projections; Technical VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 determined the annual measured change in CMI for inpatient hospital services to oscillate around an underlying real trend of 1 percent annual growth. In 1991 the Medicare specific trend in real CMI growth was found in a then-HCFA funded study 4 to be within a range of 1 to 1.4 percent. In the annual study conducted by CMS, there has been no evidence to support a real case-mix increase in excess of the annually projected 1 percent upper bound in the period. MedPAC findings have echoed this with its recent study of real casemix change finding growth rates for years 2002, 2003, and 2004 of 1 percent, 0.6 percent, and 0.4 percent, respectively.5 We believe that adoption of the MS– RGs proposed in this proposed rule would create a risk of increased aggregate levels of payment as a result of increased documentation and coding. MedPAC notes that ‘‘refinements in DRG definitions have sometimes led to substantial unwarranted increase in payments to hospitals, reflecting more complete reporting of patients’ diagnoses and procedures.’’ MedPAC further notes that ‘‘refinements to the DRG definitions and weights would substantially strengthen providers’ incentives to accurately report patients’ comorbidities and complications.’’ To address this issue, MedPAC recommended that the Secretary ‘‘project the likely effect of reporting improvements on total payments and make an offsetting adjustment to the national average base payment amounts.’’ 6 The Secretary has broad discretion under section 1886(d)(3)(A)(vi) of the Act to adjust the standardized amount so as to eliminate the effect of changes in coding or classification of discharges that do not reflect real changes in casemix. While we modeled the changes to the DRG system and relative weights to ensure budget neutrality, we are concerned that the large increase in the number of DRGs will provide opportunities for hospitals to do more accurate documentation and coding of information contained in the medical record. Coding that has no effect on payment under the current CMS DRGs may result in a case being assigned to Review Panel on the Medicare Trustees Reports, December 2000. 4 ‘‘Has DRG Creep Crept Up? Decomposing the Case Mix Index Change Between 1987 and 1988’’; Carter, Newhouse, Relles ; R–4098–HCFA/ProPAC (1991). 5 Medicare Payment Advisory Commission: Report to the Congress, March 2006 (p. 52). 6 Medicare Payment Advisory Commission: Report to Congress on Physician-Owned Specialty Hospitals, March 2005, p. 42. PO 00000 Frm 00030 Fmt 4701 Sfmt 4702 a higher paid DRG under the proposed MS–DRGs. Thus, more accurate and complete documentation and coding may occur because it will result in higher payments under the proposed MS–DRGs. We believe the potential for more accuate and complete documentation and coding will apply equally under the acute IPPS as well as under the LTCH PPS because the same DRGs are used for both payment systems. Thus, the analysis below will apply to both the IPPS and the LTCH PPS. CMS in the past has adjusted standardized amounts under the IRF PPS to account for case-mix increases due to improvements in documentation and coding. In 2004, RAND 7 published a technical report as part of the followup to the implementation of the IRF PPS. The initial weights used within the IRF PPS were based on a mix of CY 1999 and CY 1998 data. The study reviewed the changes between this base data set and the IRF PPS implementation year of 2002. The report found that the weight per discharge for IRFs had grown by 3.4 percent between the CY 1999 data set and the CY 2002 data set. In a detailed analysis of both statistical patterns in acute stay records and directly measured coding behaviors, RAND found that the level of case-mix increase associated with documentation and coding-induced changes in the transition year ranged between 1.9 and 5.8 percent, with the upper end of the estimate associated with real declines in resource use. (We note that RAND revised its report in late 2005 to reflect an upper bound of 5.9 percent, instead of the 5.8 percent that we reported in the FY 2006 IRF PPS proposed and final rules.) We used the results of this analysis to justify a 1.9 percent adjustment to payment rates for IRFs in FY 2006 (70 FR 47904) and a 2.6 percent adjustment to payment rates for IRFs in FY 2007 (71 FR 48370), for a combined total adjustment of 4.5 percent. The implementation year was marked by the transitioning of hospitals to the IRF PPS payment based on cost reports beginning January 1, 2002, and staggered to October 1, 2002. A combination of increased familiarity with the system by providers and the staggered transition could mean that documentation and coding-induced case-mix change continued as hospitals experienced ongoing changes in the early years of the IRF PPS and as the 7 Carter, Paddock: Preliminary Analyses of Changes in Coding and Case Mix Under the Inpatient Rehabilitation Facility Prospective Payment System, RAND, 2004. E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB incentives within the system were more widely recognized. We also recognize that significant changes in IRF patient populations may be occurring as a result of recent regulatory changes, such as the phase-in of the 75 percent rule compliance percentage. We intend to continue analyzing changes in coding and case-mix closely, using the most current available data, as part of our ongoing monitoring of the IRF PPS and, based on this analysis, we intend to propose additional payment refinements for IRFs in the future as the analysis indicates such adjustments are warranted. Furthermore, as part of our analysis of this issue, we considered the recent experience of the State of Maryland with adopting the APR DRG system. Maryland introduced APR DRGs for payment for three teaching hospitals in 2000. Between State fiscal years (SFYs) 2001 and 2005,8 the remaining hospitals continued to be paid using modified CMS DRGs. In June 2004, the remaining hospitals were notified that Maryland would expand the use of APR DRGs throughout its all payer charge-per-case system beginning in July 2005. Hospitals in Maryland improved coding and documentation in response to the adoption of APR DRGs. As a result of this improved documentation and coding, reported CMI increased at a greater rate than real CMI. Given the similarity between coding incentives using the APR DRGs in Maryland and the MS–DRGs that are being proposed for Medicare, we analyzed Maryland data to develop an adjustment for improved documentation and coding. For the Maryland analysis, we assume that, in SFY 2005, those hospitals not already being paid under the APR DRG system began acting as if the transition to the new DRG logic had already taken place. This assumption is supported by the following facts: (a) Maryland hospitals were reporting to the Health Services and Cost Review Commission (HSCRC), Maryland’s governing body of its all-payer ratesetting system) using the APR DRG GROUPER in 2005; (b) hospitals were provided training in coding under the APR DRG GROUPER; (c) hospitals had access to reports based on APR DRG logic; and (d) hospitals were given large amounts of feedback as to their performance under the 8 Maryland uses a July 1 to June 30 State fiscal year. Prior to FY 2003, Maryland had a 6-month lag in the data used to calculate the hospital base casemix index and case-mix change. Maryland used 12 months data ending December even though the hospitals’ rate year was July 1 to June 30. In FY 2003, Maryland moved to what it called ‘‘Real Time Case-Mix’’ and started using 12 months data ending June 30 to calculate case-mix index and case-mix change for a rate year beginning July 1. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 GROUPER by the HSCRC relative to peer hospitals. The incentives for Maryland hospitals are to code as completely and accurately as possible because, beginning in July 2005, all Maryland hospitals were paid using APR DRGs. SFY 2005 was an important year in Maryland, as it marked the beginning of the 2-year period of transition after which a hospital’s revenues were reduced if coding was not as complete as a peer hospital. Under the current CMS DRGs, each secondary diagnosis code is recognized as either a CC or non-CC. Hospitals in Maryland and nationally for Medicare only needed to code one secondary diagnosis as a CC when paid using CMS DRGs for the patient to be assigned to a higher weighted DRG split based on the presence or absence of a CC. Under the APR DRGs, each secondary diagnosis is designated as minor, moderate, major, or extreme. Under the proposed MS–DRGs, each secondary diagnosis is designated as a non-CC, CC, or MCC. Hospitals in Maryland have incentives under the APR DRGs to code until a case is assigned to the highest of the four severity levels within a base DRG. Under the proposed MS–DRGs, hospitals will have incentives to code until a case is assigned to one of up to three severity levels within a base DRG. Although the APR DRGs and the proposed MS–DRGs may be different, we believe that hospitals have the same incentive under both systems to code as completely as possible. For this reason, we believe that the Maryland experience is a reasonable basis for projecting behavioral changes in the wider national hospital population for the first 2 years of the MS–DRGs. We believe the analysis presented below provides a reasonable analysis of the potential growth in CMI due to improved documentation and coding. In addition to the similarity between coding incentives under the proposed MS–DRGs and the APR DRGs, we note that Maryland is an all-payer State; therefore, hospitals are paid by all third party payers—not just the State’s Medicaid program—using the APR DRGs. Coding has been very important for each hospital’s overall revenue for many years, and the incentives are uniform across all third party payers. The transition to APR DRGs was known well in advance of the actual date and, as stated above, hospitals were provided training in coding under the APR DRGs. It is reasonable to expect that hospitals’ experience with improved documentation and coding will occur over a period of at least 2 years. Thus, the experience in Maryland may be PO 00000 Frm 00031 Fmt 4701 Sfmt 4702 24709 similar to expectations for case-mix growth for the nation as a whole. Finally, in reviewing the results from Maryland, we note that three large teaching hospitals began using APR DRGs prior to SFY 2005. These facilities generally treat a wider variety of patients with higher acuity that gives them a greater potential for increasing coding under the APR DRG system than other hospitals throughout Maryland. Because these hospitals were paid using the APR DRGs earlier than other Maryland hospitals, we believe data for them need to be analyzed from an earlier time period. However, based on the consultations with the HSCRC, we believe there were special issues with one of these hospitals that may have made its case-mix growth during the early years of the transition to the APR DRGs atypical of the other teaching hospitals.9 Therefore, we did not separately analyze the data for this hospital from the earlier time period and, as stated below, included its data with the rest of Maryland hospitals. As part of its contract with CMS, 3M Health Information Systems reviewed the Maryland data in the context of our proposed changes to adopt MS–DRGs. 3M grouped Medicare cases in Maryland through both the CMS DRGs Version 24.0 and the MS–DRGs that we are proposing to adopt for FY 2008. At our request, 3M deleted two of the three early transition hospitals from the data. It compared the results of the observed growth in case-mix from these data to the same process applied to Medicare data, excluding Maryland hospitals. The MedPAR data file for Federal fiscal year (FFY) 2006 (October 2005 through September 2006) was used to create relative weights for both CMS DRG Version 24.0 and the proposed MS–DRGs. The MedPAR data file contained 12,794,280 records. In constructing the weights, the following edits were used: <bullet≤ Cases with zero covered charges or length of stay were excluded. <bullet≤ Cases with length of stay greater than 2 years were excluded. <bullet≤ Only hospitals contained in the impact file for the FY 2007 IPPS final rule were included. 9 The HSCRC informed us that it began using APR DRGs for this hospital to calculate the CMI and case-mix change to set the hospital’s charge per case target (CPC) that is used in Maryland’s all-payer ratesetting system for payment. However the HSCRC also compared the reasonableness of hospital rates and costs for this hospital relative to peer institutions using modified CMS DRGs to calculate CMI and case-mix change. This use of dual systems to calculate CMI and case-mix change made it difficult for the hospital to code aggressively in the first few years of using APR DRGs. E:\FEDREG\03MYP2.LOC 03MYP2 24710 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules The latter criterion excluded providers reimbursed outside of the IPPS, including Maryland hospitals, from the weight calculation. 3M employed standardized charge-based relative weights developed in accordance with the CMS methodology. Cost-based weights were not used and no adjustment to the charge weights was made for application of CMS transfer and postacute care transfer payment policy. 3M further grouped 2 years of MedPAR data from FY 2004 and FY 2005, using CMS DRG Version 24.0 and the proposed MS–DRGs for hospitals nationally. Using 2 years of MedPAR data with one version of each DRG system further required 3M to make adjustments to the data to reflect revisions to ICD–9–CM codes that are made each year. MedPAR data for Maryland IPPS acute care providers within the IPPS data set were similarly assigned to the proposed MS–DRGs and CMS DRGs for FYs 2004 through 2006. Each Maryland record, exclusive of the two early transition teaching hospitals for the 3 observed years (SFY 2004 to SFY 2006), was assigned to a proposed MS–DRG based on the ICD–9– CM codes the hospital submitted. The same results were obtained from data at the national level using the proposed MS–DRGs. Further, we obtained data from the HSCRC showing the weighted average increase in case-mix for calendar years 2001 to 2003 for the two large academic medical centers that began an early transition to the APR DRGs. In addition, we also obtained case-mix increases under the CMS DRGs for FYs 2004 through 2006. The Medicare Actuary examined the data below: TABLE Q.—MARYLAND AND NATIONAL DATA USED FOR CASE-MIX ADJUSTMENT ANALYSIS FY 2005 to 2006 FY 2004 to 2006 Rest of Maryland MS–DRG CMI [Delta] ..................................................................................................... 2.30% .................. 2.57% .................. Early Transition Hospitals ............................................................................................................................ National MS–DRG CMI [Delta] .................................................................................................................... National CMS DRG CMI [Delta] .................................................................................................................. Blend of MS–DRG & CMS DRG [Delta] using 0.47 Percent for 2005 and 1.2 Percent for 2006 .............. Difference between Maryland Early Transition Hospitals and National Data ............................................. Difference between Rest of Maryland and National Data ........................................................................... Medicare Actuary Estimate (75%/25%) between Early Transition and Rest of Maryland ......................... mmaher on DSK3CLS3C1PROD with $$_JOB FY 2004 to 2005 4.4 0.47 -0.04 .................. .................. .................. .................. 6.7 2.65 1.20 .................. .................. .................. .................. 4.93% CY 2000 to FY 2003 11.4 3.13 1.16 1.68 9.58 3.20 4.8 The data above show that case-mix for hospitals increased by 4.93 percent from SFYs 2004 to 2006, during which Maryland adopted the APR DRGs for most hospitals. Case-mix for the two large teaching hospitals that were paid using the APR DRGs earlier than other hospitals in the State increased by 11.4 percent from SFYs 2001 to 2003. The weighted average increase in Maryland from these two categories of hospitals is 5.58 percent. Case-mix using the proposed MS–DRGs would have increased 0.47 percent in FY 2005 and 2.65 percent in FY 2006. Nationally, Medicare case-mix using the CMS DRGs decreased by 0.04 percent in FY 2005 and increased by 1.2 percent in FY 2006. The Actuary calculated a Medicare case-mix increase nationally over 2 years using a blend of these data from proposed MS–DRGs for FY 2005 and national Medicare data for FY 2006 from the CMS DRGs. The Actuary did not use either the -0.04 percent for the CMS DRGs or the 2.65 percent for the proposed MS–DRGs to create this blended case-mix because these figures appeared atypical to national trends. Therefore, the Actuary dropped one atypically high and low number from each of the 2 years of data and calculated an average increase of 1.68 percent from FY 2004 to FY 2006. These data demonstrate that the measure of average CMI for Medicare cases is VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 growing more rapidly within Maryland than nationally. Case-mix for the Maryland teaching hospitals and the rest of Maryland increased 9.58 percent and 3.20 percent more, respectively, than the national average over 2 years, suggesting that improved documentation and coding lead to perceived, but not real, changes in casemix. The Actuary noted that the case-mix increase in Maryland for two large teaching hospitals over a 2-year period was much higher in the early years of the APR DRGs than other Maryland hospitals (11.4 percent compared to 4.93 percent for the rest of Maryland). Further, teaching hospitals generally treat cases with higher acuity than other hospitals and have more opportunity to improve coding and documentation to increase case-mix than other hospitals. Teaching hospitals also represent a higher proportion of national Medicare data than they do of the data in Maryland. The two early transition teaching hospitals in Maryland account for approximately 10 percent of the Medicare discharges in Maryland. Nationally, teaching hospitals account for approximately 50 percent of Medicare discharges. Therefore, the Actuary believes that the teaching hospitals should be given a higher weight in the national data than they represent in Maryland. However, like other hospitals, teaching hospitals vary PO 00000 Frm 00032 Fmt 4701 Sfmt 4702 in size and patient-mix and not all have the same opportunity to improve documentation and coding. Therefore, we believe the weight given to teaching hospitals should be higher than the 10 percent for the two early transition hospitals in Maryland but lower than the 50 percent of discharges that they account for in Maryland. The Actuary gave a weight of 25 percent for teaching hospitals and 75 percent for the rest of Maryland to the excess growth in casemix over the national average and estimates that an adjustment of 4.8 percent will be necessary to maintain budget neutrality for the transition to the MS–DRGs. This analyis reflects our current estimate of the necessary adjustment needed to maintain budget neutrality for improvements in documentation and coding that lead to increases in case-mix. Consistent with the statute, we will compare the actual increase in case-mix due to documentation and coding to our projection once we have actual data to revise the Actuary’s estimate and the adjustment we make to the standardized amounts. Based on the Actuary’s analysis, using the Secretary’s authority under section 1886(d)(3)(A)(vi) of the Act to adjust the standardized amount to eliminate the effect of changes in coding or classification of discharges that do not reflect real changes in case-mix, we are proposing to reduce the IPPS E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules standardized amounts by 2.4 percent each year for FY 2008 and FY 2009. We are considering proposing a 4.8 percent adjustment for FY 2008. However, we believe it would be appropriate to provide a transition because we would be making a significant adjustment to the standardized amounts. We are interested in public comments on whether we should apply the proposed adjustment in a single year, over 2 years, or in different increments than 1⁄2 of the adjustment each year. Section 1886(d)(3)(A)(vi) of the Act further gives the Secretary authority to revisit adjustments to the standardized amounts for changes in coding or classification of discharges that were based on estimates in a future year. Consistent with the statute, we will compare the actual increase in case-mix due to documentation and coding to our projection once we have actual data for FY 2008 and FY 2009 for the FY 2010 and FY 2011 IPPS rules. At that time, if necessary, we may make a further adjustment to the standardized amounts to account for the difference between our projection and actual data. Under section 123(a)(1) of Pub. L. 105–33, as amended by section 307(b) of Pub. L. 106–554, we are also proposing to adjust the DRG relative weights that are used for the LTCH PPS by -2.4 percent (0.976) in FYs 2008 and 2009 to account for the anticipated increase in case mix from improved documentation and coding. This proposed budget neutrality adjustment is necessary to ensure that estimated aggregate LTCH PPS payments would be neither greater than nor less than the estimated aggregate LTCH PPS payments that would have been made without the proposed LTC–DRG reclassification and update of the relative weights. As discussed earlier with regards to the IPPS, we have estimated that a 2.4 percent adjustment is needed to maintain budget neutrality. We believe an adjustment of at least 2.4 percent for both FYs 2008 and 2009 is appropriate under the LTCH PPS because LTCHs have an average inpatient length of stay greater than 25 days and due to the comorbidities of these patients, LTCHs will have a significantly increased opportunity to better code for these paitents under the proposed MS–LTC– DRG system. In the LTCH proposed rule (72 FR 4793) for rate year (RY) 2008, we proposed to update the LTCH standardized amounts by 0.71 percent. The proposed changes to the LTCH standardized amounts will be effective on July 1. However, the proposed changes to adopt MS–LTC–DRGs for LTCHs would not be effective until VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 October 1 if finalized. Because changes to the LTCH standardized amounts for RY 2008 are already being set through a separate rulemaking process and are effective on July 1 instead of October 1, we decided that the adjustment for increases in case mix due to improvements and documentation and coding should be applied to the LTCH relative weights rather than the standardized amounts. 7. Effect of the Proposed MS–DRGs on the Outlier Threshold To qualify for outlier payments, a case must have costs greater than Medicare’s payment rate for the case plus a ‘‘fixed loss’’ or cost threshold. The statute requires that the Secretary set the cost threshold so that outlier payments for any year are projected to be not less than 5 percent or more than 6 percent of total operating DRG payments plus outlier payments. The Secretary is required by statute to reduce the average standardized amount by a factor to account for the estimated proportion of total DRG payments made to outlier cases. Historically, the Secretary has set the cost threshold so that 5.1 percent of estimated IPPS payments are paid as outliers. The FY 2007 cost outlier threshold is $24,485. Therefore, for any given case, a hospital’s charge adjusted to cost by its hospital-specific CCR must exceed Medicare’s DRG payment by $24,485 for the case to receive cost outlier payments. Adoption of the proposed MS–DRGs will have an effect on calculation of the outlier threshold. For this proposed rule, we analyzed how the outlier threshold would be affected by adopting the proposed MS–DRGs. Using FY 2005 MedPAR data, we have simulated the effect of the proposed MS–DRGs on the outlier threshold. By increasing the number of DRGs from 538 to 745 to better recognize severity of illness, the proposed MS–DRGs would be providing increased payment that better recognizes complexity and severity of illness for cases that are currently paid as outliers. That is, many cases that are high-cost outlier cases under the current CMS DRG system would be paid using an MCC DRG under the proposed MS– DRGs and could potentially be paid as nonoutlier cases. For this reason, we expected the proposed FY 2008 outlier threshold to decline from its FY 2007 level of $24,485. We are proposing an FY 2008 outlier threshold of $23,015. In section II.A.4. of the Addendum to this proposed rule, we provide a more detailed explanation of how we determined the proposed FY 2008 cost outlier threshold. PO 00000 Frm 00033 Fmt 4701 Sfmt 4702 24711 8. Effect of the Proposed MS–DRGs on the Postacute Care Transfer Policy Existing regulations at § 412.4(a) define discharges under the IPPS as situations in which a patient is formally released from an acute care hospital or dies in the hospital. Section 412.4(b) defines transfers from one acute care hospital to another. Section 412.4(c) establishes the conditions under which we consider a discharge to be a transfer for purposes of our postacute care transfer policy. In transfer situations, each transferring hospital is paid a per diem rate for each day of the stay, not to exceed the full DRG payment that would have been made if the patient had been discharged without being transferred. The per diem rate paid to a transferring hospital is calculated by dividing the full DRG payment by the geometric mean length of stay for the DRG. Based on an analysis that showed that the first day of hospitalization is the most expensive (60 FR 45804), our policy provides for payment that is double the per diem amount for the first day (§ 412.4(f)(1)). Transfer cases are also eligible for outlier payments. The outlier threshold for transfer cases is equal to the fixed-loss outlier threshold for nontransfer cases, divided by the geometric mean length of stay for the DRG, multiplied by the length of stay for the case, plus one day. The purpose of the IPPS postacute care transfer payment policy is to avoid providing an incentive for a hospital to transfer patients to another hospital early in the patients’ stay in order to minimize costs while still receiving the full DRG payment. The transfer policy adjusts the payments to approximate the reduced costs of transfer cases. Beginning with FY 2006 IPPS, the regulations at § 412.4 specified that, effective October 1, 2005, we make a DRG subject to the postacute care transfer policy if, based on Version 23.0 of the DRG Definitions Manual (FY 2006), using data from the March 2005 update of FY 2004 MedPAR file, the DRG meets the following criteria: <bullet≤ The DRG had a geometric mean length of stay of at least 3 days; <bullet≤ The DRG had at least 2,050 postacute care transfer cases; and <bullet≤ At least 5.5 percent of the cases in the DRG were discharged to postacute care prior to the geometric mean length of stay for the DRG. In addition, if the DRG was one of a paired set of DRGs based on the presence or absence of a CC or major cardiovascular condition (MCV), both paired DRGs would be included if either one met the three criteria above. E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24712 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules If a DRG met the above criteria based on the Version 23.0 DRG Definitions Manual and FY 2004 MedPAR data, we made the DRG subject to the postacute care transfer policy. We noted in the FY 2006 final rule that we would not revise the list of DRGs subject to the postacute care transfer policy annually unless we make a change to a specific CMS DRG. We established this policy to promote certainty and stability in the postacute care transfer payment policy. Annual reviews of the list of CMS DRGs subject to the policy would likely lead to great volatility in the payment methodology with certain DRGs qualifying for the policy in one year, deleted the next year, only to be reinstated the following year. However, we noted that, over time, as treatment practices change, it was possible that some CMS DRGs that qualified for the policy will no longer be discharged with great frequency to postacute care. Similarly, we explained that there may be other CMS DRGs that at that time had a low rate of discharges to postacute care, but which might have very high rates in the future. The regulations at § 412.4 further specify that if a DRG did not exist in Version 23.0 of the DRG Definitions Manual or a DRG included in Version 23.0 of the DRG Definitions Manual is revised, the DRG will be a qualifying DRG if it meets the following criteria based on the version of the DRG Definitions Manual in use when the new or revised DRG first became effective, using the most recent complete year of MedPAR data: <bullet≤ The total number of discharges to postacute care in the DRG must equal or exceed the 55th percentile for all DRGs; and <bullet≤ The proportion of short-stay discharges to postacute care to total discharges in the DRG exceeds the 55th percentile for all DRGs. A short-stay discharge is a discharge before the geometric mean length of stay for the DRG. A DRG also is a qualifying DRG if it is paired with another DRG based on the presence or absence of a CC or MCV that meets either of the above two criteria. The MS–DRGs that we are proposing to adopt for FY 2008 are a significant revision to the current CMS DRG system. Because the proposed new MS– DRGs are not reflected in Version 23.0 of the DRG Definitions Manual, consistent with § 412.4, we will need to recalculate the 55th percentile thresholds in order to determine which proposed MS–DRGs, if adopted, would be subject to the postacute care transfer policy. Further, under the proposed MS–DRGs, the subdivisions within the base DRGs will be different than those VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 under the current CMS DRGs. Unlike the current CMS DRGs, the proposed MS–DRGs are not divided based on the presence or absence of a CC or MCV. Rather, the proposed MS–DRGs have up to three subdivisions based on: (1) The presence of a MCC; (2) the presence a CC; or (3) the absence of either an MCC or CC. Consistent with our existing policy under which both DRGs in a CC/ non-CC pair are qualifying DRGs if one of the pair qualifies, we are proposing that each MS–DRG that shares a base MS–DRG would be a qualifying DRG if one of the MS–DRGs that shares the base DRG qualifies. We are proposing to revise § 412.4(d)(3)(ii) to codify this proposed policy. Similarly, we believe that the proposed changes to adopt MS–DRGs also necessitate a revision to one of the criteria used in § 412.4(f)(5) of the regulations to determine whether a DRG meets the criteria for payment under the ‘‘special payment methodology.’’ Under the special payment methodology, a case subject to the special payment methodology that is transferred early to a postacute care setting will be paid 50 percent of the total IPPS payment plus the average per diem for the first day of the stay. Fifty percent of the per diem amount will be paid for each subsequent day of the stay, up to the full MS–DRG payment amount. A CMS DRG is currently subject to the special payment methodology if it meets the criteria of § 412.4(f)(5). Section 412.4(f)(5)(iv) specifies that if a DRG meets the criteria specified under § 412.4(f)(5)(i) through (f)(5)(iii), any DRG that is paired with it based on the presence or absence of a CC or MCV is also subject to the special payment methodology. Given that this criterion would no longer be applicable under the proposed MS–DRGs, we are proposing to add a new § 412.4(f)(6) that includes a DRG in the special payment methodology if it is part of a CC/non-CC MCV/non-MCV pair. We are proposing to update this criterion so that it conforms to the proposed changes to adopt MS–DRGs for FY 2008. The proposed revision would make an MS– DRG subject to the special payment methodology if it shares a base MS–DRG with an MS–DRG that meets the criteria for receiving the special payment methodology. Section 412.4(f)(3) states that the postacute care transfer policy does not apply to CMS DRG 385 for newborns who die or are transferred. We are proposing to make a conforming change to this paragraph to reflect that this CMS DRG would become MS–DRG 789 (Neonates, Died or Transferred to Another Acute Care Facility) under our proposed DRG changes for FY 2008. PO 00000 Frm 00034 Fmt 4701 Sfmt 4702 These revisions do not constitute a change to the application of the postacute care transfer policy. Therefore, any savings attributed to the postacute care transfer policy would be unchanged as a result of adopting the MS–DRGs. Consistent with section 1886(d)(4)(C)(iii) of the Act, aggregate payments from adoption of the proposed MS–DRGs cannot be greater or less than those that would have been made had we not proposed to make any DRG changes. We are also proposing technical changes to § § 412.4(f)(5)(i) and (f)(5)(iv) to correct a cross-reference and a typographical error, respectively. E. Refinement of the Relative Weight Calculation (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: Relative Weight Calculations’’ at the beginning of your comment.) In the FY 2007 IPPS final rule (71 FR 47882), effective for FY 2007, we began to implement significant revisions to Medicare’s inpatient hospital rates by basing the relative weights on hospitals’ estimated costs rather than on charges. This reform was one of several measured steps to improve the accuracy of Medicare’s payment for inpatient stays that include using costs rather than charges to set the relative weights and making refinements to the current DRGs so they better account for the severity of the patient’s condition. Prior to FY 2007, we used hospital charges as a proxy for hospital resource use in setting the relative weights. Both MedPAC and CMS have found that the limitations of charges as a measure of resource use include the fact that hospitals cross-subsidize departmental services in many different ways that bear little relation to cost, frequently applying a lower charge markup to routine and special care services than to ancillary services. In MedPAC’s 2005 Report to the Congress on PhysicianOwned Specialty Hospitals, MedPAC found that hospitals charge much more than their costs for some types of services (such as operating room time, imaging services and supplies) than others (such as room and board and routine nursing care).10 Our analysis of the MedPAC report in the FY 2007 IPPS proposed rule (71 FR 24006) produced consistent findings. In the FY 2007 IPPS proposed rule, we proposed to implement cost-based weights incorporating aspects of a 10 Medicare Payment Advisory Commission: Report to the Congress: Physician-Owned Specialty Hospitals, March 2005, p. 26. E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules methodology recommended by MedPAC, which we called the hospitalspecific relative value cost center (HSRVcc) methodology. MedPAC indicated that an HSRVcc methodology would reduce the effect of cost differences among hospitals that may be present in the national relative weights due to differences in case-mix adjusted costs. After studying Medicare cost report data, we proposed to establish 10 national cost center categories from which to compute 10 national CCRs based upon broad hospital accounting definitions. We made several important changes to the HSRVcc methodology that MedPAC recommended using in its March 2005 Report to the Congress on Physician-Owned Specialty Hospitals. We refer readers to the FY 2007 IPPS proposed rule (71 FR 24007 through 24011) for an explanation and our reasons for the modification to MedPAC’s methodology. In its public comments on the FY 2007 IPPS proposed rule, MedPAC generally agreed with the adaptations we made to its methodology, with the exception of expanding the number of distinct hospital department CCRs being used from 10 to 13 and basing the CCRs on Medicare-specific costs and charges.11 We did not finalize the HSRVcc methodology for FY 2007 because of concerns raised in the public comments on the FY 2007 IPPS proposed rule (71 FR 47882 through 47898). Rather, we adopted a cost-weighting methodology without the hospital-specific relative weight feature. We also expanded the number of distinct hospital departments with CCRs from 10 to 13. We indicated our intent to study whether to adopt the HSRVcc methodology after we had the opportunity to further consider some of the issues raised in the public comments. In the interim, we adopted a cost-weighting methodology over a 3year transition period, substantially mitigating the redistributive payment impacts illustrated in the proposed rule, while we engaged a contractor to assist us with evaluating the HSRVcc methodology. Some public commenters raised concerns about potential bias in cost weights due to ‘‘charge compression,’’ which is the practice of applying a lower percentage markup to higher cost services and a higher percentage markup to lower cost services. These commenters were concerned that our proposed weighting methodology may undervalue high cost items and overvalue low cost items if a single CCR is applied to items of widely varying costs in the same cost center. The 11 Hackbarth, Glenn: MedPAC Comments on the IPPS Rule, June 12, 2006, page 2. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 commenters suggested that the HSRVcc methodology would exacerbate the effect of charge compression on the final relative weights. One of the commenters suggested an analytic technique of using regression analysis to identify adjustments that could be made to the CCRs to better account for charge compression. We indicated our interest in researching whether a rigorous model should allow an adjustment for charge compression to the extent that it exists. We engaged a contractor, RTI International (RTI), to study several issues with respect to the cost weights, including charge compression, and to review the statistical model provided to us by the commenter for adjusting the weights to account for it. We discuss RTI’s findings in detail below. Commenters also suggested that the cost report data used in the cost methodology are outdated, not consistent across hospitals, and do not account for the costs of newer technologies such as medical devices. However, the relationship between costs and charges (not costs alone) is the important variable in setting the relative weights under this new system. Older cost reports also do not include the hospital’s higher charges for these same medical devices. Therefore, it cannot be known whether the CCR for the more recent technologies will differ from those we are using to set the relative weights. The use of national average cost center CCRs rather than hospitalspecific CCRs may mitigate potential inconsistencies in hospital cost reporting. Nevertheless, we agree that it is important to review how hospitals report costs and charges on the cost reports and on the Medicare claims and asked RTI to further study this issue as well. In summary, we proposed to adopt HSRVcc relative weights for FY 2007 using national average CCRs for 10 hospital departments. Based on public comments concerned about charge compression and the accuracy of cost reporting, we decided not to finalize the HSRVcc methodology, but adopted costs weights without the hospital-specific feature. In response to comments from MedPAC, we expanded the number of hospital cost centers used in calculating the national CCRs from 10 to 13. Finally, we decided to implement the cost-based weighting methodology gradually, by blending the cost and charge weights over a 3-year transition period beginning with FY 2007, while we further studied many of the issues raised in the public comments. We refer readers to the FY 2007 IPPS final rule (71 FR 47882) for more details on our final policy for calculating the costbased DRG relative weights. PO 00000 Frm 00035 Fmt 4701 Sfmt 4702 24713 1. Summary of RTI’s Report on Charge Compression In August 2006, we awarded a contract to RTI to study the effects of charge compression in calculating DRG relative weights. The purpose of the study was to develop more accurate estimates of the costs of Medicare inpatient hospital stays that can be used in calculating the relative weights per DRG. RTI was asked to assess the potential for bias in relative weights due to CCR differences within the 13 CCR groups used in calculating the costbased DRG relative weights and to develop an analysis plan that explored alternative methods of estimating costs, with the objective of better aligning the charges and costs used in those calculations. RTI was asked to consider methods of reducing the variation in CCRs across services within cost centers by: <bullet≤ Modifying existing cost centers and/or creating new costs centers. <bullet≤ Using statistical methods, such as the regression adjustment for charge compression. Some commenters on the FY 2007 IPPS proposed rule suggested that we use a regression adjustment to account for charge compression. As part of its contract, RTI convened a Technical Expert Panel composed of individuals representing academic institutions, hospital associations, medical device manufacturers, and MedPAC. The members of the panel met on October 27, 2006, to evaluate RTI’s analytic plan, to identify other areas that are likely to be affected by compression or aggregation problems, and to propose suggestions for adjustments for charge compression. We posted RTI’s draft interim report on the CMS Web site in March 2007. For more information, interested individuals can view RTI’s report at the following Web site: https:// cms.hhs.gov/reports/downloads/ Dalton.pdf. As the first step in its analysis, RTI compared the reported Medicare program charge amounts from the cost reports to the total Medicare charges summed across all claims filed by providers. Using cost and charge data from the most recent available Medicare cost reports and inpatient claims from IPPS hospitals, RTI was charged with performing an analysis to determine how well the MedPAR charges matched the cost report charges used to compute CCRs. The accuracy of the DRG cost estimates is directly affected by this match because MedPAR charges are multiplied by CCRs to estimate cost. RTI found consistent matching of charges E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24714 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules from the Medicare cost report to charges grouped in the MedPAR claims for some cost centers but there appeared to be problems with others. For example, RTI found that the data between the cost report and the claims matched well for total discharges, days, covered charges, nursing unit charges, pharmacy, and laboratory. However, there appeared to be inconsistent reporting between the cost reports and the claims data for charges in several ancillary departments (medical supplies, operating room, cardiology, and radiology). For example, the data suggested that hospitals often include costs and charges for devices and other medical supplies within the Medicare cost report cost centers for Operating Room, Radiology or Cardiology instead of the Medical Supplies cost center. RTI found that some charge mismatching results from the way in which charges are grouped in the MedPAR file. Examples include the intermediate care nursing charges being grouped with intensive care nursing charges, and electroencephalography (EEG) charges being grouped with laboratory charges. RTI suggested that reclassifying intermediate care charges from the intensive care unit to the routine cost center could address the former problem. As the second step in its analysis, RTI reviewed the existing cost centers that are combined into the 13 groups used in calculating the national average CCRs. RTI identified CCRs with potential aggregation problems and considered whether separating the charge groups could result in more accurate cost conversion at the DRG level. The analysis led RTI to calculate separate CCRs for Emergency Room and Blood and Blood Administration, both of which had been included in ‘‘Other Services’’ in FY 2007. During this second step, RTI noted that a variation of charge compression is also present in inpatient nursing services because most patients are charged a single type of accommodation rate per day that is linked to the type of nursing unit (routine, intermediate, or intensive), but not to the hours of nursing services given to individual patients. Unlike the situation with charge compression in ancillary service areas, there are virtually no detailed charge codes that can distinguish patient nursing care use. Therefore, any potential bias cannot be empirically evaluated or adjustments made without additional data. Next, RTI examined individual revenue codes within the cost centers and used regression analysis to determine whether certain revenue VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 codes in the same cost center had significantly different markup rates. Those revenue codes include devices, prosthetics, implants within the Medical Supplies cost center, IV Solutions within the Drugs cost center, CT scanning and MRI within the Radiology cost center, Cardiac Catheterization within the Cardiology cost center, and Intermediate Care Units within the Routine Nursing Care cost center. Devices, prosthetics, and implants within the Medical Supplies cost center have a lower markup and, as a result, a higher CCR than the remainder of the medical supplies group according to RTI’s analysis. Within the Drugs CCR, IV Solutions have a much higher markup and much lower CCR than the other drugs included in the category. Within the Radiology CCR, CT scanning and MRI have higher markups and lower CCRs than the remaining radiology services. RTI’s results for Cardiac Catheterization and Intermediate Care Units were ambiguous due to data problems. RTI’s analysis also determined the impact of the disaggregated CCRs on the relative weights. Differences in CCRs alone do not necessarily alter the DRG relative weights. The impact on the relative weights is the result of the interaction of CCR differences and DRG differences in the proportions of the services with different CCRs. In FY 2007, we calculated relative weights using CCRs for 13 hospital departments. The RTI analysis suggests expanding the number of distinct hospital department CCRs from 13 to 19. Of the additional six CCRs, two would result from separating the Emergency Department and Blood (Products and Administration) from the residual ‘‘Other Services’’ category. Four additional CCRs would result from applying a regression method similar to a method suggested in last year’s public comments to three existing categories: supplies, radiology, and drugs. This method, as adapted by RTI, used detailed coding of charges to disaggregate hospital cost centers and derive separate, predicted alternative CCRs for the disaggregated services. RTI’s analysis suggests splitting Medical Supplies into one CCR for devices, implants, and prosthetics and one CCR for Other Supplies; splitting Radiology into one CCR for MRIs, one CCR for CT scans, and one CCR for Other Radiology; and splitting Drugs into one CCR for IV Solutions and one CCR for Other Drugs. RTI’s draft report provides the potential impacts of adopting these changes to the CCRs. We note that RTI’s analysis was based on Version 24.0 of the CMS DRGs. Because the proposed PO 00000 Frm 00036 Fmt 4701 Sfmt 4702 MS–DRGs were under development for the FY 2008 IPPS proposed rule, they were unavailable to RTI for their analysis. The results of RTI’s analysis may be different if applied to the proposed MS–DRGs. However, it seems reasonable to believe that the impact of RTI’s suggestions will be consistent using Version 24.0 of the CMS DRGs and the proposed MS–DRGs, as both systems generally use the same base DRGs while applying different subdivisions to recognize severity of illness. Of all the adjusted CCRs, the largest impact on weights came from accounting for charge compression in medical supplies for devices and implants. The impact on weights from accounting for CCR differences among drugs was modest. The impact of splitting MRI and CT scanning from the radiology CCR was greater than the impact of modifying the Drugs CCRs, but less than the impact of splitting the medical supplies group. Separating Emergency Department and Blood Products and Administration from the ‘‘Other Services’’ category would raise the CCR for other services in the group. RTI found that disaggregating cost centers may have a mitigating effect on the impact of transitioning from chargebased weights to cost-based weights. That is, the changes being suggested by RTI will generally offset (fully or more than fully in some cases or in part in other cases) the impacts of fully implemented cost weights that we are adopting over the FY 2007–FY 2009 transition period. Thus, RTI’s analysis suggests that expanding the number of distinct hospital department CCRs used to calculate cost weights from 13 to 19 will generally increase the relative weights for surgical DRGs and decrease them for the medical DRGs compared to the fully implemented cost-based weights to which we began transitioning in FY 2007. 2. RTI Recommendations In its report, RTI provides recommendations for the short term, medium term, and long term, to mitigate aggregation bias in the calculation of relative weights. We summarize RTI’s recommendations below and respond to each of them. a. Short-Term Recommendations Most of RTI’s short-term recommendations have already been described above. The most immediate changes that RTI recommends implementing include expanding from 13 distinct hospital department CCRs to 19 by: E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules <bullet≤ Disaggregating ‘‘Emergency Room’’ and ‘‘Blood and Blood Products’’ from the ‘‘Other Services’’ cost center; <bullet≤ Establishing regression-based estimates as a temporary or permanent method for disaggregating the Medical Supplies, Drugs, and Radiology cost centers; and <bullet≤ Reclassifying intermediate care charges from the intensive care unit cost center to the routine cost center. We believe these recommendations have significant potential to address issues of charge compression and potential mismatches between how costs and charges are reported in the cost reports and on the Medicare claims. RTI’s recommendations show significant promise in the short term for addressing issues raised in the public comments on the cost weights in the FY 2007 IPPS proposed rule. However, in the time available for the development of this proposed rule, we have been unable to investigate how RTI’s recommended changes may interact with other potential changes to the DRGs and to the method of calculating the DRG relative weights. As we noted above, RTI’s analysis was done on the Version 24.0 of the CMS DRGs and not the MS-DRGs we are proposing for FY 2008. For this proposed rule, we were not able to examine the combined impacts of the proposed MS-DRGs and RTI’s recommendations. In addition, we believe it is also important to consider that, in the FY 2007 IPPS final rule (71 FR 47897), we anticipated undertaking further analysis of the HSRVcc methodology over the next year in conjunction with the research we were to do on charge compression. Analysis of the HSRVcc methodology will be part of the second phase of the RAND study of alternative DRG systems to be completed by September 1, 2007, that has not been completed in time for this proposed rule. As a result, we have also been unable to consider the effects of the HSRVcc methodology together with the proposed MS-DRGs and RTI’s recommendations. Finally, we note that in order to complete the analysis in time for this proposed rule, RTI’s study used only inpatient hospital claims. However, hospital ancillary departments typically include both inpatient and outpatient services within the same department and only a single CCR covering both inpatient and outpatient services can be calculated from Medicare cost reports. Although we believe that applying the regression method used by RTI to only inpatient services is unlikely to have had much impact for the adjustments recommended by RTI, the preferred approach would be to apply the VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 regression method to the combined inpatient and outpatient services. The latter approach would ensure that any potential CCR adjustments in the IPPS would be consistent with potential CCR adjustments in the OPPS. We hope to expand their analysis to incorporate outpatient services during the coming year. For all of these reasons, we are not proposing to adopt RTI’s recommendations for FY 2008. Although we are not proposing to adopt RTI’s recommendations for FY 2008, we are interested in public comments on expanding from 13 CCRs to 19 CCRs. Again, we note that RTI’s analysis suggests significant improvements that could result in the cost weights from adopting its recommendations to adjust for charge compression. Therefore, we are also interested in public comments on whether we should proceed to adopt the RTI recommended changes for FY 2008 in the absence of a detailed analysis of how the relative weights would change if we were to address charge compression while simultaneously adopting an HSRVcc methodology together with the proposed MS-DRGs. Given the change in the impacts that were illustrated in last year’s FY 2007 IPPS final rule (71 FR 47915–47916), going from a hospital-specific to a nonhospital-specific cost-weighting methodology, we believe that sequentially adjusting for charge compression and later adopting an HSRVcc methodology could create the potential for instability in IPPS payments over the next 2 years (that is, payments for surgical DRGs would increase and payment for medical DRGs would decrease if we were adopt the RTI recommended changes for FY 2008, but could potentially reverse direction if we were to adopt an HSRVcc methodology for FY 2009). Again, we are interested in public comments on all of these issues before we make a final decision as to whether to proceed with the RTI’s short-term recommendations in the final rule for FY 2008. Among its other short-term recommendations, RTI also suggested that we incorporate edits to reject or require more intensive review of cost reports from hospitals with extreme CCRs. This action would reduce the number of hospitals with excluded data in the national CCR computations, and would also improve the accuracy of all departmental CCRs within problem cost reports by forcing hospitals to review and correct the assignment of costs and charges before the cost report is filed. Although we do not have a substantive disagreement with the recommendation, we generally focus our audit resources PO 00000 Frm 00037 Fmt 4701 Sfmt 4702 24715 on areas in which cost report information directly affects payments to individual providers. RTI further suggested revising cost report instructions to reduce cost and charge mismatching and program charge misalignment in its short-term recommendations. Although RTI suggests such an action could be immediately effective for correcting the reporting of costs and charges for medical supply items that are now distributed across multiple cost centers, we note that changes to improve cost reporting now will not become part of the relative weights for several years because of lags between the submission of hospital reports and our ability to use them in setting the relative weights. Currently, we expect there will continue to be a 3-year lag between a hospital’s cost report fiscal year and the year it is used to set the relative weights. Thus, even if it were possible to issue instructions immediately beginning for FY 2008, revised reporting would not affect the relative weights until at least FY 2011. Nevertheless, we agree with this recommendation, and we welcome public input on potential changes to cost reporting instructions to improve consistency between how charges are reported on cost reports and in the Medicare claims. We will consider these changes to the cost reporting instructions as we consider further changes to the cost report described below. b. Medium-Term Recommendations RTI recommended that we expand the MedPAR file to include separate fields that disaggregate several existing charge departments. For compatibility with prior years’ data, the new fields should partition the existing ones rather than recombine charges. RTI recommended including additional fields in the MedPAR file for the hospital departments that it statistically disaggregated in its report, as well as intermediate care, observation beds, other special nursing codes, therapeutic radiation and EEG, and possibly others. As with some of RTI’s earlier recommendations with respect to cost reports, we will examine this suggestion in conjunction with other competing priorities CMS has been given for our information systems. We have limited information systems resources, and we will need to consider whether the time constraints we have to develop the IPPS final rule, in conjunction with the inconvenience of using the SAF and accounting for charge compression through regression, will justify the infrastructure cost to our information E:\FEDREG\03MYP2.LOC 03MYP2 24716 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB systems of incorporating these variables into the MedPAR. Finally, RTI’s medium-term recommendations include encouraging providers to use existing standard cost centers, particularly those for Blood and Blood Administration and for Therapeutic Radiology, in the current Medicare cost report. We believe this recommendation is closely related to the one for improved cost reporting instructions. Therefore, we will consider this recommendation as part of any further effort we may undertake to revise cost reporting instructions or change the cost report. c. Long-Term Recommendations RTI’s long-term recommendations include adding new cost centers to the Medicare cost report and/or undertaking the following activities: <bullet≤ Add ‘‘Devices, Implants and Prosthetics’’ under the line for ‘‘Medical Supplies Charged to Patients.’’ Consider also adding a similar line for IV Solutions as a subscripted line under the line for ‘‘Drugs Charged to Patients.’’ <bullet≤ Add CT Scanning and MRI as subscripted lines under the line for ‘‘Radiology-Diagnostic.’’ About onethird of hospitals that offer CT Scanning and/or MRI services are already reporting these services on nonstandard line numbers. More consistent reporting for both cost centers would eliminate the need for statistical estimation on the radiology CCRs. <bullet≤ In consultation with hospital industry representatives, determine the best way to separate cardiology cost centers and add a new standard cost center for cardiac catheterization and/or for all other cardiac diagnostic laboratory services. About 20 percent of hospitals already include a nonstandard line on their cost reports for catheterization. Creating a new standard cost center could improve consistency in reporting and substantially improve the program charge mismatching that now occurs. <bullet≤ In consultation with hospital industry representatives, consider establishing a new cost center to capture intermediate care units as distinct from routine or intensive care. <bullet≤ Establish expert study groups or other research vehicles to study options for improving patient-level charging within nursing units. Nursing accounts for one-fourth of IPPS charges and 41 percent of the computed costs from our claims analysis file. Historically, nursing charges and costs have been assigned to patients without relying on individual measures of service use. Consideration should be given to finding ways to improve VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 precision in nursing cost-finding that will improve relative resource weights without adding substantial administrative costs to either the Medicare program or to hospitals. We agree with RTI that attention should be paid to these issues as we consider changes to the Medicare cost report. The cost report has not been revised in nearly 10 years. During this time, there have been significant changes to the Medicare statute and regulations that have affected the Medicare payment policies. Necessary incremental changes have been made to the Medicare cost report over the years to accommodate the Medicare wage index, disproportionate share payments, indirect and direct graduate medical education payments, reporting of uncompensated care costs, among others. The adoption of cost-based weights for the IPPS beginning in FY 2007 has brought further attention to the importance of the Medicare cost report and how hospitals report costs and charges. We recently began doing a comprehensive review of the Medicare cost report and plan to make updates that will consider its many uses. As we update the cost report, we will give strong consideration to RTI’s recommendations and potential longterm improvements that could be made to the IPPS cost-based relative weighting methodology. F. Hospital-Acquired Conditions, Including Infections (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: Hospital-Acquired Conditions’’ at the beginning of your comment.) 1. General Medicare’s IPPS encourages hospitals to treat patients efficiently. Hospitals receive the same DRG payment for stays that vary in length. In many cases, complications acquired in the hospital do not generate higher payments than the hospital would otherwise receive for other cases in the same DRG. To this extent, the IPPS does encourage hospitals to manage their patients well and to avoid complications, when possible. However, complications, such as infections, acquired in the hospital can trigger higher payments in two ways. First, the treatment of complications can increase the cost of hospital stays enough to generate outlier payments. However, the outlier payment methodology requires that hospitals experience large losses on outlier cases (for example, in FY 2007, the fixed-loss amount was $24,485 before a case qualified for outlier PO 00000 Frm 00038 Fmt 4701 Sfmt 4702 payments, and the hospital then only received 80 percent of its costs above the fixed-loss cost threshold). Second, there are about 121 sets of DRGs that split based on the presence or absence of a complication or comorbidity (CC). The CC DRG in each pair would generate a higher Medicare payment. If a condition acquired during the beneficiary’s hospital stay is one of the conditions on the CC list, the result may be a higher payment to the hospital under a CC DRG. Under the proposed MS–DRGs, there will be 258 sets of DRGs that are split into 2 or 3 subgroups based on the presence or absence of a major CC (MCC) or CC. If a condition acquired during the beneficiary’s hospital stay is one of the conditions on the MCC or CC list, the result may be a higher payment to the hospital under the MS–DRGs. (See section II.C. of the FY 2007 IPPS final rule (71 FR 47881) for a detailed discussion of proposed DRG reforms.) 2. Legislative Requirement Section 5001(c) of Pub. L. 109–171 requires the Secretary to select, by October 1, 2007, at least two conditions that are (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines. For discharges occurring on or after October 1, 2008, hospitals will not receive additional payment for cases in which one of the selected conditions was not present on admission. That is, the case will be paid as though the secondary diagnosis was not present. Section 5001(c) provides that we can revise the list of conditions from time to time, as long as the list contains at least two conditions. Section 5001(c) also requires hospitals to submit the secondary diagnoses that are present at admission when reporting payment information for discharges on or after October 1, 2007. 3. Public Input In the FY 2007 IPPS proposed rule (71 FR 24100), we sought input from the public about which conditions and which evidence-based guidelines should be selected in order to implement section 5001(c) of Public Law 109–171. The comments that we received were summarized in the FY 2007 IPPS final rule (71 FR 48051 through 48053). In that final rule, we indicated that the next opportunity for formal public comment would be this FY 2008 proposed rule and encouraged the public to comment on our proposal at that time. E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules In summary, the majority of the comments that we received in response to the FY 2007 IPPS proposed rule addressed conceptual issues concerning the selection, measurement, and prevention of hospital-acquired infections. Many commenters encouraged CMS to engage in a collaborative discussion with relevant experts in designing, evaluating, and implementing this section. The commenters urged CMS to include individuals with expertise in infection control and prevention, as well as representatives from the provider community, in the discussions. Many commenters supported the statutory requirement for hospitals to submit information regarding secondary diagnoses present on admission beginning in FY 2008, and suggested that it would better enable CMS and health care providers to more accurately differentiate between comorbidities and hospital-acquired complications. MedPAC, in particular, noted that this requirement was recommended in its March 2005 Report to Congress and indicated that this information is important to Medicare’s value-based purchasing efforts. Other commenters cautioned us about potential problems with relying on secondary diagnosis codes to identify hospital-acquired complications, and indicated that secondary diagnosis codes may be an inaccurate method for identifying true hospital-acquired complications. A number of commenters expressed concerns about the data coding requirement for this payment change and asked for detailed guidance from CMS to help them identify and document hospital-acquired complications. Other commenters expressed concern that not all hospitalacquired infections are preventable and noted that sicker and more complex patients are at greater risk for hospitalacquired infections and complications. Commenters suggested that CMS include standardized infectionprevention process measures, in addition to outcome measures of hospital-acquired infections. Some commenters proposed that CMS expand the scope of the payment changes beyond the statutory minimum of two conditions. They noted that the death, injury, and cost of hospitalacquired infections are too high to limit this provision to only two conditions. Commenters also recommended that CMS annually select additional hospital-acquired complications for the payment change. Conversely, a number of commenters proposed that CMS initially begin with limited demonstrations to test CMS’ methodology before nationwide VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 implementation. One commenter recommended that CMS include appropriate consumer protections to prevent providers from billing patients for the nonreimbursed costs of the hospital-acquired complications and to prevent hospitals from selectively avoiding patients perceived at risk of complications. In addition to the broad conceptual suggestions, some commenters recommended specific conditions for possible inclusion in the payment changes, which we discuss in detail in section II.D.4. of this preamble. We also discuss throughout section II.D. of this preamble other comments that we have considered in developing hospitalacquired conditions that would be subject to reporting. 4. Collaborative Effort CMS worked with public health and infectious disease experts from the Centers for Disease Control and Prevention (CDC) to identify a list of hospital-acquired conditions, including infections, as required by section 5001(c) of Public Law 109–171. As previously stated, the selected conditions must meet the following three criteria: (a) High cost or high volume or both; (b) result in the assignment of the case to a DRG that has a higher payment when present as a secondary diagnosis; and (c) could reasonably have been prevented through the application of evidence-based guidelines. CMS and CDC staff also collaborated on developing a process for hospitals to submit a Present on Admission (POA) indicator with each secondary condition. The statute requires the Secretary to begin collecting this information as of October 1, 2007. The POA indicator is required in order for us to determine which of the selected conditions developed during a hospital stay. The current electronic format used by hospitals to obtain this information (ASC X12N 837, Version 4010) does not provide a field to obtain the POA information. We are in the process of issuing instructions to require acute care IPPS hospitals to submit the POA indicator for all diagnosis codes effective October 1, 2007. The instructions will specify how hospitals under the IPPS will submit this information in segment K3 in the 2300 loop, data element K301 on the ASC X12N 837, Version 4010 claim. Specific instructions on how to select the correct POA indicator for a diagnosis code are included in the ICD– 9–CM Official Guidelines for Coding and Reporting. These guidelines can be found at the following Web site: https:// www.cdc.gov/nchs/datawh/ftpserv/ ftpicd9/ftpicd9.htm PO 00000 Frm 00039 Fmt 4701 Sfmt 4702 24717 CMS and CDC staff also received input from a number of groups and organizations on hospital-acquired conditions, including infections. Many of these groups and organizations recommended the selection of conditions mentioned in the FY 2007 IPPS final rule, including the following because of the high cost or high volume (frequency) of the condition, or both, and because in some cases preventable guidelines already exist: <bullet≤ Surgical site infections. The groups and organizations stated that there were evidence-based measures to prevent the occurrence of these infections which are currently measured and reported as part of the Surgical Care Improvement Program (SCIP). <bullet≤ Ventilator-associated pneumonias. The groups and organizations pointed out that these conditions are currently measured and reported through SCIP. However, other organizations counseled against selecting these conditions because they believed it was difficult to obtain good definitions and that it was not always clear which ones are hospital-acquired. <bullet≤ Catheter associated bloodstream infections. <bullet≤ Pressure ulcers, as an alternative to hospital-acquired infections. The groups and organizations pointed out that the specific language in section 5001(c) of Public Law 109–171 mentions hospitalacquired conditions; therefore, the language does not restrict the Secretary to the selection of infections. <bullet≤ Hospital falls, as an alternative to hospital-acquired infections. The injury prevention groups included this condition among a group referred to as ‘‘serious preventable events,’’ also commonly referred to as ‘‘never events’’ or ‘‘serious reportable events.’’ A serious preventable event is defined as a condition which should not occur during an inpatient stay. In addition to the aforementioned conditions, we received other recommendations for the selection of hospital-acquired conditions. These recommendations were also based on the high cost and the high volume of the condition, or both, or the fact that preventable guidelines exist. The recommendations include— <bullet≤ Bloodstream infections/ septicemia. Some commenters suggested that we focus on one specific organism, such as staph aureus septicemia. <bullet≤ Pneumonia. Some commenters recommended the inclusion of a broader group of pneumonia patients, instead of restricting cases to ventilator-associated pneumonias. Some commenters E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24718 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mentioned that while prevention guidelines exist for pneumonia, it is not clear how effective these guidelines may be in preventing pneumonia. <bullet≤ Vascular catheter associated infections. Commenters pointed out that there are CDC guidelines for these infections. Other commenters pointed out that while this condition certainly deserves focused attention by health care providers, there is not a clear one unique ICD–9–CM code that identifies vascular catheter-associated infections. Therefore, these commenters suggested that there would be difficulty separately identifying these conditions. <bullet≤ Clostridium difficileassociated disease (CDAD). Several commenters identified this condition as a significant public health issue. Other commenters pointed out that while prevalence of this condition is emerging as a public health problem, there is not currently a strategy for reasonably preventing these infections. <bullet≤ Methicillin-resistant staphylococcus aureus (MRSA). Several commenters pointed out that MRSA has become a very common bacteria occurring both in and outside the hospital environment. However, other organizations pointed out that the code for MRSA (V09.0, Infection with microorganism resistant to penicillins Methicillin-resistant staphylococcus aureus) is not currently classified as a CC. Therefore, the commenters stated that MRSA does not lead to a higher reimbursement when the code is reported. <bullet≤ Serious preventable events. As stated earlier, some commenters representing injury prevention groups suggested including a broader group of conditions than hospital falls which should not be expected to occur during a hospital admission. Hey notes that these conditions are referred to as ‘‘serious preventable events,’’ and include events such as the following: (a) Leaving an object in during surgery; (b) operating on the wrong body part or patient, or performing the wrong surgery; (c) air embolism as a result of surgery; and (d) providing incompatible blood or blood products. Other commenters indicated that serious preventable events are so rare that they should not be selected as a hospital condition that cannot result in a case being assigned to a higher paying DRG. 5. Criteria for Selection of the HospitalAcquired Conditions CMS and CDC staff greatly appreciate the many comments and suggestions offered by organizations and groups that were interested in providing input into VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 the selection of the initial hospitalacquired conditions. CMS and CDC staff evaluated each recommended condition under the three criteria established by section 1886(d)(4)(D)(iv) of the Act. In order to meet the higher payment criterion, the condition selected must have an ICD–9– CM diagnosis code that clearly identifies the condition and is classified as a CC, or as an MCC as proposed for the MS–DRGs in this proposed rule. Some conditions recommended for inclusion among the initial hospitalacquired conditions did not have codes that clearly identified the conditions. Because there has not been national reporting of a POA indicator for each diagnosis, there is no Medicare data to determine the incidence of the reported secondary diagnoses occurring after admission. To the extent possible, we used information from the CDC on the incidence of these conditions. CDC’s data reflect the incidence of hospitalacquired conditions in 2002. We also examined FY 2006 Medicare data on the frequency that these conditions were reported as secondary diagnoses. We developed the following criteria to assist in our analysis of the conditions. The conditions described were those recommended for inclusion in the initial hospital-acquired infection provision. <bullet≤ Coding—Under section 1886(d)(4)(D)(ii)(I) of the Act, a discharge is subject to the payment adjustment if ‘‘the discharge includes a condition identified by a diagnosis code’’ selected by the Secretary under section 1886(d)(4)(D)(iv) of the Act. We only selected conditions that have (or could have) a unique ICD–9–CM code that clearly describes the condition. Some conditions recommended by the commenters would require the use of two or more ICD–9–CM codes to clearly identify the conditions. Although we did not exclude these conditions from further consideration, the need to utilize multiple ICD–9–CM codes to identify them may present operational issues. For instance, below we describe in detail the complexities associated with selecting septicemia as a hospitalacquired condition that would be subject to section 5001(c) of the DRA. In some cases, septicemia may be a reasonably preventable condition with proper hospital care. However, in other cases, clinicians may argue that the condition arose from further development of another infection the patient did have upon admission and the septicemia was not preventable. As we indicate in detail below, there could be a significant variety of clinical scenarios and potential coding vignettes PO 00000 Frm 00040 Fmt 4701 Sfmt 4702 to describe situations where septicemia occurs. Although we could select septicemia, we would also have to identify many exclusions for situations where the septicemia is not preventable. The vast number of clinical scenarios that we would have to account for could complicate implementation of the provision. <bullet≤ Burden (High Cost/High Volume)—Under section 1886(d)(4)(D)(iv)(I) of the act, we must select cases that have conditions that are high cost or high volume, or both. <bullet≤ Prevention guidelines— Under section 1886(d)(4)(D)(iv)(II) of the Act, we must select codes that describe conditions that could reasonably have been prevented through application of evidence-based guidelines. We evaluated whether there is information available for hospitals to follow to prevent the condition from occurring. <bullet≤ CC—Under section 1886(d)(4)(D)(iv)(III) of the Act, we must select codes that result in assignment of the case to a DRG that has a higher payment when the code it present as a secondary diagnosis. The condition must be an MCC or a CC that would, in the absence of this provision, result in assignment to a higher paying DRG. <bullet≤ Considerations—We evaluate each condition above according to how it meets the statutory criteria in light of the potential difficulties that we would face if the condition were selected. 6. Proposed Selection of HospitalAcquired Conditions We discuss below our analysis of each of the conditions that were raised as possible candidates for selection under section 5001(c) of Pub. L. 109–171 according to the criteria described above in section II.D.5. of this preamble. We also discuss any considerations, which would include any administrative issues surrounding the selection of a proposed condition. For example, the condition may only be able to be identified by multiple codes, thereby requiring the development of special GROUPER logic to also exclude similar or related ICD– 9–CM codes from being classified as a CC. Similarly, a condition acquired during a hospital stay may arise from another condition that the patient had prior to admission, making it difficult to determine whether the condition was reasonably preventable. Following a discussion of each condition, we provide a summary table that describes the extent to which each condition meets each of the above criteria. We present 13 conditions in rank order. In our view, the conditions listed at the top of the table best meet the statutory selection criteria, while the conditions E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB listed lower may meet the selection criteria but could present a particular challenge (that is, they may be preventable only in some circumstances but not in others). Therefore, we would submit that the first conditions listed should receive the highest consideration of selection among our initial group of hospital-acquired conditions. We encourage comments on whether or not we have ranked these conditions appropriately. We also encourage additional comments on clinical, coding, and prevention issues that may affect the conditions selected. While we have ranked these conditions, there may be compelling public health reasons for including conditions that are not at the top of our list. We ask commenters to recommend how many and which conditions should be selected for implementation on October 1, 2008, along with justifications for these selections. (a) Catheter-Associated Urinary Tract Infections <bullet≤ Coding—ICD–9–CM code 996.64 (Infection and inflammatory reaction due to indwelling urinary catheter) clearly identifies this condition. The hospital would also report the code for the specific type of urinary infection. For instance, when a patient develops a catheter associated urinary tract infection during the inpatient stay, the hospital would report code 996.64 and 599.0 (Urinary tract infection, site not specified) to clearly identify the condition. There are also a number of other more specific urinary tract infection codes that could also be coded with code 996.64. These codes are classified as CCs. If we were to select catheter-associated urinary tract infections, we would implement the decision by not counting code 996.64 and any of the urinary tract infection codes listed below when both codes are present and the condition was acquired after admission. If only code 996.64 were coded on the claim as a secondary diagnosis, we would not count it as a CC. Burden (High Cost/High Volume)— CDC reports that there are 561,667 catheter-associated urinary tract infections per year. For FY 2006, there were 11,780 reported cases of Medicare patients who had a catheter associated urinary tract infection as a secondary diagnosis. The cases had average charges of $40,347 for the entire hospital stay. According to a study in the American Journal of Medicine, catheter-associated urinary tract infection is the most common nosocomial infection, accounting for more than 1 million cases in hospitals VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 and nursing homes nationwide.12 Approximately 11.3 million women in the United States had at least one presumed acute community-acquired urinary tract infection resulting in antimicrobial therapy in 1995, with direct costs estimated at $659 million and indirect costs totaling $936 million. Nosocomial urinary tract infection necessitates one extra hospital day per patient, or nearly 1 million extra hospital days per year. It is estimated that each episode of symptomatic urinary tract infection adds $676 to a hospital bill. In total, according to the study, the estimated annual cost of nosocomial urinary tract infection in the United States ranges between $424 and $451 million. Prevention guidelines—There are widely recognized guidelines for the prevention of catheter-associated urinary tract infections. Guidelines can be found at the following Web site: https://www.cdc.gov/ncidod/dhqp/gl— catheter—assoc.html. CC—Codes 996.64 and 599.0 are classified as CCs in the current CMS DRGs as well as in the proposed MS– DRGs. Considerations—The primary prevention intervention would be not using catheters or removing catheters as soon as possible, both of which are worthy goals because once catheters are in place for 3 to 4 days, most clinicians and infectious disease/infection control experts do not believe urinary tract infections are preventable. While there may be some concern about the selection of catheter associated urinary tract infections, it is an important public health goal to encourage practices that will reduce urinary tract infections. Approximately 40 percent of Medicare beneficiaries have a urinary catheter during hospitalization based on Medicare Patient Safety Monitoring System (MPSMS) data. As stated above in the Coding section, this condition is clearly identified through ICD–9–CM code 996.64. Code 996.64 is classified as a CC. The hospital would also report the code for the specific type of urinary infection. For instance, when a patient develops a catheter associated urinary tract infection during the inpatient stay, the hospital would report codes 996.64 and 599.0 or another more specific code that clearly identifies the condition. These codes are classified as CCs under the current CMS DRGs as well as the proposed MS–DRGs. To select catheterassociated urinary tract infections as 12 Foxman, B.: ‘‘Epidemiology of urinary tract infections: incidence, morbidity, and economic costs,’’ The American Journal of Medicine, 113 Suppl. 1A, pp. 5s–13s, 2002. PO 00000 Frm 00041 Fmt 4701 Sfmt 4702 24719 one of the hospital-acquired conditions that would not be counted as a CC, we would not classify code 996.64 as a CC if the condition occurred after admission. Furthermore, we would also not classify any of the codes listed below as CCs if present on the claim with code 996.64 because these additional codes identify the same condition. The following codes represent specific types of urinary infections. We did not include codes for conditions that could be considered chronic urinary infections, such as code 590.00 (Chronic pyelonephritis, without lesion or renal medullary necrosis). Chronic conditions may indicate that the condition was not acquired during the current stay. We would not count code 996.64 or any of the following codes representing acute urinary infections if they developed after admission and were coded together on the same claim. <bullet≤ 112.2 (Candidiasis of other urogenital sites) <bullet≤ 590.10 (Acute pyelonephritis, without lesion of renal medullary necrosis) <bullet≤ 590.11 (Acute pyelonephritis, with lesion of renal medullary necrosis) <bullet≤ 590.2 (Renal and perinephric abscess) <bullet≤ 590.3 (Pyeloureteritis cystica) <bullet≤ 590.80 (Pyelonephritis, unspecified) <bullet≤ 590.81 (Pyelitis or pyelonephritis in diseases classified elsewhere) <bullet≤ 590.9 (Infection of kidney, unspecified) <bullet≤ 595.0 (Acute cystitis) <bullet≤ 595.3 (Trigonitis) <bullet≤ 595.4 (Cystitis in diseases classified elsewhere) <bullet≤ 595.81 (Cystitis cystica) <bullet≤ 595.89 (Other specified type of cystitis, other) <bullet≤ 595.9 (Cystitis, unspecified) <bullet≤ 597.0 (Urethral abscess) <bullet≤ 597.80 (Urethritis, unspecified) <bullet≤ 599.0 (Urinary tract infection, site not specified) We believe the condition of catheterassociated urinary tract infection meets all of our criteria for selection as one of the initial hospital-acquired conditions. We can easily identify the cases with ICD–9–CM codes. The condition is a CC under both the current CMS DRGs and the proposed MS–DRGs that are discussed earlier in this proposed rule. The condition meets our burden criterion with its high cost and high frequency. There are prevention guidelines on which the medical community agrees. Of all 13 conditions discussed in this proposed rule, we believe this condition best meets the E:\FEDREG\03MYP2.LOC 03MYP2 24720 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB criteria discussed. Therefore, we are proposing the selection of catheterassociated urinary tract infections as one of the initial hospital-acquired conditions. We encourage comments on both the selection of this condition and the related conditions that we are proposing to exclude from being counted as CCs. (b) Pressure Ulcers Coding—Pressure ulcers are also referred to as decubitus ulcers. The following codes clearly identify pressure ulcers. <bullet≤ 707.00 (Decubitus ulcer, unspecified site) <bullet≤ 707.01 (Decubitus ulcer, elbow) <bullet≤ 707.02 (Decubitus ulcer, upper back) <bullet≤ 707.03 (Decubitus ulcer, lower back) <bullet≤ 707.04 (Decubitus ulcer, hip) <bullet≤ 707.05 (Decubitus ulcer, buttock) <bullet≤ 707.06 (Decubitus ulcer, ankle) <bullet≤ 707.07 (Decubitus ulcer, heel) <bullet≤ 707.09 (Decubitus ulcer, other site) Burden (High Cost/High Volume)— This is both a high-cost and highvolume condition. For FY 2006, there were 322,946 reported cases of Medicare patients who had a pressure ulcer as a secondary diagnosis. These cases had average charges for the hospital stay of $40,381. Prevention guidelines—Prevention guidelines can be found at the following Web sites: https://www.npuap.org/ positn1.html. https:// www.ncbi.nlm.nih.gov/books/ bv.fcgi?rid=hstat2.chapter.4409 CC—Decubitus ulcer codes are classified as CCs under the current CMS DRGs. Codes 707.00, 707.01, and 707.09 are CCs under the proposed MS–DRGs. Codes 707.02 through 707.07 are considered MCCs under the proposed MS–DRGs. As discussed earlier, MCCs result in even larger payments than CCs. Considerations—Pressure ulcers are an important hospital-acquired complication. Prevention guidelines exist (non-CDC) and can be implemented by hospitals. Clinicians may state that some pressure ulcers present on admission cannot be identified (skin is not yet broken (Stage I) but damage to tissue is already done and skin will eventually break down. However, by selecting this condition, we would provide hospitals the incentive to perform careful examination of the skin of patients on admission to identify decubitus ulcers. If the condition is present on admission, the provision will not apply. We are VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 proposing to include pressure ulcers as one of our initial hospital-acquired conditions. This condition can be clearly identified through ICD–9–CM codes. These codes are classified as a CC under the current CMS DRGs and as a CC or MCC under the proposed MS– DRGs. Pressure ulcers meet the burden criteria because they are both high cost and high frequency cases. There are clear prevention guidelines. While there is some question as to whether all cases with developing pressure ulcers can be identified on admission, we believe the selection of this condition will result in a closer examination of the patient’s skin on admission. This will result in better quality of care. We welcome comments on the proposed inclusion of this condition. Serious Preventable Events Serious preventable events are events that should not occur in health care. The injury prevention community has developed information on serious preventable events. CMS reviewed the list of serious preventable events and identified those events for which there was an ICD–9–CM code that would assist in identifying them. We identified four types of serious preventable events to include in our evaluation. These include leaving an object in a patient; performing the wrong surgery (surgery on the wrong body part, wrong patient, or the wrong surgery); air embolism following surgery; and providing incompatible blood or blood products. Three of these serious preventable events have unique ICD–9–CM codes to identify them. There is not a clear and unique code for surgery performed on the wrong body part, wrong patient, or the wrong surgery. Each of these events is discussed separately. (c) Serious Preventable Event—Object Left in During Surgery Coding—Retention of a foreign object in a patient after surgery is identified through ICD–9–CM code 998.4 (Foreign body accidentally left during a procedure). Burden (High Cost/High Volume)— For FY 2006, there were 764 cases reported of Medicare patients who had an object left in during surgery reported as a secondary diagnosis. The average charges for the hospital stay were $61,962. This is a rare event. Therefore, it is not high volume. However, an individual case will likely have high costs, given that the patient will need additional surgery to remove the foreign body. Potential adverse events stemming from foreign body could further raise costs for an individual case. PO 00000 Frm 00042 Fmt 4701 Sfmt 4702 Prevention guidelines—There are widely accepted and clear guidelines for the prevention of this event. Prevention guidelines for avoiding leaving objects in during surgery are located at the following Web site: https:// www.qualityindicators.ahrq.gov/psi— download.htm. This event should not occur. CC—This code is a CC under the current CMS DRGs as well as under the proposed MS–DRGs. Considerations—There are no significant considerations for this condition. There is a unique ICD–9–CM code and wide agreement on the prevention guidelines. We are proposing to include this condition as one of our initial hospital-acquired conditions. The cases can be clearly identified through an ICD–9–CM. This code is a CC under both the current CMS DRGs and the proposed MS–DRGs. There are clear prevention guidelines. While the cases may not meet the high frequency criterion, they do meet the high-cost criterion. Individual cases can be high cost. We welcome comments on including this condition as one of our initial hospital-acquired conditions. (d) Serious Preventable Event—Air Embolism Coding—An air embolism is identified through ICD–9–CM code 999.1 (Complications of medical care, NOS, air embolism). Burden (High Cost/High Volume)— This event is rare. For FY 2006, there were 45 reported cases of air embolism for Medicare patients. The average charges for the hospital stay were $66,007. Prevention guidelines—There are clear prevention guidelines for air embolisms. This event should not occur. Serious preventable event guidelines can be found at the following Web site: https://www.qualityindicators.ahrq.gov/ psi—download.htm. CC—This code is a CC under the current CMS DRGs and is an MCC under the proposed MS–DRGs. Considerations—There are no significant considerations for this condition. There is a unique ICD–9–CM code and wide agreement on the prevention guidelines. In addition, as stated earlier, the condition is a CC under the current CMS DRGs and an MCC under the proposed MS–DRGs. While the condition is rare, it does meet the cost burden criterion because individual cases can be expensive. Therefore, air embolism is a high-cost condition because average charges per case are high. We welcome comments on the proposal to include this condition. E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules (e) Serious Preventable Event—Blood Incompatibility mmaher on DSK3CLS3C1PROD with $$_JOB Coding—Delivering ABO-incompatible blood or blood products is identified by ICM–9–CM code 999.6 (Complications of medical care, NOS, ABO incompatibility reaction). Burden (High Cost/High Volume)— This event is rare. Therefore, it is not high volume. For FY 2006, there were 33 reported cases of blood incompatibility among Medicare patients, with average charges of $46,492 for the hospital stay. Therefore, individual cases have high costs. Prevention guidelines—There are prevention guidelines for avoiding the delivery of incompatible blood or blood products. The event should not occur. Serious preventable event guidelines can be found at the following Web site: https://www.qualityindicators.ahrq.gov/ psi—download.htm CC—This code is a CC under the current CMS DRGs as well as the proposed MS–DRGs. Considerations—There are no significant considerations for this condition. There is a unique ICD–9–CM code which is classified as a CC under the CMS DRGs as well as the proposed MS–DRGs. There is wide agreement on the prevention guidelines. While this may not be a high-volume condition, average charges per case are high. Therefore, we believe this condition is a high-cost condition and, therefore, meets our burden criterion. We are proposing to include this condition as one of our initial hospital-acquired conditions. (f) Staphylococcus Aureus Bloodstream Infection/Septicemia Coding—ICD–9–CM Code 038.11 (Staphylococcus aureus septicemia) identifies this condition. However, the codes selected to identify septicemia are somewhat complex. The following ICD– 9–CM codes may also be reported to identify septicemia: <bullet≤ 995.91 (Sepsis) and 995.92 ( Severe sepsis). These codes are reported as secondary codes and further define cases with septicemia. <bullet≤ 998.59 (Other postoperative infections). This code includes septicemia that develops postoperatively. <bullet≤ 999.3 (Other infection). This code includes but is not limited to sepsis/septicemia resulting from infusion, injection, transfusion, vaccination (ventilator-associated pneumonia also included here). Burden (High Cost/High Volume)— CDC reports that there are 290,000 cases of staphylococcus aureus infection VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 annually in hospitalized patients of which approximately 25 percent are bloodstream infections or sepsis. For FY 2006, there were 29,500 cases of Medicare patients who had staphylococcus aureus infection reported as a secondary diagnosis. The average charges for the hospital stay were $82,678. Inpatient staphylococcus aureus result in an estimated 2.7 million days in excess length of stay, $9.5 billion in excess charges, and approximately 12,000 inpatient deaths per year. Prevention guidelines—CDC guidelines are located at the following Web site: https://www.cdc.gov/ncidod/ dhqp/gl—intravascular.html. CC—Codes 038.11, 995.91, 998.59, and 999.3 are classified as CCs under the current CMS DRGs and as MCCs under the proposed MS–DRGs. Considerations—Preventive health care associated bloodstream infections/ septicemia that are preventable are primarily those that are related to a central venous/vascular catheter, a surgical procedure (postoperative sepsis) or those that are secondary to another preventable infection (for example, sepsis due to catheterassociated urinary tract infection). Otherwise, physicians and other public health experts may argue whether septicemia is reasonably preventable. The septicemia may not be simply a hospital-acquired infection. It may simply be a progression of an infection that occurred prior to admission. Furthermore, physicians cannot always tell whether the condition was hospitalacquired. We examined whether it might be better to limit the septicemia cases to a specific organism (for example, code 038.11 (Staphylococcus aureus septicemia)). CDC staff recommended that we focus on staphylococcus aureus septicemia because this condition is a significant public health issue. As stated earlier, there is a specific code for staphylococcus aureus septicemia, code 038.11. Therefore, the cases would be easy to identify. However, as stated earlier, while this type of septicemia is identified through code 038.11, coders may also provide sepsis code 995.91 or 995.92 to more fully describe the staphylococcus aureus septicemia. Codes 995.91 and 995.92 are reported as secondary codes and further define cases with septicemia. Codes 995.91 and 995.92 are CCs under the current CMS DRGs and MCCs under the proposed MS–DRGs. <bullet≤ 998.59 (Other postoperative infections). This code includes septicemia that develops postoperatively. PO 00000 Frm 00043 Fmt 4701 Sfmt 4702 24721 <bullet≤ 999.3 (Other infection). This code includes but is not limited to sepsis/septicemia resulting from infusion, injection, transfusion, vaccination (ventilator-associated pneumonia also indexed here). To implement this condition as one of our initial ones, we would have to exclude the specific code for staphylococcus aureus septicemia, 038.11, and the additional septicemia codes, 995.91, 995.92, 998.59, and 999.3. We acknowledge that there are additional issues involved with the selection of this condition that may involve developing an exclusion list of conditions present on admission for which we would not apply a CC exclusion to staphylococcus aureus septicemia. For example, a patient may come into the hospital with a staphylococcus aureus infection such as pneumonia. The pneumonia might develop into staphylococcus aureus septicemia during the admission. It may be appropriate to consider excluding cases such as those of patients admitted with staphylococcus aureus pneumonia that subsequently develop staphylococcus aureus septicemia from the provision. In order to exclude cases that did not have a staphylococcus aureus infection prior to admission, we would have to develop a list of specific codes that identified all types of staphylococcus aureus infections such as code 482.41 (Pneumonia due to staphylococcus aureus). We likely would not apply the new provision to cases of staphylococcus aureus septicemia if a patient were admitted with staphylococcus aureus pneumonia. However, if the patient had other types of infections, not classified as being staphylococcus aureus, and then developed staphylococcus aureus septicemia during the admission, we would apply the provision and exclude the staphylococcus aureus septicemia as a CC. We were not able to identify any other specific ICD–9–CM codes that identify specific infections as being due to staphylococcus aureus. Other types of infections, such as urinary tract infections, would require the reporting of an additional code, 041.11 (Staphylococcus aureus), to identify the staphylococcus aureus infection. This additional coding presents administrative issues, because it will not always be clear which condition code 041.11 (Staphylococcus aureus) is describing. We do not believe it would be appropriate to make code 041.11, in combination with other codes, subject to the hospital-acquired conditions provision until we better understand how to address the E:\FEDREG\03MYP2.LOC 03MYP2 24722 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB administrative issues that would be associated with their selection. Therefore, we would exclude staphylococcus aureus septicemia cases with code 482.41 reported as being subject to the hospital-acquired conditions provision. Stated conversely, we would allow staphylococcus aureus septicemia to count as a CC if the patient was admitted with staphylococcus aureus pneumonia. We recognize that there may be other conditions which we should consider for this type of exclusion. We are proposing to include staphylococcus aureus bloodstream infection/ septicemia (code 038.11) as one of our initial hospital-acquired conditions. We would also exclude codes 995.91, 998.59, and 999.3 from counting as an MCC/CC when they are reported with code 038.11. The condition can be clearly identified through ICD–9–CM codes that are classified as CC under the current CMS DRGs and MCCs under the proposed MS–DRGs. The condition meets our burden criterion by being both high cost and high volume. There are prevention guidelines which we acknowledge are subject to some debate among the medical community. We also acknowledge that we would have to exclude this condition if a patient were admitted with a staphylococcus aureus infection of a more limited location, such as pneumonia. We encourage commenters to make suggestions on this issue and to recommend any other appropriate exclusion for staphylococcus aureus septicemia. We encourage comments on the appropriateness of selecting staphylococcus aureus septicemia as one of our proposed initial hospitalacquired conditions. (g) Ventilator Associated Pneumonia (VAP) and Other Types of Pneumonia Coding ‘‘ Pneumonia is identified through the following codes: <bullet≤ 073.0 (Ornithosis with pneumonia) <bullet≤ 112.4 (Candidiasis of lung) <bullet≤ 136.3 (Pneumocystosis) <bullet≤ 480.0 (Pneumonia due to adenovirus) <bullet≤ 480.1 (Pneumonia due to respiratory syncytial virus) <bullet≤ 480.2 (Pneumonia due to parainfluenza virus) <bullet≤ 480.3 (Pneumonia due to SARS-associated coronavirus) <bullet≤ 480.8 (Pneumonia due to other virus not elsewhere classified) <bullet≤ 480.9 (Viral pneumonia, unspecified) <bullet≤ 481 (Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia]) VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 <bullet≤ 482.0 (Pneumonia due to Klebsiella pneumoniae) <bullet≤ 482.1 (Pneumonia due to Pseudomonas) <bullet≤ 482.2 (Pneumonia due to Hemophilus influenzae [H. influenzae]) <bullet≤ 482.30 (Pneumonia due to Streptococcus, unspecified) <bullet≤ 482.31 (Pneumonia due to Streptococcus, Group A) <bullet≤ 482.32 (Pneumonia due to Streptococcus, Group B) <bullet≤ 482.39 (Pneumonia due to other Streptococcus) <bullet≤ 482.40 (Pneumonia due to Staphylococcus, unspecified) <bullet≤ 482.41 (Pneumonia due to Staphylococcus aureus) <bullet≤ 482.49 (Other Staphylococcus pneumonia) <bullet≤ 482.81 (Pneumonia due to Anaerobes) <bullet≤ 482.82 (Pneumonia due to Escherichia coli [E. coli]) <bullet≤ 482.83 (Pneumonia due to other gram-negative bacteria) <bullet≤ 482.84 (Pneumonia due to Legionnaires’ disease) <bullet≤ 482.89 (Pneumonia due to other specified bacteria) <bullet≤ 482.9 (Bacterial pneumonia unspecified) <bullet≤ 483.0 (Pneumonia due to Mycoplasma pneumoniae) There is not a unique code that identifies ventilator associated pneumonia. The creation of a code for ventilator associated pneumonia was discussed at the September 29, 2006 meeting of the ICD–9–CM Coordination and Maintenance Committee meeting. Many issues and concerns were raised at the meeting concerning the creation of this proposed new code. It has been difficult to define ventilator-associated pneumonia. We plan to continue working closely with the CDC to develop a code that can accurately describe this condition for implementation in FY 2009. CDC will address the creation of a unique code for this condition at the September 28–29, 2007 ICD–9–CM Coordination and Maintenance Committee meeting. While we list 27 pneumonia codes above, our clinical advisors do not believe that all of the codes mentioned could possibly be associated with ventilator-associated pneumonia. Our clinical advisors specifically question whether the following codes would ever represent cases of ventilator-associated pneumonia: 073.0, 480.0, 480.1, 480.2, 480.3, 480.8, 480.9, and 483.0. Therefore, we have a range of pneumonia codes, all of which may not represent cases that could involve ventilator-associated pneumonia. In addition, we do not have a specific code PO 00000 Frm 00044 Fmt 4701 Sfmt 4702 that uniquely identifies cases of ventilator-associated pneumonia. Burden (High Cost/High Volume)— CDC reports that there are 250,205 ventilator-associated pneumonias per year. Because there is not a unique ICD– 9–CM code for ventilator-associated pneumonia, there is not accurate data for FY 2006 on the number of Medicare patients who had this condition as a secondary diagnosis. However, we did examine data for FY 2006 on the number of Medicare patients who listed pneumonia as a secondary diagnosis. There were 92,586 cases with a secondary diagnosis of pneumonia, with average charges of $88,781. According to the journal Critical Care Medicine, patients with ventilator-associated pneumonia have statistically significantly longer intensive care lengths of stay (mean = 6.10 days) than those who do not (mean = 5.32–6.87 days). In addition, patients who develop ventilator-associated pneumonia incur, on average, greater than or equal to $10,019 in additional hospital costs compared to those who do not.13 Therefore, we believe that this is a highvolume condition. Prevention guidelines—Prevention guidelines are located at the following Web site: https://www.cdc.gov/ncidod/ dhqp/ gl—hcpneumonia.html. However, it is not clear how effective these guidelines are in preventing pneumonia. Ventilator-associated pneumonia may be particularly difficult to prevent. CC—All of the pneumonia codes listed above are CCs under the current CMS DRGs and under the proposed MS–DRGs, except for the following pneumonia codes which are non-CCs: 073.0, 480.0, 480.1, 480.2, 480.3, 480.8, 480.9, 483.0. However, as mentioned earlier, there is not a unique ICD–9–CM code for ventilator-associated pneumonia. Therefore, this condition does not currently meet the statutory criteria for being selected. Considerations—Hospital-acquired pneumonias, and specifically ventilator associated pneumonias, are an important problem. However, based on our work with the medical community to develop specific codes for this condition, we have learned that it is difficult to define what constitutes ventilator associated pneumonia. Although prevention guidelines exist, it is not clear how effective these are in preventing pneumonia. Clinicians cannot always tell which pneumonias are acquired in a hospital. In addition, 13 Safdar N.: Clinical and Economic Consequences of Ventilator-Associated Pneumonia: A Systematic Review, Critical Care Medicine, 2005, 33(10), pp. 2184–2193. E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB as mentioned above, there is not a unique code that identifies ventilatorassociated pneumonia. There are a number of codes that capture a range of pneumonia cases. It is not possible to specifically identify if these pneumonia cases are ventilator-associated or arose from other sources. Because we cannot identify cases with ventilator-associated pneumonia and there are questions about its preventability, we are not proposing to select this condition as one of our initial hospital-acquired conditions. However, we welcome public comments on how to create an ICD–9–CM code that identifies ventilator-associated pneumonia, and we encourage participation in our September 28–29, 2007 ICD–9–CM Coordination and Maintenance Committee meeting where this issue will be discussed. We will reevaluate the selection of this condition in FY 2009. (h) Vascular Catheter-Associated Infections Coding—The code used to identify vascular catheter associated infections is ICD–9–CM code 996.62 (Infection due to other vascular device, implant, and graft). This code includes infections associated with all vascular devices, implants, and grafts. It does not uniquely identify a vascular catheter associated infections. Therefore, there is not a unique ICD–9–CM code for this infection. CDC and CMS staff requested that the ICD–9–CM Coordination and Maintenance Committee discuss the creation of a unique ICD–9–CM code for vascular catheter associated infections because the issue is important for public health. The proposal to create a new ICD–9–CM was discussed at the March 22–23, 2007 meeting of the ICD–9–CM Coordination and Maintenance Committee. A summary of this meeting can be found at: https://www.cdc.gov/ nchs/icd9.htm. Coders would also assign an additional code for the infection such as septicemia. Therefore, a list of specific infection codes would have to be developed to go along with code 996.62. If the vascular catheter associated infection was hospitalacquired, the DRG logic would have to be modified so that neither the code for the vascular catheter associated infection along with the specific infection code would count as a CC. Burden (High Cost/High Volume)— CDC reports that there are 248,678 central line associated bloodstream infections per year. It appears to be both high cost and high volume. However, we were not able to identify Medicare data on these cases because there is no existing unique ICD–9–CM code. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Prevention guidelines—CDC guidelines are located at the following Web site: https://www.cdc.gov/ncidod/ dhqp/gl—intravascular.html. CC—Code 996.62 is a CC under the current CMS DRGs and the proposed MS–DRGs. However, as stated earlier, this code is broader than vascular catheter-associated infections. Therefore, there is not a unique ICD–9– CM code to identify the condition at this time, and it does not currently meet the statutory criteria to be selected. However, as indicated above, we will be creating a code(s) to identify this condition and may select it as a condition under the provision beginning in FY 2009. Considerations—There is not yet a unique ICD–9–CM code to capture this condition. If one is implemented on October 1, 2007, we would be able to specifically identify these cases. Some patients require long-term indwelling catheters, which are more prone to infections. Ideally catheters should be changed at certain time intervals. However, circumstances might prevent such practice (for example, the patient has a bleeding diathesis). In addition, a patient may acquire an infection from another source which can colonize the catheter. As mentioned earlier, coders would also assign an additional code for the infection, such as septicemia. Therefore, a list of specific infection codes would have to be developed to go along with code 996.62. If the vascular catheter-associated infection was hospital-acquired, the DRG logic would have to be modified so that neither the code for the vascular catheter-associated infection along with the specific infection code would count as a CC. Without a specific code for infections due to a catheter, it would be difficult to identify these patients. Given the current lack of an ICD–9–CM code for this condition, we are not proposing to include it as one of our initial hospitalacquired conditions at this time. However, we believe it shows merit for inclusion in future lists of hospitalacquired conditions once we have resolved the coding issues and are able to better identify the condition in the Medicare data. We will reevaluate the selection of this condition in FY 2009. We encourage comments on this condition which was identified as an important public health issue by several organizations that provided recommendations on hospital-acquired conditions. We are particularly interested in receiving comments on how we should handle additional associated infections that might develop along with the vascular catheterassociated infection. PO 00000 Frm 00045 Fmt 4701 Sfmt 4702 24723 (i) Clostridium Difficile-Associated Disease (CDAD) Coding—This condition is identified by ICD–9–CM code 008.45 (Clostridium difficile). Burden (High Cost/High Volume)— CDC reports that there are 178,000 cases per year in U.S. hospitals. For FY 2006, there were 110,761 reported cases of Medicare patients with CDAD as a secondary diagnosis, with average charges for the hospital stay of $52,464. Therefore, this is a high-volume condition. Prevention guidelines—Prevention guidelines are not available. Therefore, we do not believe this condition can reasonably be prevented through the application of evidence-based guidelines. CC—Code 008.45 is a CC under the current CMS DRGs and the proposed MS–DRGs. Considerations—CDAD is an emerging problem with significant public health importance. If found early CDAD cases can easily be treated. However, cases not diagnosed early can be expensive and difficult to treat. CDAD occurs in patients on a variety of antibiotic regiments, many of which are unavoidable, and therefore preventability is an issue. We are not proposing to include CDAD as one of our initial hospital-acquired conditions at this time, given the lack of prevention guidelines. We welcome public comments on CDAD, specifically on its preventability and whether there is potential to develop guidelines to identify it early in the disease process and/or diminish its incidence. We will reevaluate the selection of this condition in FY 2009. (j) Methicillin-Resistant Staphylococcus Aureus (MRSA) Coding—MRSA is identified by ICD– 9–CM code V09.0 (Infection with microorganisms resistant to penicillins). One would also assign a code(s) to describe the exact nature of the infection. Burden (High Cost/High Volume)— For FY 2006, there were 95,103 reported cases of Medicare patients who had MRSA as a secondary diagnosis. The average charges for these cases were $31,088. This condition is a high-cost and high-volume infection. MRSA has become a very common bacteria occurring both in and outside of the hospital environment. Prevention guidelines—CDC guidelines are located at the following Web site: https://www.cdc.gov/ncidod/ dhqp/pdf/ar/mdroGuideline2006.pdf. CC—Code V09.0 is not a CC under the current CMS DRGs and the proposed E:\FEDREG\03MYP2.LOC 03MYP2 24724 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules MS–DRGs. The specific infection would be identified in a code describing the exact nature of the infection, which may be a CC. Considerations—As stated earlier, preventability may be hard to ascertain since the bacteria has become so common both inside and outside the hospital. There are also considerations in identifying MRSA infections because hospitals would report the code for MRSA along with additional codes that would describe the exact nature of the infection. We would have to develop a list of specific infections that could be the result of MRSA. We are not proposing to include MRSA as one of our initial hospital-acquired conditions because the condition is not a CC. We recognize that associated conditions may be a CC. We welcome comments on the proposal not to include this condition. Should there be support for including this condition, we request recommendations on what codes might be selected to identify the specific types of infections associated with MRSA. mmaher on DSK3CLS3C1PROD with $$_JOB (k) Surgical Site Infections Coding—Surgical site infections are identified by ICD–9–CM code 998.59 (Other postoperative infection). The code does not tell the exact location or nature of the postoperative wound infection. The code includes wound infections and additional types of postoperative infections such as septicemia. The coding guidelines instruct the coder to add an additional code to identify the type of infection. To implement this condition we would have to remove both code 998.59 and the specific infection from counting as a CC if they occurred after the admission. We would have to develop an extensive list of possible infections that would be subject to the provision. We may also need to recommend the creation of a series of new ICD–9–CM codes to identify various types of surgical site infections, should this condition merit inclusion among those that are subject to the proposed hospital-acquired conditions provision. Burden (High Cost/High Volume)— CDC reports that there are 290,485 surgical sites infections each year. As stated earlier, there is not a unique code for surgical site infection. Therefore, we examined Medicare data on patients with any type of postoperative infection. For FY 2006, there were 38,763 reported cases of Medicare patients who had a postoperative infection. These patients had average charges for the hospital stay of $79,504. We are unable to determine how many of these patients had surgical site infections. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Prevention guidelines—CDC guidelines are available at the following Web site: https://www.cdc.gov/ncidod/ dhqp/gl—surgicalsite.html CC—Code 998.59 is a CC under the current CMS DRGs and the proposed MS–DRGs. Considerations—As mentioned earlier, code 998.59 is not exclusive to surgical site infections. It includes other types of postoperative infections. Therefore, code 998.59 does not currently meet the statutory criteria for being subject to the provision because it does not uniquely identify surgical site infections. To identify surgical site infections, we would need new codes that provide more detail about the type of postoperative infection as well as the site of the infection. In addition, one would report both code 998.59 as well a more specific code for the specific type of infection, making implementation difficult. While there are prevention guidelines, it is not always possible to identify the specific types of surgical infections that are preventable. Therefore, we are not proposing to select surgical site infections as one of our proposed hospital-acquired conditions at this time. However, we welcome public comments on whether we can develop criteria and codes to identify preventable surgical site infections that would assist us in reducing their incidence. We are exploring ways to identify surgical site infections and will reevaluate this condition in FY 2009. (l) Serious Preventable Event—Surgery on Wrong Body Part, Patient, or Wrong Surgery Coding—Surgery performed on the wrong body part, wrong patient, or the wrong surgery would be identified by ICD–9–CM code E876.5 (Performance of inappropriate operation). This diagnosis code does not specifically identify which of these events has occurred. Burden (High Cost/High Volume)—As stated earlier, there are not unique ICD– 9–CM codes which capture surgery performed on the wrong body part or the wrong patient, or the wrong surgery. Therefore, we examined Medicare data on the code for performance of an inappropriate operation. For FY 2006, there was one Medicare case reported with this code, and the patient had average charges for the hospital stay of $24,962. This event is rare. Therefore, it is not high volume. Individual cases could have high costs. However, we were unable to determine the impact with our limited data. Prevention guidelines—There are prevention guidelines for performing the correct surgery on the correct patient PO 00000 Frm 00046 Fmt 4701 Sfmt 4702 or correct patient’s body part. This event should not occur. CC—This code is not a CC under the current CMS DRGs and the proposed MS–DRGs. Therefore, it does not meet the criteria for selection under section 1886(d)(4)(D)(iv) of the Act. However, Medicare does not pay for performing surgery on the wrong body part or patient, or performing the wrong surgery. These services are not considered to be reasonable and necessary and are excluded from Medicare coverage. Considerations—There are significant considerations for the selection of this condition. There is not a unique ICD–9– CM code that would describe the nature of the inappropriate operation. All types of inappropriate operations are included in code E876.5. Unlike other conditions, performance of an inappropriate operation is not a complication of a prior medical event that was medically necessary. Rather, in this case, there was a needed intervention but it was done to either the wrong body part or the wrong patient, or was not the correct operation. Thus, a service was completed that was not reasonable and necessary and Medicare does not pay for any inpatient service associated with the wrong surgery. It is not necessary for us to select this condition because Medicare does not pay for it under any circumstances. (m) Falls Coding—There is no single code that shows that a patient has suffered a fall in the hospital. Codes would be assigned to identify the nature of any resulting injury from the fall such as a fracture, contusion, concussion, etc. There is a code to indicate that a patient fell from bed, code E884.4 (Fall from bed). One would then assign a code that identifies the external cause of the injury (the fall from the bed) and an additional code(s) for any resulting injury (a fractured bone). Burden (High Cost/High Volume)—As stated earlier, there is not a code to capture all types of falls. Therefore, we examined Medicare data on the number of Medicare beneficiaries who fell out of bed. For FY 2006, there were 2,591 cases reported of Medicare patients who fell out of bed. These patients had average charges of the hospital stay of $24,962. However, depending on the nature of the injury, costs may vary in specific cases. Prevention guidelines—Falls may or may not be preventable. Serious preventable event guidelines can be found at the following Web site: https:// www.qualityindicators.ahrq.gov/psi— download.htm E:\FEDREG\03MYP2.LOC 03MYP2 24725 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules CC—Code E884.4 is not a CC under the current CMS DRGs or the proposed MS–DRGs. Considerations—There are not clear codes that identify all types of falls. Hospitals would also have to use additional codes for fractures and other injuries that result from the fall. In addition, depending on the circumstances, the falls may or may not be preventable. We are not proposing the inclusion of falls as one of our initial hospital-acquired conditions at this time because we can only identify a limited number of these cases, and they are not classified as a CC. However, we welcome public comments on how to develop codes or coding logic that would allow us to identify injuries that result from falls in the hospital so that Medicare would not recognize the higher costs associated with treating patients who acquire these conditions in the hospital. We will reevaluate this condition in FY 2009. The following table summarizes whether or not the potential conditions meet our criteria and if there are significant considerations with selecting the particular condition. As mentioned earlier, we have listed these conditions in the priority order according to how well they meet the statutory criteria. As discussed earlier, we are proposing to select the first six conditions (catheter associated urinary tract infections through Staphylococcus aureus septicemia) as our initial hospitalacquired conditions. We would not include the last seven conditions (ventilator-associated pneumonia through falls) as initial hospitalacquired conditions. We welcome comments on how appropriately we have evaluated and proposed the selection of the first six conditions. We also encourage specific comments on any additional conditions we should select for October 1, 2008 implementation. We request commenters to include a rationale for selecting any suggested additional conditions, as well as an analysis of why each suggested additional condition meets the criteria under section 1886(d)(4)(D)(iv) of the Act and whether there would be coding issues or other considerations associated with selecting each condition. PROPOSED HOSPITAL-ACQUIRED CONDITIONS AND CRITERIA Proposed hospital-acquired condition Coding—unique code? Burden—high cost and/or high volume? Prevention guidelines? CC? Considerations? 1. Catheter associated urinary tract infections. 2. Pressure ulcers (Decubitus ulcers) 3. Serious preventable event—Object left in surgery. Yes ...................... Yes ...................... Yes ...................... Yes ...................... Yes ...................... Yes ...................... Yes ...................... Yes ...................... Yes ...................... Yes ...................... 4. Serious preventable event—air embolism. Yes ...................... Yes ...................... Yes ...................... No . 5. Serious preventable event—Blood incompatibility. Yes ...................... Yes ...................... Yes ...................... No. 6. Staphylococcus aureus septicemia Yes—multiple codes reported. No VAP code, multiple pneumonia codes. Yes ...................... Yes—high cost in specific circumstances. Yes—high cost in specific circumstances. Yes—high cost in specific circumstances. Yes ...................... Minimal—additional infection codes. No. No. Yes ...................... Yes ...................... Multiple codes. Yes ...................... Yes ...................... No—no unique codes. Preventability issues. VAPs— identification issues. Preventability issues. Preventability issues. Preventability issues. Cannot identify. 7. Ventilator associated pneumonia (VAP)/Pneumonia/. 8. Vascular catheter associated infections. 9. Clostridium difficile-associated disease (CDAD). 10. Methicillin-resistant staphylococcus aureus (MRSA). 11. Surgical site infections ................ No ........................ Yes ...................... Yes ...................... Yes ...................... Yes ...................... No ........................ Yes—but code is too broad. Yes ...................... Yes ...................... Yes ...................... Yes ...................... No ........................ No ........................ Yes ...................... Yes ...................... 12. Serious preventable Wrong surgery. Yes ...................... Yes—high cost in specific circumstances. Yes—high cost in specific circumstances. Yes ...................... Yes—but code is too broad. No ........................ event— mmaher on DSK3CLS3C1PROD with $$_JOB 13. Falls ............................................. No—not for all types of falls. As stated earlier, we are soliciting comments on the six conditions we proposed to include among the initial hospital-acquired conditions. We welcome any comments on the clinical aspects of the conditions and on which conditions should be selected for implementation on October 1, 2008. We also solicit comments on any problematic issues for specific conditions that may support not VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 No—for all types of falls. selecting them as one of the initial conditions. We encourage comments on how some of the administrative problems can be overcome if there is support for a particular condition. 7. Other Issues Under section 1886(d)(4)(D)(vi) of the Act, ‘‘[a]ny change resulting from the application of this subparagraph shall not be taken into account in adjusting PO 00000 Frm 00047 Fmt 4701 Sfmt 4702 No ........................ Not a CC. Cannot identify. the weighting factors under subparagraph (C)(i) or in applying budget neutrality under subparagraph (C)(iii).’’ Subparagraph (C)(i) refers to DRG classifications and relative weights. Therefore, the statute requires the Secretary to continue counting the conditions selected under section 5001(c) of the DRA as MCCs or CCs when updating the relative weights annually. Thus, the higher costs E:\FEDREG\03MYP2.LOC 03MYP2 24726 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules associated with a case with a hospitalacquired MCC or CC will continue to be assigned to the MCC or CC DRG when calculating the relative weight but payment will not be made to the hospital at one of these higher-paying DRGs. Further, subparagraph (C)(iii) refers to the budget neutrality calculations that are done so aggregate payments do not increase as a result of changes to DRG classifications and relative weights. Again, the higher costs associated with the cases that have a hospital-acquired MCC or CC will be included in the budget neutrality calculation but Medicare will make a lower payment to the hospital for the specific case that include an MCC or CC. Thus, to the extent that the provision applies and cases with an MCC or CC are assigned to a lower-paying DRG, section 5001(c) of the DRA will result in cost savings to the Medicare program. We note that the provision will only apply when the selected conditions are the only MCCs and CCs present on the claim. Therefore, if a nonselected MCC or CC is on the claim, the case will continue to be assigned to the higher paying MCC or CC DRG, and there will be no savings to Medicare from the case. We believe the provision will apply in a small minority of cases because it is rare that one of the selected conditions will be the only MCC or CC present on the claim. We provide our estimate of the savings associated with this provision in the impact section of this proposed rule. G. Proposed Changes to Specific DRG Classifications 1. Pre-MDC: Intestinal Transplantation (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: Intestinal Transplantation’’ at the beginning of your comment.) In the FY 2005 IPPS final rule (69 FR 48976), we reassigned intestinal transplant cases from CMS DRG 148 (Major Small and Large Bowel Procedures with CC) and CMS DRG 149 (Major Small and Large Bowel Procedures without CC) to CMS DRG ROPOSED 480 (Liver Transplant and/or Intestinal Transplantation). In the FY 2006 IPPS final rule (70 FR 47286), we continued to evaluate these cases to see if a further DRG change was warranted. While we found that intestinal only transplants and combination liver-intestine transplants have higher average charges than other cases in CMS DRG 480, these cases are extremely rare (there were only 4 cases in FY 2004) and the insufficient number of cases does not warrant creating a separate DRG. For FY 2008, we examined the September 2006 update of the FY 2006 MedPAR file and found 1,208 cases assigned to CMS DRG 480. In the proposed MS–DRGs described in section II.C. of the preamble of this proposed rule, we are proposing to split CMS DRG 480 into two severity levels: proposed MS–DRG 005 (Liver Transplant and/or Intestinal Transplant with MCC) and proposed MS–DRG 006 (Liver Transplant and/or Intestinal Transplant without MCC). The following table displays our results: MS–DRG Number of cases Proposed MS–DRG mmaher on DSK3CLS3C1PROD with $$_JOB MS–DRG MS–DRG MS–DRG MS–DRG MS–DRG 006—All cases .............................................................................................................................. 006—Intestinal transplant cases only ........................................................................................... 005—All cases .............................................................................................................................. 005—Intestinal transplant cases only ........................................................................................... 005—Intestinal and liver transplant .............................................................................................. Under the proposed MS–DRGs, 10 of 13 intestinal transplant cases are assigned to proposed MS–DRG 005 based on the secondary diagnosis of the patient. The three remaining intestinal transplant cases do not have an MCC and would have been assigned to proposed MS–DRG 006, absent further changes to the DRG logic. These three intestinal transplants have average charges of approximately $354,793 and an average length of stay of 34 days. Average charges and length of stay for these three cases are more comparable to the average charges of approximately $243,271 and average length of stay of 40.22 days for all cases assigned to proposed MS–DRG 005. For this reason, we are proposing to move all intestinal transplant cases to proposed MS–DRG 005. As part of this proposal, we would redefine proposed MS–DRG 005 as ‘‘Liver Transplant with MCC or Intestinal Transplant.’’ The presence of a liver transplant with MCC or an intestinal transplant would assign a case to the higher severity level. Proposed VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 MS–DRG would also be redefined as ‘‘Liver Transplant without MCC.’’ 2. MDC 1 (Diseases and Disorders of the Nervous System) a. Implantable Neurostimulators (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: Neurostimulators’’ at the beginning of your comment.) We received a joint request from three manufacturers to review the DRG assignment for cases involving neurostimulators. The commenters are concerned that: <bullet≤ Neurostimulator cases may be assigned to 30 different DRGs in 12 different MDCs depending upon the patient’s principal diagnosis. <bullet≤ Neurostimulator cases represent a small proportion of the total cases in their assigned DRG and have higher costs. <bullet≤ The 11 new ICD–9–CM codes created beginning in FY 2007 that identify pain are assigned to MDC 23 (Factors Influencing Health Status and PO 00000 Frm 00048 Fmt 4701 Sfmt 4702 446 3 762 9 1 Average length of stay 10.05 34 22.25 40.22 56 Average charges $129,519 354,793 243,271 460,089 1,179,425 Other Contacts With Health Services) rather than MDC 1 (Diseases and Disorders of the Nervous System). The commenters are concerned that these pain codes will be a common principal diagnosis for patients who receive a neurostimulator and will be assigned to MDC 23, which contains a wide variety of dissimilar diagnoses. The new ICD– 9–CM codes are: 338.0 (Central pain syndrome), 338.11 (Acute pain due to trauma), 338.12 (Acute postthoracotomy pain), 338.18 (Other acute postoperative pain), 338.19 (Other acute pain), 338.21 (Chronic pain due to trauma), 338.22 (Chronic postthoracotomy pain), 338.28 (Other chronic postoperative pain), 338.29 (Other chronic pain), 338.3 (Neoplasm related pain (acute)(chronic)), and 338.4 (Chronic pain syndrome) The commenters recommended that we: <bullet≤ Reroute all spinal and peripheral neurostimulator cases into a common set of base DRGs. E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules <bullet≤ Reclassify ICD–9–CM pain codes 338.0 through 338.4 currently assigned to MDC 23 into MDC 1 when reported as principal diagnosis. <bullet≤ Revise surgical CMS DRGs in MDC 1 based on whether the patient received a major device. <bullet≤ Split the single surgical CMS DRG in MDC 19 (Mental Diseases and Disorders) and MDC 23 into two CMS DRGs: one CMS DRG for minor procedures as defined by CMS DRGs 477 (Non-Extensive O.R. Procedure Unrelated to Principal Diagnosis) and CMS DRG 468 (Extensive O.R. Procedure Unrelated to Principal Diagnosis) and one CMS DRG for major procedures. <bullet≤ Create a new CMS DRG in MDC 1 for major devices. The commenters recognize that implementing a re-routing feature in the CMS DRG system would be a major undertaking and, alternatively, suggested reassigning the pain codes to MDC 1 as an interim step. We agree with this suggestion as described further below. With respect to the suggestion to split the single surgical CMS DRG in MDCs 19 and 23 into two CMS DRGs and create a major device CMS DRG within MDC 1, we encourage the commenters to examine the assignment of neurostimulator cases under the MS– DRGs to determine whether the changes we are proposing to adopt to better recognize severity in the CMS DRG system would address these concerns. The implantation of a neurostimulator requires two types of procedures. First, the surgeons implant leads containing electrodes into the targeted section of the brain, spine, or peripheral nervous system. Second, a neurostimulator pulse generator is implanted into the pectoral region and extensions from the neurostimulator pulse generator are tunneled under the skin and connected with the proximal ends of the leads. Hospitals stage the two procedures required for a full system neurostimulator implant. There are separate ICD–9–CM procedure codes that identify the implant of the leads and the insertion of the pulse generator. The three codes for the leads insertion are: 02.93 (Implantation or replacement of intracranial neurostimulator lead(s)); 03.93 (Implantation or replacement of spinal neurostimulator lead(s)); and code 04.92 (Implantation or replacement of peripheral neurostimulator lead(s). The five codes for the insertion of the pulse generator are: 86.94 (Insertion or replacement of single array neurostimulator pulse generator, not specified as rechargeable); 86.95 (Insertion or replacement of dual array VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 neurostimulator pulse generator, not specified as rechargeable); 86.96 (Insertion or replacement of other neurostimulator pulse generator); 86.97 (Insertion or replacement of single array rechargeable neurostimulator pulse generator); and 86.98 (Insertion or replacement of dual array rechargeable neurostimulator pulse generator). The patient’s principal diagnosis determines the MDC assignment. Implant of a cranial, spinal or peripheral neurostimulator will result in assignment of the case to a surgical DRG within that MDC. Although the commenters are correct that neurostimulator cases can potentially be assigned to many different CMS DRGs based on the patient’s principal diagnosis, they also provided data that showed that nearly 90 percent are assigned to 6 different CMS DRGs that cross two MDCs. In MDC 1, neurostimulator cases are assigned to four CMS DRGs: CMS DRG 7 (Peripheral and Cranial Nerve and Other Nervous System Procedures With CC); CMS DRG 8 (Peripheral and Cranial Nerve and Other Nervous System Procedures Without CC); CMS DRG 531 (Spinal Procedures With CC); and CMS DRG 532 (Spinal Procedures Without CC). In MDC 8 (Disease and Disorders of the Musculoskeletal System and Connective Tissue), neurostimulator cases are assigned to two CMS DRGs: CMS DRG 499 (Back and Neck Procedures Except Spinal Fusion With CC); and CMS DRG 500 (Back and Neck Procedures Except Spinal Fusion Without CC). With very limited exceptions, such as tracheostomies and certain types of transplants, the principal diagnosis is fundamental to the assignment of a case to an MDC within the DRG system. By relying on the patient’s principal diagnosis, the DRG system will group together patients who are clinically similar. For this reason, we are concerned about adopting the suggestion that all neurostimulator cases be rerouted to a common DRG irrespective of the patient’s principal diagnosis. We believe such a step would be fundamentally inconsistent with the idea of creating common groups of patients who are clinically similar based on diagnosis and procedures. For this reason, we do not believe that a rerouting step should be adopted that would group together all neurostimulator cases. However, we do agree with the commenters’ suggestion that the new ICD–9–CM codes created in FY 2007 for central and chronic pain syndrome and chronic pain (codes 338.0, 338.21 through 338.29, and 338.4) should be assigned to MDC 1 when present as the PO 00000 Frm 00049 Fmt 4701 Sfmt 4702 24727 principal diagnosis. The commenters requested that we reclassify the pain codes (338.0 through 338.4) from MDC 23 to MDC 1. Our medical consultants advised that the acute pain codes (codes 338.11 through 338.19) should remain in MDC 23 because the acute pain is not a neurological condition. According to the commenters, the National Center for Health Statistics’ (NCHS) choice in locating the pain codes within ICD–9– CM’s Nervous System chapter has much clinical validity, particularly for chronic pain. The commenters further noted that acute pain is typically self-limited, a symptomatic response to an immediate insult that serves the body as a warning sign. However, chronic pain is unrelenting and serves no warning or protective function. It is a disease process of its own accord, according to the commenters. The commenters described pain as follows. Broadly, there are two main categories of pain: nociceptive and neuropathic. Nociceptive pain is caused by sensory neurons, called nociceptors, responding to tissue damage. This type of pain is the body’s normal response to injury. The pain is usually localized and time-limited. That is, when the tissue damage heals, the pain typically resolves. Acute pain is typically nociceptive. In general, nociceptive pain is typically treated with antiinflammatories and, in more severe cases, with opioids via a morphine pump for example. In contrast, neuropathic pain is caused by malfunctioning or pathologically altered nervous pathways stemming from injury to the nervous system, either as a direct result of trauma to a nerve (phantom limb syndrome, reflex sympathetic dystrophy/complex regional pain syndrome after injury) or due to other medical conditions that cause damage to the nerve such as herpes (postherpetic neuralgia), diabetes (diabetic neuropathy), and peripheral vascular disease (critical limb ischemia). Failed back surgery syndrome (FBSS) is another common source of neuropathic pain. Typically, neuropathic pain is chronic and may persist for months or years beyond the healing of damaged tissue. Because the nerves themselves have been damaged, neuropathic pain can be considered its own disease process. Neuropathic pain may be more difficult to treat than nociceptive pain and has been shown to be more responsive to neurostimulation. The pain codes, created effective October 1, 2006, are currently assigned to MDC 23. The neurostimulator cases with a principal diagnosis using the pain codes were assigned to CMS DRG E:\FEDREG\03MYP2.LOC 03MYP2 24728 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB 461 (O.R. Procedure With Diagnoses of Other Contact With Health Services) for the first time in FY 2007. As explained above, prior to our adoption of the new pain codes in FY 2007, these cases had historically been assigned to CMS DRGs 7 and 8 (Peripheral and Cranial Nerve and Other Nervous System Procedure With and Without CC, respectively) tin MDC 1. Adopting the commenters’ recommendation would result in the neurostimulator cases being assigned to their historic CMS DRGs. Our medical officers agree that cases that use the new pain diagnosis codes for central and chronic pain syndrome and chronic pain (codes 338.0, 338.21 through 338.29, and 338.4) as a principal diagnosis should be assigned to MDC 1. For this reason, we are proposing to assign cases with a principal diagnosis of central pain syndrome (code 338.0), chronic pain due to trauma (code 338.21), chronic post-thoracotomy pain (code 338.22), other chronic postoperative pain (code 338.28), other chronic pain (code 338.29), or chronic pain syndrome (code 338.4) to MDC 1, although we plan to monitor their use and may reassign them if needed. b. Intracranial Stents (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: Intracranial Stents’’ at the beginning of your comment.) Effective October 1, 2004, the ICD–9– CM Coordination and Maintenance Committee created procedure code 00.62 (Percutaneous angioplasty or atherectomy of intracranial vessel(s)). At the same time, we created code 00.65 (Percutaneous insertion of intracranial vascular stent(s)). It is our customary practice to assign new codes to the same DRG as their predecessor codes. Code 00.62 was removed from code 39.50 (Angioplasty or atherectomy of other noncoronary vessel(s)), which is assigned to CMS DRG 533 (Extracranial Procedures with CC) and CMS DRG 534 (Extracranial Procedures Without CC) (proposed MS–DRGs 37, 38, and 39 (Extracranial Procedures With MCC, With CC, and Without CC/MCC, respectively)) when the patient has principal diagnosis in MDC 1. Therefore, we assigned code 00.62 to CMS DRGs 533 and 534 in MDC 1 beginning in FY 2005. In addition, we made code 00.65 a non-O.R. procedure for DRG assignment. We also assigned code 00.62 to the Non-Covered Procedure edit of the MCE, as Medicare had a national noncoverage determination for intracranial angioplasty and atherectomy with stenting. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Effective November 7, 2006, Medicare covers percutaneous transluminal angioplasty (PTA) and stenting of intracranial arteries for the treatment of cerebral artery stenosis in cases in which stenosis is 50 percent or greater in patients with intracranial atherosclerotic disease when furnished in accordance with FDA-approved protocols governing Category B Investigational Device Exemption (IDE) clinical trials. CMS determined that coverage of intracranial PTA and stenting is reasonable and necessary under these circumstances. All other indications for PTA without stenting to treat obstructive lesions of the vertebral and cerebral arteries remain noncovered. This decision can be found online in the CMS Coverage Manual: https://www.cms.hhs.gov/Manuals/IOM/ itemdetail.asp at section 20.7.B.5. A manufacturer recently met with CMS to request that code 00.62 be reassigned to CMS DRGs 1 and 2 (Craniotomy Age ≤ 17 With and Without CC, respectively) (proposed MS–DRGs 37 (Extracranial Procedures With MCC), 38 (Extracranial Procedures With CC), and 39 (Extracranial Procedures Without CC/MCC)) and CMS DRG 543 (Craniotomy with Major Device Implant or Acute Complex Central Nervous System Principal Diagnosis) (proposed MS–DRGs 23 and 24 (Craniotomy With Major Device Implant or Acute Complex Central Nervous System Principal Diagnosis With MCC and Without MCC, respectively). The manufacturer noted that other similar endovascular intracranial procedures that treat a cerebrovascular blockage are currently assigned to the craniotomy CMS DRGs. These endovascular-approach cases already assigned to the craniotomy CMS DRGs are identified by procedure codes 39.72 (Endovascular repair or occlusion of head and neck vessels), 39.74 (Endovascular removal of obstruction from head and neck vessel(s)), and 39.79 (Other endovascular repair (of aneurysm) of other vessels). Under the proposed MS–DRGs, we are proposing to assign procedure codes 39.72, 39.74, and 39.79 to MS–DRGs 011 through 013 and MS–DRG 543. Although we are concerned about the assignment of additional endovascular procedures to an open surgical DRG, we agree that there is clinical consistency between procedure codes 39.72, 39.74, and 39.79 and procedure code 00.62. For this reason, we agree that procedure code 00.62 should be assigned to CMS DRGs 1, 2, and 543 (proposed MS–DRGs 37, 38, and 39 and 243 and 24, respectively, that are divided by the presence or absence of specific CCs). PO 00000 Frm 00050 Fmt 4701 Sfmt 4702 For FY 2008, we are proposing to remove code 00.62 from CMS DRGs 533 and 534 and assign them to proposed MS–DRGs 37, 38, and 39, as well as to proposed MS–DRGs 23 and 24. In order to assure appropriate DRG assignment as described above, we are proposing to make conforming changes to the MCE by removing code 00.62 from the Non-Covered Procedure edit. However, as intracranial PTA is only covered when performed in conjunction with insertion of a stent, we are proposing to redefine the edit by specifying that code 00.62 must be accompanied by code 00.65 (Percutaneous insertion of intracranial vascular stent(s)). Should code 00.65 not be reported on the claim, the case would fail the MCE edit. For a full discussion of this proposed change, we refer readers to the MCE discussion in section II.F.6. of the preamble of this proposed rule. Although we are proposing to assign endovascular intracranial procedures to the same DRG as craniotomy, we remain concerned that endovascular intracranial procedures are clinically different than open craniotomy surgical procedures and may have very different resource requirements. At the current time, there are an insufficient number of cases to warrant creation of a separate base DRG for endovascular intracranial procedures. However, we intend to revisit the assignment of intracranial endovascular procedures at a later date when more data are available to analyze these cases. 3. MDC 3 (Diseases and Disorders of the Ear, Nose, Mouth, and Throat)— Cochlear Implants (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: Cochlear Implants’’ at the beginning of your comment.) Cochlear implants were first covered by Medicare in 1986 and were assigned to CMS DRG 49 (Major Head and Neck Procedures) in MDC 3 (Diseases and Disorders of the Ear, Nose, Mouth, and Throat). CMS DRG 49 is the highest weighted DRG in that MDC. However, two manufacturers of cochlear implants contend that this DRG assignment is clinically and economically inappropriate and have requested that cochlear implant cases be reassigned from CMS DRG 49 to CMS DRG 543 (Craniotomy With Major Device Implant or Acute Complex Central Nervous System Principal Diagnosis). The manufacturers stated that procedures assigned to CMS DRG 49 are performed mostly for diseases such as head and neck cancers, while procedures in CMS DRG 543 include E:\FEDREG\03MYP2.LOC 03MYP2 24729 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules operations on and inside the skull and implantation of complex devices, including intracranial neurostimulators. The manufacturers described the cochlear implant procedure as requiring incisions behind the ear to remove a section of the temporal bone, followed by microscopic neurotologic surgery under general anesthesia, and is typically completed in 2 to 4 hours to restore hearing to the profoundly deaf. For these reasons, these manufacturers believe cochlear implant procedures are similar to open craniotomies. Based on their analysis of the FY 2005 MedPAR data, the manufacturers identified a total of 139 cochlear implant cases using ICD–9–CM procedure codes 20.96 (Implantation or replacement of cochlear prosthetic device NOS), 20.97 (Implantation or replacement of cochlear prosthetic device, single channel), and 20.98 (Implantation or replacement of cochlear prosthetic device, multiple channel). The manufacturers reported 121 out of 139 cochlear implant cases were assigned to CMS DRG 49 with average standardized charges of approximately $58,078. When we reviewed the FY 2006 MedPAR data, we identified 104 cochlear implant cases assigned to CMS DRG 49. In the proposed MS–DRGs, CMS DRG 49 is subdivided into two severity levels: Proposed MS–DRG 129 (Major Head and Neck Procedures With CC or MCC) and proposed MS–DRG 130 (Major Head and Neck Procedures Without CC). The following table displays our results: Number of cases Proposed MS–DRG mmaher on DSK3CLS3C1PROD with $$_JOB MS–DRG MS–DRG MS–DRG MS–DRG MS–DRG MS–DRG MS–DRG MS–DRG 130—All cases ........................................................................................................................ 130—Code 20.96 cases only .................................................................................................. 130—Code 20.97 only ............................................................................................................ 130—Code 20.98 only ............................................................................................................ 129—All cases ........................................................................................................................ 129—Code 20.96 only ............................................................................................................ 129—Code 20.97 only ............................................................................................................ 129—Code 20.98 only ............................................................................................................ Under the proposed MS–DRGs, 19 out of 104 cochlear implant cases are assigned to proposed MS–DRG 129 based on the secondary diagnosis of the patient. The 85 remaining cochlear implant cases do not have a CC or MCC and would be assigned to proposed MS– DRG 130, absent further changes to the DRG logic. The average charges of approximately $54,238 for cochlear implant cases are higher than the average charges of approximately $29,375 for the other cases in CMS DRG 49. However, the average charges are not as high as the average charges of approximately $78,118 for cases assigned to CMS DRG 543. Further, our medical advisors do not believe that surgery to implant a cochlear implant is clinically similar to an open craniotomy in MDC 1 because typically a craniotomy involves removing and then replacing a section of the skull in order to perform a procedure on or within the brain, whereas a cochlear implant involves drilling a hole in the mastoid bone in order to insert the implant into the inner ear. We have been unable to address this issue under the current DRGs because there are not enough inpatient cochlear implant cases to warrant creation of a separate DRG. Although these cases will continue to have higher charges than other cases in their assigned DRG, we are proposing to move the cochlear implant cases to the higher DRG severity level within CMS DRG 49. As part of this proposal, we would redefine proposed MS–DRG 129 as ‘‘Major Head VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 and Neck Procedures With CC or MCC or Major Device’’. The presence of a major head and neck procedure with a CC or MCC or major device would assign the case to the higher severity level within CMS DRG 49. 4. MDC 8 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue) a. Hip and Knee Replacements (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: Hip and Knee Replacements’’ at the beginning of your comment.) In the FY 2006 IPPS final rule (70 FR 47303), we deleted DRG 209 (Major Joint and Limb Reattachment Procedures of Lower Extremity) and created two new DRGs: 544 (Major Joint Replacement or Reattachment of Lower Extremity) and 545 (Revision of Hip or Knee Replacement). The two new DRGs were created to identify that revisions of joint replacement procedures are significantly more resource intensive than original hip and knee replacements procedures. DRG 544 includes the following procedure code assignments: <bullet≤ 81.51, Total hip replacement <bullet≤ 81.52, Partial hip replacement <bullet≤ 81.54, Total knee replacement <bullet≤ 81.56, Total ankle replacement <bullet≤ 84.26, Foot reattachment <bullet≤ 84.27, Lower leg or ankle reattachment <bullet≤ 84.28, Thigh reattachment PO 00000 Frm 00051 Fmt 4701 Sfmt 4702 1,095 38 2 45 1,244 10 1 8 Average length of stay 3.04 1.63 1.50 1.24 5.35 2.70 5.00 3.13 Average charges $23,928 51,740 38,855 50,219 34,169 81,351 95,441 53.510 DRG 545 includes the following procedure code assignments: <bullet≤ 00.70, Revision of hip replacement, both acetabular and femoral components <bullet≤ 00.71, Revision of hip replacement, acetabular component <bullet≤ 00.72, Revision of hip replacement, femoral component <bullet≤ 00.73, Revision of hip replacement, acetabular liner and/or femoral head only <bullet≤ 00.80, Revision of knee replacement, total (all components) <bullet≤ 00.81, Revision of knee replacement, tibial component <bullet≤ 00.82, Revision of knee replacement, femoral component <bullet≤ 00.83, Revision of knee replacement, patellar component <bullet≤ 00.84, Revision of knee replacement, tibial insert (liner) <bullet≤ 81.53, Revision of hip replacement, not otherwise specified <bullet≤ 81.55, Revision of knee replacement, not otherwise specified Further, we created a number of new ICD–9–CM procedure codes effective October 1, 2005, that better distinguish the many different types of joint replacement procedures that are currently being performed. In the FY 2006 IPPS final rule (70 FR 47305), we indicated that a commenter had requested that, once we receive claims data using the new procedure codes, we closely examine data from the use of the codes under the two new DRGs to determine if future additional DRG modifications are needed. Further, the American Association of Hip & Knee Surgeons (AAHKS) recommended that we make further E:\FEDREG\03MYP2.LOC 03MYP2 24730 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules refinements to the DRGs for knee and hip arthroplasty procedures. AAHKS previously presented data to CMS on the important differences in clinical characteristics and resource utilization between primary and revision total joint arthroplasty procedures. AAHKS stated that CMS’ decision to create a separate DRG for revision of total joint arthroplasty (TJA) in October 2005 resulted in more equitable reimbursement for hospitals that perform a disproportionate share of complex revision of TJA procedures, recognizing the higher resource utilization associated with these cases. AAHKS stated that this important payment policy change led to increased access to care for patients with failed total joint arthroplasties, and ensured that high volume TJA centers could continue to provide a high standard of care for these challenging patients. AAHKS further stated that the addition of new, more descriptive ICD– 9–CM diagnosis and procedure codes for TJA in October 2005 gave it the opportunity to further analyze differences in clinical characteristics and resource intensity among TJA patients and procedures. Inclusive of the preparatory work to submit its recommendations, the AAHKS compiled, analyzed, and reviewed detailed clinical and resource utilization data from over 6,000 primary and revision TJA procedure codes from 4 high volume joint arthroplasty centers located within different geographic regions of the United States: University of California, San Francisco, CA; Mayo Clinic, Rochester, MN; Massachusetts General Hospital, Boston, MA; and the Hospital for Special Surgery, New York, NY. Based on its analysis, AAHKS recommended that CMS examine Medicare claims data and consider the creation of separate DRGs for total hip and total knee arthroplasty procedures. DRG 545 currently contains revisions of both hip and knee replacement procedures. AAHKS stated that based on the differences between patient characteristics, procedure characteristics, resource utilization, and procedure code payment rates between total hip and total knee replacements, separate DRGs were warranted. Furthermore, AAHKS recommended that CMS create separate base DRGs for routine versus complex joint revision or replacement procedures as shown below. Routine Hip Replacements <bullet≤ 00.73, Revision of hip replacement, acetabular liner and/or femoral heal only <bullet≤ 00.85, Resurfacing hip, total, acetabulum and femoral head <bullet≤ 00.86, Resurfacing hip, partial, femoral head <bullet≤ 00.87, Resurfacing hip, partial, acetabulum <bullet≤ 81.51, Total hip replacement <bullet≤ 81.52, Partial hip replacement <bullet≤ 81.53, Revision of hip replacement, not otherwise specified Complex Hip Replacements <bullet≤ 00.70, Revision of hip replacement, both acetabular and femoral components <bullet≤ 00.71, Revision of hip replacement, acetabular component <bullet≤ 00.72, Revision of hip replacement, femoral component Routine Knee Replacements and Ankle Procedures <bullet≤ 00.83, Revision of knee replacement, patellar component <bullet≤ 00.84, Revision of knee replacement, tibial insert (liner) <bullet≤ 81.54, Revision of knee replacement, not otherwise specified <bullet≤ 81.55, Revision of knee replacement, not otherwise specified <bullet≤ 81.56, Total ankle replacement Complex Knee Replacements and other reattachments <bullet≤ 00.80, Revision of knee replacement, total (all components) <bullet≤ 00.81, Revision of knee replacement, tibial component <bullet≤ 00.82, Revision of knee replacement, femoral component <bullet≤ 84.26, Foot reattachment <bullet≤ 84.27, Lower leg or ankle reattachment <bullet≤ 84.28, Thigh reattachment AAHKS also recommended the continuation of DRG 471 (Bilateral or Multiple Major Joint Procedures of Lower Extremity) without modifications. DRG 471 includes any combination of two or more of the following procedure codes: <bullet≤ 00.70, Revision of hip replacement, both acetabular and femoral components <bullet≤ 00.80, Revision of knee replacement, total (all components) <bullet≤ 00.85, Resurfacing hip, total, acetabulum and femoral head <bullet≤ 00.86, Resurfacing hip, partial, femoral head <bullet≤ 00.87, Resurfacing hip, partial, acetabulum <bullet≤ 81.51, Total hip replacement <bullet≤ 81.52, Partial hip replacement <bullet≤ 81.54, Total knee replacement <bullet≤ 81.56, Total ankle replacement As discussed in section II.C. of the preamble of this proposed rule, we are proposing to adopt MS–DRGs to better recognize severity of illness for FY 2008. The proposed MS–DRGs include two new severity of illness levels under the current base DRG 544. We are also proposing to add three new severity of illness levels to the base DRG for Revision of Hip or Knee Replacement (currently DRG 545). The new MS– DRGs are as follows: <bullet≤ Proposed MS–DRG 466 (Revision of Hip or Knee Replacement with MCC) <bullet≤ Proposed MS–DRG 467 (Revision of Hip or Knee Replacement with CC) <bullet≤ Proposed MS–DRG 468 (Revision of Hip or Knee Replacement without CC) <bullet≤ Proposed MS–DRG 483 (Major Joint Replacement or Reattachment of Lower Extremity with CC/MCC) <bullet≤ Proposed MS–DRG 484 (Major Joint Replacement or Reattachment of Lower Extremity without CC/MCC) We found that the proposed MS– DRGs greatly improved our ability to identify joint procedures with higher resource costs. The following table indicates the average charges for each new proposed MS–DRG for the joint procedures. PROPOSED MS–DRGS THAT REPLACE DRGS 544 AND 535 WITH NEW SEVERITY LEVELS Number of cases mmaher on DSK3CLS3C1PROD with $$_JOB Proposed MS–DRG MS–DRG MS–DRG MS–DRG MS–DRG MS–DRG 466 467 468 483 484 VerDate Mar 15 2010 .............................................................................................................................. .............................................................................................................................. .............................................................................................................................. .............................................................................................................................. .............................................................................................................................. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00052 Fmt 4701 Sfmt 4702 390,344 28,211 26,718 10,078 3,886 E:\FEDREG\03MYP2.LOC 03MYP2 Average length of stay 4.03 8.46 4.06 6.06 9.55 Average charges $33,465.85 53,676.09 38,720.28 48,575.01 69,649.08 24731 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB AAHKS analyzed Medicare data under the current DRG system and was unaware of how its analysis would change under the proposed MS–DRGs. Under the current DRGs, the AAHKS recommendation would replace 2 DRGs with 4 new ones. However, under the proposed MS–DRGs, the AAHKS recommendation would result in 5 DRGs becoming 12. Because AAHKS is recommending four new joint replacement DRGs (two for knees and two for hips), each would need to be subdivided into severity levels under our proposed MS–DRG system. Therefore, the four new joint DRGs could be subdivided into three levels each, leading to 12 new DRGs. At this time, we believe that the changes we are proposing to make to adopt the proposed MS–DRGs are sufficiently better for recognizing severity of illness among the hip and knee replacement cases. We do not believe that there would be significant improvements in the proposed MS–DRGs recognition of severity of illness from creating an additional 7 DRGs. However, we acknowledge the valuable assistance the AAHKS has provided to CMS in creating the new joint replacement procedure codes and modifying the joint replacement DRGs beginning in FY 2006. These efforts greatly improved our ability to categorize significantly different groups of patients according to severity of illness. We welcome comments from AAHKS on whether the proposed MS–DRGs recognize patient complexity and severity of illness in the hip and knee replacement DRGs consistent with the concerns it expressed to us in previous comments. We also welcome public comments from others as well on whether the proposed changes to the hip and knee replacement DRGs better recognize severity of illness and complexity of these operations in the Medicare patient population. b. Spinal Fusions (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: Spinal Procedures’’ at the beginning of your comment.) In the FY 2007 final rule (71 FR 47947), we discussed a request that urged CMS to consider applying a severity concept to all of the back and spine surgical cases, similar to the approach that was used in the FY 2006 final rule in refining the cardiac DRGs with an MCV. Specifically, the commenter recommended that the use of spinal devices be uniquely identified within the spine DRGs. The commenter’s suggestion involved the development of 10 new spine DRGs as well as additional modifications. One of these modifications included revising DRG 546 (Spinal Fusions Except Cervical with Curvature of the Spine or Malignancy). The commenter stated DRG 546 did not adequately recognize clinical severity or the resource differences among spinal fusion patients whose surgeries include fusing multiple levels of their spinal vertebrae. We agreed with the commenter that it was important to recognize severity when classifying groups of patients into specific DRGs. In addition, in response to recommendations from MedPAC’s March 2005 Report to Congress, we stated that we were conducting a comprehensive analysis of the entire DRG system to determine if we could better identify severity of illness. We further stated that until results from our analysis were available, it would be premature to implement a severity concept for the spine DRGs. Therefore, we did not make any adjustments to those DRGs at that time. Under the proposed MS–DRGs described in section II.D. of the preamble of this proposed rule, we are proposing a number of refinements that would better recognize severity for FY 2008. The proposed MS–DRGs include several refinements to the spine DRGs. These refinements are described in detail below. In the FY 2006 IPPS final rule, we noted that there are numerous innovations occurring in spinal surgery such as artificial spinal disc prostheses, kyphoplasty, vertebroplasty and the use of spine decompression devices. As part of our analysis of the DRG system for this proposed rule, we did a comprehensive review of the DRGs for spinal fusion and other back and neck procedures to determine whether additional refinements beyond the proposed MS–DRGs were necessary. We studied data from the FY 2006 MedPAR file for the entire group of spine DRGs. This group included DRG 496 (Combined Anterior/Posterior Spinal Fusion), DRGs 497 and 498 (Spinal Fusion Except Cervical With and Without CC, respectively), DRGs 499 and 500 (Back and Neck Procedures Except Spinal Fusion With and Without CC, respectively), DRGs 519 and 520 (Cervical Spinal Fusion With and Without CC, respectively), and DRG 546 (Spinal Fusion Except Cervical with Curvature of the Spine or Malignancy). As indicated earlier, we are proposing a two or three-way split for each of these spine DRGs to better recognize severity of illness, complexity of service, and resource utilization. In addition, we examined the procedure codes that identify multiple fusion or refusion of the vertebrae (codes 81.62 through 81.64) to determine if the data supported further refinement when a greater number of vertebrae are fused. In applying the proposed MS–DRG logic, CMS DRG 497 and 498 were collapsed and the result is a split with two severity levels: proposed MS–DRG 459 (Spinal Fusion Except Cervical With MCC) and proposed MS–DRG 460 (Spinal Fusion Except Cervical Without MCC). There were a total of 51,667 cases in proposed MS–DRGs 459 and 460. We identified 288 cases where nine or more noncervical vertebrae were fused (code 81.64) that currently are assigned to proposed MS–DRGs 459 and 460. The average charges and length of stay for cases in these MS–DRGs are closer to the average charges and length of stay for cases in proposed MS–DRGs 456 through 458 (Spinal Fusion Except Cervical With Curvature of the Spine or Malignancy With MCC, With CC, and Without CC, respectively). For example, in proposed MS–DRG 460, there were 238 cases with an average length of stay of 6.20 days and average charges of $110,908 when nine or more noncervical vertebrae are fused. There are an additional 50 cases where nine or more vertebrae were fused in proposed MS–DRG 459 with average charges of $171,839. Without any further modification to the proposed MS–DRGs, these cases would be assigned to proposed MS–DRGs 459 and 460 that have average charges of $59,698, and $99,298, respectively. The average charges for these cases are more comparable to $142,871, $95,489, and $77,528, respectively, for proposed MS– DRGs 456 through 458. We believe these data support assigning cases where nine or more noncervical vertebrae are fused from proposed MS–DRG 459 and 460 into proposed MS–DRG 456 through 458. The table below represents our findings. Number of cases Proposed MS–DRG MS–DRG 459 (Spinal Fusion Except Cervical With MCC)—All Cases .................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00053 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 3,186 03MYP2 Average length of stay 10.10 Average charges $99,298 24732 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules Number of cases Proposed MS–DRG MS–DRG 459 (Spinal Fusion Except Cervical With MCC)—Cases with Procedure Code 81.64 (Fusion or refusion of 9 or more vertebrae) .............................................................................................. MS–DRG 460 (Spinal Fusion Except Cervical Without MCC)—All Cases ............................................. MS–DRG 460 (Spinal Fusion Except Cervical Without MCC)—Cases with Procedure Code 81.64 (Fusion or refusion of 9 or more vertebrae) ........................................................................................ MS–DRG 456 (Spinal Fusion Except Cervical With Curvature of the Spine or Malignancy With MCC)—All Cases ................................................................................................................................. MS–DRG 456 (Spinal Fusion Except Cervical With Curvature of the Spine or Malignancy With MCC)—Cases With Procedure Code 81.64 (Fusion or refusion of 9 or more vertebrae) .................. MS–DRG 457 (Spinal Fusion Except Cervical With Curvature of the Spine or Malignancy With CC)—All Cases .................................................................................................................................... MS–DRG 457 (Spinal Fusion Except Cervical With Curvature of the Spine or Malignancy With CC)—Cases With Procedure Code 81.64 (Fusion or refusion of 9 or more vertebrae) ..................... MS–DRG 458 (Spinal Fusion Except Cervical With Curvature of the Spine or Malignancy Without CC—All Cases ..................................................................................................................................... MS–DRG 458 (Spinal Fusion Except Cervical With Curvature of the Spine or Malignancy Without CC)—Cases With Procedure Code 81.64 (Fusion or refusion of 9 or more vertebrae) ..................... Therefore, we are proposing to move those cases that include fusing or refusing nine or more vertebrae from proposed MS–DRGs 459 and 460 into proposed MS–DRGs 456 through 458. This proposed modification would include revising the MS–DRG title to reflect the fusion of nine or more vertebrae. The revised titles for proposed MS–DRGs 456 through 458 would be as follows: <bullet≤ Proposed MS–DRG 456 (Spinal Fusion Except Cervical with Spinal Curvature or Malignancy or 9+ Fusions With MCC) <bullet≤ Proposed MS–DRG 457 (Spinal Fusion Except Cervical with Spinal Curvature or Malignancy or 9+ Fusions With CC) <bullet≤ Proposed MS–DRG 458 (Spinal Fusion Except Cervical with Spinal Curvature or Malignancy or 9+ Fusions Without CC/MCC) We invite public comment on this topic as well as on the additional changes we are proposing to the spine MS–DRGs discussed below. Average length of stay Average charges 50 48,481 13.00 4.36 171.839 59,698 238 6.20 110,908 548 14.79 142,871 61 13.34 170,655 1,500 8.14 95,489 146 8.88 125,722 1,340 4.58 77,528 81 6.21 123,823 Further analysis demonstrates that spinal fusion cases with a principal diagnosis of tuberculosis or osteomyelitis also have higher average charges than other cases in CMS DRG 497 (proposed MS–DRGs 459 and 460) that are more similar to the cases assigned to CMS DRG 546 (proposed MS–DRGs 456 through 458). Although the volume of cases is relatively low, the data show very high average charges for these patients. The following tables display our results: Number of cases Proposed MS–DRG MS–DRG 459 (Spinal Fusion Except Cervical With MCC) ..................................................................... MS–DRG 460 (Spinal Fusion Except Cervical Without MCC) ................................................................ 3,186 48,481 Number of cases Proposed MS–DRG MS–DRG 456 (Spinal Fusion Except Cervical with Spinal Curvature or Malignancy or 9+ Fusions With MCC) ............................................................................................................................................ MS–DRG 457 (Spinal Fusion Except Cervical with Spinal Curvature or Malignancy or 9+ Fusions With CC) ............................................................................................................................................... MS–DRG 458 (Spinal Fusion Except Cervical With Spinal Curvature or Malignancy or 9+ Fusions Without CC/MCC) ................................................................................................................................ Average length of stay 10.10 4.36 Average length of stay Average charges $99,298 59,698 Average charges 548 14.79 $142,870 1,500 8.14 95,489 1,340 4.58 77,528 Tuberculosis and Osteomyelitis Number of cases Principal diagnosis mmaher on DSK3CLS3C1PROD with $$_JOB Codes 015.02, 015.04, 015.05, 730.08, 730.18 and 730.28 .................................................................. For this reason, we are proposing to add the following diagnoses to the principal diagnosis list for proposed MS–DRGs 456 through 458: <bullet≤ 015.02, Tuberculosis of bones and joints, vertebral column, VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 bacteriological or histological examination unknown (at present) <bullet≤ 015.04, Tuberculosis of bones and joints, vertebral column, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture PO 00000 Frm 00054 Fmt 4701 Sfmt 4702 194 Average length of stay 24.8 Average charges $128,073 <bullet≤ 015.05, Tuberculosis of bones and joints, vertebral column, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically <bullet≤ 730.08, Acute osteomyelitis of other specified sites E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB <bullet≤ 730.18, Chronic osteomyelitis of other specified sites <bullet≤ 730.28, Unspecified osteomyelitis of other specified sites For the complete list of principal diagnosis codes that lead to assignment of CMS DRG 546 (proposed MS–DRGs 496 through 498), we refer readers to section II.D.4.b. of the preamble of the FY 2007 IPPS final rule (71 FR 47947). c. Spinal Disc Devices Over the past several years, manufacturers of spinal disc devices have requested reassignment of DRGs for their products and applied for new technology add-on payments. CHARITETM is one of these devices. CHARITETM is a prosthetic intervertebral disc. On October 26, 2004, the FDA approved the CHARITETM Artificial Disc for single level spinal arthroplasty in skeletally mature patients with degenerative disc disease between L4 and S1. On October 1, 2004, we created new procedure codes for the insertion of spinal disc prostheses (codes 84.60 through 84.69). We provided the CMS DRG assignments for these new codes in Table 6B of the FY 2005 IPPS proposed rule (69 FR 28673). We received comments on the FY 2005 proposed rule recommending that we change the assignments for these codes from CMS DRG 499 (Back and Neck Procedures Except Spinal Fusion With CC) and CMS DRG 500 (Back and Neck Procedures Except Spinal Fusion Without CC) to the CMS DRGs for spinal fusion, CMS DRG 497 (Spinal Fusion Except Cervical With CC) and CMS DRG 498 (Spinal Fusion Except Cervical Without CC) for procedures on the lumbar spine and to CMS DRGs 519 and 520 for procedures on the cervical spine. In the FY 2005 IPPS final rule (69 FR 48938), we indicated that CMS DRGs 497 and 498 are limited to spinal fusion procedures. Because the surgery involving the CHARITETM Artificial Disc is not a spinal fusion, we decided not to include this procedure in these CMS DRGs. However, we stated that we would continue to analyze this issue and solicited further public comments on the DRG assignment for spinal disc prostheses. In the FY 2006 final rule (70 FR 47353), we noted that, if a product meets all of the criteria for Medicare to pay for the product as a new technology under section 1886(d)(5)(K) of the Act, there is a clear preference expressed in the statute for us to assign the technology to a DRG based on similar clinical or anatomical characteristics or costs. However, for FY 2006, we did not find that the CHARITETM Artificial Disc met the substantial clinical VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 improvement criterion and, thus, did not qualify as a new technology. Consequently, we did not address the DRG classification request made under the authority of this provision of the Act. We did evaluate whether to reassign the CHARITETM Artificial Disc to different CMS DRGs using the Secretary’s authority under section 1886(d)(4) of the Act (70 FR 47308). We indicated that we did not have Medicare charge information to evaluate CMS DRG changes for cases involving an implant of a prosthetic intervertebral disc like the CHARITETM and did not make a change in its CMS DRG assignments. We stated that we would consider whether changes to the CMS DRG assignments for the CHARITETM Artificial Disc were warranted for FY 2007, once we had information from Medicare’s data system that would assist us in evaluating the costs of these patients. As we discussed in the FY 2007 IPPS proposed rule (71 FR 24036), we received correspondence regarding the CMS DRG assignments for the CHARITETM Artificial Disc, code 84.65 (Insertion of total spinal disc prosthesis, lumbosacral). The commenter had previously submitted an application for the CHARITETM Artificial Disc for new technology add-on payments for FY 2006 and had requested a reassignment of cases involving CHARITETM implantation to CMS DRGs 497 and 498. The commenter asked that we examine claims data for FY 2005 and reassign procedure code 84.65 from CMS DRGs 499 and 500 into CMS DRGs 497 and 498. The commenter again stated the view that cases with the CHARITETM Artificial Disc reflect comparable resource use and similar clinical indications as do those in CMS DRGs 497 and 498. If CMS were to reject reassignment of the CHARITETM Artificial Disc to CMS DRGs 497 and 498, the commenter suggested creating two separate DRGs for lumbar disc replacements. On February 15, 2006, we posted a proposed national coverage determination (NCD) on the CMS Web site seeking public comment on our proposed finding that the evidence is not adequate to conclude that lumbar artificial disc replacement with the CHARITETM Artificial Disc is reasonable and necessary. The proposed NCD stated that lumbar artificial disc replacement with the CHARITETM Artificial Disc is generally not indicated in patients over 60 years old. Further, it stated that there is insufficient evidence among either the aged or disabled Medicare population to make a PO 00000 Frm 00055 Fmt 4701 Sfmt 4702 24733 reasonable and necessary determination for coverage. With an NCD pending to make spinal arthroplasty with the CHARITETM Artificial Disc noncovered, we indicated in the FY 2007 IPPS proposed rule that we did not believe it was appropriate at that time to reassign procedure code 84.65 from CMS DRGs 499 and 500 to CMS DRGs 497 and 498. After considering the public comments and additional evidence received, we made a final NCD on May 16, 2006, that Medicare would not cover the CHARITETM Artificial Disc for the Medicare population over 60 years of age. For Medicare beneficiaries 60 years of age and under, local Medicare contractors have the discretion to determine coverage for lumbar artificial disc replacement procedures involving the CHARITETM Artificial Disc. The final NCD can be found on the CMS Web site at: https://www.cms.hhs.gov/ mcd/ viewncd.asp:ncd-id 150.10&ncd— version1& basket=ncd%3A150 %2E10%3A1%3ALumbar+ Artificial+Disc+Replacement %280ADR%29. We agreed with a commenter on the FY 2007 IPPS proposed rule that it was not appropriate to consider a DRG revision at that time for the CHARITETM Artificial Disc, given the recent decision to limit coverage for surgical procedures involving this device. Although we had reviewed the Medicare charge data, we were concerned that there were a very small number of cases for patients under 60 years of age who had received the CHARITETM Artificial Disc. We believed it appropriate to base the decision of a DRG change on charge data only on the population for which the procedure is covered. We had an extremely small number of cases for Medicare beneficiaries under 60 on which to base such a decision. For this reason, we did not believe it was appropriate to modify the CMS DRGs in FY 2007 for CHARITETM cases. For FY 2008, we collapsed CMS DRGs 499 and 500 (Back and Neck Procedures Except Spinal Fusion With and Without CC, respectively) and identified a total of 74,989 cases. Under the proposed MS–DRGs, the result of the analysis of the data supports that these CMS DRGs split into two severity levels: proposed MS–DRG 490 (Back and Neck Procedures Except Spinal Fusion with CC or MCC) and proposed MS–DRG 491 (Back and Neck Procedures Except Spinal Fusion Without CC or MCC). We found a total of 53 cases that used the CHARITETM Artificial Disc. Without any further modification to the proposed MS–DRGs, average charges are $26,481 for 6 cases with a CC or MCC and $37,324 for 47 CHARITETM cases E:\FEDREG\03MYP2.LOC 03MYP2 24734 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules without a CC or MCC. (We find it counterintuitive that average charges for cases in the higher severity level are lower but checked our data and found it to be correct). We also analyzed data for other spinal disc devices. Average charges for the X Stop Interspinous Process Decompression Device (code 84.58) are $31,400 for cases with a CC or MCC and $28,821 for cases without a CC or MCC. Average charges for other specified spinal devices described by code 84.59 (Coflex, Dynesys, M-Brace) are $34,002 for 18 cases with a CC or MCC and $33,873 for 65 cases without a CC or MCC. We compared these average charges to data in the proposed spinal fusion MS–DRGs 453 (Combined Anterior/Posterior Spinal Fusion With MCC), 454 (Combined Anterior/ Posterior Spinal Fusion With CC), 455 (Combined Anterior/Posterior Spinal Fusion Without CC/MCC), 459 (Spinal Fusion Except Cervical With MCC), and 460 (Spinal Fusion Except Cervical Without MCC). These cases have lower average charges than the spinal fusion MS–DRGs. The following tables display the results: Number of cases Proposed MS–DRGs 490 and 491 MS–DRG MS–DRG MS–DRG MS–DRG MS–DRG 490—All Cases ....................................................................................................................... 490—Cases with Procedure Code 84.65 (CHARITETM) ........................................................ 491—All Cases ....................................................................................................................... 491—Cases with Procedure Code 84.65 (CHARITETM) ........................................................ 491—Cases without Procedure Code 84.65 (CHARITETM) ................................................... MS–DRG MS–DRG MS–DRG MS–DRG MS–DRG MS–DRG 490—All Cases ....................................................................................................................... 490—Cases with Procedure Code 84.58 (X Stop) ................................................................. 490—Cases without Procedure Code 84.58 (X Stop) ............................................................ 491—All Cases ....................................................................................................................... 491—Cases with Procedure Code 84.58 (X Stop) ................................................................. 491—Cases without Procedure Code 84.58 (X-Stop) ............................................................ 490—All Cases ....................................................................................................................... 490—Cases with Procedure Code 84.59 (Coflex/Dynesys/M-Brace) .................................... 490—Cases without Procedure Code 84.59 (Coflex/Dynesys/M-Brace) ............................... 491—All Cases ....................................................................................................................... 491—Cases with Procedure Code 84.59 (Coflex/Dynesys/M-Brace) .................................... 491—Cases without Procedure Code 84.59 (Coflex/Dynesys/M-Brace) ............................... mmaher on DSK3CLS3C1PROD with $$_JOB MS–DRG MS–DRG MS–DRG MS–DRG MS–DRG 453—Combined Anterior/Posterior Spinal Fusion With MCC ................................................ 454—Combined Anterior/Posterior Spinal Fusion With CC ................................................... 455—Combined Anterior/Posterior Spinal Fusion Without CC/MCC ..................................... 459—Spinal Fusion Except Cervical with MCC ..................................................................... 460—Spinal Fusion Except Cervical Without MCC ................................................................ The data demonstrate that the average charges for CHARITETM and the other devices are higher than other cases in proposed MS–DRGs 490 and 491 but lower than proposed MS–DRGs 453 through 55 and 459 and 460. For this reason, we do not believe that any of the cases that use these spine devices should be assigned to the spinal fusion MS–DRGs. However, we do believe that the average charges for cases using these spine devices are more similar to the higher severity level in MS–DRG 490. As such, we are proposing to move cases with procedure codes 84.58, 84.59, and 84.65 into proposed MS– DRG 490 and revise the title to reflect VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 disc devices. The proposed modified MS–DRG title would be: MS–DRG 490 (Back and Neck Procedures Except Spinal Fusion with CC or MCC or Disc Devices). We believe these proposed changes to the spine DRGs are appropriate to recognize the similar utilization of resources, differences in levels of severity, and complexity of the services performed for various types of spinal procedures described above. We encourage commenters to provide input on this approach to better recognize the types of patients these procedures are being performed upon and their outcomes. PO 00000 Frm 00056 Fmt 4701 Sfmt 4702 Average length of stay 5.13 2.65 5.15 2.27 1.34 2.29 Average length of stay 17,493 18 17,475 57,496 65 57,431 Number of cases Proposed MS–DRGs 453, 454, 455, 459 and 460 5.13 3.33 2.27 2.43 2.27 17,493 179 17,314 57,496 1,174 56,322 Number of cases Proposed MS–DRGs 490 and 491 MS–DRG MS–DRG MS–DRG MS–DRG MS–DRG MS–DRG 17,493 6 57,496 47 57,449 Number of cases Proposed MS–DRGs 490 and 491 Average length of stay 5.13 5.56 5.13 2.27 2.35 2.27 Average length of stay 792 1,411 1,794 3,186 48,481 15.84 8.69 4.84 10.10 4.36 Average charges $29,656 26,481 17,789 37,324 17,773 Average charges $29,656 31,400 29,638 17,789 28,821 17,559 Average charges $29,656 34,002 29,651 17,789 33,873 17,770 Average charges $180,658 116,402 85,927 99,298 59,698 d. Other Spinal DRGs We did not identify any data to support moving cases in or out of CMS DRGs 496 (Combined Anterior/Posterior Spinal Fusion), 519 (Cervical Spinal Fusion With CC), or 520 (Cervical Spinal Fusion Without CC)). Under the proposed MS–DRG system, CMS DRG 496 would be split into three severity levels: proposed MS–DRG 453 (Combined Anterior/Posterior Spinal Fusion With MCC), proposed MS–DRG 454 (Combined Anterior/Posterior Spinal Fusion With CC), and proposed MS–DRG 455 (Combined Anterior/ Posterior Spinal Fusion Without CC). E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB CMS DRG 519 would also be split into three severity levels: proposed MS–DRG 471 (Cervical Fusion With MCC), proposed MS–DRG 472 (Cervical Fusion With CC), and proposed MS–DRG 473 (Cervical Fusion Without CC). We are not proposing changes to these DRGs at this time. 5. MDC 17 (Myeloproliferative Diseases and Disorders, Poorly Differentiated Neoplasm): Endoscopic Procedures (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: Endoscopy’’ at the beginning of your comment.) We received a request from a manufacturer to review the DRG assignment of codes 33.71 (Endoscopic insertion or replacement of bronchial valve(s)), 33.78 (Endoscopic removal of bronchial device(s) or substances), and 33.79 (Endoscopic insertion of other bronchial device or substances) with the intent of moving these three codes out of CMS DRG 412 (History of Malignancy With Endoscopy) (proposed MS–DRGs 843, 844, and 845). The requestor has noted that CMS DRG 412 is titled to be a DRG for cases with a history of malignancy, and none of the three codes (33.71, 33.78, or 33.79) necessarily involve treatment for malignancies. In addition, the requestor believed the integrity of the DRG is compromised because the other endoscopy codes assigned to CMS DRG 412 are all diagnostic in nature, while codes 33.71, 33.78, and 33.79 represent therapeutic procedures. The requestor also stated that while the diagnostic endoscopies in CMS DRG 412 do not have significant costs for equipment or pharmaceutical agents beyond the basic endoscopy, the therapeutic procedures described by codes 33.71, 33.78, and 33.79 involve substantial costs for devices or substances in relation to the cost of the endoscopic procedure itself. The requestor was concerned that, if these three codes continue to be assigned to CMS DRG 412, payment will be so inadequate as to constitute a substantial barrier to Medicare beneficiaries for these treatments. ICD–9–CM procedure codes 33.71, 33.78, and 33.79 were all created for use beginning October 1, 2006. As these codes have been in use only for a few months, we have no data to make a different DRG assignment. We assigned these codes based on the advice of our medical officers to a DRG that includes similar clinical procedures. On the matter of codes 33.71, 33.78, and 33.79 being therapeutic in nature while all other endoscopies assigned to CMS DRG 412 are diagnostic, we VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 disagree with the commenter. CMS DRG 412 includes procedure codes for therapeutic endoscopic destruction of lesions of the bronchus, lung, stomach, anus, and duodenum, as well as codes for polypectomy of the intestine and rectum. In addition, we note that there are codes for insertion of therapeutic devices currently located in this DRG. We believe it would be premature to assign these codes to another DRG without any supporting data. We will reconsider our decision for these codes if we have data suggesting that a DRG reassignment is warranted. Therefore, aside from the proposed changes to the MS–DRGs, we are not proposing to change the current DRG assignment for codes 33.71, 33.78, and 33.79 at this time. 6. Medicare Code Editor (MCE) Changes (If you choose to comment on issues in this section, please include the caption ‘‘Medicare Code Editor’’ at the beginning of your comment.) As explained under section II.B.1. of this preamble, the Medicare Code Editor (MCE) is a software program that detects and reports errors in the coding of Medicare claims data. Patient diagnoses, procedure(s), discharge status, and demographic information go into the Medicare claims processing systems and are subjected to a series of automated screens. The MCE screens are designed to identify cases that require further review before classification into a DRG. For FY 2008, we are proposing to make the following changes to the MCE edits. a. Non-Covered Procedure Edit: Code 00.62 (Percutaneous angioplasty or atherectomy of intracranial vessel(s)) As discussed in II.G.2. of the preamble of this proposed rule, under MDC 1, code 00.62 is a covered service when performed in conjunction with code 00.65 (Percutaneous insertion of intracranial vascular stent(s)). Effective November 6, 2006, Medicare covers PTA and stenting of intracranial arteries for the treatment of cerebral artery stenosis in cases in which stenosis is 50 percent or greater in patients with intracranial atherosclerotic disease when furnished in accordance with the FDA-approved protocols governing Category B Investigational Device Exemption (IDE) clinical trials. CMS determines that coverage of intracranial PTA and stenting is reasonable and necessary under these circumstances. Therefore, we are proposing to make a conforming change and to add the following language to this edit: Procedure code 00.62 (PTA of intracranial vessel(s)) is identified as a PO 00000 Frm 00057 Fmt 4701 Sfmt 4702 24735 noncovered procedure except when it is accompanied by procedure code 00.65 (Intracranial stent). b. Non-Specific Principal Diagnosis Edit 7 and Non-Specific O.R. Procedures Edit 10 When MCE Non-Specific Principal Diagnosis Edit 7 and Non-Specific O.R. Procedures Edit 10 were created at the beginning of the IPPS, it was with the intent that they were to encourage hospitals to code as specifically as possible. While the codes on both edits are valid according to the ICD–9–CM coding scheme, more precise codes are preferable to give a more complete understanding of the services provided on the Medicare claims. When the MCE was created, we had intended that these specific edits would allow educational contact between the provider and the contractor. It was never the intention that these edits would be used to deny/ reject or return-to-provider claims submitted with non-specific codes. However, we found these two edits to be misunderstood, and found that claims were erroneously being denied, rejected, or returned. On November 11, 2006, CMS issued a Joint Signature Memorandum which instructed all fiscal intermediaries and all Part A and Part B Medicare Administrative Contractors (A/B MACs) to deactivate the Fiscal Intermediary Shared System Edits W1436 through W1439 and W1489 through W1491 which edited for Non-Specific Diagnoses and the NonSpecific Procedures. Therefore, we are proposing to make a conforming change to the MCE by removing the following codes from Edit 7: 00320 01590 01591 01592 01593 01594 01596 0369 0399 0528 05310 0538 05440 0548 0558 05600 0568 06640 07070 07071 0728 0738 07420 08240 0979 09810 09830 E:\FEDREG\03MYP2.LOC 03MYP2 1109 1129 1149 1279 129 1309 13100 1319 1329 1369 1370 1371 1372 1373 1374 138 1390 1391 1398 1409 1419 1429 1439 1449 1469 1479 1509 1543 1579 1589 1590 1609 1619 1629 1639 1649 1709 1719 1729 1739 1749 1769 179 1809 1839 1874 1879 1889 1899 1909 1929 1949 1969 1991 mmaher on DSK3CLS3C1PROD with $$_JOB 24736 09950 0999 1009 20591 20690 20691 20890 20891 2129 2139 2149 2159 2169 2189 2199 2229 2239 2249 2259 2279 22800 2299 2306 2319 2329 2349 23690 23770 23875 2390 2391 2392 2393 2394 2396 2397 2398 2399 2469 2519 25200 2529 2539 2549 25510 2569 2579 2589 2681 2709 2719 2729 2739 27540 2759 27650 27730 38800 38810 38830 38840 38860 38870 3889 38900 38910 3897 3899 41090 41091 41092 412 4149 4179 42650 4275 VerDate Mar 15 2010 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 1519 1529 1539 2779 2793 2799 28730 28800 28850 28860 28950 3239 3249 326 32700 32710 32720 32730 32740 3309 3319 3349 3359 34120 3419 3439 3449 34690 34691 3489 3499 3509 3519 3529 3539 3569 3579 3589 3599 3609 3619 3629 3639 3649 3659 3669 3679 3689 36900 36901 36902 36903 36904 36905 36906 36907 36908 52140 5219 52320 52330 52340 5239 52400 52420 52430 52450 52460 52470 5249 52520 52540 52550 52560 5259 5269 02:00 Aug 26, 2011 20490 20491 20590 36910 36911 36912 36913 36914 36915 36916 36917 36918 36920 36921 36922 36923 36924 36925 3693 3694 36960 36961 36962 36963 36964 36965 36966 36967 36968 36969 36970 36971 36972 36973 36974 36975 36976 3698 3699 3709 3719 3729 3739 3749 3759 3769 3779 3789 37960 3809 3819 3829 3839 3849 3859 3879 6089 6109 6169 6170 61800 6184 6189 6199 6209 62130 6219 62210 6229 6239 6249 6269 6279 62920 63390 Jkt 223001 PO 00000 4279 42820 42830 42840 4289 4299 4329 43390 43490 4379 4389 4419 4429 4449 44620 4479 4519 45340 4539 4579 4599 4619 46450 46451 4749 4919 5169 51900 5199 5209 52100 52110 52120 52130 64660 64670 64680 64690 64700 64710 64720 64730 64740 64750 64760 64780 64790 64791 64792 64793 64794 64800 64810 64820 64830 64840 64850 64860 64870 64880 64890 64900 64910 64920 64930 64940 64950 64960 65100 65110 65120 65130 65140 65150 65160 Frm 00058 5279 52800 5299 5309 53640 5379 5539 56400 5649 5679 5689 56960 5699 5739 57510 5759 5769 5779 5799 5859 5889 5890 5891 5899 5909 5959 5969 5989 59960 5999 60090 60091 6019 6029 60820 65290 65291 65293 65300 65310 65320 65330 65340 65350 65360 65370 65380 65390 65391 65393 65400 65410 65420 65430 65440 65450 65460 65470 65480 65490 65491 65492 65493 65494 65500 65510 65520 65530 65540 65550 65560 65570 65580 65590 65591 65593 Fmt 4701 Sfmt 4702 63391 64090 64091 64093 64100 64110 64120 64130 64180 64190 64191 64193 64200 64210 64220 64230 64240 64250 64260 64270 64290 64300 64310 64320 64380 64390 64400 64410 64420 64600 64610 64620 64630 64640 64650 65820 65830 65840 65880 65890 65891 65893 65900 65910 65920 65930 65940 65950 65960 65980 65990 65991 65993 66000 66010 66020 66030 66040 66050 66060 66070 66080 66090 66100 66110 66120 66130 66140 66190 66191 66193 66200 66210 66220 66230 66300 65180 65190 65191 65193 65200 65210 65220 65230 65240 65250 65260 65270 65280 66430 66440 66441 66444 66450 66480 66490 66491 66494 66500 66510 66520 66530 66540 66550 66560 66570 66580 66590 66591 66592 66593 66594 66600 66610 66620 66630 66700 66710 66800 66810 66820 66880 66890 66891 66892 66893 66894 66900 66910 66920 66930 66940 66950 66960 66970 66980 66990 66991 66992 66993 66994 67000 67100 7509 7529 75310 75312 75320 7539 7559 75670 7579 E:\FEDREG\03MYP2.LOC 03MYP2 65600 65610 65620 65630 65640 65650 65660 65670 65680 65690 65700 65800 65810 67110 67120 67130 67140 67150 67180 67190 67191 67192 67193 67194 67200 67300 67310 67320 67330 67380 67400 67410 67420 67430 67440 67450 67480 67490 67492 67494 67500 67510 67520 67580 67590 67600 67610 67620 67630 67640 67650 67660 67680 67690 67691 67692 67693 67694 677 6809 6819 6829 68600 6869 6949 7019 7049 7769 7789 7799 78031 78051 78052 78053 78054 78055 66310 66320 66330 66340 66350 66360 66380 66390 66391 66393 66400 66410 66420 7059 7069 70700 70710 7079 7149 71590 7179 71849 71850 71870 72230 72270 72280 72290 7239 7244 7289 73000 73010 73020 73030 73090 73091 73092 73093 73094 73095 73096 73097 73098 73099 73310 73340 73390 7359 73600 73620 73630 73670 7369 73810 7389 74100 74190 7429 7439 7449 7459 7469 74760 7489 74900 74910 9009 9029 9039 9048 9049 9050 9051 9052 9053 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 7599 7600 7601 7602 7603 7604 7605 7606 76070 76072 76073 76074 76079 7608 7609 7610 7611 7612 7613 7614 7615 7616 7617 7618 7619 7629 7630 7631 7632 7633 7634 7635 7636 7637 76383 7639 76520 7679 7689 77010 7709 77210 7729 7759 9289 9299 9349 9399 94100 94101 94102 94103 94104 94105 94106 94107 94108 94109 94200 94201 94202 94203 94204 94205 94209 94300 94301 94302 94303 94304 94305 94306 94309 94400 94401 94402 94403 VerDate Mar 15 2010 78057 78058 78079 7825 78261 78262 78340 78830 78900 78930 78940 78960 79009 7901 7904 7905 7906 79091 79092 79099 7929 79380 79500 7954 7964 7969 7993 79989 7999 8290 ...................... 8291 8398 8399 8409 8419 8439 8469 8479 8489 8678 8679 86800 86810 94404 94405 94406 94407 94408 94500 94501 94502 94503 94504 94505 94506 94509 9460 9479 9490 9491 9492 9493 9494 9495 9519 9529 9539 9549 9559 9569 9579 95890 9599 9609 9639 9649 02:00 Aug 26, 2011 9054 9055 9056 9057 9058 9059 9060 9061 9062 9063 9064 9065 9066 9067 9068 9069 9070 9071 9072 9073 9074 9075 9079 9080 9081 9082 9083 9084 9085 9086 9089 9090 9091 9092 9093 9094 9095 9099 9219 9229 9239 9249 9269 9279 9659 9679 9699 9709 9739 9769 9779 9809 9849 9859 9889 9899 9929 9939 99520 99522 99523 99529 99550 99580 99590 99600 99630 99640 99660 99670 99680 99690 99700 99760 9989 ...................... ...................... Jkt 223001 In addition, we are proposing to make a conforming change to the MCE by removing the following codes from Edit 10: 0650 0700 0763 0769 0780 2630 3500 3510 3520 3550 3560 3570 3610 3710 7670 7700 7720 7760 7770 7780 7790 7800 7810 7820 7830 7840 7850 7870 3770 3800 3810 3830 3840 3850 3860 3880 4040 4050 4100 4210 4240 ...................... 7880 7890 7910 7920 7930 7940 7950 7960 7980 7990 8000 8010 8020 8040 4400 4440 4500 4590 4610 4620 4640 4650 4660 4680 5300 5310 5640 7550 8070 8080 8090 8100 8120 8130 8153 8155 8400 8440 8460 8469 8660 8670 c. Limited Coverage Edit 17 Edit 17 in the MCE contains ICD–9– CM procedure codes describing medically complex procedures, including lung volume reduction surgery, organ transplants, and implantable heart assist devices which are to be performed only in certain preapproved medical centers. CMS has established, through a regulation (CMS– 3835–F: Medicare Conditions of Participation: Requirements for Approval and Reapproval of Transplant Centers to Perform Organ Transplants, published in the Federal Register on March 30, 2007 (72 FR 15198)), a survey and certification process for organ transplant programs. The organs covered in this regulation are heart, heart and lung combined, intestine, kidney, liver, lung, pancreas, and multivisceral. Historically, kidney transplants have been regulated under the End-Stage Renal Disease (ESRD) conditions for coverage. Other types of organ transplant facilities have been regulated under various NCDs. The regulation becomes effective on June 28, 2007. Organ transplant programs will have 180 days from the June 28, 2007 effective date of the regulation to apply for participation in the Medicare program under the new survey and certification process. After these programs apply, we will survey and approve programs that meet the new Medicare conditions of participation. Until transplant facilities are surveyed and approved, kidney PO 00000 Frm 00059 Fmt 4701 Sfmt 4702 24737 transplant facilities will continue to be regulated under the ESRD conditions for coverage, and other types of organ transplant facilities will continue to be regulated under the NCDs. In this proposed rule, we are proposing to add conforming Medicare Part A payment edits to the MCE, consistent with the requirements of the organ transplant regulation (CMS–3835– F), to ensure that Medicare covers only those organ transplants performed in Medicare-approved facilities. We are proposing to add the following procedure codes to the existing list of limited coverage procedures under Edit 17: <bullet≤ 55.69, Other kidney transplantation <bullet≤ 52.80, Pancreatic transplant, not otherwise specified <bullet≤ 52.82, Homotransplant of pancreas 7. Surgical Hierarchies (If you choose to comment on issues in this section, please include the caption ‘‘Surgical Hierarchies’’ at the beginning of your comment.) Some inpatient stays entail multiple surgical procedures, each one of which, occurring by itself, could result in assignment of the case to a different DRG within the MDC to which the principal diagnosis is assigned. Therefore, it is necessary to have a decision rule within the GROUPER by which these cases are assigned to a single DRG. The surgical hierarchy, an ordering of surgical classes from most resource-intensive to least resourceintensive, performs that function. Application of this hierarchy ensures that cases involving multiple surgical procedures are assigned to the DRG associated with the most resourceintensive surgical class. Because the relative resource intensity of surgical classes can shift as a function of DRG reclassification and recalibrations, we reviewed the surgical hierarchy of each MDC, as we have for previous reclassifications and recalibrations, to determine if the ordering of classes coincides with the intensity of resource utilization. A surgical class can be composed of one or more DRGs. For example, in MDC 11, the surgical class ‘‘kidney transplant’’ consists of a single DRG (DRG 302) and the class ‘‘kidney, ureter and major bladder procedures’’ consists of three DRGs (DRGs 303, 304, and 305). Consequently, in many cases, the surgical hierarchy has an impact on more than one DRG. The methodology for determining the most resourceintensive surgical class involves weighting the average resources for each E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24738 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules DRG by frequency to determine the weighted average resources for each surgical class. For example, assume surgical class A includes DRGs 1 and 2 and surgical class B includes DRGs 3, 4, and 5. Assume also that the average charge of DRG 1 is higher than that of DRG 3, but the average charges of DRGs 4 and 5 are higher than the average charge of DRG 2. To determine whether surgical class A should be higher or lower than surgical class B in the surgical hierarchy, we would weight the average charge of each DRG in the class by frequency (that is, by the number of cases in the DRG) to determine average resource consumption for the surgical class. The surgical classes would then be ordered from the class with the highest average resource utilization to that with the lowest, with the exception of ‘‘other O.R. procedures’’ as discussed below. This methodology may occasionally result in assignment of a case involving multiple procedures to the lowerweighted DRG (in the highest, most resource-intensive surgical class) of the available alternatives. However, given that the logic underlying the surgical hierarchy provides that the GROUPER search for the procedure in the most resource-intensive surgical class, in cases involving multiple procedures, this result is sometimes unavoidable. We note that, notwithstanding the foregoing discussion, there are a few instances when a surgical class with a lower average charge is ordered above a surgical class with a higher average charge. For example, the ‘‘other O.R. procedures’’ surgical class is uniformly ordered last in the surgical hierarchy of each MDC in which it occurs, regardless of the fact that the average charge for the DRG or DRGs in that surgical class may be higher than that for other surgical classes in the MDC. The ‘‘other O.R. procedures’’ class is a group of procedures that are only infrequently related to the diagnoses in the MDC, but are still occasionally performed on patients in the MDC with these diagnoses. Therefore, assignment to these surgical classes should only occur if no other surgical class more closely related to the diagnoses in the MDC is appropriate. A second example occurs when the difference between the average charges for two surgical classes is very small. We have found that small differences generally do not warrant reordering of the hierarchy because, as a result of reassigning cases on the basis of the hierarchy change, the average charges are likely to shift such that the higherordered surgical class has a lower average charge than the class ordered below it. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 For FY 2008, we are not proposing any revisions of the surgical hierarchy for any MDC. In general, the MS–DRGs that are being proposed for use in FY 2008 and discussed in section II.D. of the preamble of this proposed rule follow the same hierarchical order as the CMS DRGs they are to replace, except for DRGs that were deleted and consolidated. 8. CC Exclusion List Proposed for FY 2008 (If you choose to comment on issues in this section, please include the caption ‘‘CC Exclusion List’’ at the beginning of your comment.) a. Background As indicated earlier in this preamble, under the IPPS DRG classification system, we have developed a standard list of diagnoses that are considered complications or comorbidities (CCs). Historically, we developed this list using physician panels that classified each diagnosis code based on whether the diagnosis, when present as a secondary condition, would be considered a substantial complication or comorbidity. A substantial complication or comorbidity was defined as a condition that, because of its presence with a specific principal diagnosis, would cause an increase in the length of stay by at least 1 day in at least 75 percent of the patients. We refer readers to section II.D.2. and 3. of the preamble of this proposed rule for a discussion of the refinement of CCs in relation to the MS–DRGs we are proposing to adopt for FY 2008. b. Proposed CC Exclusions List for FY 2008 In the September 1, 1987 final notice (52 FR 33143) concerning changes to the DRG classification system, we modified the GROUPER logic so that certain diagnoses included on the standard list of CCs would not be considered valid CCs in combination with a particular principal diagnosis. We created the CC Exclusions List for the following reasons: (1) To preclude coding of CCs for closely related conditions; (2) to preclude duplicative or inconsistent coding from being treated as CCs; and (3) to ensure that cases are appropriately classified between the complicated and uncomplicated DRGs in a pair. As we indicated above, we developed a list of diagnoses, using physician panels, to include those diagnoses that, when present as a secondary condition, would be considered a substantial complication or comorbidity. In previous years, we have made changes to the list of CCs, either by adding new CCs or deleting CCs already on the list. PO 00000 Frm 00060 Fmt 4701 Sfmt 4702 In the May 19, 1987 proposed notice (52 FR 18877) and the September 1, 1987 final notice (52 FR 33154), we explained that the excluded secondary diagnoses were established using the following five principles: <bullet≤ Chronic and acute manifestations of the same condition should not be considered CCs for one another. <bullet≤ Specific and nonspecific (that is, not otherwise specified (NOS)) diagnosis codes for the same condition should not be considered CCs for one another. <bullet≤ Codes for the same condition that cannot coexist, such as partial/total, unilateral/bilateral, obstructed/ unobstructed, and benign/malignant, should not be considered CCs for one another. <bullet≤ Codes for the same condition in anatomically proximal sites should not be considered CCs for one another. <bullet≤ Closely related conditions should not be considered CCs for one another. The creation of the CC Exclusions List was a major project involving hundreds of codes. We have continued to review the remaining CCs to identify additional exclusions and to remove diagnoses from the master list that have been shown not to meet the definition of a CC.14 For FY 2008, we are proposing to make limited revisions to the CC Exclusions List to take into account the changes that will be made in the ICD– 14 See the FY 1989 final rule (53 FR 38485, September 30, 1988), for the revision made for the discharges occurring in FY 1989; the FY 1990 final rule (54 FR 36552, September 1, 1989), for the FY 1990 revision; the FY 1991 final rule (55 FR 36126, September 4, 1990), for the FY 1991 revision; the FY 1992 final rule (56 FR 43209, August 30, 1991) for the FY 1992 revision; the FY 1993 final rule (57 FR 39753), September 1, 1992), for the FY 1993 revision; the FY 1994 final rule (58 FR 46278, September 1, 1993), for the FY 1994 revisions; the FY 1995 final rule (59 FR 45334, September 1, 1994), for the FY 1995 revisions; the FY 1996 final rule (60 FR 45782, September 1, 1995), for the FY 1996 revisions; the FY 1997 final rule (61 FR 46171, August 30, 1996), for the FY 1997 revisions; the FY 1998 final rule (62 FR 45966, August 29, 1997) for the FY 1998 revisions; the FY 1999 final rule (63 FR 40954, July 31, 1998), for the FY 1999 revisions; the FY 2001 final rule (65 FR 47064, August 1, 2000), for the FY 2001 revisions; the FY 2002 final rule (66 FR 39851, August 1, 2001), for the FY 2002 revisions; the FY 2003 final rule (67 FR 49998, August 1, 2002), for the FY 2003 revisions; the FY 2004 final rule (68 FR 45364, August 1, 2003), for the FY 2004 revisions; the FY 2005 final rule (69 FR 49848, August 11, 2004), for the FY 2005 revisions; the FY 2006 final rule (70 FR 47640, August 12, 2005), for the FY 2006 revisions; and the FY 2007 final rule (71 FR 47870) for the FY 2007 revisions. In the FY 2000 final rule (64 FR 41490, July 30, 1999), we did not modify the CC Exclusions List because we did not make any changes to the ICD–9–CM codes for FY 2000. E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 9–CM diagnosis coding system effective October 1, 2007. (See section II.G.10. of this preamble for a discussion of ICD– 9–CM changes.) We are proposing to make these changes in accordance with the principles established when we created the CC Exclusions List in 1987. In addition, as discussed in section II.D.3. of the preamble of this proposed rule, we are proposing to indicate on the CC Exclusion List some updates to reflect the proposed exclusion of a few codes from being an MCC under the MS–DRG system that we are proposing to adopt for FY 2008. Table 6I (which is available through the Internet on the CMS Web site at: https://www.cms.hhs.gov/ AcuteInpatientPPS) contains the complete CC Exclusions List that will be effective for discharges occurring on or after October 1, 2007. Table 6I shows the principal diagnoses for which there is a CC exclusion. Each of these principal diagnoses is shown with an asterisk, and the conditions that will not count as a CC, are provided in an indented column immediately following the affected principal diagnosis. Tables 6G and 6H, Additions to and Deletions from the CC Exclusion List, respectively, are also available through the Internet on the CMS Web site at: https://www.cms.hhs.gov/ AcuteInpatientPPS.) Beginning with discharges on or after October 1, 2007, the indented diagnoses will not be recognized by the GROUPER as valid CCs for the asterisked principal diagnosis. Alternatively, the complete documentation of the GROUPER logic, including the current CC Exclusions List, is available from 3M/Health Information Systems (HIS), which, under contract with CMS, is responsible for updating and maintaining the GROUPER program. The current DRG Definitions Manual, Version 24.0, is available for $225.00, which includes $15.00 for shipping and handling. Version 25.0 of this manual, which will include the final FY 2008 DRG changes, will be available in hard copy for $250.00. Version 25.0 of the manual is also available on a CD for $200.00; a combination hard copy and CD is available for $400.00. These manuals may be obtained by writing 3M/HIS at the following address: 100 Barnes Road, Wallingford, CT 06492; or by calling (203) 949–0303. Please specify the revision or revisions requested. 9. Review of Procedure Codes in CMS DRGs 468, 476, and 477 Each year, we review cases assigned to CMS DRG 468 (Extensive O.R. Procedure Unrelated to Principal Diagnosis), CMS DRG 476 (Prostatic O.R. Procedure Unrelated to Principal VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Diagnosis), and CMS DRG 477 (Nonextensive O.R. Procedure Unrelated to Principal Diagnosis) to determine whether it would be appropriate to change the procedures assigned among these CMS DRGs. Under the MS–DRGs that we are proposing to adopt for FY 2008, discussed in section II.D. of the preamble of this proposed rule, CMS DRG 468 would have a three-way split and would become proposed MS–DRGs 981, 982, and 983 (Extensive O.R. Procedure Unrelated to Principal Diagnosis with MCC, with CC, and without CC/MCC). CMS DRG 476 would become proposed MS–DRGs 984, 985, and 986 (Prostatic O.R. Procedure Unrelated to Principal Diagnosis with MCC, with CC, and Without CC/MCC). CMS DRG 477 would become proposed MS–DRGs 987, 988, and 989 (Nonextensive O.R. Procedure Unrelated to Principal Diagnosis with MCC, with CC, and without CC/MCC). Proposed MS–DRGs 981 through 983, 984 through 986, and 987 through 989 (formerly CMS DRGs 468, 476, and 477, respectively) are reserved for those cases in which none of the O.R. procedures performed are related to the principal diagnosis. These CMS DRGs are intended to capture atypical cases, that is, those cases not occurring with sufficient frequency to represent a distinct, recognizable clinical group. Proposed MS–DRGs 984 through 986 (previously CMS DRG 476) are assigned to those discharges in which one or more of the following prostatic procedures are performed and are unrelated to the principal diagnosis: <bullet≤ 60.0, Incision of prostate <bullet≤ 60.12, Open biopsy of prostate <bullet≤ 60.15, Biopsy of periprostatic tissue <bullet≤ 60.18, Other diagnostic procedures on prostate and periprostatic tissue <bullet≤ 60.21, Transurethral prostatectomy <bullet≤ 60.29, Other transurethral prostatectomy <bullet≤ 60.61, Local excision of lesion of prostate <bullet≤ 60.69, Prostatectomy, not elsewhere classified <bullet≤ 60.81, Incision of periprostatic tissue <bullet≤ 60.82, Excision of periprostatic tissue <bullet≤ 60.93, Repair of prostate <bullet≤ 60.94, Control of (postoperative) hemorrhage of prostate <bullet≤ 60.95, Transurethral balloon dilation of the prostatic urethra <bullet≤ 60.96, Transurethral destruction of prostate tissue by microwave thermotherapy <bullet≤ 60.97, Other transurethral destruction of prostate tissue by other thermotherapy PO 00000 Frm 00061 Fmt 4701 Sfmt 4702 24739 <bullet≤ 60.99, Other operations on prostate All remaining O.R. procedures are assigned to proposed MS–DRGs 981 through 983 and 987 through 989 (previously CMS DRGs 468 and 477), with proposed MS–DRGs 987 through 989 (previously CMS DRG 477) assigned to those discharges in which the only procedures performed are nonextensive procedures that are unrelated to the principal diagnosis.15 For FY 2008, we are not proposing to change the procedures assigned among these CMS DRGs. a. Moving Procedure Codes From CMS DRG 468 (Proposed MS–DRGs 981 Through 983) or CMS DRG 477 (Proposed MS–DRGs 987 Through 989) to MDCs We annually conduct a review of procedures producing assignment to CMS DRG 468 (proposed MS–DRGs 981 through 983) or CMS DRG 477 (proposed MS–DRGs 987 through 989) on the basis of volume, by procedure, to see if it would be appropriate to move procedure codes out of these DRGs into one of the surgical DRGs for the MDC into which the principal diagnosis falls. The data are arrayed in two ways for comparison purposes. We look at a frequency count of each major operative procedure code. We also compare procedures across MDCs by volume of procedure codes within each MDC. We identify those procedures occurring in conjunction with certain principal diagnoses with sufficient frequency to justify adding them to one of the surgical DRGs for the MDC in which the diagnosis falls. Based on this 15 The original list of the ICD–9–CM procedure codes for the procedures we consider nonextensive procedures, if performed with an unrelated principal diagnosis, was published in Table 6C in section IV. of the Addendum to the FY 1989 final rule (53 FR 38591). As part of the FY 1991 final rule (55 FR 36135), the FY 1992 final rule (56 FR 43212), the FY 1993 final rule (57 FR 23625), the FY 1994 final rule (58 FR 46279), the FY 1995 final rule (59 FR 45336), the FY 1996 final rule (60 FR 45783), the FY 1997 final rule (61 FR 46173), and the FY 1998 final rule (62 FR 45981), we moved several other procedures from DRG 468 to DRG 477, and some procedures from DRG 477 to DRG 468. No procedures were moved in FY 1999, as noted in the final rule (63 FR 40962); in FY 2000 (64 FR 41496); in FY 2001 (65 FR 47064); or in FY 2002 (66 FR 39852). In the FY 2003 final rule (67 FR 49999) we did not move any procedures from DRG 477. However, we did move procedure codes from DRG 468 and place them in more clinically coherent DRGs. In the FY 2004 final rule (68 FR 45365), we moved several procedures from DRG 468 to DRGs 476 and 477 because the procedures are nonextensive. In the FY 2005 final rule (69 FR 48950), we moved one procedure from DRG 468 to 477. In addition, we added several existing procedures to DRGs 476 and 477. In the FY 2006 (70 FR 47317), we moved one procedure from DRG 468 and assigned it to DRG 477. In FY 2007, we moved one procedure from DRG 468 and assigned it to DRGs 479, 553, and 554. E:\FEDREG\03MYP2.LOC 03MYP2 24740 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules year’s review, we are not proposing to remove any procedures from CMS DRG 477 or CMS DRG 468 with assignment to one of the surgical DRGs. b. Reassignment of Procedures Among CMS DRGs 468, 476, and 477 (Proposed MS–DRGs 981 Through 983, 984 Through 986, and 987 Through 989) We also annually review the list of ICD–9–CM procedures that, when in combination with their principal diagnosis code, result in assignment to CMS DRGs 468, 476, and 477 (proposed MS–DRGs 981 through 983, 984 through 986, and 987 through 989, respectively), to ascertain whether any of those procedures should be reassigned from one of these three DRGs to another of the three DRGs based on average charges and the length of stay. We look at the data for trends such as shifts in treatment practice or reporting practice that would make the resulting DRG assignment illogical. If we find these shifts, we would propose to move cases to keep the DRGs clinically similar or to provide payment for the cases in a similar manner. Generally, we move only those procedures for which we have an adequate number of discharges to analyze the data. We are not proposing to move any procedure codes from CMS DRG 476 (proposed MS–DRGs 984, 985, and 986) to CMS DRG 468 (proposed MS–DRGs 981, 982, and 983) or to CMS DRG 477 (proposed MS–DRGs 987, 988, and 989), or from CMS DRG 477 (proposed MS– DRGs 987, 988, and 989) to CMS DRGs 468 (proposed MS–DRGs 981, 982, and 983) or to CMS DRG 476 (proposed MS– DRGs 984, 985, and 986) for FY 2008. mmaher on DSK3CLS3C1PROD with $$_JOB c. Adding Diagnosis or Procedure Codes to MDCs Based on our review this year, we are not proposing to add any diagnosis codes to MDCs for FY 2008. 10. Changes to the ICD–9–CM Coding System (If you choose to comment on issues in this section, please include the caption ‘‘ICD–9–CM Coding System’’ at the beginning of your comment.) As described in section II.B.1. of this preamble, the ICD–9–CM is a coding system used for the reporting of diagnoses and procedures performed on a patient. In September 1985, the ICD– 9–CM Coordination and Maintenance Committee was formed. This is a Federal interdepartmental committee, co-chaired by the National Center for Health Statistics (NCHS), the Centers for Disease Control and Prevention, and CMS, charged with maintaining and updating the ICD–9–CM system. The VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Committee is jointly responsible for approving coding changes, and developing errata, addenda, and other modifications to the ICD–9–CM to reflect newly developed procedures and technologies and newly identified diseases. The Committee is also responsible for promoting the use of Federal and non-Federal educational programs and other communication techniques with a view toward standardizing coding applications and upgrading the quality of the classification system. The Official Version of the ICD–9–CM contains the list of valid diagnosis and procedure codes. (The Official Version of the ICD–9–CM is available from the Government Printing Office on CD– ROM for $25.00 by calling (202) 512– 1800.) The Official Version of the ICD– 9–CM is no longer available in printed manual form from the Federal Government; it is only available on CD– ROM. Users who need a paper version are referred to one of the many products available from publishing houses. The NCHS has lead responsibility for the ICD–9–CM diagnosis codes included in the Tabular List and Alphabetic Index for Diseases, while CMS has lead responsibility for the ICD–9–CM procedure codes included in the Tabular List and Alphabetic Index for Procedures. The Committee encourages participation in the above process by health-related organizations. In this regard, the Committee holds public meetings for discussion of educational issues and proposed coding changes. These meetings provide an opportunity for representatives of recognized organizations in the coding field, such as the American Health Information Management Association (AHIMA), the American Hospital Association (AHA), and various physician specialty groups, as well as individual physicians, health information management professionals, and other members of the public, to contribute ideas on coding matters. After considering the opinions expressed at the public meetings and in writing, the Committee formulates recommendations, which then must be approved by the agencies. The Committee presented proposals for coding changes for implementation in FY 2008 at a public meeting held on September 28–29, 2006, and finalized the coding changes after consideration of comments received at the meetings and in writing by December 4, 2006. Those coding changes are announced in Tables 6A through 6F in the Addendum to this proposed rule. The Committee held its 2007 meeting on March 22–23, 2007. Proposed new codes for which PO 00000 Frm 00062 Fmt 4701 Sfmt 4702 there was a consensus of public support and for which complete tabular and indexing changes can be made by May 2007 will be included in the October 1, 2007 update to ICD–9–CM. Code revisions that were discussed at the March 22–23, 2007 Committee meeting could not be finalized in time to include them in the Addendum to this proposed rule. These additional codes will be included in Tables 6A through 6F of the final rule and are marked with an asterisk (*). Copies of the minutes of the procedure codes discussions at the Committee’s September 28–29, 2006 meeting can be obtained from the CMS Web site at: https://cms.hhs.gov/ ICD9ProviderDiagnosticCodes/03— meetings.asp. The minutes of the diagnosis codes discussions at the September 28–29, 2006 meeting are found at: https://www.cdc.gov/nchs/ icd9.htm. Paper copies of these minutes are no longer available and the mailing list has been discontinued. These Web sites also provide detailed information about the Committee, including information on requesting a new code, attending a Committee meeting, and timeline requirements and meeting dates. We encourage commenters to address suggestions on coding issues involving diagnosis codes to: Donna Pickett, CoChairperson, ICD–9–CM Coordination and Maintenance Committee, NCHS, Room 2402, 3311 Toledo Road, Hyattsville, MD 20782. Comments may be sent by E-mail to: dfp4@cdc.gov. Questions and comments concerning the procedure codes should be addressed to: Patricia E. Brooks, CoChairperson, ICD–9–CM Coordination and Maintenance Committee, CMS, Center for Medicare Management, Hospital and Ambulatory Policy Group, Division of Acute Care, C4–08–06, 7500 Security Boulevard, Baltimore, MD 21244–1850. Comments may be sent by E-mail to: patricia.brooks2@cms.hhs.gov. The ICD–9–CM code changes that have been approved will become effective October 1, 2007. The new ICD– 9–CM codes are listed, along with their DRG classifications, in Tables 6A and 6B (New Diagnosis Codes and New Procedure Codes, respectively) in the Addendum to this proposed rule. As we stated above, the code numbers and their titles were presented for public comment at the ICD–9–CM Coordination and Maintenance Committee meetings. Both oral and written comments were considered before the codes were approved. In this proposed rule, we are only soliciting E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules comments on the proposed classification of these new codes. For codes that have been replaced by new or expanded codes, the corresponding new or expanded diagnosis codes are included in Table 6A. New procedure codes are shown in Table 6B. Diagnosis codes that have been replaced by expanded codes or other codes or have been deleted are in Table 6C (Invalid Diagnosis Codes). These invalid diagnosis codes will not be recognized by the GROUPER beginning with discharges occurring on or after October 1, 2007. Table 6D contains invalid procedure codes. These invalid procedure codes will not be recognized by the GROUPER beginning with discharges occurring on or after October 1, 2007. Revisions to diagnosis code titles are in Table 6E (Revised Diagnosis Code Titles), which also includes the DRG assignments for these revised codes. Table 6F includes revised procedure code titles for FY 2008. In the September 7, 2001 final rule implementing the IPPS new technology add-on payments (66 FR 46906), we indicated we would attempt to include proposals for procedure codes that would describe new technology discussed and approved at the Spring meeting as part of the code revisions effective the following October. As stated previously, ICD–9–CM codes discussed at the March 22–23, 2007 Committee meeting that received consensus and that were finalized by May 2007, will be included in Tables 6A through 6F of the Addendum to the final rule. Section 503(a) of Pub. L. 108–173 included a requirement for updating ICD–9–CM codes twice a year instead of a single update on October 1 of each year. This requirement was included as part of the amendments to the Act relating to recognition of new technology under the IPPS. Section 503(a) amended section 1886(d)(5)(K) of the Act by adding a clause (vii) which states that the ‘‘Secretary shall provide for the addition of new diagnosis and procedure codes on April 1 of each year, but the addition of such codes shall not require the Secretary to adjust the payment (or diagnosis-related group classification) * * * until the fiscal year that begins after such date.’’ This requirement improves the recognition of new technologies under the IPPS system by providing information on these new technologies at an earlier date. Data will be available 6 months earlier than would be possible with updates occurring only once a year on October 1. While section 1886(d)(5)(K)(vii) of the Act states that the addition of new VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 diagnosis and procedure codes on April 1 of each year shall not require the Secretary to adjust the payment, or DRG classification, under section 1886(d) of the Act until the fiscal year that begins after such date, we have to update the DRG software and other systems in order to recognize and accept the new codes. We also publicize the code changes and the need for a mid-year systems update by providers to identify the new codes. Hospitals also have to obtain the new code books and encoder updates, and make other system changes in order to identify and report the new codes. The ICD–9–CM Coordination and Maintenance Committee holds its meetings in the spring and fall in order to update the codes and the applicable payment and reporting systems by October 1 of each year. Items are placed on the agenda for the ICD–9–CM Coordination and Maintenance Committee meeting if the request is received at least 2 months prior to the meeting. This requirement allows time for staff to review and research the coding issues and prepare material for discussion at the meeting. It also allows time for the topic to be publicized in meeting announcements in the Federal Register as well as on the CMS Web site. The public decides whether or not to attend the meeting based on the topics listed on the agenda. Final decisions on code title revisions are currently made by March 1 so that these titles can be included in the IPPS proposed rule. A complete addendum describing details of all changes to ICD–9–CM, both tabular and index, is publicized on CMS and NCHS Web sites in May of each year. Publishers of coding books and software use this information to modify their products that are used by health care providers. This 5-month time period has proved to be necessary for hospitals and other providers to update their systems. A discussion of this timeline and the need for changes are included in the December 4–5, 2005 ICD–9–CM Coordination and Maintenance Committee minutes. The public agreed that there was a need to hold the fall meetings earlier, in September or October, in order to meet the new implementation dates. The public provided comment that additional time would be needed to update hospital systems and obtain new code books and coding software. There was considerable concern expressed about the impact this new April update would have on providers. In the FY 2005 IPPS final rule, we implemented section 1886(d)(5)(K)(vii) of the Act, as added by section 503(a) PO 00000 Frm 00063 Fmt 4701 Sfmt 4702 24741 of Pub. L. 108–173, by developing a mechanism for approving, in time for the April update, diagnosis and procedure code revisions needed to describe new technologies and medical services for purposes of the new technology add-on payment process. We also established the following process for making these determinations. Topics considered during the Fall ICD–9–CM Coordination and Maintenance Committee meeting are considered for an April 1 update if a strong and convincing case is made by the requester at the Committee’s public meeting. The request must identify the reason why a new code is needed in April for purposes of the new technology process. The participants at the meeting and those reviewing the Committee meeting summary report are provided the opportunity to comment on this expedited request. All other topics are considered for the October 1 update. Participants at the Committee meeting are encouraged to comment on all such requests. There were no requests for an expedited April l, 2007 implementation of an ICD–9–CM code at the September 28–29, 2006 Committee meeting. Therefore, there were no new ICD–9–CM codes implemented on April 1, 2007. We believe that this process captures the intent of section 1886(d)(5)(K)(vii) of the Act. This requirement was included in the provision revising the standards and process for recognizing new technology under the IPPS. In addition, the need for approval of new codes outside the existing cycle (October 1) arises most frequently and most acutely where the new codes will identify new technologies that are (or will be) under consideration for new technology addon payments. Thus, we believe this provision was intended to expedite data collection through the assignment of new ICD–9–CM codes for new technologies seeking higher payments. Current addendum and code title information is published on the CMS Web site at: https://www.cms.hhs.gov/ icd9ProviderDiagnosticCodes/01— overview.asp#TopofPage. Information on ICD–9–CM diagnosis codes, along with the Official ICD–9–CM Coding Guidelines, can be found on the Web site at: https://www.cdc.gov/nchs/ icd9.htm. Information on new, revised, and deleted ICD–9–CM codes is also provided to the AHA for publication in the Coding Clinic for ICD–9–CM. AHA also distributes information to publishers and software vendors. CMS also sends copies of all ICD–9– CM coding changes to its contractors for E:\FEDREG\03MYP2.LOC 03MYP2 24742 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules use in updating their systems and providing education to providers. These same means of disseminating information on new, revised, and deleted ICD–9–CM codes will be used to notify providers, publishers, software vendors, contractors, and others of any changes to the ICD–9–CM codes that are implemented in April. The code titles are adopted as part of the ICD–9–CM Coordination and Maintenance Committee process. Thus, although we publish the code titles in the IPPS proposed and final rules, they are not subject to comment in the proposed or final rules. We will continue to publish the October code updates in this manner within the IPPS proposed and final rules. For codes that are implemented in April, we will assign the new procedure code to the same DRG in which its predecessor code was assigned so there will be no DRG impact as far as DRG assignment. This mapping was specified by section 1886(d)(5)(K)(vii) of the Act as added by section 503(a) of Pub. L. 108–173. Any midyear coding updates will be available through the Web sites indicated above and through the Coding Clinic for ICD–9–CM. Publishers and software vendors currently obtain code changes through these sources in order to update their code books and software systems. We will strive to have the April 1 updates available through these Web sites 5 months prior to implementation (that is, early November of the previous year), as is the case for the October 1 updates. 11. Other Issues (If you choose to comment on issues in this section, please include the caption ‘‘DRGs: Headaches and Seizures’’ at the beginning of your comment.) a. Seizures and Headaches After publication of the FY 2007 IPPS final rule (71 FR 47928), we received correspondence expressing concerns about the revisions we made to the seizure and headache DRGs effective on October 1, 2006. We created new DRGs 562 (Seizure Age ≤17 With CC), DRG 563 (Seizure Age ≤17 Without CC), and DRG 564 (Headaches Age ≤17) as an interim step to better recognize severity of illness among seizure and headache patients for FY 2007. Although national Medicare utilization data supported the revised DRGs, the commenter indicated that the change did not appropriately recognize hospital resources associated with the patients treated in the hospital’s inpatient headache program. The commenter stated that patients who are admitted to the hospital’s inpatient headache program suffer from chronic headache pain and require inpatient treatment that can last up to 12 days. The commenter noted that these patients are referred from around the country after several months of Number of cases Proposed MS–DRG mmaher on DSK3CLS3C1PROD with $$_JOB MS–DRG 102 (Headaches with MCC) ........................................................................................ MS–DRG 103 (Headaches without MCC) ................................................................................... (The criteria for determining whether to subdivide a DRG are described in detail earlier in section II.D. of the preamble of this proposed rule.) Thus, we are proposing to create two MS– DRGs for headaches under the MS– DRGs as shown below: <bullet≤ Proposed MS–DRG 102 (Headaches With MCC) <bullet≤ Proposed MS–DRG 103 (Headaches Without MCC) We believe this proposed structure would better recognize those headaches patients who are severely ill and require more resources as described by the commenter. We refer the readers to section II.D. of the preamble of this proposed rule for a detailed discussion of the MS–DRG proposal. b. Devices That Are Replaced Without Cost or Where Credit for a Replaced Device Is Furnished to the Hospital (If you choose to comment on issues in this section, please include the VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 caption ‘‘Replaced Devices’’ at the beginning of your comment.) (1) Background We addressed the topic of Medicare payment for devices that are replaced without costs or where credit for a replaced device is furnished to the hospital in the FY 2007 IPPS final rule (71 FR 47962). In that final rule, we included the following background information: In recent years, there have been several field actions and recalls with regard to failure of implantable cardiac defibrillators (ICDs) and pacemakers. In many of these cases, the manufacturers have offered replacement devices without cost to the hospital or credit for the device being replaced if the patient required a more expensive device. In some circumstances, manufacturers have also offered, through a warranty package, to pay specified amounts for PO 00000 Frm 00064 unsuccessful pain relief and treatment. The commenter indicated that the majority of patients treated at the hospital’s inpatient headache program are drug dependent from being administered increasing dosages of pain relievers that have been unsuccessful in resolving chronic headache pain. Further, the commenter noted that the patients require detoxification before any headache treatment begins. The commenter urged CMS to subdivide the headache DRG to better recognize the higher level of severity associated with treating chronic headache patients in the hospital’s program. Although we are sympathetic to the commenter, it is not feasible to design a DRG system that addresses concerns that may be unique to one facility. Other than this one commenter, we did not receive any concern about our decision to create separate DRGs for seizures and headaches. However, we agreed to review this issue as part of our effort to redesign the DRG system to better recognize severity of illness for FY 2008. As discussed in section II.C. of the preamble of this proposed rule, we are proposing to adopt MS–DRGs for FY 2008. While our current DRG structure did not support splitting the headache DRG based on the presence or absence of a CC, the proposed MS–DRGs support the creation of a split for the headache DRGs based on whether the patient has an MCC as shown below: Fmt 4701 Sfmt 4702 1,268 14,277 Average length of stay 5.04 3.22 Average charges 19,077.33 11,989.43 unreimbursed expenses to persons who had replacement devices implanted. Nonetheless, we believe that incidental device failures that are covered by manufacturer warranties occur routinely. While we understand that some device malfunctions may be inevitable as medical technology grows increasingly sophisticated, we believe that early recognition of problems would reduce the number of people who would be potentially adversely affected by these device problems. The medical community needs heightened and early awareness of patterns of device failures, voluntary field actions, and recalls so that it can take appropriate corrective action to care for patients. Systematic efforts must be undertaken by all interested and involved parties, including manufacturers, insurers, and the medical community, to ensure that E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules device problems are recognized, and are addressed as early as possible so that patients’ quality of health care is protected and high quality medical care, equipment, and technologies are provided. We are taking several steps to assist in the early recognition and analysis of patterns of device problems to minimize the potential for harm from device-related defects to Medicare beneficiaries and the public in general. In recent years, CMS has recognized the importance of data collection as a condition of Medicare coverage for selected services. In 2005, we issued an NCD that expanded coverage of ICDs and also required registry participation when the devices were implanted for certain clinical indications. The NCD included this requirement in order to ensure that the medical care received by Medicare beneficiaries was reasonable and necessary and, therefore, that the provider or supplier would be appropriately paid. Presently, the American College of Cardiology— National Cardiovascular Data Registry (ACC–NCDR) collects these data and maintains the registry. In addition to ensuring appropriate payment of claims, collection, and ongoing analysis of ICD implantation, registry data can facilitate public response to the quality of health care issues in the event of future device recalls. Analysis of registry data may uncover patterns of device malfunction, device-related infection, or early battery depletion that would trigger a more specific investigation. Patterns found in registry data may identify problems in patient outcomes earlier than the currently available mechanisms, which do not systematically collect detailed information about each patient who receives an ICD. We encourage the medical community to work to develop additional registries for implantable devices, so that timely and comprehensive information is available regarding devices, recipients of those devices, and patients’ quality of health care status and medical outcomes. While participation in an ICD registry is required as a Medicare condition of coverage for ICD implantation for certain clinical conditions, we believe that the potential benefits of other data collection extend well beyond their application in Medicare’s specific NCDs. As medical technology continues to advance swiftly, data collection regarding the short-term and long-term medical outcomes of new technologies, especially concerning implanted devices that may remain in the bodies of patients for their lifetimes, will be essential to the timely recognition of VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 any specific device-related problems, patterns of complications, and healthrelated outcomes. This information will facilitate early interventions to mitigate any harm potentially imposed upon Medicare beneficiaries and the public, and to improve the quality and efficiency of health care services provided. Moreover, published data from registries may further help the development of high quality, evidencebased clinical practice guidelines for the care of patients who may receive device implants. In turn, widespread use of evidence-based guidelines may reduce variation in medical practice, leading to improved personal care and overall public health. Registry information may also contribute to the development of more comprehensive and refined quality metrics that may be used to systematically assess the collected data, and then improve the safety and quality of health care provided to Medicare beneficiaries. Such improvements in the quality of care that result in better personal health will require the sustained commitment of industry, payers, health care providers, and others to progressively work towards that goal, and to ensure excellent and open communication and rapid systemwide responses. One strategy for this data collection involves adding information to the claims forms. CMS has a long history of collecting hemoglobin or hematocrit data from ESRD patients on the claims form. Modification of claims forms was necessary to do that. CMS is exploring the use of claims data to collect other types of clinical or technical data such as device manufacturer and model number. The systematic recording of model numbers can enhance knowledge of device-related outcomes and complications. We look forward to further discussions with the public about new strategies to both recognize device-related problems early as well as recognize health-related outcomes of new technologies. In addition, we believe that the routine identification of Medicare claims for certain device implantation procedures in situations where a payment adjustment is appropriate may enhance the medical community’s recognition of device-related problems, potentially leading to more timely improvements in medical device technologies. This systematic approach, which enables hospitals to identify and then appropriately report selected services when devices are replaced without cost to the hospital, or with full or partial credit to the hospital for the cost of the replaced device, should PO 00000 Frm 00065 Fmt 4701 Sfmt 4702 24743 provide comprehensive information regarding the hospitals’ experiences with Medicare beneficiaries who have specific medical devices that are being replaced. Because Medicare beneficiaries are common recipients of implanted devices, the claims information may be particularly helpful in identifying patterns of device-related problems early in their natural history, so that appropriate strategies to reduce future problems may be developed. One possible strategy would be for the Medicare program to use information obtained through the use of bar coding of medical devices. The FDA issued a final rule in the Federal Register on February 26, 2004 (69 FR 9119), that required bar codes for human drugs and biological product labels effective April 26, 2006. In the final rule, FDA deferred action on requiring bar codes for medical devices, noting the difficulty in standardizing medical devices, as compared to drugs and biologicals, which have the unique NDC numbering system. This rule can be reviewed on the Federal Register’s Web site at: https://www.docket.access.gpo.gov/2004/ 04-4249.htm. We intend to monitor FDA’s work in this area to determine how this technology could help CMS promote higher quality through better clinical decision making and, as discussed below, assist in improving the accuracy of the Medicare payment system. In addition to our concern for overall public health, we also have a fiduciary responsibility to the Medicare Trust Fund to ensure that Medicare pays only for covered services. Therefore, in the FY 2007 IPPS final rule, we indicated that we believe we need to consider whether it is appropriate to reduce the Medicare payment in cases in which an implanted device is replaced at reduced or no cost to the hospital or with partial or full credit for the removed device. Such consideration could cover certain devices for which credit for the replaced medical device is given, or medical devices that are replaced as a result of or pursuant to a warranty, field action, voluntary recall, or involuntary recall, and medical devices that are provided free of charge. We indicated that conveying this information to the Medicare beneficiary could provide for a reduction in the IPPS payment if we determine that the device is replaced without cost to the provider or beneficiary or when the provider receives full credit for the cost of a replaced device. In FY 2007 IPPS final rule, we indicated a need to develop a methodology to determine the amount of the reduction to the otherwise E:\FEDREG\03MYP2.LOC 03MYP2 24744 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules payable IPPS payment for medical devices furnished to Medicare beneficiaries. We believe that this policy is appropriate because, in these cases, the full cost of the replaced device is not incurred and, therefore, an adjustment to the payment is necessary to remove the cost of the device. (2) Current and Proposed Policies In the CY 2007 OPPS final rule (71 FR 68071 through 68077), we adopted a policy that requires a reduced payment to a hospital or ambulatory surgical center when a device is provided to them at no cost. From our experience with the OPPS, we understand that a manufacturer will often provide a credit or partial credit for the recalled device rather than a free replacement. In other situations, a manufacturer will provide either a full or partial credit for a device that needs to be replaced only during the manufacturer’s warranty period. In either of these situations, the original implantation of the device was paid for either by Medicare, another third party on behalf of the beneficiary by making payment directly to the hospital, or the implantation was paid for directly by the beneficiary. Therefore, we believe that Medicare should not pay the hospital for the full cost of the replacement if the hospital is receiving a partial or full credit, either due to a recall or service during the warranty period. The device was already paid for at the time of initial implantation, and Medicare should retain the credit that is being provided to the hospital for service to a Medicare beneficiary. Moreover, we also believe that a proposed adjustment is consistent with section 1862(a)(2) of the Act, which excludes from Medicare coverage an item or service for which neither the beneficiary, nor anyone on his or her behalf, has an obligation to pay. Payment of the full IPPS payment amount in cases in which the device was replaced under warranty or in which there was a full or partial credit for the price of the recalled or failed device effectively results in Medicare payment for a noncovered item. Therefore, we are proposing to adjust the IPPS payment amount in these circumstances under the authority of section 1886(d)(5)(I) of the Act, which permits the Secretary to make ‘‘exceptions and adjustments to such payment amounts * * * as the Secretary deems appropriate.’’ Under the OPPS, we currently only apply the reduced payment amount in situations where the hospital received a replacement device at no cost or at full credit for the replacement device. Unlike the current OPPS policy, we are proposing for purposes of the IPPS to apply the policy for partial as well as full credit for a replacement device. As we indicated above, our experience with the OPPS suggests that the policy should be applied beyond full replacement of a recalled device. We are proposing to reduce the amount of the Medicare IPPS payment when a full or partial credit towards a replacement device is made or the device is replaced without cost to the hospital or with full credit for the removed device. However, we do not believe that the IPPS policy should apply to all DRGs and all situations in which a device is replaced without cost to the hospital for the device or with full or partial credit for the removed device. We recognize that, in many cases, the cost of the device is a relatively modest part of the IPPS payment. In other situations, we believe the amount of the credit will also be nominal. In these cases, we believe that the averaging nature of payments under the IPPS would incorporate any significant savings from a warranty replacement, field action, or recall into the payment rate for the associated DRG, and that no specific adjustment would be necessary or appropriate. For this reason, we are proposing to apply the policy only to those DRGs under the IPPS where the implantation of the device determines the base DRG assignment and situations where the hospital received a credit equal to 20 percent or more of the cost of the device. We believe a credit that is equal to or more than this percentage is substantial, and Medicare should not pay for the full cost of these replacement devices because hospitals have received significant savings from the manufacturer for its replacement costs. We are seeking comment on the application of this percentage amount. We further believe that it is appropriate to limit application of the policy only to those DRGs where implantation of the device determines the DRG assignment. In making a decision to assign a case based on whether a device was implanted, we recognized that the device cost was a significant portion of the overall costs faced by the hospital that treats the case. Therefore, we believe that Medicare should not make full payment for those DRGs where the assignment of the case is made based on implantation of the device when the hospital is receiving either a full or significant partial credit for the device. We have listed the CMS DRGs that would be subject to this proposed policy below. We have also listed, in parentheses after the CMS DRG title, the proposed new MS–DRG title to which these cases would be assigned. CMS DRGS SUBJECT TO PROPOSED POLICY MDC CMS DRG Narrative Description of DRG 103 1 ........... 1 1 ........... 2 1 ........... 7 1 ........... mmaher on DSK3CLS3C1PROD with $$_JOB PRE ..... 8 1 ........... 543 3 ........... 49 5 ........... 104 VerDate Mar 15 2010 Heart Transplant or Implant of Heart Assist System (Proposed MS–DRGs 1 and 2, Heart Transplant or Implant of Heart Assist System With and Without MCC, respectively). Craniotomy Age ≤ 17 With CC (Proposed MS–DRG 25 and 26, Craniotomy and Endovascular Intracranial Procedure With MCC or Without CC, respectively). Craniotomy Age ≤ 17 Without CC (Proposed MS–DRGs 26 and 27, Craniotomy and Endovascular Intracranial Procedure Without CC/MCC). Peripheral & Cranial Nerve & Other Nervous System Procedures With CC (Proposed MS–DRGs 40 and 41, Peripheral & Cranial Nerve & Other Nervous System Procedure With MCC or With CC, respectively). Peripheral & Cranial Nerve & Other Nervous System Procedures Without CC (Proposed MS–DRG 42, Peripheral & Cranial Nerve & Other Nervous System Procedure Without CC/MCC). Craniotomy With Major Device Implant or Acute Complex Central Nervous System Principal Diagnosis (Proposed MS– DRGs 23 and 24, Craniotomy with Major Device Implant or Acute Complex Central Nervous System Principal Diagnosis With and Without MCC, respectively). Major Head & Neck Procedures (Proposed MS–DRGs 129 and 130, Major Head & Neck Procedures With CC/MCC or Major Device or Without CC/MCC, respectively). Cardiac Valve & Other Major Cardiothoracic Procedures with Cardiac Catheterization (Proposed MS–DRGs 216, 217, and 218, Cardiac Valve & Other Major Cardiothoracic Procedure With Cardiac Catheterization With MCC, or Without CC, or Without CC/MCC, respectively). 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00066 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24745 CMS DRGS SUBJECT TO PROPOSED POLICY—Continued MDC CMS DRG 105 5 ........... 5 ........... 5 ........... 110 111 117 5 ........... 118 5 ........... 515 5 ........... 5 ........... 525 535 5 ........... 536 5 ........... 551 5 ........... 552 8 ........... 471 8 ........... 544 8 ........... mmaher on DSK3CLS3C1PROD with $$_JOB 5 ........... 545 Narrative Description of DRG Cardiac Valve & Other Major Cardiothoracic Procedures Without Cardiac Catheterization (Proposed MS–DRGs 219, 220, and 221, Cardiac Valve & Other Major Cardiothoracic Procedure Without Cardiac Catheterization With MCC, or With CC, or Without CC/MCC, respectively). Major Cardiovascular Procedures With CC (Proposed MS–DRG 237, Major Cardiovascular Procedures With MCC). Major Cardiovascular Procedures Without CC (Proposed MS–DRG 238, Major Cardiovascular Procedures Without MCC). Cardiac Pacemaker Revision Except Device Replacement (Proposed MS–DRGs 260, 261, and 262, Cardiac Pacemaker Revision Except Device Replacement With MCC, or With CC, or Without CC/MCC, respectively). Cardiac Pacemaker Device Replacement (Proposed MS–DRGs 258 and 259, Cardiac Pacemaker Device Replacement With MCC, and Without MCC, respectively). Cardiac Defibrillator Implant Without Cardiac Catheterization (Proposed MS–DRGs 226 and 227, Cardiac Defibrillator Implant Without Cardiac Catheterization With MCC and Without MCC, respectively). Other Heart Assist System Implant (Proposed MS–DRG 215, Other Heart Assist System Implant). Cardiac Defibrillator Implant With Cardiac Catheterization With Acute Myocardial Infarction/Heart Failure/Shock (Proposed MS–DRGs 222 and 223, Cardiac Defibrillator Implant With Cardiac Catheterization With Acute Myocardial Infarction/ Heart Failure/Shock With MCC and Without MCC, respectively). Cardiac Defibrillator Implant With Cardiac Catheterization Without Acute Myocardial Infarction/Heart Failure/Shock (Proposed MS–DRGs 224 and 225, Cardiac Defibrillator Implant With Cardiac Catheterization Without Acute Myocardial Infarction/Heart Failure/Shock With MCC and Without MCC, respectively). Permanent Cardiac Pacemaker Implant With Major Cardiovascular Diagnosis or AICD Lead or Generator (Proposed MS– DRGs 242, 243, and 244, Permanent Cardiac Pacemaker Implant With MCC, With CC, and Without CC/MCC, respectively). Other Permanent Cardiac Pacemaker Implant Without Major Cardiovascular Diagnosis (Proposed MS–DRGs 242, 243, and 244, Permanent Cardiac Pacemaker Implant With MCC, With CC, and Without CC/MCC, respectively). Bilateral or Multiple Major Joint Procedures of Lower Extremity (Proposed MS–DRGs 461 and 462, Bilateral or Multiple Major Joint Procedures of Lower Extremity With MCC, or Without MCC, respectively). Major Joint Replacement or Reattachment of Lower Extremity (Proposed MS–DRGs 469 and 470, Major Joint Replacement or Reattachment of Lower Extremity With MCC or Without MCC, respectively). Revision of Hip or Knee Replacement (Proposed MS–DRGs 466, 467, and 468, Revision of Hip or Knee Replacement With MCC, With CC, or Without CC/MCC, respectively). CMS has requested and received new condition codes from the National Uniform Billing Committee to describe claims where a provider has received a device or product without cost. We will use these condition codes to reduce payment when the hospital used a device for which full or partial credit is given, or the item was replaced as a result of or under a warranty, field action, voluntary recall, involuntary recall, or otherwise provided free of charge. On November 4, 2005, we issued Change Request 4058, Transmittal 741, in the Medicare Claims Processing Manual. The effective date of this transmittal was April 1, 2006, and the implementation date was April 3, 2006. This transmittal specifies that the following two new condition codes have been created. They are defined below: <bullet≤ Condition Code 49—Product Replacement within Product Lifecycle. Replacement of a product earlier than the anticipated lifecycle due to an indication that the product is not functioning properly. <bullet≤ Condition Code 50—Product Replacement for Known Recall of a Product. The manufacturer or the FDA has identified the product for recall and therefore replacement. Hospitals must report these codes on any claim for IPPS services that includes a replacement device or VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 product for which they received full or partial credit. Hospital billing offices would report one of these condition codes in addition to the specific code for the type of procedure performed (for example, replacement of a defibrillator). When this code is received by Medicare and the discharge is assigned to a DRG that is subject to this policy, we are proposing to suspend the claim so that it does not automatically process and the fiscal intermediary (or, if applicable, the MAC) makes a manual payment determination. We are proposing to require the hospital to provide invoices or other information indicating its normal cost of the device and the amount of the credit it received. This transmittal can be accessed at the following Web site: https:// www.cms.hhs.gov/Transmittals/ downloads/R741CP.pdf. Under our policy, the fiscal intermediary (or, if applicable, the MAC) would manually process claims involving DRGs that are subject to this policy that include a device that is replaced without cost to the hospital for the device or with full or partial credit for the removed device as identified by condition codes 49 or 50. For a device provided to the hospital without cost, the fiscal intermediary (or, if applicable, the MAC) would subtract the cost of the device from the DRG payment. For a PO 00000 Frm 00067 Fmt 4701 Sfmt 4702 device for which the hospital received a full or partial credit, the fiscal intermediary (or, if applicable, the MAC) would subtract the amount credited from the DRG payment. We are proposing to require the hospital to provide invoices or other information indicating the cost of the device and the amount of credit it received. We are seeking comment on the best approach to making this payment adjustment and what types of documentation hospitals should provide to the fiscal intermediary or MAC. We are proposing to invoke our special exceptions and adjustment authority under section 1886(d)(5)(I)(i) of the Act to make this adjustment. The special exceptions and adjustment authority authorizes us to provide ‘‘for such other exceptions and adjustments to [IPPS] payment amounts* * *as the Secretary deems appropriate.’’ We believe it would be appropriate to adjust payments for surgical procedures to replace certain devices by providing payments to hospitals only for the nondevice-related procedural costs when such a device is replaced without cost to the hospital for the device or with full credit for the removed device. To codify in regulations the proposed policies for the IPPS discussed above, we are proposing to add a new paragraph (g) to § 412.2 and a new E:\FEDREG\03MYP2.LOC 03MYP2 24746 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB § 412.89 to 42 CFR Part 412, Subpart F. We are also proposing to make a technical, conforming change to the heading of Subpart F and to add an uncoded center heading before the proposed new § 412.89. H. Recalibration of DRG Weights (If you choose to comment on issues in this section, please include the caption ‘‘Recalibration of DRG Weights’’ at the beginning of your comment.) In section II.D.3. of the preamble of this proposed rule, we stated that we are proposing to continue to implement the cost-based DRG relative weights under a 3-year transition period such that, in FY 2008, year two of the transition, the relative weights would be recalibrated using a blend of 67 percent of the cost relative weight and 33 percent of the charge relative weight. By FY 2009, the relative weights will be 100 percent cost-based. We are proposing a few minor changes to the cost-weighting methodology that we adopted in the FY 2007 IPPS final rule (71 FR 47962 through 47971). However, in section II.E.2. of the preamble of this proposed rule, we request public comments about whether to adopt any of the short-term recommendations to the cost relative weighting methodology for FY 2008 made by RTI. Therefore, if we were to adopt any of the RTI recommendations based on public comment, our description of the cost-weighting methodology shown below would be modified accordingly in the IPPS final rule. In developing the FY 2008 proposed system of weights, we used two data sources: claims data and cost report data. As in previous years, the claims data source is the MedPAR file. This file is based on fully coded diagnostic and procedure data for all Medicare inpatient hospital bills. The FY 2006 MedPAR data used in this proposed rule include discharges occurring on October 1, 2005, through September 30, 2006, based on bills received by CMS through December 2006, from all hospitals subject to the IPPS and short-term acute care hospitals in Maryland (which are under a waiver from the IPPS under section 1814(b)(3) of the Act). The FY 2006 MedPAR file used in calculating the relative weights includes data for approximately 11,748,387 Medicare discharges from IPPS providers. Discharges for Medicare beneficiaries enrolled in a Medicare Advantage managed care plan are excluded from this analysis. The data exclude CAHs, including hospitals that subsequently became CAHs after the period from which the data were taken. The second data source used in the cost relative weight methodology is the FY 2005 VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Medicare cost report data files from HCRIS, which represents the most recent full set of cost report data available. We used the December 31, 2006 update of the HCRIS cost report files for FY 2005 in setting the proposed relative cost based weights. Because we are implementing the relative weights on a transitional basis, it is necessary to calculate both chargebased and cost-based relative weights. The charge-based methodology used to calculate the DRG relative weights from the MedPAR data is the same methodology that was in place for FY 2006 and FY 2007 and was applied as follows: <bullet≤ To the extent possible, all the claims were regrouped using the MS– DRGs being proposed for FY 2008, as discussed in section II.D. of this preamble. <bullet≤ The transplant cases that were used to establish the relative weight for heart and heart-lung, liver and/or intestinal, and lung transplants (proposed MS–DRGs 001, 002, 005, 006, and 007, respectively; previously CMS DRGs 103, 480, and 495) were limited to those Medicare-approved transplant centers that have cases in the FY 2005 MedPAR file. (Medicare coverage for heart, heart-lung, liver and/or intestinal, and lung transplants is limited to those facilities that have received approval from CMS as transplant centers.) <bullet≤ Organ acquisition costs for kidney, heart, heart-lung, liver, lung, pancreas, and intestinal (or multivisceral organs) transplants continue to be paid on a reasonable cost basis. Because these acquisition costs are paid separately from the IPPS rates, it was necessary to subtract the acquisition charges from the total charges on each transplant bill that showed acquisition charges before computing the average charge for the DRG and before eliminating statistical outliers. <bullet≤ Total charges were standardized to remove the effects of differences in area wage levels, indirect medical education and disproportionate share payments, and, for hospitals in Alaska and Hawaii, the applicable costof-living adjustment. <bullet≤ Statistical outliers were eliminated by removing all cases that were beyond 3.0 standard deviations from the mean of the log distribution of both the standardized charges per case and the standardized charges per day for each DRG. <bullet≤ The average charge for each DRG was then recomputed (excluding the statistical outliers). To compute the average DRG charge, we sum the standardized charges by DRG and divide by the transfer adjusted case count. A PO 00000 Frm 00068 Fmt 4701 Sfmt 4702 transfer case is counted as a fraction of a case based on the ratio of its transfer payment under the per diem payment methodology to the full DRG payment for nontransfer cases. That is, a transfer case receiving payment under the transfer methodology equal to half of what the case would receive as a nontransfer would be counted as 0.5 of a total case. The average charge per DRG is then divided by the national average standardized charge per case to determine the relative weight. The new charge-based weights were then normalized by an adjustment factor of 1.50808 so that the average case weight after recalibration was equal to the average case weight before recalibration. This normalization adjustment is intended to ensure that recalibration by itself neither increases nor decreases total payments under the IPPS as required by section 1886(d)(4)(C)(iii) of the Act. The methodology we used to calculate the DRG cost-based weights from the FY 2006 MedPAR claims data and FY 2005 Medicare cost report data is as follows: <bullet≤ To the extent possible, all the claims were regrouped using the FY 2008 proposed MS–DRG classifications discussed in section II.D. of this preamble. <bullet≤ The transplant cases that were used to establish the relative weight for heart and heart-lung, liver and/or intestinal, and lung transplants (proposed MS–DRGs 001, 002, 005, 006, and 007, respectively; previously CMS DRGs 103, 480, and 495) were limited to those Medicare-approved transplant centers that have cases in the FY 2006 MedPAR file. (Medicare coverage for heart, heart-lung, liver and/or intestinal, and lung transplants is limited to those facilities that have received approval from CMS as transplant centers.) <bullet≤ Organ acquisition costs for kidney, heart, heart-lung, liver, lung, pancreas, and intestinal (or multivisceral organs) transplants continue to be paid on a reasonable cost basis. Because these acquisition costs are paid separately from the prospective payment rate, it is necessary to subtract the acquisition charges from the total charges on each transplant bill that showed acquisition charges before computing the average cost for each DRG and before eliminating statistical outliers. <bullet≤ Claims with total charges or total length of stay less than or equal to zero were deleted. Claims that had an amount in the total charge field that differed by more than $10.00 from the sum of the routine day charges, intensive care charges, pharmacy charges, special equipment charges, therapy services charges, operating E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB room charges, cardiology charges, laboratory charges, radiology charges, other service charges, labor and delivery charges, inhalation therapy charges and anesthesia charges were also deleted. <bullet≤ At least 94 percent of the providers in the MedPAR file had charges for 10 of the 13 cost centers. Claims for providers that did not have charges greater than zero for at least 10 of the 13 cost centers were deleted. <bullet≤ Statistical outliers were eliminated by removing all cases that were beyond 3.0 standard deviations from the mean of the log distribution of both the total charges per case and the total charges per day for each DRG. Once the MedPAR data were trimmed and the statistical outliers were removed, the charges for each of the 13 cost groups for each claim were standardized to remove the effects of differences in area wage levels, indirect medical education and disproportionate share payments, and for hospitals in Alaska and Hawaii, the applicable costof-living adjustment. Charges were then VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 summed by DRG for each of the 13 cost groups such that each DRG had 13 standardized charge totals. These charges were then adjusted to cost by applying the national average CCRs developed from the FY 2005 cost report data. The 13 cost centers that we used in the relative weight calculation are shown in the following table. In addition, the table shows the lines on the cost report that we used to create the national cost center CCRs that we used to adjust the DRG charges to cost. For FY 2008, we are proposing to make minor revisions to the Cardiology, Laboratory, Radiology, and Other Services CCRs we are using to calculate the DRG relative weights, as follows: <bullet≤ The costs for cases involving Electroencephalography (EEG), cost report line 54, are currently in the Cardiology cost center group. However, MedPAR categorizes the claims data for EEG under Laboratory Charges (revenue codes 0740 and 0749). In order to maintain consistency with matching PO 00000 Frm 00069 Fmt 4701 Sfmt 4702 24747 costs on the cost report to charges on MedPAR claims, we are proposing to move cost report line 54 for EEG out of the Cardiology cost center group into the Laboratory cost center group. <bullet≤ In the FY 2007 IPPS proposed rule, we originally included the costs for Radioisotopes, cost report line 43, in the Radiology cost center group. However, in response to comments, we moved Radioisotopes to the Other Services cost center group. After researching this issue further over the past year, we believe that Radioisotopes is a radiology-related service that more appropriately belongs in the Radiology cost center group. Accordingly, for FY 2008, we are proposing to move the cost report line item for line 43, Radioisotopes, out of the Other Services cost center group and into the Radiology cost center group. The proposed version of the 13 cost center groupings are in the table below: BILLING CODE 4120–01–P E:\FEDREG\03MYP2.LOC 03MYP2 VerDate Mar 15 2010 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00070 Fmt 4701 Sfmt 4725 E:\FEDREG\03MYP2.LOC 03MYP2 EP03MY07.001 mmaher on DSK3CLS3C1PROD with $$_JOB 24748 VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00071 Fmt 4701 Sfmt 4725 E:\FEDREG\03MYP2.LOC 03MYP2 24749 EP03MY07.002 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules VerDate Mar 15 2010 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00072 Fmt 4701 Sfmt 4725 E:\FEDREG\03MYP2.LOC 03MYP2 EP03MY07.003 mmaher on DSK3CLS3C1PROD with $$_JOB 24750 VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00073 Fmt 4701 Sfmt 4725 E:\FEDREG\03MYP2.LOC 03MYP2 24751 EP03MY07.004 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules VerDate Mar 15 2010 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00074 Fmt 4701 Sfmt 4725 E:\FEDREG\03MYP2.LOC 03MYP2 EP03MY07.005 mmaher on DSK3CLS3C1PROD with $$_JOB 24752 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules We developed the national average CCRs as follows: Taking the FY 2005 cost report data, we removed CAHs, Indian Health Service hospitals, all-inclusive rate hospitals, and cost reports that represented time periods of less than 1 year (365 days). We included hospitals located in Maryland as we are including VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 their charges in our claims database. We then created CCRs for each provider for each cost center (see prior table for line items used in the calculations) and removed any CCRs that were greater than 10 or less than 0.01. We normalized the departmental CCRs by dividing the CCR for each department by the total CCR for the hospital for the purpose of trimming the data. We then PO 00000 Frm 00075 Fmt 4701 Sfmt 4702 took the logs of the normalized cost center CCRs and removed any cost center CCRs where the log of the cost center CCR was greater or less than the mean log plus/minus 3 times the standard deviation for the log of that cost center CCR. Once the cost report data were trimmed, we calculated a Medicare-specific CCR. The Medicarespecific CCR was determined by taking E:\FEDREG\03MYP2.LOC 03MYP2 EP03MY07.006 mmaher on DSK3CLS3C1PROD with $$_JOB BILLING CODE 4120–01–C 24753 24754 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules the Medicare charges for each line item from Worksheet D, Part 4 and deriving the Medicare specific costs by applying the hospital-specific departmental CCRs to the Medicare-specific charges for each line item from Worksheet D, Part 4. Once each hospital’s Medicarespecific costs were established, we summed the total Medicare-specific costs and divided by the sum of the total Medicare-specific charges to produce national average, charge-weighted CCRs. After we multiplied the total charges for each DRG in each of the 13 cost centers by the corresponding national average CCR, we summed the 13 ‘‘costs’’ across each DRG to produce a total standardized cost for the DRG. The average standardized cost for each DRG was then computed as the total standardized cost for the DRG divided by the transfer adjusted case count for the DRG. The average cost for each DRG was then divided by the national average standardized cost per case to determine the relative weight. The new cost-based weights were then normalized by an adjustment factor of 1.50988 so that the average case weight after recalibration was equal to the average case weight before recalibration. Since more trims were applied to the data under the cost-based weights methodology than under the charge-based methodology, a smaller universe of claims was used in the costbased methodology. In this instance, the different universe of claims also resulted in a slightly higher cost-based normalization factor than the normalization factor derived for chargebased weights. The normalization adjustment is intended to ensure that recalibration by itself neither increases nor decreases total payments under the IPPS as required by section 1886(d)(4)(C)(iii) of the Act. The 13 proposed national average CCRs for FY 2008 are as follows: Group Routine Days ...................................... Intensive Days .................................... Drugs .................................................. Supplies & Equipment ........................ Therapy Services ................................ Laboratory ........................................... Operating Room ................................. Cardiology ........................................... Radiology ............................................ Other Services .................................... Labor & Delivery ................................. Inhalation Therapy .............................. Anesthesia .......................................... DRG title 789 .......... 791 .......... Neonates, Died or Transferred to Another Acute Care Facility. Extreme Immaturity or Respiratory Distress Syndrome, Neonate. Prematurity With Major Problems ............... 792 .......... Prematurity Without Major Problems .......... 793 .......... Full-term Neonate With Major Problems .... 794 .......... Neonate With Other Significant Problems .. 795 .......... Normal Newborn ......................................... 790 .......... Crosswalk to DRG I. Proposed MS–LTC–DRG Reclassifications and Relative Weights for LTCHs for FY 2008 (If you choose to comment on issues in this section, please include the caption ‘‘MS–LTC–DRGs’’ at the beginning of your comment.) VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 0.52 0.48 0.21 0.34 0.42 0.17 0.30 0.19 0.18 0.37 0.47 0.19 0.14 When we recalibrated the DRG weights for previous years, we set a threshold of 10 cases as the minimum number of cases required to compute a reasonable weight. We used that same case threshold in recalibrating the DRG weights for FY 2008. Using the FY 2006 MedPAR data set, there are 7 proposed MS–DRGs that contain fewer than 10 cases. Under the proposed MS–DRGs, we have fewer low-volume DRGs than under the CMS DRGs because we no longer have separate DRGs for patients age 0 to 17 years. With the exception of newborns, we previously separated Low-volume DRG mmaher on DSK3CLS3C1PROD with $$_JOB CCR some DRGs based on whether the patient was age 0–17 or age 17 and older. Other than the age split, cases grouping to these DRGs are identical. The DRGs for patients age 0 to 17 years generally have very low volumes because children are typically ineligible for Medicare. In the past, we have found that the low volume of cases for the pediatric DRGs could lead to significant year-to-year instability in their relative weights. Although we have always encouraged non-Medicare payers to develop weights applicable to their own patient populations, we have heard frequent complaints from providers about the use of the Medicare relative weights in the pediatric population. We believe that eliminating this age split in the proposed MS–DRGs will provide more stable payment for pediatric cases by determining their payment using adult cases that are much higher in total volume. All of the low-volume DRGs listed below are for newborns. Newborns are unique and require separate DRGs that are not mirrored in the adult population. Therefore, it remains necessary to retain separate DRGs for newborns. In FY 2008, because we do not have sufficient MedPAR data to set accurate and stable cost weights for these low-volume DRGs, we are proposing to compute weights for the low-volume DRGs by adjusting their FY 2007 weights by the percentage change in the average weight of the cases in other DRGs. The crosswalk table we are proposing is shown below: FY 2007 FR weight other DRGs). FY 2007 FR weight other DRGs). FY 2007 FR weight other DRGs). FY 2007 FR weight other DRGs). FY 2007 FR weight other DRGs). FY 2007 FR weight other DRGs). FY 2007 FR weight other DRGs). (adjusted by percent change in average weight of the cases in (adjusted by percent change in average weight of the cases in (adjusted by percent change in average weight of the cases in (adjusted by percent change in average weight of the cases in (adjusted by percent change in average weight of the cases in (adjusted by percent change in average weight of the cases in (adjusted by percent change in average weight of the cases in 1. Background In the June 6, 2003 LTCH PPS final rule (68 FR 34122), we changed the LTCH PPS annual payment rate update cycle to be effective July 1 through June 30 instead of October 1 through September 30. In addition, because the patient classification system utilized under the LTCH PPS uses the same CMS DRGs as those currently used under the PO 00000 Frm 00076 Fmt 4701 Sfmt 4702 IPPS for acute care hospitals, in that same final rule, we explained that the annual update of the long-term care diagnosis-related group (LTC–DRG) classifications and relative weights will continue to remain linked to the annual reclassification and recalibration of the CMS DRGs used under the IPPS. Therefore, we specified that we will continue to update the LTC–DRG E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules classifications and relative weights to be effective for discharges occurring on or after October 1 through September 30 each year. We further stated that we will publish the annual proposed and final update of the LTC–DRGs in same notice as the proposed and final update for the IPPS (69 FR 34125). In the past, the annual update to the IPPS CMS DRGs has been based on the annual revisions to the ICD–9–CM codes and was effective each October 1. As discussed in the FY 2007 IPPS final rule (71 FR 47971 through 47994) and in the Rate Year (RY) 2008 LTCH PPS proposed rule (72 FR 4783 through 4789), with the implementation of section 503(a) of Pub. L. 108–173, there is the possibility that one feature of the GROUPER software program may be updated twice during a Federal fiscal year (October 1 and April 1) as required by the statute for the IPPS. Section 503(a) of Pub. L. 108–173 amended section 1886(d)(5)(K) of the Act by adding a new clause (vii) which states that ‘‘the Secretary shall provide for the addition of new diagnosis and procedure codes in [sic] April 1 of each year, but the addition of such codes shall not require the Secretary to adjust the payment (or diagnosis-related group classification) * * * until the fiscal year that begins after such date.’’ This requirement improves the recognition of new technologies under the IPPS by accounting for those ICD–9–CM codes in the MedPAR claims data earlier than the agency had accounted for new technology in the past. In implementing the statutory change, the agency has provided that ICD–9–CM diagnosis and procedure codes for new medical technology may be created and assigned to existing CMS DRGs in the middle of the Federal fiscal year, on April 1. However, this policy change will not impact the DRG relative weights in effect for that year, which will continue to be updated only once a year (October 1), nor will it have any impact on Medicare payments. The use of the ICD– 9–CM code set is also compliant with the current requirements of the Transactions and Code Sets Standards regulations at 45 CFR Parts 160 and 162, promulgated in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Pub. L. 104–191. As noted above, the patient classification system used under the LTCH PPS (LTC–DRGs) is based on the patient classification system used under the IPPS (CMS DRGs). Therefore, the ICD–9–CM codes currently used under both the IPPS and LTCH PPS may be updated as often as twice a year. This requirement is included as part of the VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 amendments to the Act relating to recognition of new medical technology under the IPPS. Because we do not publish a midyear IPPS rule, any April 1 ICD–9–CM coding update will not be published midyear. Rather, we will assign any new diagnosis or procedure codes to the same DRG in which its predecessor code was assigned, so that there will be no impact on the DRG assignments (as also discussed in section II.G.10. of this preamble). Any coding updates will be available through the Web sites provided in section II.G.10. of this preamble and through the Coding Clinic for ICD–9–CM, a product of the American Hospital Association. Publishers and software vendors currently obtain code changes through these sources in order to update their code books and software system. If new codes are implemented on April 1, revised code books and software systems, including the GROUPER software program, will be necessary because we must use current ICD–9–CM codes. Therefore, for purposes of the LTCH PPS, because each ICD–9–CM code must be included in the GROUPER algorithm to classify each case into a LTC–DRG, the GROUPER software program used under the LTCH PPS would need to be revised to accommodate any new codes. In implementing section 503(a) of Pub. L. 108–173, there will only be an April 1 update if new technology codes are requested and approved. We note that any new codes created for April 1 implementation will be limited to those diagnosis and procedure code revisions primarily needed to describe new technologies and medical services. However, we reiterate that the process of discussing updates to the ICD–9–CM is an open process through the ICD–9– CM Coordination and Maintenance Committee. Requestors will be given the opportunity to present the merits for a new code and to make a clear and convincing case for the need to update ICD–9–CM codes for purposes of the IPPS new technology add-on payment process through an April 1 update (as also discussed in section II.G.10. of this preamble). As we discussed in the RY 2008 LTCH PPS proposed rule (72 FR 4783 through 4789), at the September 28, 2006 ICD–9–CM Coordination and Maintenance Committee meeting, there were no requests for an April 1, 2007 implementation of ICD–9–CM codes. Therefore, the next update to the ICD– 9–CM coding system will not occur until October 1, 2007 (FY 2008). Because there were no coding changes suggested for an April 1, 2007 update, PO 00000 Frm 00077 Fmt 4701 Sfmt 4702 24755 the ICD–9–CM coding set implemented on October 1, 2006, will continue through September 30, 2007 (FY 2008). The update to the ICD–9–CM coding system for FY 2008 is discussed above in section II.G.10. of this preamble. Accordingly, in this proposed rule, as discussed in greater detail below, we are proposing to modify and revise the LTC–DRG classifications and relative weights, to be effective October 1, 2007 through September 30, 2008 (FY 2008). In addition, we will notify LTCHs of any revisions to the GROUPER software used under the IPPS and the LTCH PPS that may be implemented on April 1, 2008. The proposed LTC–DRGs and proposed relative weights for FY 2008 in this proposed rule are based on the proposed IPPS MS–DRGs (GROUPER Version 25.0) discussed in section II.B. of the preamble to this proposed rule. 2. Proposed Changes in the LTC–DRG Classifications a. Background Section 123 of Pub. L. 106–113 specifically requires that the agency implement a PPS for LTCHs that is a per discharge system with a DRG-based patient classification system reflecting the differences in patient resources and costs in LTCHs while maintaining budget neutrality. Section 307(b)(1) of Pub. L. 106–554 modified the requirements of section 123 of Pub. L. 106–113 by specifically requiring that the Secretary examine ‘‘the feasibility and the impact of basing payment under such a system [the LTCH PPS] on the use of existing (or refined) hospital diagnosis-related groups (DRGs) that have been modified to account for different resource use of long-term care hospital patients as well as the use of the most recently available hospital discharge data.’’ In accordance with section 123 of Pub. L. 106–113 as amended by section 307(b)(1) of Pub. L. 106–554 and § 412.515 of our existing regulations, the LTCH PPS uses information from LTCH patient records to classify patient cases into distinct LTC–DRGs based on clinical characteristics and expected resource needs. As described in II.D. of the preamble of this proposed rule, we are proposing to adopt MS–DRGs under the IPPS because we believe that adopting this system will result in a significant improvement in the DRG system’s recognition of severity of illness and resource usage. We believe these improvements in the DRG system would be equally applicable to the LTCH PPS. The changes we are currently proposing for the IPPS would be reflected in the FY 2008 GROUPER, E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24756 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules Version 25.0, to be effective for discharges occurring on or after October 1, 2007 through September 30, 2008. Currently, the LTC–DRGs used as the patient classification component of the LTCH PPS correspond to the current CMS DRGs applicable under the IPPS for acute care hospitals Consistent with our historical practice of having LTC–DRGs correspond to the DRGs applicable under the IPPS, under the broad authority of section 123(a) of Pub. L. 106–113, as modified by section 307(b) of Pub. L. 106–554, we are proposing to use MS–LTC–DRGs which correspond to the proposed MS–DRGs. In addition, as stated above, we are proposing to use the FY 2008 GOUPER Version 25.0, to be effective for discharges occurring on or after October 1, 2007 through September 30, 2008. The proposed changes to the current CMS DRG classification system used under the IPPS for FY 2008 (GROUPER Version 25.0) are discussed in section II.D. of the preamble to this proposed rule. As noted above, the patient classification system used under the LTCH PPS (LTC–DRGs) is based on the patient classification system used under the IPPS (CMS DRGs), which historically has been updated annually as authorized by section 1886(d)(4)(C) of the Act and is effective for discharges occurring on or after October 1 through September 30 of each year. As such, the proposed updates to the CMS DRG classification system used under the IPPS for FY 2008 (GROUPER Version 25.0), discussed in section II.D. of the preamble of this proposed rule, would be applicable to updates under the LTCH PPS. In conjunction with the proposed changes to the existing CMS DRGs for the IPPS by adoption of the proposed MS–DRGs, we are proposing to adopt the MS–DRGs for the LTCH PPS, as both sets of DRGs are based on the same DRG structure. However, we refer to the proposed DRGs under the LTCH PPS as MS–LTC–DRGs. This proposed conforming change, that is, to replicate the MS–LTC–DRG structure after the proposed MS–DRG structure is appropriate in order to maintain consistency and uniformity among a number of stakeholders, such as acute care hospitals, LTCHs, epidemiologists, ratesetting organizations, and payors, among others. Under the LTCH PPS, as described in greater detail below, we determine relative weights for each of the DRGs to account for the difference in resource use by patients exhibiting the case complexity and multiple medical problems characteristic of LTCH patients. (Unless otherwise noted in this VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 proposed rule, our MS–LTC–DRG analysis is based on LTCH data from the December 2006 update of the FY 2006 MedPAR file, which contains hospital bills received through December 31, 2006, for discharges occurring in FY 2006.) LTCHs do not typically treat the full range of diagnoses as do acute care hospitals. Therefore, as we discussed in the August 30, 2002 LTCH PPS final rule (67 FR 55985), which implemented the LTCH PPS, and the FY 2006 IPPS final rule (70 FR 47324), we use lowvolume quintiles in determining the LTC–DRG relative weights for LTC– DRGs with less than 25 LTCH cases (low-volume LTC–DRGs). Specifically, we group those low-volume LTC–DRGs into 5 quintiles based on average charges per discharge. (A listing of the composition of low-volume quintiles for the FY 2007 LTC–DRGs (based on FY 2005 MedPAR data) appears in section II.I.2.d. of the FY 2007 IPPS final rule (71 FR 47975 through 47978).) We also adjust for cases in which the stay at the LTCH is less than or equal to five-sixths of the geometric average length of stay; that is, short-stay outlier cases (§ 412.529), as discussed below in section II.I.4. of this preamble. b. Patient Classifications into DRGs Generally, under the LTCH PPS, Medicare payment is made at a predetermined specific rate for each discharge; that is, payment varies by the LTC–DRG to which a beneficiary’s stay is assigned. Just as cases have been classified into the proposed MS–DRGs for acute care hospitals under the IPPS (section II. of the preamble of this proposed rule), cases have been classified into proposed MS–LTC–DRGs for payment under the LTCH PPS based on the principal diagnosis, up to eight additional diagnoses, and up to six procedures performed during the stay, as well as age, sex, and discharge status of the patient. The diagnosis and procedure information is reported by the hospital using the ICD–9–CM codes. Under the proposed MS–DRGs for the IPPS and the proposed MS–LTC–DRGs for the LTCH PPS, these factors will not change. Section II.B. of the preamble of this proposed rule discusses the organization of the existing CMS DRGs, which we are proposing to maintain under the proposed MS–DRG and MS– LTC–DRG systems. As noted above, the patient classification system for the LTCH PPS is derived from the CMS DRGs and is similarly organized into 25 major diagnostic categories (MDCs). Most of these MDCs are based on a particular organ system of the body and PO 00000 Frm 00078 Fmt 4701 Sfmt 4702 the remainder involves multiple organ systems (such as MDC 22, Burns). Accordingly, the principal diagnosis determines MDC assignment. Within most MDCs, cases are then divided into surgical DRGs and medical DRGs. Under the present CMS DRGs, some surgical and medical DRGs are further differentiated based on the presence or absence of CCs. The existing LTC–DRGs are similarly categorized. (See section II.B. of the preamble of this proposed rule for further discussion of surgical DRGs and medical DRGs.) The proposed MS–DRGs and the proposed MS–LTC–DRGs contain base DRGs that have been subdivided into one, two, or three severity levels. The most severe level has at least one code that is a major CC, referred to as ‘‘with MCC’’. The next lower severity level contains cases with at least one CC, referred to as ‘‘with CC’’. Those DRGs without an MCC or a CC are referred to as ‘‘without CC/MCC’’. When data did not support the creation of three severity levels, the base DRG was divided into either two levels or the base was not subdivided. The proposed two-level subdivisions consist of one of the following subdivisions: <bullet≤ With CC/MCC <bullet≤ Without CC/MCC In this type of subdivision, cases with at least one code that is on the CC or MCC list are assigned to the ‘‘with CC/ MCC’’ DRG. Cases without a CC or an MCC are assigned to the ‘‘without CC/ MCC’’ DRG. The other type of proposed two-level subdivision is as follows: <bullet≤ With MCC <bullet≤ Without MCC In this type of subdivision, cases with at least one code that is on the MCC list are assigned to the ‘‘with MCC’’ DRG. Cases that do not have an MCC are assigned to the ‘‘without MCC’’ DRG. This type of subdivision could include cases with a CC code, but no MCC. As under the present LTC–DRG system, we are proposing that the assignment of a case to a particular MS– LTC–DRG will determine the amount that is paid for the case. Therefore, it is important that the coding is accurate. Classifications and terminology used under the LTCH PPS are consistent with the ICD–9–CM and the Uniform Hospital Discharge Data Set (UHDDS), as recommended to the Secretary by the National Committee on Vital and Health Statistics (‘‘Uniform Hospital Discharge Data: Minimum Data Set, National Center for Health Statistics, April 1980’’) and as revised in 1984 by the Health Information Policy Council (HIPC) of the U.S. Department of Health and Human Services. Again, we point E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules out that the ICD–9–CM coding terminology and the definitions of principal and other diagnoses of the UHDDS are consistent with the requirements of the Transactions and Code Sets Standards under HIPAA (45 CFR Parts 160 and 162). The emphasis on the need for proper coding cannot be overstated. As under the present LTC–DRG system, inappropriate coding of cases under the proposed MS–LTC–DRG system could adversely affect the uniformity of cases in each proposed MS–LTC–DRG and produce inappropriate weighting factors at recalibration and result in inappropriate payments under the LTCH PPS. LTCHs are required to follow the same coding guidelines established under the IPPS, described in section II.G.10 of the preamble of this proposed rule established under the IPPS. It is mandatory that the coders continue to report the same principal diagnosis on all claims and include all diagnosis codes for conditions that coexist at the time of admission, for conditions that are subsequently developed, or for conditions that affect the treatment received. Similarly, all procedures performed in a LTCH, or paid for under arrangements by a LTCH (§ 412.509), during that stay are to be reported on each claim. Consistent with current practice, there will be only one proposed MS–LTC–DRG assigned to each discharge of the patient from a LTCH. Under the proposed MS–LTC–DRG classification system, as is required under existing policy, upon the discharge of the patient from a LTCH, the LTCH must assign appropriate diagnosis and procedure codes from the ICD–9–CM. Completed claim forms are to be submitted electronically to the LTCH’s fiscal intermediary (or, if applicable, MAC). The fiscal intermediary or MAC enters the clinical and demographic information into their claims processing systems and subject this information to a series of automated screening processes called the MCE. These screens are designed to identify cases that require further review before assignment into a LTC–DRG can be made. After screening through the MCE, each LTCH claim will be classified into the appropriate LTC–DRG by the Medicare LTCH GROUPER. The LTCH GROUPER is specialized computer software and is the same GROUPER used under the IPPS. After the LTC– DRG is assigned, the fiscal intermediary or MAC determines the prospective payment by using the Medicare LTCH PPS PRICER program, which accounts for LTCH hospital-specific adjustments VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 and payment rates. As provided for under the IPPS, we provide an opportunity for the LTCH to review the LTC–DRG assignments made by the fiscal intermediary or MAC and to submit additional information, if necessary, within a specified timeframe (§ 412.513(c)). Under the proposed adoption of the MS–LTC–DRG, there would be no changes in this procedure. The LTCH GROUPER is used both to classify past cases in order to measure relative hospital resource consumption to establish the proposed MS–LTC–DRG weights and to classify current cases for purposes of determining payment. The records for all Medicare hospital inpatient discharges are maintained in the MedPAR file. The data in this file are used to evaluate possible DRG classification changes and to recalibrate the DRG weights during our annual update (as discussed in section II.H. of the preamble of this proposed rule). The proposed MS–LTC–DRG relative weights are based on data for the population of LTCH discharges. 3. Development of the Proposed FY 2008 MS–LTC–DRG Relative Weights a. General Overview of Development of the Proposed MS–LTC–DRG Relative Weights As we stated in the August 30, 2002 LTCH PPS final rule (67 FR 55981), one of the primary goals for the implementation of the LTCH PPS is to pay each LTCH an appropriate amount for the efficient delivery of medical care to Medicare patients. The system must be able to account adequately for each LTCH’s case-mix in order to ensure both fair distribution of Medicare payments and access to adequate care for those Medicare patients whose care is more costly. To accomplish these goals, we have annually adjusted the LTCH PPS standard Federal prospective payment system rate by the applicable LTC–DRG relative weight in determining payment to LTCHs for each case. (As we have noted above, we are proposing to adopt the MS–LTC–DRGs for the LTCH PPS for FY 2008. However, this proposed change in the patient classification system does not affect the basic principles of the development of relative weights under a DRG-based prospective payment system. For purposes of clarity, in the general discussion below in which we describe the basic methodology of the patient classification system, in use since the start of the LTCH PPS, we use ‘‘MS– LTC–DRG’’ to specify the proposed DRG system to be used by the LTCH prospective payment system in FY 2008.) PO 00000 Frm 00079 Fmt 4701 Sfmt 4702 24757 Although the proposed adoption of the MS–LTC–DRGs will result in some modifications of existing procedures for assigning weights in cases of zero volume and/or nonmonotonicity, discussed in detail in the following sections, the basic methodology for developing the proposed FY 2008 MS– LTC–DRG relative weights in this proposed rule continue to be determined in accordance with the general methodology established in the August 30, 2002 LTCH PPS final rule (67 FR 55989 through 55991). (Therefore, as noted above, in this preamble, ‘‘LTC–DRGs’’ will be used in descriptions of the basic methodology established at the beginning of the LTCH PPS that will remain unchanged if we adopt the proposed MS–LTC– DRGs. Use of ‘‘MS–LTC–DRGs’’ will indicate a discussion of specifics aspects of our proposed adoption of the severity-weighted patient classification system for FY 2008.) Under the LTCH PPS, relative weights for each proposed MS–LTC–DRG are a primary element used to account for the variations in cost per discharge and resource utilization among the payment groups (§ 412.515). To ensure that Medicare patients classified to each proposed MS–LTC–DRG have access to an appropriate level of services and to encourage efficiency, we calculate a relative weight for each proposed MS– LTC–DRG that represents the resources needed by an average inpatient LTCH case in that proposed MS–LTC–DRG. For example, cases in a proposed MS– LTC–DRG with a relative weight of 2 will, on average, cost twice as much to treat as cases in a proposed MS–LTC– DRG with a weight of 1. b. Data To calculate the proposed MS–LTC– DRG relative weights for FY 2008 in his proposed rule, we obtained total Medicare allowable charges from FY 2006 Medicare LTCH bill data from the December 2006 update of the MedPAR file, which are the best available data at this time, and we used the proposed Version 25.0 of the CMS GROUPER used under the IPPS (as discussed in section II.B. of the preamble of this proposed rule) to classify cases. To calculate the final MS–LTC–DRG relative weights for FY 2008, we are proposing that, if more recent data are available (that is, data from the March 2007 update of the MedPAR file), we would use those data and the finalized Version 25.0 of the CMS GROUPER used under the IPPS. As we discussed in the FY 2007 IPPS final rule (71 FR 47974), we have excluded the data from LTCHs that are E:\FEDREG\03MYP2.LOC 03MYP2 24758 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB all-inclusive rate providers and LTCHs that are reimbursed in accordance with demonstration projects authorized under section 402(a) of Pub. L. 90–248. Data from demonstration projects authorized under section 222(a) of Pub. L. 92–603 are also excluded. Therefore, in the development of the proposed FY 2008 MS–LTC–DRG relative weights in this proposed rule, we have excluded the data of the 19 all-inclusive rate providers and the 3 LTCHs that are paid in accordance with demonstration projects that had claims in the FY 2006 MedPAR file. c. Hospital-Specific Relative Value Methodology By nature, LTCHs often specialize in certain areas, such as ventilatordependent patients and rehabilitation and wound care. Some case types (DRGs) may be treated, to a large extent, in hospitals that have, from a perspective of charges, relatively high (or low) charges. This nonarbitrary distribution of cases with relatively high (or low) charges in specific proposed MS–LTC–DRGs has the potential to inappropriately distort the measure of average charges. To account for the fact that cases may not be randomly distributed across LTCHs, we use a hospital-specific relative value (HSRV) method to calculate the proposed MS– LTC–DRG relative weights instead of the methodology used to determine the proposed CMS DRG relative weights under the IPPS described in section II.H. of the preamble this proposed rule. We believe this method will remove this hospital-specific source of bias in measuring LTCH average charges. Specifically, we reduce the impact of the variation in charges across providers on any particular LTC–DRG relative weight by converting each LTCH’s charge for a case to a relative value based on that LTCH’s average charge. Under the HSRV method, we standardize charges for each LTCH by converting its charges for each case to hospital-specific relative charge values and then adjusting those values for the LTCH’s case-mix. The adjustment for case-mix is needed to rescale the hospital-specific relative charge values (which, by definition, average 1.0 for each LTCH). The average relative weight for a LTCH is its case-mix, so it is reasonable to scale each LTCH’s average relative charge value by its case-mix. In this way, each LTCH’s relative charge value is adjusted by its case-mix to an average that reflects the complexity of the cases it treats relative to the complexity of the cases treated by all other LTCHs (the average case-mix of all LTCHs). VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 In accordance with the methodology established under § 412.523, as implemented in the August 30, 2002 LTCH PPS final rule (67 FR 55989 through 55991), we continue to standardize charges for each case by first dividing the adjusted charge for the case (adjusted for short-stay outliers under § 412.529 as described in section II.I.4. (step 3) of the preamble of this proposed rule) by the average adjusted charge for all cases at the LTCH in which the case was treated. Short-stay outliers under § 412.529 are cases with a length of stay that is less than or equal to five-sixths the average length of stay of the proposed MS–LTC–DRG. The average adjusted charge reflects the average intensity of the health care services delivered by a particular LTCH and the average cost level of that LTCH. The resulting ratio is multiplied by that LTCH’s case-mix index to determine the standardized charge for the case. Multiplying by the LTCH’s case-mix index accounts for the fact that the same relative charges are given greater weight at a LTCH with higher average costs than they would at a LTCH with low average costs, which is needed to adjust each LTCH’s relative charge value to reflect its case-mix relative to the average case-mix for all LTCHs. Because we standardize charges in this manner, we count charges for a Medicare patient at a LTCH with high average charges as less resource intensive than they would be at a LTCH with low average charges. For example, a $10,000 charge for a case at a LTCH with an average adjusted charge of $17,500 reflects a higher level of relative resource use than a $10,000 charge for a case at a LTCH with the same case-mix, but an average adjusted charge of $35,000. We believe that the adjusted charge of an individual case more accurately reflects actual resource use for an individual LTCH because the variation in charges due to systematic differences in the markup of charges among LTCHs is taken into account. d. Proposed Treatment of Severity Levels in Developing Relative Weights With the implementation of the LTCH PPS for FY 2003, we established a procedure to address setting relative weights for LTC–DRG ‘‘pairs’’ that were differentiated on the presence or absence of CCs (71 FR 47979). For FY 2008, we are proposing to adopt a severity-based patient classification system for the LTCH PPS, the MS–LTC– DRGs described above, which requires us to adapt our existing procedures for dealing with setting relative weights for the severity levels within a specific base DRG. We are also proposing to modify our existing methodology for PO 00000 Frm 00080 Fmt 4701 Sfmt 4702 maintaining monotonicity when setting relative weights for the proposed MS– LTC–DRGs. As under the existing procedure, under the proposed MS–LTC–DRGs, for purposes of the annual setting of the relative weights, there continue to be three different categories of DRGs based on volume of cases within specific LTC– DRGs. DRGs with at least 25 cases are each assigned a relative weight; lowvolume proposed MS–LTC–DRGs (that is, proposed MS–LTC–DRGs that contain between one and 24 cases annually) are grouped into quintiles (described below) and assigned the weight of the quintile. Cases with novolume proposed MS–LTC–DRGs (that is, no cases in the databases were assigned to those proposed MS–LTC– DRGs) are crosswalked to other proposed MS–LTC–DRGs based on the clinical similarities and assigned the weight of the quintile that is closest to the relative weight of the crosswalked proposed MS–LTC–DRG. (We provide in-depth discussions of our proposals regarding weightsetting for low-volume MS–LTC–DRGs in section II.I.3.e. of the preamble of this proposed rule and for no-volume MS–LTC–DRGs, under Step 4 in section II.I.4. of the preamble of this proposed rule.) As described above, in response to the need to account for severity and pay appropriately for cases, we have developed a severity-adjusted patient classification system which we are proposing for both the IPPS and the LTCH PPS. As described in greater detail above, the proposed MS–LTC– DRG system can accommodate three severity levels: MCC (most severe); without CC/MCC (the least severe), and with CC, with each level assigned an individual MS–LTC–DRG number. In cases with two subdivisions, the levels are either with CC/MCC and without CC/MCC or with MCC and without MCC. Two parallel numbering systems have been developed, based on the MS– DRG patient classification system proposed under the IPPS, to describe proposed MS–LTC–DRGs. That is, while each severity level in each DRG category gets a unique MS–LTC–DRG number, in conjunction, each of the severity levels in a single DRG category are also assigned the same ‘‘base-DRG’’ number. We are proposing that the term ‘‘base DRG’’ is actually the MS–LTC–DRG number of the highest severity level and would be used when we refer to the MS–LTC–DRG category that encompasses all the levels of severity for that DRG. Therefore, under the proposed system, multiple sclerosis and cerebellar ataxia with MCC is MS–LTC– DRG 58; multiple sclerosis and E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules cerebellar ataxia with CC is MS–LTC– DRG 59; and multiple sclerosis and cerebellar ataxia without CC/MCC is MS–LTC–DRG 59, and the base MS– LTC–DRG for each is 58. As noted above, for FY 2008, we are proposing to adopt the MS–DRGs for use in both the LTCH PPS and the IPPS. While the LTCH PPS and the IPPS use the same patient classification system, the methodology that is used to set the DRG weights for use in each payment system differs because the overall volume of cases in the LTCH PPS is much less than in the IPPS. As a general rule, we are proposing to set the weights for the MS–LTC–DRGs using the following steps: (1) If an MS–LTC–DRG has at least 25 cases, it is assigned its own relative weight; (2) if an MS–LTC– DRGs has between 1 and 24 cases, it is assigned to a quintile to which we will assign a relative weight; and (3) if an MS–LTC–DRG has no cases, it is crosswalked to another DRG based upon clinical similarities and assigned the appropriate relative weight (as described in detail in Step 5, below). Theoretically, as with the existing LTC–DRG system, cases under the proposed MS–LTC–DRG system that are more severe require greater expenditure of medical care resources and will result in higher average charges. Therefore, in the three severity levels, weights should increase with severity, from lowest to highest. If the weights do not increase (that is, if based on the weight calculation, a proposed MS–LTC–DRG with MCC would have a lower relative weight than one with CC, or the DRG without CC/MCC would have a higher relative weight than either of the others), there is a problem with monotonicity. Since the start of the LTCH PPS for FY 2003 (67 FR 55990), we have adjusted the setting of the LTC– DRG relative weight in order to maintain monotonicity by grouping both sets of cases together and establishing a new relative weight that is assigned to both LTC–DRGs. Similarly, we are proposing a procedure for dealing with nonmonotonicity under the proposed MS–LTC–DRG classification system that we describe in detail in our explanation of our methodology for setting the proposed FY 2008 relative weights for the LTCH PPS, which is discussed in section II.F.4 of the preamble of this proposed rule. e. Low-Volume Proposed MS–LTC– DRGs In order to account for LTC–DRGs with low volume (that is, with fewer than 25 LTCH cases), under current VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 policy, in accordance with the methodology established in the August 30, 2002 LTCH PPS final rule (67 FR 55984), we group those ‘‘low-volume LTC–DRGs’’ (that is, DRGs that contained between 1 and 24 cases annually) into one of five categories (quintiles) based on average charges, for the purposes of determining relative weights. For this FY 2008 IPPS proposed rule, we are proposing to continue to employ this treatment of low-volume proposed MS–LTC–DRGs with a modification to combine proposed MS–LTC–DRGs for the purpose of computing a relative weight in cases where necessary to maintain monotonicity in determining the proposed FY 2008 MS–LTC–DRG relative weights using the best available LTCH data. In this proposed rule, using LTCH cases from the December 2006 update of the FY 2006 MedPAR file, we identified 307 proposed MS–LTC–DRGs that contained between 1 and 24 cases. This list of proposed MS–LTC–DRGs was then divided into one of the 5 lowvolume quintiles, each containing a minimum of 61 proposed MS–LTC– DRGs (307/5 = 61, with a remainder of 2 proposed MS–LTC–DRGs). Consistent with our current methodology, we are proposing to make an assignment to a specific low-volume quintile by sorting the low-volume proposed MS–LTC– DRGs in ascending order by average charge. For this proposed rule, this results in a proposed assignment to a specific low-volume quintile of the sorted 307 low-volume proposed MS– LTC–DRGs by ascending order by average charge. Because the number of low-volume proposed MS–LTC–DRGs for FY 2008 is not evenly divisible by five, to determine the composition of the low-volume quintiles in accordance with our established methodology, the average charge of the low-volume proposed MS–LTC–DRG was used to determine which low-volume quintile received the additional proposed MS– LTC–DRGs. After sorting the 307 lowvolume proposed MS–LTC–DRGs in ascending order, we grouped the first fifth (1st through 61st) of low-volume proposed MS–LTC–DRGs (with the lowest average charge) into Quintile 1. Because the average charge of the 62nd proposed MS–LTC–DRG in the sorted list is closer to the 61st proposed MS– LTC–DRGs average charge (assigned to Quintile 1) than to the average charge of the 63rd proposed MS–LTC–DRG in the sorted list (to be assigned to Quintile 2), we placed the 62nd proposed MS–LTC– DRG into Quintile 1. This process was repeated through the remaining low- PO 00000 Frm 00081 Fmt 4701 Sfmt 4702 24759 volume proposed MS–LTC–DRGs so that 2 low-volume quintiles contain 62 proposed MS–LTC–DRGs and 3 lowvolume quintiles contain 61 proposed MS–LTC–DRGs. The highest average charge cases were grouped into Quintile 5. In order to determine the proposed relative weights for the proposed MS– LTC–DRGs with low-volume for FY 2008, based on the methodology established in the August 30, 2002 LTCH PPS final rule (67 FR 55984), we are proposing to use the five lowvolume quintiles described above. In addition, in cases where the initial assignment of the low-volume proposed MS–LTC–DRGs to quintiles results in nonmonotonicity within a base DRG, we are proposing to combine those proposed MS–LTC–DRGs for the purpose of computing a relative weight and set the same relative weight to each of the proposed MS–LTC–DRGs within the base DRG that required combining. The treatment of low-volume proposed MS–LTC–DRGs to preserve monotonicity is further discussed in detail in section II.I.4 (Step 6 of the methodology for determining the proposed FY 2008 MS–LTC–DRG relative weights). The composition of each of the proposed five low-volume quintiles shown in the chart below was used in determining the proposed MS– LTC–DRG relative weights for FY 2008. We would determine a proposed relative weight and (geometric) average length of stay for each of the proposed five low-volume quintiles using the methodology that we apply to the regular proposed MS–LTC–DRGs (25 or more cases), as described below in section II.I.4. of the preamble of this proposed rule. We are proposing to assign the same relative weight and average length of stay to each of the proposed MS–LTC–DRGs that make up an individual proposed low-volume quintile. We note that, as this system is dynamic, it is possible that the number and specific type of MS–LTC–DRGs with a low volume of LTCH cases will vary in the future. We use the best available claims data in the MedPAR file to identify low-volume MS–LTC– DRGs and to calculate the relative weights based on our methodology. Therefore, we are proposing that, if we have updated data for the final rule, we will use that data to determine the finalized FY 2008 relative weights. E:\FEDREG\03MYP2.LOC 03MYP2 24760 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules PROPOSED COMPOSITION OF LOW-VOLUME QUINTILES FOR FY 2008 Proposed MS–LTC– DRG Proposed MS–LTC–DRG description mmaher on DSK3CLS3C1PROD with $$_JOB QUINTILE 1 30 ................. 32 ................. 33 ................. 58 ................. 60 ................. 66 ................. 67 ................. 68 ................. 69 ................. 72 ................. 76 ................. 79 ................. 88 ................. 133 ............... 122 ............... 123 ............... 149 ............... 153 ............... 182 ............... 183 ............... 184 ............... 201 ............... 261 ............... 262 ............... 313 ............... 328 ............... 331 ............... 349 ............... 376 ............... 434 ............... 446 ............... 505 ............... 512 ............... 544 ............... 547 ............... 563 ............... 598 ............... 630 ............... 645 ............... 661 ............... 688 ............... 696 ............... 714 ............... 718 ............... 724 ............... 726 ............... 756 ............... 759 ............... 761 ............... 825 ............... 836 ............... 869 ............... 876 ............... 881 ............... 882 ............... 883 ............... 886 ............... 894 ............... 895 ............... 906 ............... 916 ............... 922 ............... 923 ............... Spinal procedures w/o CC/MCC. Ventricular shunt procedures w CC. Ventricular shunt procedures w/o CC/MCC. Multiple sclerosis & cerebellar ataxia w MCC*. Multiple sclerosis & cerebellar ataxia w/o CC/MCC*. Intracranial hemorrhage or cerebral infarction w/o CC/MCC. Nonspecific CVA & precerebral occlusion w/o infarct w MCC. Nonspecific CVA & precerebral occlusion w/o infarct w/o MCC. Transient ischemia. Nonspecific cerebrovascular disorders w/o CC/MCC. Viral meningitis w/o CC/MCC. Hypertensive encephalopathy w/o CC/MCC. Concussion w MCC***. Other ear, nose, mouth & throat O.R. procedures w CC/MCC***. Acute major eye infections w/o CC/MCC. Neurological eye disorders. Dysequilibrium. Otitis media & URI w/o MCC. Respiratory neoplasms w/o CC/MCC. Major chest trauma w MCC. Major chest trauma w CC**. Pneumothorax w/o CC/MCC. Cardiac pacemaker revision except device replacement w CC. Cardiac pacemaker revision except device replacement w/o CC/MCC. Chest pain. Stomach, esophageal & duodenal proc w/o CC/MCC. Major small & large bowel procedures w/o CC/MCC. Anal & stomal procedures w/o CC/MCC. Digestive malignancy w/o CC/MCC. Cirrhosis & alcoholic hepatitis w/o CC/MCC*. Disorders of the biliary tract w/o CC/MCC. Foot procedures w/o CC/MCC. Shoulder, elbow or forearm proc, exc major joint proc w/o CC/MCC. Pathological fractures & musculoskelet & conn tiss malig w/o CC/MCC. Connective tissue disorders w/o CC/MCC. Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o MCC. Malignant breast disorders w CC***. Other endocrine, nutrit & metab O.R. proc w/o CC/MCC. Endocrine disorders w/o CC/MCC. Kidney & ureter procedures for non-neoplasm w/o CC/MCC. Kidney & urinary tract neoplasms w/o CC/MCC. Kidney & urinary tract signs & symptoms w/o MCC. Transurethral prostatectomy w/o CC/MCC. Other male reproductive system O.R. proc exc malignancy w/o CC/MCC. Malignancy, male reproductive system w/o CC/MCC. Benign prostatic hypertrophy w/o MCC. Malignancy, female reproductive system w/o CC/MCC. Infections, female reproductive system w/o CC/MCC. Menstrual & other female reproductive system disorders w/o CC/MCC. Lymphoma & non-acute leukemia w other O.R. proc w/o CC/MCC. Acute leukemia w/o major O.R. procedure w/o CC/MCC. Other infectious & parasitic diseases diagnoses w/o CC/MCC. O.R. procedure w principal diagnoses of mental illness. Depressive neuroses. Neuroses except depressive. Disorders of personality & impulse control. Behavioral & developmental disorders. Alcohol/drug abuse or dependence, left ama. Alcohol/drug abuse or dependence w rehabilitation therapy. Hand procedures for injuries. Allergic reactions w/o MCC. Other injury, poisoning & toxic effect diag w MCC. Other injury, poisoning & toxic effect diag w/o MCC. QUINTILE 2 75 ................. 77 ................. VerDate Mar 15 2010 Viral meningitis w CC/MCC. Hypertensive encephalopathy w MCC. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00082 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules PROPOSED COMPOSITION OF LOW-VOLUME QUINTILES FOR FY 2008—Continued mmaher on DSK3CLS3C1PROD with $$_JOB Proposed MS–LTC– DRG Proposed MS–LTC–DRG description 78 ................. 83 ................. 84 ................. 99 ................. 102 ............... 113 ............... 121 ............... 125 ............... 148 ............... 152 ............... 156 ............... 157 ............... 158 ............... 184 ............... 188 ............... 200 ............... 245 ............... 282 ............... 285 ............... 304 ............... 311 ............... 336 ............... 382 ............... 384 ............... 390 ............... 433 ............... 437 ............... 443 ............... 499 ............... 514 ............... 534 ............... 535 ............... 553 ............... 555 ............... 556 ............... 578 ............... 598 ............... 599 ............... 600 ............... 601 ............... 642 ............... 660 ............... 687 ............... 693 ............... 694 ............... 723 ............... 730 ............... 744 ............... 769 ............... 803 ............... 815 ............... 816 ............... 842 ............... 848 ............... 864 ............... 897 ............... 903 ............... 905 ............... 917 ............... 918 ............... 929 ............... 956 ............... 964 ............... 965 ............... 977 ............... Hypertensive encephalopathy w CC**. Traumatic stupor & coma, coma ≤1 hr w CC. Traumatic stupor & coma, coma ≤1 hr w/o CC/MCC. Non-bacterial infect of nervous sys exc viral meningitis w/o CC/MCC. Headaches w MCC***. Orbital procedures w CC/MCC. Acute major eye infections w CC/MCC. Other disorders of the eye w/o MCC. Ear, nose, mouth & throat malignancy w/o CC/MCC. Otitis media & URI w MCC. Nasal trauma & deformity w/o CC/MCC. Dental & Oral Diseases w MCC***. Dental & Oral Diseases w CC***. Major chest trauma w CC***. Pleural effusion w/o CC/MCC*. Pneumothorax w CC. AICD lead & generator procedures. Circulatory disorders w AMI, discharged alive w/o CC/MCC. Circulatory disorders w AMI, expired w/o CC/MCC*. Hypertension w MCC. Angina pectoris. Peritoneal adhesiolysis w CC. Complicated peptic ulcer w/o CC/MCC. Uncomplicated peptic ulcer w/o MCC. G.I. obstruction w/o CC/MCC. Cirrhosis & alcoholic hepatitis w CC*. Malignancy of hepatobiliary system or pancreas w/o CC/MCC. Disorders of liver except malig, cirr, alc hepa w/o CC/MCC. Local excision & removal int fix devices of hip & femur w/o CC/MCC. Hand or wrist proc, except major thumb or joint proc w/o CC/MCC. Fractures of femur w/o MCC. Fractures of hip & pelvis w MCC. Bone diseases & arthropathies w MCC. Signs & symptoms of musculoskeletal system & conn tissue w MCC. Signs & symptoms of musculoskeletal system & conn tissue w/o MCC. Skin graft &/or debrid exc for skin ulcer or cellulitis w/o CC/MCC. Malignant breast disorders w CC**. Malignant breast disorders w/o CC/MCC**. Non-malignant breast disorders w CC/MCC. Non-malignant breast disorders w/o CC/MCC. Inborn errors of metabolism. Kidney & ureter procedures for non-neoplasm w CC. Kidney & urinary tract neoplasms w CC. Urinary stones w/o ESW lithotripsy w MCC. Urinary stones w/o ESW lithotripsy w/o MCC**. Malignancy, male reproductive system w CC. Other male reproductive system diagnoses w/o CC/MCC. D&C, conization, laparoscopy & tubal interruption w CC/MC Postpartum & post abortion diagnoses w O.R. procedure. Other O.R. proc of the blood & blood forming organs w CC. Reticuloendothelial & immunity disorders w CC. Reticuloendothelial & immunity disorders w/o CC/MCC**. Lymphoma & non-acute leukemia w/o CC/MCC. Chemotherapy w/o acute leukemia as secondary diagnosis w/o CC/MCC. Fever of unknown origin. Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC. Wound debridements for injuries w/o CC/MCC. Skin grafts for injuries w/o CC/MCC. Poisoning & toxic effects of drugs w MCC. Poisoning & toxic effects of drugs w/o MCC. Full thickness burn w skin graft or inhal inj w/o CC/MCC. Limb reattachment, hip & femur proc for multiple significant trauma. Other multiple significant trauma w CC. Other multiple significant trauma w/o CC/MCC. HIV w or w/o other related condition. QUINTILE 3 42 ................. 53 ................. VerDate Mar 15 2010 Periph & cranial nerve & other nerv syst proc w/o CC/MCC. Spinal disorders & injuries w/o CC/MCC. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00083 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 24761 24762 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules PROPOSED COMPOSITION OF LOW-VOLUME QUINTILES FOR FY 2008—Continued mmaher on DSK3CLS3C1PROD with $$_JOB Proposed MS–LTC– DRG Proposed MS–LTC–DRG description 78 ................. 102 ............... 103 ............... 133 ............... 134 ............... 157 ............... 158 ............... 159 ............... 238 ............... 246 ............... 250 ............... 263 ............... 284 ............... 287 ............... 294 ............... 347 ............... 348 ............... 352 ............... 354 ............... 358 ............... 380 ............... 381 ............... 383 ............... 387 ............... 420 ............... 421 ............... 424 ............... 425 ............... 494 ............... 502 ............... 504 ............... 507 ............... 517 ............... 533 ............... 597 ............... 599 ............... 604 ............... 618 ............... 619 ............... 620 ............... 624 ............... 644 ............... 657 ............... 662 ............... 665 ............... 667 ............... 694 ............... 695 ............... 711 ............... 722 ............... 746 ............... 749 ............... 755 ............... 809 ............... 810 ............... 816 ............... 821 ............... 826 ............... 834 ............... 835 ............... 838 ............... 843 ............... 844 ............... 855 ............... 896 ............... 963 ............... 989 ............... Hypertensive encephalopathy w CC***. Headaches w MCC**. Headaches w/o MCC. Other ear, nose, mouth & throat O.R. procedures w CC/MCC**. Other ear, nose, mouth & throat O.R. procedures w/o CC/MCC**. Dental & Oral Diseases w MCC**. Dental & Oral Diseases w CC**. Dental & Oral Diseases w/o CC/MCC**. Major cardiovascular procedures w/o MCC. Percutaneous cardiovascular proc w drug-eluting stent w MCC. Perc cardiovasc proc w/o coronary artery stent or AMI w MCC. Vein ligation & stripping. Circulatory disorders w AMI, expired w CC*. Circulatory disorders except AMI, w card cath w/o MCC. Deep vein thrombophlebitis w CC/MCC. Anal & stomal procedures w MCC. Anal & stomal procedures w CC. Inguinal & femoral hernia procedures w/o CC/MCC. Hernia procedures except inguinal & femoral w CC. Other digestive system O.R. procedures w/o CC/MCC. Complicated peptic ulcer w MCC. Complicated peptic ulcer w CC. Uncomplicated peptic ulcer w MCC. Inflammatory bowel disease w/o CC/MCC*. Hepatobiliary diagnostic procedures w MCC. Hepatobiliary diagnostic procedures w CC. Other hepatobiliary or pancreas O.R. procedures w CC. Other hepatobiliary or pancreas O.R. procedures w/o CC/MCC. Lower extrem & humer proc except hip, foot, femur w/o CC/MCC. Soft tissue procedures w/o CC/MCC. Foot procedures w CC. Major shoulder or elbow joint procedures w CC/MCC. Other musculoskelet sys & conn tiss O.R. proc w/o CC/MCC. Fractures of femur w MCC. Malignant breast disorders w MCC. Malignant breast disorders w/o CC/MCC***. Trauma to the skin, subcut tiss & breast w MCC. Amputat of lower limb for endocrine, nutrit, & metabol dis w/o CC/MCC. O.R. procedures for obesity w MCC. O.R. procedures for obesity w CC**. Skin grafts & wound debrid for endoc, nutrit & metab dis w/o CC/MCC. Endocrine disorders w CC. Kidney & ureter procedures for neoplasm w CC. Minor bladder procedures w MCC. Prostatectomy w MCC. Prostatectomy w/o CC/MCC. Urinary stones w/o ESW lithotripsy w/o MCC***. Kidney & urinary tract signs & symptoms w MCC. Testes procedures w CC/MCC***. Malignancy, male reproductive system w MCC. Vagina, cervix & vulva procedures w CC/MCC. Other female reproductive system O.R. procedures w CC/MCC. Malignancy, female reproductive system w CC. Major hematol/immune diag exc sickle cell crisis & coagul w CC. Major hematol/immune diag exc sickle cell crisis & coagul w/o CC/MCC. Reticuloendothelial & immunity disorders w/o CC/MCC***. Lymphoma & leukemia w major O.R. procedure w CC. Myeloprolif disord or poorly diff neopl w maj O.R. proc w MCC. Acute leukemia w/o major O.R. procedure w MCC. Acute leukemia w/o major O.R. procedure w CC. Chemo w acute leukemia as sdx or w high dose chemo agent w CC. Other myeloprolif dis or poorly diff neopl diag w MCC***. Other myeloprolif dis or poorly diff neopl diag w CC***. Infectious & parasitic diseases w O.R. procedure w/o CC/MCC. Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC. Other multiple significant trauma w MCC. Non-extensive O.R. proc unrelated to principal diagnosis w/o CC/MCC. QUINTILE 4 28 ................. VerDate Mar 15 2010 Spinal procedures w MCC. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00084 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules PROPOSED COMPOSITION OF LOW-VOLUME QUINTILES FOR FY 2008—Continued mmaher on DSK3CLS3C1PROD with $$_JOB Proposed MS–LTC– DRG Proposed MS–LTC–DRG description 29 ................. 38 ................. 39 ................. 88 ................. 89 ................. 124 ............... 168 ............... 241 ............... 242 ............... 244 ............... 254 ............... 257 ............... 286 ............... 351 ............... 368 ............... 369 ............... 370 ............... 408 ............... 407 ............... 412 ............... 414 ............... 415 ............... 418 ............... 423 ............... 472 ............... 476 ............... 478 ............... 479 ............... 482 ............... 486 ............... 487 ............... 490 ............... 493 ............... 497 ............... 503 ............... 511 ............... 516 ............... 562 ............... 576 ............... 577 ............... 584 ............... 620 ............... 659 ............... 675 ............... 709 ............... 711 ............... 712 ............... 717 ............... 725 ............... 754 ............... 760 ............... 776 ............... 781 ............... 823 ............... 824 ............... 843 ............... 844 ............... 845 ............... 880 ............... 909 ............... 928 ............... 933 ............... 958 ............... 983 ............... 985 ............... 986 ............... Spinal procedures w CC. Extracranial procedures w CC. Extracranial procedures w/o CC/MCC. Concussion w MCC**. Concussion w CC. Other disorders of the eye w MCC. Other resp system O.R. procedures w/o CC/MCC. Amputation for circ sys disorders exc upper limb & toe w/o CC/MCC Permanent cardiac pacemaker implant w MCC***. Permanent cardiac pacemaker implant w/o CC/MCC. Other vascular procedures w/o CC/MCC. Upper limb & toe amputation for circ system disorders w/o CC/MCC*. Circulatory disorders except AMI, w card cath w MCC. Inguinal & femoral hernia procedures w CC. Major esophageal disorders w MCC. Major esophageal disorders w CC. Major esophageal disorders w/o CC/MCC**. Biliary tract proc except only cholecyst w or w/o c.d.e. w MCC***. Pancreas, liver & shunt procedures w/o CC/MCC. Cholecystectomy w c.d.e. w CC. Cholecystectomy except by laparoscope w/o c.d.e. w MCC. Cholecystectomy except by laparoscope w/o c.d.e. w CC. Laparoscopic cholecystectomy w/o c.d.e. w CC. Other hepatobiliary or pancreas O.R. procedures w MCC. Cervical spinal fusion w CC. Amputation for musculoskeletal sys & conn tissue dis w/o CC/MCC*. Biopsies of musculoskeletal system & connective tissue w CC. Biopsies of musculoskeletal system & connective tissue w/o CC/MCC. Hip & femur procedures except major joint w/o CC/MCC. Knee procedures w pdx of infection w CC. Knee procedures w pdx of infection w/o CC/MCC. Back & neck procedures except spinal fusion w CC/MCC or disc devices. Lower extrem & humer proc except hip, foot, femur w CC. Local excision & removal int fix devices exc hip & femur w/o CC/MCC. Foot procedures w MCC. Shoulder, elbow or forearm proc, exc major joint proc w CC. Other musculoskelet sys & conn tiss O.R. proc w CC. Fx, sprn, strn & disl except femur, hip, pelvis & thigh w MCC. Skin graft &/or debrid exc for skin ulcer or cellulitis w MCC. Skin graft &/or debrid exc for skin ulcer or cellulitis w CC. Breast biopsy, local excision & other breast procedures w CC/MCC. O.R. procedures for obesity w CC***. Kidney & ureter procedures for non-neoplasm w MCC. Other kidney & urinary tract procedures w/o CC/MCC. Penis procedures w CC/MCC. Testes procedures w CC/MCC**. Testes procedures w/o CC/MCC**. Other male reproductive system O.R. proc exc malignancy w CC/MCC. Benign prostatic hypertrophy w MCC. Malignancy, female reproductive system w MCC. Menstrual & other female reproductive system disorders w CC/MCC. Postpartum & post abortion diagnoses w/o O.R. procedure. Other antepartum diagnoses w medical complications. Lymphoma & non-acute leukemia w other O.R. proc w MCC. Lymphoma & non-acute leukemia w other O.R. proc w CC. Other myeloprolif dis or poorly diff neopl diag w MCC**. Other myeloprolif dis or poorly diff neopl diag w CC**. Other myeloprolif dis or poorly diff neopl diag w/o CC/MCC**. Acute adjustment reaction & psychosocial dysfunction. Other O.R. procedures for injuries w/o CC/MCC. Full thickness burn w skin graft or inhal inj w CC/MCC. Extensive burns or full thickness burns w MV 96+ hrs w/o skin graft. Other O.R. procedures for multiple significant trauma w CC. Extensive O.R. procedure unrelated to principal diagnosis w/o CC/MCC. Prostatic O.R. procedure unrelated to principal diagnosis w CC. Prostatic O.R. procedure unrelated to principal diagnosis w/o CC/MCC. QUINTILE 5 12 ................. VerDate Mar 15 2010 Tracheostomy for face, mouth & neck diagnoses w CC. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00085 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 24763 24764 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules PROPOSED COMPOSITION OF LOW-VOLUME QUINTILES FOR FY 2008—Continued mmaher on DSK3CLS3C1PROD with $$_JOB Proposed MS–LTC– DRG Proposed MS–LTC–DRG description 26 ................. 31 ................. 37 ................. 131 ............... 134 ............... 137 ............... 139 ............... 159 ............... 164 ............... 226 ............... 227 ............... 237 ............... 242 ............... 243 ............... 248 ............... 258 ............... 260 ............... 327 ............... 329 ............... 330 ............... 335 ............... 350 ............... 370 ............... 405 ............... 406 ............... 408 ............... 409 ............... 417 ............... 454 ............... 456 ............... 459 ............... 460 ............... 466 ............... 467 ............... 469 ............... 470 ............... 471 ............... 477 ............... 480 ............... 481 ............... 485 ............... 488 ............... 492 ............... 498 ............... 513 ............... 582 ............... 664 ............... 668 ............... 669 ............... 670 ............... 691 ............... 712 ............... 713 ............... 715 ............... 802 ............... 829 ............... 837 ............... 845 ............... 957 ............... 969 ............... 970 ............... 984 ............... Craniotomy & endovascular intracranial procedures w CC. Ventricular shunt procedures w MCC. Extracranial procedures w MCC. Cranial/facial procedures w CC/MCC. Other ear, nose, mouth & throat O.R. procedures w/o CC/MCC***. Mouth procedures w CC/MCC. Salivary gland procedures. Dental & Oral Diseases w/o CC/MCC***. Major chest procedures w CC. Cardiac defibrillator implant w/o cardiac cath w MCC. Cardiac defibrillator implant w/o cardiac cath w/o MCC. Major cardiovascular procedures w MCC. Permanent cardiac pacemaker implant w MCC**. Permanent cardiac pacemaker implant w CC. Percutaneous cardiovasc proc w non-drug-eluting stent w MCC. Cardiac pacemaker device replacement w MCC. Cardiac pacemaker revision except device replacement w MCC. Stomach, esophageal & duodenal proc w CC. Major small & large bowel procedures w MCC. Major small & large bowel procedures w CC. Peritoneal adhesiolysis w MCC. Inguinal & femoral hernia procedures w MCC. Major esophageal disorders w/o CC/MCC***. Pancreas, liver & shunt procedures w MCC. Pancreas, liver & shunt procedures w CC. Biliary tract proc except only cholecyst w or w/o c.d.e. w MCC**. Biliary tract proc except only cholecyst w or w/o c.d.e. w CC. Laparoscopic cholecystectomy w/o c.d.e. w MCC. Combined anterior/posterior spinal fusion w CC. Spinal fusion exc cerv w spinal curv, malig or 9+ fusions w MCC. Spinal fusion except cervical w MCC. Spinal fusion except cervical w/o MCC. Revision of hip or knee replacement w MCC. Revision of hip or knee replacement w CC. Major joint replacement or reattachment of lower extremity w MCC. Major joint replacement or reattachment of lower extremity w/o MCC. Cervical spinal fusion w MCC. Biopsies of musculoskeletal system & connective tissue w MCC. Hip & femur procedures except major joint w MCC. Hip & femur procedures except major joint w CC. Knee procedures w pdx of infection w MCC. Knee procedures w/o pdx of infection w CC/MCC. Lower extrem & humer proc except hip, foot, femur w MCC. Local excision & removal int fix devices of hip & femur w CC/MCC. Hand or wrist proc, except major thumb or joint proc w CC/MCC. Mastectomy for malignancy w CC/MCC. Minor bladder procedures w/o CC/MCC. Transurethral procedures w MCC. Transurethral procedures w CC. Transurethral procedures w/o CC/MCC. Urinary stones w esw lithotripsy w CC/MCC. Testes procedures w/o CC/MCC***. Transurethral prostatectomy w CC/MCC. Other male reproductive system O.R. proc for malignancy w CC/MCC. Other O.R. proc of the blood & blood forming organs w MCC. Myeloprolif disord or poorly diff neopl w other O.R. proc w CC/MCC. Chemo w acute leukemia as sdx or w high dose chemo agent w MCC. Other myeloprolif dis or poorly diff neopl diag w/o CC/MCC***. Other O.R. procedures for multiple significant trauma w MCC. HIV w extensive O.R. procedure w MCC. HIV w extensive O.R. procedure w/o MCC. Prostatic O.R. procedure unrelated to principal diagnosis w MCC * One of the original 307 low-volume proposed MS–LTC–DRGs initially assigned to this proposed low-volume quintile; removed from this proposed low-volume quintile in addressing nonmonotonicity (see step 6 below). ** One of the original 307 low-volume proposed MS–LTC–DRGs initially assigned to a different proposed low-volume quintile but moved to this proposed low-volume quintile in addressing nonmonotonicity (see step 6 below). *** One of the original 307 low-volume proposed MS–LTC–DRGs initially assigned to this proposed low-volume quintile but moved to a different proposed low-volume quintile in addressing nonmonotonicity (see step 6 below). VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00086 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB We note that we will continue to monitor the volume (that is, the number of LTCH cases) in these low-volume quintiles to ensure that our proposed quintile assignment results in appropriate payment for such cases and does not result in an unintended financial incentive for LTCHs to inappropriately admit these types of cases. 4. Steps for Determining the Proposed FY 2008 MS–LTC–DRG Relative Weights As we noted previously, although the proposed adoption of the MS–LTC– DRGs will result in some modifications of existing procedures for assigning weights in cases of zero volume and/or nonmonotonicity, described in detail elsewhere in this section, the proposed FY 2008 MS–LTC–DRG relative weights in this proposed rule are based on the methodology established in the August 30, 2002 LTCH PPS final rule (67 FR 55989 through 55991). In summary, for FY 2008, LTCH cases would be grouped to the appropriate MS–LTC–DRG, while taking into account the low-volume proposed MS–LTC–DRGs as described above, before the proposed FY 2008 MS–LTC–DRG relative weights can be determined. After grouping the cases to the appropriate proposed MS–LTC– DRG, we are proposing to calculate the proposed relative weights for FY 2008 by first removing statistical outliers and cases with a length of stay of 7 days or less, as discussed in greater detail below. Next, we are proposing to adjust the number of cases in each proposed MS–LTC–DRG for the effect of shortstay outlier cases under § 412.529, as also discussed in greater detail below. The short-stay adjusted discharges and corresponding charges are used to calculate ‘‘relative adjusted weights’’ in each proposed MS–LTC–DRG using the HSRV method described above. Below we discuss in detail the steps for calculating the proposed FY 2008 MS–LTC–DRG relative weights. We note that, as we stated above in section II.I.3.b. of the preamble of this proposed rule, we have excluded the data of allinclusive rate LTCHs and LTCHs that are paid in accordance with demonstration projects that had claims in the FY 2006 MedPAR file. Step 1—Remove statistical outliers. The first step in the calculation of the proposed FY 2008 MS–LTC–DRG relative weights is to remove statistical outlier cases. We define statistical outliers as cases that are outside of 3.0 standard deviations from the mean of the log distribution of both charges per case and the charges per day for each proposed MS–LTC–DRG. These statistical outliers are removed prior to VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 calculating the proposed relative weights. As noted above, we believe that they may represent aberrations in the data that distort the measure of average resource use. Including those LTCH cases in the calculation of the proposed relative weights could result in an inaccurate relative weight that does not truly reflect relative resource use among the proposed MS–LTC–DRGs. Step 2—Remove cases with a length of stay of 7 days or less. The proposed FY 2008 MS–LTC–DRG relative weights reflect the average of resources used on representative cases of a specific type. Generally, cases with a length of stay of 7 days or less do not belong in a LTCH because these stays do not fully receive or benefit from treatment that is typical in a LTCH stay, and full resources are often not used in the earlier stages of admission to a LTCH. As explained above, if we were to include stays of 7 days or less in the computation of the proposed FY 2008 MS–LTC–DRG relative weights, the value of many relative weights would decrease and, therefore, payments would decrease to a level that may no longer be appropriate. We do not believe that it would be appropriate to compromise the integrity of the payment determination for those LTCH cases that actually benefit from and receive a full course of treatment at a LTCH, by including data from these very short-stays. Thus, as explained above, in determining the proposed FY 2008 MS–LTC–DRG relative weights, we remove LTCH cases with a length of stay of 7 days or less. Step 3—Adjust charges for the effects of short-stay outliers. After removing cases with a length of stay of 7 days or less, we are left with cases that have a length of stay of greater than or equal to 8 days. The next step in the calculation of the proposed FY 2008 MS–LTC–DRG relative weights is to adjust each LTCH’s charges per discharge for those remaining cases for the effects of short-stay outliers as defined in § 412.529(a). (We note that even if a case was removed in Step 2 (that is, cases with a length of stay of 7 days or less), it was paid as a short-stay outlier if its length of stay was less than or equal to five-sixths of the average length of stay of the MS–LTC–DRG, in accordance with § 412.529.) We make this adjustment by counting a short-stay outlier as a fraction of a discharge based on the ratio of the length of stay of the case to the average length of stay for the proposed MS– LTC–DRG for non-short-stay outlier cases. This has the effect of proportionately reducing the impact of the lower charges for the short-stay PO 00000 Frm 00087 Fmt 4701 Sfmt 4702 24765 outlier cases in calculating the average charge for the proposed MS–LTC–DRG. This process produces the same result as if the actual charges per discharge of a short-stay outlier case were adjusted to what they would have been had the patient’s length of stay been equal to the average length of stay of the proposed MS–LTC–DRG. As we explained in the FY 2007 IPPS final (71 FR 47979), counting short-stay outlier cases as full discharges with no adjustment in determining the proposed MS–LTC–DRG relative weights would lower the proposed LTC–DRG relative weight for affected proposed MS–LTC– DRGs because the relatively lower charges of the short-stay outlier cases would bring down the average charge for all cases within a proposed MS– LTC–DRG. This would result in an ‘‘underpayment’’ for nonshort-stay outlier cases and an ‘‘overpayment’’ for short-stay outlier cases. Therefore, we adjust for short-stay outlier cases under § 412.529 in this manner because it results in more appropriate payments for all LTCH cases. Step 4—Calculate the proposed FY 2008 MS–LTC–DRG relative weights on an iterative basis. The process of calculating the proposed MS–LTC–DRG relative weights using the HSRV methodology is iterative. First, for each LTCH case, we calculate a hospital-specific relative charge value by dividing the short-stay outlier adjusted charge per discharge (see step 3) of the LTCH case (after removing the statistical outliers (see step 1)) and LTCH cases with a length of stay of 7 days or less (see step 2) by the average charge per discharge for the LTCH in which the case occurred. The resulting ratio is then multiplied by the LTCH’s case-mix index to produce an adjusted hospital-specific relative charge value for the case. An initial case-mix index value of 1.0 is used for each LTCH. For each proposed DRG, the proposed FY 2008 MS–LTC–DRG relative weight is calculated by dividing the average of the adjusted hospital-specific relative charge values (from above) for the proposed MS–LTC–DRG by the overall average hospital-specific relative charge value across all cases for all LTCHs. Using these proposed recalculated MS– LTC–DRG relative weights, each LTCH’s average relative weight for all of its cases (case-mix) is calculated by dividing the sum of all the LTCH’s proposed MS–LTC–DRG relative weights by its total number of cases. The LTCHs’ hospital-specific relative charge values above are multiplied by these hospital-specific case-mix indexes. These hospital-specific case-mix E:\FEDREG\03MYP2.LOC 03MYP2 24766 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules adjusted relative charge values are then used to calculate a new set of proposed MS–LTC–DRG relative weights across all LTCHs. In this proposed rule, this iterative process is continued until there is convergence between the weights produced at adjacent steps, for example, when the maximum difference is less than 0.0001. Step 5—Determine a proposed FY 2007 MS–LTC–DRG relative weight for proposed MS–LTC–DRGs with no LTCH cases. As we stated above, we determine the proposed relative weight for each proposed MS–LTC–DRG using total Medicare allowable charges reported in the December 2006 update of the FY 2006 MedPAR file. Of the 745 proposed MS–LTC–DRGs for FY 2008, we identified 124 proposed MS–LTC–DRGs for which there were no LTCH cases in the database. That is, based on data from the FY 2006 MedPAR file used in this proposed rule, no patients who would have been classified to those proposed MS–LTC–DRGs were treated in LTCHs during FY 2006 and, therefore, no charge data were reported for those proposed MS–LTC–DRGs. Thus, in the process of determining the proposed MS–LTC–DRG relative weights, we are unable to determine weights for these 124 proposed MS–LTC–DRGs using the methodology described in Steps 1 through 4 above. However, because patients with a number of the diagnoses under these proposed MS–LTC–DRGs may be treated at LTCHs beginning in FY 2008, for this proposed rule, we are proposing to assign relative weights to each of the 124 no-volume proposed MS–LTC–DRGs based on clinical similarity and relative costliness to one of the remaining 621 (745-124 = 621) proposed MS–LTC–DRGs for which we are able to determine proposed relative weights, based on FY 2006 LTCH claims data. In general, we determined proposed relative weights for the 124 proposed MS–LTC–DRGs with no LTCH cases in the FY 2006 MedPAR file used in this proposed rule by crosswalking these proposed MS–LTC–DRGs to other proposed MS–LTC–DRGs and then grouping them to the appropriate proposed low-volume quintile. This methodology is consistent with our methodology used in determining relative weights to account for the lowvolume proposed MS–LTC–DRGs described above. Our proposed methodology for determining the relative weights for the no-volume MS–LTC–DRGs is as follows: We crosswalk the no-volume proposed MS–LTC–DRG to a proposed MS–LTC– DRG for which there are LTCH cases in the FY 2006 MedPAR file and to which it is similar clinically and in intensity of use of resources as determined by care provided during the period of time surrounding surgery, surgical approach (if applicable), length of time of surgical procedure, postoperative care, and length of stay. If the proposed MS–LTC– DRG to which it is crosswalked is grouped to one of the proposed lowvolume quintiles, we assign the relative weight for the applicable low-volume quintile to the no volume proposed MS– LTC–DRG. However, if the proposed MS–LTC–DRG to which the no-volume proposed MS–LTC–DRG is crosswalked is not one of the proposed MS–LTC– DRGs in a low-volume quintile, we do the following: (1) compare the relative weight of the proposed MS–LTC–DRG to which the no-volume proposed MS– LTC–DRG is crosswalked to the relative weights of each of the five quintiles; (2) assign the no volume proposed MS– LTC–DRG the relative weight of the lowvolume quintile with the relative weight that is closest to the proposed MS–LTC– DRG to which the no volume proposed MS–LTC–DRG is crosswalked. (We note that in the infrequent case where nonmonotonicity involving a no volume proposed MS–LTC–DRG results, additional measures as described in Step 6 are required in order to maintain monotonically increasing relative weights.) or this proposed rule, a list of the no-volume proposed FY 2008 MS– LTC–DRGs and the proposed FY 2008 MS–LTC–DRG to which it is crosswalked is shown in the chart below. NO-VOLUME PROPOSED MS–LTC–DRG CROSSWALK FOR FY 2008 mmaher on DSK3CLS3C1PROD with $$_JOB Proposed MS–LTC– DRG Proposed MS–LTC–DRG description 9 .................. 20 ................ 21 ................ 22 ................ 23 ................ 24 ................ 34 ................ 35 ................ 36 ................ 61 ................ 62 ................ 63 ................ 115 .............. 116 .............. 117 .............. 129 .............. 130 .............. 135 .............. 136 .............. 150 .............. 151 .............. 215 .............. 216 .............. 217 .............. 218 .............. 219 .............. 220 .............. 221 .............. Bone marrow transplant ............................................................................................................................................. Intracranial vascular procedures w PDX hemorrhage w MCC .................................................................................. Intracranial vascular procedures w PDX hemorrhage w CC ..................................................................................... Intracranial vascular procedures w PDX hemorrhage w/o CC/MCC ........................................................................ Craniotomy w major device implant or acute complex CNS PDX w MCC ............................................................... Craniotomy w major device implant or acute complex CNS PDX w/o MCC ............................................................ Carotid artery stent procedure w MCC ...................................................................................................................... Carotid artery stent procedure w CC ......................................................................................................................... Carotid artery stent procedure w/o CC/MCC ............................................................................................................. Acute ischemic stroke w use of thrombolytic agent w MCC ..................................................................................... Acute ischemic stroke w use of thrombolytic agent w CC ........................................................................................ Acute ischemic stroke w use of thrombolytic agent w/o CC/MCC ............................................................................ Extraocular procedures except orbit .......................................................................................................................... Intraocular procedures w CC/MCC ............................................................................................................................ Intraocular procedures w/o CC/MCC ......................................................................................................................... Major head & neck procedures w CC/MCC or major device .................................................................................... Major head & neck procedures w/o CC/MCC ........................................................................................................... Sinus & mastoid procedures w CC/MCC .................................................................................................................. Sinus & mastoid procedures w/o CC/MCC ............................................................................................................... Epistaxis w MCC ........................................................................................................................................................ Epistaxis w/o MCC ..................................................................................................................................................... Other heart assist system implant ............................................................................................................................. Cardiac valve & oth maj cardiothoracic proc w card cath w MCC ............................................................................ Cardiac valve & oth maj cardiothoracic proc w card cath w CC ............................................................................... Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC .................................................................. Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC ......................................................................... Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC ............................................................................ Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC ............................................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00088 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC Proposed crosswalked MS–LTC–DRG 03MYP2 823 31 32 33 31 33 37 38 39 70 71 72 125 125 125 146 148 133 133 152 153 238 237 238 250 237 238 250 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24767 NO-VOLUME PROPOSED MS–LTC–DRG CROSSWALK FOR FY 2008—Continued mmaher on DSK3CLS3C1PROD with $$_JOB Proposed MS–LTC– DRG 222 223 224 225 228 229 230 231 232 233 234 235 236 296 297 298 332 333 334 338 339 340 341 342 343 344 345 346 457 461 462 483 484 506 509 537 538 614 615 625 626 627 653 654 655 666 671 672 697 707 708 734 735 736 737 738 739 740 741 742 743 748 765 766 767 768 770 774 775 777 .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. VerDate Mar 15 2010 Proposed crosswalked MS–LTC–DRG Proposed MS–LTC–DRG description Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC ................................................................................ Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC ............................................................................. Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC ............................................................................. Cardiac defib implant w cardiac cath w/oAMI/HF/shock w/o MCC ........................................................................... Other cardiothoracic procedures w MCC .................................................................................................................. Other cardiothoracic procedures w CC ..................................................................................................................... Other cardiothoracic procedures w/o CC/MCC ......................................................................................................... Coronary bypass w PTCA w MCC ............................................................................................................................ Coronary bypass w PTCA w/o MCC ......................................................................................................................... Coronary bypass w cardiac cath w MCC .................................................................................................................. Coronary bypass w cardiac cath w/o MCC ............................................................................................................... Coronary bypass w/o cardiac cath w MCC ............................................................................................................... Coronary bypass w/o cardiac cath w/o MCC ............................................................................................................ Cardiac arrest, unexplained w MCC .......................................................................................................................... Cardiac arrest, unexplained w CC ............................................................................................................................. Cardiac arrest, unexplained w/o CC/MCC ................................................................................................................. Rectal resection w MCC ............................................................................................................................................ Rectal resection w CC ............................................................................................................................................... Rectal resection w/o CC/MCC ................................................................................................................................... Appendectomy w complicated principal diag w MCC ............................................................................................... Appendectomy w complicated principal diag w CC .................................................................................................. Appendectomy w complicated principal diag w/o CC/MCC ...................................................................................... Appendectomy w/o complicated principal diag w MCC ............................................................................................ Appendectomy w/o complicated principal diag w CC ............................................................................................... Appendectomy w/o complicated principal diag w/o CC/MCC ................................................................................... Minor small & large bowel procedures w MCC ......................................................................................................... Minor small & large bowel procedures w CC ............................................................................................................ Minor small & large bowel procedures w/o CC/MCC ................................................................................................ Spinal fusion exc cerv w spinal curv, malig or 9+ fusions w CC .............................................................................. Bilateral or multiple major joint procs of lower extremity w MCC ............................................................................. Bilateral or multiple major joint procs of lower extremity w/o MCC .......................................................................... Major joint & limb reattachment proc of upper extremity w CC/MCC ....................................................................... Major joint & limb reattachment proc of upper extremity w/o CC/MCC .................................................................... Major thumb or joint procedures ................................................................................................................................ Arthroscopy ................................................................................................................................................................ Sprains, strains, & dislocations of hip, pelvis & thigh w CC/MCC ............................................................................ Sprains, strains, & dislocations of hip, pelvis & thigh w/o CC/MCC ......................................................................... Adrenal & pituitary procedures w CC/MCC ............................................................................................................... Adrenal & pituitary procedures w/o CC/MCC ............................................................................................................ Thyroid, parathyroid & thyroglossal procedures w MCC ........................................................................................... Thyroid, parathyroid & thyroglossal procedures w CC .............................................................................................. Thyroid, parathyroid & thyroglossal procedures w/o CC/MCC .................................................................................. Major bladder procedures w MCC ............................................................................................................................. Major bladder procedures w CC ................................................................................................................................ Major bladder procedures w/o CC/MCC .................................................................................................................... Prostatectomy w CC .................................................................................................................................................. Urethral procedures w CC/MCC ................................................................................................................................ Urethral procedures w/o CC/MCC ............................................................................................................................. Urethral stricture ........................................................................................................................................................ Major male pelvic procedures w CC/MCC ................................................................................................................ Major male pelvic procedures w/o CC/MCC ............................................................................................................. Pelvic evisceration, rad hysterectomy & rad vulvectomy w CC/MCC ....................................................................... Pelvic evisceration, rad hysterectomy & rad vulvectomy w/o CC/MCC .................................................................... Uterine & adnexa proc for ovarian or adnexal malignancy w MCC .......................................................................... Uterine & adnexa proc for ovarian or adnexal malignancy w CC ............................................................................. Uterine & adnexa proc for ovarian or adnexal malignancy w/o CC/MCC ................................................................. Uterine,adnexa proc for non-ovarian/adnexal malig w MCC ..................................................................................... Uterine,adnexa proc for non-ovarian/adnexal malig w CC ........................................................................................ Uterine,adnexa proc for non-ovarian/adnexal malig w/o CC/MCC ........................................................................... Uterine & adnexa proc for non-malignancy w CC/MCC ............................................................................................ Uterine & adnexa proc for non-malignancy w/o CC/MCC ......................................................................................... Female reproductive system reconstructive procedures ........................................................................................... Cesarean section w CC/MCC .................................................................................................................................... Cesarean section w/o CC/MCC ................................................................................................................................. Vaginal delivery w sterilization &/or D&C .................................................................................................................. Vaginal delivery w O.R. proc except steril &/or D&C ................................................................................................ Abortion w D&C, aspiration curettage or hysterotomy .............................................................................................. Vaginal delivery w complicating diagnoses ............................................................................................................... Vaginal delivery w/o complicating diagnoses ............................................................................................................ Ectopic pregnancy ..................................................................................................................................................... 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00089 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 242 243 242 243 252 253 254 237 238 237 238 237 238 283 284 285 356 357 358 371 372 373 371 372 373 371 372 373 456 480 482 480 482 514 505 505 505 629 630 628 629 630 659 660 661 665 687 688 688 660 661 717 718 754 755 756 754 755 756 755 756 749 744 769 769 769 769 769 769 769 24768 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules NO-VOLUME PROPOSED MS–LTC–DRG CROSSWALK FOR FY 2008—Continued Proposed MS–LTC– DRG mmaher on DSK3CLS3C1PROD with $$_JOB 778 779 780 782 789 790 791 792 793 794 795 799 800 801 827 887 927 955 .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. Threatened abortion ................................................................................................................................................... Abortion w/o D&C ...................................................................................................................................................... False labor ................................................................................................................................................................. Other antepartum diagnoses w/o medical complications .......................................................................................... Neonates, died or transferred to another acute care facility ..................................................................................... Extreme immaturity or respiratory distress syndrome, neonate ................................................................................ Prematurity w major problems ................................................................................................................................... Prematurity w/o major problems ................................................................................................................................ Full term neonate w major problems ......................................................................................................................... Neonate w other significant problems ....................................................................................................................... Normal newborn ......................................................................................................................................................... Splenectomy w MCC ................................................................................................................................................. Splenectomy w CC .................................................................................................................................................... Splenectomy w/o CC/MCC ........................................................................................................................................ Myeloprolif disord or poorly diff neopl w maj O.R. proc w CC .................................................................................. Other mental disorder diagnoses .............................................................................................................................. Extensive burns or full thickness burns w MV 96+ hrs w skin graft ......................................................................... Craniotomy for multiple significant trauma ................................................................................................................ To illustrate this methodology for determining the proposed relative weights for the 124 proposed MS–LTC– DRGs with no LTCH cases, we are providing the following example, which refers to the no volume proposed MS– LTC–DRGs crosswalk information for FY 2008 provided in the chart above. Example 1: There were no cases in the FY 2006 MedPAR file used for this proposed rule for proposed MS–LTC–DRG 22 (Intracranial vascular procedures w PDX hemorrhage w/o CC/MCC). We determined that proposed MS–LTC– DRG 33 (Ventricular shunt procedures w/o CC/MCC), which is assigned to lowvolume Quintile 1 for the purpose of determining the proposed FY 2008 relative weights, is similar clinically and based on resource use to proposed MS–LTC–DRG 22. Therefore, we are proposing to assign the same relative weight of proposed MS–LTC–DRG 33 of 0.48011 (Quintile 1) for FY 2008 (Table 11 in the Addendum to this proposed rule) to proposed MS–LTC–DRG 22. Furthermore, for FY 2008 we are proposing to establish proposed MS– LTC–DRG relative weights of 0.0000 for the following transplant proposed MS– LTC–DRGs: Heart transplant or implant of heart assist system w MCC (proposed LTC–DRG 1); Heart transplant or implant of heart assist system w/o MCC (proposed LTC–DRG 2); Liver transplant w MCC or intestinal transplant (proposed LTC–DRG 5); Liver transplant w/o MCC (proposed LTC–DRG 6); Lung transplant (proposed LTC–DRG 7); Simultaneous pancreas/kidney transplant (proposed LTC–DRG 8); and Pancreas transplant (proposed LTC– DRG 10). This is because Medicare will VerDate Mar 15 2010 Proposed crosswalked MS–LTC–DRG Proposed MS–LTC–DRG description 02:00 Aug 26, 2011 Jkt 223001 only cover these procedures if they are performed at a hospital that has been certified for the specific procedures by Medicare and presently no LTCH has been so certified. Based on our research, we found that most LTCHs only perform minor surgeries, such as minor small and large bowel procedures, to the extent any surgeries are performed at all. Given the extensive criteria that must be met to become certified as a transplant center for Medicare, we believe it is unlikely that any LTCHs will become certified as a transplant center. In fact, in the nearly 20 years since the implementation of the IPPS, there has never been a LTCH that even expressed an interest in becoming a transplant center. If in the future a LTCH applies for certification as a Medicare-approved transplant center, we believe that the application and approval procedure would allow sufficient time for us to determine appropriate weights for the proposed MS–LTC–DRGs affected. At the present time, we would only include these seven proposed transplant MS– LTC–DRGs in the GROUPER program for administrative purposes only. Because we use the same GROUPER program for LTCHs as is used under the IPPS, removing these proposed MS– LTC–DRGs would be administratively burdensome. Again, we note that, as this system is dynamic, it is entirely possible that the number of proposed MS–LTC–DRGs with no volume of LTCH cases based on the system will vary in the future. We used the most recent available claims data in the MedPAR file to identify no volume proposed MS–LTC–DRGs and to PO 00000 Frm 00090 Fmt 4701 Sfmt 4702 759 759 759 759 761 761 760 761 760 760 761 423 424 425 823 881 933 26 determine the proposed relative weights in this proposed rule. Table 11 in the Addendum to this proposed rule lists the proposed MS– LTC–DRGs and their respective proposed relative weights, geometric mean length of stay, and five-sixths of the geometric mean length of stay (to assist in the determination of short-stay outlier payments under § 412.529) for FY 2008. Step 6—Adjust the proposed FY 2008 MS–LTC–DRG relative weights to account for nonmonotonically increasing relative weights. As explained in section II.B. of this preamble, the IPPS proposed FY 2008 MS–DRGs, on which the proposed FY 2008 MS–LTC–DRGs are based, provide a significant improvement in the DRG system’s recognition of severity of illness and resource usage. The proposed MS-DRGs contain base DRGs that have been subdivided into one, two, or three severity levels. Where there are three severity levels, the most severe level has at least one code that is referred to as an MCC. The next lower severity level contains cases with at least one code that is a CC. Those cases without a MCC or a CC are referred to as without CC/MCC. When data did not support the creation of three severity levels, the base was divided into either two levels or the base was not subdivided. The two-level subdivisions could consist of the CC/MCC and the without CC/MCC. Alternatively, the other type of two level subdivision could consist of the MCC and without MCC. In base DRGs with two levels, cases classified into a ‘‘without CC/ MCC’’ proposed MS–LTC–DRG are expected to have lower resource use E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules (and lower costs) than the ‘‘with CC/ MM’’ and ‘‘with MCC.’’ That is, theoretically, cases that are more severe typically require greater expenditure of medical care resources and will result in higher average charges. Therefore, in the three severity levels, relative weights should increase by severity, from lowest to highest. If the weights do not increase (that is, if within a base MS–LTC–DRG, a proposed MS–LTC–DRG with MCC has a lower relative weight than one with CC, or the proposed MS–LTC–DRG without CC/MCC has a higher relative weight than either of the others, they are nonmonotonic. We continue to believe that utilizing nonmonotonic relative weights to adjust Medicare payments would result in inappropriate payments. Consequently, we are proposing that, in general, we would combine proposed MS–LTC–DRG severity levels within a proposed base MS–LTC–DRG for the purpose of computing a relative weight when necessary to ensure that monotonicity is maintained. Specifically, under each of the example scenarios provided below, we would combine severity levels within a proposed base MS–LTC–DRG as follows: The first example of nonmonotonically increasing relative weights for MS–LTC–DRG pertains to base DRGs with a three-level split and each of the three levels has 25 or more LTCH cases and, therefore, did not fall into one of the proposed five lowvolume quintiles. If nonmonotonicity is detected in the relative weights of proposed MS–LTC–DRGs in adjacent severity levels (for example, the relative weight of the ‘‘with MCC’’ (the highest severity level) is less than the ‘‘with CC’’ (the middle level), or the ‘‘with CC’’ is less than the ‘‘without CC/MCC’’), we are proposing to combine the adjacent proposed MS–LTC–DRGs and determine one relative weight based on the caseweighted average of the combined LTCH cases of the nonmonotonic proposed MS–LTC–DRG. The case-weighted average charge is determined by dividing the total charges for all LTCH cases in both severity levels by the total number of LTCH cases for the combined proposed MS–LTC–DRGs. We are proposing to apply this relative weight to both affected levels of the proposed base MS–LTC–DRG. If nonmonotonicity remains an issue because the above process results in a relative weight that is still nonmonotonic to the remaining proposed MS–LTC–DRG, we are proposing to combine all three of the severity levels to determine one relative weight which is assigned to each of the VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 proposed MS–LTC–DRG in that proposed base MS–LTC–DRG. A second scenario of nonmonotonically increasing relative weights for an MS–LTC–DRG pertains to the situation where one or more of the severity levels within a base DRG has less than 25 LTCH cases (that is, low volume). If nonmonotonicity occurs in the case where either the highest or lowest severity level (with MCC’’ or ‘‘without CC/MCC’’) has 25 LTCH cases or more and the other two severity levels are low volume (and therefore the other two severity levels would otherwise be assigned to quintiles), we are proposing to combine the data for the cases in the two adjacent lowvolume proposed MS–LTC–DRGs for the purpose of determining a relative weight. If the combination results in at least 25 cases, we are proposing to calculate one relative weight and assign it to both of the proposed severity levels. If the combination results in less than 25 cases, based on the caseweighted average charge of the combined low-volume MS–LTC–DRGs, both MS–LTC–DRGs, are assigned the relative weight of the quintile that has the closest relative weight to the case weighted average change of the combined low volume case. If nonmonotonicity persists, we are proposing to combine all three severity levels and one relative weight would be assigned to all three levels based on the case weighted average of the combined severity level. Similarly, in nonmonotonic cases where the middle level has 25 cases or more but either or both the lowest or highest severity level has less than 25 cases (that is, low volume), we are proposing to combine the nonmonotonic low-volume proposed MS–LTC–DRG with the middle level proposed MS–LTC–DRG of the base DRG. We are proposing to calculate one relative weight and apply it to both of the affected proposed MS– LTC–DRGs. If the nonmonotonicity persists, we are proposing to combine all three levels for the purpose of determining a relative weight, and apply that relative weight to all three levels. A third scenario addresses nonmonotonicity in a base DRG where at least one of the severity levels has no cases. As discussed in greater detail in Step 5, based on clinical similarity, we would cross-walk the proposed MS– LTC–DRG to a proposed MS–LTC–DRG to which it is similar clinically and in intensity of resource use and then assign it to a quintile with the relative weight closest to that of the MS–LTC–DRG to which the no-volume MS–LTC–DRG had been cross-walked. If this results in nonmonotonicity, in the case where the PO 00000 Frm 00091 Fmt 4701 Sfmt 4702 24769 no-volume proposed MS–LTC–DRG is either the lowest or highest severity level, we are proposing to assign to the no-volume proposed MS–LTC–DRG the same relative weight that is assigned to the middle level of the MS–LTC–DRG in that base DRG. If nonmonotonicity persists, we are proposing that all three severity levels be combined for the purpose of calculating one relative weight which is applied to each of the three levels. We note that this is a departure from our current treatment of no-volume LTC–DRGs which results in an ultimate assignment to a quintile. However, we propose that in the infrequent case where nonmonotonicity involves a no-volume proposed MS– LTC–DRG, we believe it is appropriate to resolve the nonmonotonicity by assigning the no-volume proposed MS– LTC–DRG the relative weight of the proposed MS–LTC–DRG(s) in the base DRG, regardless of whether the other proposed MS–LTC–DRG(s) is low volume (therefore assigned a relative weight of a quintile) or high volume (assigned its own relative weight). We believe this treatment achieves monotonically increasing relative weights while providing appropriate payment for the no-volume proposed MS–LTC–DRG because the relative weight assigned to the no-volume proposed MS–LTC–DRG is based on the average charges of services rendered within the same proposed base MS– LTC–DRG, rather than a quintile which contains proposed MS–LTC–DRGs from different proposed base MS–LTC–DRGs. We are proposing to apply the same process where the proposed base MS– LTC–DRG contains a two-level split. For example, if nonmonotonicity occurs in a proposed base MS–LTC–DRG with two severity levels (that is, the higher severity level relative weight is less than the lower severity level), where both of the MS–LTC–DRGs have at least 25 cases or where one or both of the proposed MS–LTC–DRGs is low volume, we are proposing to combine the two proposed MS–LTC–DRGs of that proposed base MS–LTC–DRG for the purpose of determining a case-weighted relative weight. If the combination still results in at least 25 cases, we are proposing to calculate one relative weight and assign it to both of the proposed MS–LTC–DRGs. If the combination results in less than 25 cases, we determine the quintile assignment for both MS–LTC–DRGs based on the case-weighted average charge and assign both MS–LTC–DRGs the same relative weight of the appropriate quintile. Step 7—Calculate the proposed FY 2008 budget neutrality factor. E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24770 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules As we stated in the FY 2008 LTCH PPS proposed rule (72 FR 4784 through 4786), under the broad authority conferred upon the Secretary under section 123 of Pub. L. 106–113 as amended by section 307(b) of Pub. L. 106–554 to develop the LTCH PPS, we proposed that, beginning with the MS– LTC–DRG update for FY 2008, the annual update to the proposed MS– LTC–DRG classifications and relative weights would be done in a budget neutral manner such that estimated aggregate LTCH PPS payments would be unaffected, that is, would be neither greater than nor less than the estimated aggregate LTCH PPS payments that would have been made without the proposed MS–LTC–DRG classification and relative weight changes. Currently under § 412.517, the LTC–DRG classifications and relative weights are adjusted annually to reflect changes in factors affecting the relative use of LTCH resources, such as treatment patterns, technology and number of discharges. In addition, there are currently no statutory or regulatory requirements that the annual update to the LTC–DRG classifications and relative weights be done in a budget neutral manner. Since the initial implementation of the LTCH PPS in FY 2003, we have updated the LTC–DRG relative weights each year without a budget neutrality adjustment based on the most recent available LTCH claims data, which reflect current LTCH patient mix and coding practices, and appropriately reflected more or less resource use than the previous year’s LTC–DRG relative weights (71 FR 47991). Historically, we have not updated the LTC–DRGs in a budget neutral manner because we believed that past fluctuations in the LTC–DRG relative weights were primarily due to changes in LTCH coding practices. We believe that changes in the LTCH PPS payment rates, including the LTC–DRG relative weights, should accurately reflect changes in LTCHs’ true cost of treating patients (real CMI increase), and should not be influenced by changes in coding practices (apparent CMI increase). Because LTCH 2006 claims data does not appear to significantly reflect changes in LTCH coding practices in response to the implementation of the LTCH PPS, we believe that it may be appropriate to update the LTC–DRGs so that estimated aggregate LTCH PPS payments would neither increase nor decrease. Thus, in the FY 2008 LTCH PPS proposed rule (72 FR 4784), we proposed that the annual update to the LTC–DRG classifications and relative weights be done in a budget neutral manner. (For VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 a detailed discussion on updating the LTC–DRG classifications and relative weights in a budget neutral manner, refer to the FY 2008 LTCH PPS proposed rule (72 FR 4784 through 4786). Updating the LTC–DRGs in a budget neutral manner would result in an annual update to the individual LTC–DRG classifications and relative weights based on the most recent available data to reflect changes in relative LTCH resource use, and the LTC–DRG relative weights would be uniformly adjusted to ensure that estimated aggregate payments under the LTCH PPS would not be affected (that is, decreased or increased). Consistent with that proposal, we are proposing to update the proposed MS–LTC–DRG classifications and relative weights for FY 2008 based on the most recent available data and include a budget neutrality adjustment. To ensure budget neutrality in updating the MS–LTC–DRG classifications and relative weights under the proposed change to § 412.517, we are proposing to use a method that is similar to the methodology used under the IPPS. (A discussion of the IPPS DRG budget neutrality adjustment can be found in the FY 2007 IPPS final rule (71 FR 47970).) Specifically, we are proposing that, after recalibrating the proposed MS–LTC–DRG relative weights, as we do under the methodology as described in detail in Steps 1 through 6 above, we would calculate and apply a normalization factor to the proposed MS–LTC–DRG relative weights to ensure that estimated payments are not influenced by changes in the composition of case types or changes made to the classification system. That is, the normalization adjustment is intended to ensure that the recalibration of the proposed MS–LTC–DRG relative weights (that is, the process itself) neither increases nor decreases total estimated payments. To calculate the normalization factor, we are proposing to use the most recent available claims data (FY 2006) and apply the proposed GROUPER (Version 25.0) to calculate the proposed relative weights. Furthermore, we are proposing to use the most recent available claims data in the analysis for the final rule. These weights are determined such that the average CMI value is 1.0. Then, we are proposing to group the same claims data (FY 2006) using the current GROUPER (Version 24.0) and current relative weights. The average CMI is calculated for the claims data using the current GROUPER and relative weights. Finally, the ratio of the average CMI of the claims data set under the current PO 00000 Frm 00092 Fmt 4701 Sfmt 4702 GROUPER and the proposed GROUPER is calculated as the proposed normalization factor. For FY 2008, based on the latest available data, the proposed normalization factor is estimated as 1.020302, which is applied to each proposed MS–LTC–DRG relative weight. (However, if more current data become available prior to publication of the final rule, we will use those data to determine the normalization factor.) That is, each proposed MS–LTC–DRG relative weight is multiplied by 1.020302 in the first step of the budget neutrality process. We are also proposing to ensure that estimated aggregate LTCH PPS payments (based on the most recent available LTCH claims data) after recalibration (the proposed relative weights) would be equal to estimated aggregate LTCH PPS payments (for the same most recent available LTCH claims data) before recalibration (the existing relative weights). Therefore, we are proposing to calculate the budget neutrality adjustment factor by simulating estimated payments under both sets of GROUPERs and relative weights. We are proposing to simulate total estimated payments under the current payment policies (RY 2007) using the most recent available claims data (FY 2006) and using the proposed GROUPER (Version 25.0), and normalized relative weights. Then, we are proposing to simulate estimated payments using the most recent available claims data (FY 2006) and apply the proposed GROUPER (Version 25.0). We next calculate payments using the same claims data (FY 2006) with the current GROUPER (Version 24.0). The ratio of the estimated average payment under the current GROUPER and the proposed GROUPER is calculated as the proposed budget neutrality factor. Then each of the proposed normalized relative weights is multiplied by the budget neutrality factor to determine the proposed budget neutral relative weight for each proposed MS–LTC–DRG. Accordingly, based on the most recent available data, we are proposing a budget neutrality factor of 1.003924 that is applied to the relative weights after normalizing. If more current data become available prior to publication of the final rule, we will use those data to determine the budget neutrality factor. The relative weights in Table 11 in the Addendum of this proposed rule reflect those budget neutral weights. If, as a result of comments, we decide not to finalize the proposed budget neutrality policy, the proposed weights in Table 11 of the Addendum to this proposed E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules rule change by the two factors discussed herein. Step 8—Apply the proposed case-mix budget neutrality factor to the proposed MS–LTC–DRG relative weight. As discussed under section II.D.6. of the preamble of this proposed rule, we are proposing a budget neutral adjustment for FY 2008 and FY 2009 to eliminate the effect of changes in coding or classification of discharges that do not reflect real change in case-mix because we believe that adoption of the proposed MS–LTC–DRGs would create a risk of increased aggregate levels of payment as a result of increased documentation and coding. The additional step 8 would be necessary for FY 2008 and FY 2009 to ensure that estimated aggregate LTCH PPS payments would be neither greater than nor less than the estimated aggregate LTCH PPS payments that would have been made without the adoption of the proposed MS–LTC–DRG patient classification system. Accordingly, each of the relative weights in Table 11 of the Addendum to this proposed rule reflects this proposed adjustment. That is, each proposed MS–LTC–DRG relative weight is multiplied by a factor of 0.976 to account for changes in coding or classification of discharges resulting from the adoption of the new patient classification system. mmaher on DSK3CLS3C1PROD with $$_JOB J. Proposed Add-On Payments for New Services and Technologies (If you choose to comment on issues in this section, please include the caption ‘‘New Technology’’ at the beginning of your comment.) 1. Background Sections 1886(d)(5)(K) and (L) of the Act establish a process of identifying and ensuring adequate payment for new medical services and technologies (sometimes collectively referred to in this section as ‘‘new technologies’’) under the IPPS. Section 1886(d)(5)(K)(vi) of the Act specifies that a medical service or technology will be considered new if it meets criteria established by the Secretary after notice and opportunity for public comment. Section 1886(d)(5)(K)(ii)(I) of the Act specifies that the process must apply to a new medical service or technology if, ‘‘based on the estimated costs incurred with respect to discharges involving such service or technology, the DRG prospective payment rate otherwise applicable to such discharges under this subsection is inadequate.’’ The regulations implementing this provision establish three criteria for new medical services and technologies to receive an additional payment. First, § VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 412.87(b)(2) defines when a specific medical service or technology will be considered new for purposes of new medical service or technology add-on payments. The statutory provision contemplated the special payment treatment for new medical services or technologies until such time as data are available to reflect the cost of the technology in the DRG weights through recalibration. There is a lag of 2 to 3 years from the point a new medical service or technology is first introduced on the market and when data reflecting the use of the medical service or technology are used to calculate the DRG weights. For example, data from discharges occurring during FY 2006 are used to calculate the proposed FY 2008 DRG weights in this proposed rule. Section 412.87(b)(2) provides that, ‘‘a medical service or technology may be considered new within 2 or 3 years after the point at which data begin to become available reflecting the ICD–9-CM code assigned to the new medical service or technology (depending on when a new code is assigned and data on the new medical service or technology become available for DRG recalibration). After CMS has recalibrated the DRGs based on available data to reflect the costs of an otherwise new medical service or technology, the medical service or technology will no longer be considered ‘new’ under the criterion for this section.’’ The 2-year to 3-year period during which a medical service or technology can be considered new would ordinarily begin with FDA approval, unless there was some documented delay in bringing the product onto the market after that approval (for instance, component production or drug production has been postponed until FDA approval due to shelf life concerns or manufacturing issues). After the DRGs have been recalibrated to reflect the costs of an otherwise new medical service or technology, the special add-on payment for new medical services or technologies ceases (§ 412.87(b)(2)). For example, an approved new technology that received FDA approval in October 2006 and entered the market at that time may be eligible to receive add-on payments as a new technology until FY 2010 (discharges occurring before October 1, 2009), when data reflecting the costs of the technology could be used to recalibrate the DRG weights. Because the FY 2009 DRG weights would be calculated using FY 2007 MedPAR data, the costs of such a new technology would be reflected in the FY 2009 DRG weights. Section 412.87(b)(3) further provides that new medical services or PO 00000 Frm 00093 Fmt 4701 Sfmt 4702 24771 technologies must be inadequately paid otherwise under the DRG system to receive the add-on payment. To assess whether technologies would be inadequately paid under the DRGs, we establish thresholds to evaluate applicants for new technology add-on payments. In the FY 2004 IPPS final rule (68 FR 45385), we established the threshold at the geometric mean standardized charge for all cases in the DRG plus 75 percent of 1 standard deviation above the geometric mean standardized charge (based on the logarithmic values of the charges and transformed back to charges) for all cases in the DRG to which the new medical service or technology is assigned (or the case-weighted average of all relevant DRGs, if the new medical service or technology occurs in many different DRGs). However, section 503(b)(1) of Pub. L. 108–173 amended section 1886(d)(5)(K)(ii)(I) of the Act to provide for ‘‘applying a threshold * * * that is the lesser of 75 percent of the standardized amount (increased to reflect the difference between cost and charges), or 75 percent of 1 standard deviation for the diagnosis-related group involved.’’ The provisions of section 503(b)(1) apply to classification for fiscal years beginning with FY 2005. (Refer to section IV.D. of the preamble to the FY 2005 IPPS final rule (69 FR 49084) for a discussion of the revision of the regulations to incorporate the change made by section 503(b)(1) of Pub. L. 108–173.) Table 10 of the Addendum to the FY 2007 IPPS final rule (71 FR 48319) contained the final thresholds that are being used to evaluate applications for new technology add-on payments for FY 2008. An applicant must demonstrate that the cost threshold is met using information from inpatient hospital claims. We were recently asked to revisit the issue of whether the HIPAA Privacy Rule at 45 CFR Parts 160 and 164 applies to claims information that providers submit with applications for new technology add-on payments. We previously addressed this issue in the September 7, 2001 final rule (66 FR 46917) that established the new technology add-on payment regulations. In the preamble to that final rule, we explained that health plans, including Medicare, and providers that conduct certain transactions electronically, including the hospitals that would be receiving payment under the FY 2001 IPPS final rule, are required to comply with the HIPAA Privacy Rule. We further explained how such entities could meet the applicable HIPAA E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24772 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules requirements by discussing how the HIPAA Privacy Rule permitted providers to share with health plans information needed to ensure correct payment, if they have obtained consent from the patient to use that patient’s data for treatment, payment, or health care operations. We also explained that because the information to be provided within applications for new technology add-on payment would be needed to ensure correct payment, no additional consent would be required. The HHS Office of Civil Rights has since amended the HIPAA Privacy Rule, but the results remain. The HIPAA Privacy Rule no longer requires covered entities to obtain consent from patients to use or disclose individually identifiable health information for treatment, payment, or health care operations, and expressly permits such entities to use or to disclose individually identifiable health information to covered entities for any of these purposes (45 CFR § § 164.502(a)(1)(ii), and 506(c)(1) and (c)(3); and the Standards for Privacy of Individually Identifiable Health Information published in the Federal Register on August 14, 2002 for a full discussion of changes in consent requirements). Section 412.87(b)(1) of our existing regulations provides that a new technology is an appropriate candidate for an additional payment when it represents ‘‘an advance that substantially improves, relative to technologies previously available, the diagnosis or treatment of Medicare beneficiaries.’’ For example, a new technology represents a substantial clinical improvement when it reduces mortality, decreases the number of hospitalizations or physician visits, or reduces recovery time compared to the technologies previously available. (Refer to the September 7, 2001 final rule (66 FR 46902) for a complete discussion of this criterion.) The new medical service or technology add-on payment policy provides additional payments for cases with high costs involving eligible new medical services or technologies while preserving some of the incentives under the average-based payment system. The payment mechanism is based on the cost to hospitals for the new medical service or technology. Under § 412.88, Medicare pays a marginal cost factor of 50 percent for the costs of a new medical service or technology in excess of the full DRG payment. If the actual costs of a new medical service or technology case exceed the DRG payment by more than the 50-percent marginal cost factor of the new medical service or technology, Medicare VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 payment is limited to the DRG payment plus 50 percent of the estimated costs of the new technology. The Congressional report language accompanying section 533 of Pub. L. 106–554 indicated Congress’ intent to require the Secretary to implement the new mechanism on a budget neutral basis (H.R. Conf. Rep. No. 106–1033, 106th Cong., 2nd Sess. at 897 (2000)). Section 1886(d)(4)(C)(iii) of the Act requires that the adjustments to annual DRG classifications and relative weights must be made in a manner that ensures that aggregate payments to hospitals are not affected. Therefore, in the past, we accounted for projected payments under the new medical service and technology provision during the upcoming fiscal year at the same time we estimated the payment effect of changes to the DRG classifications and recalibration. The impact of additional payments under this provision was then included in the budget neutrality factor, which was applied to the standardized amounts and the hospital-specific amounts. Section 1886(d)(5)(K)(ii)(III) of the Act, as amended by section 503(d)(2) of Pub. L. 108–173, provides that there shall be no reduction or adjustment in aggregate payments under the IPPS due to add-on payments for new medical services and technologies. Therefore, add-on payments for new medical services or technologies for FY 2005 and later years have not been budget neutral. Applicants for add-on payments for new medical services or technologies for FY 2009 must submit a formal request, including a full description of the clinical applications of the medical service or technology and the results of any clinical evaluations demonstrating that the new medical service or technology represents a substantial clinical improvement, along with a significant sample of data to demonstrate the medical service or technology meets the high-cost threshold. Complete application information, along with final deadlines for submitting a full application, will be available on our web site after publication of the IPPS FY 2008 final rule at: https://www.cms.hhs.gov/ AcuteInpatientPPS/08—newtech.asp. To allow interested parties to identify the new medical services or technologies under review before the publication of the proposed rule for FY 2009, the web site will also list the tracking forms completed by each applicant. 2. Public Input Before Publication of a Notice of Proposed Rulemaking on AddOn Payments Section 1886(d)(5)(K)(viii) of the Act, as amended by section 503(b)(2) of Pub. PO 00000 Frm 00094 Fmt 4701 Sfmt 4702 L. 108–173, provides for a mechanism for public input before publication of a notice of proposed rulemaking regarding whether a medical service or technology represents a substantial clinical improvement or advancement. The process for evaluating new medical service and technology applications requires the Secretary to— <bullet≤ Provide, before publication of a proposed rule, for public input regarding whether a new service or technology represents an advance in medical technology that substantially improves the diagnosis or treatment of Medicare beneficiaries. <bullet≤ Make public and periodically update a list of the services and technologies for which applications for add-on payments are pending. <bullet≤ Accept comments, recommendations, and data from the public regarding whether a service or technology represents a substantial clinical improvement. <bullet≤ Provide, before publication of a proposed rule, for a meeting at which organizations representing hospitals, physicians, manufacturers, and any other interested party may present comments, recommendations, and data regarding whether a new medical service or technology represents a substantial clinical improvement to the clinical staff of CMS. In order to provide an opportunity for public input regarding add-on payments for new medical services and technologies for FY 2008 before publication of the FY 2008 IPPS proposed rule, we published a notice in the Federal Register on December 22, 2006 (71 FR 77031), and held a town hall meeting at the CMS Headquarters Office in Baltimore, MD, on February 22, 2007. In the announcement notice for the meeting, we stated that the opinions and alternatives provided during the meeting would assist us in our evaluations of applications by allowing public discussion of the substantial clinical improvement criterion for each of the FY 2008 new medical service and technology add-on payment applications before the publication of the FY 2008 IPPS proposed rule. Approximately 70 individuals attended the town hall meeting in person, while additional participants listened over an open telephone line. Boston Scientific presented data on how its product (Wingspan[reg] Stent System with GatewayTM PTA Balloon Catheter) meets the substantial clinical improvement criterion, as well as the need for additional payments to ensure its access to Medicare beneficiaries. No other attendees at the town hall meeting E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB made a presentation with regard to the Wingspan[reg] new technology add-on payment application. We considered Boston Scientific’s presentation made at the town hall meeting, as well as written comments submitted with their application, in our evaluation of the Wingspan[reg] new technology application for FY 2008 in this proposed rule. We have summarized these comments under section I.4. of this preamble. We did not receive any other comments regarding substantial clinical improvement of Wingspan[reg]. However, there were a number of public comments made at the town hall meeting suggesting that CMS provide more specific detail about how it would apply the substantial clinical improvement criterion. For example, the public commenters at the town hall meeting suggested that CMS provide clear guidance with respect to the type of data that applicants should submit to support an application for add-on payments for new medical services and technologies. We were asked to work with stakeholders, including researchers, clinicians, representatives of patients, and manufacturers, to develop specific criteria and data quality standards that would make determinations of ‘‘substantial clinical improvement’’ more predictable and transparent. We welcome public comment on this issue. In particular, we are interested in any ‘‘specific criteria or data quality standards’’ that the commenters believe we should adopt to improve the new technology add-on application process, or any concerns or challenges that commenters believe we may encounter in undertaking this effort. Again, as we stated at the new technology town hall meeting, we are always interested in working with our stakeholders to improve the inpatient new technology add-on payment process. We are interested in ensuring that the latest medical technology that improves care for the Medicare patient population continues to be available to our beneficiaries. 3. FY 2008 Status of Technologies Approved for FY 2007 Add-On Payments a. Endovascular Graft Repair of the Thoracic Aorta W. L. Gore & Associates, Inc. submitted an application for consideration of its Endovascular Graft Repair of the Thoracic Aorta (GORE TAG) for new technology add-on payments for FY 2006. The manufacturer argued that endovascular stent-grafting of the descending thoracic aorta provides a less invasive alternative VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 to the traditional open surgical approach required for the management of descending thoracic aortic aneurysms. The GORE TAG device is a tubular stent-graft mounted on a catheter-based delivery system, and it replaces the synthetic graft normally sutured in place during open surgery. The device was initially identified using ICD–9–CM procedure code 39.79 (Other endovascular repair (of aneurysm) of other vessels). The applicant also requested a unique ICD–9–CM procedure code. As noted in Table 6B of the FY 2006 IPPS final rule (70 FR 47637), new procedure code 39.73 (Endovascular implantation of graft in thoracic aorta) was assigned to this technology. In the FY 2006 IPPS final rule (70 FR 47356), we approved the GORE TAG device for new technology add-on payment for FY 2006. FDA approved GORE TAG on March 23, 2005. Because the technology remained within the 2to 3-year period during which it could be considered new for FY 2007, we continued add-on payments for the endovascular graft repair of the thoracic aorta in the FY 2007 IPPS final rule (71 FR 47999). GORE TAG will have been on the market for more than 3 years as of March 23, 2008, or less than 6 months of FY 2008. Our practice has been to begin and end new technology add-on payments on the basis of a fiscal year. In general, we extend add-on payments for an additional year only if the 3-year anniversary date of the product’s entry on the market occurs in the latter half of the fiscal year (70 FR 47362). Because the 3-year anniversary date of GORE TAG’s entry onto the market was in the first half of the fiscal year, we are proposing to discontinue its new technology add-on payment for FY 2008. b. Restore[supreg] Rechargeable Implantable Neurostimulator Medtronic Neurological submitted an application for new technology add-on payments for its Restore[supreg] Rechargeable Implantable Neurostimulator for FY 2006. The Restore[supreg] Rechargeable Implantable Neurostimulator is designed to deliver electrical stimulation to the spinal cord to block the sensation of pain. The technology standard for neurostimulators uses internal sealed batteries as the power source to generate the electrical current. These internal batteries have finite lives, and require replacement when their power has been completely discharged. According to the manufacturer, the Restore[supreg] Rechargeable Implantable Neurostimulator ‘‘represents the next generation of PO 00000 Frm 00095 Fmt 4701 Sfmt 4702 24773 neurostimulator technology, allowing the physician to set the voltage parameters in such a way that fully meets the patient’s requirements to achieve adequate pain relief without fear of premature depletion of the battery.’’ The applicant stated that the expected life of the Restore[supreg] rechargeable battery is 9 years, compared to an average life of 3 years for conventional neurostimulator batteries. We approved new technology add-on payments for all rechargeable, implantable neurostimulators for FY 2006 and FY 2007. Cases involving these devices, made by any manufacturer, are identified by the presence of newly created ICD–9–CM code 86.98 (Insertion or replacement of dual array rechargeable neurostimulator pulse generator). The FDA approved the Restore[supreg] Rechargeable Implantable Neurostimulator in 2005. However, as noted in the FY 2006 IPPS final rule (70 FR 47358), at least one similar product was approved by the FDA as early as April 2004. Because the Restore’’ Rechargeable Implantable Neurostimulator will be beyond the 2to 3-year period during which it can be considered new for FY 2008, we are proposing to discontinue add-on payments for the technology in FY 2008. c. X STOP Interspinous Process Decompression System St. Francis Medical Technologies submitted an application for new technology add-on payments for the X STOP Interspinous Process Decompression System (X STOP) for FY 2007. Lumbar spinal stenosis describes a condition that occurs when the spaces between bones in the spine become narrowed due to arthritis and other agerelated conditions. This narrowing, or stenosis, causes nerves coming from the spinal cord to be compressed, thereby causing symptoms including pain, numbness, and weakness. It particularly causes symptoms when the spine is in extension, when a patient stands fully upright or leans back. The X STOP device is inserted between the spinous processes of adjacent vertebrae in order to provide a minimally invasive alternative to conservative treatment (exercise and physical therapy) and invasive surgery (spinal fusion). It works by limiting the spine’s extension that compresses the nerve’s roots while still preserving as much motion as possible. The device is inserted in a relatively simple, primarily outpatient procedure using local anesthesia. However, in some circumstances, the physician may prefer to admit the E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24774 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules patient for an inpatient stay. The manufacturer described the device as providing ‘‘a new minimally invasive, stand-alone alternative treatment for lumbar spinal stenosis.’’ The X STOP Interspinous Process Decompression system received premarket approval from the FDA on November 21, 2005. The device is currently described by ICD–9–CM code 84.58 (Implantation of Interspinous process decompression device) (excluding: Fusion of spine (codes 81.00 through 81.08, and 81.30 through 81.39)). This ICD–9–CM code went into effect on October 1, 2005. In the FY 2007 final rule, with respect to substantial clinical improvement, we noted our concern that, during the FDA approval process, the Center for Devices and Radiological Health Advisory Panel voted against pre-market approval of X STOP because of concerns about proper patient selection, as well as the lack of objective endpoints. The applicant addressed our concerns by demonstrating that the mechanism of effect on the spine in cadavers with in vivo clinical radiographic data. That is, the applicant was able to show that the X STOP device limits spine extension that compresses the nerve. Thus, we indicated that we believed the technology has promise for providing a less invasive alternative to procedures such as laminectomy or fusion for patients that have failed conservative treatment (exercise, physical therapy and medication). The X STOP system represents a new level of treatment on the continuum of care for patients with lumbar spinal stenosis that previously did not exist. Accordingly, after consideration of the comments received, we approved the X STOP Interspinous Process Decompression System for new technology add-on payment for FY 2007. Cases involving X STOP are identified by ICD–9–CM code 84.58 (Implantation of interspinous process decompression device). These cases are generally included in CMS–DRG 499 (Back and Neck Procedures Except Spinal Fusion with CC) and CMS–DRG 500 (Back and Neck Procedures Except Spinal Fusion without CC) for FY 2007. The X STOP Interspinous Process Decompression System is still within the 2- to 3-year period during which it can be considered new for FY 2008. However, we are concerned that it may no longer meet the cost-threshold criterion. In section II.D. of the preamble of this proposed rule, we are proposing to adopt MS–DRGs for FY 2008 and assign cases with procedure codes 84.58 into proposed MS–DRG 490 (Back and Neck Procedures Except Spinal Fusion VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 with CC or MCC or Disc Devices). Proposed MS–DRG 490 includes back and neck procedures except spinal fusion with a CC or MCC. As indicated earlier, we did a comprehensive review of the spinal fusion and nonspinal fusion DRGs. Based on this review, we are proposing to further modify MS– DRG 490 to also include the higher cost of cases where the patient receives a spinal disc device such as an artificial spinal disc prosthesis, or an interspinous process decompression system. Our earlier analysis of the spinal and nonspinal fusion DRGs showed that the average charge per case for cases involving X STOP is $29,162. The average charge per case for MS– DRG 490 is $29,656. Therefore, cases that use X STOP have a lower average charge per case than all cases in MS– DRG 490. The data show that the technology is not inadequately paid under the revised MS–DRGs, and it no longer meets the cost threshold for new technology add-on payment. For this reason, we are proposing to discontinue new technology add-on payments for X STOP in FY 2008 and correlate the payments under MS–DRG 490. The high costs for cases using X STOP that necessitated an add-on payment under the CMS DRGs will no longer be necessary because of the higher payment that would be made under the proposed MS–DRG 490. 4. FY 2008 Application for New Technology Add-On Payments Boston Scientific submitted an application for the Wingspan[reg] Stent System with Gateway PTA Balloon Catheter (Wingspan[reg]) for new technology add-on payments for FY 2008. The device is designed for the treatment of patients with significant intracranial arterial stenosis who are refractory to medical management. The device consists of the following: a selfexpanding nitinol stent; a multilumen over wire delivery catheter; and a GatewayTM PTA Balloon Catheter. The device is used to treat stenoses that occur in the intracranial vessels. Prior to stent placement, the GatewayTM PTA Balloon is inflated to dilate the target lesion, and then the stent is deployed across the lesion to restore and maintain luminal patency. Effective October 1, 2004, two new ICD–9–CM procedure codes were created to code intracranial angioplasty and intracranial stenting procedures: procedure codes 00.62 (Percutaneous angioplasty or atherectomy of intracranial vessels) and 00.65 (Percutaneous insertion of intracranial vascular stents). On August 3, 2005, the Wingspan[reg] was approved by the FDA as a PO 00000 Frm 00096 Fmt 4701 Sfmt 4702 Humanitarian Device Exemption (HDE). We note that the applicant submitted an application for new technology add-on payments in FY 2006 but was not approved for add-on payments because it had not yet received FDA approval. In November 2006, we issued a national coverage determination (NCD) on intracranial stents. The NCD stated that the treatment of cerebral artery stenosis in patients with intracranial atherosclerotic disease with intracranial percutaneous transluminal angioplasty (PTA) and stenting is reasonable and necessary when furnished in accordance with the FDA-approved protocols governing Category B Investigational Device Exemption (IDE) clinical trials. Currently, there are no clinical trials in place for the Wingspan[reg]. However, because the technology is covered by Medicare, if it is used in the setting of a clinical trial, we will evaluate whether the Wingspan[reg] meets the criteria for an inpatient new technology add-on payment. The Wingspan[reg] has been available on the market since August 3, 2005. Therefore, we believe that the technology meets the newness criterion. The applicant noted in its application that cases of intracranial angioplasty and stenting cases are currently grouped to CMS DRGs 533 (Extracranial Procedure with CC) and 534 (Extracranial Procedure Without CC). However, the applicant believes these cases should be assigned to CMS DRGs 1 (Craniotomy Age ≤ 17 With CC), 2 (Craniotomy Age ≤ 17 Without CC), and 543 (Craniotomy With Major Device Implant or Acute Complex Central Nervous System Principal Diagnosis) based on resource use and for clinical consistency with other endovascular intracranial procedures assigned to these DRGs. As discussed in section II.D. of the preamble of this proposed rule, we are proposing to move procedure code 00.62 to proposed MS– DRGs 25, 26, and 27 (Craniotomy & Endovascular Intracranial Procedures With MCC, With CC, and Without CC/ MCC, respectively) and proposed MS– DRGs 23 and 24 (Craniotomy With Major Device Implant or Acute Complex Central Nervous System Principal Diagnosis With MCC or Without MCC, respectively) under the proposed MS– DRG system, which are comparable to DRGs 1, 2, and 543 under the current CMS–DRG system. To demonstrate that the Wingspan[reg] meets the cost threshold, the manufacturer submitted data from MedPAR and non-MedPAR databases. Using the FY 2005 MedPAR data, the applicant identified cases of intracranial angioplasty that had a procedure code of 39.50 (Angioplasty or atherectomy of E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules other noncoronary vessels) in combination with one of the following principal diagnosis codes: Any principal diagnosis code that begins with the prefix of 433 (Occlusion and stenosis of precerebral arteries), excluding 433.10 (Cartoid artery without mention of cerebral infarction) and 433.11 (Cartoid artery with cerebral infarction); any principal diagnosis code that begins with the prefix of 434 (Occlusion of cerebral arteries), 437.0 (Cerebral atherosclerosis), 437.1 (Other generalized ischemic cerebrovascular disease), or 437.9 (Unspecified). The applicant noted that procedure code 39.50 is the predecessor code for identifying cases of intracranial angioplasty. The applicant explained that, given the newness of procedure codes 00.62 and 00.65 that were implemented beginning October 1, 2005, it believes there are still cases being coded with the predecessor procedure codes. Using this methodology, the applicant found 577 cases in DRG 533 and 179 cases in DRG 534. The applicant noted that charges in the MedPAR file do not include the total costs of devices, drugs, and medical supplies associated with the Wingspan[reg], so the applicant conducted an estimate of the charges associated with the Wingspan[reg]. The applicant determined that costs associated with the Wingspan[reg] are approximately $10,073. Because we use charges to determine if a technology meets the threshold, it is necessary to inflate the costs to charges. Using the national average CCR of 0.47, the applicant inflated the costs associated with the Wingspan[reg] to $21,432 in charges. After adding the charges associated with the Wingspan[reg], the average standardized charge per case was $76,416 and $51,277 for DRGs 533 and 534, respectively. We are concerned regarding whether the cases identified by the applicant are a useful proxy to identify cases of intracranial angioplasty. Procedure code 39.50 describes cases of angioplasty in any artery of the body except the heart. Intracranial angioplasty with stenting was not covered by Medicare in any circumstance prior to October 2006. Therefore, the Medicare cases submitted by the applicant under procedure code 39.50 should not involve intracranial angioplasty because they are neither described by the code nor covered by Medicare. Furthermore, procedure code 00.62 is assigned to the Non-Covered Procedure edit of the MCE. The applicant supplied Medicare data from FY 2005 for claims coded with procedure code 00.62. It is unclear to us how these claims were processed despite the Non-Covered Procedure edit. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Because these data appear to be based on claims that may not have been coded or processed correctly, we question the reliability and validity of these data. We are concerned that it may not be appropriate to rely on these data for purposes of determining whether the technology meets the cost threshold. As stated above, the applicant also submitted non-Medicare data. The applicant used the 2005 patient discharge data from California’s Office of Statewide Health Planning and Development database for hospitals in California and the 2005 patient data from Florida’s Agency for Health Care Administration for hospitals in Florida. Similar to the analysis above, the applicant identified cases of intracranial angioplasty using procedure code 39.50 in combination with the diagnosis codes listed above. The applicant identified 43 cases in DRG 533, and 21 cases in DRG 534. Because these cases already include charges associated with Wingspan[supreg], it was not necessary to include the $21,432 in charges associated with Wingspan[supreg]. The average standardized charge per case was $89,697 and $40,475 for DRGs 533 and 534, respectively. As discussed above, we are concerned about whether these cases actually represent cases of intracranial angioplasty. We also note that we are unable to validate these data because they are non-Medicare data. In addition, similar to the analysis described above, the applicant also identified cases of intracranial angioplasty using procedure code 00.62. The applicant found 30 cases in DRG 533, and 23 cases in DRG 534. The average standardized charge per case was $93,215 and $31,479 for DRGs 533 and 534, respectively. Based on these data, the applicant maintains that the technology meets the cost threshold. As noted above, the applicant has requested that cases of the Wingspan[supreg] be reassigned to CMS DRGs 1, 2 and 543. In section II.G.2. of the preamble of this proposed rule, we are proposing to assign procedure code 00.62 to proposed MS-DRGs 23, 24, 25, 26 and 27, which replace DRGs 1, 2, and 543 of the current CMS DRGs. The thresholds in Table 10 of the Addendum of the FY 2007 IPPS final rule (as corrected at 71 FR 60040) for DRGs 1, 2 and 543 are $53,969, $37,116 and $64,397, respectively. Analyzing the same Medicare and non-Medicare data that the applicant used to demonstrate that the Wingspan[supreg] exceeds the cost threshold for DRGs 533 and 534, the applicant compared the average standardized charge per case to the thresholds for DRGs 1, 2, and 543. The applicant maintains that the Wingspan[supreg] would still exceed PO 00000 Frm 00097 Fmt 4701 Sfmt 4702 24775 the cost threshold even if it were reassigned to DRGs 1, 2, and 543. However, for the reasons described above, it is not clear whether Wingspan[supreg] meets the cost threshold for new technology add-on payment. We welcome public comments on this issue. The applicant also maintains that the technology meets the substantial clinical improvement criterion. In the past there has been no surgical or medical treatment available for recurrent strokes that occur despite optimal medical management. The applicant asserts that the Wingspan[supreg] provides a new treatment option for these patients. The applicant submitted three studies to support this position. First, the applicant cites data derived from a series of cases of 45 patients who received the Wingspan[supreg] that demonstrate 4.4 percent composite ipsilateral stroke or death at 30 days, 7.0 percent composite ipsilateral stroke or death at 6 months, and 9.3 percent ipsilateral stroke or death at 13 months. The applicant then used patients in the well known Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial as a historical control against which to compare patients who received Wingspan[supreg]. The WASID trial compared the warfarin vs. aspirin therapy in treating symptomatic intracranial arterial stenosis, and it demonstrated a 23 percent stroke/death rate at one year in patients with severe (70 percent or greater) stenosis, and a 21 percent stroke/death rate at 2 years in patients with 50 percent or greater stenosis. The applicant also submitted data from an ongoing Wingspan[supreg] registry of patients that demonstrate a 4.8 percent stroke/death rate at 30 days, and a 9.7 percent stroke/death rate at 3 to 6 month follow up in 72 patients. In addition, the applicant submitted data from a multicenter NIH registry of 131 patients with 70 percent or greater stenosis that demonstrate an 8.4 percent rate of stroke, intracerebral hemorrhage or death at 30 days and a 9.9 percent rate of stroke and death at the mean 3.2 months followup. While we recognize that Wingspan[supreg] may represent a promising technology in patients with significant intracranial arterial stenosis who are refractory to medical management, we are concerned that, to date, there has been no controlled, randomized trial to demonstrate its clinical efficacy. We are also concerned that the Wingspan[supreg] data did not compare patients over the same followup periods as WASID. In addition, we are concerned over the use E:\FEDREG\03MYP2.LOC 03MYP2 24776 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules of WASID patients as a control group against which to compare Wingspan[supreg] patients. The current FDA Humanitarian Device Exemption, in combination with the current CMS NCD, while providing access to this technology for very ill patients with generally poor prognoses who have few other options, also effectively designates the technology as investigational, and in need of further studies to prove its effectiveness. We would prefer that the product’s effectiveness be demonstrated before we judge whether the product represents a substantial clinical improvement. For these reasons, we are concerned that there may not be sufficient evidence that Wingspan[supreg] represents an advance that substantially improves the diagnosis or treatment of Medicare beneficiaries. However, we welcome public comments that may pertain to this matter. 5. Technical Correction Section 1886(d)(5)(K)(i) of the Act requires that the Secretary establish a mechanism to recognize the costs of new medical services and technologies under subsection (d) of section 1886 of the Act. As made clear under section 1886(d)(1)(A) of the Act, subsection (d) provides the methodology for payment with respect to the operating costs of inpatient hospital services. Section 1886(g) of the Act provides for payment of capital costs of inpatient hospital services. Although it has always been our policy that new technology add-on payment is available only with respect to operating costs, § 412.88(a)(2) of our regulations does not specifically refer to operating costs or the operating CCR. Therefore, we are proposing to revise § 412.88(a)(2) to clarify that the new technology add-on payment is available only for operating costs, and that we estimate the costs of a case by applying the hospital’s operating CCR to the billed charges. This proposed correction would not have an impact on new technology add-on payments because, to the best of our knowledge, MACs already correctly apply only the operating CCR to calculate new technology add-on payments. mmaher on DSK3CLS3C1PROD with $$_JOB III. Proposed Changes to the Hospital Wage Index A. Background Section 1886(d)(3)(E) of the Act requires that, as part of the methodology for determining prospective payments to hospitals, the Secretary must adjust the standardized amounts ‘‘for area differences in hospital wage levels by a factor (established by the Secretary) reflecting the relative hospital wage VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 level in the geographic area of the hospital compared to the national average hospital wage level.’’ In accordance with the broad discretion conferred under the Act, we currently define hospital labor market areas based on the definitions of statistical areas established by the Office of Management and Budget (OMB). A discussion of the proposed FY 2008 hospital wage index based on the statistical areas, including OMB’s revised definitions of Metropolitan Areas, appears under section III.B. of this preamble. Beginning October 1, 1993, section 1886(d)(3)(E) of the Act requires that we update the wage index annually. Furthermore, this section provides that the Secretary base the update on a survey of wages and wage-related costs of short-term, acute care hospitals. The survey must exclude the wages and wage-related costs incurred in furnishing skilled nursing services. This provision also requires us to make any updates or adjustments to the wage index in a manner that ensures that aggregate payments to hospitals are not affected by the change in the wage index. The proposed adjustment for FY 2008 is discussed in section II.B. of the Addendum to this proposed rule. As discussed below in section III.I. of this preamble, we also take into account the geographic reclassification of hospitals in accordance with sections 1886(d)(8)(B) and 1886(d)(10) of the Act when calculating IPPS payment amounts. Under section 1886(d)(8)(D) of the Act, the Secretary is required to adjust the standardized amounts so as to ensure that aggregate payments under the IPPS after implementation of the provisions of sections 1886(d)(8)(B) and (C) and 1886(d)(10) of the Act are equal to the aggregate prospective payments that would have been made absent these provisions. The proposed budget neutrality adjustment for FY 2008 is discussed in section II.A.4.b. of the Addendum to this proposed rule. Section 1886(d)(3)(E) of the Act also provides for the collection of data every 3 years on the occupational mix of employees for short-term, acute care hospitals participating in the Medicare program, in order to construct an occupational mix adjustment to the wage index. A discussion of the occupational mix adjustment that we are proposing to apply beginning October 1, 2007 (the FY 2008 wage index) appears under section III.C. of this preamble. B. Core-Based Statistical Areas for the Hospital Wage Index (If you choose to comment on issues in this section, please include the PO 00000 Frm 00098 Fmt 4701 Sfmt 4702 caption ‘‘CBSAs’’ at the beginning of your comments.) The wage index is calculated and assigned to hospitals on the basis of the labor market area in which the hospital is located. In accordance with the broad discretion under section 1886(d)(3)(E) of the Act, beginning with FY 2005, we define hospital labor market areas based on the Core-Based Statistical Areas (CBSAs) established by OMB and announced in December 2003 (69 FR 49027). For a discussion of OMB’s revised definitions of CBSAs and our implementation of the CBSA definitions, we refer readers to the preamble of the FY 2005 IPPS final rule (69 FR 49026 through 49032). The revised area designations established by OMB resulted in a higher wage index for some areas and a lower wage index for others. Further, some hospitals that were previously classified as urban became classified as rural. Given the significant payment impacts upon some hospitals because of these changes, we provided a transition period to the new labor market areas in the FY 2005 IPPS final rule. As part of that transition, we allowed urban hospitals that became rural under the new definitions to maintain their assignment to the MSA where they were previously located for the 3-year period of FY 2005, FY 2006, and FY 2007. For a discussion of the transition, we refer readers to the FY 2005 IPPS final rule (69 FR 49032 through 49034). FY 2007 was the last year of the transition period for urban hospitals that became classified as rural. Therefore, for discharges on or after October 1, 2007 (FY 2008), these hospitals will receive their statewide rural wage index or their FY 2008 MGCRB reclassified age index. (These hospitals were and are eligible to apply for reclassification by the MGCRB both during the transition period and in subsequent years. These hospitals are considered rural for reclassification purposes.) Consistent with the FY 2005, FY 2006, and FY 2007 IPPS final rules, for FY 2008 we are proposing to provide that hospitals receive 100 percent of their wage index based upon the CBSA configurations. Specifically, for each hospital, we will determine a wage index for FY 2008 employing wage index data from FY 2004 hospital cost reports and using the CBSA labor market definitions. We consider CBSAs that are MSAs to be urban, and CBSAs that are Micropolitan Statistical Areas as well as areas outside of CBSAs to be rural. In addition, where an MSA has been divided into Metropolitan Divisions, we consider the Metropolitan E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB Division to comprise the labor market areas for purposes of calculating the wage index (69 FR 49029). On December 18, 2006, OMB announced the inclusion of two new CBSAs and the revision of designations for six areas (OMB Bulletin No. 07–01). The new CBSAs are as follows: <bullet≤ Lake Havasu-Kingman, Arizona (CBSA 29420). This CBSA comes from Mohave County, Arizona; <bullet≤ Palm Coast, Florida (CBSA 37380). This CBSA comes from Flager County, Florida; The revised CBSA designations are as follows: <bullet≤ Mauldin, South Carolina and Easley, South Carolina qualify as new principal cities of the GreenvilleMauldin-Easley, South Carolina CBSA; <bullet≤ Conway, Arkansas qualifies as a new principal city of the Little Rock-North Little Rock-Conway, Arkansas CBSA; <bullet≤ Goleta, California qualifies as a new principal city of the Santa Barbara-Santa Maria-Goleta, California CBSA; <bullet≤ Franklin, Tennessee qualifies as a new principal city of the NashvilleDavidson-Murfreesboro-Franklin, Tennessee CBSA; <bullet≤ Fort Pierce, Florida no longer qualifies as a principal city of the Port St. Lucie-Fort Pierce, Florida CBSA; the new designation is Port St. Lucie, Florida CBSA. (We note also that OMB renamed the Essex County, Massachusetts Metropolitan Division as the Peabody, Massachusetts Metropolitan Division. OMB also changed the CBSA code from 21604 to 37764.) The OMB bulletin is available on the OMB Web site at https:// www.whitehouse.gov/OMB—go to ‘‘Bulletins’’ or ‘‘Statistical Programs and Standards.’’ CMS will apply these changes to the IPPS beginning October 1, 2007. C. Proposed Occupational Mix Adjustment to the Proposed FY 2008 Wage Index (If you choose to comment on issues in this section, please include the caption ‘‘Occupational Mix Adjustment’’ at the beginning of your comment.) As stated earlier, section 1886(d)(3)(E) of the Act provides for the collection of data every 3 years on the occupational mix of employees for each short-term, acute care hospital participating in the Medicare program, in order to construct an occupational mix adjustment to the wage index, for application beginning October 1, 2004 (the FY 2005 wage index). The purpose of the occupational VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 mix adjustment is to control for the effect of hospitals’ employment choices on the wage index. For example, hospitals may choose to employ different combinations of registered nurses, licensed practical nurses, nursing aides, and medical assistants for the purpose of providing nursing care to their patients. The varying labor costs associated with these choices reflect hospital management decisions rather than geographic differences in the costs of labor. 1. Development of Data for the Proposed FY 2008 Occupational Mix Adjustment On October 14, 2005, we published a notice in the Federal Register (70 FR 60092) proposing to use a new survey, the 2006 Medicare Wage Index Occupational Mix Survey (the 2006 survey) to apply an occupational mix adjustment to the FY 2008 wage index. In the proposed 2006 survey, we included several modifications based on the comments and recommendations we received on the 2003 survey, including (1) allowing hospitals to report their own average hourly wage rather than using BLS data; (2) extending the prospective survey period; and (3) reducing the number of occupational categories but refining the subcategories for registered nurses. We made the changes to the occupational categories in response to MedPAC comments to the FY 2005 IPPS final rule (69 FR 49036). Specifically, MedPAC recommended that CMS assess whether including subcategories of registered nurses would result in a more accurate occupational mix adjustment. MedPAC believed that including all registered nurses in a single category may obscure significant wage differences among the subcategories of registered nurses, for example, the wages of surgical registered nurses and floor registered nurses may differ. Also, to offset additional reporting burden for hospitals, MedPAC recommended that CMS should combine the general service categories that account for only a small percentage of a hospital’s total hours with the ‘‘all other occupations’’ category because most of the occupational mix adjustment is correlated with the nursing general service category. In addition, in response to the public comments on the October 14, 2005 notice, we modified the 2006 survey. On February 10, 2006, we published a Federal Register notice (71 FR 7047) that solicited comments and announced our intent to seek OMB approval on the revised occupational mix survey (Form CMS–10079 (2006)). OMB approved the survey on April 25, 2006. PO 00000 Frm 00099 Fmt 4701 Sfmt 4702 24777 The 2006 survey provides for the collection of hospital-specific wages and hours data, a 6-month prospective reporting period (that is, January 1, 2006, through June 30, 2006), the transfer of each general service category that comprised less than 4 percent of total hospital employees in the 2003 survey to the ‘‘all other occupations’’ category (the revised survey focuses only on the mix of nursing occupations), additional clarification of the definitions for the occupational categories, an expansion of the registered nurse category to include functional subcategories, and the exclusion of average hourly rate data associated with advance practice nurses. The 2006 survey included only two general occupational categories: nursing and ‘‘all other occupations.’’ The nursing category has four subcategories: registered nurses, licensed practical nurses, aides, orderlies, attendants, and medical assistants. The registered nurse subcategory includes two functional subcategories: Management personnel and staff nurses or clinicians. As indicated above, the 2006 survey provided for a 6-month data collection period, from January 1, 2006 through June 30, 2006. However, we allowed flexibility for the reporting period begin and end dates to accommodate some hospitals’ bi-weekly payroll and reporting systems. That is, the 6-month reporting period had to begin on or after December 25, 2005, and end before July 9, 2006. We are proposing to use the 6-month 2006 survey data to calculate the occupational mix adjustment for the FY 2008 wage index. We used the 1st quarter of 2006 survey data in the FY 2007 wage index to comply with a court decision in Bellevue Hosp. Center v. Leavitt, 443 F.3d 163 (2nd Cir. 2006). For a discussion of our use of the 2006 survey data in the FY 2007 wage index, in compliance with the Bellevue decision, we refer readers to the FY 2007 IPPS final rule (71 FR 48007) as well as the FY 2007 IPPS final notice (71 FR 90886). However, as stated above, we are proposing to use the entire 6-month 2006 survey data (that is, from the period January 1, 2006 through June 30, 2006) to calculate the occupational mix adjustment for the FY 2008 wage index. 2. Timeline for the Collection, Review, and Correction of the Occupational Mix Data In a Joint-Signature Memorandum that we issued on April 21, 2006 (JSM– 06412), and in the FY 2007 IPPS final rule (71 FR 48008), we discussed the schedule for the 1st quarter 2006 E:\FEDREG\03MYP2.LOC 03MYP2 24778 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules occupational mix survey data that would be used in the FY 2007 wage index. The schedule included deadlines for— <bullet≤ Hospitals to submit 1st quarter occupational mix data. The deadline was June 1, 2006. <bullet≤ MAC review of the submitted 1st quarter data. The deadline was June 22, 2006. <bullet≤ Availability of the submitted first quarter data on the CMS Web site. The deadline was June 29, 2006. <bullet≤ Hospitals to submit requests to their MACs for corrections to their 1st quarter occupational mix data. The deadline was July 13, 2006. <bullet≤ MACs to submit corrected 1st quarter occupational mix survey data to CMS. The deadline was July 27, 2006. In the Joint-Signature Memorandum, we also indicated that hospitals were to submit their 2nd quarter 2006 occupational mix survey data to their intermediaries (MACs) by August 31, 2006. On October 6, we published on our web site both the audited 1st quarter and unaudited 2nd quarter 2006 occupational survey data and Worksheet S–3 wage data to be used in calculating the FY 2008 wage index. In addition, we sent a letter to hospitals through their MACs (dated October 6, 2006) that discussed the timeframe for reviewing and correcting Worksheet S–3 wage data and the 2nd quarter 2006 survey data, and an opportunity for hospitals to request additional adjustments to their 1st quarter 2006 survey data for the FY 2008 wage index. The revision and correction process for all of the data to be used for computing the FY 2008 wage index is discussed in detail in section III.K. of this preamble. mmaher on DSK3CLS3C1PROD with $$_JOB 3. Calculation of the Proposed Occupational Mix Adjustment for FY 2008 For FY 2008 (as we did for FY 2007), we are proposing to calculate the occupational mix adjustment factor using the following steps: Step 1—For each hospital, determine the percentage of the total nursing category attributable to a nursing subcategory by dividing the nursing subcategory hours by the total nursing category’s hours (registered nurse management personnel and registered nurse staff nurses or clinicians are treated as separate nursing subcategories). Repeat this computation for each of the five nursing subcategories: registered nurse VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 management personnel, registered nurse staff nurses or clinicians, licensed practical nurses; nursing aides, orderlies, and attendants; and medical assistants. Step 2—Determine a national average hourly rate for each nursing subcategory by dividing a subcategory’s total salaries for all hospitals in the occupational mix survey database by the subcategory’s total hours for all hospitals in the occupational mix survey database. Step 3—For each hospital, determine an adjusted average hourly rate for each nursing subcategory by multiplying the percentage of the total nursing category (from Step 1) by the national average hourly rate for that nursing subcategory (from Step 2). Repeat this calculation for each of the five nursing subcategories. Step 4—For each hospital, determine the adjusted average hourly rate for the total nursing category by summing the adjusted average hourly rate (from Step 3) for each of the nursing subcategories. Step 5—Determine the national average hourly rate for the total nursing category by dividing total nursing category salaries for all hospitals in the occupational mix survey database by total nursing category hours for all hospitals in the occupational mix survey database. Step 6—For each hospital, compute the occupational mix adjustment factor for the total nursing category by dividing the national average hourly rate for the total nursing category (from Step 5) by the hospital’s adjusted average hourly rate for the total nursing category (from Step 4). If the hospital’s adjusted average hourly rate is less than the national average hourly rate (indicating the hospital employs a less costly mix of nursing employees), the occupational mix adjustment factor would be greater than 1.0000. If the hospital’s adjusted average hourly rate is greater than the national average hourly rate, the occupational mix adjustment factor would be less than 1.0000. Step 7—For each hospital, calculate the occupational mix adjusted salaries and wage-related costs for the total nursing category by multiplying the hospital’s total salaries and wage-related costs (from Step 5 of the unadjusted wage index calculation in section III.F. of this preamble) by the percentage of the hospital’s total workers attributable to the total nursing category (using the occupational mix survey data, this percentage is determined by dividing the hospital’s total nursing category PO 00000 Frm 00100 Fmt 4701 Sfmt 4702 salaries by the hospital’s total salaries for ‘‘nursing and all other’’) and by the total nursing category’s occupational mix adjustment factor (from Step 6 above). The remaining portion of the hospital’s total salaries and wage-related costs that is attributable to all other employees of the hospital is not adjusted by the occupational mix. A hospital’s all other portion is determined by subtracting the hospital’s nursing category percentage from 100 percent. Step 8—For each hospital, calculate the total occupational mix adjusted salaries and wage-related costs for a hospital by summing the occupational mix adjusted salaries and wage-related costs for the total nursing category (from Step 7) and the portion of the hospital’s salaries and wage-related costs for all other employees (from Step 7). To compute a hospital’s occupational mix adjusted average hourly wage, divide the hospital’s total occupational mix adjusted salaries and wage-related costs by the hospital’s total hours (from Step 4 of the unadjusted wage index calculation in section III.F. of this preamble). Step 9—To compute the occupational mix adjusted average hourly wage for an urban or rural area, sum the total occupational mix adjusted salaries and wage-related costs for all hospitals in the area, then sum the total hours for all hospitals in the area. Next, divide the area’s occupational mix adjusted salaries and wage-related costs by the area’s hours. Step 10—To compute the national occupational mix adjusted average hourly wage, sum the total occupational mix adjusted salaries and wage-related costs for all hospitals in the Nation, then sum the total hours for all hospitals in the Nation. Next, divide the national occupational mix adjusted salaries and wage-related costs by the national hours. Step 11—To compute the occupational mix adjusted wage index, divide each area’s occupational mix adjusted average hourly wage (Step 9) by the national occupational mix adjusted average hourly wage (Step 10). Step 12—To compute the Puerto Rico specific occupational mix adjusted wage index, follow Steps 1 through 11 above. The table below is an illustrative example of the proposed occupational mix adjustment. BILLING CODE 4120–01–P E:\FEDREG\03MYP2.LOC 03MYP2 VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00101 Fmt 4701 Sfmt 4725 E:\FEDREG\03MYP2.LOC 03MYP2 24779 EP03MY07.007 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules BILLING CODE 4120–01–C VerDate Mar 15 2010 02:00 Aug 26, 2011 Because the occupational mix adjustment is required by statute, all Jkt 223001 PO 00000 Frm 00102 Fmt 4701 Sfmt 4702 hospitals that are subject to payments under the IPPS, or any hospital that E:\FEDREG\03MYP2.LOC 03MYP2 EP03MY07.008 mmaher on DSK3CLS3C1PROD with $$_JOB 24780 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules would be subject to the IPPS if not granted a waiver, must complete the occupational mix survey, unless the hospital has no associated cost report wage data that are included in the proposed FY 2008 wage index. For the FY 2007 wage index, if a hospital did not respond to the occupational mix survey, or if we determined that a hospital’s submitted data were too erroneous to include in the wage index, we assigned the hospital the average occupational mix adjustment for the labor market area (71 FR 48013). We believed this method had the least impact on the wage index for other hospitals in the area. For areas where no hospital submitted data for purposes of calculating the occupational mix adjustment, we applied the national occupational mix factor of 1.0000 in calculating the area’s FY 2007 occupational mix adjusted wage index. We indicated in the FY 2007 IPPS final rule that we reserve the right to apply a different approach in future years, including potentially penalizing nonresponsive hospitals. For the FY 2008 wage index, we are proposing to handle the data for hospitals that did not respond to the occupational mix survey (neither the 1st quarter nor 2nd quarter data) in the same manner as discussed above for the FY 2007 wage index. In addition, if a hospital submitted survey data for either the 1st quarter or 2nd quarter, but not for both quarters, we are proposing to use the data the hospital submitted for one quarter to calculate the hospital’s FY 2008 occupational mix adjustment factor. Lastly, if a hospital submitted a survey(s), but that survey data could not be used because we determined it to be aberrant, we also assigned the hospital the average occupational mix adjustment for its labor market area. For example, if a hospital’s individual nurse category average hourly wages were out of range (that is, unusually high or low), and the hospital did not provide sufficient documentation to explain the aberrancy, or the hospital did not submit any registered nurse staff salaries or hours data, we assigned the hospital the average occupational mix adjustment for the labor market area in which it is located. In calculating the average occupational mix adjustment factor for a labor market area, we replicated Steps 1 through 6 of the calculation for the occupational mix adjustment. However, instead of performing these steps at the hospital level, we aggregated the data at the labor market area level. In following these steps, for example, for CBSAs that contain providers that did not submit occupational mix survey data, the VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 occupational mix adjustment factor ranged from a low of 0.8972 (CBSA 39820, Redding, CA), to a high of 1.0728 (CBSA 19, Rural Louisiana). Also, in computing a hospital’s occupational mix adjusted salaries and wage-related costs for nursing employees (Step 7 of the calculation), in the absence of occupational mix survey data, we multiplied the hospital’s total salaries and wage-related costs by the percentage of the area’s total workers attributable to the area’s total nursing category. For FY 2008, there is one CBSA in which none of the providers submitted the occupational mix survey (CBSA 49740, Yuma, AZ). In the absence of any data in this labor market area, we applied an occupational mix adjustment factor of 1.0 to all provider(s). In the FY 2007 IPPS final rule, we also indicated that we would give serious consideration to applying a hospital-specific penalty if a hospital does not comply with regulations requiring submission of occupational mix survey data in future years. We stated that we believe that section 1886(d)(5)(I)(i) of the Act provides us with the authority to penalize hospitals that do not submit occupational mix survey data. That section authorizes us to provide for exceptions and adjustments to the payment amounts under IPPS as the Secretary deems appropriate. We also indicated that we would address this issue in the FY 2008 IPPS proposed rule. We are soliciting comments and suggestions for a hospital-specific penalty for hospitals that do not submit occupational mix survey. In response to the FY 2007 IPPS proposed rule, some commenters suggested a 1-percent to 2percent reduction in the hospital’s wage index value or a set percentage of the standardized amount. Any penalty that we would determine for nonresponsive hospitals would apply to a future wage index, not the FY 2008 wage index. 4. Proposed 2007–2008 Occupational Mix Survey for the FY 2010 Wage Index As stated earlier, section 304(c) of Pub. L. 106–554 amended section 1886(d)(3)(E) of the Act to require CMS to collect data every 3 years on the occupational mix of employees for each short-term, acute care hospital participating in the Medicare program. We are currently using occupational mix survey data collected in 2006 in the FY 2007 IPPS. Since we implemented the 2006 survey, we received several public comments suggesting further improvements to the occupational mix survey instructions and definitions. Specifically, some commenters PO 00000 Frm 00103 Fmt 4701 Sfmt 4702 24781 recommended that we include certain employees, such as surgical technicians and paramedics in the occupational mix adjustment. The commenters indicated that these occupations perform similar functions, and in some cases, are used as substitutes for nursing staff. Therefore, they recommended that CMS include these occupations with the nursing categories on the survey. (On the 2003 and 2006 surveys, these categories were included in the ‘‘All Other Occupations’’ category.) The commenters also recommended that CMS expand the list of cost centers for the survey to include additional cost centers that contain a significant number of nursing personnel. Some commenters suggested that CMS not collect occupational mix data for the ‘‘Registered Nurse’’ subcategories (that is, Management Personnel and Staff Nurse/Clinician). The commenters expressed concern that requiring the subcategories led to errors and inconsistencies in reporting, and added to the hospitals’ collection burden. The commenters did not believe that this level of specificity significantly affects the adjustment. Therefore they recommended that CMS eliminate the RN subcategories. In addition, commenters recommended that CMS provide for a 1year data collection period rather than a 6-month data collection period for the next survey collection. The commenters suggested that a 1-year data collection period would provide a better representation of a hospital’s employment mix, which can vary during different times of the year. The commenters also indicated that a 1-year data collection period would allow hospitals to verify their wages and hours to year-end payroll reports and contractor invoices. In response to these suggestions we have modified the occupational mix survey. The revised 2007–2008 occupational mix survey will provide for the collection of hospital-specific wages and hours data for a 1-year prospective reporting period from July 1, 2007, through June 30, 2008, additional clarifications to the survey instructions, the elimination of the registered nurse subcategories, some refinements to the definitions of the occupational categories, and the inclusion of additional cost centers that typically provide nursing services. The revised 2007–2008 Medicare occupational mix survey will be applied beginning with the FY 2010 wage index. On February 2, 2007, we published a notice soliciting comments on the proposed revisions to the occupational mix survey (Form CMS–10079 (2006)) E:\FEDREG\03MYP2.LOC 03MYP2 24782 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules (72 FR 5055). The comment period for the proposed survey ended on April 3, 2007. A final notice is expected to be published in the Federal Register by July 1, 2007. D. Worksheet S–3 Wage Data for the Proposed FY 2008 Wage Index (If you choose to comment on issues in this section, please include the caption ‘‘Wage Data’’ at the beginning of your comment.) The proposed FY 2008 wage index values (to be effective for hospital discharges occurring on or after October 1, 2007, and before October 1, 2008) in section II.B. of the Addendum to this proposed rule are based on the data collected from the Medicare cost reports submitted by hospitals for cost reporting periods beginning in FY 2004 (the FY 2007 wage index was based on FY 2003 wage data). mmaher on DSK3CLS3C1PROD with $$_JOB 1. Included Categories of Costs The proposed FY 2008 wage index includes the following categories of data associated with costs paid under the IPPS (as well as outpatient costs): <bullet≤ Salaries and hours from short-term, acute care hospitals (including paid lunch hours and hours associated with military leave and jury duty). <bullet≤ Home office costs and hours. <bullet≤ Certain contract labor costs and hours (which includes direct patient care, certain top management, pharmacy, laboratory, and nonteaching physician Part A services). <bullet≤ Wage-related costs, including pensions and other deferred compensation costs. 2. Contract Labor for Indirect Patient Care Services In the FY 2003 IPPS final rule (67 FR 50022), we discussed the inclusion of contract labor cost in calculating the wage index. Our policy has evolved over the years with the increasing role of contract labor in meeting special personnel needs of hospitals. In response to suggestions that we further expand our definition of contract labor for the wage index, we indicated our intent to begin collecting data in future Medicare cost reports on the following overhead services: administrative and general (A&G); housekeeping; and dietary. We selected these three overhead services for consideration because they are provided at all hospitals, either directly or through contracts, and together they comprise about 60 percent of a hospital’s overhead hours. Consistent with our consideration of contract A&G services, we also stated that we would begin collecting costs and hours data VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 associated with other contract management services that would not be included on the cost report as overhead A&G and are not top management contracts (that is, the chief executive officer, chief financial officer, chief operating officer, and nurse administrator) that are included on Line 9 of Worksheet S–3, Part II. We revised the cost report, beginning October 1, 2003 (the FY 2004 cost report), to provide for the collection of cost and hours data for the four identified contract indirect patient care services. We added four new line items to Worksheet S–3, Part II: Line 9.03 (Contract management and administrative services); Line 22.01 (Contract A & G services); Line 26.01 (Contract housekeeping services); and Line 27.01 (Contract dietary services). We stated in the FY 2003 final rule that our decision on whether to include these costs in calculating the wage index would depend on our analyses of the data and public comments. The FY 2008 wage index, which is based on FY 2004 cost report data, is the first year that we can assess the impact of including these costs in the wage index. As part of the FY 2008 wage index desk review program, we required the fiscal intermediaries (or, if applicable, the MAC) to verify the accuracy of the data reported on the new Lines 9.03, 22.01, 26.01, and 27.01. After the completion of these reviews, some hospitals continued to fail our edits for reasonableness: 12 hospitals (0.3 percent) failed edits for Line 9.03; 130 hospitals (3.6 percent) failed edits for Line 22.01; 56 hospitals (1.6 percent) failed edits for Line 26.01; and 99 hospitals (2.8 percent) failed edits for Line 27.01. Many of these edit failures are for wage data that are not to be included in the wage index and will be excluded through the wage index calculation. That is, as specified in the cost reporting instructions in the Provider Reimbursement Manual, Part II, section 3605.2, if a hospital’s ratio of excluded area hours (Lines 8 and 8.0) on Worksheet S–3, Part II to total adjusted hours is less than 15 percent, Lines 21 through 35 of Part II should not be completed by hospitals. In addition, some of the aberrant data will be resolved by the final rule through the correction process described in section III.K. of the preamble of this proposed rule. Nevertheless, we believe that the amount of aberrant data on these new line items is minimal and will have little impact on area wage index values. In addition, we have simulated the effect of including these wage data for contract indirect patient care services on the wage index. Under this simulation, we found that the resulting average PO 00000 Frm 00104 Fmt 4701 Sfmt 4702 hourly wage would not affect 3,231 hospitals (90.2 percent), would decrease for 121 hospitals (3.4 percent), and would increase for 229 hospitals (6.4 percent). Only one hospital would experience a decrease of greater than 1 percent (3 percent), and 19 hospitals would experience an increase of greater than 1 percent (the largest being 7.8 percent). At the labor market area level, we found that the resulting average hourly wage would not affect 316 areas (72.6 percent), would decrease for 28 areas (6.4 percent), and would increase for 91 areas (20.9 percent). No area, rural or urban, would experience an increase or decrease of greater than 0.6 percent in its wage index. We believe that the combined effect of including these costs in the wage index is negligible because the higher labor costs associated with contract management and A&G services are offset by the lower labor costs associated with contract housekeeping and dietary services. Public commenters have expressed interest in including in the wage index the costs and hours for contract management, A&G, housekeeping, and dietary services. We also believe that including a more comprehensive measure of area differences in the cost of labor will improve the accuracy of the wage index. For these reasons, we are proposing to include these contract services in the wage index, beginning with FY 2008. Although we invite public comment on whether we should revise a future cost report to collect contract labor data for the remaining indirect patient care cost centers on Worksheet S–3, Part II for possible inclusion in the wage index, we will consider these comments in the context of potential reforms of the IPPS wage index for FY 2009 and subsequent years. As indicated in section III.M. of the preamble of this proposed rule, section 106(b) of the MIEA-TRHCA (Pub. L. 109–432) requires the Secretary to consider a MedPAC study and nine specific aspects of the wage index in making one or more proposals for revisions in FY 2009. 3. Excluded Categories of Costs Consistent with the wage index methodology for FY 2007, the proposed wage index for FY 2008 also excludes the direct and overhead salaries and hours for services not subject to IPPS payment, such as SNF services, home health services, costs related to GME (teaching physicians and residents) and certified registered nurse anesthetists (CRNAs), and other subprovider components that are not paid under the IPPS. The proposed FY 2008 wage index E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules also excludes the salaries, hours, and wage-related costs of hospital-based rural health clinics (RHCs), and Federally qualified health centers (FQHCs) because Medicare pays for these costs outside of the IPPS (68 FR 45395). In addition, salaries, hours, and wage-related costs of CAHs are excluded from the wage index, for the reasons explained in the FY 2004 IPPS final rule (68 FR 45397). mmaher on DSK3CLS3C1PROD with $$_JOB 4. Use of Wage Index Data by Providers Other Than Acute Care Hospitals under the IPPS Data collected for the IPPS wage index are also currently used to calculate wage indices applicable to other providers, such as SNFs, home health agencies, and hospices. In addition, they are used for prospective payments to IRFs, IPFs, and LTCHs, and for hospital outpatient services. We note that, in the IPPS rules, we do not address comments pertaining to the wage indices for non-IPPS providers. Such comments should be made in response to separate proposed rules for those providers. E. Verification of Worksheet S–3 Wage Data (If you choose to comment on this section, please include the caption ‘‘Wage Data’’ at the beginning of your comment.) The wage data for the proposed FY 2008 wage index were obtained from Worksheet S–3, Parts II and III of the FY 2004 Medicare cost reports. Instructions for completing the Worksheet S–3, Parts II and III are in the Provider Reimbursement Manual, Part I, sections 3605.2 and 3605.3. The data file used to construct the proposed wage index includes FY 2004 data submitted to us as of February 26, 2007 As in past years, we will perform an intensive review of the wage data, mostly through the use of edits designed to identify aberrant data. We asked our fiscal intermediaries/ MACs to revise or verify data elements that resulted in specific edit failures. We identified and excluded 23 hospitals with data that was too aberrant to include in the proposed wage index, although if these data elements are corrected, we may include some of these providers in the FY 2008 final wage index. However, some unresolved data elements are included in the calculation of the proposed FY 2008 wage index. We instructed fiscal intermediaries/ MACs to complete their data verification of questionable data elements and to transmit any changes to the wage data no later than April 13, 2007. We believe all unresolved data VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 elements will be resolved by the date the final rule is issued. The revised data will be reflected in the final rule. In constructing the proposed FY 2008 wage index, we include the wage data for facilities that were IPPS hospitals in FY 2004, even for those facilities that have since terminated their participation in the program as hospitals, as long as those data do not fail any of our edits for reasonableness. We believe that including the wage data for these hospitals is, in general, appropriate to reflect the economic conditions in the various labor market areas during the relevant past period. However, we exclude the wage data for CAHs as discussed in 68 FR 45397. For this proposed rule, we removed 18 hospitals that converted to CAH status between February 17, 2006, the cut-off date for CAH exclusion from the FY 2007 wage index, and February 16, 2007, the cut-off date for CAH exclusion from the FY 2008 wage index. After removing hospitals with aberrant data and hospitals that converted to CAH status, the proposed FY 2008 wage index is calculated based on 3,581 hospitals. F. Wage Index for Multicampus Hospitals (If you choose to comment on issues in this section, please include the caption ‘‘Multicampus Hospitals’’ at the beginning of your comment.) As discussed earlier under section III.B. of this preamble, effective October 1, 2004, for the IPPS, CMS implemented new labor market areas based on the CBSA definitions of MSAs. As a result of the new labor market areas, there are multicampus hospitals previously located in a single MSA that are now located in more than one CBSA. A multicampus hospital is a single integrated institution. For this reason, the multicampus hospital has one provider number and submits a single cost report that combines the total wages and hours of each of its campuses. When campuses of a multicampus hospital are located in the same CBSA, the wages and hours for the entire institution are included in the calculation of the wage index for that labor market area and there is no need to separate the data by campus. However, when a multicampus hospital has campuses located in different labor market areas, wages and hours are reported in a single CBSA even though the hospital’s staff is working at campuses in more than one labor market area. The wage data are reported in the labor market area of the hospital campus associated with the provider number. Wages and hours are not reported PO 00000 Frm 00105 Fmt 4701 Sfmt 4702 24783 separately for each campus and no data from the multicampus hospital are used in determining the wage index for the labor market area(s) where the other campus(es) are located. Under § 412.64(b)(5) of our regulations, the wage-adjusted standardized amount is based on geographic location of the hospital facility at which the discharge occurred. Therefore, the wage index for each hospital campus used to make the IPPS payment is based on its geographic location, while the wage data from all of the campuses, including those that may be located in a different geographic area, are applied to one area only. We have received inquiries from several hospitals suggesting that we should adopt a policy that results in an allocation of a multicampus hospital’s wages and hours across the different labor market areas where its campuses are located. The wage index was developed to adjust the IPPS standardized amount to reflect area differences in hospital wage levels in the hospital’s geographic area compared to the national hospital wage level as required under section 1886(d)(3)(E) of the Act. Although we acknowledge that reporting the wage data into a single labor market area when individual campuses of a multicampus hospital are located in different labor market areas may not allocate wage data with exact precision, the Medicare cost report, in its current form, does not enable a multicampus hospital to separately report its costs by location. The fact that a multicampus hospital submits a single cost report reflects that it is an integrated institution with one accounting structure. Nevertheless, we agree with the comments brought to our attention that we should consider a policy that allocates a multicampus hospital’s wages and hours among the different labor market areas where it is located. That is, rather than giving 100 percent of the hospital’s wage data to the labor market area associated with its provider number, we believe that an allocation of its wage data should be made to each campus. We considered three alternative methods of apportionment: beds, discharges, or FTE staff. A hospital’s number of discharges can fluctuate from year to year and may be an unstable data source to use in allocating a hospital’s wages and hours among the different campuses. Alternatively, while a hospital’s number of beds is a more static number, it likely does not correlate well with how a hospital incurs its wage costs. Furthermore, neither of these numbers is available on a campus-specific basis in Medicare’s data systems. (While an individual E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24784 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules campus of a multicampus hospital located in a different labor market area than the remainder of the institution is required to indicate a suffix on its provider number when submitting a claim in order to receive payment using the wage index for its geographic location, the suffix is only used by the fiscal intermediary (or, if applicable, the MAC) and is not retained in Medicare’s historical data files that we use to determine IPPS rates). Given the unavailability of beds and discharges and their respective drawbacks for allocating wages and hours across multiple campuses, we are proposing to apportion wages and hours for each campus of a multicampus hospital based on FTE staff. For example, a multicampus hospital may have three campuses located in two different labor market areas. Campuses A and B are located in labor market area 1 and have 50 and 25 FTEs, respectively. Campus C is located in labor market area 2 and has an additional 25 FTEs. Therefore, 75 percent of the hospital’s FTEs work in labor market 1 and 25 percent in labor market area 2. Under the proposed policy, we would apportion 75 percent of the hospital’s occupational mix adjusted total salaries, wage-related costs and hours to labor market 1 and 25 percent to labor market 2. We believe that the number of FTEs will provide the best method of apportioning wages and hours among the different campuses, thereby allowing the apportioned wage data to be included in each geographic area where the hospital has employees working. This proposed policy requires the identification of all multicampus hospitals located in more than one CBSA, the county, State, and zip code of each campus, and the campusspecific number of FTEs. Based on our comprehensive interactions with our fiscal intermediaries since adopting the revised labor market areas beginning in FY 2005, we are only aware of three multicampus hospitals that are located in more than one labor market area. We are beginning the process to make updates and refinements to the cost report for the future. We are currently planning to add additional lines to Worksheet S–2 of the cost report that will allow a multicampus hospital to report the locations of its different campuses (county, State, and zip code) and number of FTE staff by location so this information would become part of the cost report submission process. The effective date of the revised cost report is not expected until FY 2009. Therefore, we would not have data from multicampus hospitals under our VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 normal wage data collection process to be able to allocate wages to each labor market area by FTEs until at least the FY 2013 wage index. In the interim, we will collect this information from multicampus hospitals on a small survey form through our fiscal intermediaries/MACs as part of the wage index desk review process beginning with the FY 2009 wage index. We will not be able to apply this policy to the FY 2008 wage index unless we have this information from multicampus hospitals prior to the close of the comment period on this proposed rule. Therefore, for the FY 2008 wage index, multicampus hospitals with campuses located in more than one geographic area should submit the information during the comment period on this proposed rule for the county, State, and zip code of its campuses, and the FTE number, including contract labor, per campus along with supporting documentation to: Centers for Medicare & Medicaid Services, Wage Index Team, C4–08–06, 7500 Security Boulevard, Baltimore, Maryland 21244, Attn: Kathy Ellingson. The hospitals should submit data from their FY 2004 cost reporting period to match the same data that will be used for the FY 2008 wage index. However, if unavailable, the hospital may submit the data for a subsequent cost reporting period that is closest to the FY 2004 reporting period that provides the information in order to apportion the hospital’s wage data among its campuses. These data will enable CMS to apportion the wages and hours of the multicampus hospital among its different campuses for use in the FY 2008 wage index calculations should this proposal become final. As stated earlier, we are only aware of three hospitals that would be affected by this proposed information collection request. As stipulated under 5 CFR 1320.3(c)(4), the proposed information collection request is exempt from the Paperwork Reduction Act (PRA) as it does not affect 10 or more persons within a 12-month period. However, if during the IPPS rule comment period, we determine the number of affected persons surpasses the threshold of 10 as specified in 5 CFR 1320.3(c)(4), we will not adopt the policy until FY 2009 in order for us to seek the requisite approval from OMB under the PRA. G. Computation of the Proposed FY 2008 Unadjusted Wage Index (If you choose to comment on issues in this section, please include the caption ‘‘Wage Index’’ at the beginning of your comment.) PO 00000 Frm 00106 Fmt 4701 Sfmt 4702 1. Method for Computing the Proposed FY 2008 Unadjusted Wage Index The method used to compute the proposed FY 2008 wage index without an occupational mix adjustment follows: Step 1—As noted above, we based the proposed FY 2008 wage index on wage data reported on the FY 2004 Medicare cost reports. We gathered data from each of the non-Federal, short-term, acute care hospitals for which data were reported on the Worksheet S–3, Parts II and III of the Medicare cost report for the hospital’s cost reporting period beginning on or after October 1, 2003, and before October 1, 2004. In addition, we include data from some hospitals that had cost reporting periods beginning before October 2003 and reported a cost reporting period covering all of FY 2004. These data are included because no other data from these hospitals would be available for the cost reporting period described above, and because particular labor market areas might be affected due to the omission of these hospitals. However, we generally describe these wage data as FY 2004 data. We note that, if a hospital had more than one cost reporting period beginning during FY 2004 (for example, a hospital had two short cost reporting periods beginning on or after October 1, 2003, and before October 1, 2004), we include wage data from only one of the cost reporting periods, the longer, in the wage index calculation. If there was more than one cost reporting period and the periods were equal in length, we include the wage data from the later period in the wage index calculation. Step 2—Salaries—The method used to compute a hospital’s average hourly wage excludes certain costs that are not paid under the IPPS. In calculating a hospital’s average salaries plus wagerelated costs, we subtract from Line 1 (total salaries) the GME and CRNA costs reported on Lines 2, 4.01, 6, and 6.01, the Part B salaries reported on Lines 3, 5 and 5.01, home office salaries reported on Line 7, and exclude salaries reported on Lines 8 and 8.01 (that is, direct salaries attributable to SNF services, home health services, and other subprovider components not subject to the IPPS). We also subtract from Line 1 the salaries for which no hours were reported. To determine total salaries plus wage-related costs, we add to the net hospital salaries the costs of contract labor for direct patient care, certain top management, pharmacy, laboratory, and nonteaching physician Part A services (Lines 9 and 10), home office salaries and wage-related costs reported by the E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules hospital on Lines 11 and 12, and nonexcluded area wage-related costs (Lines 13, 14, and 18). We note that contract labor and home office salaries for which no corresponding hours are reported are not included. In addition, wage-related costs for nonteaching physician Part A employees (Line 18) are excluded if no corresponding salaries are reported for those employees on Line 4. Step 3—Hours—With the exception of wage-related costs, for which there are no associated hours, we compute total hours using the same methods as described for salaries in Step 2. Step 4—For each hospital reporting both total overhead salaries and total overhead hours greater than zero, we then allocate overhead costs to areas of the hospital excluded from the wage index calculation. First, we determine the ratio of excluded area hours (sum of Lines 8 and 8.01 of Worksheet S–3, Part II) to revised total hours (Line 1 minus the sum of Part II, Lines 2, 3, 4.01, 5, 5.01, 6, 6.01, 7, and Part III, Line 13 of Worksheet S–3). We then compute the amounts of overhead salaries and hours to be allocated to excluded areas by multiplying the above ratio by the total overhead salaries and hours reported on Line 13 of Worksheet S–3, Part III. Next, we compute the amounts of overhead wage-related costs to be allocated to excluded areas using three steps: (1) we determine the ratio of overhead hours (Part III, Line 13) to revised hours (Line 1 minus the sum of Lines 2, 3, 4.01, 5, 5.01, 6, 6.01, 7, 8, and 8.01); (2) we compute overhead wage-related costs by multiplying the overhead hours ratio by wage-related costs reported on Part II, Lines 13, 14, and 18; and (3) we multiply the computed overhead wagerelated costs by the above excluded area hours ratio. Finally, we subtract the computed overhead salaries, wagerelated costs, and hours associated with excluded areas from the total salaries (plus wage-related costs) and hours derived in Steps 2 and 3. Step 5—For each hospital, we adjust the total salaries plus wage-related costs to a common period to determine total adjusted salaries plus wage-related costs. To make the wage adjustment, we estimate the percentage change in the employment cost index (ECI) for compensation for each 30-day increment from October 14, 2003, through April 15, 2005, for private industry hospital workers from the BLS’ 24785 Compensation and Working Conditions. We use the ECI because it reflects the price increase associated with total compensation (salaries plus fringes) rather than just the increase in salaries. In addition, the ECI includes managers as well as other hospital workers. This methodology to compute the monthly update factors uses actual quarterly ECI data and assures that the update factors match the actual quarterly and annual percent changes. We also note that, since April 2006 with the publication of March 2006 data, the BLS’ ECI uses a different classification system, the North American Industrial Classification System (NAICS), instead of the Standard Industrial Codes (SICs), which no longer exist. We have consistently used the ECI as the data source for our wages and salaries and other price proxies in the IPPS market basket and are not proposing to make any changes to the usage at this time. However, we are soliciting comments on our continued use of the BLS ECI data in light of the BLS change in system usage to the NAICS-based ECI. The factors used to adjust the hospital’s data were based on the midpoint of the cost reporting period, as indicated below. MIDPOINT OF COST REPORTING PERIOD Before Adjustment Factor 10/14/2003 11/14/2003 12/14/2003 01/14/2004 02/14/2004 03/14/2004 04/14/2004 05/14/2004 06/14/2004 07/14/2004 08/14/2004 09/14/2004 10/14/2004 11/14/2004 12/14/2004 01/14/2005 02/14/2005 03/14/2005 mmaher on DSK3CLS3C1PROD with $$_JOB After 11/15/2003 12/15/2003 01/15/2004 02/15/2004 03/15/2004 04/15/2004 05/15/2004 06/15/2004 07/15/2004 08/15/2004 09/15/2004 10/15/2004 11/15/2004 12/15/2004 01/15/2005 02/15/2005 03/15/2005 04/15/2005 1.05743 1.05355 1.04964 1.04578 1.04198 1.03830 1.03482 1.03153 1.02821 1.02466 1.02086 1.01705 1.01344 1.01003 1.00671 1.00336 1.00000 0.99663 For example, the midpoint of a cost reporting period beginning January 1, 2004, and ending December 31, 2004, is June 30, 2004. An adjustment factor of 1.02821 would be applied to the wages of a hospital with such a cost reporting period. In addition, for the data for any cost reporting period that began in FY 2004 and covered a period of less than 360 days or more than 370 days, we annualize the data to reflect a 1-year cost report. Dividing the data by the number of days in the cost report and then multiplying the results by 365 accomplishes annualization. Step 6—Each hospital is assigned to its appropriate urban or rural labor market area before any reclassifications under section 1886(d)(8)(B), section 1886(d)(8)(E), or section 1886(d)(10) of the Act. Within each urban or rural labor market area, we add the total adjusted salaries plus wage-related costs obtained in Step 5 for all hospitals in that area to determine the total adjusted salaries plus wage-related costs for the labor market area. Step 7—We divide the total adjusted salaries plus wage-related costs obtained under both methods in Step 6 by the sum of the corresponding total hours (from Step 4) for all hospitals in each labor market area to determine an average hourly wage for the area. Step 8—We add the total adjusted salaries plus wage-related costs obtained in Step 5 for all hospitals in the Nation and then divide the sum by the national VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00107 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 24786 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB sum of total hours from Step 4 to arrive at a national average hourly wage. Using the data as described above, the proposed national average hourly wage is $30.9298. Step 9—For each urban or rural labor market area, we calculate the hospital wage index value, unadjusted for occupational mix, by dividing the area average hourly wage obtained in Step 7 by the national average hourly wage computed in Step 8. Step 10—Following the process set forth above, we develop a separate Puerto Rico-specific wage index for purposes of adjusting the Puerto Rico standardized amounts. (The national Puerto Rico standardized amount is adjusted by a wage index calculated for all Puerto Rico labor market areas based on the national average hourly wage as described above.) We add the total adjusted salaries plus wage-related costs (as calculated in Step 5) for all hospitals in Puerto Rico and divide the sum by the total hours for Puerto Rico (as calculated in Step 4) to arrive at an overall proposed average hourly wage of $13.4729 for Puerto Rico. For each labor market area in Puerto Rico, we calculate the Puerto Rico-specific wage index value by dividing the area average hourly wage (as calculated in Step 7) by the overall Puerto Rico average hourly wage. Step 11—Section 4410 of Pub. L. 105– 33 provides that, for discharges on or after October 1, 1997, the area wage index applicable to any hospital that is located in an urban area of a State may not be less than the area wage index applicable to hospitals located in rural areas in that State. For FY 2008, this change affects 239 hospitals in 65 urban areas. The areas affected by this provision are identified by a footnote in Table 4A in the Addendum of this proposed rule. 2. Expiration of the Imputed Floor (If you choose to comment on issues in this section, please include the caption ‘‘Imputed Floor’’ at the beginning of your comment.) Section 4410 of Pub. L. 105–33 provides that the area wage index applicable to any hospital that is located in an urban area of a State may not be less than the area wage index applicable to hospitals located in rural areas of that State (‘‘the rural floor’’). There are two States that have no rural areas (New Jersey and Rhode Island) and one State that has rural areas but no IPPS hospitals located in the rural areas of the State (Massachusetts). In the FY 2005 IPPS final rule (69 FR 49109), we adopted an ‘‘imputed’’ floor measure to address the concern that hospitals in all- VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 urban States were disadvantaged by the absence of rural areas, because there is no floor within the State. We limited application of the policy to FYs 2005, 2006, and 2007 and indicated our intent to make additional changes to the policy or eliminate it for fiscal years after FY 2007. In FY 2008, the rural floor will apply to 239 hospitals in 25 States. If the imputed rural floor were to continue into FY 2008, it would apply to an additional 28 hospitals in New Jersey. In FY 2007, 40 hospitals in 10 urban areas received higher wage indices due to the imputed floor policy: Massachusetts (10 hospitals in 2 areas); New Jersey (30 hospitals in 8 areas); Rhode Island (no areas and no hospitals). In Massachusetts, the imputed rural floor will no longer apply even if it were to continue because one hospital acquired rural status under § 412.103. We note that if a State has a hospital reclassified as rural under § 412.103, the State will be considered to have IPPS hospitals located in rural areas because, in this case, the reclassified hospital is treated as being located in a rural area in accordance with section 1886(d)(8)(E) of the Act. This policy also accords with how we defined an ‘‘all-urban State’’ under § 412.64(h)(5) of the regulations, which specifies that ‘‘A State with rural areas and with hospitals reclassified as rural under § 412.103 is not an allurban State.’’ Therefore, in the case where a State has no hospitals that are geographically located in its rural areas, and one or more hospitals in the State are reclassified as rural under § 412.103, the data for the reclassified rural hospitals will be used to set the rural floor for the State until a new geographically located rural hospital opens and data are available from that hospital (as noted above, 4 years later) to compute the rural floor. We are proposing to discontinue the imputed floor policy after the FY 2007 wage index. After further considering the issue, we do not believe that it is necessary to have an ‘‘imputed’’ rural floor in States that have no rural areas or no rural hospitals. As discussed above, the imputed floor would not apply to two of the three States: it is not necessary for Rhode Island and is no longer necessary for Massachusetts. In addition, the imputed rural floor methodology creates a disadvantage in the application of the wage index to hospitals in States with rural hospitals but no urban hospitals receiving the rural floor. Because the application of a rural floor requires a transfer of payments from hospitals in States with rural hospitals but where the rural floor is not applied to hospitals in States PO 00000 Frm 00108 Fmt 4701 Sfmt 4702 where either a rural or imputed floor is applied, we believe the policy should apply only when required by statute. Thus, only States with both rural areas and hospitals located in such areas (including any hospital reclassified under § 412.103) would benefit from the rural floor, as required by Congress. For all of the reasons stated above, we are not proposing to continue the imputed rural floor. Nevertheless, we recognize that we would still need a policy for determining the rural wage index when a new IPPS hospital opens in a State that has rural areas, but no IPPS hospitals. There is a lag between the time a hospital opens or becomes an IPPS provider and when the hospital’s cost report wage data are available to include in calculating the area wage index. For example, if a hospital files its first Medicare cost report as an IPPS provider with a beginning date of January 1, 2007, and an ending date of December 31, 2007, the hospital’s FY 2007 wage data would not be included in the wage index until the FY 2011 IPPS update. Therefore, when a rural IPPS hospital opens in a State that has rural areas, but no wage data are available to calculate a rural wage index, we are proposing to apply a wage index to that hospital using the same methodology that we currently use for home health and other post-acute care providers in rural Massachusetts (71 FR 65906). That is, we would use the unweighted average of the wage indices from all CBSAs that are contiguous to the rural counties of the State. (We define contiguous as sharing a border.) We would apply the wage index calculated above until the new IPPS hospital files a cost report for the base year that is used in calculating the wage index. (In the above example, the rural hospital’s wage index would be calculated for FYs 2008, 2009, and 2010 using urban area data.) Further, under section 4410 of Pub. L. 105–33, the wage index for this rural hospital would become the State’s rural floor. As stated above, however, if a State has rural areas, and a hospital is reclassified as rural under § 412.103, then there would be no need to apply the above policy. The reclassified hospital would set the rural floor, and the wage data of the newly opened rural hospitals would be included in the calculation of the wage index of the rural area only once their wage data correlated with the survey year used to establish the wage index (4 years after wage data are reported). 3. CAHs Reverting Back to IPPS Hospitals and Raising the Rural Floor (If you choose to comment on issues in this section, please include the E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules caption ‘‘Rural Floor’’ at the beginning of your comment.) Medicare payments to CAHs are based on 101 percent of reasonable costs and are generally greater than the payments Medicare would make if the same hospitals were paid under the IPPS, which pays hospitals a fixed rate per discharge. Also, as a CAH, a hospital is guaranteed to recover is costs, while under the IPPS, it is not. We are aware of a situation where two rural hospitals in a State are considering converting from CAH status back to IPPS even though they continue to be CAH eligible. The CAHs would convert back to IPPS even though it would not directly benefit them. As IPPS providers, the hospitals’ wage data would eventually set the rural floor for the State (that is, in 4 years when the hospitals’ first IPPS cost reports would be included in a base year used in calculating the State’s rural wage index). In this case, we are concerned that these hospitals are converting solely in order to take advantage of the rural floor provisions for the other hospitals in the State, but not for any reasons that are intrinsic to the two specific hospitals. Because the hospitals’ wage levels are higher than most, if not all, of the urban IPPS hospitals in the State, including one hospital in the State that acquired rural status under § 412.103, the wage indices for most, if not all, of the State’s urban hospitals would increase as a result of the rural floor provision if the CAHs convert to IPPS status. Such an arrangement would increase payments to the hospitals in the State at the expense of every other IPPS hospital in the nation. The two rural hospitals that are currently CAHs were last paid under the IPPS in FY 2003. We simulated the effect of allowing these two hospitals to set the State’s rural floor with the same data used to calculate the FY 2003 wage index as would occur in FY 2011 if these hospitals were to convert to IPPS status in FY 2007 and no other hospitals were to open in the rural area of the State. Based on this simulation, all hospitals except two would be paid using the rural floor, increasing payments in excess of $220 million for a single year. If the average hourly wage for these two hospitals increased faster than the national average, the increase in payments would be even higher. It seems likely that over 5 years, Medicare payments to hospitals in this State would increase by more than $1 billion. Again, these increased payments would be budget neutralized at the expense of all other IPPS hospitals nationwide. Given that the hospitals continue to be eligible for the higher paying CAH VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 status, we are concerned that hospitals are converting to IPPS status solely in order to raise the State’s rural floor. We are concerned about the propriety of such an arrangement if the intent is to manipulate the State’s area wage index values to receive higher Medicare reimbursement. Section 1886(d)(5)(I)(i) of the Act allows the Secretary the authority to ‘‘provide by regulation for such other exceptions and adjustments * * * as the Secretary deems appropriate.’’ We are soliciting comments regarding whether it would be appropriate for CMS to establish a policy under this authority to preclude the arrangement described above and, if so, how such a policy would be applied. We believe that any policy should only apply to a CAH that continues to meet the CAH certification requirements and should not apply if a CAH no longer met those requirements and converted to an IPPS provider. 4. Application of Rural Floor Budget Neutrality Section 4410 of the Balanced Budget Act of 1997 (BBA) established the rural floor by requiring that the wage index for a hospital in any urban area cannot be less than the area wage index determined for the State’s rural area. Since FY 1998, we have implemented the budget neutrality requirement of this provision by adjusting the standardized amounts. A discussion and illustration of the calculation of the standardized amounts is shown in the Addendum of every year’s IPPS rule.16 In this proposed rule, we are proposing a prospective change to how budget neutrality is applied to implement the rural floor for FY 2008 and subsequent years. Section 4410(a) of the BBA indicates that ‘‘the area wage index applicable * * * to any hospital which is not located in a rural area’may not be less than the area wage index applicable * * * to hospitals located in rural areas in the State in which the hospital is located.’’ Section 4410(b) of the BBA imposes the budget neutrality requirement and states that the Secretary shall ‘‘adjust the area wage index referred to in subsection (a) for 16 The BBA was enacted on August 5, 1997, and required application of the rural floor beginning with the FY 1998 IPPS. See the following for a description and calculation of the IPPS standardized amounts since that time: 62 FR 46038–46043, August 29, 1997; 63 FR 41006–41010, July 31, 1998; 64 FR 41544–41549, July 30, 1999; 65 FR 47111–47116, August 1, 2000; 66 FR 39939– 39946, August 1, 2001; 67 FR 50120–50126, August 1, 2002; 68 FR 45474–45480, August 1, 2003; 69 FR 49273–49282, August 11, 2004; 70 FR 47491–47498, August 12, 2005; 71 FR 59889–58980, October 11, 2006. PO 00000 Frm 00109 Fmt 4701 Sfmt 4702 24787 hospitals not described in such subsection.’’ One possible interpretation of section 4410(b) of the BBA is that the budget neutrality adjustment would be applied only to those hospitals that do not receive the rural floor. In other words, the wage index of an urban hospital subject to the rural floor would be increased to the level of the rural wage index in the same State, but would not be adjusted for budget neutrality. Thus, urban hospitals receiving the rural floor would receive a higher wage index than the rural hospitals within the same State (because rural floor hospitals would not be subject to budget neutrality, whereas rural hospitals would be). We believe such a reading would not be in accordance with Congressional intent, which was to set a floor for urban hospitals, not to pay urban hospitals a wage index higher than the wage index applicable to rural hospitals. In order to avoid the apparent contradiction between raising an urban hospital’s wage index to the rural floor and not applying budget neutrality to its wage index, we also believe the statute could be read to allow an iterative calculation of budget neutrality and wage indices. Under such iterative calculations (consistent with section 4410(a) of the BBA), we would raise the wage index for urban hospitals to the level of the pre-budget neutrality rural wage index. Consistent with section 4410(b) of the BBA, we would adjust the wage index for all nonrural floor hospitals to achieve budget neutrality. However, such an adjustment would result in an urban hospital that would receive the rural floor having a higher wage index than a rural hospital in the same State. Therefore, we would then decrease wage indices for the rural floor hospitals so they are equal to the adjusted rural wage index in the same State. At this point, payments would be less in the aggregate than they were prior to applying the rural floor. Accordingly, a new budget neutrality adjustment would have to be calculated to raise the wage indices and total payments for rural hospitals and nonrural floor urban hospitals. The rural wage index would now be higher than the wage index for the rural floor hospitals in the same State. Therefore, the wage index for rural floor hospitals would then be increased again to the level of the State’s rural wage index, leading to budget neutrality being recalculated again, the wage index reduced for rural floor hospitals, and so forth until the wage index and the budget neutrality adjustment stabilize. We have determined that the iterative method is substantively equivalent to E:\FEDREG\03MYP2.LOC 03MYP2 24788 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules simply adjusting all area wage indices by a uniform percentage. We have performed the iterative calculation using provider-level data based on FY 2007 MedPAR data and the first half of FY 2007 wage index data. Using such data, we determined that the iterative method results in the same final wage indices through four decimal places that would result if a uniform budget neutrality factor were applied to all hospitals’ wage indices. Furthermore, an iterative method, which requires adjusting only the wage index values of nonrural floor providers, reassigning the lowered rural floor value to rural floor providers, and reiterating the budget neutrality factor applied to the nonrural floor providers would require an excessive number of iterations and computer processing, which is not necessary if we simply apply a uniform budget neutrality adjustment to all wage index values. The latter method is accomplished more quickly, is less complex, and arrives at the same final wage index values. Because the IPPS schedule is relatively condensed, with a proposed rule issued in April, a 60-day comment period until June, and then only 2 months to analyze comments, respond to them, determine final policies and calculate final rates prior to the August 1 publication, we believe it would not be practical to require such multiple layers of calculations, when a uniform adjustment would produce substantively identical results. Therefore, we are proposing to implement the rural floor budget neutrality requirement by applying a uniform budget neutrality adjustment to all hospital wage indices rather than the more complicated iterative process illustrated below. The following hypothetical example, which includes a series of nine iterations, illustrates how the iterative process works. The example assumes three IPPS hospitals in one State. Hospital A is rural and Hospitals B and C are urban. PRE-FLOOR WAGE INDEX Hospital A Wage Index ............................ Relative Weights .................... Location .................................. Standardized Amounts ........... Payments ............................... Hospital B Hospital C Total 0.9500 .................................... 100 ......................................... Rural ...................................... $1,000 .................................... $95,000 .................................. 1.1700 .................................... 200 ......................................... Urban ..................................... $1,000 .................................... $234,000 ................................ 0.8600 .................................... 150 ......................................... Urban ..................................... $1,000 .................................... $129,000 ................................ ........................ ........................ ........................ ........................ $458,000 Note: Hospital C is urban and has a lower wage index than Hospital A which is rural. Post-Floor Wage Index; Pre-Budget Neutrality I Hospital A Hospital B Hospital C Total Wage Index ............................ Relative Weights .................... Location .................................. Standardized Amounts ........... Payments ............................... 0.9500 .................................... 100 ......................................... Rural ...................................... $1,000 .................................... $95,000 .................................. 1.1700 .................................... 200 ......................................... Urban ..................................... $1,000 .................................... $234,000 ................................ 0.9500 .................................... 150 ......................................... Urban ..................................... $1,000 .................................... $142,500 ................................ ........................ ........................ ........................ ........................ $471,500 Note: Hospital C’s wage index is raised to the same level as Hospital A. Post Floor—Budget Neutrality Process Iteration 1: Step 1: Apply budget neutrality to Hospital A and Hospital B. I Hospital A Hospital B Hospital C Wage Index ....................... Relative Weights ............... Location ............................. Standardized Amounts ...... Payments ........................... 0.9110 ............................... 100 .................................... Rural .................................. $1,000 ............................... $91,102 ............................. 1.1220 ............................... 200 .................................... Urban ................................ $1,000 ............................... $224,398 ........................... 0.9500 ............................... 150 .................................... Urban ................................ $1,000 ............................... $142,500 ........................... Total BN Factor. 0.95897. Target. $458,000. $458,000. Step 2: Reduce Hospital C’s wage index to Hospital A’s level. mmaher on DSK3CLS3C1PROD with $$_JOB I Hospital A Hospital B Hospital C Wage Index ....................... Relative Weights ............... Location ............................. Standardized Amounts ...... Payments ........................... 0.9110 ............................... 100 .................................... Rural .................................. $1,000 ............................... $91,102 ............................. 1.1220 ............................... 200 .................................... Urban ................................ $1,000 ............................... $224,398 ........................... 0.9110 ............................... 150 .................................... Urban ................................ $1,000 ............................... $136,653 ........................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00110 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 Total BN Factor. 0.95897. Target. $458,000. $452,153. 24789 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules Iteration 2: Step 1: Apply budget neutrality to Hospital A and Hospital B. I Hospital A Hospital B Hospital C Wage Index ....................... Relative Weights ............... Location ............................. Standardized Amounts ...... Payments ........................... 0.9279 ............................... 100 .................................... Rural .................................. $1,000 ............................... $92,790 ............................. 1.1428 ............................... 200 .................................... Urban ................................ $1,000 ............................... $228,557 ........................... 0.9110 ............................... 150 .................................... Urban ................................ $1,000 ............................... $136,653 ........................... Total BN Factor. 1.01853. Target. $458,000. $458,000. Step 2: Increase Hospital C’s wage index to Hospital A’s level. I Hospital A Hospital B Hospital C Wage Index ....................... Relative Weights ............... Location ............................. Standardized Amounts ...... Payments ........................... 0.9279 ............................... 100 .................................... Rural .................................. $1,000 ............................... $92,790 ............................. 1.1428 ............................... 200 .................................... Urban ................................ $1,000 ............................... $228,557 ........................... 0.9279 ............................... 150 .................................... Urban ................................ $1,000 ............................... $139,185 ........................... Iteration 3: Total BN Factor. 1.01854. Target. $458,000. $460,532. Step 1: Apply budget neutrality to Hospital A and Hospital B. I Hospital A Hospital B Hospital C Wage Index ....................... Relative Weights ............... Location ............................. Standardized Amounts ...... Payments ........................... 0.9206 ............................... 100 .................................... Rural .................................. $1,000 ............................... $92,059 ............................. 1.1338 ............................... 200 .................................... Urban ................................ $1,000 ............................... $226,756 ........................... 0.9279 ............................... 150 .................................... Urban ................................ $1,000 ............................... $139,185 ........................... Total BN Factor. 0.99212. Target. $458,000. $458,000. Step 2: Reduce Hospital C’s wage index to Hospital A’s level. I Hospital A Hospital B Hospital C Wage Index ....................... Relative Weights ............... Location ............................. Standardized Amounts ...... Payments ........................... 0.9206 ............................... 100 .................................... Rural .................................. $1,000 ............................... $92,059 ............................. 1.1338 ............................... 200 .................................... Urban ................................ $1,000 ............................... $226,756 ........................... 0.9206 ............................... 150 .................................... Urban ................................ $1,000 ............................... $138,088 ........................... Iteration 4: Total BN Factor. 0.99212. Target. $458,000. $456,903. Step 1: Apply budget neutrality to Hospital A and Hospital B. I Hospital A Hospital B Hospital C Wage Index ....................... Relative Weights ............... Location ............................. Standardized Amounts ...... Payments ........................... 0.9238 ............................... 100 .................................... Rural .................................. $1,000 ............................... $92,376 ............................. 1.1377 ............................... 200 .................................... Urban ................................ $1,000 ............................... $227,536 ........................... 0.9206 ............................... 150 .................................... Urban ................................ $1,000 ............................... $138,088 ........................... Total BN Factor. 1.00344. Target. $458,000. $458,000. mmaher on DSK3CLS3C1PROD with $$_JOB Step 2: Increase Hospital C’s wage index to Hospital A’s level. I Hospital A Hospital B Hospital C Wage Index ....................... Relative Weights ............... Location ............................. Standardized Amounts ...... Payments ........................... 0.9238 ............................... 100 .................................... Rural .................................. $1,000 ............................... $92,376 ............................. 1.1377 ............................... 200 .................................... Urban ................................ $1,000 ............................... $227,536 ........................... 0.9238 ............................... 150 .................................... Urban ................................ $1,000 ............................... $138,563 ........................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00111 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 Total BN Factor. 1.00344. Target. $458,000. $458,475. 24790 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules Iteration 5: Step 1: Apply budget neutrality to Hospital A and Hospital B. I Hospital A Hospital B Hospital C Wage Index ....................... Relative Weights ............... Location ............................. Standardized Amounts ...... Payments ........................... 0.9224 ............................... 100 .................................... Rural .................................. $1,000 ............................... $92,238 ............................. 1.1360 ............................... 200 .................................... Urban ................................ $1,000 ............................... $227,198 ........................... 0.9238 ............................... 150 .................................... Urban ................................ $1,000 ............................... $138,563 ........................... Total BN Factor. 0.99852. Target. $458,000. $458,000. Step 2: Reduce Hospital C’s wage index to Hospital A’s level. I Hospital A Hospital B Hospital C Wage Index ....................... Relative Weights ............... Location ............................. Standardized Amounts ...... Payments ........................... 0.9224 ............................... 100 .................................... Rural .................................. $1,000 ............................... $92,238 ............................. 1.1360 ............................... 200 .................................... Urban ................................ $1,000 ............................... $227,198 ........................... 0.9224 ............................... 150 .................................... Urban ................................ $1,000 ............................... $138,358 ........................... Iteration 6: Total BN Factor. 0.99852. Target. $458,000. $457,794. Step 1: Apply budget neutrality to Hospital A and Hospital B. I Hospital A Hospital B Hospital C Wage Index ....................... Relative Weights ............... Location ............................. Standardized Amounts ...... Payments ........................... 0.9230 ............................... 100 .................................... Rural .................................. $1,000 ............................... $92,298 ............................. 1.1367 ............................... 200 .................................... Urban ................................ $1,000 ............................... $227,344 ........................... 0.9224 ............................... 150 .................................... Urban ................................ $1,000 ............................... $138,358 ........................... Total BN Factor. 1.00064. Target. $458,000. $458,000. Step 2: Increase Hospital C’s wage index to Hospital A’s level. I Hospital A Hospital B Hospital C Wage Index ....................... Relative Weights ............... Location ............................. Standardized Amounts ...... Payments ........................... 0.9230 ............................... 100 .................................... Rural .................................. $1,000 ............................... $92,298 ............................. 1.1367 ............................... 200 .................................... Urban ................................ $1,000 ............................... $227,344 ........................... 0.9230 ............................... 150 .................................... Urban ................................ $1,000 ............................... $138,447 ........................... Iteration 7: Total BN Factor. 1.00064. Target. $458,000. $458,089. Step 1: Apply budget neutrality to Hospital A and Hospital B. I Hospital A Hospital B Hospital C Wage Index ....................... Relative Weights ............... Location ............................. Standardized Amounts ...... Payments ........................... 0.9227 ............................... 100 .................................... Rural .................................. $1,000 ............................... $92,272 ............................. 1.1364 ............................... 200 .................................... Urban ................................ $1,000 ............................... $227,281 ........................... 0.9230 ............................... 150 .................................... Urban ................................ $1,000 ............................... $138,447 ........................... Total BN Factor. 0.99972. Target. $458,000. $458,000. mmaher on DSK3CLS3C1PROD with $$_JOB Step 2: Reduce Hospital C’s wage index to Hospital A’s level. I Hospital A Hospital B Hospital C Wage Index ....................... Relative Weights ............... Location ............................. Standardized Amounts ...... Payments ........................... 0.9227 ............................... 100 .................................... Rural .................................. $1,000 ............................... $92,272 ............................. 1.1364 ............................... 200 .................................... Urban ................................ $1,000 ............................... $227,281 ........................... 0.9227 ............................... 150 .................................... Urban ................................ $1,000 ............................... $138,408 ........................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00112 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 Total BN Factor. 0.99972. Target. $458,000. $457,961. 24791 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules Iteration 8: Step 1: Apply budget neutrality to Hospital A and Hospital B. I Hospital A Hospital B Hospital C Wage Index ....................... Relative Weights ............... Location ............................. Standardized Amounts ...... Payments ........................... 0.9228 ............................... 100 .................................... Rural .................................. $1,000 ............................... $92,283 ............................. 1.1365 ............................... 200 .................................... Urban ................................ $1,000 ............................... $227,308 ........................... 0.9227 ............................... 150 .................................... Urban ................................ $1,000 ............................... $138,408 ........................... Total BN Factor. 1.00012. Target. $458,000. $458,000. Step 2: Increase Hospital C’s wage index to Hospital A’s level. I Hospital A Hospital B Hospital C Wage Index ....................... Relative Weights ............... Location ............................. Standardized Amounts ...... Payments ........................... 0.9228 ............................... 100 .................................... Rural .................................. $1,000 ............................... $92,283 ............................. 1.1365 ............................... 200 .................................... Urban ................................ $1,000 ............................... $227,308 ........................... 0.9228 ............................... 150 .................................... Urban ................................ $1,000 ............................... $138,425 ........................... Iteration 9: Total BN Factor. 1.00012. Target. $458,000. $458,016. Step 1: Apply budget neutrality to Hospital A and Hospital B. I Hospital A Hospital B Hospital C Wage Index ....................... Relative Weights ............... Location ............................. Standardized Amounts ...... Payments ........................... 0.9228 ............................... 100 .................................... Rural .................................. $1,000 ............................... $92,279 ............................. 1.1365 ............................... 200 .................................... Urban ................................ $1,000 ............................... $227,297 ........................... 0.9228 ............................... 150 .................................... Urban ................................ $1,000 ............................... $138,425 ........................... In the example above, the wage indices are shown only to the 4th decimal place even though they are not rounded. However, the actual wage indices that we calculate for the IPPS are rounded to 4 decimal places. In the 9th and final iteration of the budget neutrality adjustment shown above, there was no change to the wage indices through the 4th decimal place relative to the 8th iteration. Therefore, because the wage indices stopped changing, we could not obtain further precision in the budget neutrality and wage index calculations in the example shown above with further iterations. We note Total BN Factor. 0.99995. Target. $458,000. $458,000. that the example above produces the same result as simply applying a uniform adjustment to hospital wage indices. Using the same data as the above hypothetical example, we show this result below: PRE-FLOOR WAGE INDEX Hospital A Wage Index ............................ Relative Weights .................... Location .................................. Standardized Amounts ........... Payments ............................... Hospital B Hospital C Total 0.9500 .................................... 100 ......................................... Rural ...................................... $1,000 .................................... $95,000 .................................. 1.1700 .................................... 200 ......................................... Urban ..................................... $1,000 .................................... $234,000 ................................ 0.8600 .................................... 150 ......................................... Urban ..................................... $1,000 .................................... $129,000 ................................ ........................ ........................ ........................ ........................ $458,000 Note: Hospital C is urban and has a lower wage index than Hospital A which is rural. Post-Floor Wage Index; Pre-Budget Neutrality mmaher on DSK3CLS3C1PROD with $$_JOB I Hospital A Hospital B Hospital C Total Wage Index ............................ Relative Weights .................... Location .................................. Standardized Amounts ........... Payments ............................... 0.9500 .................................... 100 ......................................... Rural ...................................... $1,000 .................................... $95,000 .................................. 1.1700 .................................... 200 ......................................... Urban ..................................... $1,000 .................................... $234,000 ................................ 0.9500 .................................... 150 ......................................... Urban ..................................... $1,000 .................................... $142,500 ................................ ........................ ........................ ........................ ........................ $471,500 Note: Hospital C’s wage index is raised to the same level as Hospital A. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00113 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 24792 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules Post Floor—Budget Neutrality I Hospital A Hospital B Hospital C Wage Index ............................ Relative Weights .................... Location .................................. Standardized Amounts ........... Payments ............................... 0.9228 .................................... 100 ......................................... Rural ...................................... $1,000 .................................... $92,280 .................................. 1.1365 .................................... 200 ......................................... Urban ..................................... $1,000 .................................... $227,300 ................................ 0.9228 .................................... 150 ......................................... Urban ..................................... $1,000 .................................... $138,420 ................................ mmaher on DSK3CLS3C1PROD with $$_JOB We note that our proposed change would apply the budget neutrality adjustment to the wage index, and not to the standardized amount. In previous years, we applied a budget neutrality adjustment to the standardized amount to ensure that payments remained constant to payments that would have occurred in the absence of the rural floor requirement in section 4410 of the BBA. We believe such an adjustment is in keeping with the statute, which requires that the rural floor will not result in aggregate payments that are greater or less than those that would have been made in the absence of a rural floor. We believe that an adjustment to the wage index would result in a substantially similar payment as an adjustment to the standardized amount, as both involve multipliers to the standardized amount, and both would be based upon the same modeling parameters. We do note that because hospitals have different labor-related shares (62 percent for hospitals with wage indices less than or equal to 1; 69.7 percent for hospitals with wage indices greater than 1), an adjustment to the wage index would have slightly different effects from an adjustment to the standardized amount, as each wage index would be adjusted by a uniform percentage. For FY 2008, we are proposing to use FY 2006 discharge data and FY 2008 wage indices to simulate IPPS payments without the rural floor. We would compare these simulated payments to simulated payments using the same data with a rural floor. We believe that the statute supports either an adjustment to the standardized amount or the wage indices because under either methodology, the rural floor would not result in aggregate payments that were greater or less than those that would have been made in the absence of a rural floor. H. Analysis and Implementation of the Proposed Occupational Mix Adjustment and the Proposed FY 2008 Occupational Mix Adjusted Wage Index (If you choose to comment on issues in this section, please include the caption ‘‘Occupational Mix Adjusted Wage Index’’ at the beginning of your comment.) As discussed in section III.C. of this preamble, for FY 2008, we are proposing VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Total BN Factor 0.971368 Target $458,000 $458,000 Based on the January through June 2006 occupational mix survey data, we determined (in Step 7 of the occupational mix calculation) that the proposed national percentage of hospital employees in the Nurse category is 42.9 percent, and the proposed national percentage of hospital employees in the All Other Occupations category is 57.1 percent. At the CBSA level, the percentage of hospital employees in the Nurse category ranged from a low of 27.3 percent in one CBSA, to a high of 85.3 percent in another CBSA. We compared the final FY 2007 occupational mix adjusted wage indices for each CBSA to the proposed FY 2008 wage indices adjusted for occupational mix. In proposing to implement an occupational mix adjusted wage index based on the above calculation using 6 months of survey data for FY 2008 as opposed to 3 months of survey data used for FY 2007, the final wage index values for 17 rural areas (36.2 percent) and 189 urban areas (48.7 percent) would decrease as a result of the adjustment. Nine rural areas (19.1 percent) and 127 urban areas (32.7 percent) would experience a decrease of 1 percent or greater in their wage index values. The largest negative impacts Occupational mix nursing Average hour- would be 3.40 percent and 14.82 subcategory ly wage percent for a rural and urban area, National RN Management .... $38.6214 respectively. In addition, 30 rural areas National RN Staff .................. 33.4800 (63.8 percent) and 197 urban areas (50.8 National LPN ........................ 19.2485 percent) would experience an increase National Nurse Aides, Orderin their wage index values. Twelve rural lies, and Attendants .......... 13.7267 areas (25.5 percent) and 131 urban areas National Medical Assistants 15.7936 National Nurse Category ...... 28.7439 (33.8 percent) would experience an increase of 1 percent or greater in their The proposed national average hourly wage index values. The largest increase for a rural area would be 10.75 percent wage for the entire nurse category as and the largest increase for an urban computed in Step 5 of the occupational mix calculation is $28.7439. Hospitals area would be 16.87 percent. Two urban with a nurse category average hourly areas would be unaffected. These results wage (as calculated in Step 4) of greater indicate that a larger percentage of rural than the national nurse category average areas benefit from an occupational mix hourly wage receive an occupational adjustment than do urban areas. mix adjustment factor (as calculated in However, as was the case with the FY Step 6) of less than 1.0. Hospitals with 2007 occupational mix data, a nurse category average hourly wage (as approximately a third of rural CBSAs calculated in Step 4) of less than the (36.2 percent) continue to experience a national nurse category average hourly decrease in their wage indices as a wage receive an occupational mix result of the occupational mix adjustment factor (as calculated in Step adjustment. 6) of greater than 1.0. to apply the occupational mix adjustment to 100 percent of the FY 2008 wage index. We calculated the occupational mix adjustment using data from the 2006 occupational mix survey data, using the methodology described in section III.C.3. of this preamble. Using the first and second quarter occupational mix survey data and applying the occupational mix adjustment to 100 percent of the FY 2008 wage index results in a proposed national average hourly wage of $30.9074 and a proposed Puerto Ricospecific average hourly wage of $13.4678. After excluding data of hospitals that either submitted aberrant data that failed critical edits, or that do not have FY 2004 Worksheet S–3 cost report data for use in calculating the proposed FY 2008 wage index, we calculated the proposed FY 2008 wage index using the occupational mix survey data from 3,368 hospitals. Using the Worksheet S–3 cost report data of 3,581 hospitals and occupational mix first and/or second quarter survey data from 3,368 hospitals represents a 94.1 percent survey response rate. The proposed FY 2008 national average hourly wages for each occupational mix nursing subcategory as calculated in Step 2 of the occupational mix calculation are as follows: PO 00000 Frm 00114 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules The proposed wage index values for FY 2008 (except those for hospitals receiving wage index adjustments under section 1886(d)(13) of the Act) are shown in Tables 4A, 4B, 4C, and 4F in the Addendum to this proposed rule. Tables 3A and 3B in the Addendum to this proposed rule list the 3-year average hourly wage for each labor market area before the redesignation of hospitals based on FYs 2006, 2007, and 2008 cost reporting periods. Table 3A lists these data for urban areas and Table 3B lists these data for rural areas. In addition, Table 2 in the Addendum to this proposed rule includes the adjusted average hourly wage for each hospital from the FY 2002 and FY 2003 cost reporting periods, as well as the FY 2004 period used to calculate the proposed FY 2008 wage index. The 3year averages are calculated by dividing the sum of the dollars (adjusted to a common reporting period using the method described previously) across all 3 years, by the sum of the hours. If a hospital is missing data for any of the previous years, its average hourly wage for the 3-year period is calculated based on the data available during that period. The proposed wage index values in Tables 4A, 4B, 4C, and 4F and the average hourly wages in Tables 2, 3A, and 3B in the Addendum to this proposed rule include the proposed occupational mix adjustment as well as the budget neutrality adjustment for the rural floor. I. Revisions to the Proposed Wage Index Based on Hospital Redesignations (If you choose to comment on issues in this section, please include the caption ‘‘Hospital Reclassifications and Redesignations’’ at the beginning of your comment.) mmaher on DSK3CLS3C1PROD with $$_JOB 1. General Under section 1886(d)(10) of the Act, the Medicare Geographic Classification Review Board (MGCRB) considers applications by hospitals for geographic reclassification for purposes of payment under the IPPS. Hospitals must apply to the MGCRB to reclassify by September 1 of the year preceding the year during which reclassification is sought. Generally, hospitals must be proximate to the labor market area to which they are seeking reclassification and must demonstrate characteristics similar to hospitals located in that area. The MGCRB issues its decisions by the end of February for reclassifications that become effective for the following fiscal year (beginning October 1). The regulations applicable to reclassifications by the MGCRB are located in § § 412.230 through 412.280. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Section 1886(d)(10)(D)(v) of the Act provides that, beginning with FY 2001, a MGCRB decision on a hospital reclassification for purposes of the wage index is effective for 3 fiscal years, unless the hospital elects to terminate the reclassification. Section 1886(d)(10)(D)(vi) of the Act provides that the MGCRB must use the 3 most recent years’ average hourly wage data in evaluating a hospital’s reclassification application for FY 2003 and any succeeding fiscal year. Section 304(b) of Pub. L. 106–554 provides that the Secretary must establish a mechanism under which a statewide entity may apply to have all of the geographic areas in the State treated as a single geographic area for purposes of computing and applying a single wage index, for reclassifications beginning in FY 2003. The implementing regulations for this provision are located at § 412.235. Section 1886(d)(8)(B) of the Act requires the Secretary to treat a hospital located in a rural county adjacent to one or more urban areas as being located in the MSA to which the greatest number of workers in the county commute, if the rural county would otherwise be considered part of an urban area under the standards for designating MSAs and if the commuting rates used in determining outlying counties were determined on the basis of the aggregate number of resident workers who commute to (and, if applicable under the standards, from) the central county or counties of all contiguous MSAs. In light of the new CBSA definitions and the Census 2000 data that we implemented for FY 2005 (69 FR 49027), we undertook to identify those counties meeting these criteria. The eligible counties are identified under section III.I.8. of this preamble. 2. Effects of Reclassification/ Redesignation Section 1886(d)(8)(C) of the Act provides that the application of the wage index to redesignated hospitals is dependent on the hypothetical impact that the wage data from these hospitals would have on the wage index value for the area to which they have been redesignated. These requirements for determining the wage index values for redesignated hospitals is applicable both to the hospitals located in rural counties deemed urban under section 1886(d)(8)(B) of the Act and hospitals that were reclassified as a result of the MGCRB decisions under section 1886(d)(10) of the Act. Therefore, as provided in section 1886(d)(8)(C) of the Act, the wage index values were determined by considering the following: PO 00000 Frm 00115 Fmt 4701 Sfmt 4702 24793 <bullet≤ If including the wage data for the redesignated hospitals would reduce the wage index value for the area to which the hospitals are redesignated by 1 percentage point or less, the area wage index value determined exclusive of the wage data for the redesignated hospitals applies to the redesignated hospitals. <bullet≤ If including the wage data for the redesignated hospitals reduces the wage index value for the area to which the hospitals are redesignated by more than 1 percentage point, the area wage index determined inclusive of the wage data for the redesignated hospitals (the combined wage index value) applies to the redesignated hospitals. <bullet≤ If including the wage data for the redesignated hospitals increases the wage index value for the urban area to which the hospitals are redesignated, both the area and the redesignated hospitals receive the combined wage index value. Otherwise, the hospitals located in the urban area receive a wage index excluding the wage data of hospitals redesignated into the area. Rural areas whose wage index values would be reduced by excluding the wage data for hospitals that have been redesignated to another area continue to have their wage index values calculated as if no redesignation had occurred (otherwise, redesignated rural hospitals are excluded from the calculation of the rural wage index). The wage index value for a redesignated rural hospital cannot be reduced below the wage index value for the rural areas of the State in which the hospital is located. CMS has also adopted the following policies by regulation: <bullet≤ The wage data for a reclassified urban hospital is included in both the wage index calculation of the area to which the hospital is reclassified (subject to the rules described above) and the wage index calculation of the urban area where the hospital is physically located. <bullet≤ In cases where urban hospitals have reclassified to rural areas under 42 CFR 412.103, the urban hospital wage data are: (a) Included in the rural wage index calculation, unless doing so would reduce the rural wage index; and (b) included in the urban area where the hospital is physically located. 3. FY 2008 MGCRB Reclassifications (If you choose to comment on issues in this section, please include the caption ‘‘MGCRB’’ at the beginning of your comment.) Under section 1886(d)(10) of the Act, the MGCRB considers applications by hospitals for geographic reclassification E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24794 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules for purposes of payment under the IPPS. The specific procedures and rules that apply to the geographic reclassification process are outlined in § 412.230 through § 412.280. At the time this proposed rule was constructed, the MGCRB had completed its review of FY 2008 reclassification requests. There were 365 hospitals approved for wage index reclassifications by the MGCRB for FY 2008. Because MGCRB wage index reclassifications are effective for 3 years, hospitals reclassified during FY 2006 or FY 2007 are eligible to continue to be reclassified based on prior reclassifications to current MSAs during FY 2008. There were 299 hospitals reclassified for wage index in FY 2006 and 214 hospitals reclassified for wage index in FY 2007. Some of the hospitals that reclassified for FY 2006 and FY 2007 have elected not to continue their reclassifications in FY 2008 because, under the revised labor market area definitions, they are now physically located in the areas to which they previously reclassified. Of all of the hospitals approved for reclassification for FY 2006, FY 2007, and FY 2008, 866 hospitals are in a reclassification status for FY 2008. Prior to FY 2004, hospitals had been able to apply to be reclassified for purposes of either the wage index or the standardized amount. Section 401 of Pub. L. 108–173 established that all hospitals will be paid on the basis of the large urban standardized amount, beginning with FY 2004. Consequently, all hospitals are paid on the basis of the same standardized amount, which made such reclassifications moot. Although there could still be some benefit in terms of payments for some hospitals under the DSH payment adjustment for operating IPPS, section 402 of Pub. L. 108–173 equalized DSH payment adjustments for rural and urban hospitals, with the exception that the rural DSH adjustment is capped at 12 percent (except that rural referral centers and, effective for discharges occurring on or after October 1, 2006, MDHs have no cap). (A detailed discussion of this application appears in section IV.I. of the preamble of the FY 2005 IPPS final rule (69 FR 49085). The exclusion of MDHs from the 12 percent DSH cap under Pub. L. 109–171 was discussed under section IV.F.4. of the preamble of the FY 2007 IPPS final rule (71 FR 48066.) Under § 412.273, hospitals that have been reclassified by the MGCRB are permitted to withdraw their applications within 45 days of the publication of a proposed rule. The request for withdrawal of an application VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 for reclassification or termination of an existing 3-year reclassification that would be effective in FY 2008 must be received by the MGCRB within 45 days of the publication of this proposed rule. If a hospital elects to withdraw its wage index application after the MGCRB has issued its decision, but prior to the above date, it may later cancel its withdrawal in a subsequent year and request the MGCRB to reinstate its wage index reclassification for the remaining fiscal year(s) of the 3-year period (§ 412.273(b)(2)(i)). The request to cancel a prior withdrawal or termination must be in writing to the MGCRB no later than the deadline for submitting reclassification applications for the following fiscal year (§ 412.273(d)). For further information about withdrawing, terminating, or canceling a previous withdrawal or termination of a 3-year reclassification for wage index purposes, we refer the reader to § 412.273, as well as the August 1, 2002, IPPS final rule (67 FR 50065) and the August 1, 2001 IPPS final rule (66 FR 39887). Changes to the wage index that result from withdrawals of requests for reclassification, wage index corrections, appeals, and the Administrator’s review process will be incorporated into the wage index values published in the final rule. These changes may affect not only the wage index value for specific geographic areas, but also the wage index value redesignated hospitals receive; that is, whether they receive the wage index that includes the data for both the hospitals already in the area and the redesignated hospitals. Further, the wage index value for the area from which the hospitals are redesignated may be affected. Applications for FY 2009 reclassifications are due to the MGCRB by September 4, 2007 (the first working day of September 2007). We note that this is also the deadline for canceling a previous wage index reclassification withdrawal or termination under § 412.273(d). Applications and other information about MGCRB reclassifications may be obtained, beginning in mid-July 2007, via the CMS Internet Web site at: https:// cms.hhs.gov/providers/prrb/ mgcinfo.asp, or by calling the MGCRB at (410) 786–1174. The mailing address of the MGCRB is: 2520 Lord Baltimore Drive, Suite L, Baltimore, MD 21244– 2670. PO 00000 Frm 00116 Fmt 4701 Sfmt 4702 4. Hospitals That Applied for Reclassification Effective in FY 2008 and Reinstating Reclassifications in FY 2008 Applications for FY 2008 reclassifications were due to the MGCRB by September 1, 2006. We note that this deadline also applied for canceling a previous wage index reclassification withdrawal or termination under § 412.273(d). The MGCRB, in evaluating a hospital’s request for reclassification for FY 2008 for the wage index, utilized the official data used to develop the FY 2007 wage index. The wage data used to support the hospital’s wage comparisons were from the CMS hospital wage survey. Generally, the source for these data is the IPPS final rule to be published on or before August 1, 2006. However, the wage tables identifying the 3-year average hourly wage of hospitals were not available in time to include them in the FY 2007 IPPS final rule. Therefore, we made the data available subsequent to the publication of the FY 2007 IPPS final rule. Section 1886(d)(10)(C)(ii) of the Act indicates that a hospital requesting a change in geographic classification for a fiscal year must submit its application to the MGCRB not later than the first day of the 13-month period ending on September 30 of the preceding fiscal year. Thus, the statute requires that FY 2008 reclassification applications were to be submitted to the MGCRB by no later than September 1, 2006. For this reason, we required hospitals to file an FY 2008 reclassification application by the September 1, 2006 deadline even though the average hourly wage data used to develop the final FY 2007 wage indices were not yet available. However, as outlined in § 412.256(c)(2), we also allowed hospitals with incomplete applications submitted by the deadline to request an extension beyond September 1, 2006, to complete their applications. We also allowed hospitals 30 days from the date the final wage data were posted on the CMS Web site to request to cancel a withdrawal or termination in order to reinstate a reclassification for FY 2008 or FY 2009, or both fiscal years. For a more detailed discussion of the procedures used for the FY 2008 MGCRB applications we refer readers to the FY 2007 IPPS final rule (71 FR 48022–48023). 5. Clarification of Policy on Reinstating Reclassifications Under § 412.273(a) of our regulations, a hospital or group of hospitals may withdraw its application for reclassification at any time before the E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules MGCRB issues its decision or, if after the MGCRB issues its decision, within 45 days after publication of CMS’s annual notice of proposed rulemaking for the upcoming fiscal year. In addition, a hospital may terminate a reclassification that is already in effect within 45 days after publication of the notice of proposed rulemaking for the upcoming fiscal year. Once a withdrawal or termination has been made, the hospital or group of hospitals will not be reclassified for purposes of the wage index to the same area for that year. The hospital also will not be reclassified to the withdrawn or terminated reclassification area in subsequent fiscal years unless the hospital subsequently cancels its withdrawal or termination. The procedures for making a withdrawal or termination, as well as for canceling a withdrawal or termination are specified at § 412.273. In the FY 2003 IPPS final rule (67 FR 50065–50066), we clarified our existing policy stating that a previous 3-year reclassification may not be reinstated after a subsequent 3-year reclassification to another area takes effect. Therefore, a hospital can only have one active 3-year reclassification at a time. We have been asked whether a hospital (or group of hospitals) can reinstate the two remaining years of a previously approved 3-year reclassification to one area, while at the same time the individual hospital (or group) request a new 3-year reclassification from the MGCRB to a different area and be approved for both at the same time. In this case, the hospital or group of hospitals is permitted to apply to a different area than the previously approved reclassification but, as stated in § 412.273(b)(2), once they accept a newly approved reclassification, a previously terminated and reinstated 3-year reclassification would be permanently terminated. Following the policy set forth at § 412.273(d), a hospital may cancel a previous withdrawal or termination by submitting written notice of its intent to the MGCRB no later than September 1 for reclassifications effective at the start of the second following fiscal year 13 months later. At the same time (because the deadline for geographic reclassification applications for the second following fiscal year 13 months later is also September 1), a hospital or group of hospitals could apply for reclassification to a different area. If the application is denied, the hospital or group of hospitals can select between the reinstated geographic reclassification and the home area wage VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 index for the following fiscal year. The hospital or group of hospitals must file a written request to the MGCRB within 45 days after publication of the notice of proposed rulemaking to terminate the reinstated reclassification and receive the home area wage index. If the hospital or group of hospitals takes no action, the pending geographic reclassification will go into effect. If the new geographic reclassification application is approved, the hospital or group of hospitals will have 45 days from publication of the notice of proposed rulemaking to accept either of the two pending geographic reclassifications or revert to the home area wage index. If the hospital or group of hospitals takes no action, the most recent approved geographic reclassification will go into effect and the prior reclassification will be permanently terminated. Alternatively, the hospital or group of hospitals can withdraw the most recent approved reclassification and accept the previously approved and reinstated reclassification within 45 days of publication of the notice of proposed rulemaking. Such an action will permanently terminate the most recently approved geographic reclassification. Finally, the hospital or group hospitals can write to the MGCRB within 45 days of publication of the notice of proposed rulemaking to withdraw both geographic reclassifications in order to receive the home area wage index. In this case, the hospital or group of hospitals can only reinstate one of the two geographic reclassifications. The other geographic reclassification is permanently terminated. Once a hospital or group of hospitals makes a decision for the following fiscal year within 45 days of publication of the notice of proposed rulemaking, the hospital or group of hospitals cannot change the decision for that fiscal year. It is also important to note that the reinstatement of a reclassification only applies to those withdrawals which were made after the MGCRB issued an approved 3-year decision, not a withdrawal made prior to the MGCRB issuing an approval decision. For example, a hospital has been reclassified to area ‘‘A’’ for FYs 2007 through 2009. The hospital accepts this geographic reclassification for FY 2007. The hospital also applies for reclassification to a different area ‘‘B’’ for FYs 2008 through 2010 by September 1, 2006. If reclassification to area ‘‘B’’ is denied, the hospital can either withdraw or terminate its reclassification to area ‘‘A’’ within 45 PO 00000 Frm 00117 Fmt 4701 Sfmt 4702 24795 days of publication of the proposed rule for FY 2008 and receive the home area wage index for FY 2008 or receive the reclassification to area ‘‘A’’ for FY 2008. If the hospital does nothing, it will receive the area ‘‘A’’ reclassification. If the hospital’s reclassification application to area ‘‘B’’ is approved by the MGCRB, the hospital can (1) do nothing (and, therefore, receives the reclassification to area ‘‘B’’ for FY 2008, permanently terminating the reclassification to area ‘‘A’’); (2) within 45 days of publication of the notice of proposed rulemaking, withdraw the reclassification to area ‘‘B’’ and receive the reclassification to area ‘‘A’’ for FY 2008 (permanently terminating the reclassification to area ‘‘B’’); or (3) withdraw or terminate both the reclassifications to both areas ‘‘A’’ and ‘‘B’’ and receive the home area wage index for FY 2008). If the latter option is selected, the hospital can only reinstate one of the withdrawn/ terminated reclassifications by September 1, 2007 (to take effect for FY 2009). Upon the sunset of the 45-day window, the reclassification selection is final and the hospital will receive that wage index for the fiscal year, in this case for FY 2008. 6. ‘‘Fallback’’ Reclassifications As indicated in section III.I.3. of this preamble, the regulations at § 412.273 provide the process that a hospital wishing to withdraw or terminate a reclassification must follow. If a hospital has an existing reclassification and then applies to the MGCRB to a second area and is approved, it has a choice between two reclassifications and its home area wage index for the following fiscal year. We have been asked a procedural question about how the hospital accepts its previously approved reclassification (its ‘‘fall back’’ reclassification) or how it can ‘‘fall back’’ to its home area wage index. As the example provided in the section III.I.5. of this preamble illustrates, a hospital will automatically be given its most recently approved reclassification (thereby permanently terminating any previously approved reclassifications) unless it provides written notice to the MGCRB within 45 days of publication of the notice of proposed rulemaking that it wishes to withdraw its most recently approved reclassification and ‘‘fall back’’ to either its prior reclassification or its home area wage index for the following fiscal year. If the hospital wishes to accept its home area wage index in preference to its previous ‘‘fall back’’ reclassification, the hospital must also state in its request to the MGCRB that it is not only withdrawing its most E:\FEDREG\03MYP2.LOC 03MYP2 24796 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules recently approved reclassification but also terminating its previously approved reclassification. mmaher on DSK3CLS3C1PROD with $$_JOB 7. Geographic Reclassification Issues for Multicampus Hospitals (If you choose to comments on issues in this section, please include the caption ‘‘Multicampus Hospitals’’ at the beginning of your comment.] In FY 2005, we modified the reclassification rules at § 412.230(d)(2)(iii) to allow campuses of multicampus hospitals located in separate wage index areas to support a reclassification application to the geographic area in which another campus is located using the average hourly wage data submitted on the cost report for the entire hospital. This special rule applies for applications for reclassifications effective in FYs 2006 through FY 2008. In the FY 2007 IPPS final rule, we decided not to extend this special rule for multicampus hospitals. However, we believe that the proposed change to how we allocate a multicampus hospital’s wage data has implications for multicampus hospitals’ reclassification requests. As stated above, we are proposing to allocate the multicampus hospital’s wage data across the different labor market areas where the campuses are located based upon FTEs. For this reason, an individual campus located in a geographic area distinct from the geographic area associated with the provider number of the multicampus hospital will now have published, hospital-specific wage data that it may use to support a request for individual reclassification. The campus’s wage data will be included in the wage data public use file and also provided to the MGCRB. These data will be considered appropriate wage data under § 412.230, because it will be part of the CMS hospital wage survey used to construct the wage index. We note, that where a multicampus hospital spanning two or more geographic areas does not provide us with appropriate FTE data, its campus-specific data will not be included in the public use files we use to construct the wage index. For this reason, unless a multicampus hospital has provided us with FTE data, we will not have appropriate campus-specific wage data that could be used to support an individual reclassification under § 412.230, and the reclassification request for the individual campus would be denied. In this sense, our policy allowing the allocation of wage data using FTEs is somewhat different from our prior policy on multicampus hospitals. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 We note that when a multicampus hospital’s wage data are divided by FTEs, the ratio of wages to hours remains constant. Thus, the effect of our policy, in some sense, is that the individual campus of a multicampus hospital effectively uses the average hourly wage of the entire multicampus institution to support its individual reclassification request. However, as stated in the paragraph above, appropriate wage data will exist, only if the hospital has provided FTE data that can be used to allocate institution-wide wages and hours. Under current policy, an individual campus of a multicampus hospital located in a different area than the one associated with the provider number does not have to provide any official wage index data to join a group reclassification. However, given that we are allocating a portion of the average hourly wage of the hospital’s data to the labor market area that includes this campus, we are also proposing that this same data be used as part of a group reclassification application. Again, these data will be published in a public use file and will be considered appropriate wage data under § § 412.232 and 412.234. If a multicampus hospital spanning more than one geographic area has not provided us with FTE data, then, in accordance with our current policies for treating hospitals without official wage data, the individual campus would still be permitted to join the group application (and indeed would be required to join the application since all hospitals in a group must join in the application). In this case, the group application would omit the wage data from the individual campus of a multicampus hospital. 8. Redesignations of Hospitals Under Section 1886(d)(8)(B) of the Act Beginning October 1, 1988, section 1886 (d)(8)(B) of the Act required us to treat a hospital located in a rural county adjacent to one or more urban areas as being located in the MSA if certain criteria were met. Prior to FY 2005, the rule was that a rural county adjacent to one or more urban areas would be treated as being located in the MSA to which the greatest number of workers in the county commute, if the rural county would otherwise be considered part of an urban area under the standards published in the Federal Register on January 3, 1980 (45 FR 956) for designating MSAs (and New England County Metropolitan Areas (NECMAs)), and if the commuting rates used in determining outlying counties (or, for New England, similar recognized areas) were determined on the basis of the PO 00000 Frm 00118 Fmt 4701 Sfmt 4702 aggregate number of resident workers who commute to (and, if applicable under the standards, from) the central county or counties of all contiguous MSAs (or NECMAs). Hospitals that met the criteria using the January 3, 1980 version of these OMB standards were deemed urban for purposes of the standardized amounts and for purposes of assigning the wage data index. Effective beginning FY 2005, we use OMB’s 2000 CBSA standards and the Census 2000 data to identify counties qualifying for redesignation under section 1886(d)(8)(B) for the purpose of assigning the wage index to the urban area. Hospitals located in these counties have been known as ‘‘Lugar’’ hospitals and the counties themselves are often referred to as ‘‘Lugar’’ counties. We provide the chart below with the listing of the rural counties designated as urban under section 1886(d)(8)(B) of the Act that we are proposing to use for FY 2008. For discharges occurring on or after October 1, 2007, hospitals located in the first column of this chart will be redesignated for purposes of using the wage index of the urban area listed in the second column. RURAL COUNTIES REDESIGNATED AS URBAN UNDER SECTION 1886(D)(8)(B) OF THE ACT [Based on CBSAs and Census 2000 Data] Rural county Cherokee, AL Macon, AL ...... Talladega, AL Hot Springs, AR. Windham, CT Bradford, FL ... Flagler, FL ...... Hendry, FL ..... Levy, FL ......... Walton, FL ..... Banks, GA ...... Chattooga, GA Jackson, GA .. Lumpkin, GA .. Morgan, GA ... Peach, GA ..... Polk, GA ......... Talbot, GA ...... Bingham, ID ... Christian, IL .... DeWitt, IL ....... Iroquois, IL ..... Logan, IL ........ Mason, IL ....... Ogle, IL .......... E:\FEDREG\03MYP2.LOC 03MYP2 CBSA Rome, GA. Auburn-Opelika, AL. Anniston-Oxford, AL. Hot Springs, AR. Hartford-West Hartford-East Hartford, CT. Gainesville, FL. Deltona-Daytona Beach-Ormond Beach, FL. West Palm Beach-Boca Raton-Boynton, FL. Gainesville, FL. Fort Walton BeachCrestview-Destin, FL. Gainesville, GA. Chattanooga, TN–GA. Atlanta-Sandy Springs-Marietta, GA. Atlanta-Sandy Springs-Marietta, GA. Atlanta-Sandy Springs-Marietta, GA. Macon, GA. Atlanta-Sandy Springs-Marietta, GA. Columbus, GA–AL. Idaho Falls, ID. Springfield, IL. Bloomington-Normal, IL. Kankakee-Bradley, IL. Springfield, IL. Peoria, IL. Rockford, IL. Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules RURAL COUNTIES REDESIGNATED AS URBAN UNDER SECTION 1886(D)(8)(B) OF THE ACT—Continued RURAL COUNTIES REDESIGNATED AS URBAN UNDER SECTION 1886(D)(8)(B) OF THE ACT—Continued [Based on CBSAs and Census 2000 Data] [Based on CBSAs and Census 2000 Data] Rural county Rural county CBSA Clinton, IN ...... Henry, IN ........ Spencer, IN .... Starke, IN ....... Warren, IN ..... Boone, IA ....... Buchanan, IA Cedar, IA ........ Allen, KY ........ Assumption Parish, LA. St. James Parish, LA. Allegan, MI ..... Montcalm, MI Oceana, MI .... Shiawassee, MI. Tuscola, MI .... Fillmore, MN .. Dade, MO ...... Pearl River, MS. Caswell, NC ... Granville, NC Harnett, NC .... Lincoln, NC .... Polk, NC ......... Los Alamos, NM. Lyon, NV ........ Cayuga, NY ... Columbia, NY Genesee, NY Greene, NY .... Schuyler, NY .. Sullivan, NY ... Wyoming, NY Ashtabula, OH mmaher on DSK3CLS3C1PROD with $$_JOB Champaign, OH. Columbiana, OH. Cotton, OK ..... Linn, OR ......... Adams, PA ..... Clinton, PA ..... Greene, PA .... Monroe, PA .... Schuylkill, PA Susquehanna, PA. Clarendon, SC Lee, SC .......... Oconee, SC ... Union, SC ...... Meigs, TN ...... Bosque, TX .... Falls, TX ......... VerDate Mar 15 2010 CBSA Lafayette, IN. Indianapolis-Carmel, IN. Evansville, IN–KY. Gary, IN. Lafayette, IN. Ames, IA. Waterloo-Cedar Falls, IA. Iowa City, IA. Bowling Green, KY. Baton Rouge, LA. Fannin, TX ..... Grimes, TX ..... Harrison, TX ... Henderson, TX Milam, TX ....... Van Zandt, TX Willacy, TX ..... Buckingham, VA. Floyd, VA ....... Baton Rouge, LA. Middlesex, VA Holland-Grand Haven, MI. Grand Rapids-Wyoming, MI. Muskegon-Norton Shores, MI. Lansing-East Lansing, MI. Page, VA ........ Shenandoah, VA. Island, WA ..... Saginaw-Saginaw Township North, MI. Rochester, MN. Springfield, MO. Gulfport-Biloxi, MS. Burlington, NC. Durham, NC. Raleigh-Cary, NC. Charlotte-Gastonia-Concord, NC–SC. Spartanburg, NC. Santa Fe, NM. Carson City, NV. Syracuse, NY. Albany-Schenectady-Troy, NY. Rochester, NY. Albany-Schenectady-Troy, NY. Ithaca, NY. Poughkeepsie-NewburghMiddletown, NY. Buffalo-Niagara Falls, NY. Cleveland-Elyria-Mentor, OH. Springfield, OH. Youngstown-WarrenBoardman, OH–PA. Lawton, OK. Corvallis, OR. York-Hanover, PA. Williamsport, PA. Pittsburgh, PA. Allentown-Bethlehem-Easton, PA–NJ. Reading, PA. Binghamton, NY. Sumter, SC. Sumter, SC. Greenville, SC. Spartanburg, SC. Cleveland, TN. Waco, TX. Waco, TX. 02:00 Aug 26, 2011 Jkt 223001 Mason, WA .... Wahkiakum, WA. Jackson, WV .. Roane, WV .... Green, WI ...... Green Lake, WI. Jefferson, WI .. Walworth, WI Dallas-Plano-Irving, TX. College Station-Bryan, TX. Longview, TX. Dallas-Plano-Irving, TX. Austin-Round Rock, TX. Dallas-Plano-Irving, TX. Brownsville-Harlingen, TX. Charlottesville, VA. Blacksburg-ChristiansburgRadford, VA. Virginia Beach-Norfolk-Newport News, VA. Harrisonburg, VA. Winchester, VA–WV. Seattle-Bellevue-Everett, WA. Olympia, WA. Longview, WA. Charleston, WV. Charleston, WV. Madison, WI. Fond du Lac, WI. Milwaukee-Waukesha-West Allis, WI. Milwaukee-Waukesha-West Allis, WI. As in the past, hospitals redesignated under section 1886(d)(8)(B) of the Act are also eligible to be reclassified to a different area by the MGCRB. Affected hospitals are permitted to compare the reclassified wage index for the labor market area in Table 4C in the Addendum to this proposed rule into which they have been reclassified by the MGCRB to the wage index for the area to which they are redesignated under section 1886(d)(8)(B) of the Act. Hospitals may withdraw from an MCGRB reclassification within 45 days of the publication of this proposed rule. 9. Reclassifications Under Section 1886(d)(8)(B) of the Act We have been asked whether Lugar hospitals and counties (discussed above in section III.H.8. of this preamble) are considered urban or rural for MGCRB reclassification purposes. As stated in the regulations at 42 CFR 412.64(b)(3), as well as in section 1886(d)(8)(C) of the Act, Lugar hospitals and counties are deemed to be located in an urban area. Therefore, because they are physically located in a rural area and are deemed urban, they receive the reclassified wage index (Table 4C in the Addendum to this proposed rule) for the urban area to PO 00000 Frm 00119 Fmt 4701 Sfmt 4702 24797 which they have been redesignated. Because Lugar hospitals are treated like reclassified hospitals, when they are seeking reclassification by the MCGRB, they are subject to the rural reclassification rules set forth at § 412.230. The procedural rules set forth at § 412.230 list the criteria which a hospital must meet in order to reclassify as a rural hospital. Lugar hospitals would be subject to the proximity criteria and payment thresholds that apply to rural hospitals. Specifically, the hospital would have to be no more than 35 miles from the area to which it seeks reclassification (§ 412.230(b)(1)); the hospital would have to show that its average hourly wage is at least 106 percent of the average hourly wage of all other hospitals in the area in which the hospital is located (§ 412.230(d)(1)(iii)(C)); and the hospital would have to demonstrate that its average hourly wage is equal to at least 82 percent of the average hourly wage of hospitals in the area to which it seeks redesignation (§ 412.230(d)(1)(iv)(C)). Hospitals not located in a Lugar county seeking reclassification to the urban area where the Lugar hospitals have been redesignated are not permitted to measure to the Lugar county to demonstrate proximity (no more than 15 miles for an urban hospital, and no more than 35 miles for a rural hospital or the closest urban or rural area for RRCs or SCHs) in order to be reclassified to such urban area. These hospitals must measure to the urban area exclusive of the Lugar County to meet the proximity or nearest urban or rural area requirement. 10. New England Deemed Counties Our regulations at 42 CFR 412.64(b)(1)(ii)(B) list New England counties that are deemed to be parts of urban areas under section 601(g) of the Social Security Amendments of 1983 (Pub. L. 98–21, 42 U.S.C. 1395ww(note)). These counties include Litchfield County, Connecticut; York County, Maine; Sagadahoc County, Maine; Merrimack County, New Hampshire; and Newport County, Rhode Island. OMB standards designate and define two categories of CBSAs: Metropolitan Statistical Areas (MSAs) and Micropolitan Statistical Areas (65 FR 82235). For our labor market area definitions, we treat micropolitan areas as rural. Of these five counties, three (York County, Sagadahoc County, and Newport County) are also included in metropolitan areas by OMB, whereas the remaining two, Litchfield County and Merrimack County, are located in micropolitan statistical areas and would E:\FEDREG\03MYP2.LOC 03MYP2 24798 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB be treated as rural under our labor market area definitions were they not deemed urban under § 412.64(b)(1)(ii)(B) of the regulations. Litchfield County and Merrimack County have been listed as being part of urban CBSA 25540 Hartford-West Hartford-East Hartford, CT, and urban CBSA 31700 Manchester-Nashua, NH, respectively. Even though hospitals located in Litchfield County and Merrimack County are in micropolitan statistical areas, they have been treated as urban for reclassification purposes. Under our regulations, we have deemed both of these two New England counties and the hospitals within them as urban. Because the counties themselves were deemed urban, the hospitals within them have also been treated as urban for reclassification purposes, even though Litchfield and Merrimack counties are in micropolitan statistical areas. However, upon further consideration of this issue, we believe the hospitals located within these New England counties should be treated the same as Lugar hospitals. That is, the area would be considered rural but the hospitals within them would be deemed to be urban. Therefore, we are proposing to change our policy and consider Litchfield County and Merrimack County as rural but would continue to consider the hospitals within them as being redesignated to urban CBSA 25540 Hartford-West Hartford-East Hartford, CT, and urban CBSA 31700 Manchester-Nashua, NH, respectively. Under our proposal, hospitals located in these counties—like the Lugar hospitals described in section III.I.8. of this preamble—must meet the rural requirements set forth at § 412.230 for individual reclassifications and § 412.232 for group reclassifications. We are proposing to revise § 412.64(b)(1)(ii)(B) accordingly. Hospitals not located inside one of these deemed New England counties are not permitted to measure to these counties to demonstrate close proximity in order to be reclassified to the CBSA(s) to which the hospitals in Litchfield and Merrimack counties are redesignated. We note that Tables 2, 3A, 3B, 4A, and 4B in the Addendum to this proposed rule do not reflect this proposed change; rather, they reflect the wage index based on the current policy. 11. Reclassifications Under Section 508 of Pub. L. 108–173 (If you choose to comment on issues in this section, please include the caption ‘‘508 Reclassifications’’ at the beginning of your comment.) Under section 508 of Pub. L. 108–173, a qualifying hospital could appeal the VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 wage index classification otherwise applicable to the hospital and apply for reclassification to another area of the State in which the hospital is located (or, at the discretion of the Secretary, to an area within a contiguous State). We implemented this process through notices published in the Federal Register on January 6, 2004 (69 FR 661), and February 13, 2004 (69 FR 7340). Such reclassifications were applicable to discharges occurring during the 3year period beginning April 1, 2004, and ending March 31, 2007. Section 106(a) of the MIEA–TRHCA (Pub. L. 109–432), extended any geographic reclassifications of hospitals that were made under section 508 and that would expire on March 31, 2007, by 6 months until September 30, 2007. On March 23, 2007, we published a notice in the Federal Register (72 FR 13799) that indicated how we are implementing section 106(a) of the MIEA–TRHCA through September 30, 2007. Because the section 508 provision will expire on September 30, 2007, and will not be applicable in FY 2008, in this proposed rule, we are not making any proposals related to the provision. 12. Other Issues We have been advised of a reclassification scenario of concern to a particular hospital. In this scenario, two hospitals were approved by the Medicare Geographic Classification Review Board (MGCRB) for a 3-year group reclassification. Prior to the second year of the 3-year reclassification, one of the hospitals reclassified individually to another area. Consistent with our policy, the second hospital retained its group geographic reclassification for the two remaining years (see 66 FR 39888, August 1, 2001). However, once the group reclassification expires, the second hospital does not qualify to reclassify individually to another area. We have been asked to consider potential regulatory options that would allow this hospital to either reclassify or receive a declining blend of its home area and reclassified wage index as a transition to its post-reclassified wage index. There are no options under our current regulations that would allow this hospital to reclassify individually or as a group. The hospital does not meet the well established wage data comparison criteria to reclassify as an individual hospital. In order for a group reclassification to be approved, all hospitals in the county must apply as a group. We have been informed that one hospital will not join the group reclassification because it qualifies individually to reclassify to a different PO 00000 Frm 00120 Fmt 4701 Sfmt 4702 area with a higher wage index than where the group applied. We considered whether to change our regulations for this type of situation. However, we decided not to propose a change to our regulations given the need to gather additional information and better understand the policy issues in such a case. In this regard, we would be interested in receiving comments on whether such a situation is consistent with the purpose of reclassification. In particular, we would like to receive comments on how a hospital that is applying to reclassify would demonstrate similarity to hospitals in the neighboring area when the hospital would qualify to be part of a group reclassification if all other hospitals in the county the hospital is located agreed to apply. In addition, we would be interested in comments on how we could make a determination that a hospitals own area wage index is inappropriate when the hospital does not meet the current criteria for reclassification on its own, but would meet the criteria for a group reclassification in the event all hospitals in the county in which the hospital is located would agree to submit a group application. Finally, given that reclassifications are in effect for three years, we request comments on whether or how we could address this situation while simultaneously maintaining the distinction between group and individual reclassifications— particularly the rule that all members of a group must apply for a group reclassification. For all the above reasons, we decided, as noted, not to propose changes to the regulations to address the situation brought to our attention. Rather, we think it is appropriate to gather additional information and seek comment on this or similar situations. If commenters wish to raise issues with the points described in this section or comment on other issues we did not consider in the questions raised above, we welcome such public comments. J. Proposed FY 2008 Wage Index Adjustment Based on Commuting Patterns of Hospital Employees (If you choose to comment on issues in this section, please include the caption ‘‘Out-Migration Adjustment’’ at the beginning of your comment.) In accordance with the broad discretion under section 1886(d)(13) of the Act, as added by section 505 of Pub. L. 108–173, beginning with FY 2005, we established a process to make adjustments to the hospital wage index based on commuting patterns of hospital employees. The process, E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules outlined in the FY 2005 IPPS final rule (69 FR 49061), provides for an increase in the wage index for hospitals located in certain counties that have a relatively high percentage of hospital employees who reside in the county but work in a different county (or counties) with a higher wage index. Such adjustments to the wage index are effective for 3 years, unless a hospital requests to waive the application of the adjustment. A county will not lose its status as a qualifying county due to wage index changes during the 3-year period, and counties will receive the same wage index increase for those 3 years. However, a county that qualifies in any given year may no longer qualify after the 3-year period, or it may qualify but receive a different adjustment to the wage index level. Hospitals that receive this adjustment to their wage index are not eligible for reclassification under section 1886(d)(8) or section 1886(d)(10) of the Act. Adjustments under this provision are not subject to the budget neutrality requirements under section 1886(d)(3)(E) of the Act. Hospitals located in counties that qualify for the wage index adjustment are to receive an increase in the wage index that is equal to the average of the differences between the wage indices of the labor market area(s) with higher wage indices and the wage index of the resident county, weighted by the overall percentage of hospital workers residing in the qualifying county who are employed in any labor market area with a higher wage index. To date, we have used pre-reclassified wage indices when determining the out-migration adjustment. In the FY 2005 IPPS final rule (69 FR 49061 through 49063), we stated that it was reasonable to interpret the term ‘‘wage index’’ in section 1886(d)(13)(D) of the Act to mean the pre-reclassified, pre-adjusted wage index. At the time, we stated that it was unclear whether to use the pre- or postreclassified wage index as the basis for comparison to determine the outmigration adjustment. We also cited complicating factors such as the use of blended wage indices as a result of the labor market area transition as another reason to base the out-migration adjustment on the pre-reclassified wage index. However, we indicated that we will continue to examine the possibility of employing post-reclassification wage indexes as we refine our policy for future adjustments. We have reconsidered our policy in this proposed rule and are proposing to calculate the out-migration adjustment using the post-reclassified wage index. First, the labor-market area transition has ended and the use of blended wage VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 indexes is no longer a complicating factor in determining whether to use pre- or post-reclassified wage indexes to determine the out-migration adjustment. Second, we are proposing to apply budget neutrality for application of the rural floor to area wage indices rather than to the standardized amount beginning in FY 2008. The budget neutrality adjustment for the rural floor is being applied to the postreclassification wage indices and is a component of the wage index that is being used to adjust for area differences in wages. Therefore, we believe the outmigration adjustment should be determined using post-reclassified wage index that reflects the budget neutrality adjustment for application of the rural floor. We are proposing to use the same formula described in the FY 2005 final rule (69 FR 49064), with the addition of now using the post-reclassified wage indices, to calculate the out-migration adjustment. This adjustment is calculated as follows: Step 1. Subtract the wage index for the qualifying county from the wage index of each of the higher wage area(s) to which hospital workers commute. Step 2. Divide the number of hospital employees residing in the qualifying county who are employed in such higher wage index area by the total number of hospital employees residing in the qualifying county who are employed in any higher wage index area. For each of the higher wage areas, multiply this result by the result obtaining in Step 1. Step 3. Sum the products resulting from Step 2 (if the qualifying county has workers commuting to more than one higher wage area). Step 4. Multiply the result from Step 3 by the percentage of hospital employees who are residing in the qualifying county and who are employed in any higher wage index area. These adjustments will be effective for each county for a period of 3 fiscal years. Hospitals that received the adjustment in FY 2007 will be eligible to retain that same adjustment for FY 2008. For hospitals in newly qualified counties, adjustments to the wage index are effective for 3 years, beginning with discharges occurring on or after October 1, 2007. Hospitals receiving the wage index adjustment under section 1886(d)(13)(F) of the Act are not eligible for reclassification under sections 1886(d)(8) or (d)(10) of the Act unless they waive the out-migration adjustment. Consistent with our FY 2005, 2006, and 2007 final rules, we are PO 00000 Frm 00121 Fmt 4701 Sfmt 4702 24799 proposing that hospitals redesignated under section 1886(d)(8) of the Act or reclassified under section 1886(d)(10) of the Act will be deemed to have chosen to retain their redesignation or reclassification. Section 1886(d)(10) hospitals that wish to receive the outmigration adjustment, rather than their reclassification, should follow the termination/withdrawal procedures specified in 42 CFR 412.273 and section III.I.3. of the preamble of this proposed rule. Otherwise, they will be deemed to have waived the out-migration adjustment. Hospitals redesignated under section 1886(d)(8) of the Act will be deemed to have waived the outmigration adjustment, unless they explicitly notify CMS that they elect to receive the out-migration adjustment instead within 45 days from the publication of this proposed rule. These notifications should be sent to the following address: Centers for Medicare and Medicaid Services, Center for Medicare Management, Attention: Wage Index Adjustment Waivers, Division of Acute Care, Room C4–08–06, 7500 Security Boulevard, Baltimore, MD 21244–1850. Table 4J in the Addendum to this proposed rule lists the proposed outmigration wage index adjustments for FY 2008. Hospitals that are not otherwise reclassified or redesignated under section 1886(d)(8) or section 1886(d)(10) of the Act will automatically receive the listed adjustment. In accordance with the procedures discussed above, redesignated/reclassified hospitals will be deemed to have waived the outmigration adjustment unless CMS is otherwise notified. Hospitals that are eligible to receive the out-migration wage index adjustment and that withdraw their application for reclassification automatically receive the wage index adjustment listed in Table 4J in the Addendum to this proposed rule. Hospitals should carefully review the wage index adjustment that they would receive under this provision (as listed in Table 4J) and the area wage index value as listed in Table 4A (both included in the Addendum to this proposed rule) in comparison to the wage index value that they would receive under the MGCRB reclassification (Table 4C in the Addendum to this proposed rule). K. Process for Requests for Wage Index Data Corrections (If you choose to comment on issues in this section, please include the caption ‘‘Wage Index Data Corrections’’ at the beginning of your comment.) E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24800 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules The preliminary Worksheet S–3 wage data and occupational mix survey data files (1st and 2nd quarter 2006) for the FY 2008 wage index were made available on October 6, 2006, through the Internet on the CMS Web site at: https://cms.hhs.gov/AcuteInpatientPPS/. In a memorandum dated October 6, 2006, we instructed all fiscal intermediaries to inform the IPPS hospitals they service of the availability of the wage index data files and the process and timeframe for requesting revisions (including the specific deadlines listed below). We also instructed the fiscal intermediaries to advise hospitals that these data are also made available directly through their representative hospital organizations. If a hospital wished to request a change to its data as shown in the October 6, 2006 wage and occupational mix data files, the hospital was to submit corrections along with complete, detailed supporting documentation to its fiscal intermediary by December 4, 2006. Hospitals were notified of this deadline and of all other possible deadlines and requirements, including the requirement to review and verify their data as posted on the preliminary wage index data file on the Internet, through the October 6, 2006 memorandum referenced above. In the October 6, 2006 memorandum, we also specified that a hospital could request revisions to 1st and/or 2nd quarter occupational mix survey data if they missed the previous deadlines (June 1, 2006, for the 1st quarter data collection and August 31, 2006, for the 2nd quarter collection) for submitting occupational mix survey data to their fiscal intermediaries. A hospital requesting revisions to its 1st and/or 2nd quarter occupational mix survey data was to copy its record(s) from the CY 2006 occupational mix preliminary files posted to our website in October, highlight the revised cells on its spreadsheet, and submit its spreadsheet(s) and complete documentation to its fiscal intermediary no later than December 4, 2006. The fiscal intermediaries (or, if applicable, the MAC) notified the hospitals by mid-February 2007 of any changes to the wage index data as a result of the desk reviews and the resolution of the hospitals’ earlyDecember revision requests. The fiscal intermediaries or MAC also submitted the revised data to CMS by midFebruary 2007. CMS published the proposed wage index public use files that included hospitals’ revised wage data on February 23, 2007. In a memorandum also dated February 23, 2007, we instructed fiscal VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 intermediaries and the MAC to notify all hospitals regarding the availability of the proposed wage index public use files and the criteria and process for requesting corrections and revisions to the wage index data. Hospitals had until March 12, 2007 to submit requests to the fiscal intermediaries or the MAC for reconsideration of adjustments made by the fiscal intermediaries or the MAC as a result of the desk review, and to correct errors due to CMS’s or the fiscal intermediary’s (or, if applicable, the MAC’s) mishandling of the wage index data. Hospitals were also required to submit sufficient documentation to support their requests. After reviewing requested changes submitted by hospitals, fiscal intermediaries or the MAC are to transmit any additional revisions resulting from the hospitals’ reconsideration requests by April 13, 2007. The deadline for a hospital to request CMS intervention in cases where the hospital disagreed with the fiscal intermediary’s (or, if applicable, the MAC’s) policy interpretations is April 20, 2007. Hospitals should also examine Table 2 in the Addendum to this proposed rule. Table 2 of this proposed rule contained each hospital’s adjusted average hourly wage used to construct the wage index values for the past 3 years, including the FY 2004 data used to construct the proposed FY 2008 wage index. We note that the hospital average hourly wages shown in Table 2 only reflect changes made to a hospital’s data and transmitted to CMS by February 21, 2007. We will release the final wage index data public use files in early May 2007 on the Internet at http:/ www.cms.hhs.gov/AcuteInpatientPPS/. The May 2007 public use files will be made available solely for the limited purpose of identifying any potential errors made by CMS or the fiscal intermediary or MAC in the entry of the final wage index data that result from the correction process described above (revisions submitted to CMS by the fiscal intermediaries or the MAC by April 13, 2007). If, after reviewing the May 2007 final files, a hospital believes that its wage or occupational mix data are incorrect due to a fiscal intermediary or MAC or CMS error in the entry or tabulation of the final data, the hospital should send a letter to both its fiscal intermediary or MAC and CMS that outlines why the hospital believes an error exists and to provide all supporting information, including relevant dates (for example, when it first became aware of the error). CMS and the fiscal intermediaries (or, if applicable, PO 00000 Frm 00122 Fmt 4701 Sfmt 4702 the MAC) must receive these requests no later than June 08, 2007. Requests mailed to CMS should be sent to: Centers for Medicare & Medicaid Services, Center for Medicare Management, Attention: Wage Index Team, Division of Acute Care, C4–08– 06, 7500 Security Boulevard, Baltimore, MD 21244–1850. Each request also must be sent to the fiscal intermediary or the MAC. The fiscal intermediary or the MAC will review requests upon receipt and contact CMS immediately to discuss its findings. At this point in the process, that is, after the release of the May 2007 wage index data files, changes to the wage and occupational mix data will only made in those very limited situations involving an error by the fiscal intermediary or the MAC or CMS that the hospital could not have known about before its review of the final wage index data files. Specifically, neither the fiscal intermediary or the MAC nor CMS will approve the following types of requests: <bullet≤ Requests for wage index data corrections that were submitted too late to be included in the data transmitted to CMS by fiscal intermediaries or the MAC on or before April 13, 2007. <bullet≤ Requests for correction of errors that were not, but could have been, identified during the hospital’s review of the February 23, 2007 wage index public use files. <bullet≤ Requests to revisit factual determinations or policy interpretations made by the fiscal intermediary or the MAC or CMS during the wage index data correction process. Verified corrections to the wage index data received timely by CMS and the fiscal intermediaries or the MAC (that is, by June 08, 2007) will be incorporated into the final wage index to be published by August 1, 2007, to be effective October 1, 2007. We created the processes described above to resolve all substantive wage index data correction disputes before we finalize the wage and occupational mix data for the FY 2008 payment rates. Accordingly, hospitals that do not meet the procedural deadlines set forth above will not be afforded a later opportunity to submit wage index data corrections or to dispute the fiscal intermediary’s (or, if applicable the MAC’s) decision with respect to requested changes. Specifically, our policy is that hospitals that do not meet the procedural deadlines set forth above will not be permitted to challenge later, before the Provider Reimbursement Review Board, the failure of CMS to make a requested data revision. (See W.A. Foote Memorial E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules Hospital v. Shalala, No. 99–CV–75202– DT (E.D. Mich. 2001) and Palisades General Hospital v. Thompson, No. 99– 1230 (D.D.C. 2003.) We refer the reader also to the FY 2000 final rule (64 FR 41513) for a discussion of the parameters for appealing to the PRRB for wage index data corrections. Again, we believe the wage index data correction process described above provides hospitals with sufficient opportunity to bring errors in their wage and occupational mix data to the fiscal intermediary’s (or, if applicable, the MAC’s) attention. Moreover, because hospitals will have access to the final wage index data by early May 2007, they have the opportunity to detect any data entry or tabulation errors made by the fiscal intermediary or the MAC or CMS before the development and publication of the final FY 2008 wage index by August 1, 2007, and the implementation of the FY 2008 wage index on October 1, 2007. If hospitals avail themselves of the opportunities afforded to provide and make corrections to the wage and occupational mix data, the wage index implemented on October 1 should be accurate. Nevertheless, in the event that errors are identified by hospitals and brought to our attention after June 08, 2007, we retain the right to make midyear changes to the wage index under very limited circumstances. Specifically, in accordance with § 412.64(k)(1) of our existing regulations, we make midyear corrections to the wage index for an area only if a hospital can show that: (1) The fiscal intermediary or the MAC or CMS made an error in tabulating its data; and (2) the requesting hospital could not have known about the error or did not have an opportunity to correct the error, before the beginning of the fiscal year. For purposes of this provision, ‘‘before the beginning of the fiscal year’’ means by the June deadline for making corrections to the wage data for the following fiscal year’s wage index. This provision is not available to a hospital seeking to revise another hospital’s data that may be affecting the requesting hospital’s wage index for the labor market area. As indicated earlier, since CMS makes the wage index data available to hospitals on the CMS Web site prior to publishing both the proposed and final IPPS rules, and the fiscal intermediaries or the MAC notify hospitals directly of any wage index data changes after completing their desk reviews, we do not expect that midyear corrections will be necessary. However, under our current policy, if the correction of a data error changes the wage index value for an area, the VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 revised wage index value will be effective prospectively from the date the correction is made. In the FY 2006 IPPS final rule (70 FR 47385), we revised § 412.64(k)(2) to specify that, effective on October 1, 2005, that is beginning with the FY 2006 wage index, a change to the wage index can be made retroactive to the beginning of the Federal fiscal year only when: (1) the fiscal intermediary (or, if applicable, the MAC) or CMS made an error in tabulating data used for the wage index calculation; (2) the hospital knew about the error and requested that the fiscal intermediary (or if applicable the MAC) and CMS correct the error using the established process and within the established schedule for requesting corrections to the wage index data, before the beginning of the fiscal year for the applicable IPPS update (that is, by the June 08, 2007 deadline for the FY 2008 wage index); and (3) CMS agreed that the fiscal intermediary (or if applicable, the MAC) or CMS made an error in tabulating the hospital’s wage index data and the wage index should be corrected. In those circumstances where a hospital requests a correction to its wage index data before CMS calculates the final wage index (that is, by the June deadline), and CMS acknowledges that the error in the hospital’s wage index data was caused by CMS’s or the fiscal intermediary’s (or, if applicable, the MAC’s) mishandling of the data, we believe that the hospital should not be penalized by our delay in publishing or implementing the correction. As with our current policy, we indicated that the provision is not be available to a hospital seeking to revise another hospital’s data. In addition, the provision cannot be used to correct prior years’ wage index data; it can only be used for the current Federal fiscal year. In other situations where our policies would allow midyear corrections, we continue to believe that it is appropriate to make prospectiveonly corrections to the wage index. We note that, as with prospective changes to the wage index, the final retroactive correction will be made irrespective of whether the change increases or decreases a hospital’s payment rate. In addition, we note that the policy of retroactive adjustment will still apply in those instances where a judicial decision reverses a CMS denial of a hospital’s wage index data revision request. L. Labor-Related Share for the Proposed Wage Index for FY 2008 (If you choose to comment on issues in this section, please include the PO 00000 Frm 00123 Fmt 4701 Sfmt 4702 24801 caption ‘‘Labor-Related Share’’ at the beginning of your comment.) Section 1886(d)(3)(E) of the Act directs the Secretary to adjust the proportion of the national prospective payment system base payment rates that are attributable to wages and wagerelated costs by a factor that reflects the relative differences in labor costs among geographic areas. It also directs the Secretary to estimate from time to time the proportion of hospital costs that are labor-related: ‘‘The Secretary shall adjust the proportion (as estimated by the Secretary from time to time) of hospitals’ costs which are attributable to wages and wage-related costs of the DRG prospective payment rates* * *’’ We refer to the portion of hospital costs attributable to wages and wage-related costs as the labor-related share. The labor-related share of the prospective payment rate is adjusted by an index of relative labor costs, which is referred to as the wage index. Section 403 of Pub. L. 108–173 amended section 1886(d)(3)(E) of the Act to provide that the Secretary must employ 62 percent as the labor-related share unless this ‘‘would result in lower payments to a hospital than would otherwise be made.’’ However, this provision of Pub. L. 108–173 did not change the legal requirement that the Secretary estimate ‘‘from time to time’’ the proportion of hospitals’ costs that are ‘‘attributable to wages and wagerelated costs.’’ We believe that this reflected Congressional intent that hospitals receive payment based on either a 62-percent labor-related share, or the labor-related share estimated from time to time by the Secretary, depending on which labor-related share resulted in a higher payment. We have continued our research into the assumptions employed in calculating the labor-related share. Our research involves analyzing the compensation share separately for urban and rural hospitals, using regression analysis to determine the proportion of costs influenced by the area wage index, and exploring alternative methodologies to determine whether all or only a portion of professional fees and nonlabor intensive services should be considered labor-related. In the FY 2006 IPPS final rule (70 FR 47392), we presented our analysis and conclusions regarding the frequency and methodology for updating the laborrelated share for FY 2006. We also recalculated a labor-related share of 69.731 percent, using the FY 2002-based PPS market basket for discharges occurring on or after October 1, 2005. In addition, we implemented this revised and rebased labor-related share in a E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24802 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules budget neutral manner, but consistent with section 1886(d)(3)(E) of the Act, we did not take into account the additional payments that would be made as a result of hospitals with a wage index less than or equal to 1.0 being paid using a labor-related share lower than the labor-related share of hospitals with a wage index greater than 1.0. The labor-related share is used to determine the proportion of the national PPS base payment rate to which the area wage index is applied. In this proposed rule, we are not proposing to make any changes to the national average proportion of operating costs that are attributable to wages and salaries, fringe benefits, professional fees, contract labor, and labor intensive services. Therefore, we are proposing to continue to use a labor-related share of 69.731 percent for discharges occurring on or after October 1, 2007. Tables 1A and 1B will reflect this proposed labor-related share. We note that section 403 of Pub. L. 108–173 amended sections 1886(d)(3)(E) and 1886(d)(9)(C)(iv) of the Act to provide that the Secretary must employ 62 percent as the laborrelated share unless this employment ‘‘would result in lower payments to a hospital than would otherwise be made.’’ We also are proposing to continue to use a labor-related share for the Puerto Rico-specific standardized amounts of 58.7 percent for discharges occurring on or after October 1, 2007. Consistent with our methodology for determining the national labor-related share, we added the Puerto Rico-specific relative weights for wages and salaries, fringe benefits, contract labor, nonmedical professional fees, and other labor-intensive services to determine the labor-related share. Puerto Rico hospitals are paid based on 75 percent of the national standardized amounts and 25 percent of the Puerto Rico-specific standardized amounts. For Puerto Rico hospitals, the national labor-related share will always be 62 percent because the wage index for all Puerto Rico hospitals is less than 1.0. A Puerto Rico-specific wage index is applied to the Puerto Rico-specific portion of payments to the hospitals. The labor-related share of a hospital’s Puerto Rico-specific rate will be either 62 percent or the Puerto Rico-specific labor-related share depending on which results in higher payments to the hospital. If the hospital has a Puerto Rico-specific wage index of greater than 1.0, we will set the hospital’s rates using a labor-related share of 62 percent for the 25 percent portion of the hospital’s payment determined by the Puerto Rico standardized amounts because this amount will result in higher payments. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Conversely, a hospital with a Puerto Rico-specific wage index of less than 1.0 will be paid using the Puerto Ricospecific labor-related share of 58.7 percent of the Puerto Rico-specific rates because the lower labor-related share will result in higher payments. The Puerto Rico labor-related share of 58.7 percent for FY 2007 is reflected in the Table 1C of the Addendum to this proposed rule. M. Wage Index Study Required Under Pub. L. 109–432 Section 106(b)(1) of the MIEA– TRHCA (Pub. L. 109–432) requires MedPAC to submit to Congress, not later than June 30, 2007, a report on the Medicare wage index classification system applied under the Medicare Prospective Payment System. Section 106(b) of MIEA–TRHCA requires the report to include any alternatives that MedPAC recommends to the method to compute the wage index under section 1886(d)(3)(E) of the Act. In addition, section 106(b)(2) of Pub. L. 109–432 instructs the Secretary of Health and Human Services, taking into account MedPAC’s recommendations on the Medicare wage index classification system, to include in the FY 2009 IPPS proposed rule one or more proposals to revise the wage index adjustment applied under section 1886(d)(3)(E) of the Act for purposes of the IPPS. The proposal (or proposals) must consider each of the following: <bullet≤ Problems associated with the definition of labor markets for the wage index adjustment; <bullet≤ The modification or elimination of geographic reclassifications and other adjustments; <bullet≤ The use of Bureau of Labor of Statistics data or other data or methodologies to calculate relative wages for each geographic area; <bullet≤ Minimizing variations in wage index adjustments between and within MSAs and statewide rural areas; <bullet≤ The feasibility of applying all components of CMS’ proposal to other settings; <bullet≤ Methods to minimize the volatility of wage index adjustments while maintaining the principle of budget neutrality; <bullet≤ The effect that the implementation of the proposal would have on health care providers on each region of the country; <bullet≤ Methods for implementing the proposal(s) including methods to phase in such implementations; and <bullet≤ Issues relating to occupational mix such as staffing practices and any evidence on quality of care and patient safety including any PO 00000 Frm 00124 Fmt 4701 Sfmt 4702 recommendation for alternative calculations to the occupational mix. We look forward to reviewing the MedPAC report on the wage index later this year. As required by the law, we will consider MedPAC’s recommendations and each of the factors specified above in making a proposal (or proposals) in the FY 2009 IPPS proposed rule. N. Proxy for the Hospital Market Basket (If you choose to comment on issues in this section, please include the caption ‘‘Hospital Market Basket’’ at the beginning of your comment.) In the FY 2006 IPPS final rule (70 FR 47387), we changed the base year cost structure for the IPPS hospital index for the hospital market basket for operating costs from FY 1997 to FY 2002. As discussed in that final rule, the IPPS hospital index primarily uses the BLS data as price proxies, which are grouped in one of the three BLS categories. The categories are Producer Price Indexes (PPIs), Consumer Price Indexes (CPIs), and Employment Cost Indexes (ECIs), discussed in detail in the FY 2006 IPPS final rule (70 FR 47388 through 47391). We evaluate the price proxies using the criteria of reliability, timeliness, availability, and relevance. The PPIs, CPIs, and ECIs selected by us and used for this proposed rule meet these criteria as described in the FY 2006 IPPS final rule. We believe they continue to be the best measures of price changes for the cost categories. Beginning April 2006 with the publication of March 2006 data, the BLS’ ECI began using a different classification system, the North American Industrial Classification System (NAICS), instead of the Standard Industrial Codes (SIC), which no longer exists. We have consistently used the ECI as the data source for our wages and salaries and other price proxies in the IPPS market basket and are not making any changes to the usage at this time. Thus, we propose to use the BLS– NAICS-based ECIs as price proxies in the market basket. IV. Other Decisions and Proposed Changes to the IPPS for Operating Costs and GME Costs A. Reporting of Hospital Quality Data for Annual Hospital Payment Update (§ 412.64(d)(2)) (If you choose to comment on issues in this section, please include the caption ‘‘Hospital Quality Data’’ at the beginning of your comment.) 1. Background Section 5001(a) of the Deficit Reduction Act of 2005, Pub. L. 109–171 E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules (DRA), set out new requirements for the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program. We established the RHQDAPU program in order to implement section 501(b) of Pub. L. 108–173. It builds on our ongoing voluntary Hospital Quality Initiative which is intended to empower consumers with quality of care information to make more informed decisions about their health care while also encouraging hospitals and clinicians to improve their quality of care. Section 5001(a) of the DRA revised the mechanism used to update the standardized amount for payment for hospital inpatient operating costs. Specifically, sections 1886(b)(3)(B)(viii)(I) and (II) of the Act provide that the payment update for FY 2007 and each subsequent fiscal year will be reduced by 2.0 percentage points for any ‘‘subsection (d) hospital’’ (that is, a hospital paid under the IPPS) that does not submit certain quality data in a form and manner, and at a time, specified by the Secretary. Sections 1886(b)(3)(B)(viii)(III) and (IV) of the Act required that we expand the ‘‘starter set’’ of 10 quality measures established by the Secretary as of November 1, 2003, provided certain requirements were met. In expanding this set of measures, section 1886(b)(3)(B)(viii)(IV) of the Act provides that we must begin to adopt the baseline set of performance measures as set forth in a 2005 report issued by the Institute of Medicine (IOM) of the National Academy of Sciences under section 238(b) of the MMA,17 effective for payments beginning with FY 2007. The IOM measures include: Hospital Quality Alliance (HQA) quality measures (the HQA is a public-private collaboration to improve the quality of care provided by the nation’s hospitals by measuring and publicly reporting on that care), the HCAHPS patient perspective survey, and three structural measures. The structural measures are: (1) Implementation of computerized provider order entry for prescriptions, (2) staffing of intensive care units with intensivists, and (3) evidence-based hospital referrals. These structural measures constitute the Leapfrog Group’s original ‘‘three leaps,’’ and are part of the National Quality Forum’s 30 Safe Practices for Better Healthcare. Sections 1886(b)(3)(B)(viii)(V) and (VI) of the Act require that, effective for payments beginning with FY 2008, we 17 Institute of Medicine, ‘‘Performance Measurement: Accelerating Improvement,’’ December 1, 2005, available at https://www.iom.edu/ CMS/3809/ 19805/31310.aspx. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 add other quality measures that reflect consensus among affected parties, and provide the Secretary with the discretion to replace any quality measures or indicators in appropriate cases, such as where all hospitals are effectively in compliance with a measure, or the measures or indicators have been subsequently shown to not represent the best clinical practice. Thus, the Secretary has broad discretion to replace measures on the basis that they are not appropriate. Section 1886(b)(3)(B)(viii)(VII) of the Act requires that we establish procedures for making quality data available to the public after ensuring that a hospital has the opportunity to review, in advance, its data that are to be made public. In addition, this section requires that we report quality measures of process, structure, outcome, patients’ perspective on care, efficiency, and costs of care that relate to services furnished in inpatient settings on the CMS Web site. Section 1886(b)(3)(B)(viii)(I) of the Act also provides that any reduction in a hospital’s payment update will apply only with respect to the fiscal year involved, and will not be taken into account for computing the applicable percentage increase for a subsequent fiscal year. The starter set of 10 quality measures we established as of November 1, 2003 are as follows: Heart Attack (Acute Myocardial Infarction or AMI) <bullet≤ Was aspirin given to the patient upon arrival to the hospital? <bullet≤ Was aspirin prescribed when the patient was discharged? <bullet≤ Was a beta-blocker given to the patient upon arrival to the hospital? <bullet≤ Was a beta-blocker prescribed when the patient was discharged? <bullet≤ Was an ACE inhibitor given for the patient with heart failure? Heart Failure (HF) <bullet≤ Did the patient get an assessment of his or her heart function? <bullet≤ Was an ACE inhibitor given to the patient? Pneumonia (PNE) <bullet≤ Was an antibiotic given to the patient in a timely way? <bullet≤ Had the patient received a pneumococcal vaccination? <bullet≤ Was the patient’s oxygen level assessed? We adopted these measures after the Secretary of HHS joined in a partnership with several collaborators intended to promote hospital quality improvement and public reporting of hospital quality information. These collaborators included the American Hospital Association, the Federation of American Hospitals, the Association of American PO 00000 Frm 00125 Fmt 4701 Sfmt 4702 24803 Medical Colleges, the Joint Commission on Accreditation of Healthcare Organizations (the Joint Commission), the National Quality Forum (NQF), the American Medical Association, the Consumer-Purchaser Disclosure Project, the AARP, the American Federation of Labor-Congress of Industrial Organizations, the Agency for Healthcare Research and Quality (AHRQ), as well as CMS and others. This collaboration, originally known as the National Voluntary Hospital Reporting Initiative, is now known as the HQA. This starter set of 10 quality measures was endorsed by the NQF. NQF is a voluntary consensus standard-setting organization established to standardize health care quality measurement and reporting through its consensus development process. In addition, this starter set is a subset of measures currently collected for The Joint Commission as part of its certification program. We chose these 10 quality measures in order to collect data that will: (1) Provide useful and valid information about hospital quality to the public; (2) provide hospitals with a sense of predictability about public reporting expectations; (3) begin to standardize data and data collection mechanisms; and (4) foster hospital quality improvement. Hospitals submit quality data through the QualityNet Exchange secure Web site (https://www.qnetexchange.org). We believe that this Web site meets or exceeds all current Health Insurance Portability and Accountability Act requirements for security of personal health information. Data from this initiative are used to populate the Hospital Compare Web site, https:// www.hospitalcompare.hhs.gov. This Web site assists beneficiaries and the general public by providing information on hospital quality of care for consumers who need to select a hospital. It further serves to encourage consumers to work with their doctors and hospitals to discuss the quality of care they provide to patients, thereby providing an additional incentive to improve their quality of that care. In the FY 2007 IPPS final rule (71 FR 48137), we amended our regulations at § 412.64(d)(2) to reflect the 2.0 percentage point reduction in the payment update for FY 2007 and subsequent fiscal years for hospitals that do not comply with requirements for reporting quality data as provided for under section 5001(a) of the DRA. We also added 11 additional quality E:\FEDREG\03MYP2.LOC 03MYP2 24804 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules measures to the 10 measure starter set to establish an expanded set of 21 quality measures (71 FR 48029 through 48037). These 21 measures are as follows: Topic Quality measure Heart Attack (Acute Myocardial Infarction) .............................................. <bullet≤ Aspirin at arrival.* <bullet≤ Aspirin prescribed at discharge.* <bullet≤ ACE inhibitor (ACE–I) or Angiotensin Receptor Blocker (ARBs) for left ventricular systolic dysfunction.* <bullet≤ Beta blocker at arrival.* <bullet≤ Beta blocker prescribed at discharge.* <bullet≤ Thrombolytic agent received within 30 minutes of hospital arrival. <bullet≤ Percutaneous Coronary Intervention (PCI) received within 120 minutes of hospital arrival. <bullet≤ Adult smoking cessation advice/counseling. <bullet≤ Left ventricular function assessment.* <bullet≤ ACE inhibitor (ACE–I) or Angiotensin Receptor Blocker (ARBs) for left ventricular systolic dysfunction.* <bullet≤ Discharge instructions. <bullet≤ Adult smoking cessation advice/counseling. <bullet≤ Initial antibiotic received within 4 hours of hospital arrival.* <bullet≤ Oxygenation assessment.* <bullet≤ Pneumococcal vaccination status.* <bullet≤ Blood culture performed before first antibiotic received in hospital. <bullet≤ Adult smoking cessation advice/counseling. <bullet≤ Appropriate initial antibiotic selection. <bullet≤ Influenza vaccination status. <bullet≤ Prophylactic antibiotic received within 1 hour prior to surgical incision. <bullet≤ Prophylactic antibiotics discontinued within 24 hours after surgery end time. Heart Failure (HF) .................................................................................... Pneumonia (PNE) ..................................................................................... Surgical Care Improvement Project (SCIP)—named SIP for discharges prior to July 2006 (3Q06). *Measure included in 10 measure starter set. In addition, in the FY 2007 IPPS final rule (71 FR 48031 through 48044), we set out RHQDAPU program procedures for data submission, program withdrawal, data validation, attestation, public display of hospitals’ quality data, and reconsiderations. In response to public comments, we required that reporting of the expanded quality measures begin with discharges occurring on or after the third calendar quarter of 2006 (July through September discharges). We also responded to public comments regarding whether we should establish more structured reconsideration procedures for FY 2008 and what such procedures might include. Under section 1886(b)(3)(B)(viii)(V) of the Act, for payments beginning with FY 2008, we are required to add other measures that reflect consensus among affected parties, and, to the extent feasible and practicable, we must include measures set forth by one or more national consensus building entities. 2. FY 2008 Quality Measures Commenters on the FY 2007 IPPS proposed rule requested that we notify the public as far in advance as possible of any proposed expansions of the measurement set and program procedures in order to encourage broad collaboration and to give hospitals time to prepare for any anticipated change. Taking these concerns into account, in the CY 2007 OPPS final rule (71 FR 68201), we adopted additional quality measures for the FY 2008 update. The six additional measures we adopted are as follows: <bullet≤ HCAHPS survey <bullet≤ SCIP Quality Measures —SCIP–VTE 1: Venous thromboembolism (VTE) prophylaxis ordered for surgery patient —SCIP–VTE 2: VTE prophylaxis within 24 hours pre/post surgery —SCIP Infection 2: Prophylactic antibiotic selection for surgical patients <bullet≤ Mortality (Medicare Patients) —Acute Myocardial Infarction 30-day mortality Medicare patients —Heart Failure 30-day mortality Medicare patients For the FY 2008 payment determination, hospitals are required to report the following 27 measures: Quality measure Heart Attack (Acute Myocardial Infarction) .............................................. mmaher on DSK3CLS3C1PROD with $$_JOB Topic <bullet≤ Aspirin at arrival.* <bullet≤ Aspirin prescribed at discharge.* <bullet≤ ACE inhibitor (ACE–I) or Angiotensin Receptor Blocker (ARBs) for left ventricular systolic dysfunction.* <bullet≤ Beta blocker at arrival.* <bullet≤ Beta blocker prescribed at discharge.* <bullet≤ Thrombolytic agent received within 30 minutes of hospital arrival.** <bullet≤ Percutaneous Coronary Intervention (PCI) received within 120 minutes of hospital arrival.** <bullet≤ Adult smoking cessation advice/counseling.** <bullet≤ Left ventricular function assessment.* <bullet≤ ACE inhibitor (ACE–I) or Angiotensin Receptor Blocker (ARBs) for left ventricular systolic dysfunction.* Heart Failure (HF) .................................................................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00126 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules Topic 24805 Quality measure Pneumonia (PNE) ..................................................................................... Surgical Care Improvement Project (SCIP)—named SIP for discharges prior to July 2006 (3Q06). Mortality Measures (Medicare patients) ................................................... Patients’ Experience of Care .................................................................... <bullet≤ Discharge instructions.** <bullet≤ Adult smoking cessation advice/counseling.** <bullet≤ Initial antibiotic received within 4 hours of hospital arrival.* <bullet≤ Oxygenation assessment.* <bullet≤ Pneumococcal vaccination status.* <bullet≤ Blood culture performed before first antibiotic received in hospital.** <bullet≤ Adult smoking cessation advice/counseling.** <bullet≤ Appropriate initial antibiotic selection.** <bullet≤ Influenza vaccination status.** <bullet≤ Prophylactic antibiotic received within 1 hour prior to surgical incision.** <bullet≤ Prophylactic antibiotics discontinued within 24 hours after surgery end time.** <bullet≤ SCIP–VTE 1: Venous thromboembolism (VTE) prophylaxis ordered for surgery patients.*** <bullet≤ SCIP–VTE 2: VTE prophylaxis within 24 hours pre/post surgery.*** <bullet≤ SCIP Infection 2: Prophylactic antibiotic selection for surgical patients.*** <bullet≤ Acute Myocardial Infarction 30-day mortality Medicare patients.*** <bullet≤ Heart Failure 30-day mortality Medicare patients.*** <bullet≤ HCAHPS patient survey.*** *Measure included in 10 measure starter set. **Measure included in 21 measure expanded set. *** Measure added in CY 2007 OPPS final rule. We did not adopt any other new RHQDAPU measures for FY 2008. 3. New Quality Measures and Program Requirements for FY 2009 and Subsequent Years mmaher on DSK3CLS3C1PROD with $$_JOB a. Proposed New Quality Measures for FY 2009 and Subsequent Years We are proposing to add 1 outcome measure and 4 process measures to the existing 27 measure set to establish a new set of 32 quality measures to be used for the FY 2009 annual payment determination. We plan to adopt these measures a year in advance in order to provide additional time for hospitals to prepare for changes related to the RHQDAPU program. We are proposing to add the following quality measures for the FY 2009 RHQDAPU program. <bullet≤ Pneumonia 30-day Mortality (Medicare patients) <bullet≤ SCIP Infection 4: Cardiac Surgery Patients with Controlled 6AM Postoperative Serum Glucose <bullet≤ SCIP Infection 6: Surgery Patients with Appropriate Hair Removal <bullet≤ SCIP Infection 7: Colorectal Patients with Immediate Postoperative Normothermia <bullet≤ SCIP Cardiovascular 2: Surgery Patients on a Beta-Blocker Prior to Arrival Who Received a Beta-Blocker During the Perioperative Period The above measures reflect our continuing commitment to quality improvement in both clinical care and VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 patient safety. These additional measures also demonstrate our commitment to include in the RHQDAPU program only those quality measures that reflect consensus among the affected parties and that have been reviewed by a consensus building process. The proposed measures have been put forth by the HQA for inclusion in its public reporting set, contingent on endorsement by the NQF. (In the case of SCIP Infection 7, the HQA recently withdrew its previous support unless the measure receives NQF endorsement.) We anticipate that the NQF will endorse these measures prior to the publication of the FY 2008 IPPS final rule. Any measure that has not been endorsed by that time will not be finalized in that rule. CMS requests public comment on these five measures, as well as whether to add other measures to the RHQDAPU program measure set for FY 2009 and subsequent years. CMS may, based on comments received, include one or more of the measures discussed below in the RHQDAPU program measure set for FY 2009 payments. We will finalize the FY 2009 RHQDAPU measure set in the FY 2008 IPPS final rule. The following table contains a list of 18 measures and 8 measure sets from which additional quality measures could be selected for inclusion in the RHQDAPU program. It includes measures and measure sets that PO 00000 Frm 00127 Fmt 4701 Sfmt 4702 highlight CMS’ interest in improving patient safety and outcomes of care, with a particular focus on the quality of surgical care and patient outcomes. In order to engender a broad review of potential performance measures, the list includes measures that have not yet been considered for approval by the HQA or endorsement by the NQF consensus review process for public reporting. It also includes measures developed by organizations other than CMS as well as measures that are to be derived from administrative data (such as claims) that may need to be modified for specific use by the Medicare program if implemented under the RHQDAPU program. We hope to receive comment from a broad set of stakeholders on the measures and measure sets that are listed, as well as any critical gaps or ‘‘missing’’ measures or measure sets. We specifically requests input concerning the following: <bullet≤ Which of the measures or measure sets should be included in the FY 2009 RHQDAPU program or in subsequent years? <bullet≤ What challenges for data collection and reporting are posed by the identified measures and measure sets? What improvements could be made to data collection or reporting that might offset or otherwise address those challenges? E:\FEDREG\03MYP2.LOC 03MYP2 24806 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules POSSIBLE MEASURES AND MEASURE SETS FOR THE RHQDAPU PROGRAM FOR FY 2009 AND SUBSEQUENT YEARS Measure Clinical condition Intensive Care Unit (ICU) Critical Care Measures 1 ....... 2 ....... Stress Ulcer Disease Prophylaxis ..................................................................................................................... Urinary Catheter-Associated Urinary Tract Infection For Intensive Care Unit (ICU) Patients .......................... ICU/critical care. ICU/critical care. Readmission Measures 3 4 5 6 ....... ....... ....... ....... Readmission Readmission Readmission Readmission Heart Failure (HF) Within 30 Days Rate—Medicare Only (CMS Methodology) ......................... (same hospital) Acute Myocardial Infarction (AMI) Within 30 Days Rate ................................... (same hospital) PNE Within 30 Days Rate ................................................................................. Within 30 Days Of Surgery—Medicare Only (SCIP Global–2) ................................................... Efficiency/HF. Efficiency/AMI. Efficiency/PNE. Surgical Care. NQF—Nursing Sensitive Condition Set (Outcomes Measures Only) 7 ....... 8 ....... 9 ....... 10 ..... Failure To Rescue—Nursing Sensitive Measure .............................................................................................. Pressure Ulcer Prevalence—Nursing Sensitive Measure ................................................................................. Patient Falls Prevalence—Nursing Sensitive Measure ..................................................................................... Patient Falls With Injury—Nursing Sensitive Measure ...................................................................................... Patient Patient Patient Patient centered. centered. centered. centered. Cancer (Inpatient) Measures 11 12 13 14 15 ..... ..... ..... ..... ..... Patients With Early Stage Breast Cancer Who Have Evaluation Of The Axilla ............................................... College Of American Pathologists Breast Cancer Protocol .............................................................................. Surgical Resection Includes At Least 12 Nodes (ACOS–02) ........................................................................... College Of American Pathologists Colon And Rectum Protocol ....................................................................... Completeness Of Pathologic Reporting (CCO–04) ........................................................................................... Cancer—Breast. Cancer—Breast. Cancer—Colon. Cancer—Colon. Cancer—Colon. Leapfrog Leaps, identified by IOM and Deficit Reduction Act 16 ..... 17 ..... 18 ..... Use Of Computerized Physician Order Entry (CPOE) Systems ....................................................................... Use of Intensivists in ICUs/ICU Physician Staffing (IPS) .................................................................................. Evidence-Based Hospital Referrals ................................................................................................................... Patient safety. Patient safety. Patient Safety. Measure Sets of Potential Interest (Individual measures not specified in this proposed rule) Sets Under Active Review by National Quality Forum (NQF) 1 ....... 2 ....... 3 ....... 4 ....... Healthcare-Associated Infection measures—under consideration by the NQF National Voluntary Consensus Standards for Reporting of Healthcare-associated Infections Data Project. Readmission Rates by Condition—under consideration by NQF National Voluntary Consensus Standards for Hospital Care: Additional Priorities, 2007 Project. Average Length of Stay (ALOS) by Condition—under consideration by NQF National Voluntary Consensus Standards for Hospital Care: Additional Priorities, 2007 Project. AHRQ Quality Indicators, including Patient Safety Indicators—under consideration by NQF National Voluntary Consensus Standards for Hospital Care: Additional Priorities, 2007 Project. Patient Safety. Efficiency. Efficiency. Patient Safety, various conditions. Measure Sets/Practices Previously Endorsed by NQF 5 ....... 6 ....... Safe Practices for Better Healthcare ................................................................................................................. Serious Reportable Events in Healthcare (‘‘Never Events’’) ............................................................................. Patient Safety. Patient Safety. Other Hospital Measure Sets 7 ....... 8 ....... Hospital Emergency Department Measures ...................................................................................................... Vascular Surgery Complications (for Carotid Endarterectomy, Lower Extremity Bypass, Open Surgery Abdominal Aortic Aneurysm Repair, Endovascular Abdominal Aortic Aneurysm Repair). mmaher on DSK3CLS3C1PROD with $$_JOB b. Data Submission In order to be eligible for the full FY 2009 market basket update, we are proposing that hospitals will be required to submit data on 32 measures (the 27 existing measures plus the 5 proposed new measures). The technical specifications for this requirement are published in the CMS/Joint Commission Specifications Manual for National Hospital Quality Measures. This manual can be found on the QualityNet.org Web site. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 For the additional SCIP measures that we are proposing to add through this rule, (SCIP Infection 4, 6, and 7 and SCIP–Card–2), hospitals will be required to submit data to the QIO Clinical Warehouse starting with discharges that occur in CY 2008. We are proposing that the deadline for hospitals to submit this data for first calendar quarter of 2008 would be August 15, 2008. Data must be submitted for each subsequent quarter PO 00000 Frm 00128 Fmt 4701 Sfmt 4702 Various. Surgical Care. by 4.5 months after the end of the quarter. We are proposing this time period to allow hospitals sufficient time to prepare for the data collection. The three SCIP Infection measures that we are proposing to include for FY 2009 were added to the Manual in version 2.0, effective with third calendar quarter of 2006 (3Q06) and the proposed SCIP Cardiovascular measure was added in version 2.1d of the Manual, effective with fourth calendar quarter of 2006 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB (4Q06). Hospitals may report data on these measures for discharges prior to CY 2008 discharges, if they so choose. For the proposed Pneumonia 30-day Mortality measure, we are proposing to use claims data that are already being collected for index hospitalizations to calculate the mortality rates. As is the case with the other 30-day mortality (outcome) measures already associated with the RHQDAPU program (AMI, HF), hospitals need not submit additional data. Claims data submitted to CMS for index hospitalizations occurring from July 2006 through June 2007 (3Q06 through 2Q07) will be used to calculate the Pneumonia 30-day mortality rate that will be used for FY 2009 annual payment determination. All measures that we have previously finalized, and that we finalize in the future through the rulemaking process, will be required for the RHQDAPU program annual payment determination each year until further notice. CMS, working in conjunction with The Joint Commission, maintains the specifications for the set of measures used both for the RHQDAPU program and for reporting under the HQA initiative. The specifications are updated semiannually and changes are made prospectively, except in exceptional circumstances. Revised specifications can be found at https:// www.qualitynet.org. 4. Retiring or Replacing RHQDAPU Program Quality Measures Over time, CMS expects that the set of measures used for the RHQDAPU program will evolve and change. New measures will be added to reflect clinical and other program goals. Measures that are no longer supported by clinical evidence would be modified or dropped. Through its public reporting and RHQDAPU program activities, CMS seeks to balance the competing goals of assuring the development of a comprehensive yet parsimonious set of quality measures while reducing reporting burden on hospitals. Section 1886(b)(3)(B)(viii)(VI) of the Act gives the Secretary authority to replace any measures or indicators in appropriate cases, such as where all hospitals are effectively in compliance or the measures or indicators have been subsequently shown not to represent the best clinical practice. CMS recognizes the need to develop a process related to the retirement and/or replacement of measures that comprise the RHQDAPU program measure set. In this proposed rule, we solicit public comment and suggestions concerning the criteria and mechanism for a process that would identify and, where appropriate, retire VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 or replace measures that comprise the RHQDAPU program measure set. 5. Procedures for the RHQDAPU Program for FY 2008 and FY 2009 a. Procedures for Participating in the RHQDAPU Program The ‘‘Reporting Hospital Quality Data for Annual Payment Update Reference Checklist’’ section of the QualityNet Exchange Web site contains all of the forms to be completed by hospitals participating in the program. In order to participate in the hospital reporting initiative for FY 2008, hospitals must follow these steps: <bullet≤ Identify a QualityNet Exchange Administrator who follows the registration process and submits the information through the QIO Clinical Warehouse. This must be done regardless of whether the hospital uses a vendor for transmission of data. <bullet≤ Complete the revised ‘‘Reporting Hospital Quality Data for Annual Payment Update Notice of Participation’’ form. These hospitals must send this form to their QIO, no later than August 15, 2007. In effort to alleviate the burden associated with submitting this form annually, we are proposing that a hospital that submits this form will be considered an active RHQDAPU program participant until such time as the hospital submits a withdrawal form to CMS. In addition, before participating hospitals initially begin reporting data, they must register with the QualityNet Exchange, regardless of the method used for submitting data. <bullet≤ Collect and report data for 24 of the 27 required measures (listed in Table—under the following headings: Acute Myocardial Infarction, Heart Failure, Pneumonia and SCIP). A hospital must report this data for discharges occurring in or after first quarter CY 2007. Hospitals must submit the data to the QIO Clinical Warehouse either using the CMS Abstraction & Reporting Tool (CART), the JCAHO ORYX[reg] Core Measures Performance Measurement System, or using another third-party vendor tool that has met the measurement specification requirements for data transmission to QualityNet Exchange. All submissions will be executed through QualityNet Exchange. Because the information in the QIO Clinical Warehouse is considered QIO information, it is subject to the stringent QIO confidentiality regulations in 42 CFR part 480. The QIO Clinical Warehouse will submit the data to CMS on behalf of the hospitals. <bullet≤ For each quality measure that requires hospitals to collect and PO 00000 Frm 00129 Fmt 4701 Sfmt 4702 24807 report data, submit complete data regarding the quality measures in accordance with the joint CMS/Joint Commission sampling requirements located on the QualityNet Exchange Web site. These requirements specify that hospitals must submit a random sample or complete population of cases for each of topics covered by the quality measures. Hospitals must meet these sampling requirements for these quality measures for discharges in each quarter. <bullet≤ Submit aggregate population and sample size counts for Medicare and non-Medicare discharges for the four topic areas (AMI, HF, PNE, and SCIP) on a quarterly basis to CMS. <bullet≤ Continuously collect HCAHPS data beginning with July 2007 discharges in accordance with the HCAHPS Quality Assurance Guidelines, Version 2.0, located at https:// www.hcahpsonline.org. The CY 2007 OPPS rule required HCAHPS-eligible hospitals to participate in the March 2007 dry run of the HCAHPS survey, if they have not already participated in a previous dry run. Hospitals must submit HCAHPS dry run data to the QIO Clinical Warehouse by July 13, 2007. As part of the March 2007 dry run, hospitals were required to survey HCAHPS-eligible discharges between 48 hours and 6 weeks following hospital discharge. <bullet≤ For the AMI 30-day and HF 30-day mortality measures, CMS will use Part A and Part B claims for Medicare fee-for-service patients to calculate the mortality measures. For FY 2008, hospital inpatient claims (Part A) from July 1, 2005 to June 30, 2006 will be used to identify the relevant patients and the index hospitalizations. Inpatient claims for the index hospitalization and Part A and Part B claims for all inpatient, outpatient and physician services received one year prior to the index hospitalizations are used to determine patient comorbidity, which is used in the risk adjustment calculation (see https://www.qualitynet.org/ dcs/ ContentServer?cid=1163010398556 &pagename=QnetPublic%2FPage %2FQnetTier2&c=Page). No other hospital data submission is required to calculate the mortality rates. b. Procedures for Participating in the RHQDAPU Program for FY 2009 For FY 2009, the requirements for FY 2008 discussed above will apply, except that hospitals will be required to collect and report data on any additional measures that we finalize through the rulemaking process and for which we specify that data submission is required. Mortality measures will be expanded to E:\FEDREG\03MYP2.LOC 03MYP2 24808 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules include pneumonia pending final NQF endorsement. mmaher on DSK3CLS3C1PROD with $$_JOB c. Chart Validation Requirements (1) FY 2008 Validation Requirements For the FY 2008 update, and until further notice, we will continue to require that hospitals meet the chart validation requirements that we implemented in the FY 2006 IPPS final rule. There were no chart-audit validation criteria in place for FY 2005. Based upon our experience with the FY 2005 submissions and our requirement for reliable and validated data, in the FY 2006 IPPS final rule we discussed additional requirements that we had established for the data that hospitals were required to submit in order to receive the full FY 2006 payment update (70 FR 47421 and 47422). These requirements, as well as additional information on validation requirements, will continue and are being placed on the QualityNet Exchange Web site. For the FY 2008 payment update, and until further notice, hospitals must pass our validation requirement of a minimum of 80 percent reliability, based upon our chart-audit validation process, for the first three quarters of data from CY 2006. These data are due to the QIO Clinical Warehouse by August 15, 2006 (first quarter CY 2006 discharges), November 15, 2006 (second quarter CY 2006 discharges), and February 15, 2007 (third quarter CY 2006 discharges). We use confidence intervals to determine if a hospital has achieved an 80-percent reliability aggregated over the three quarters. The use of confidence intervals allows us to establish an appropriate range below the 80-percent reliability threshold that demonstrates a sufficient level of reliability to allow the data to still be considered validated. We estimate the percent reliability based upon a review of five charts, and then calculate the upper 95-percent confidence limit for that estimate. If this upper limit is above the required 80-percent reliability, the hospital data are considered validated. We are using the design-specific estimate of the variance for the confidence interval calculation, which, in this case, is a stratified single stage cluster sample, with unequal cluster sizes. (For reference, see Cochran, William G.: Sampling Techniques, John Wiley & Sons, New York, chapter 3, section 3.12 (1977); and Kish, Leslie.: Survey Sampling, John Wiley & Sons, New York, chapter 3, section 3.3 (1964).) Each quarter is treated as a stratum for variance estimation purposes. We will use a two-step process to determine if a hospital is submitting VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 valid data. In the first step, we calculate the percent agreement for all of the variables submitted in all of the charts. If a hospital falls below the 80-percent cutoff, we proceed to the second step and restrict the comparison to those variables associated with payment. For first and second quarter CY 2006 discharges (1Q06, 2Q06), that means we limit the calculations to the 10-measure starter set. For third quarter CY 2006 discharges (3Q06), we include 21 measures. We recalculate the percent agreement and the estimated 95-percent confidence interval and again compare to the 80-percent cutoff point. If a hospital passes under this restricted set of variables, the hospital is considered to be submitting valid data for purposes of the RHQDAPU program. Due to time constraints, we will not apply the validation requirement for the FY 2008 update to 3 SCIP measures that are included in the RHQDAPU measure set, Infection 2, VTE 1 and VTE 2. For HCAHPS, hospitals and survey vendors must participate in a quality oversight process conducted by the HCAHPS project team. Prior to July 2007, the purpose of the oversight activities will be to provide feedback to hospitals and survey vendors on data collection procedures. Starting in July 2007, we may ask hospitals/survey vendors to correct any problems that are found and provide follow-up documentation of corrections for review within a defined time period. If the HCAHPS project team finds that the hospital has not made these corrections, CMS may determine that the hospital is not submitting appropriate HCAHPS data for the RHQDAPU program. As part of these activities, HCAHPS project staff will review and discuss with survey vendors and hospitals selfadministering the survey their specific Quality Assurance Plans, survey management procedures, sampling and data collection protocols, and data preparation and submission. This review may take place in-person or through other means of communication. (2) FY 2009 Chart Validation Requirements For the FY 2009 update, all 2008 requirements apply, except for the following modifications. We will modify the validation requirement to pool the quarterly validation estimates for 4th quarter CY 2006 through 3rd quarter 2007 discharges. We will also expand the list of validated measures in the FY 2009 update to add SCIP Infection-2, SCIP VTE–1, and SCIP VTE–2 starting with 4th quarter CY 2006 discharges. We will also drop the current two-step process to determine if the hospital is submitting valid data. We PO 00000 Frm 00130 Fmt 4701 Sfmt 4702 propose for the FY 2009 update to pool validation estimates covering the 4 quarters (4th quarter CY 2006 discharges through 3rd quarter 2007 discharges) in a similar manner to the current 3 quarter pooled confidence interval. (3) Validation and Submission Requirements We plan to apply the validation and submission requirements for FY 2008 and FY 2009 payment determination for the quality measures. For the validation and submission requirements for the FY 2008 payment year, we plan to use the following: <bullet≤ The 10 measure starter set for both submission and validation for 1st through 3rd quarters CY 2006 discharges. <bullet≤ The additional 11 measures that make up the expanded measure set for both submission and validation for 3rd quarter CY 2006 discharges. <bullet≤ SCIP VTE 1, 2, and SCIP Infection 2 submission only for 1Q 2007 discharges only. <bullet≤ HCAHPS measures, both submission of dry run data and continuous submission beginning with July 2007 discharges. <bullet≤ AMI and HF 30-day mortality measures as described previously. For FY 2009 payment year, we plan to use the following: <bullet≤ The 21 expanded measure set for submission and validation starting with fourth quarter CY 2006 (4Q06) through third quarter CY 2007 discharges. <bullet≤ SCIP VTE 1, 2, and SCIP Infection 2 submission and validation second quarter CY 2007 and 3rd Quarter CY 2007 discharges. <bullet≤ HCAHPS measures, continuous submission. <bullet≤ AMI, HF, and PN 30-day mortality measures as described previously. As additional measures are finalized for inclusion in the FY 2009 payment decision, we anticipate making changes to the above plan to incorporate those measures. c. Data Validation and Attestation For the FY 2008 update and in subsequent years, we will revise and post up-to-date confidence interval information on the QualityNet Exchange Web site explaining the application of the confidence interval to the overall validation results. The data are being validated at several levels. There are consistency and internal edit checks to ensure the integrity of the submitted data; there are external edit checks to E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules verify expectations about the volume of the data received. We will require for FY 2008 and subsequent years that hospitals attest each quarter to the completeness and accuracy of their data, including the volume of data, submitted to the QIO Clinical Warehouse in order to improve aspects of the validation checks. We will provide additional information to explain this attestation requirement, as well as provide the relevant form to be completed on the QualityNet Exchange Web site. mmaher on DSK3CLS3C1PROD with $$_JOB d. Public Display We will continue to display quality information for public viewing as required by section 1886(b)(3)(B)(viii)(VII) of the Act. Before we display this information, hospitals will be permitted to review their information as recorded in the QIO Clinical Warehouse. Currently, hospitals that share the same Medicare Provider Number (MPN) must combine data collection and submission across their multiple campuses (for both clinical measures and for HCAHPS). These measures are then publicly reported as if they apply to a single hospital. We estimate that approximately 5 to 10 percent of the hospitals reported on the Hospital Compare Web site share MPNs. For FY 2008 and subsequent years, we are proposing to require hospitals to begin to report the name and address of each hospital that shares the same MPN. This information will be gathered through the RHQDAPU program Notice of Participation form, which hospitals will submit to their QIOs by August 15, 2007. To increase transparency in public reporting and improve the usefulness of Hospital Compare, CMS plans to note on the Web site where publicly reported measures combine results from two or more hospitals. e. Reconsideration and Appeal Procedures If we deny a hospital the full market basket update, the hospital may submit a letter requesting that we reconsider our decision that the hospital did not meet the RHQDAPU program requirements. For FY 2008, a hospital must submit such a request for reconsideration on or before November 1, 2007. We also are establishing additional procedural rules that will govern RHQDAPU program reconsiderations. We will post these rules on the QualityNet Exchange Web site. If a hospital is dissatisfied with the result of a RHQDAPU program reconsideration, the hospital may file a VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 claim under 42 CFR Part 405, Subpart R (a Provider Reimbursement Review Board (PRRB) appeal). In this proposed rule we are again soliciting public comment and suggestions related to reconsideration. f. RHQDAPU Program Withdrawal Requirements For the FY 2008 update, hospitals may withdraw from the RHQDAPU program at any time up to August 15, 2007. If a hospital withdraws from the program, it will receive a 2.0 percentage point reduction in its payment update. 6. Electronic Medical Records In the FY 2006 IPPS final rule, we encouraged hospitals to take steps toward the adoption of electronic medical records (EMRs) that will allow for reporting of clinical quality data from the EMRs directly to a CMS data repository (70 FR 47420). We intend to begin working toward creating measures specifications and a system or mechanism, or both, that will accept the data directly without requiring the transfer of the raw data into an XML file as is currently done. The Department continues to work cooperatively with other Federal agencies in the development of Federal health architecture data standards. We encouraged hospitals that are developing systems to conform them to both industry standards and, when developed, the Federal Health Architecture Data standards, and to ensure that the data necessary for quality measures are captured. Ideally, such systems will also provide point-ofcare decision support that enables high levels of performance on the measures. Hospitals using EMRs to produce data on quality measures will be held to the same performance expectations as hospitals not using EMRs. Due to the low volume of comments we received on this issue in response to the FY 2006 proposed IPPS rule, in the proposed IPPS rule for FY 2007 (71 FR 24095), we again invited comments on these requirements and options. In the FY 2007 IPPS final rule, we summarized and addressed the additional comments we received. We would welcome additional comments on this issue. 7. New Hospitals In addition, we are proposing a minor change to our policies regarding new hospitals. In the FY 2006 IPPS final rule, we noted that a new hospital should begin collecting and reporting data immediately and complete the registration requirements for the RHQDAPU. (70 FR 47421 and 47428). We also explained that a new hospital PO 00000 Frm 00131 Fmt 4701 Sfmt 4702 24809 would be held to the same standard as established facilities when determining the expected number of discharges for the calendar quarters covered for each fiscal year. We also stated that fiscal intermediaries would provide information on new hospitals to the QIO in the state in which the hospital has opened for operations as a Medicare provider as soon as possible so that the QIO can enter the provider information into its Program Resource System (PRS) and follow through with ensuring provider participation with the requirements for quality data reporting under this rule. We believe that some new hospitals have found it difficult to start reporting RHQDAPU measures immediately after signing up to participate in the RHADAPU program. Therefore, we are proposing a modification to our policy to reduce burden on new hospitals. We are proposing that the fiscal intermediary would continue to provide information on the new hospital to the QIO in the state in which the hospital is located as soon as possible so that the QIO could enter the provider information into its PRS and follow through with ensuring provider participation with the requirements for quality data reporting. However, for a new hospital that receives a provider number on or after October 1st of each year (beginning with October 1, 2007), we are proposing that the hospital would be required to report RHQDAPU data beginning with the first day of the quarter following the date the hospital registers to participate in the RHQDAPU program. For example, a hospital that receives its MPN on October 2, 2007 and signs up to participate in RHQDAPU on November 1, 2007 will be expected to meet all data submission requirements for discharges on or after January 1, 2008. B. Development of the Medicare Hospital Value-Based Purchasing Plan (If you choose to comment on issues in this section, please include the caption ‘‘Value-Based Purchasing Plan’’ at the beginning of your comment.) Section 5001(b) of the DRA specifies that CMS develop a plan to implement a Value-Based Purchasing (VBP) Program for payments under the Medicare program for subsection (d) hospitals beginning with FY 2009. Congress specified that the ‘‘plan’’ include consideration of the following issues: <bullet≤ The ongoing development, selection, and modification process for measures of quality and efficiency in hospital inpatient settings. E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24810 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules <bullet≤ The reporting, collection, and validation of quality data. <bullet≤ The structure of value-based payment adjustments, including the determination of thresholds or improvements in quality that would substantiate a payment adjustment, the size of such payments, and the sources of funding for the value-based payments. <bullet≤ The disclosure of information on hospital performance. In developing the plan, we must consult with relevant affected parties and consider experience with demonstrations that are relevant to the value-based purchasing program. We have created an internal Hospital Pay-for-Performance Workgroup that is charged with developing the VBP Plan for Medicare hospital services. The workgroup is organized into four subgroups to address each of the required planning issues: (1) measures; (2) data collection and validation; (3) incentive structure; and (4) public reporting. The workgroup has been charged with preparing a set of design options, narrowing the set of design options to prepare a draft plan, and preparing the final plan for implementing VBP for Medicare hospital services that will be provided to Congress. CMS is hosting two public ‘‘Listening Sessions’’ in early 2007 to solicit comments from relevant affected parties on outstanding design questions associated with development of the final plan. The first listening session was held on January 17, 2007, to consider design questions posed in an issues paper that has been posted since December 22, 2006, on the Medicare Web site, Hospital Center, under Spotlights at: https://www.cms.hhs.gov/ center/ hospital.asp. An audio download of the listening session and the PowerPoint slides used during the session are also posted on this Web site. The second listening session will be held on April 12, 2007, to consider the draft plan, which will be posted on the Medicare Web site, Hospital Center, on March 22, 2007. A notice announcing this listening session was published in the Federal Register on February 23, 2007 (71 FR 8179). It is hoped that hospitals, hospital associations, and other interested parties will attend and make comments on the draft plan in person. It will also be possible to participate by teleconference, and limited time will be allocated for verbal comments by telephone participants. Registration to participate in person or by telephone is open until April 5, 2007. The agenda and PowerPoint slides for the session will be posted by April 9, 2007. An audio download of the second VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 listening session will be posted by April 17, 2007. Written comments are welcomed and will be accepted until 5 PM EDT on April 19, 2007. The perspectives expressed during this session and in writing will assist CMS in making revisions to the draft plan to create the final Medicare Hospital Value-Based Purchasing Plan expected to be completed by June 2007. While section 5001(b) of the DRA authorized development of this plan, additional legislation will be required to establish and implement the Medicare Hospital Value-Based Purchasing Program. As described in the draft plan, we proposed that the current RHQDAPU Program will provide the foundation for and be incorporated into the new Medicare Hospital Value-Based Purchasing Program. C. Rural Referral Centers (RRCs) (§ 412.96) (If you choose to comment on issues in this section, please include the caption ‘‘RRCs’’ at the beginning of your comment.) Under the authority of section 1886(d)(5)(C)(i) of the Act, the regulations at § 412.96 set forth the criteria that a hospital must meet in order to qualify under the IPPS as an RRC. For discharges occurring before October 1, 1994, RRCs received the benefit of payment based on the other urban standardized amount rather than the rural standardized amount. Although the other urban and rural standardized amounts are the same for discharges occurring on or after October 1, 1994, RRCs continue to receive special treatment under both the DSH payment adjustment and the criteria for geographic reclassification. Section 402 of Pub. L. 108–173 raised the DSH adjustment for other rural hospitals with less than 500 beds and RRCs. Other rural hospitals with less than 500 beds are subject to a 12-percent cap on DSH payments. RRCs are not subject to the 12-percent cap on DSH payments that is applicable to other rural hospitals (with the exception of rural hospitals with 500 or more beds). RRCs are not subject to the proximity criteria when applying for geographic reclassification, and they do not have to meet the requirement that a hospital’s average hourly wage must exceed 106 percent of the average hourly wage of the labor market area where the hospital is located. Section 4202(b) of Pub. L. 105–33 states, in part, ‘‘[a]ny hospital classified as an RRC by the Secretary * * * for fiscal year 1991 shall be classified as such an RRC for fiscal year 1998 and each subsequent year.’’ In the August 29, 1997 final rule with comment period PO 00000 Frm 00132 Fmt 4701 Sfmt 4702 (62 FR 45999), we also reinstated RRC status for all hospitals that lost the status due to triennial review or MGCRB reclassification, but not to hospitals that lost RRC status because they were now urban for all purposes because of the OMB designation of their geographic area as urban. However, subsequently, in the August 1, 2000 final rule (65 FR 47089), we indicated that we were revisiting that decision. Specifically, we stated that we would permit hospitals that previously qualified as an RRC and lost their status due to OMB redesignation of the county in which they are located from rural to urban to be reinstated as an RRC. Otherwise, a hospital seeking RRC status must satisfy the applicable criteria. We used the definitions of ‘‘urban’’ and ‘‘rural’’ specified in Subpart D of 42 CFR Part 412. 1. Proposed Annual Update of RRC Status Criteria One of the criteria under which a hospital may qualify as a RRC is to have 275 or more beds available for use (§ 412.96(b)(1)(ii)). A rural hospital that does not meet the bed size requirement can qualify as an RRC if the hospital meets two mandatory prerequisites (a minimum CMI and a minimum number of discharges) and at least one of three optional criteria (relating to specialty composition of medical staff, source of inpatients, or referral volume) (§ 412.96(c)(1) through (c)(5)). (See also the September 30, 1988 Federal Register (53 FR 38513).) With respect to the two mandatory prerequisites, a hospital may be classified as an RRC if— <bullet≤ The hospital’s CMI is at least equal to the lower of the median CMI for urban hospitals in its census region, excluding hospitals with approved teaching programs, or the median CMI for all urban hospitals nationally; and <bullet≤ The hospital’s number of discharges is at least 5,000 per year, or, if fewer, the median number of discharges for urban hospitals in the census region in which the hospital is located. (The number of discharges criterion for an osteopathic hospital is at least 3,000 discharges per year, as specified in section 1886(d)(5)(C)(i) of the Act.) a. Case-Mix Index Section 412.96(c)(1) provides that CMS will establish updated national and regional CMI values in each year’s annual notice of prospective payment rates for purposes of determining RRC status. The methodology we use to determine the national and regional CMI values is set forth in regulations at § 412.96(c)(1)(ii). The proposed national E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules median CMI value for FY 2008 includes all urban hospitals nationwide, and the regional values for FY 2008 are the median CMI values of urban hospitals within each census region, excluding those hospitals with approved teaching programs (that is, those hospitals receiving indirect medical education payments as provided in § 412.105(f)). These values are based on discharges occurring during FY 2006 (October 1, 2005 through September 30, 2006) and include bills posted to CMS’ records through December 2006. We are proposing that, in addition to meeting other criteria, if they are to qualify for initial RRC status for cost reporting periods beginning on or after October 1, 2007, rural hospitals with fewer than 275 beds must have a CMI value for FY 2006 that is at least— <bullet≤ 1.2258; or <bullet≤ The median CMI value (not transfer-adjusted) for urban hospitals (excluding hospitals with approved teaching programs as identified in § 412.105(f)) calculated by CMS for the census region in which the hospital is located. The proposed median CMI values by region are set forth in the following table: Case-mix index value Region 1. 2. 3. 4. 5. 6. 7. 8. 9. New England (CT, ME, MA, NH, RI, VT) .................................................................................................................................... Middle Atlantic (PA, NJ, NY) ....................................................................................................................................................... South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV) ........................................................................................................... East North Central (IL, IN, MI, OH, WI) ...................................................................................................................................... East South Central (AL, KY, MS, TN) ......................................................................................................................................... West North Central (IA, KS, MN, MO, NE, ND, SD) .................................................................................................................. West South Central (AR, LA, OK, TX) ........................................................................................................................................ Mountain (AZ, CO, ID, MT, NV, NM, UT, WY) ........................................................................................................................... Pacific (AK, CA, HI, OR, WA) ..................................................................................................................................................... The preceding numbers will be revised in the final rule to the extent required to reflect the updated FY 2006 MEDPAR file, which will contain data from additional bills received through March 2007. Hospitals seeking to qualify as RRCs or those wishing to know how their CMI value compares to the criteria should obtain hospital-specific CMI values (not transfer-adjusted) from their fiscal intermediaries. Data are available on the Provider Statistical and Reimbursement (PS&R) System. In keeping with our policy on discharges, these CMI values are computed based on all Medicare patient discharges subject to the IPPS DRG-based payment. b. Discharges Section 412.96(c)(2)(i) provides that CMS will set forth the national and regional numbers of discharges in each year’s annual notice of prospective payment rates for purposes of determining RRC status. As specified in section 1886(d)(5)(C)(ii) of the Act, the national standard is set at 5,000 discharges. We are proposing to update the regional standards based on discharges for urban hospitals’ cost reporting periods that began during FY 2004 (that is, October 1, 2003 through September 30, 2004), which is the latest Number of discharges mmaher on DSK3CLS3C1PROD with $$_JOB New England (CT, ME, MA, NH, RI, VT) .................................................................................................................................... Middle Atlantic (PA, NJ, NY) ....................................................................................................................................................... South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV) ........................................................................................................... East North Central (IL, IN, MI, OH, WI) ...................................................................................................................................... East South Central (AL, KY, MS, TN) ......................................................................................................................................... West North Central (IA, KS, MN, MO, NE, ND, SD) .................................................................................................................. West South Central (AR, LA, OK, TX) ........................................................................................................................................ Mountain (AZ, CO, ID, MT, NV, NM, UT, WY) ........................................................................................................................... Pacific (AK, CA, HI, OR, WA) ..................................................................................................................................................... These numbers will be revised in the FY 2008 IPPS final rule based on the latest available cost report data. We note that the median number of discharges for hospitals in each census region is greater than the national standard of 5,000 discharges. Therefore, 5,000 discharges is the minimum criterion for all hospitals. We reiterate that if an osteopathic hospital is to qualify for RRC status for cost reporting periods beginning on or after October 1, 2007, the hospital VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 would be required to have at least 3,000 discharges for its cost reporting period that began during FY 2004. 2. Acquired Rural Status and RRCs (§ 412.103(g)) With the following exceptions, a hospital must be rural to qualify as an RRC: <bullet≤ Consistent with section 4202(b) of Pub. L. 105–33, any hospital designated as an RRC in FY 1991 retains PO 00000 Frm 00133 Fmt 4701 1.2389 1.2675 1.3524 1.3499 1.2909 1.2780 1.4013 1.4260 1.3722 available cost report data we have at this time. Therefore, we are proposing that, in addition to meeting other criteria, a hospital, if it is to qualify for initial RRC status for cost reporting periods beginning on or after October 1, 2007, must have as the number of discharges for its cost reporting period that began during FY 2004 a figure that is at least— <bullet≤ 5,000 (3,000 for an osteopathic hospital); or <bullet≤ The median number of discharges for urban hospitals in the census region in which the hospital is located, as indicated in the following table: Region 1. 2. 3. 4. 5. 6. 7. 8. 9. 24811 Sfmt 4702 7,749 10,603 10,562 9,209 7,596 7,963 7,167 9,116 8,420 that status for FY 1998 and each subsequent year. <bullet≤ Hospitals located in a rural county that would have lost their RRC status as a result of an OMB redesignation of the area from rural to urban were permitted to remain as RRCs (69 FR 49056). <bullet≤ Hospitals located in urban areas that apply for reclassification as rural under § 412.103 (that is, the hospital is located in an urban area but it E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24812 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules ‘‘acquires’’ rural status under the regulations) also may qualify as RRCs. Under § 412.103(g), a hospital may cancel its rural reclassification by submitting a written request to the CMS Regional Office no less than 120 days prior to the end of its current cost reporting period. A hospital may choose to cancel its acquired rural status if it determines it may be more financially beneficial to return to urban status and the associated IPPS payments rather than remain rural and receive the special treatments of certain rural providers such as RRCs, SCHs and CAHs. The hospital’s acquired rural status is canceled beginning with its next cost reporting period. We have received inquiries asking whether a hospital retains its RRC status once it voluntarily cancels its acquired rural status. As indicated above, a hospital generally must be rural to be classified as an RRC. However, a hospital may retain its RRC status only in the special circumstances where it would have lost status due to OMB redesignation of its area from rural to urban, or where it was already designated as an RRC in 1991. In these situations, there were either special statutory provisions that require the hospital to retain its RRC status or the hospital’s geographic status changed from rural to urban through no action of its own. We do not believe that an urban hospital that acquires rural status under § 412.103 and subsequently is approved as an RRC should be able to retain the benefits of being an RRC when it voluntarily cancels that acquired rural status. For this reason, Medicare’s policy has been that a hospital cannot continue to be an RRC once it cancels acquired rural status under § 412.103. It follows from the requirement that an RRC must be located in a rural area that cancellation of acquired rural status negates a hospital’s RRC designation. In this proposed rule, we are clarifying our current policy that a hospital that cancels its acquired rural status, received under § 412.103, would also lose its RRC designation under § 412.96. In this situation, the hospital would lose its RRC designation under § 412.96 as of the date the cancellation of its acquired rural status takes effect. As indicated above, RRCs are not subject to a maximum DSH adjustment of 12 percent that applies to other rural hospitals with less than 500 beds. Further, RRCs are not subject to the proximity criteria when applying for geographic reclassification (§ 412.230(a)(3)), and they do not have to meet certain wage comparison tests for reclassification (§ 412.230(d)(1)(iii)). A hospital located in an urban area that VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 cancels its acquired rural status under § 412.103 loses its RRC status and would become subject to a 12-percent cap on the DSH adjustment applicable to urban hospitals with less than 100 beds (if the hospital has 100 beds or more, it would not be subject to the cap on the DSH adjustment). Further, the hospital would also have to meet the proximity requirement for geographic reclassification at § 412.230(a)(3). We note that the hospital would maintain the benefit of being exempt from the average hourly wage criterion for geographic reclassification requiring the comparison of the hospital’s wages to the wages of the area in which it is located, as stated in section 1886(d)(10)(D)(iii) of the Act. We are also proposing to revise the regulations at § 412.103(g) with respect to when cancellation of acquired rural status becomes effective. Currently, § 412.103(g)(2) states ‘‘The hospital’s cancellation of the classification is effective beginning with the hospital’s next full cost reporting period following the date of its request for cancellation.’’ While this policy is appropriate for hospitals paid under reasonable costs, such as CAHs, it is inconsistent with the IPPS that makes changes prospectively on the basis of a Federal fiscal year. In addition, to address concerns that some IPPS hospitals are acquiring rural status solely to benefit from reclassification rules applying to hospitals that were once RRCs and then canceling that rural status within a short period of time, such as a few months, we are proposing to require IPPS hospitals to retain acquired rural status for at least one 12month cost reporting period. If the hospital chooses to cancel its rural reclassification, the effective date of that cancellation would occur both after at least one 12-month cost reporting period and at the start of the next Federal fiscal year. Thus, for example, if a hospital with a cost reporting period from July 1, 2008, to June 30, 2009, becomes rural on May 30, 2008, its acquired rural status under § 412.103 would remain in effect from May 30, 2008, through at least September 30, 2009 (that is, the date it acquired rural status through the end of the fiscal year containing a full cost reporting period). We believe this policy is reasonable, given that acquired rural status for IPPS hospitals should be a considered decision for hospitals that truly wish to be considered as rural, and not purely as a mechanism for reclassifying. We are not proposing a duration requirement for hospitals paid under cost reimbursement because we are not aware of similar manipulations of rural status in these cases. Therefore, we are proposing to change our current PO 00000 Frm 00134 Fmt 4701 Sfmt 4702 policy by revising § 412.103(g) to specify that a hospital’s cancellation of its acquired rural status under § 412.103 is effective for hospitals under reasonable cost reimbursement (such as CAHs) with the hospital’s next cost reporting period and for hospitals under the IPPS after at least one 12-month cost reporting period as rural and not until the beginning of a Federal fiscal year following both the request for cancellation and the 12-month cost reporting period. Under the proposed revised regulations, an IPPS hospital (such as an RRC or SCH) that cancels its acquired rural status would continue to be paid as rural until the beginning of the next fiscal year after at least one 12month cost reporting period as rural. In addition, for these IPPS hospitals, the deadline for seeking cancellation of the acquired rural status would be not less than 120 days before the end of the fiscal year. D. Indirect Medical Education (IME) Adjustment (§ 412.105) (If you choose to comment on issues in this section, please include the caption ‘‘IME Adjustment’’ at the beginning of your comment.) 1. Background Section 1886(d)(5)(B) of the Act provides that prospective payment hospitals that have residents in an approved graduate medical education (GME) program receive an additional payment to reflect the higher indirect patient care costs of teaching hospitals relative to nonteaching hospitals. The regulations regarding the calculation of this additional payment, known as the indirect medical education (IME) adjustment, are located at § 412.105. The Balanced Budget Act of 1997 (Pub. L. 105–33) established a limit on the number of allopathic and osteopathic residents that a hospital may include in its full-time equivalent (FTE) resident count for direct GME and IME payment purposes. Under section 1886(h)(4)(F) of the Act, a hospital’s unweighted FTE count of residents may not exceed the hospital’s unweighted FTE count for its most recent cost reporting period ending on or before December 31, 1996. Under section 1886(d)(5)(B)(v) of the Act, the limit on the FTE resident count for IME purposes is effective for discharges occurring on or after October 1, 1997. A similar limit is effective for direct GME purposes for cost reporting periods beginning on or after October 1, 1997. 2. IME Adjustment Factor for FY 2008 The IME adjustment to the DRG payment is based in part on the E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules applicable IME adjustment factor. The IME adjustment factor is calculated using a hospital’s ratio of residents to beds, which is represented as r, and a formula multiplier, which is represented as c, in the following equation: c x [●1 + rb .405–1]. The formula is traditionally described in terms of a certain percentage increase in payment for every 10-percent increase in the resident-to-bed ratio. Section 502(a) of Pub. L. 108–173 modified the formula multiplier (c) to be used in the calculation of the IME adjustment. Prior to the enactment of Pub. L. 108–173, the formula multiplier was fixed at 1.35 for discharges occurring during FY 2003 and thereafter. Section 502(a) modified the formula multiplier beginning midway through FY 2004 and provided for a new schedule of formula multipliers for FY 2005 and thereafter. In the FY 2005 IPPS rule, we announced the schedule of formula multipliers to be used in the calculation of the IME adjustment and incorporated the schedule in our regulations at § 412.105(d)(3)(viii) through (d)(3)(xii). In this proposed rule, we are specifying that, for any discharges occurring during FY 2008, the statutorily mandated formula multiplier is 1.35. Previously, for discharges occurring during FY 2007, the mandated formula multiplier was 1.32. We estimate that application of the mandated formula multiplier for FY 2008 will result in an increase of 5.5 percent in IME payment for every approximately 10-percent increase in the resident-to-bed ratio. mmaher on DSK3CLS3C1PROD with $$_JOB 3. Time Spent by Residents on Vacation or Sick Leave and in Orientation a. Background In the FY 2007 IPPS final rule (71 FR 48080), we clarified our policy with respect to the time that residents spend in nonpatient care activities (such as conferences and seminars) as part of approved residency programs. We amended our regulations concerning the FTE resident count at 42 CFR 412.105(f)(1)(iii)(C) to state, ‘‘In order to be counted, a resident must be spending time in patient care activities, as defined in § 413.75(b) * * *’’ The regulations at § 413.75(b) define patient care activities as ‘‘the care and treatment of particular patients, including services for which a physician or other practitioner may bill.’’ In light of this clarification, during the past year, we have received questions from the teaching hospital community as to whether the time that residents spend on vacation or sick leave, and in orientation activities that typically occur at the beginning of a VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 residency training program, is counted for IME payment purposes. Historically, time spent by residents on vacation or sick leave and in initial orientation activities has been included in the FTE resident count for IME and direct GME. (The sick leave we are referring to throughout this discussion is sick leave that does not require the resident to make up for his or her absence by adding additional training time at the end of the program.) The practice of allowing vacation and sick leave to be included in the IME count appears to be based on a provision in the Provider Reimbursement Manual, Part I, at section 2405.3.H.2. This manual provision discusses the treatment of residents who are on vacation or sick leave in the context of our prior ‘‘one day count’’ policy for counting residents for IME payment. Generally, effective with cost reporting periods beginning on or after October 1, 1984, and before July 1, 1991, residents were counted for IME purposes on a uniform reporting date of September 1. A hospital’s FTE residents were counted based on their assignment to that hospital’s IPPS or outpatient areas on September 1 of an academic year. Because it was possible that a resident might not actually be present in the hospital on September 1 because he or she was on approved vacation or sick leave, to ensure that the hospital’s IME FTE count would not be understated for the entire year, section 2405.3.H.2 of the PRM–I states that ‘‘interns and residents using vacation and sick leave on the day of the count may be included in the count.’’ Although the regulations were changed effective for cost reporting periods beginning on or after July 1, 1991 (55 FR 36059) to reflect the current resident-counting methodology (that is, to count the number of FTE residents based on the amount of time required to fill a residency slot as specified at § 412.105(f)(1)(iii)(A)), the fiscal intermediary (or MAC) have continued to include time spent by residents on vacation and sick leave in the FTE resident counts for purposes of both IME and direct GME payments. Orientation time is time spent by residents in activities that typically take place at the beginning of a resident’s training program, and include orientation regarding hospital employment, the hospital’s policies and procedures in general, as well as policies and procedures specific to the residency training program. As is the case for vacation and sick leave, time spent by residents in orientation has continued to be included by intermediaries/MACs in the FTE PO 00000 Frm 00135 Fmt 4701 Sfmt 4702 24813 resident counts for purposes of both IME and direct GME. We understand why we have received numerous questions regarding whether FTE resident time spent on vacation or sick leave, or in orientation activities, should be counted for purposes of IME payment. The time a resident spends on vacation or sick leave is not addressed within the current definition of ‘‘patient care activities’’ at § 413.75(b). In fact, time spent on vacation or sick leave would not be spent at the hospital location at all, so no patient care activities would occur during this time. Time spent in orientation might be spent in the hospital complex (or at a nonhospital setting), but would not involve the care and treatment of particular patients. Thus, although time spent by residents on vacation or sick leave or in orientation has historically been included in the IME and direct GME FTE counts, it seems apparent that this time should be carefully considered in light of our clarified policy and current regulations. We believe these types of activities (vacation time, sick leave, and orientation) are inherently different from the types of ‘‘patient care activities’’ and ‘‘nonpatient care activities’’ we have discussed in depth in previous rules, and most recently in the FY 2007 IPPS final rule. We believe the aforementioned activities should be distinguished from other activities, patient care or otherwise, in which the resident participates as part of the approved program. b. Vacation and Sick Leave Time We believe that approved vacation time and sick leave are not appropriately categorized as patient care activities, or as didactic, research, or other nonpatient care activities. In addition, although the Accreditation Council for Graduate Medical Education (ACGME) has some rules regarding resident duty hours and work environment, the ACGME is not explicit regarding resident vacation and sick leave policies. Rather, vacation and sick leave policies are determined by the resident’s employer and can vary by residency training program. Consequently, although vacation and sick leave are fringe benefits to which every employee, hospital or otherwise, is typically entitled, vacation and sick leave are not, in fact, part of the training time spent by residents in an approved program. Therefore, we believe vacation and sick leave are not properly considered as either patient care time or nonpatient care time, but are within a distinct third category of time. As we noted above, it has been our policy to include the time spent by residents on E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24814 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules vacation or sick leave in the FTE resident count for IME and direct GME. However, we do not believe the continuation of this policy is appropriate in light of our current policy as clarified in the FY 2007 IPPS final rule and expressed in revised regulations that permit only time spent by residents in patient care activities to be counted for purposes of IME. We initially considered proposing a policy to no longer count the time spent by residents on vacation or sick leave for purposes of IME on the ground that this time is not spent in patient care activities in accordance with our regulations. However, we do not believe such a policy would have recognized the unique character of vacation and sick time as time that is not spent in any aspect of residency training—patient care or nonpatient care. Because we believe time spent by residents on vacation and sick leave is not properly considered patient care time or nonpatient care time, but fit within a distinct third category of time that is neither patient care nor nonpatient care, we believe it would be more appropriate to remove the time altogether from the FTE calculation for each resident for both IME and direct GME payment purposes. Accordingly, we are proposing to remove vacation and sick leave from the total time considered to constitute an FTE resident for purposes of IME payment effective for cost reporting periods beginning on or after October 1, 2007. Further, in order to have a consistent conception of an FTE resident for purposes of IME and direct GME payment, we are proposing to remove vacation and sick leave from the total FTE resident time for purposes of direct GME payment as well effective for cost reporting periods beginning on or after October 1, 2007. We acknowledge that removing vacation and sick leave time from the denominator of the FTE count for both IME and direct GME could have some impact on the FTE count, but the impact is fact-specific. In some cases, it would result in a lower FTE count, and in some cases, it would result in a higher FTE count. In addition, we note that under our current policy, residents who are on maternity leave or other approved sick leave of extended duration that prolongs the total time a resident is participating in the approved program beyond the normal duration of the program are not counted while they are out on extended sick or maternity leave. This is because the FTE time spent by such residents is counted in accordance with our FTE counting policies during the training time they VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 spend to make up for their absence. For example, a resident in an internal medicine program who takes 3 months of approved maternity leave and, therefore, must stay an additional 3 months beyond the normal 3 years to complete her training, would not be counted while she is on maternity leave for IME and direct GME payment purposes. Rather, time spent during the additional 3 months of training in which she must participate to make up for her 3 month absence will be counted in accordance with our FTE-counting policies for IME and direct GME. We are not proposing to change our policy with respect to time spent by residents on maternity leave or other approved sick leave of extended duration. c. Orientation Activities As discussed above, we believe that orientation activities in which residents participate, often prior to the start of their residency training program, are also distinct from the typical ‘‘patient care’’ and ‘‘nonpatient care’’ activities in which residents participate as part of their training program. For example, before residents begin training in an approved residency program, the hospital (or in many cases, the medical school as the employer of the residents) is required to provide orientation for their residents. Most of these orientation activities involve neither patient care nor the typical didactic or research activities that comprise the residency training program. Instead, such orientation consists of basic informational sessions in which all new employees, residents and other staff, must participate at the beginning of employment. There could also be other orientation activities designed specifically to prepare residents to furnish patient care in a particular setting or to participate in a particular approved residency training program. We recognize that certain portions of orientation activities are specific to residents in particular approved programs and are required by the accrediting organizations. Other components of orientation relate to employment and are common to all employees. Still other components of orientation may involve training regarding particular hospital policies and procedures, some of which would relate to patient care and safety. In many ways, these orientation activities resemble ‘‘didactic’’ activities. However, we believe there are important differences between the ‘‘didactic’’ activities that are part of orientation and the other conferences and seminars in which the residents engage throughout the course of their training. That is, we PO 00000 Frm 00136 Fmt 4701 Sfmt 4702 do not envision orientation activities as including scholarly didactic activities such as conferences or seminars that may occur throughout a residency training program. Rather, we believe orientation activities would occur either at the beginning of a particular specialty program, or when a resident goes to another facility for training. In orientation sessions, much of the information being imparted to the residents is essential knowledge for the residents in order to furnish patient care services in a particular hospital facility or approved program. Thus, the information furnished during orientation is not information that merely enhances the resident’s patient care delivery knowledge and skills during the residency program, but it is a necessary prerequisite for the residents as they commence (or continue) their training program and is often required as a term of employment. Because we recognize the distinct character of orientation activities as essential to the provision of patient care by residents, and the fundamental differences between orientation and the typical didactic activities in which a resident may participate throughout a residency training program, we are proposing to continue to count the time spent by residents in orientation activities, whether they occur in the hospital or nonhospital setting, and are proposing to amend our regulations accordingly. (We note that orientation activities in the hospital setting have historically been counted for direct GME payment purposes in accordance with the regulations at § 413.78(a) which state ‘‘Residents in an approved program working in all areas of the hospital complex may be counted.’’) We are proposing to amend § 413.75(b) to add a definition of the term ‘‘orientation activities,’’ to mean ‘‘activities that are principally designed to prepare an individual for employment as a resident in a particular setting, or for participation in a particular specialty program and patient care activities associated with that particular specialty program.’’ We understand that orientation activities typically occur at the beginning of a resident’s first program year. However, we are interested in hearing from commenters on whether orientation activities typically occur during other times during an approved residency training program. We are proposing to amend the definition of ‘‘patient care activities’’ at § 413.75(b) as follows: ‘‘the care and treatment of particular patients, including services for which a physician or other practitioner may bill, and E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules orientation activities as defined at § 413.75(b).’’ In addition, we are proposing to amend the regulations at § § 412.105(f)(1)(iii)(A) and 413.78(b) to specify that ‘‘Vacation and sick leave are not included in the determination of full-time equivalency.’’ d. Proposed Regulation Changes In summary, we are proposing, for cost reporting periods beginning on or after October, 1, 2007, for direct GME and IME, that time spent by residents on vacation or sick leave would not be included in the determination of what constitutes an FTE resident (or would be removed from both the numerator and denominator of the FTE count) for both IME and direct GME payment purposes. In addition, we are proposing to continue to count time spent by residents in orientation activities for both IME and direct GME payment purposes. We are proposing to amend the regulations at § § 412.105(f)(1)(iii)(A) and 413.78(b). Lastly, we are proposing to amend § 413.75(b) to include the definition of the term ‘‘orientation activities’’ and to amend the definition of ‘‘patient care activities’’ to add ‘‘orientation activities.’’ mmaher on DSK3CLS3C1PROD with $$_JOB E. Hospital Emergency Services Under EMTALA (§ 489.24) (If you choose to comment on issues in this section, please include the caption ‘‘EMTALA’’ at the beginning of your comments.) 1. Background Sections 1866(a)(1)(I), 1866(a)(1)(N), and 1867 of the Act impose specific obligations on certain Medicareparticipating hospitals and CAHs. (Throughout this section of this proposed rule, when we reference the obligation of a ‘‘hospital’’ under these sections of the Act and in our regulations, we mean to include CAHs as well.) These obligations concern individuals who come to a hospital emergency department and request examination or treatment for medical conditions, and apply to all of these individuals, regardless of whether they are beneficiaries of any program under the Act. The statutory provisions cited above are frequently referred to as the Emergency Medical Treatment and Labor Act (EMTALA), also known as the patient antidumping statute. EMTALA was passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), Pub. L. 99–272. Congress enacted these antidumping provisions in the Social Security Act to ensure that individuals with emergency medical conditions are VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 not denied essential lifesaving services because of a perceived inability to pay. Under section 1866(a)(1)(I)(i) of the Act, a hospital that fails to fulfill its EMTALA obligations under these provisions may be liable for termination of its Medicare provider agreement, which would result in loss of all Medicare and Medicaid payments. Section 1867 of the Act sets forth requirements for medical screening examinations for individuals who come to the hospital and request examination or treatment for a medical condition. The section further provides that if a hospital finds that such an individual has an emergency condition, it is obligated to provide that individual with either necessary stabilizing treatment or an appropriate transfer to another medical facility where stabilization can occur. The EMTALA statute also outlines the obligation of hospitals to receive appropriate transfers from other hospitals. Section 1867(g) of the Act states that a participating hospital that has specialized capabilities or facilities (such as burn units, shock-trauma units, neonatal intensive care units or (with respect to rural areas) regional referral centers as identified by the Secretary in regulation) shall not refuse to accept an appropriate transfer of an individual who requires these specialized capabilities or facilities if the hospital has the capacity to treat the individual. The regulations implementing section 1867 of the Act are found at 42 CFR 489.24. 2. Recent Legislation Affecting EMTALA Implementation a. Secretary’s Authority To Waive Requirements During National Emergencies Section 1135 of the Act authorizes the Secretary to temporarily waive or modify the application of several requirements of titles XVIII, XIX, or XXI of the Act (the Medicare, Medicaid, and State Children’s Health Insurance Program provisions) and their implementing regulations in an emergency area during an emergency period. Section 1135(g)(1) of the Act defines an ‘‘emergency area’’ as the geographical area in which there exists an emergency or disaster declared by the President pursuant to the National Emergencies Act or the Robert T. Stafford Disaster Relief and Emergency Assistance Act (subsection A) and a public health emergency declared by the Secretary pursuant to section 247d of Title 42 of the United States Code. Section 1135(g)(1) of the Act also defines an ‘‘emergency period’’ as the period during which such a disaster exists. PO 00000 Frm 00137 Fmt 4701 Sfmt 4702 24815 Section 1135(b) of the Act lists the actions for which the otherwise applicable statutory provisions and implementing regulations may be waived. Included among these actions are, in subparagraph (b)(3)(A), a transfer of an individual who has not been stabilized in violation of the EMTALA requirements restricting transfer until an individual has been stabilized (section 1867(c) of the Act) and, in subparagraph (b)(3)(B), the direction or relocation of an individual to receive medical screening in an alternate location, in accordance with an appropriate State emergency preparedness plan. Section 1135(b) of the Act further states that a waiver or modification provided for under section 1135(b)(3) of the Act shall be limited to a 72-hour period beginning upon implementation of a hospital disaster protocol. All other waivers arising out of section 1135(b) of the Act (except for section 1135(b)(7)) ordinarily may continue in effect for the duration of the declaration of emergency or disaster, or the declaration of a public health emergency, or for 60-day periods as described in section 1135(e)(1) of the Act. To take into account the effect of section 1135 waivers on the EMTALA requirements, § 489.24(a)(2) of our regulations specifies that sanctions under the EMTALA regulations for inappropriate transfer during a national emergency do not apply to a hospital with a dedicated emergency department located in an emergency area, as specified in section 1135(g)(1) of the Act. For further information about section 1135 of the Act and its applicability, we refer readers to the CMS Web site: https://www.cms.hhs.gov/Emergency/ 02—Hurricanes.asp. b. Provisions of the Pandemic and AllHazards Preparedness Act On December 19, 2006, Congress enacted the Pandemic and All-Hazards Preparedness Act, Pub. L. 109–417. Section 302(b) of Pub. L. 109–417 makes two specific changes that affect EMTALA implementation in emergency areas during an emergency period. As noted above, section 1135(b)(3) of the Act authorizes the Secretary to waive sanctions for either the transfer of an unstabilized individual in violation of the requirements of section 1867(c) of the Act where such transfer is necessitated by the circumstances of the declared emergency in the emergency area during the emergency period or the direction or relocation of an individual to receive medical screening in an E:\FEDREG\03MYP2.LOC 03MYP2 24816 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB alternate location in accordance with an appropriate State emergency preparedness plan. Section 302(b)(1)(A) of Pub. L. 109–417 amended section 1135(b)(3)(B) of the Act to state that sanctions for the direction or relocation of an individual for screening may be waived where, in the case of a public health emergency that involves a pandemic infectious disease, that direction or relocation occurs pursuant to a State pandemic preparedness plan or to an appropriate State emergency preparedness plan. In addition, sections 302(b)(1)(B) and (b)(1)(C) of Pub. L. 109– 417 amended section 1135(b) of the Act to state that, if a public health emergency involves a pandemic infectious disease (such as pandemic influenza), the duration of a waiver or modification for such emergency shall be determined in accordance with section 1135(e) of the Act as that subsection applies to public health emergencies. The amendments to section 1135(b) of the Act made by section 302(b) of Pub. L. 109–417 are effective as of the date of enactment of that legislation (December 19, 2006) and apply to public health emergencies declared pursuant to section 247(d) of Title 42 of the United States Code. c. Proposed Revisions to the EMTALA Regulations Currently, the EMTALA regulation at 42 CFR 489.24(a)(2) specifies that sanctions under this section (§ 489.24) for inappropriate transfer during a national emergency do not apply to a hospital with a dedicated emergency department located in an emergency area, as specified in section 1135(g)(1) of the Act. To implement the changes made by section 302(b) of Pub. L. 109– 417 and to ensure that our regulations accurately reflect section 1135 of the Act, we are proposing to make two changes to paragraph (a)(2) of § 489.24. First, we would specify that the sanctions that do not apply are those for either the inappropriate transfer of an individual who has not been stabilized or those for the direction or relocation of an individual to receive medical screening at an alternate location. We also are proposing to revise § 489.24 by adding a second sentence to paragraph (a)(2) to state that a waiver of these sanctions for EMTALA violations is limited to a 72-hour period beginning upon the implementation of a hospital disaster protocol, except that if a public health emergency involves a pandemic infectious disease (such as pandemic influenza), the duration of the waiver will be determined in accordance with subsection (e) of section 1135 of the Act as that subsection applies to public VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 health emergencies. This proposed change would clarify that, in the case of public health emergencies involving pandemic infectious diseases, the waiver of EMTALA sanctions is not limited to 72 hours, but will remain in effect until the termination of the applicable declaration of a public health emergency as described in section 1135(e)(1)(B) of the Act. F. Disclosure of Physician Ownership in Hospitals and Patient Safety Measures 1. Disclosure of Physician Ownership in Hospitals (If you choose to comment on issues in this section, please include the caption ‘‘Physician Ownership in Hospitals’’ at the beginning of your comment.) Section 1866 of the Act states that any provider of services (except a fund designated for purposes of section 1814(g) and section 1835(e) of the Act) shall be qualified to participate in the Medicare program and shall be eligible for Medicare payments if it files a Medicare provider agreement and abides by the requirements applicable to Medicare provider agreements. These requirements are incorporated into our regulations in 42 CFR part 489, subparts A and B (Provider Agreements and Supplier Approval). Section 1861(e) of the Act defines the term ‘‘hospital.’’ Section 1861(e)(9) of the Act defines a hospital and authorizes the Secretary to establish requirements as he finds necessary in the interest of patient health and safety. Section 1820(e)(3) of the Act authorizes the Secretary to establish criteria necessary for an institution to be certified as a critical access hospital. Section 5006 of Pub. L. 109–171 (DRA) required the Secretary to develop a ‘‘strategic and implementing plan’’ to address certain issues related to physician investment in ‘‘specialty hospitals.’’ In the strategic and implementing plan included in our ‘‘Final Report to the Congress and Strategic and Implementing Plan Required under Section 5006 of the Deficit Reduction Act of 2005’’ issued on August 8, 2006 (page 69), available on our Web site at: https://www.cms. hhs.gov/PhysicianSelfReferral/06a— DRA—Reports.asp (hereinafter referred to as the ‘‘DRA Report to Congress’’), we stated that our plan for addressing issues related to physician investment in specialty hospitals involved promoting transparency of investment. Consistent with that approach, we stated that we would adopt a disclosure requirement that would require hospitals to disclose to patients whether PO 00000 Frm 00138 Fmt 4701 Sfmt 4702 they are physician-owned, and if so, disclose the names of the physician owners. Accordingly, we are proposing changes to regulations governing Medicare provider agreements to effectuate this change, under our authority at sections 1861(e)(9), 1820(e) and 1866 of the Act and under our rulemaking authority at sections 1871 and 1102 of the Act. We are seeking comment as to whether these changes best effectuated through changes to the Medicare provider agreement regulations or whether it would be more appropriate to include these changes in the conditions of participation requirements applicable to hospitals and critical access hospitals. Specifically, we are proposing to amend § 489.3 to define a ‘‘physicianowned hospital’’ as any participating hospital (as defined in § 489.24) in which a physician or physicians have an ownership or investment interest. We solicit comments on whether, for purposes of the ownership disclosure requirements only, the definition of ‘‘physician-owned hospital’’ should exclude certain physician ownership or investment interests based on the nature of the interest or the relative size of the interest or the entity’s assets (for example, whether the interest would satisfy the exception at § 4111.356(a) for physician ownership or investment interest in public-traded securities and mutual funds). We are proposing to add a new provision at § 489.20(u)(1) to require that patients be given written notice that a hospital is physician-owned and that the list of physician owners is available upon request. We are proposing to require that the notice, in a manner reasonably designed to be understood by all patients, disclose the fact that the hospital meets the Federal definition of a ‘‘physician-owned hospital’’ and that patients will be provided the list of the hospital’s physician owners upon request. In addition, we are proposing to add a new provision at § 489.20(u)(2) which will require hospitals to require that all physician owners who are also members of the hospital’s medical staff disclose, in writing, their ownership interest in the hospital to all patients they refer to the hospital, as a condition of continued medical staff membership. Patient disclosure would be required at the time a physician makes a referral. We believe that these provisions are in the interest of the health and safety of individuals who are furnished services in these institutions. This notice requirement will permit individuals to make more informed decisions regarding their treatment and to E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB evaluate whether the existence of a financial relationship, in the form of an ownership interest, suggests a conflict of interest that is not in their best interest. In order to enforce these proposed requirements, we are proposing to amend § 489.12 to deny a provider agreement to a hospital that does not have procedures in place to notify patients of physician ownership in the hospital. In addition, we are proposing to amend § 489.53 to permit CMS to terminate a provider agreement with a physician-owned hospital if the hospital fails to comply with the requirements of § 489.20(u). 2. Patient Safety Measures (If you choose to comment on issues in this section, please include the caption ‘‘Patient Safety Measures’’ at the beginning of your comment.) In the DRA Report to Congress (page 67), we stated that it was appropriate to issue further guidance on what we expect of all hospitals with respect to the appraisal, initial treatment, and referral, when appropriate, of patients with medical emergencies. The Medicare hospital conditions of participation regulations at 42 CFR part 482 impose requirements on hospitals that have emergency departments, as well as requirements on hospitals without emergency departments. We believe that hospitals should be required to disclose to patients at the time of inpatient admission or registration for an outpatient service information concerning whether a physician is available on the premises 24 hours a days, 7 days a week. Under the authority at sections 1861(e)(9), 1820(e)(3), 1866, 1871, and 1102 of the Act (described previously), we are proposing to add a new provision at § 489.20(v)(1) to require that hospitals furnish all patients notice at the beginning of their hospital stay or outpatient service if a doctor of medicine or a doctor of osteopathy is not present in the hospital 24 hours per day, 7 days a week, and to describe how the hospital will meet the medical needs of any patient who develops an emergency medical condition, at a time when no physician is present in the hospital. We are seeking comment as to whether this change best effectuated through changes to the Medicare provider agreement regulations or whether it would be more appropriate to include this change in the conditions of participation requirements applicable to hospitals and critical access hospitals. It has also come to our attention that some hospitals have called 9–1–1 when a patient has gone into respiratory arrest, a physician has not been on the VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 premises, and the onsite clinical personnel have lacked the requisite equipment or training to provide the required assessment, initial treatment, and referral that are required of all hospitals. In some cases, required interventions to initiate emergency treatment may be outside the scope of practice of the clinical personnel onsite. This has occurred even in hospitals that operate emergency departments. Therefore, in this proposed rule, we are soliciting comments on whether current requirements for emergency service capability in hospitals with or without emergency departments should be strengthened in certain areas. Specifically, we are seeking feedback on whether present regulatory provisions should be expanded with respect to the type of clinical personnel that must be present at all times in hospitals with and without emergency departments; the competencies that such personnel must demonstrate, such as training in Advanced Cardiac Life Support, or successful completion of specified professional training programs; the type of emergency response equipment that must be available and the manner in which it must be available, such as in each emergency department, or inpatient unit, among others; and whether emergency departments must be operated 24 hours/day, 7 days a week. After evaluating the comments we receive, we will consider whether we should amend the Medicare hospital conditions of participation related to provision of emergency services in hospitals with and without emergency departments. G. Rural Community Hospital Demonstration Program (If you choose to comment on issues in this section, please include the caption ‘‘Rural Community Hospital Demonstration’’ at the beginning of your comments.) In accordance with the requirements of section 410A(a) of Pub. L. 108–173, the Secretary has established a 5-year demonstration program (beginning with selected hospitals’ first cost reporting period beginning on or after October 1, 2004) to test the feasibility and advisability of establishing ‘‘rural community hospitals’’ for Medicare payment purposes for covered inpatient hospital services furnished to Medicare beneficiaries. A rural community hospital, as defined in section 410A(f)(1), is a hospital that— <bullet≤ Is located in a rural area (as defined in section 1886(d)(2)(D) of the Act) or is treated as being located in a rural area under section 1886(d)(8)(E) of the Act; PO 00000 Frm 00139 Fmt 4701 Sfmt 4702 24817 <bullet≤ Has fewer than 51 beds (excluding beds in a distinct part psychiatric or rehabilitation unit) as reported in its most recent cost report; <bullet≤ Provides 24-hour emergency care services; and <bullet≤ Is not designated or eligible for designation as a CAH. As we indicated in the FY 2005 IPPS final rule (69 FR 49078), in accordance with sections 410A(a)(2) and (a)(4) of Pub. L. 108–173 and using 2002 data from the U.S. Census Bureau, we identified 10 States with the lowest population density from which to select hospitals: Alaska, Idaho, Montana, Nebraska, Nevada, New Mexico, North Dakota, South Dakota, Utah, and Wyoming (Source: U.S. Census Bureau Statistical Abstract of the United States: 2003). Nine rural community hospitals located within these States are currently participating in the demonstration program for FY 2008. (Of the 13 hospitals that participated in the first 2 years of the demonstration program, 4 hospitals located in Nebraska have withdrawn from the program; they have become CAHs.) Under the demonstration program, participating hospitals are paid the reasonable costs of providing covered inpatient hospital services (other than services furnished by a psychiatric or rehabilitation unit of a hospital that is a distinct part), applicable for discharges occurring in the first cost reporting period beginning on or after the October 1, 2004, implementation date of the demonstration program. Payments to the participating hospitals will be the lesser amount of the reasonable cost or a target amount in subsequent cost reporting periods. The target amount in the second cost reporting period is defined as the reasonable costs of providing covered inpatient hospital services in the first cost reporting period, increased by the inpatient prospective payment update factor (as defined in section 1886(b)(3)(B) of the Act) for that particular cost reporting period. The target amount in subsequent cost reporting periods is defined as the preceding cost reporting period’s target amount, increased by the inpatient prospective payment update factor (as defined in section 1886(b)(3)(B) of the Act) for that particular cost reporting period. Covered inpatient hospital services are inpatient hospital services (defined in section 1861(b) of the Act), and include extended care services furnished under an agreement under section 1883 of the Act. Section 410A of Pub. L. 108–173 requires that ‘‘in conducting the E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24818 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules demonstration program under this section, the Secretary shall ensure that the aggregate payments made by the Secretary do not exceed the amount which the Secretary would have paid if the demonstration program under this section was not implemented.’’ Generally, when CMS implements a demonstration program on a budget neutral basis, the demonstration program is budget neutral in its own terms; in other words, the aggregate payments to the participating providers do not exceed the amount that would be paid to those same providers in the absence of the demonstration program. This form of budget neutrality is viable when, by changing payments or aligning incentives to improve overall efficiency, or both, a demonstration program may reduce the use of some services or eliminate the need for others, resulting in reduced expenditures for the demonstration program’s participants. These reduced expenditures offset increased payments elsewhere under the demonstration program, thus ensuring that the demonstration program as a whole is budget neutral or yields savings. However, the small scale of this demonstration program, in conjunction with the payment methodology, makes it extremely unlikely that this demonstration program could be viable under the usual form of budget neutrality. Specifically, cost-based payments to the nine participating small rural hospitals are likely to increase Medicare outlays without producing any offsetting reduction in Medicare expenditures elsewhere. Therefore, a rural community hospital’s participation in this demonstration program is unlikely to yield benefits to the participant if budget neutrality were to be implemented by reducing other payments for these providers. In order to achieve budget neutrality for this demonstration program for FY 2008, we are proposing to adjust the national inpatient PPS rates by an amount sufficient to account for the added costs of this demonstration program. We are proposing to apply budget neutrality across the payment system as a whole rather than merely across the participants in this demonstration program. As we discussed in the FY 2005, FY 2006, and FY 2007 IPPS final rules (69 FR 49183; 70 FR 47462; and 71 FR 48100), we believe that the language of the statutory budget neutrality requirements permits the agency to implement the budget neutrality provision in this manner. For FY 2008, using cost report data for FY 2003, adjusted to account for the VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 increased estimated costs for the remaining nine participating hospitals, we estimate that the adjusted amount would be $9,681,893. This proposed estimated adjusted amount reflects the estimated difference between the participating hospitals’ costs and the IPPS payment based on data from the hospitals’ cost reports. We discuss the proposed payment rate adjustment that would be required to ensure the budget neutrality of the demonstration program for FY 2008 in section II.A.4. of the Addendum to this proposed rule. V. Proposed Changes to the IPPS for Capital-Related Costs (If you choose to comment on issues in this section, please include the caption ‘‘Capital IPPS’’ at the beginning of your comment.) A. Background Section 1886(g) of the Act requires the Secretary to pay for the capital-related costs of inpatient acute hospital services ‘‘in accordance with a prospective payment system established by the Secretary.’’ Under the statute, the Secretary has broad authority in establishing and implementing the IPPS for acute care hospital inpatient capitalrelated costs. We initially implemented the IPPS for capital-related costs in the August 30, 1991 IPPS final rule (56 FR 43358), in which we established a 10year transition period to change the payment methodology for Medicare hospital inpatient capital-related costs from a reasonable cost-based methodology to a prospective methodology (based fully on the Federal rate). Federal fiscal year (FFY) 2001 was the last year of the 10-year transition period established to phase in the IPPS for hospital inpatient capital-related costs. For cost reporting periods beginning in FY 2002, capital IPPS payments are based solely on the Federal rate for most acute care hospitals (other than certain new hospitals and hospitals receiving certain exception payments). The basic methodology for determining capital prospective payments using the Federal rate is set forth in § 412.312. For the purpose of calculating payments for each discharge, the standard Federal rate is adjusted as follows: (Standard Federal Rate) x (DRG Weight) x (Geographic Adjustment Factor (GAF)) x (Large Urban Add-on, if applicable) x (COLA for hospitals located in Alaska and Hawaii) x (1 + Capital DSH Adjustment Factor + Capital IME Adjustment Factor, if applicable). Hospitals also may receive outlier payments for those cases that qualify PO 00000 Frm 00140 Fmt 4701 Sfmt 4702 under the threshold established for each fiscal year as specified in § 412.312(c) of the regulations. The regulations at § 412.348(f) provide that a hospital may request an additional payment if the hospital incurs unanticipated capital expenditures in excess of $5 million due to extraordinary circumstances beyond the hospital’s control. This policy was originally established for hospitals during the 10-year transition period, but as we discussed in the August 1, 2002 IPPS final rule (67 FR 50102), we revised the regulations at § 412.312 to specify that payments for extraordinary circumstances are also made for cost reporting periods after the transition period (that is, cost reporting periods beginning on or after October 1, 2001). Additional information on the exception payment for extraordinary circumstances in § 412.348(f) can be found in the FY 2005 IPPS final rule (69 FR 49185 and 49186). During the transition period, under § § 412.348(b) through (e), eligible hospitals could receive regular exception payments. These exception payments guaranteed a hospital a minimum payment percentage of its Medicare allowable capital-related costs depending on the class of hospital (§ 412.348(c)), but were available only during the 10-year transition period. After the end of the transition period, eligible hospitals can no longer receive this exception payment. However, even after the transition period, eligible hospitals receive additional payments under the special exceptions provisions at § 412.348(g), which guarantees all eligible hospitals a minimum payment of 70 percent of its Medicare allowable capital-related costs provided that special exceptions payments do not exceed 10 percent of total capital IPPS payments. Special exceptions payments may be made only for the 10 years from the cost reporting year in which the hospital completes its qualifying project, and the hospital must have completed the project no later than the hospital’s cost reporting period beginning before October 1, 2001. Thus, an eligible hospital may receive special exceptions payments for up to 10 years beyond the end of the capital IPPS transition period. Hospitals eligible for special exceptions payments were required to submit documentation to the intermediary indicating the completion date of their project. (For more detailed information regarding the special exceptions policy under § 412.348(g), refer to the August 1, 2001 IPPS final rule (66 FR 39911 through 39914) and the August 1, 2002 IPPS final rule (67 FR 50102).) E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules Under the IPPS for capital-related costs, § 412.300(b) of the regulations defines a new hospital as a hospital that has operated (under current or previous ownership) for less than 2 years. (For more detailed information, we refer readers to the August 30, 1991 final rule (56 FR 43418).) During the 10-year transition period, a new hospital was exempt from the capital IPPS for its first 2 years of operation and was paid 85 percent of its reasonable costs during that period. Originally, this provision was effective only through the transition period and, therefore, ended with cost reporting periods beginning in FY 2002. Because we believe that special protection to new hospitals is also appropriate even after the transition period, as discussed in the August 1, 2002 IPPS final rule (67 FR 50101), we revised the regulations at § 412.304(c)(2) to provide that, for cost reporting periods beginning on or after October 1, 2002, a new hospital (defined under § 412.300(b)) is paid 85 percent of its Medicare allowable capital-related costs through its first 2 years of operation, unless the new hospital elects to receive fully prospective payment based on 100 percent of the Federal rate. (We refer readers to the August 1, 2001 IPPS final rule (66 FR 39910) for a detailed discussion of the statutory basis for the system, the development and evolution of the system, the methodology used to determine capital-related payments to hospitals both during and after the transition period, and the policy for providing exception payments.) Section 412.374 provides for the use of a blended payment amount for prospective payments for capital-related costs to hospitals located in Puerto Rico. Accordingly, under the capital IPPS, we compute a separate payment rate specific to Puerto Rico hospitals using the same methodology used to compute the national Federal rate for capitalrelated costs. In general, hospitals located in Puerto Rico are paid a blend of the applicable capital IPPS Puerto Rico rate and the applicable capital IPPS Federal rate. Prior to FY 1998, hospitals in Puerto Rico were paid a blended capital IPPS rate that consisted of 75 percent of the capital IPPS Puerto Rico specific rate and 25 percent of the capital IPPS Federal rate. However, effective October 1, 1997 (FY 1998), in conjunction with the change to the operating IPPS blend percentage for Puerto Rico hospitals required by section 4406 of Pub. L. 105– 33, we revised the methodology for computing capital IPPS payments to hospitals in Puerto Rico to be based on a blend of 50 percent of the capital IPPS Puerto Rico rate and 50 percent of the VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 capital IPPS Federal rate. Similarly, in conjunction with the change in operating IPPS payments to hospitals in Puerto Rico for FY 2005 required by section 504 of Pub. L. 108–173, we again revised the methodology for computing capital IPPS payments to hospitals in Puerto Rico to be based on a blend of 25 percent of the capital IPPS Puerto Rico rate and 75 percent of the capital IPPS Federal rate effective for discharges occurring on or after October 1, 2004. B. Proposed Policy Change As we have noted above, the Secretary has broad authority under the statute in establishing and implementing the IPPS for hospital inpatient capital-related costs. We initially exercised that authority in the August 30, 1991 IPPS final rule (56 FR 43358). Among other provisions of that rule, we established the 10-year transition period to change the payment methodology for Medicare hospital inpatient capital-related costs from a reasonable cost-based methodology to a prospective methodology (based fully on the Federal rate). The purpose of that lengthy transition was to allow hospitals sufficient time to adjust to payment under a fully prospective system based on a uniform national rate. In that rule, we also established the initial standard Federal payment rate for capital-related costs, as well as the mechanism for updating that rate in subsequent years. For FY 1992, we computed the standard Federal payment rate for capital-related costs under the IPPS by updating the FY 1989 Medicare inpatient capital cost per case by an actuarial estimate of the increase in Medicare inpatient capital costs per case. Each year after FY 1992, we update the capital standard Federal rate, as provided at § 412.308(c)(1), to account for capital input price increases and other factors. The regulations at § 412.308(c)(2) provide that the capital Federal rate is adjusted annually by a factor equal to the estimated proportion of outlier payments under the capital Federal rate to total capital payments under the capital Federal rate. In addition, § 412.308(c)(3) requires that the capital Federal rate be reduced by an adjustment factor equal to the estimated proportion of payments for (regular and special) exceptions under § 412.348. Section 412.308(c)(4)(ii) requires that the capital standard Federal rate be adjusted so that the effects of the annual DRG reclassification and the recalibration of DRG weights and changes in the geographic adjustment factor are budget neutral. Since the implementation of the IPPS for hospital inpatient capital-related costs, we have carefully monitored the PO 00000 Frm 00141 Fmt 4701 Sfmt 4702 24819 adequacy of the standard Federal payment rate for capital-related costs and the updates provided under the existing regulations. On several occasions, the standard Federal payment rate has been adjusted. Section 1886(g)(1)(A) of the Act required a 7.4 percent reduction to the capital rate for discharges occurring after September 30, 1993. (We implemented that reduction to the rate in § 412.308(b)(2) of our regulations, effective in FY 1994.) Section 412.308(b)(3) of the regulations describes the 0.28 percent reduction to the capital rate made in FY 1996 as a result of the revised policy of paying for transfers. In FY 1998, we implemented section 4402 of Pub. L. 105–33, which required that, for discharges occurring on or after October 1, 1997, and before October 1, 2002, the unadjusted capital standard Federal rate be reduced by 17.78 percent (above the previous statutory reduction of 7.4 percent). (As a result of that reduction, the FY 1998 standard Federal payment rate for capital-related costs was $371.51, compared to $438.92 in FY 1997.) As we discussed in the FY 2003 IPPS final rule (67 FR 50102) and implemented in § 412.308(b)(6), a small part of that reduction was restored effective October 1, 2002. In general, under a PPS, standard payment rates should reflect the costs that an average, efficient provider would bear to provide the services required for quality patient care. Payment rate updates should also account for the changes necessary to continue providing such services. Updates should reflect, for example, the increased costs that are necessary to provide for the introduction of new technology that improves patient care. Updates should also take into account the productivity gains that, over time, allow providers to realize the same, or even improved, quality outcomes with reduced inputs and lower costs. Hospital margins, the difference between the costs of actually providing services and the payments received under a particular system, thus provide some evidence concerning whether payment rates have been established and updated at an appropriate level over time for efficient providers to provide necessary services. All other factors being equal, sustained substantial positive margins may suggest that payment rates and updates have exceeded what is required to provide those services. It is to be expected, under a PPS, that highly efficient providers might regularly realize positive margins, while less efficient providers might regularly E:\FEDREG\03MYP2.LOC 03MYP2 24820 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules realize negative margins. However, a PPS that is correctly calibrated should not necessarily experience sustained periods in which providers generally realize substantial positive Medicare margins. Under the capital IPPS in particular, it seems especially appropriate that there should not be sustained significant positive margins across the system as a whole. Prior to the implementation of the capital IPPS, Congress mandated that the Medicare program pay only 85 percent of hospitals’ inpatient Medicare capital costs. During the first 5 years of the capital IPPS, Congress also mandated a budget neutrality adjustment, under which the standard Federal capital rate was set each year so that payments under the system as a whole equaled 90 percent of estimated hospitals’ inpatient Medicare capital costs for the year. Finally, as we discussed above, Congress has twice adjusted the standard Federal capital rate (a 7.4 percent reduction beginning in FY 1994, followed by a 17.78 percent reduction beginning in FY 1998). On the second occasion in particular, the specific congressional mandate was ‘‘to apply the budget neutrality factor used to determine the Federal capital payment rate in effect on September 30, 1995 * * * to the unadjusted standard Federal capital payment rate’’ for FY 1998 and beyond. (The designated budget neutrality factor constituted a 17.78 percent reduction.) This statutory language indicates that Congress considered the payment levels in effect during FYs 1992 through 1995, established under the budget neutrality provision to pay 90 percent of hospitals’ inpatient Medicare capital costs in the aggregate, appropriate for the capital IPPS. The statutory history of the capital IPPS thus suggests that the system in the aggregate should not provide for continuous, large positive margins. In analyzing the adequacy of the existing capital IPPS rates, we recently conducted a comprehensive review of hospital experience under the IPPS for hospital inpatient capital-related costs, with particular attention to the relationship between acute care hospital capital Medicare costs and payments under the capital IPPS. Specifically, we examined the relationship between the Medicare inpatient capital costs of hospitals that are paid under the IPPS for hospital inpatient capital-related costs and their payments under that system over a number of years. We derived both cost and revenue data from the Medicare cost report. Specifically, cost data were derived from Worksheet D, Part I, columns 10 and 12 and Part II, columns 6 and 8, and revenue data from Worksheet E, Part A, Lines 9 and 10. We began our analysis with FY 1996, the year in which the statutory budget neutrality provision expired. (As we have discussed, for FYs 1992 through 1995, section 1886(g)(1)(A) of the Act required that the capital Federal rate also be adjusted by a budget neutrality factor so that aggregate payments for inpatient hospital capital costs were projected to equal 90 percent of the payments that would have been made for capital-related costs on a reasonable cost basis during the fiscal year. As discussed in section III. of the Addendum to this proposed rule, we employed an actuarial capital cost model (described in Appendix B of the FY 2002 IPPS final rule (66 FR 40099)) to estimate the aggregate payments that would have been made on the basis of reasonable cost in order to determine the required budget neutrality adjustment. As a result of the expiration of the budget neutrality provision, the standard Federal payment rate for capital-related costs increased to $461.96 in FY 1996 from $376.83 in FY 1995.) Our analysis extended through FY 2004, the most recent year for which we have relatively complete cost report information. We examined data across all hospitals subject to the capital IPPS and across the categories of hospitals (for example, urban and rural, and teaching and nonteaching) that we normally employ in conducting impact analyses. Specifically, we looked at the difference between aggregate hospital revenues from the capital IPPS and hospitals’ aggregate Medicare inpatient capital costs. We determined the inpatient hospital Medicare capital margins for each year of the period from FY 1996 through FY 2004. (A margin is calculated as the difference between payments and costs, divided by payments.) We similarly calculated the aggregate margins for the period (the aggregate difference between payments and costs over the period, divided by total payments over the period). We also calculated aggregate margins for the period FY 1998 through FY 2004 (excluding FY 1996 and 1997). As a result of the expiration of the statutory budget neutrality provision, the capital standard Federal rate increased to $461.96 in FY 1996 from $376.83 in FY 1995. The capital standard Federal rate was $438.92 in FY 1997, before it was reduced to $371.51 in FY 1998 under section 4402 of Pub. L. 105–33, which required that the unadjusted capital standard Federal rate be reduced by 17.78 percent. The capital standard Federal rates for FYs 1996 and 1997 were thus substantially higher than the rates for the periods immediately preceding those years, and in the subsequent years (FY 1998 and beyond). The margins for those years are correspondingly higher than the margins for the other years in the period, and thus it could be argued that the margins for FYs 1996 and 1997 are unrepresentative. The table below summarizes the findings of this analysis. HOSPITAL INPATIENT MEDICARE CAPITAL MARGINS mmaher on DSK3CLS3C1PROD with $$_JOB 1996 U.S. .................................................... URBAN ........................................ RURAL ........................................ No DSH Payments ............................. Has DSH Payments ........................... $1–$249,999 ............................... $250,000–$999,999 .................... $1,000,000–$2,999,999 .............. $3,000,000 or more .................... TEACHING ......................................... NON-TEACHING ................................ Census Division: New England (1) ......................... Middle Atlantic (2) ....................... South Atlantic (3) ........................ East North Central (4) ................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 1997 1998 1999 2000 2001 2002 2003 2004 1996–2004 1998–2004* 17.5 17.6 17.2 16.2 18.3 14.5 15.5 16.8 20.1 19.4 15.3 13.4 13.8 11.1 11.8 14.4 12.9 9.3 12.8 16.6 15.7 10.5 7.0 7.8 2.0 4.4 8.5 -0.4 2.2 8.5 10.4 9.8 3.3 6.8 7.4 2.7 4.4 8.1 3.1 1.5 9.2 9.1 9.7 2.9 7.3 8.3 1.3 5.6 8.2 1.6 3.0 8.6 9.7 11.1 2.2 7.9 8.9 1.5 5.6 8.7 4.2 2.5 7.2 11.6 11.7 2.8 8.7 10.3 -1.7 5.0 9.9 2.5 -1.2 9.0 13.4 13.9 1.6 7.7 9.1 -1.2 4.8 8.6 0.6 0.2 4.6 12.5 13.2 0.2 5.1 6.3 -2.9 -0.9 6.7 -3.5 -3.8 3.0 10.1 11.3 -3.2 9.0 9.9 3.4 6.9 9.9 3.3 2.9 8.7 12.4 12.9 3.9 7.2 8.3 0.26 4.2 8.4 1.8 0.5 7.1 11.1 11.6 1.3 26.9 19.1 17.9 18.2 25.8 15.5 13.9 12.7 17.0 11.0 5.8 6.2 15.1 11.5 3.9 7.2 18.2 13.8 5.9 8.8 20.5 16.3 5.2 8.6 21.3 18.4 6.3 6.3 21.2 17.9 7.5 8.1 20.5 15.0 4.9 7.1 20.9 15.5 7.9 9.2 19.3 15.0 5.7 7.5 PO 00000 Frm 00142 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 24821 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules HOSPITAL INPATIENT MEDICARE CAPITAL MARGINS—Continued % 1996 East South Central (5) ................ West North Central (6) ................ West South Central (7) ............... Mountain (8) ................................ Pacific (9) .................................... Code 99 ...................................... Bed Size: < 100 beds .................................. 100–249 beds ............................. 250–499 beds ............................. 500–999 beds ............................. ≤= 1000 beds .............................. 1997 1998 1999 2000 2001 2002 2003 2004 1996–2004 1998–2004* 14.8 14.2 13.3 17.3 20.5 24.1 11.1 6.9 8.3 14.8 16.1 26.1 3.3 0.0 3.4 8.4 12.4 14.9 4.1 -0.4 3.1 7.6 11.3 16.7 3.4 -1.6 0.6 7.4 11.5 20.0 2.9 1.9 0.1 6.4 12.8 20.9 3.0 2.6 1.4 3.2 15.5 20.6 -1.8 3.3 -1.2 3.1 12.8 25.2 -4.2 1.1 -4.2 0.7 9.2 22.3 3.9 3.2 2.5 7.2 13.5 21.4 1.4 1.1 0.3 4.9 12.2 20.3 17.7 15.1 18.9 19.7 8.2 13.0 10.6 14.0 17.5 13.8 4.7 3.5 8.7 11.1 2.1 3.5 4.5 8.3 10.3 0.2 2.8 4.7 10.4 10.7 -6.6 2.5 6.0 10.5 10.4 -3.5 -1.7 6.1 11.7 12.5 8.7 -1.3 4.5 11.6 10.3 6.3 -5.6 1.1 10.6 6.8 1.4 3.5 6.2 11.7 12.0 3.1 0.5 4.4 10.4 10.2 1.8 mmaher on DSK3CLS3C1PROD with $$_JOB Notes: * Excluding 1996 and 1997. Based on Medicare Cost Report hospital data updated as of the 4th quarter of 2006. Revenue are from Worksheet E, Part A, Lines 9 and 10. Expenses are from Worksheet D, Part I, columns 10 and 12 and Part II, columns 6 and 8. We apply the outlier trimming methodology developed by MedPAC. As the table shows, hospital inpatient Medicare capital margins have been very high across all hospitals during the period from FY 1996 through FY 2004. The margin for the entire period was 9.0 percent (7.2 percent, excluding FYs 1996 and 1997). For particular years, margins across all hospitals ranged from a high of 17.5 percent in FY 1996 to a low 5.1 percent in FY 2004. While the margins fell after a high in FY 1996 of 17.5 to 6.8 percent in FY 1999, they rose again to 8.7 percent in FY 2002 before declining modestly to 5.1 percent in FY 2004. There are similar results among most types of hospitals and groupings of hospitals by geographic region. For example, teaching hospitals have realized margins of 12.9 percent (11.6 percent, excluding FYs 1996 and 1997) during the period from FY 1996 through FY 2004, with a high margin of 19.4 percent in FY 1996 and a low margin of 9.7 percent in FY 1999. Urban hospitals realized margins of 9.9 percent during the period from FY 1996 through FY 2004 (8.3 percent, excluding FYs 1996 and 1997). DSH hospitals realized margins of 9.9 percent over the period (8.4 percent, excluding FYs 1996 and 1997), while non-DSH had aggregate margins of 6.9 percent (4.2 percent, excluding FYs 1996 and 1997). During the period from FY 1996 through FY 2004, every type of hospital and geographic grouping of hospitals has realized a positive aggregate margin from their capital IPPS payments. Of course, the aggregate capital margins for some types of hospitals have been lower than the margins for others. In particular, inpatient hospital Medicare capital margins for rural hospitals have lagged considerably behind the margins for urban hospitals. The aggregate VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 margin for rural hospitals during the period from FY 1996 through FY 2004 was 3.4 percent (0.2 percent, excluding FYs 1996 and 1997), compared to 9.9 percent for urban hospitals and 9.0 percent for all hospitals. Rural hospitals have even experienced negative margins during several years of the period (-1.7 percent in FY 2002, -1.2 percent in FY 2003, and -2.9 percent in FY 2004). Similarly, nonteaching hospitals have experienced lower margins than teaching hospitals. Teaching hospitals have experienced an aggregate margin of 12.9 percent during the period from FY 1996 through FY 2004 (11.6 percent, excluding FYs 1996 and 1997). However, nonteaching hospitals have experienced an aggregate margin of 3.9 percent during that period (1.3 percent, excluding FYs 1996 and 1997). There may be various factors reflected in these margins. For example, one factor in the lower margins experienced by rural hospitals may be the transition of many rural hospitals to CAHs that are paid outside the IPPS. The number of rural hospitals in our analysis fell from 2,243 in FY 1996 to 1,211 in FY 2004, as the inpatient Medicare capital margins realized by rural hospitals fell from 17.2 percent to -2.9 percent. This suggests that more rural hospitals with relatively higher inpatient Medicare capital margins have made the transition to CAH status. However, it remains to be seen whether this trend in inpatient Medicare capital margins will continue as the relative numbers of CAHs and rural hospitals subject to the IPPS stabilize. The low aggregate for nonteaching hospitals is largely a function of the effect of the low, and for some years even negative, margin of the rural hospitals, as discussed earlier. PO 00000 Frm 00143 Fmt 4701 Sfmt 4702 We believe that there could be a number of reasons for the relatively high margins that most IPPS hospitals have realized under the capital IPPS. One possibility is that the updates to the capital IPPS rates have been higher than the actual increases in Medicare inpatient capital costs that hospitals have experienced in recent years. As we discuss in section III. of the Addendum to this proposed rule, we update the capital standard Federal rate on the basis of an analytical framework that takes into account changes in a capital input price index (CIPI) and several other policy adjustment factors. Specifically, we have adjusted the projected CIPI rate-of-increase as appropriate each year for case-mix index-related changes, for intensity, and for errors in previous CIPI forecasts. Under the framework that we have been using, the update factor for FY 2008 would be 0.8 percent, based on the best data available at this time. That update factor is derived from a projected 1.2 percent increase in the CIPI, a 0.0 percent adjustment for intensity, a 0.0 percent adjustment for case-mix, a -0.4 percent adjustment for the FY 2005 DRG reclassification and recalibration, and a forecast error correction of 0.0 percent. We discuss this update framework, and the computation of the policy adjustment factors, in section III. of the Addendum to this proposed rule. We believe that the CIPI is the most appropriate input price index for capital costs to measure capital price changes in a given year. We also believe that the update framework successfully captures several factors that should be taken into account in determining appropriate updates for hospitals subject to the capital IPPS. However, there may be factors affecting the rate-of-increase in E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24822 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules capital costs that are not yet captured in our analytical framework. For example, hospitals may be experiencing productivity gains in their use of capital equipment. As productivity increases, hospitals would be able to reduce the number of inputs required to produce a unit of service. MedPAC has taken the position that payment ‘‘rate for health care providers should be set so that the Federal Government benefits from providers’ productivity gains, just as private purchasers of goods in competitive markets benefit from the productivity gains of their suppliers.’’ MedPAC has, therefore, included a productivity improvement target in its framework for updating Medicare hospital payments on the grounds that ‘‘as a prudent purchaser, Medicare should also require some productivity gains each year from its providers.’’ (MedPAC, Report to Congress, March 2006, p. 66) While we have not as yet included a specific productivity factor, such as MedPAC’s productivity improvement target, in our analytical frameworks for updating the IPPS payment rates, we will continue to study the appropriateness of adopting such a measure. Another possible reason for the relatively high margins of most capital IPPS hospitals may be that the payment adjustments provided under the system are too high, or perhaps even unnecessary. Specifically, the adjustments for teaching hospitals, disproportionate share hospitals, and large urban hospitals appear to be contributing to excessive payment levels for these classes of hospitals. Since the inception of the capital IPPS in FY 1992, the system has provided adjustments for teaching hospitals (the IME adjustment factor, under § 412.322 of the regulations), disproportionate share hospitals (the DHS adjustment factor, under § 412.320), and large urban hospitals (the large urban location adjustment factor, under § 412.316((b)). The classes of hospitals eligible for these adjustments have been realizing much higher margins than other hospitals under the system. Specifically, teaching hospitals (11.6 percent for FYs 1998 through 2004), urban hospitals (8.3 percent), and disproportionate share hospitals (8.4 percent) have significant positive margins. Other classes of hospitals have experienced much lower margins, especially rural hospitals (0.2 percent for FYs 1998 through 2004) and nonteaching hospitals (1.3 percent). The three groups of hospitals that have been realizing especially high margins under the capital IPPS are, therefore, classes of hospitals that are eligible to receive one VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 or more specific payment adjustments under the system. We believe that the evidence indicates that these adjustments have been contributing to the significantly large positive margins experienced by the classes of hospitals eligible for these adjustments. We believe that the data on inpatient hospital Medicare capital margins, as discussed above, provide sufficient evidence that some adjustment of the updates under the capital IPPS is warranted at this time. In light of the significant disparities in the margin performances of different classes of hospitals, we do not believe that an adjustment to the updates for FYs 2008 and 2009 should apply equally to all hospitals that are paid under the capital IPPS. In particular, an adjustment to the updates should take into account the much lower margins of rural hospitals (0.2 percent for the period from FY 1998 through FY 2004) compared to urban hospitals (8.3 percent during that period). We also believe that any initial adjustment to the rate should be relatively modest. One reason is that any adjustment should avoid unwarranted disruption to hospital finances: because of the nature of capital spending, long periods of time can be necessary for hospitals to adjust adequately to significant changes in payment. Therefore, for FYs 2008 and 2009, we are proposing that the update to the capital standard Federal rate for urban hospitals will be 0.0 percent, in place of the 0.8 percent update that would otherwise be provided in FY 2008 under the update framework that we have been employing. (We have not yet determined the update that would be provided for FY 2009 under the framework.) However, in light of the margin analysis, we are also proposing to give rural hospitals the full 0.8 percent update determined by the update framework in FY 2008. We anticipate that we will provide the full update to rural hospitals in FY 2009 as well, once we have determined what the update would be under the update framework. We are proposing to revise § 412.308(c)(1) of the regulations accordingly. For purposes of the update in FYs 2008 and 2009, an urban hospital is any hospital located in an area that meets the definitions under § 412.64(b)(1)(ii)(A) or (b)(1)(ii)(B), or § 412.64(b)(3). A rural hospital is any hospital that does not meet those definitions, or that is reclassified as rural under § 412.103. For subsequent years, we will continue to analyze the data concerning the adequacy of payments under the capital IPPS, and we may propose additional adjustments, PO 00000 Frm 00144 Fmt 4701 Sfmt 4702 positive or negative, as they are warranted. We will also continue to study our update framework and will consider whether adoption of additional or revised adjustments to account for other factors affecting capital cost changes may be warranted. In addition, we are also proposing to eliminate, for FYs 2008 and beyond, one of the payment adjustments that has been provided under the capital IPPS. Specifically, we are proposing to discontinue the 3.0 percent additional payment that has been provided to hospitals located in large urban areas. The consistent and significant positive margin of hospitals located in urban areas is strong evidence that it is not necessary to continue this adjustment. Therefore, we are proposing to amend § 412.316(b) of the regulations to provide that, effective for discharges on or after October 1, 2007, there will no longer be any additional payment for hospitals located in large urban areas, as currently provided under that section. When the payment adjustments were instituted at the inception of the program, the initial standard Federal payment rate was adjusted in a budget-neutral fashion to account for the expenditures that would be required by these adjustments. However, in light of the strong overall positive margins across the system, we are proposing not to increase the standard capital rate to account for expenditures otherwise payable due to this adjustment (approximately $147 million). Rather, in light of the excessive capital IPPS payments over the period of FYs 1996 through 2004, we believe that it is appropriate for the program to realize savings from this proposal. We will also continue to study the adequacy of payments under the capital IPPS, and will consider whether it is appropriate to make further adjustments to the standard Federal capital rate and updates of the rate. While we are formally proposing an update of 0.0 percent for urban hospitals, an update of 0.8 percent for rural hospitals in FY 2008, and elimination of the large urban add-on, we are also soliciting comment on additional adjustments to the capital payment structure. As we have noted above, the margin analysis indicates that several classes of hospitals have continuous, significant positive margins. The analysis indicates that the existing payment adjustments for teaching hospitals and disproportionate share hospitals are contributing to excessive payment levels for these classes of hospitals. Therefore, it may be appropriate to reduce these adjustments significantly, or even to eliminate them altogether, within the capital IPPS. E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules These payment adjustments, unlike the parallel adjustments under the operating IPPS, were not mandated by the Act. Rather, they were included within the original design of the capital IPPS under the Secretary’s broad authority under sections 1886(g)(1)(A) and (g)(1)(B) of the Act to include appropriate adjustments and exceptions within a capital IPPS. Therefore, we are considering whether it may be appropriate to develop a proposal to reduce or to terminate these payment adjustments in the near future. It is difficult to justify indefinite continuation of these adjustments in the light of the continuous, substantial positive margins realized by the classes of hospitals that qualify for them. When the payment adjustments were instituted at the inception of the program, the initial standard Federal payment rate was adjusted in a budgetneutral fashion to account for the expenditures that would be required by these adjustments. Therefore, if we decide to propose to reduce or eliminate these adjustments, we will also consider whether we should similarly adjust the Federal capital payment rate to account for all or a portion of these adjustments, effectively increasing the base payment rate for all hospitals (including rural, nonteaching, and non-DSH hospitals that do not benefit from these adjustments), while removing these special adjustments for the hospitals that have been eligible to receive them. We are also considering whether, in light of the substantial positive margins experienced by these teaching and DSH hospitals, the discontinuation of these adjustments should not result in a change to the standard capital rate and should instead result in savings to the program. We welcome comments on these potential proposals and on other means of appropriately adjusting and targeting payments under the capital IPPS, as well as on the proposals that we are formally making in this proposed rule. mmaher on DSK3CLS3C1PROD with $$_JOB VI. Proposed Changes for Hospitals and Hospital Units Excluded From the IPPS (If you choose to comment on the issues in this section, please include the caption ‘‘Excluded Hospitals and Hospital Units’’ at the beginning of your comment.) A. Payments to Existing and New Excluded Hospitals and Hospital Units Historically, hospitals and hospital units excluded from the prospective payment system received payment for inpatient hospital services they furnished on the basis of reasonable costs, subject to a rate-of-increase VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 ceiling. An annual per discharge limit (the target amount as defined in § 413.40(a)) was set for each hospital or hospital unit based on the hospital’s own cost experience in its base year. The target amount was multiplied by the Medicare discharges and applied as an aggregate upper limit (the ceiling as defined in § 413.40(a)) on total inpatient operating costs for a hospital’s cost reporting period. Prior to October 1, 1997, these payment provisions applied consistently to all categories of excluded providers (rehabilitation hospitals and units (now referred to as IRFs), psychiatric hospitals and units (now referred to as IPFs), LTCHs, children’s hospitals, and cancer hospitals). Payment for children’s hospitals and cancer hospitals that are excluded from the IPPS continues to be subject to the rate-of-increase ceiling based on the hospital’s own historical cost experience. (We note that, in accordance with § 403.752(a) of the regulations, RNHCIs are also subject to the rate-ofincrease limits established under § 413.40 of the regulations. IRFs, IPFs, and LTCHs were paid previously under the reasonable cost methodology. However, the statute was amended to provide for the implementation of prospective payment systems for IRFs, IPFs, and LTCHs. In general, the prospective payment systems for IRFs, IPFs, and LTCHs provide(d) transition periods of varying lengths during which time a portion of the prospective payment is (was) based on cost-based reimbursement rules under Part 413 (certain providers do not receive a transition period or may elect to bypass the transition as applicable under Subparts N, O, and P). We note that the various transition periods provided for under the IRF PPS, IPF PPS, and LTCH PPS have ended or will soon end.) For cost reporting periods beginning on or after October 1, 2002, all IRFs are paid 100 percent of the adjusted Federal rate under the IRF PPS. Therefore, for cost reporting periods beginning on or after October 1, 2002, no portion of an IRF PPS payment is subject to Part 413. Similarly, for cost reporting periods beginning on or after October 1, 2006, all LTCHs are paid 100 percent of the adjusted Federal rate under the LTCH PPS. Therefore, for cost reporting periods beginning on or after October 1, 2006, no portion of the LTCH PPS payment is subject to 42 CFR part 413. However, except as provided in § 412.426(c), IPFs remain under a blend methodology for cost reporting periods beginning on or after January 1, 2005, and before January 1, 2008. For IPFs paid under the blend methodology, the portion of the IPF PPS PO 00000 Frm 00145 Fmt 4701 Sfmt 4702 24823 payment that is based on reasonable cost principles is subject to the rules of 42 CFR part 413. In order to calculate the portion of the PPS payment that is based on reasonable cost principles, it is necessary to determine whether the IPF would be considered ‘‘existing’’ for purposes of section 1886(b)(3)(H) of the Act or ‘‘new’’ for purposes of section 1886(b)(7) of the Act. We note that readers should not confuse an IPF that is considered ‘‘new’’ for purposes of section 1886(b)(7) of the Act and § 413.40(f)(2)(ii) of the regulations with an IPF that is considered ‘‘new’’ under § 412.426(c) of the reguations. Any IPF that, under present or previous ownership or both, has its first cost reporting period as an IPF beginning on or after January 1, 2005, is considered ‘‘new’’ for purposes of § 412.426(c). An IPF that is considered ‘‘new’’ under § 412.426(c) is paid based on 100 percent of the Federal per diem payment amount. Consequently, only those IPFs considered ‘‘new’’ under section 1886(b)(7) of the Act, but not ‘‘new’’ under § 412.426(c) of the regulations will be paid under a PPS blended payment methodology. An IPF considered ‘‘new’’ for purposes of § 413.40(f)(2)(ii) would have its ‘‘reasonable cost-based’’ portion of its prospective payment subject to § 413.40(f)(2)(ii) and § 413.40(c)(4)(v), as applicable. An IPF considered ‘‘new’’ for purposes of section 1886(b)(7) of the Act has the target amount for its third cost reporting period determined in accordance with sections 1886(b)(7)(A)(ii) and 1886(b)(3)(A)(ii) of the Act. For the fourth and subsequent cost reporting periods, the target amount is calculated in accordance with section 1886(b)(3)(A)(ii) of the Act. An IPF that would be considered ‘‘existing’’ for purposes of section 1886(b)(3)(H) of the Act has the target amount for the ‘‘reasonable cost-based’’ portion of its prospective payment determined in accordance with section 1886(b)(3)(A)(ii) of the Act and the regulations at § 413.40(c)(4)(ii). We are proposing that the applicable percentage increase to update the target amount for the reasonable cost-based portion of the PPS payment of an IPF that is considered existing under section 1886(b)(3)(H) of the Act or new under section 1886(b)(7) of the Act, but not new under § 412.426(c), is 3.4 percent. (However, if more current data become available prior to publication of the final rule, we will use those data for updating the market basket.) B. Separate PPS for IRFs Section 1886(j) of the Act, as added by section 4421(a) of Pub. L. 105–33, E:\FEDREG\03MYP2.LOC 03MYP2 24824 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules provided for a phase-in of a case-mix adjusted PPS for inpatient hospital services furnished by IRFs for cost reporting periods beginning on or after October 1, 2000, and before October 1, 2002, with payments based entirely on the adjusted Federal prospective payment for cost reporting periods beginning on or after October 1, 2002. Section 1886(j) of the Act was amended by section 125 of Pub. L. 106–113 to require the Secretary to use a discharge as the payment unit under the PPS for inpatient hospital services furnished by IRFs and to establish classes of patient discharges by functional-related groups. Section 305 of Pub. L. 106–554 further amended section 1886(j) of the Act to allow IRFs, subject to the blend methodology, to elect to be paid the full Federal prospective payment rather than the transitional period payments specified in the Act. On August 7, 2001, we issued a final rule in the Federal Register (66 FR 41316) establishing the PPS for IRFs, effective for cost reporting periods beginning on or after January 1, 2002. There was a transition period for cost reporting periods beginning on or after January 1, 2002, and ending before October 1, 2002. For cost reporting periods beginning on or after October 1, 2002, payments are based entirely on the adjusted Federal prospective payment rate determined under the IRF PPS. mmaher on DSK3CLS3C1PROD with $$_JOB C. Separate PPS for LTCHs On August 30, 2002, we issued a final rule in the Federal Register (67 FR 55954) establishing the PPS for LTCHs, effective for cost reporting periods beginning on or after October 1, 2002. Except for a LTCH that made an election under § 412.533(c) or a LTCH that is defined as new under § 412.23(e)(4), there was a transition period for cost reporting periods beginning on or after October 1, 2002, and ending before October 1, 2007. For cost reporting periods beginning on or after October 1, 2006, total LTCH PPS payments are based on 100 percent of the Federal rate. D. Separate PPS for IPFs In accordance with section 124 of Pub. L. 106–113 and section 405(g)(2) of Pub. L. 108–173, we established a PPS for inpatient hospital services furnished in IPFs. On November 15, 2004, we issued in the Federal Register a final rule (69 FR 66922) that established the IPF PPS, effective for IPF cost reporting periods beginning on or after January 1, 2005. Under the final rule, we compute a Federal per diem base rate to be paid to all IPFs for inpatient psychiatric services based on the sum of the average VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 routine operating, ancillary, and capital costs for each patient day of psychiatric care in an IPF, adjusted for budget neutrality. The Federal per diem base rate is adjusted to reflect certain patient characteristics, including age, specified DRGs, selected high-cost comorbidities, days of the stay, and certain facility characteristics, including a wage index adjustment, rural location, indirect teaching costs, the presence of a fullservice emergency department, and COLAs for IPFs located in Alaska and Hawaii. We have established a 3-year transition period during which IPFs whose first cost reporting periods began before January 1, 2005, will be paid based on a blend of reasonable costbased payment and IPF PPS payments. For cost reporting periods beginning on or after January 1, 2008, all IPFs will be paid 100 percent of the Federal per diem payment amount. E. Determining Proposed LTCH Cost-toCharge Ratios (CCRs) Under the LTCH PPS (If you choose to comment on the issues in this section, please include the caption ‘‘LTCH PPS CCRs and Outlier Payments’’ at the beginning of your comment.) In determining both high-cost outlier and short-stay outlier payments under the LTCH PPS (at § 412.525(a) and § 412.529, respectively), we calculate the estimated cost of the case by multiplying the LTCH’s overall CCR by the Medicare allowable charges for the case. Under the LTCH PPS, a single prospective payment per discharge is made for both inpatient operating and capital-related costs, and, therefore, we compute a single ‘‘overall’’ or ‘‘total’’ LTCH-specific CCR based on the sum of LTCH operating and capital costs (as described in Chapter 3, section 150.24, of the Medicare Claims Processing Manual (CMS Pub. 100–4)) as compared to total charges. Specifically, a LTCH’s CCR is calculated by dividing a LTCH’s total Medicare costs (that is, the sum of its operating and capital inpatient routine and ancillary costs) by its total Medicare charges (that is, the sum of its operating and capital inpatient routine and ancillary charges) (72 FR 48117). In the June 9, 2003 IPPS high-cost outlier final rule (68 FR 34498), we made revisions to our policies concerning the determination of LTCHs’ CCRs and the reconciliation of high-cost outlier and short-stay outlier payments under the LTCH PPS. As we stated in that final rule (68 FR 34507), because the LTCH PPS high-cost outlier and short-stay outlier policies are modeled after the IPPS outlier policy, we believe PO 00000 Frm 00146 Fmt 4701 Sfmt 4702 they are susceptible to the same payment vulnerabilities. In the FY 2007 IPPS final rule (71 FR 48115 through 48122), we amended our regulations and, for discharges occurring on or after October 1, 2006, refined the methodology for determining the annual CCR ceiling and statewide average CCRs. We also codified, with modifications and editorial clarifications, our policy for the reconciliation of high-cost outlier and short-stay outlier payments under the LTCH PPS. We indicated that because, historically, updates to the LTCH PPS CCR ceiling and statewide average CCRs have been effective on October 1, we would make these updates (and include relevant impact data) as a part of the IPPS rulemaking cycle. Specifically, in the FY 2007 IPPS final rule (71 FR 48117 through 48121), under the broad authority of section 123 of Pub. L. 106–113 and section 307(b)(1) of Pub. L. 106–554, we established under the LTCH PPS high-cost outlier policy at § 412.525(a)(4)(iv)(C) and the LTCH PPS short-stay outlier policy at § 412.529(c)(3)(iv)(C), for discharges occurring on or after October 1, 2006, that the fiscal intermediary (or currently the MAC, if applicable) may use a statewide average CCR, which is established annually by CMS, if it is unable to determine an accurate CCR for a LTCH in one of the following three circumstances: (1) new LTCHs that have not yet submitted their first Medicare cost report (for this purpose, a new LTCH is defined as an entity that has not accepted assignment of an existing hospital’s provider agreement in accordance with § 489.18); (2) LTCHs whose CCR is in excess of the LTCH CCR ceiling; and (3) other LTCHs for whom data with which to calculate a CCR are not available (for example, missing or faulty data). (Other sources of data that the fiscal intermediary (or, if applicable, the MAC) may consider in determining a LTCH’s CCR include data from a different cost reporting period for the LTCH, data from the cost reporting period preceding the period in which the hospital began to be paid as a LTCH (that is, the period of at least 6 months that it was paid as a short-term acute care hospital), or data from other comparable LTCHs, such as LTCHs in the same chain or in the same region.) As noted above, a LTCH is assigned the applicable statewide average CCR if, among other things, a LTCH’s CCR is found to be in excess of the applicable maximum CCR threshold (that is, the LTCH CCR ceiling). As we explained in the FY 2007 IPPS final rule (71 FR 48117), CCRs above this threshold are E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules most likely due to faulty data reporting or entry, and, therefore, these CCRs should not be used to identify and make payments for outlier cases. Such data are clearly errors and should not be relied upon. Thus, under our established policy, if a LTCH’s calculated CCR is above the applicable ceiling, the applicable LTCH PPS statewide average CCR is assigned to the LTCH instead of the CCR computed from its most recent (settled or tentatively settled) cost report data. We revised our methodology for determining the annual CCR ceiling and statewide average CCRs under the LTCH PPS effective October 1, 2006, as we explained in the FY 2007 IPPS final rule (71 FR 48117 through 48121), because we believe that those changes are consistent with the LTCH PPS single payment rate for inpatient operating and capital costs. Therefore, under the broad authority of section 123 of Pub. L. 106– 113 and section 307(b)(1) of Pub. L. 106–554, in that same final rule, we revised our methodology used to determine the LTCH CCR ceiling. For discharges occurring on or after October 1, 2006, we established that the LTCH CCR ceiling specified under § 412.525(a)(4)(iv)(C)(2) for high-cost outliers and under § 412.529(c)(3)(iv)(C)(2) for short-stay outliers is calculated as 3 standard deviations above the corresponding national geometric mean total CCR (established and published annually by CMS). (The fiscal intermediary (or, if applicable, the MAC) may use a statewide average CCR if, among other things, a LTCH’s CCR is in excess of the LTCH CCR ceiling.) The LTCH total CCR ceiling is determined based on IPPS CCR data, by first calculating the ‘‘total’’ (that is, operating and capital) IPPS CCR for each hospital and then determining the average ‘‘total’’ IPPS CCR for all IPPS hospitals. (Our rationale for using IPPS hospital data is discussed in the FY 2007 IPPS final rule (71 FR 48117).) The LTCH CCR ceiling is then established at 3 standard deviations from the corresponding national geometric mean total CCR. (For further detail on our methodology for annually determining the LTCH CCR ceiling, we refer readers to the FY 2007 IPPS final rule (71 FR 48117 through 48119).) We also established that the LTCH ‘‘total’’ CCR ceiling used under the LTCH PPS will continue to be published annually in the IPPS proposed and final rules, and the public should continue to consult the annual IPPS proposed and final rules for changes to the LTCH total CCR ceiling that would be effective for discharges occurring on or after October 1 of each year. Accordingly, in the FY VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 2007 IPPS final rule (71 FR 48119), we established a FY 2007 LTCH PPS total CCR ceiling of 1.321, effective for discharges occurring on or after October 1, 2006. In this proposed rule, in accordance with § 412.525(a)(4)(iv)(C)(2) for highcost outliers and § 412.529(c)(3)(iv)(C)(2) for short-stay outliers, using our established methodology for determining the LTCH total CCR ceiling (described above), based on IPPS total CCR data from the December 2006 update to the ProviderSpecific File, we are proposing a total CCR ceiling of 1.273 under the LTCH PPS that would be effective October 1, 2007. Furthermore, we are proposing that, if more recent data are available, we will use such data to determine the final total CCR ceiling under the LTCH PPS for FY 2008 using our established methodology described above. In addition, under the broad authority of section 123 of Pub. L. 106–113 and section 307(b)(1) of Pub. L. 106–554, in the FY 2007 IPPS final rule (71 FR 48120), we revised our methodology to determine the statewide average CCRs under § 412.525(a)(4)(iv)(C) for highcost outliers and under § 412.529(c)(3)(iv)(C) for short-stay outliers for use under the LTCH PPS in a manner similar to the way we compute the ‘‘total’’ CCR ceiling using IPPS CCR data. Specifically, we first calculate the total (that is, operating and capital) CCR for each IPPS hospital. We then calculate the weighted average ‘‘total’’ CCR for all IPPS hospitals in the rural areas of the State and the weighted average ‘‘total’’ CCR for all IPPS hospitals in the urban areas of the State. (For further detail on our methodology for annually determining the LTCH urban and rural statewide average CCRs, we refer readers to the FY 2007 IPPS final rule (71 FR 48119 through 48121).) We also established that the applicable statewide average ‘‘total’’ (operating and capital) CCRs used under the LTCH PPS will continue to be published annually in the IPPS proposed and final rules, and the public should continue to consult the annual IPPS proposed and final rules for changes to the applicable statewide average total CCRs that would be effective for discharges occurring on or after October 1 each year. Accordingly, in the FY 2007 IPPS final rule (71 FR 48122), the FY 2007 LTCH PPS statewide average total CCRs for urban and rural hospitals, effective for discharges occurring on or after October 1, 2006, were presented in Table 8C of the Addendum of that final rule (71 FR 48303). In this proposed rule, in accordance with § 412.525(a)(4)(iv)(C) for high-cost outliers and § 412.529(c)(3)(iv)(C) for PO 00000 Frm 00147 Fmt 4701 Sfmt 4702 24825 short-stay outliers, using our established methodology for determining the LTCH statewide average CCRs (described above), based on the most recent complete IPPS total CCR data from the December 2006 update of the ProviderSpecific File, the proposed LTCH PPS statewide average total CCRs for urban and rural hospitals that would be effective October 1, 2007, are presented in Table 8C of the Addendum to this proposed rule. Furthermore, we are proposing that, if more recent data are available, we would use such data to determine the final statewide average total CCRs for urban and rural hospitals under the LTCH PPS for FY 2008 using our established methodology described above. We note that, for this proposed rule, as we established when we revised our methodology for determining the applicable LTCH statewide average CCRs in the FY 2007 IPPS final rule (71 FR 48119 through 48121), and as is the case under the IPPS, all areas in the District of Columbia, New Jersey, Puerto Rico, and Rhode Island are classified as urban, and therefore there are no proposed rural statewide average total CCRs listed for those jurisdictions in Table 8C of the Addendum to this proposed rule. In addition, as we established when we revised our methodology for determining the applicable LTCH statewide average CCRs in that same final rule, and as is the case under the IPPS, although Massachusetts has areas that are designated as rural, there are no shortterm acute care IPPS hospitals or LTCHs located in those areas as of December 2006. Therefore, there is no proposed rural statewide average total CCR listed for rural Massachusetts in Table 8C of the Addendum of this proposed rule. As we also established when we revised our methodology for determining the applicable LTCH statewide average CCRs in the FY 2007 IPPS final rule (71 FR 48120 through 48121), in determining the urban and rural statewide average total CCRs for Maryland LTCHs paid under the LTCH PPS, we used, as a proxy, the national average total CCR for urban IPPS hospitals and the national average total CCR for rural IPPS hospitals, respectively. We use this proxy because we believe that the CCR data on the Provider-Specific File for Maryland hospitals may not be accurate (as discussed in greater detail in that same final rule (71 FR 48120)). VII. Services Furnished to Beneficiaries in Custody of Penal Authorities (If you choose to comment on issues in this section, please include the E:\FEDREG\03MYP2.LOC 03MYP2 24826 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB caption ‘‘Beneficiaries in Custody’’ at the beginning of your comment.) Section 1862(a)(2) of the Act prohibits payment under Medicare Part A or Part B for any items or services for which the beneficiary has no legal obligation to pay, and which no other person or organization (such as a prepayment plan of which the beneficiary is a member) has a legal obligation to provide or pay for the service. Our current regulations at § 411.4(b) specify the special conditions when Medicare payment may be made for services furnished to individuals in custody of penal authorities. These regulatory conditions include: (1) State or local law requires those individuals or groups of individuals to repay the cost of medical services they receive while in custody; and (2) the State or local government entity enforces the requirement to pay by billing all such individuals, whether or not covered by Medicare or any other health insurance, and by pursuing collection of the amounts they owe in the same way and with the same vigor that it pursues the collection of other debts. However, § 411.4(b) does not define ‘‘custody’’ and does not clearly state that CMS will not defer to a particular State or local government’s definition (or interpretation) of what constitutes ‘‘custody.’’ In this proposed rule, we are proposing to specify that, for purposes of Medicare payment, individuals who are in ‘‘custody’’ include, but are not limited to, individuals who are under arrest, incarcerated, imprisoned, escaped from confinement, under supervised release, required to reside in mental health facilities, required to reside in halfway houses, required to live under home detention, or confined completely or partially in any way under a penal statute or rule. We believe that this proposed definition of ‘‘custody’’ is in accordance with how custody has been defined by Federal courts for purposes of the habeas corpus protections of the Constitution. For example, the term ‘‘custody’’ is not limited solely to physical confinement. (Sanders v. Freeman, 221 F.3d 846, 850– 51 (6th Cir. 2000).) Individuals on parole, probation, bail, or supervised release may be ‘‘in custody.’’ VIII. MedPAC Recommendations (If you choose to comment on issues in this section, please include the caption ‘‘MedPAC Update Recommendation’’ at the beginning of your comment.) We are required by section 1886(e)(4)(B) of the Act to respond to MedPAC’s IPPS recommendations in our annual proposed IPPS rule. We have VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 reviewed MedPAC’s March 2007 ‘‘Report to the Congress: Medicare Payment Policy’’ and have given it careful consideration in conjunction with the proposed policies set forth in this document. MedPAC’s Recommendation 2A–1 states that, ‘‘The Congress should increase payment rates for the acute inpatient and outpatient prospective payment systems in 2008 by the projected rate of increase in the hospital market basket index, concurrent with implementation of a quality incentive payment program.’’ This recommendation is discussed in Appendix B to this proposed rule. Recommendation 2A–2: MedPAC recommended that, ‘‘Concurrent with implementation of severity adjustment to Medicare’s diagnosis related group payments, the Congress should reduce the indirect medical education adjustment in fiscal year 2008 by 1 percentage point to 4.5 percent per 10 percent increment in the resident-to-bed ratio. The funds obtained from reducing the indirect medical education adjustment should be used to fund a quality incentive payment system.’’ MedPAC further states that the IME adjustment is ‘‘set above the empirical level which contributes to the large differences between teaching and nonteaching hospitals in financial performance under Medicare.’’ MedPAC asserts that since there is no accountability for how IME funds are used, and teaching hospitals will benefit from implementation of the severity adjusted DRGs the IME adjustment should be reduced in FY 2008. Response: We note that, MedPAC stated in its March 2007 Report that Congress made a conscious decision to fund the IME adjustment above the empirical level due to the concern for how teaching hospitals would fare under the PPS. Because the IME adjustment is set by Congress, as cited in section 1886(d)(5)(B) of the Act, any change to the IME adjustment, whether it is a 1 percentage point reduction or reduction of the IME adjustment to its empirical level, would require a statutory change. Therefore, absent a change to the IME provision in the Medicare statute for FY 2008, the IME adjustment will remain at the current level required by the statute, as specified in section IV.D. of this preamble. Recommendation 2A–3: MedPAC recommended that, ‘‘The Secretary should improve the form and accompanying instructions for collecting data on uncompensated care in the Medicare cost report and require hospitals to report using the revised form as soon as possible.’’ MedPAC PO 00000 Frm 00148 Fmt 4701 Sfmt 4702 indicated that ‘‘accurate data on hospitals’’ charity care and bad debts are crucial to any effort to help develop a federal payment mechanism to help hospitals with their uncompensated care.’’ Response: MedPAC convened an ‘‘Expert Panel on Measuring Uncompensated Care’’ on May 5, 2005, to address concerns raised by stakeholders on the usefulness of the S– 10 Worksheet data. CMS’ representatives participated in the discussions on this expert panel, and listened carefully to the concerns of MedPAC and the stakeholders about the S–10 Worksheet. MedPAC is recommending that we adopt the list of recommended changes to the S–10 Worksheet that resulted from the panel’s discussion. CMS is currently undertaking a major update of the hospital cost report and will be making changes to the S–10 Worksheet form and accompanying instructions based on the panel’s discussions with MedPAC. In sections II.C. through E. of the preamble of this proposed rule, we further address the recommendations included in Recommendation 1 and Recommendation 3 in the March 2005 Report to Congress on Physician-Owned Specialty Hospitals. Recommendation 1 relates to refining the DRGs used under the IPPS to more fully capture differences in severity of illness among patients; basing the DRG relative weights on the estimated cost of providing care rather than on charges; and basing the weights on the national average of hospitals’ relative values in each DRG. Recommendation 3 recommended that the Secretary implement MedPAC’s recommended policies over a transition period. For further information relating specifically to the MedPAC reports or to obtain a copy of the reports, contact MedPAC at (202) 653–7220, or visit MedPAC’s website at: https:// www.medpac.gov. IX. Other Required Information A. Requests for Data from the Public In order to respond promptly to public requests for data related to the prospective payment system, we have established a process under which commenters can gain access to raw data on an expedited basis. Generally, the data are available in computer tape or cartridge format; however, some files are available on diskette as well as on the Internet at: https://www.cms.hhs.gov/ providers/ hipps. Data files and the cost for each file, if applicable, are listed below. Anyone wishing to purchase E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules data tapes, cartridges, or diskettes should submit a written request along with a company check or money order (payable to CMS-PUF) to cover the cost to the following address: Centers for Medicare & Medicaid Services, Public Use Files, Accounting Division, P.O. Box 7520, Baltimore, MD 21207–0520, (410) 786–3691. Files on the Internet may be downloaded without charge. mix adjusted AHW, and the percent difference between the two. Media: Internet at https://www.cms. hhs.gov/AcuteInpatientPPS/ WIFN/ list.asp#TopOfPage. Periods Available: FY 2008 IPPS Update. Media: Internet at https://www.cms. hhs.gov/AcuteInpatientPPS/ FFD/ list.asp#TopOfPage. Periods Available: FY 2008 IPPS Update. 5. FY 2008 Occupational Mix Adjusted and Unadjusted AHWs and Pre-Reclass Wage Indexes by CBSA This file contains a spreadsheet with two tabs: One for providers that are geographically located in an area, and one for providers that are reclassifying. The first tab includes the pre-reclass occupational mix adjusted total wages and AHWs by provider and CBSA, and the second tab lists the providers that are reclassifying and their post-reclass occupational mix adjusted total wages and AHWs by provider and CBSA. This file is typically posted after publication of the IPPS NPRM each year. Media: Internet at https://www.cms. hhs.gov/AcuteInpatientPPS/ WIFN/ list.asp#TopOfPage. Periods Available: FY 2008 IPPS Proposed Rule Update. 1. CMS Wage Data Public Use File This file contains the hospital hours and salaries from Worksheet S–3, Parts II and Parts III from FY 2004 cost reports used to create the proposed FY 2008 IPPS wage index. The file is typically available by the end of February each year for the NPRM and will be available by the beginning of May for the final rule. Processing year 2007 .......................... 2006 .......................... 2005 .......................... Wage data year 2004 2003 2002 This file is available after publication of each IPPS NPRM and final rule, and is organized by CBSA, and contains total CBSA occupational mix wages, total CBSA hours, CBSA occupational mix adjusted AHWs, CBSA occupational mix adjusted pre-reclass wage indexes, total CBS unadjusted wages, CBSA unadjusted AHWs, and unadjusted pre-reclass wage indexes. Media: Internet at https://www.cms. PPS fishhs.gov/AcuteInpatientPPS /WIFN/ cal year list.asp#TopOfPage. Periods Available: FY 2008 IPPS 2008 Update. 2007 2006 Media: Internet at https://www.cms. hhs.gov/AcuteInpatientPPS/ WIFN/ list.asp#TopOfPage. Periods Available: FY 2006 through 2008 IPPS Updates. mmaher on DSK3CLS3C1PROD with $$_JOB 2. CMS Occupational Mix Data Public Use File This file contains the occupational mix survey data to be used to compute the occupational mix adjusted wage indexes. The file is typically available by the end of February each year for the NPRM and will be available by the beginning of May for the final rule. Media: Internet at https://www.cms. hhs.gov/AcuteInpatientPPS/ WIFN/ list.asp#TopOfPage. Periods Available: FY 2008 PPS Update. 3. Final AHWs for FY 2007 and Proposed AHWs for FY 2008 by CBSA Public Use File This file includes CBSAs, and the AHWs by CBSA for FY 2007 (final data) and FY 2008 (proposed data). This file is typically available by the end of February each year for the NPRM. Media: Internet at https://www.cms. hhs.gov/AcuteInpatientPPS/ WIFN/ list.asp#TopOfPage. Periods Available: FY 2008 IPPS Proposed Rule Update. 4. FY 2008 Occupational Mix Adjusted and Unadjusted AHWs by Provider This file is available after publication of each IPPS NPRM and final rule, and includes provider number, CBSA, the provider’s unadjusted and occupational VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 24827 9. FY 2008 Proposed Rule AHW by Provider Area Listing 6. FY 2008 Occupational Mix Factor by Provider Public Use File 10. PPS–IV to PPS–XII Minimum Data Set This file is available after publication of each IPPS NPRM and final rule, and is organized by provider, and includes occupational mix adjusted and unadjusted wages, occupational mix adjusted and unadjusted AHWs, the nurse occupational mix adjustment factor, and the CBSA nurse occupational mix adjustment factor. Media: Internet at https://www.cms. hhs.gov/AcuteInpatientPPS/ WIFN/ list.asp#TopOfPage. Periods Available: FY 2008 IPPS Update. The Minimum Data Set contains cost, statistical, financial, and other information from Medicare hospital cost reports. The data set includes only the most current cost report (as submitted, final settled, or reopened) submitted for a Medicare participating hospital by the Medicare fiscal intermediary to CMS. This data set is updated at the end of each calendar quarter and is available on the last day of the following month. Media: Compact Disc (CD). File Cost: $100.00 per year. 7. FY 2008 Average Hourly Wage by Provider and CBSA Public Use File This file is available after publication of each IPPS NPRM and final rule, and includes occupational mix adjusted wages, hours, occupational mix adjusted AHWs, and pre-reclass occupational mix adjusted wage indexes, by provider and CBSA. Media: Internet at https://www.cms. hhs.gov/AcuteInpatientPPS/ WIFN/ list.asp#TopOfPage. Periods Available: FY 2008 IPPS Update. 8. IPPS SSA/FIPS CBSA State and County Crosswalk This file contains a crosswalk of State and county codes used by the Social Security Administration (SSA) and the Federal Information Processing Standards (FIPS), county name, Core Based Statistical Area (CBSA), and the historical list of Metropolitan Statistical Areas (MSAs). PO 00000 Frm 00149 Fmt 4701 Sfmt 4702 I PPS–IV ............. PPS–V .............. PPS–VI ............. PPS–VII ............ PPS–VIII ........... PPS–IX ............. PPS–X .............. PPS–XI ............. PPS–XII ............ Periods beginning on or after 10/01/86 10/01/87 10/01/88 10/01/89 10/01/90 10/01/91 10/01/92 10/01/93 10/01/94 and before 10/01/87 10/01/88 10/01/89 10/01/90 10/01/91 10/01/92 10/01/93 10/01/94 10/01/95 (Note: The PPS–XIII, PPS–XIV, PPS–XV, PPS–XVI, PPS–XVII, PPS–XVIII, PPS–XIX PPS–XX, PPS–XXI, and PPS–XX–II Minimum Data Sets are part of the PPS–XIII, PPS–XIV, PPS–XV, PPS–XVI, PPS–XVII, PPS–XVIII, PPS–XIX, PPS–XX, PPS–XXI, and PPS–XXII Hospital Data Set Files (refer to item 10 below).) 11. PPS–XIII to PPS–XXII Hospital Data Set The file contains cost, statistical, financial, and other data from the Medicare Hospital Cost Report. The data set includes only the most current cost E:\FEDREG\03MYP2.LOC 03MYP2 24828 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 14. DRG Relative Weights (Table 5 DRG) This file contains a listing of DRGs, DRG narrative descriptions, relative weights, and geometric and arithmetic mean lengths of stay as published in the Federal Register. There are two versions of this file as published in the Federal Register: <bullet≤ NPRM. <bullet≤ Final rule. Media: Internet at https://www.cms. hhs.gov/AcuteInpatientPPS/ FFD/ and before list.asp#TopOfPage. Periods Available: FY 2006 through 10/01/96 FY 2008 PPS Update. report (as submitted, final settled, or reopened) submitted for a Medicarecertified hospital by the Medicare fiscal intermediary to CMS. The data set is updated at the end of each calendar quarter and is available on the last day of the following month. Media: Compact Disc (CD). File Cost: $100.00. Periods beginning on or after I PPS–XIII ........... PPS–XIV ........... PPS–XV ............ PPS–XVI ........... PPS–XVII .......... PPS–XVIII ......... PPS–XIX ........... PPS–XX ............ PPS–XXI ........... PPS–XXII .......... 10/01/95 10/01/96 10/01/97 10/01/98 10/01/99 10/01/00 10/01/01 10/01/02 10/01/03 10/01/04 10/01/97 10/01/98 10/01/99 10/01/00 10/01/01 10/01/02 10/01/03 10/01/04 10/01/05 12. Provider-Specific File This file is a component of the PRICER program used in the fiscal intermediary’s system to compute DRG payments for individual bills. The file contains records for all prospective payment system eligible hospitals, including hospitals in waiver States, and data elements used in the prospective payment system recalibration processes and related activities. Beginning with December 1988, the individual records were enlarged to include pass-through per diems and other elements. Media: Internet at https://www.cms. hhs.gov/ProspMedicareFeeSvcPmt Gen/ Downloads/INP—psf0107.zip. Periods Available: FY 2008 PPS Update. mmaher on DSK3CLS3C1PROD with $$_JOB 13. CMS Medicare Case-Mix Index File The Medicare case-mix indexes by provider number are published in table 2 of each year’s update of the Medicare hospital inpatient prospective payment system. The case-mix index is a measure of the costliness of cases treated by a hospital relative to the cost of the national average of all Medicare hospital cases, using DRG weights as a measure of relative costliness of cases. Two versions of this file are created each year. They support the following: <bullet≤ NPRM published in the Federal Register. <bullet≤ Final rule published in the Federal Register. Media: Internet at https://www.cms. hhs.gov/AcuteInpatientPPS/ WIFN/ list.asp#TopOfPage. Periods Available: FY 2006 through FY 2008. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 15. PPS Payment Impact File This file contains data used to estimate payments under Medicare’s hospital inpatient prospective payment systems for operating and capital-related costs. The data are taken from various sources, including the Provider-Specific File, Minimum Data Sets, and prior impact files. The data set is abstracted from an internal file used for the impact analysis of the changes to the prospective payment systems published in the Federal Register. Media: Internet at https://www.cms. hhs.gov/AcuteInpatientPPS/ FFD/ list.asp#TopOfPage and https:// www.cms.hhs.gov/ AcuteInpatientPPS/ HIF/list.asp#TopOfPage. Periods Available: FY 1994 through FY 2008 PPS Update 16. AOR/BOR Tables This file contains data used to develop the DRG relative weights. It contains mean, maximum, minimum, standard deviation, and coefficient of variation statistics by DRG for length of stay and standardized charges. The BOR tables are ‘‘Before Outliers Removed’’ and the AOR is ‘‘After Outliers Removed.’’ (Outliers refer to statistical outliers, not payment outliers.) Two versions of this file are created each year. They support the following: <bullet≤ NPRM published in the Federal Register. <bullet≤ Final rule published in the Federal Register. Media: Internet at https://www.cms. hhs.gov/AcuteInpatientPPS/ FFD/ list.asp#TopOfPage. Periods Available: FY 2008 PPS Update. 17. Prospective Payment System (PPS) Standardizing File This file contains information that standardizes the charges used to calculate relative weights to determine payments under the prospective payment system. Variables include wage index, cost-of-living adjustment (COLA), case-mix index, disproportionate share, and the Metropolitan Statistical Area (MSA). The file supports the following: PO 00000 Frm 00150 Fmt 4701 Sfmt 4702 <bullet≤ NPRM published in the Federal Register. <bullet≤ Final rule published in the Federal Register. Media: Internet. Periods Available: FY 2008 PPS Update. For further information concerning these data tapes, contact the CMS Public Use Files Hotline at (410) 786–3691. Commenters interested in obtaining or discussing any other data used in constructing this proposed rule should contact Mark Hartstein at (410) 786– 4548. B. Collection of Information Requirements Under the Paperwork Reduction Act of 1995 (PRA), we are required to provide 60-day notice in the Federal Register and solicit public comment before a collection of information requirement is submitted to the Office of Management and Budget (OMB) for review and approval. In order to fairly evaluate whether an information collection should be approved by OMB, section 3506(c)(2)(A) of the PRA requires that we solicit comment on the following issues: <bullet≤ The need for the information collection and its usefulness in carrying out the proper functions of our agency. <bullet≤ The accuracy of our estimate of the information collection burden. <bullet≤ The quality, utility, and clarity of the information to be collected. <bullet≤ Recommendations to minimize the information collection burden on the affected public, including automated collection techniques. We are soliciting public comment on each of these issues for the following sections of this document that contain information collection requirements. Section 412.103 Special Treatment: Hospitals Located in Urban Areas and That Apply for Reclassifications as Rural Section 412.103(g)(1) states that (1) for a hospital paid on the basis of reasonable costs, the hospital may cancel its rural reclassification by submitting a written request to the CMS Regional Office not less than 120 days prior to the end of its current cost reporting period, and (2) for a hospital paid under the hospital inpatient prospective payment system, the hospital may cancel its rural reclassification by submitting a written request to the CMS Regional Office not less than 120 days prior to the end of a Federal fiscal year and after being paid as rural for at least one 12-month cost reporting period. E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules The burden associated with these requirements is the time and effort required for a hospital to develop, draft, and submit its written request for the cancellation of its rural reclassification. While these requirements are subject to the PRA, we believe the burden is exempt under 5 CFR 1320.3(c)(4). We believe that the information collection requirements in § 412.103(g)(1) and § 421.103(g)(2), respectively, will impact less than 10 entities. The notices will be submitted by individual hospitals and will be reviewed on a case-by-case basis. Section 489.20 Basic Commitments Proposed § 489.20(u)(1) would require physician-owned hospitals, as defined in § 489.3, to furnish notice to all patients that the hospital is a physician-owned hospital. The notice must be furnished at the beginning of their hospital stay or outpatient visit. The burden associated with the aforementioned requirements is the time and effort associated with a physicianowned hospital developing a generic notice and providing notice to the patients. Approximately 175 physicianowned hospitals must comply with this requirement. We estimate that it will require a hospital’s general counsel 4 hours to develop a standard notice to be furnished to all patients upon admission as an inpatient or an outpatient. In addition, we estimate that it will take 30 seconds to provide the notice to a patient and it will take another 30 seconds to maintain a copy of the disclosure in the patient’s medical record. On average, each hospital will be required to make 1,092 disclosures per year. The total burden associated with the requirements in § 489.20(u)(1) is 3,885 annual burden hours. Proposed § 489.20(v) would require all hospitals, as defined in § 489.24(b), to furnish all patients notice, in accordance with § 482.13(b)(2), at the beginning of their hospital stay or outpatient visit if a doctor of medicine or a doctor of osteopathy is not present in the hospital 24 hours per day, 7 days per week. The notice must indicate how 24829 the hospital will meet the medical needs of any inpatient who develops an emergency medical condition, as defined in § 489.24(b), at a time when there is no physician present in the hospital. The burden associated with this requirement is the time and effort necessary for each hospital to develop a standard notice to furnish to its patients. We believe 2,504 hospitals will be required to comply with this requirement. Complying with the requirement will require a hospital’s general counsel 4 hours to develop a standard notice. In addition, we estimate that it will take 30 seconds to provide the notice to a patient, and it will take another 30 seconds to maintain a copy of the disclosure in the patient’s medical record. On average, each hospital will be required to make 1,092 disclosures per year. The total burden associated with the requirements in § 489.20(v)(1) is 55,588 annual burden hours. ESTIMATED ANNUAL REPORTING AND RECORDKEEPING BURDEN § 489.20(u)(1) ...................................... § 489.20(v)(1) ....................................... 0938–New ............................................ ............................................................... 0938–New ............................................ ............................................................... 175 175 2,504 2,504 75 191,100 2,504 2,734,368 4 .016667 4 .016667 700 3,185 10,016 45,572 Total ............................................... ............................................................... ........................ ........................ .................... 59,473 mmaher on DSK3CLS3C1PROD with $$_JOB Proposed Add-on Payments for New Services and Technologies Section II.I.1 of the preamble of this proposed rule discusses proposed addon payments for new services and technologies. Specifically, this section states that applicants for add-on payments for new medical services or technologies for FY 2009 must submit a formal request. A formal request includes a full description of the clinical applications of the medical service or technology and the results of any clinical evaluations demonstrating that the new medical service or VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 technology represents a substantial clinical improvement. In addition, the request must contain a significant sample of the data to demonstrate that the medical service or technology meets the high-cost threshold. We also detailed the burden associated with this requirement in a final rule published in the Federal Register on September 7, 2001 (66 FR 46902). As stated in that final rule, we believe the associated burden is exempt from the PRA as stipulated under 5 CFR 1320.3(h)(6). Collection of the information for this requirement will be conducted on individual case-by-case basis. Occupational Mix Adjustment to the FY 2008 Index (Hospital Wage Index Occupational Mix Survey) Section III. of the preamble of this proposed rule details the proposed changes to the hospital wage index. Specifically, section III.C addresses the proposed occupational mix adjustment to the proposed FY 2008 index. While PO 00000 Frm 00151 Fmt 4701 Sfmt 4702 Responses Total annual burden (hours) OMB control number This proposed rule imposes collection of information requirements as outlined in the regulation text and specified above. However, this proposed rule also makes reference to several associated information collections that are not discussed in the regulation text. The following is a discussion of these collections, which have already received the Office of Management and Budget’s (OMB) approval. Respondents Burden per response (hours) Requirements the preamble does not contain any new information collection requirements, it is important to note that there is an OMB approved collection associated with the hospital wage index. As stated in section III.C. of the preamble of this proposed rule, section 304(c) of Pub. L. 106–554 amended section 1886(d)(3)(E) of the Act to require CMS to collect data at least once every 3 years on the occupational mix of employees for each short-term, acute care hospital participating in the Medicare program, in order to construct an occupational mix adjustment to the wage index. We collect the data via the occupational mix survey. The burden associated with this information collection request is the time and effort required to collect and submit the data in the Hospital Wage Index Occupational Mix Survey to CMS. While this burden is subject to the PRA, it is already approved under OMB control number 0938–0907, with an expiration date of May 31, 2009. E:\FEDREG\03MYP2.LOC 03MYP2 24830 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules Revisions to the Wage Index Based on Hospital Redesignations (Medicare Geographic Classification Review Board) As noted in section III.I of the preamble of this proposed rule, section 1886(d)(10) of the Act established the MGCRB, an entity that has the authority to accept IPPS hospital applications requesting geographic reclassification for wage index or standardized payment amounts and to issue decisions on these requests. It is important for CMS to ensure the accuracy of the MGCRB decisions and remain apprised of potential payment impacts. Our regulations at § 412.256 require a hospital to submit a copy of its MGCRB application to CMS. The burden associated with this requirement is the time and effort associated with a hospital compiling and submitting a copy of its MGCRB application to CMS. While this requirement is subject to the PRA, the burden is approved under OMB control number 0938–0573, with an expiration date of November 30, 2008. mmaher on DSK3CLS3C1PROD with $$_JOB Reporting of Hospital Quality Data for Annual Hospital Payment Update As noted in section IV.A.1 of the preamble of this proposed rule, section 5001(a) of the DRA sets out new requirements for the RHQDAPU program. The RHQDAPU program was established to implement section 501(b) of Pub. L. 108–173, thereby expanding our Hospital Quality Initiative. The RHQDAPU program originally consisted of a ‘‘starter set’’ of 10 quality measures. Hospitals participating in the hospital quality initiative submit their quality data on the 10 measures to receive an increase in their Medicare Annual Payment Update. The Office of Management and Budget approved the collection of data associated with the original starter set of quality measures under OMB control number 0938–0918, with an expiration date of January 31, 2010. However, we recently submitted a new information collection request containing additional quality measures to OMB for approval. The new measures collect data for the Surgical Care Improvement Project (SCIP) and mortality measures. We announced and sought public comment on the information collection request in both 60-day and 30-day Federal Register notices that published on October 13, 2006 (71 FR 60532), and December 22, 2006 (71 FR 77026), respectively. The revised information collection request is currently under review at OMB. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Section IV.A.1 of the preamble of this proposed rule also discusses the use of the HCAHPS survey to capture quality data. The survey is designed to produce comparable data on the patient’s perspective on care that allows objective and meaningful comparisons between hospitals on domains that are important to consumers. The HCAHPS survey is currently approved under OMB control number 0938–0981, with an expiration date of December 31, 2007. Section IV.A.2.h of the preamble of this proposed rule addresses the reconsideration and appeal procedures for a hospital that we believe did not meet the RHQDAPU program requirements. If a hospital disagrees with our determination, it may submit a written request to us requesting that we reconsider our decision. The hospital’s letter must explain the reasons it believes it did meet the RHQDAPU program requirements. While this is a reporting requirement, the burden associated with it is not subject to the PRA under 5 CFR 1320.4(a)(2). The burden associated with information collection requirements imposed subsequent to an administrative action is not subject to the PRA. If you comment on these information collection and recordkeeping requirements, please mail copies directly to the following: Centers for Medicare & Medicaid Services, Office of Strategic Operations and Regulatory Affairs, Regulations Development Group, Attn: William N. Parham, III, CMS– 1533–P, Room C4–26–05, 7500 Security Boulevard, Baltimore, MD 21244–1850; and Office of Information and Regulatory Affairs, Office of Management and Budget, Room 10235, New Executive Office Building, Washington, DC 20503, Attn: Carolyn Lovett, CMS Desk Officer, CMS–1533–P, carolyn— lovett@omb.eop.gov. Fax (202) 395– 6974. C. Response to Comments Because of the large number of comments we normally receive on Federal Register documents, we are not able to acknowledge or respond to them individually. We will consider all comments we receive by the date and time specified in the DATES section of this preamble, and, when we proceed with a subsequent document, we will respond to the comments in the preamble to that document. PO 00000 Frm 00152 Fmt 4701 Sfmt 4702 List of Subjects 42 CFR Part 411 Kidney diseases, Medicare, Physician referral, Reporting and recordkeeping requirements. 42 CFR Part 412 Administrative practice and procedure, Health facilities, Medicare, Puerto Rico, Reporting and recordkeeping requirements. 42 CFR Part 413 Health facilities, Kidney diseases, Medicare, Puerto Rico, Reporting and recordkeeping requirements. 42 CFR Part 489 Health facilities, Medicare, Reporting and recordkeeping requirements. For the reasons stated in the preamble of this proposed rule, the Centers for Medicare & Medicaid Services is proposing to amend 42 CFR Chapter IV as follows: PART 411—EXCLUSIONS FROM MEDICARE AND LIMITATIONS ON MEDICARE PAYMENT 1. The authority citation for Part 411 continues to read as follows: Authority: Secs. 1102, 1860D–4(e)(6), 1871, and 1877(b)(4) and (5) of the Social Security Act (42 U.S.C. 1302, 1395w–10(e)(6), 1395hh, and 1395nn(b)(4) and (5). 2. Section 411.4 is amended by revising the introductory text of paragraph (b) to read as follows: § 411.4 Services for which neither the beneficiary nor any other person is legally obligated to pay. * * * * * (b) Special conditions for services furnished to individuals in custody of penal authorities. Individuals who are in custody include, but are not limited to, individuals who are under arrest, incarcerated, imprisoned, escaped from confinement, under supervised release, required to reside in mental health facilities, required to reside in halfway houses, required to live under home detention, or confined completely or partially in any way under a penal statute or rule. Payment may be made for services furnished to individuals or groups of individuals who are in the custody of police or other penal authorities or in the custody of a government agency under a penal statute only if the following conditions are met. * * * * * E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules PART 412—PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES 3. The authority citation for Part 412 is revised to read as follows: Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh), and sec. 124 of Pub. L. 106–113 (113 Stat. 1501A–332). 4. Section 412.2 is amended by adding a new paragraph (g) to read as follows: § 412.2 Basis for payment. * * * * * (g) Payment adjustment for certain replaced devices. CMS makes a payment adjustment for certain replaced devices, as provided under § 412.89. 5. Section 412.4 is amended by— a. Revising paragraphs (d)(3)(ii)(B) and (d)(3)(ii)(C). b. Adding a new paragraph (d)(3)(ii)(D). c. Revising paragraph (f)(3). d. Revising the introductory text of paragraph (f)(5). e. Revising paragraph (f)(5)(i). f. Revising paragraph (f)(5)(iv). g. Adding a new paragraph (f)(6). The revisions and additions read as follows: § 412.4 Discharges and transfers. mmaher on DSK3CLS3C1PROD with $$_JOB * * * * * (d) * * * (3) * * * * * * * * (ii) * * * (B) The proportion of short-stay discharges to postacute care to total discharges in the DRG exceeds the 55th percentile for all DRGs; (C) The DRG is paired with a DRG based on the presence or absence of a comorbidity or a complication or major cardiovascular condition that meets the criteria specified under paragraphs (d)(3)(ii)(A) and (d)(3)(ii)(B) of this section; and (D) In the case of MS–DRGs that share the same base MS–DRG, if one MS–DRG meets the criteria specified under paragraph (d)(3)(ii)(B) of this section, every MS–DRG that shares the same base MS–DRG is a qualifying DRG. * * * * * (f) * * * (3) Transfer assigned to DRG for newborns that die or are transferred to another hospital. If a transfer is classified into CMS DRG 385 (Neonates, Died or Transferred) prior to October 1, 2007, or into MS–DRG 789 (Neonates, Died or Transferred to Another Acute VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Care Facility) on or after October 1, 2007, the transferring hospital is paid in accordance with § 412.2(b). * * * * * (5) Special rule for DRGs meeting specific criteria. For discharges occurring on or after October 1, 2005, and prior to October 1, 2007, a hospital that transfers an inpatient under the circumstances described in paragraph (c) of this section is paid using the provisions of paragraphs (f)(2)(i) and (f)(2)(ii) of this section if the transfer case is assigned to one of the DRGs meeting the following criteria: (i) The DRG meets the criteria specified in paragraph (d)(3)(i) or (d)(3)(ii) of this section. * * * * * (iv) If a DRG is paired with a DRG based on the presence or absence of a comorbidity or complication or a major cardiovascular complication that meets the criteria specified in paragraphs (f)(5)(i) through (f)(5)(iii) of this section, that DRG will also be paid under the provisions of paragraphs (f)(2)(i) and (f)(2)(ii) of this section. (6) Special rule for DRGs meeting specific criteria. For discharges occurring on or after October 1, 2007, a hospital that transfers an inpatient under the circumstances described in paragraph (c) of this section is paid using the provisions of paragraphs (f)(2)(i) and (f)(2)(ii) of this section if the transfer case is assigned to one of the DRGs meeting the following criteria: (i) The DRG meets the criteria specified in paragraph (d)(3)(i) or (d)(3)(ii) of this section; (ii) The average charges of the 1-day discharge cases in the DRG must be at least 50 percent of the average charges for all cases in the DRG; and (iii) The geometric mean length of stay for the DRG is greater than 4 days. (iv) If a DRG is part of an MS–DRG group that meets the criteria specified in paragraphs (f)(6)(i) through (f)(6)(iii) of this section, that DRG will also be paid under the provisions of paragraphs (f)(2)(i) and (f)(2)(ii) of this section. 6. Section 412.64 is amended by— a. Revising paragraph (b)(1)(ii)(B). b. In paragraph (b)(3), designating the existing text as (b)(3)(i) and adding a new paragraph (b)(3)(ii). c. Adding a new paragraph (e)(3). d. Revising paragraph (i)(2). The revisions read as follows: § 412.64 Federal rates for inpatient operating costs for Federal fiscal year 2005 and subsequent fiscal years. * PO 00000 * * (b) * * * Frm 00153 * Fmt 4701 * Sfmt 4702 24831 (1) * * * (ii) * * * (B) For discharges occurring on or after October 1, 1983, and before October 1, 2007, the following New England counties, which are deemed to be parts of urban areas under section 601(g) of the Social Security Amendments of 1983 (Public Law 98– 21, 42 U.S.C. 1395ww (note); Litchfield County, Connecticut; York County, Maine; Sagadahoc County, Maine; Merrimack County, New Hampshire; and Newport County, Rhode Island. * * * * * (3)(i) * * * (ii) For discharges occurring on or after October 1, 2007, hospitals in the following New England counties, if not already located in an urban area, are deemed to be located in urban areas under section 601(g) of the Social Security Amendments of 1983 (Public Law 98–21, 42 U.S.C. 1395ww (note)): Litchfield County, Connecticut; York County, Maine; Sagadahoc County, Maine; Merrimack County, New Hampshire; and Newport County, Rhode Island. * * * * * (e) * * * (3) To the extent CMS determines that changes to the DRG classification and recalibrations of the DRG relative weights for a previous year (or estimates that such adjustments for a future fiscal year) did (or are likely to) result in a change in aggregate payments under this subsection during the fiscal year that are a result of changes in coding or classification of discharges that do not reflect real changes in case mix, CMS may adjust the standardized amount for subsequent fiscal years so as to eliminate the effect of such coding and classification changes. (i) * * * (2) Amount of adjustment. A hospital located in a county that meets the criteria under paragraphs (i)(1)(i) through (i)(1)(iii) of this section will receive an increase in its wage index that is equal to a weighted average of the difference between the postreclassified wage index of the MSA (or MSAs) with the higher wage index (or wage indices) and the postreclassified wage index of the MSA or rural statewide area in which the qualifying county is located, weighted by the overall percentage of the hospital employees residing in the qualifying county who are employed in any MSA with a higher wage index. * * * * * 7. The heading of Subpart F is revised to read as follows: E:\FEDREG\03MYP2.LOC 03MYP2 24832 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules Subpart F—Payments for Outlier Cases, Special Treatment Payment for New Technology, and Payment Adjustment for Certain Replaced Devices 8. Section 412.88 is amended by revising the introductory text of paragraph (a)(2) to read as follows: § 412.88 Additional payment for new medical service or technology. (a) * * * (2) If the costs of the discharge (determined by applying the operating cost-to-charge ratios as described in § 412.84(h)) exceed the full DRG payment, an additional amount equal to the lesser of— * * * * * 9. A new undesignated center heading and a new § 412.89 are added under Subpart F following § 412.88 to read as follows: Payment Adjustment for Certain Replaced Devices § 412.89 Payment adjustment for certain replaced devices. mmaher on DSK3CLS3C1PROD with $$_JOB (a) General rule. For discharges occurring on or after October 1, 2007, the amount of payment for a discharge described in paragraph (b) of this section is reduced when— (1) A device is replaced without cost to the hospital; (2) The provider received full credit for the cost of a device; or (3) The provider receives a credit equal to 20 percent or more of the cost of the device. (b) Discharges subject to payment adjustment. (1) Payment is reduced in accordance with paragraph (a) of this section only if the implantation of the device determines the DRG assignment. (2) CMS lists the DRGs that qualify under paragraph (b)(1) of this section in the annual final rule for the hospital inpatient prospective payment system. (c) Amount of reduction. (1) For a device provided to the hospital without cost, the cost of the device is subtracted from the DRG payment. (2) For a device for which the hospital received a full or partial credit, the amount credited is subtracted from the DRG payment. 10. Section 412.103 is amended by revising paragraph (g) to read as follows: § 412.103 Special treatment: Hospitals located in urban areas and that apply for reclassifications as rural. * * * * * (g) Cancellation of classification—(1) Hospitals paid on basis of reasonable costs. For a hospital paid on the basis of reasonable costs— VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 (i) A hospital may cancel its rural reclassification by submitting a written request to the CMS Regional Office not less than 120 days prior to the end of its current cost reporting period. (ii) The hospital’s cancellation of the classification is effective beginning with the next full cost reporting period. (2) Hospitals paid under the hospital inpatient prospective payment system. For a hospital paid under the hospital inpatient prospective payment system— (i) A hospital may cancel its rural reclassification by submitting a written request to the CMS Regional Office not less than 120 days prior to the end of a Federal fiscal year and after being paid as rural for at least one 12-month cost reporting period. (ii) The hospital’s cancellation of the classification is not effective until it has been paid as rural for at least one 12month cost reporting period, and not until the beginning of the Federal fiscal year following such 12-month cost reporting period. 11. Section 412.105 is amended by adding a sentence at the end of paragraph (f)(1)(iii)(A) to read as follows: of change to take into account forecast errors, changes to the case-mix index, the effect of changes to DRG classification and relative weights, and allowable changes in the intensity of hospital services. (iii) Effective FY 2008. Effective FY 2008, the update to the standard Federal rate for urban hospitals equals 0 and the update for rural hospitals is determined based on an analytical framework as described in paragraph (c)(1)(ii) of this section. (iv) Definition of urban and rural hospital. For purposes of paragraph (c)(1)(iii) of this section, an urban hospital is a hospital located in an area that meets the definition under § 412.64(b)(1)(ii)(A) or § 412.64(b)(1)(ii)(B) or that is deemed to be located in an urban area under § 412.64(b)(3). A rural hospital includes a hospital reclassified under § 412.103. * * * * * 13. Section 412.316 is amended by— a. Revising the introductory text of paragraph (b). b. Revising paragraph (b)(2). c. Revising paragraph (b)(3). The revisions read as follows: § 412.105 Special treatment: Hospitals that incur indirect costs for graduate medical education programs. § 412.316 * * * * * (f) * * * (1) * * * (iii) * * * (A) * * * Effective for cost reporting periods beginning on or after October 1, 2007, vacation leave and sick leave (that do not prolong the total time a resident is participating in the approved program beyond the normal duration of the program) are not included in the determination of full-time equivalency. * * * * * 12. Section 412.308 is amended by— a. Revising paragraph (c)(1)(ii). b. Adding new paragraphs (c)(1)(iii) and (c)(1)(iv). The revision and addition read as follows: § 412.308 Determining and updating the Federal rate. * * * * * (c) * * * (1) * * * (ii) Effective FY 1996. Except as specified in paragraph (c)(1)(iii) of this section, effective FY 1996, the standard Federal rate is updated based on an analytical framework. The framework includes a capital input price index, which measures the annual change in the prices associated with capitalrelated costs during the year. CMS adjusts the capital input price index rate PO 00000 Frm 00154 Fmt 4701 Sfmt 4702 Geographic adjustment factor. * * * * * (b) Large urban location. For discharges occurring on or before September 30, 2007, CMS provides an additional payment to a hospital located in a large urban area equal to 3.0 percent of what would otherwise be payable to the hospital based on the Federal rate. * * * * * (2) For discharges occurring on or after October 1, 2004, and before October 1, 2007, the definition of large urban areas under § 412.63(c)(6) continues to be in effect for purposes of the payment adjustment under this section, based on the geographic classification under § 412.64, except as provided for in paragraph (b)(3) of this section. (3) For purposes of this section, the geographic classifications specified under § 412.64 apply, except that, effective for discharges occurring on or after October 1, 2006, and before October 1, 2007, for an urban hospital that is reclassified as rural as set forth in § 412.103, the geographic classification is rural. * * * * * 14. Section 412.517 is amended by— a. Redesignating the introductory text and paragraphs (a), (b), (c), and (d) as paragraphs (a) introductory text, (a)(1), (a)(2), (a)(3), and (a)(4), respectively. b. Reserving paragraph (b). c. Adding a new paragraph (c). E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules § 413.78 Direct GME payments: Determination of the total number of FTE residents. The additions read as follows: § 412.517 Revision of LTC–DRG group classifications and weighting factors. * * * * * (b) [Reserved] (c) To the extent CMS determines that changes to the DRG classifications and recalibrations of the DRG relative weights for a previous year (or estimates that such adjustments for a future fiscal year) did (or are likely to) result in a change in aggregate payments under this subpart during the fiscal year that are a result of changes in coding or classification of discharges that do not reflect real changes in case mix, CMS may adjust the DRG relative weights for subsequent fiscal years so as to eliminate the effect of such coding and classification changes. PART 413—PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES 15. The authority citation for Part 413 is revised to read as follows: Authority: Secs. 1102, 1812(d), 1814(b), 1815, 1833(a), (i), and (n), 1861(v), 1871, 1881, 1883, and 1886 of the Social Security Act (42 U.S.C. 1302, 1395d(d), 1395f(b), 1395g, 1395l(a), (i), and (n), 1395x(v), 1395hh, 1395rr, 1395tt, and 1395ww); and sec. 124 of Pub. L. 106–133 (113 Stat. 1501A– 332). 16. Section 413.75(b) is amended by— a. Adding in alphabetical order a definition of ‘‘orientation activities’’. b. Revising the definition of ‘‘patient care activities’’. The addition and revision read as follows: § 413.75 Direct GME payments: General requirements. mmaher on DSK3CLS3C1PROD with $$_JOB * * * * * (b) * * * Orientation activities means activities that are principally designed to prepare an individual for employment as a resident in a particular setting, or for participation in a particular specialty program and patient care activities associated with that particular specialty program. Patient care activities means the care and treatment of particular patients, including services for which a physician or other practitioner may bill, and orientation activities as defined in this section. * * * * * 17. Section 413.78 is amended by adding a sentence at the end of paragraph (b) to read as follows: VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 * * * * * (b) * * * Effective for cost reporting periods beginning on or after October 1, 2007, vacation leave and sick leave (that do not prolong the total time a resident is participating in the approved program beyond the normal duration of the program) are not included in the determination of full-time equivalency. * * * * * PART 489—PROVIDER AGREEMENTS AND SUPPLIER APPROVAL 18. The authority citation for part 489 is amended to read as follows: Authority: Secs. 1102, 1819, 1820(e), 1861, 1864(m), 1866, 1869, and 1871 of the Social Security Act (41 U.S.C. 1302, 1395i–3, 1395x, 1395aa(m), 1395cc, 1395ff, and 1395hh) 19. Section 489.3 is amended by adding a definition of ‘‘physicianowned hospital’’ in alphabetical order to read as follows: § 489.3 Definitions. * * * * * Physician-owned hospital means any participating hospital (as defined in § 489.24) in which a physician or physicians have an ownership or investment interest. The ownership or investment interest may be through equity, debt, or other means, and includes an interest in an entity that holds an ownership or investment interest in the hospital. 20. Section 489.12 is amended by— a. Revising paragraph (a)(2). b. Redesignating paragraph (a)(3) as paragraph (a)(4). c. Adding a new paragraph (a)(3). The revision and addition read as follows: § 489.12 Decision to deny an agreement. (a) * * * (2) The prospective provider has failed to disclose ownership and control interests in accordance with § 420.206 of this chapter; (3) The prospective provider is a physician-owned hospital as defined in § 489.3 and does not have procedures in place for making physician ownership disclosures to patients in accordance with § 489.20(u) of this chapter; or * * * * * 21. Section 489.20 is amended by adding new paragraphs (u) and (v) to read as follows: § 489.20 Basic commitments. * * * * * (u) In the case of a physician-owned hospital as defined in § 489.3— PO 00000 Frm 00155 Fmt 4701 Sfmt 4702 24833 (1) To furnish all patients notice, in accordance with § 482.13(b)(2), at the beginning of their hospital stay or outpatient visit that the hospital is a physician-owned hospital. The notice should disclose, in a manner reasonably designed to be understood by all patients, the fact that the hospital meets the Federal definition of a physicianowned hospital specified in § 489.3 and that the list of the hospital’s physician owners or investors is available upon request. For the purposes of this paragraph, the hospital stay or outpatient visit begins with the provision of a package of information regarding scheduled preadmission testing and registration for a planned hospital admission for inpatient care or outpatient service. (2) To require all physician owners who also are members of the hospital’s medical staff to agree, as a condition of continued medical staff membership, to disclose in writing their ownership interest in the hospital to all patients they refer to the hospital. Disclosure shall be required at the time the referral is made. (v) In the case of a hospital as defined in § 489.24(b), to furnish all patients written notice, in accordance with § 482.13(b)(2), at the beginning of their hospital stay or outpatient visit if a doctor of medicine or a doctor of osteopathy is not present in the hospital 24 hours per day, seven days per week. The notice must indicate how the hospital will meet the medical needs of any inpatient who develops an emergency medical condition, as defined in § 489.24(b), at a time when there is no physician present in the hospital. For purposes of this paragraph, the hospital stay or outpatient visit begins with the provision of a package of information regarding scheduled preadmission testing and registration for a planned hospital admission for inpatient care or the provision of a package of information regarding an outpatient service. 22. Section 489.24 is amended by revising paragraph (a)(2) to read as follows: § 489.24 Special responsibilities of Medicare hospitals in emergency cases. (a) * * * (2) Nonapplicability of provisions of this section. Sanctions under this section for an inappropriate transfer during a national emergency or for the direction or relocation of an individual to receive medical screening at an alternate location do not apply to a hospital with a dedicated emergency department located in an emergency area, as specified in section 1135(g)(1) of E:\FEDREG\03MYP2.LOC 03MYP2 24834 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules the Act. A waiver of these sanctions is limited to a 72-hour period beginning upon the implementation of a hospital disaster protocol, except that, if a public health emergency involves a pandemic infectious disease (such as pandemic influenza), the waiver will continue in effect until the termination of the applicable declaration of a public health emergency, as provided for by section 1135(e)(1)(B) of the Act. * * * * * 23. Section 489.53 is amended by— a. Redesignating paragraph (c) and (d) as paragraphs (d) as (e), respectively. b. Adding a new paragraph (c). c. In newly redesignated paragraph (d) introductory text, removing the crossreference ‘‘paragraph (c)(2) of this section’’ and adding the reference ‘‘paragraph (d)(2) of this section’’ in its place. The revisions and additions read as follows: § 489.53 Termination by CMS. * * * * * (c) Termination of agreements with physician-owned hospitals. In the case of a physician-owned hospital, as defined at § 489.3, CMS may terminate the provider agreement if the hospital failed to comply with the requirements of § 489.20(u). * * * * * (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program) Dated: April 13, 2007. Leslie Norwalk, Acting Administrator, Centers for Medicare & Medicaid Services. Dated: April 13, 2007. Michael O. Leavitt, Secretary. Editorial Note: The following Addendum and appendices will not appear in the Code of Federal Regulations. mmaher on DSK3CLS3C1PROD with $$_JOB Addendum—Proposed Schedule of Standardized Amounts, Update Factors, and Rate-of-Increase Percentages Effective With Cost Reporting Periods Beginning On or After October 1, 2007 I. Summary and Background In this Addendum, we are setting forth the proposed methods and data we are using to determine the proposed prospective payment rates for Medicare hospital inpatient operating costs and Medicare hospital inpatient capital-related costs. We are also setting forth the proposed rate-of-increase percentages for updating the target amounts for certain hospitals and hospital units excluded from the IPPS. In general, except for SCHs, MDHs, and hospitals located in Puerto Rico, each hospital’s payment per discharge under the IPPS is based on 100 percent of the Federal national rate, also VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 known as the national adjusted standardized amount. This amount reflects the national average hospital cost per case from a base year, updated for inflation. SCHs are paid based on whichever of the following rates yields the greatest aggregate payment: the Federal national rate; the updated hospital-specific rate based on FY 1982 costs per discharge; the updated hospital-specific rate based on FY 1987 costs per discharge; or the updated hospitalspecific rate based on FY 1996 costs per discharge. Under section 1886(d)(5)(G) of the Act, MDHs historically have been paid based on the Federal national rate or, if higher, the Federal national rate plus 50 percent of the difference between the Federal national rate and the updated hospital-specific rate based on FY 1982 or FY 1987 costs per discharge, whichever is higher. (MDHs did not have the option to use their FY 1996 hospital-specific rate.) Section 5003(a)(1) of Pub. L. 109–171 extended and modified the MDH special payment provision which was previously set to expire on October 1, 2006, to discharges occurring on or after October 1, 2006, but before October 1, 2011. Under section 5003(b) of Pub. L. 109–171, if the change results in an increase to its target amount, an MDH must rebase its hospital-specific rates to its FY 2002 cost report. In addition, under section 5003(c) of Pub. L. 109–171, MDHs are now paid based on the Federal national rate or, if higher, the Federal national rate plus 75 percent of the difference between the Federal national rate and the updated hospitalspecific rate. Further, based upon section 5003(d) of Pub. L. 109–171, MDHs are no longer subject to the 12-percent cap on their DSH payment adjustment factor. For hospitals in Puerto Rico, the payment per discharge is based on the sum of 25 percent of a Puerto Rico rate that reflects base year average costs per case of Puerto Rico hospitals and 75 percent of the Federal national rate. (See section II.D.3. of this Addendum for a complete description.) As discussed below in section II. of this Addendum, we are proposing to make changes in the determination of the prospective payment rates for Medicare inpatient operating costs for FY 2008. In section III. of this Addendum, we discuss our proposed changes for determining the prospective payment rates for Medicare inpatient capital-related costs for FY 2008. Section IV. of this Addendum sets forth our proposed changes for determining the rate-ofincrease limits for certain hospitals excluded from the IPPS for FY 2008. The tables to which we refer in the preamble of this proposed rule are presented in section VI. of this Addendum of this proposed rule. II. Proposed Changes to Prospective Payment Rates for Hospital Inpatient Operating Costs The basic methodology for determining prospective payment rates for hospital inpatient operating costs for FY 2005 and subsequent fiscal years is set forth at § 412.64. The basic methodology for determining the prospective payment rates for hospital inpatient operating costs for hospitals located in Puerto Rico for FY 2005 and subsequent fiscal years is set forth at § § 412.211 and 412.212. Below we discuss the factors used for determining the prospective payment rates. PO 00000 Frm 00156 Fmt 4701 Sfmt 4702 In summary, the proposed standardized amounts set forth in Tables 1A, 1B, 1C, and 1D of section VI. of this Addendum reflect— <bullet≤ Equalization of the standardized amounts for urban and other areas at the level computed for large urban hospitals during FY 2004 and onward, as provided for under section 1886(d)(3)(A)(iv) of the Act, updated by the applicable percentage increase required under sections 1886(b)(3)(B)(i)(XX) and 1886(b)(3)(B)(viii) of the Act. <bullet≤ The labor-related share that is applied to the standardized amounts and Puerto Rico-specific standardized amounts to give the hospital the highest payment, as provided for under sections 1886(d)(3)(E), and 1886(d)(9)(C)(iv) of the Act. <bullet≤ Proposed updates of 3.3 percent for all areas (that is, the estimated full market basket percentage increase of 3.3 percent), as required by section 1886(b)(3)(B)(i)(XX) of the Act, as amended by section 5001(a)(1) of Pub. L. 109–171, and reflecting the requirements of section 1886(b)(3)(B)(viii) of the Act, as added by section 5001(a)(3) of Pub. L. 109–171, to reduce the applicable percentage increase by 2.0 percentage points for a hospital that fails to submit data, in a form and manner specified by the Secretary, relating to the quality of inpatient care furnished by the hospital. <bullet≤ An adjustment to the standardized amount to ensure budget neutrality for DRG recalibration and reclassification, as provided for under section 1886(d)(4)(C)(iii) of the Act. <bullet≤ An adjustment to ensure the wage index update and changes are budget neutral, as provided for under section 1886(d)(3)(E) of the Act. <bullet≤ An adjustment to ensure the effects of geographic reclassification are budget neutral, as provided for in section 1886(d)(8)(D) of the Act, by removing the FY 2007 budget neutrality factor and applying a revised factor. <bullet≤ An adjustment to remove the FY 2007 outlier offset and apply an offset for FY 2008. <bullet≤ An adjustment to ensure the effects of the rural community hospital demonstration required under section 410A of Pub. L. 108–173 are budget neutral, as required under section 410A(c)(2) of Pub. L. 108–173. <bullet≤ An adjustment to eliminate the effect of coding or classification changes that do not reflect real changes in case-mix using the Secretary’s authority under section 1886(d)(3)(A)(vi) of the Act (as discussed in section II.D.6. of the preamble to this proposed rule). We note that two budget neutrality provisions will no longer be applied to the standardized amounts beginning with FY 2008. First, in the FY 2005 IPPS final rule (69 FR 49032 through 49034), we allowed urban hospitals that became rural under the new labor market area definitions to maintain their assignment to the MSA where they were previously located for the 3-year period of FY 2005, FY 2006, and FY 2007. In these years, we provided for a budget neutrality E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB adjustment to the standardized amount to ensure that this policy did not increase Medicare expenditures for hospital inpatient services. For FY 2008, this budget neutrality adjustment to the IPPS standardized amounts will no longer be necessary because the provision has expired. Second, in this proposed rule, we are proposing a prospective change to how budget neutrality is applied to implement the rural floor for FY 2008 and subsequent years. As discussed in section III.G.4. of the preamble of this proposed rule, we are proposing to apply the budget neutrality adjustment to hospital wage indices rather than the standardized amount. A. Calculation of the Proposed Adjusted Standardized Amount 1. Standardization of Base-Year Costs or Target Amounts In general, the national standardized amount is based on per discharge averages of adjusted hospital costs from a base period (section 1886(d)(2)(A) of the Act) or, for Puerto Rico, adjusted target amounts from a base period (section 1886(d)(9)(B)(i) of the Act), updated and otherwise adjusted in accordance with the provisions of section 1886(d) of the Act. The September 1, 1983 interim final rule (48 FR 39763) contained a detailed explanation of how base-year cost data (from cost reporting periods ending during FY 1981) were established in the initial development of standardized amounts for the IPPS. The September 1, 1987 final rule (52 FR 33043 and 33066) contains a detailed explanation of how the target amounts were determined, and how they are used in computing the Puerto Rico rates. Sections 1886(d)(2)(B) and (d)(2)(C) of the Act require us to update base-year per discharge costs for FY 1984 and then standardize the cost data in order to remove the effects of certain sources of cost variations among hospitals. These effects include case-mix, differences in area wage levels, cost-of-living adjustments for Alaska and Hawaii, indirect medical education costs, and costs to hospitals serving a disproportionate share of low-income patients. In accordance with section 1886(d)(3)(E) of the Act, the Secretary estimates, from timeto-time, the proportion of hospitals’ costs that are attributable to wages and wage-related costs. In general, the standardized amount is divided into labor-related and nonlaborrelated amounts; only the proportion considered the labor-related amount is adjusted by the wage index. Section 1886(d)(3)(E) of the Act requires that 62 percent of the standardized amount be adjusted by the wage index, unless doing so would result in lower payments to a hospital than would otherwise be made. (Section 1886(d)(9)(C)(iv)(II) of the Act extends this provision to the labor-related share for hospitals located in Puerto Rico.) For FY 2008, we are not proposing to change the national and Puerto Rico-specific labor-related and nonlabor-related shares from the percentages established for FY 2007. Therefore, the labor-related share would continue to be 69.7 percent for the national standardized amounts and 58.7 percent for VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 the Puerto Rico specific standardized amount. Consistent with section 1886(d)(3)(E) of the Act, we will apply the wage index to a labor-related share of 62 percent for all non-Puerto Rico hospitals whose wage indexes are less than or equal to 1.0000. For all non-Puerto Rico hospitals whose wage indices are greater than 1.0000, we will apply the wage index to a labor share of 69.7 percent of the national standardized amount. For a Puerto Rico hospital, we will apply a labor share of 58.7 percent if its Puerto Rico-specific wage index is less than or equal to 1.0000. For Puerto Rico hospitals whose Puerto Rico-specific wage index values are greater than 1.0000, we will apply a labor share of 62 percent. The standardized amounts for operating costs appear in Table 1A, 1B, and 1C of the Addendum to this proposed rule. 2. Computing the Average Standardized Amount Section 1886(d)(3)(A)(iv) of the Act requires that, beginning with FY 2004 and thereafter, an equal standardized amount is to be computed for all hospitals at the level computed for large urban hospitals during FY 2003, updated by the applicable percentage update. Section 1886(d)(9)(A) of the Act equalizes the Puerto Rico-specific urban and rural area rates. Accordingly, we are calculating FY 2008 national and Puerto Rico standardized amounts, irrespective of whether a hospital is located in an urban or rural location. 3. Updating the Average Standardized Amount In accordance with section 1886(d)(3)(A)(iv)(II) of the Act, we are updating the equalized standardized amount for FY 2008 by the full estimated market basket percentage increase for hospitals in all areas, as specified in section 1886(b)(3)(B)(i)(XX) of the Act, as amended by section 5001(a)(1) of Pub. L. 109–171. The percentage change in the market basket reflects the average change in the price of goods and services purchased by hospitals to furnish inpatient care. The most recent forecast of the hospital market basket increase for FY 2008 is 3.3 percent. Thus, for FY 2008, the proposed update to the average standardized amount is 3.3 percent for hospitals in all areas. The estimated market basket increase of 3.3 percent is based on the 2007 first quarter forecast of the hospital market basket increase by the Office of the Actuary (as discussed in Appendix B of this proposed rule). Section 1886(b)(3)(B) of the Act specifies the mechanism used to update the standardized amount for payment for inpatient hospital operating costs. Section 1886(b)(3)(B)(viii) of the Act, as added by section 5001(a)(3) of Pub. L. 109–171, provides for a reduction of 2.0 percentage points to the update percentage increase (also known as the market basket update) for FY 2007 and each subsequent fiscal year for any ‘‘subsection (d) hospital’’ that does not submit quality data as discussed in section IV.A. of the preamble of this proposed rule. The standardized amounts in Tables 1A through 1C of section VI. of the Addendum to this proposed rule reflect these differential amounts. PO 00000 Frm 00157 Fmt 4701 Sfmt 4702 24835 Although the update factors for FY 2008 are set by law, we are required by section 1886(e)(4) of the Act to recommend, taking into account MedPAC’s recommendations, appropriate update factors for FY 2008 for both IPPS hospitals and hospitals and hospital units excluded from the IPPS. Our recommendation on the update factors (which is required by sections 1886(e)(4)(A) and (e)(5)(A) of the Act) is set forth in Appendix B of this proposed rule. 4. Other Adjustments to the Average Standardized Amount As in the past, we are adjusting the FY 2008 standardized amount to remove the effects of the FY 2007 geographic reclassifications and outlier payments before applying the FY 2008 updates. We then apply budget neutrality offsets for outliers and geographic reclassifications to the standardized amount based on FY 2008 payment policies. We do not remove the prior year’s budget neutrality adjustments for reclassification and recalibration of the DRG weights and for updated wage data because, in accordance with sections 1886(d)(4)(C)(iii) and 1886(d)(3)(E) of the Act, estimated aggregate payments after the changes in the DRG relative weights and wage index should equal estimated aggregate payments prior to the changes. If we removed the prior year adjustment, we would not satisfy these conditions. Budget neutrality is determined by comparing aggregate IPPS payments before and after making the changes that are required to be budget neutral (for example, changes to DRG classifications, recalibration of the DRG relative weights, updates to the wage index, and different geographic reclassifications). We include outlier payments in the simulations because they may be affected by changes in these parameters. We are also proposing to adjust the standardized amount this year by an estimated amount to ensure that aggregate IPPS payments do not exceed the amount of payments that would have been made in the absence of the rural community hospital demonstration required under section 410A of Pub. L. 108–173. This demonstration is required to be budget neutral under section 410A(c)(2) of Pub. L. 108–173. For FY 2008 and FY 2009, we are also proposing an adjustment to eliminate the effect of coding or classification changes that do not reflect real changes in case-mix using the Secretary’s authority under section 1886(d)(3)(A)(vi) of the Act. a. Proposed Recalibration of DRG Weights and Updated Wage Index—Budget Neutrality Adjustment Section 1886(d)(4)(C)(iii) of the Act specifies that, beginning in FY 1991, the annual DRG reclassification and recalibration of the relative weights must be made in a manner that ensures that aggregate payments to hospitals are not affected. As discussed in section II. of the preamble of this proposed rule, we normalized the recalibrated DRG weights by an adjustment factor, so that the average case weight after recalibration is equal to the average case weight prior to E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24836 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules recalibration. However, equating the average case weight after recalibration to the average case weight before recalibration does not necessarily achieve budget neutrality with respect to aggregate payments to hospitals because payments to hospitals are affected by factors other than average case weight. Therefore, as we have done in past years, we are proposing to make a budget neutrality adjustment to ensure that the requirement of section 1886(d)(4)(C)(iii) of the Act is met. Section 1886(d)(3)(E) of the Act requires us to update the hospital wage index on an annual basis beginning October 1, 1993. This provision also requires us to make any updates or adjustments to the wage index in a manner that ensures that aggregate payments to hospitals are not affected by the change in the wage index. Consistent with current policy, for FY 2008, we are adjusting 100 percent of the wage index factor for occupational mix. We describe the occupational mix adjustment in section III.C. of the preamble to this proposed rule. To comply with the requirement that DRG reclassification and recalibration of the relative weights and the updated wage index be budget neutral, we are using FY 2006 discharge data to simulate payments and compare aggregate payments using the FY 2007 relative weights and wage indexes to aggregate payments using the proposed FY 2008 relative weights and wage indexes. The same methodology was used for the FY 2007 budget neutrality adjustment. Based on this comparison, we computed a budget neutrality adjustment factor equal to 0.999317 to be applied to the national standardized amount. We also are adjusting the Puerto Rico-specific standardized amount for the effect of DRG reclassification and recalibration. We computed a budget neutrality adjustment factor of 0.998557 to be applied to the Puerto Rico-specific standardized amount. These budget neutrality adjustment factors are applied to the standardized amounts for FY 2007 without removing prior year budget neutrality adjustments. In addition, as discussed in section IV. of this addendum, we are applying the same DRG reclassification and recalibration budget neutrality factor of 0.998557 to the hospitalspecific rates that are to be effective for cost reporting periods beginning on or after October 1, 2007. b. Reclassified Hospitals—Budget Neutrality Adjustment Section 1886(d)(8)(B) of the Act provides that, effective with discharges occurring on or after October 1, 1988, certain rural hospitals are deemed urban. In addition, section 1886(d)(10) of the Act provides for the reclassification of hospitals based on determinations by the MGCRB. Under section 1886(d)(10) of the Act, a hospital may be reclassified for purposes of the wage index. Under section 1886(d)(8)(D) of the Act, the Secretary is required to adjust the standardized amount to ensure that aggregate payments under the IPPS after implementation of the provisions of sections 1886(d)(8)(B) and (C) and 1886(d)(10) of the Act are equal to the aggregate prospective payments that would have been made absent these provisions. We note that the wage VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 index adjustments provided under section 1886(d)(13) of the Act are not budget neutral. Section 1886(d)(13)(H) of the Act provides that any increase in a wage index under section 1886(d)(13) shall not be taken into account ‘‘in applying any budget neutrality adjustment with respect to such index’’ under section 1886(d)(8)(D) of the Act. To calculate the budget neutrality factor, we used FY 2006 discharge data to simulate payments, and compared total IPPS payments prior to any reclassifications under sections 1886(d)(8)(B) and (C) and 1886(d)(10) of the Act to total IPPS payments after such reclassifications. Based on these simulations, we calculated an adjustment factor of 0.991938 to ensure that the effects of this reclassification are budget neutral, consistent with the statute. The proposed adjustment factor is applied to the standardized amount after removing the effects of the FY 2007 budget neutrality adjustment factor. We note that the FY 2008 adjustment reflects FY 2008 wage index reclassifications approved by the MGCRB or the Administrator. (Section 1886(d)(10)(D)(v) of the Act makes wage index reclassifications effective for 3 years. Therefore, the FY 2008 geographic reclassification could either be the continuation of a 3-year reclassification that began in FY 2006 or FY 2007 or a new one beginning in FY 2008.) c. Case-Mix Budget Neutrality Adjustment The proposed MS–DRGs will increase the total number of DRGs from 538 to 745. Such a significant expansion in the number of DRGs could lead hospitals to improve coding and documentation in order to have a case assigned to a DRG with a higher payment. As explained above, we make an adjustment to ensure that the DRG relative weights remain budget neutral assuming constant utilization. However, without an adjustment to the IPPS rates to account for expected case mix growth due to improved coding rather than to underlying changes in patient status, the change to severity DRGs will not be budget neutral. Section 1886(d)(3)(A)(vi) of the Act provides the Secretary with explicit authority to adjust the standardized amounts to account for case mix growth due to improved documentation and coding. Further, the Secretary may subsequently revisit this adjustment if actual data is different than the projection. Based on the Actuary’s analysis, using the Secretary’s authority under section 1886(d)(3)(A)(vi) of the Act to adjust the standardized amount to eliminate the effect of changes in coding or classification of discharges that do not reflect real changes in case-mix, we are proposing to reduce the IPPS standardized amounts by 2.4 percent each year for FY 2008 and FY 2009. Section 1886(d)(3)(A)(vi) further gives the Secretary authority to revisit adjustments to the standardized amounts for changes in coding or classification of discharges that were based on estimates in a future year. Consistent with the statute, we will compare the actual increase in case-mix due to documentation and coding to our projection once we have actual data for FY 2008 and FY 2009 for the FY 2010 and FY 2011 IPPS rules. As that time, if necessary, we may make a further adjustment to the standardized amounts to PO 00000 Frm 00158 Fmt 4701 Sfmt 4702 account for the difference between our projection and actual data. d. Outliers Section 1886(d)(5)(A) of the Act provides for payments in addition to the basic prospective payments for ‘‘outlier’’ cases involving extraordinarily high costs. To qualify for outlier payments, a case must have costs greater than the sum of the prospective payment rate for the DRG, any IME and DSH payments, any new technology add-on payments, and the ‘‘outlier threshold’’ or ‘‘fixed loss’’ amount (a dollar amount by which the costs of a case must exceed payments in order to qualify for an outlier payment). We refer to the sum of the prospective payment rate for the DRG, any IME and DSH payments, any new technology add-on payments, and the outlier threshold as the outlier ‘‘fixed-loss cost threshold.’’ To determine whether the costs of a case exceed the fixed-loss cost threshold, a hospital’s CCR is applied to the total covered charges for the case to convert the charges to estimated costs. Payments for eligible cases are then made based on a marginal cost factor, which is a percentage of the estimated costs above the fixed-loss cost threshold. The marginal cost factor for FY 2008 is 80 percent, the same marginal cost factor we have used since FY 1995 (59 FR 45367). In accordance with section 1886(d)(5)(A)(iv) of the Act, outlier payments for any year are projected to be not less than 5 percent nor more than 6 percent of total operating DRG payments plus outlier payments. Section 1886(d)(3)(B) of the Act requires the Secretary to reduce the average standardized amount by a factor to account for the estimated proportion of total DRG payments made to outlier cases. Similarly, section 1886(d)(9)(B)(iv) of the Act requires the Secretary to reduce the average standardized amount applicable to hospitals in Puerto Rico to account for the estimated proportion of total DRG payments made to outlier cases. More information on outlier payments may be found on the CMS Web site at https://www.cms.hhs.gov/Acute InpatientPPS/04—outlier.asp#TopOfPage. (1) Proposed FY 2008 Outlier Fixed-Loss Cost Threshold For FY 2008, we are proposing to use the same methodology used for FY 2007 (71 FR 48148 through 484151) to calculate the outlier threshold. Similar to the methodology used in the FY 2007 final rule, for FY 2008, we are applying an adjustment factor to the CCRs to account for cost and charge inflation (as explained below). As we have done in the past, to calculate the proposed FY 2008 outlier threshold, we simulated payments by applying FY 2008 rates and policies using cases from the FY 2006 MedPAR files. Therefore, in order to determine the proposed FY 2008 outlier threshold, we inflate the charges on the MedPAR claims by 2 years, from FY 2006 to FY 2008. We are proposing to continue using a refined methodology that takes into account the lower inflation in hospital charges that is occurring as a result of the outlier final rule (68 FR 34494), which changed our methodology for determining outlier E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules payments by implementing the use of more current CCRs. Our refined methodology uses more recent data that reflect the rate-ofchange in hospital charges under the new outlier policy. Using the most recent data available, we calculated the 1-year average annualized rateof-change in charges-per-case from the last quarter of FY 2005 in combination with the first quarter of FY 2006 (July 1, 2005 through December 31, 2005) to the last quarter of FY 2006 in combination with the first quarter of FY 2007 (July 1, 2006 through December 31, 2006). This rate of change was 7.26 percent (1.0726) or 15.04 percent (1.1504) over 2 years. As we have done in the past, we are proposing to establish the proposed FY 2008 outlier threshold using hospital CCRs from the December 2006 update to the ProviderSpecific File—the most recent available at the time of this proposed rule. This file includes CCRs that reflect implementation of the changes to the policy for determining the applicable CCRs that became effective August 8, 2003 (68 FR 34494). As discussed in the FY 2007 final rule (71 FR 48150), we worked with the Actuary to derive the methodology described below to develop the CCR adjustment factor. For FY 2008, we are proposing to use the same methodology by using the operating cost per discharge increase in combination with the final updated market basket increase determined by Global Insight, Inc., as well as the charge inflation factor described above to estimate the adjustment to the CCRs. By using the market basket rate-of-increase and the increase in the average cost per discharge from hospital cost reports, we are using two different measures of cost inflation. For FY 2008, we determined the adjustment by taking the percentage increase in the operating costs per discharge from FY 2004 to FY 2005 (1.0529) from the cost report and dividing it by the final market basket increase from FY 2005 (1.043) We repeated this calculation for 2 prior years to determine the 3-year average of the rate of adjusted change in costs between the market basket rate-ofincrease and the increase in cost per case from the cost report (FY 2002 to FY 2003 percentage increase of operating costs per discharge of 1.0721 divided by FY 2003 final market basket increase of 1.041, FY 2003 to FY 2004 percentage increase of operating costs per discharge of 1.0624 divided by FY 2004 final market basket increase of 1.04). For FY 2008, we averaged the differentials calculated for FY 2003, FY 2004, and FY 2005 which resulted in a mean ratio of 1.0203. We multiplied the 3-year average of 1.0203 by the 2006 market basket percentage increase of 1.0420, which resulted in an operating cost inflation factor of 6.32 percent or 1.0632. We then divided the operating cost inflation factor by the 1-year average change in charges (1.0726) and applied an adjustment factor of 0.9912 to the operating CCRs from the Provider-Specific File. As stated in the FY 2007 final rule, we continue to believe it is appropriate to apply only a one year adjustment factor to the CCRs. On average, it takes approximately 9 months for fiscal intermediaries (or, if applicable, the MAC) to tentatively settle a cost report from the fiscal year end of a hospital’s cost reporting period. The average VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 ‘‘age’’ of hospitals’’ CCRs from the time the fiscal intermediary or the MAC inserts the CCR in the PSF until the beginning of FY 2007 is approximately 1 year. Therefore, as stated above, we believe a one year adjustment to the CCRs is appropriate. We used the same methodology for the capital CCRs and applied an adjustment factor of 0.964 (cost inflation factor of 1.0340 divided by a charge inflation factor of 1.0726) to the capital CCRs. We are using the same charge inflation factor for the capital CCRs that was used for the operating CCRs. The charge inflation factor is based on the overall billed charges. Therefore, we believe it is appropriate to apply the charge factor to both the operating and capital CCRs. Using this methodology, we are proposing an outlier fixed-loss cost threshold for FY 2008 equal to the prospective payment rate for the DRG, plus any IME and DSH payments, and any add-on payments for new technology, plus $23,015. With this threshold, we are projecting that outlier payments will equal 5.1 percent of total IPPS payments. As we did in establishing the FY 2007 outlier threshold (71 FR 48149), in our projection of FY 2008 outlier payments, we are not making any adjustments for the possibility that hospitals’ CCRs and outlier payments may be reconciled upon cost report settlement. We continue to believe that, due to the policy implemented in the outlier final rule (68 FR 34494, June 9, 2003), CCRs will no longer fluctuate significantly and, therefore, few hospitals will actually have these ratios reconciled upon cost report settlement. In addition, it is difficult to predict the specific hospitals that will have CCRs and outlier payments reconciled in any given year. We also noted that reconciliation occurs because hospitals’ actual CCRs for the cost reporting period are different than the interim CCRs used to calculate outlier payments when a bill is processed. Our simulations assume that CCRs accurately measure hospital costs based on information available to us at the time we set the outlier threshold. For these reasons, we are not making any assumptions about the effects of reconciliation on the outlier threshold calculation. We also note that there are several factors that contributed to a lower fixed loss outlier threshold for FY 2008 compared to FY 2007. First, the case-weighted national average operating CCR declined by approximately an additional 1.3 percentage points from the March 2006 (used to calculate the FY 2007 outlier threshold) to the December 2006 update of the Provider-Specific File. Second, we further reduced the CCRs by applying an adjustment to reflect the differential increase between costs and charges. As noted above, using lower CCRs from the December 2006 Provider-Specific File, in combination with the FY 2006 MedPAR claims and inflated charges, contributes to a lower outlier threshold for FY 2008 in this proposed rule compared to an outlier threshold of $24,485 in FY 2007. Finally, as discussed in section II.D. of the preamble of this proposed rule, we are proposing to adopt the use of MS– DRGs under the IPPS for FY 2008. The proposed MS–DRG system would increase the number of DRGs from 538 to 745 and better recognize severity of illness than the PO 00000 Frm 00159 Fmt 4701 Sfmt 4702 24837 CMS DRGs. Better recognition of severity of illness with the MS–DRGs means that nonoutlier payments will compensate hospitals for the higher costs of some cases that previously received outlier payments. As cases are paid more accurately, in order to meet the 5.1 percent target, we would need to decrease the fixed-loss outlier threshold so that more cases qualify for outlier payments. Therefore, we believe that all of the above factors cumulatively contributed to a lower proposed fixed-loss outlier threshold in FY 2008 compared to FY 2007. (2) Other Proposed Changes Concerning Outliers As stated in the FY 1994 IPPS final rule (58 FR 46348, September 1, 1993), we establish outlier thresholds that are applicable to both hospital inpatient operating costs and hospital inpatient capital-related costs. When we modeled the combined operating and capital outlier payments, we found that using a common set of thresholds resulted in a lower percentage of outlier payments for capital-related costs than for operating costs. We are project that the proposed thresholds for FY 2008 would result in outlier payments equal to 5.1 percent of operating DRG payments and 4.87 percent of capital payments based on the Federal rate. In accordance with section 1886(d)(3)(B) of the Act, we are reducing the FY 2008 standardized amount by the same percentage to account for the projected proportion of payments paid to outliers. The outlier adjustment factors that would be applied to the standardized amount for the proposed FY 2008 outlier threshold are as follows: Operating standardized amounts I National ..... Puerto Rico 0.948989 0.965244 Capital federal rate 0.948377 0.954922 Consistent with current policy, we are applying the outlier adjustment factors to FY 2008 rates after removing the effects of the FY 2007 outlier adjustment factors on the standardized amount. To determine whether a case qualifies for outlier payments, we apply hospital-specific CCRs to the total covered charges for the case. Estimated operating and capital costs for the case are calculated separately by applying separate operating and capital CCRs. These costs are then combined and compared with the outlier fixed-loss cost threshold. The outlier final rule (68 FR 34494) eliminated the application of the statewide average CCRs for hospitals with CCRs that fall below 3 standard deviations from the national mean CCR. However, for those hospitals for which the fiscal intermediary or MAC computes operating CCRs greater than 1.221 or capital CCRs greater than 0.150, or hospitals for whom the fiscal intermediary or MAC is unable to calculate a CCR (as described at § 412.84(i)(3) of our regulations), E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24838 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules we are still using statewide average CCRs to determine whether a hospital qualifies for outlier payments.18 Table 8A in section VI. of this Addendum contains the statewide average operating CCRs for urban hospitals and for rural hospitals for which the fiscal intermediary or MAC is unable to compute a hospital-specific CCR within the above range. Effective for discharges occurring on or after October 1, 2007, these statewide average ratios would replace the ratios published in the IPPS final rule for FY 2007 (71 FR 48303). Table 8B in section VI. of this Addendum contains the comparable statewide average capital CCRs. Again, the CCRs in Tables 8A and 8B would be used during FY 2008 when hospital-specific CCRs based on the latest settled cost report are either not available or are outside the range noted above. For an explanation of Table 8C, please see section VI. of this Addendum. We finally note that we published a manual update (Change Request 3966) to outliers on October 12, 2005 which updated Chapter 3, Section 20.1.2 of the Medicare Claims Processing Manual. The manual update covered an array of topics, including CCRs, reconciliation, and the time value of money. We encourage hospitals that are assigned the statewide average operating and/or capital CCRs to work with their fiscal intermediaries or MAC on a possible alternative operating and/or capital CCR as explained in Change Request 3966. Use of an alternative CCR developed by the hospital in conjunction with the fiscal intermediary or MAC can avoid possible overpayments or underpayments at cost report settlement thus ensuring better accuracy when making outlier payments and negating the need for outlier reconciliation. We also note a hospital may request an alternative operating or capital CCR ratio at any time as long as the guidelines of Change Request 3966 are followed. To download and view the manual instructions on outlier and cost-to-charge ratios, please visit the Web site: https:// www.cms.hhs.gov/ manuals/downloads/ clm104c03.pdf. (3) FY 2006 and FY 2007 Outlier Payments In the FY 2007 IPPS final rule (70 FR 47496), we stated that, based on available data, we estimated that actual FY 2006 outlier payments would be approximately 4.62 percent of actual total DRG payments. This estimate was computed based on simulations using the FY 2005 MedPAR file (discharge data for FY 2005 bills). That is, the estimate of actual outlier payments did not reflect actual FY 2006 bills, but instead reflected the application of FY 2006 rates and policies to available FY 2005 bills. Our current estimate, using available FY 2006 bills, is that actual outlier payments for FY 2006 were approximately 4.50 percent of actual total DRG payments. Thus, the data indicate that, for FY 2006, the percentage of actual outlier payments relative to actual total payments is lower than we projected before FY 2006. Consistent with the policy and statutory interpretation we have maintained since the inception of the IPPS, 18 These figures represent 3.0 standard deviations from the mean of the log distribution of CCRs for all hospitals. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 we do not plan to make retroactive adjustments to outlier payments to ensure that total outlier payments for FY 2006 are equal to 5.1 percent of total DRG payments. We currently estimate that actual outlier payments for FY 2007 will be approximately 4.9 percent of actual total DRG payments, 0.2 percentage points lower than the 5.1 percent we projected in setting the outlier policies for FY 2007. This estimate is based on simulations using the FY 2006 MedPAR file (discharge data for FY 2006 bills). We used these data to calculate an estimate of the actual outlier percentage for FY 2007 by applying FY 2007 rates and policies, including an outlier threshold of $24,485 to available FY 2006 bills. We believe the 0.2 percentage point difference between the projected estimate of outlier payments for FY 2007 and our current estimate of actual outlier payments in this proposed rule provides preliminary evidence that incorporating an adjustment factor to the CCRs for FY 2007 in response to public comments has improved our estimating methodology. e. Proposed Rural Community Hospital Demonstration Program Adjustment (Section 410A of Pub. L. 108–173) Section 410A of Pub. L. 108–173 requires the Secretary to establish a demonstration that will modify reimbursement for inpatient services for up to 15 small rural hospitals. Section 410A(c)(2) of Pub. L. 108–173 requires that ‘‘in conducting the demonstration program under this section, the Secretary shall ensure that the aggregate payments made by the Secretary do not exceed the amount which the Secretary would have paid if the demonstration program under this section was not implemented.’’ As discussed in section IV.G. of the preamble to this proposed rule, we have satisfied this requirement by adjusting national IPPS rates by a factor that is sufficient to account for the added costs of this demonstration. We estimate that the average additional annual payment that will be made to each participating hospital under the demonstration will be approximately $1,075,765. We based this estimate on the recent historical experience of the difference between inpatient cost and payment for hospitals that are participating in the demonstration. For 9 participating hospitals, the total annual impact of the demonstration program is estimated to be $9,681,893. The required adjustment to the Federal rate used in calculating Medicare inpatient prospective payments as a result of the demonstration is 0.999899. In order to achieve budget neutrality, we are adjusting the national IPPS rates by an amount sufficient to account for the added costs of this demonstration. In other words, we are applying budget neutrality across the payment system as a whole rather than merely across the participants of this demonstration, consistent with past practice. We believe that the language of the statutory budget neutrality requirement permits the agency to implement the budget neutrality provision in this manner. The statutory language requires that ‘‘aggregate payments made by the Secretary do not exceed the amount which the Secretary would have paid PO 00000 Frm 00160 Fmt 4701 Sfmt 4702 if the demonstration * * * was not implemented,’’ but does not identify the range across which aggregate payments must be held equal. 5. Proposed FY 2008 Standardized Amount The proposed adjusted standardized amount is divided into labor-related and nonlabor-related portions. Tables 1A and 1B in section VI. of this Addendum contain the national standardized amount that we are proposing to apply to all hospitals, except hospitals in Puerto Rico. The proposed Puerto Rico-specific amounts are shown in Table 1C. The proposed amounts shown in Tables 1A and 1B differ only in that the labor-related share applied to the standardized amounts in Table 1A is 69.7 percent, and Table 1B is 62 percent. In accordance with sections 1886(d)(3)(E) and 1886(d)(9)(C)(iv) of the Act, we are applying a labor-related share of 62 percent, unless the application of that percentage would result in lower payments to a hospital than would otherwise be made. In effect, the statutory provision means that we will apply a laborrelated share of 62 percent for all hospitals (other than those in Puerto Rico) whose wage indexes are less than or equal to 1.0000. In addition, Tables 1A and 1B include proposed standardized amounts reflecting the proposed full 3.3 percent update for FY 2008, and proposed standardized amounts reflecting the 2.0 percentage point reduction to the update (a 1.3 percent update) applicable for hospitals that fail to submit quality data consistent with section 1886(b)(3)(B)(viii) of the Act. Under section 1886(d)(9)(A)(ii) of the Act, the Federal portion of the Puerto Rico payment rate is based on the dischargeweighted average of the national large urban standardized amount (this proposed amount is set forth in Table 1A). The proposed laborrelated and nonlabor-related portions of the national average standardized amounts for Puerto Rico hospitals for FY 2008 are set forth in Table 1C of section VI. of this Addendum. This table also includes the proposed Puerto Rico standardized amounts. The labor-related share applied to the proposed Puerto Rico specific standardized amount is 58.7 percent, or 62 percent, depending on which provides higher payments to the hospital. (Section 1886(d)(9)(C)(iv) of the Act, as amended by section 403(b) of Pub. L. 108–173, provides that the labor-related share for hospitals in Puerto Rico will be 62 percent, unless the application of that percentage would result in lower payments to the hospital.) The following table illustrates the proposed changes from the FY 2007 national average standardized amount. The second column shows the proposed changes from the FY 2007 standardized amounts for hospitals that satisfy the quality data submission requirement for receiving the full update (3.3 percent). The third column shows the proposed changes for hospitals receiving the reduced update (1.3 percent). The first row of the table shows the proposed updated (through FY 2007) average standardized amount after restoring the FY 2007 offsets for outlier payments, demonstration budget neutrality, the wage index transition budget neutrality, and the E:\FEDREG\03MYP2.LOC 03MYP2 24839 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules geographic reclassification budget neutrality. The DRG reclassification and recalibration and wage index budget neutrality factor is cumulative. Therefore, the FY 2007 factor is not removed from this table. We have added two additional rows: One for the documentation and coding adjustment and the other for the rural floor adjustment. (For a complete discussion on the documentation and coding adjustment and the rural floor adjustment, see sections II.D.1.c and III.G.4 of the Addendum to this proposed rule). We have also added separate rows to this table to reflect the different labor related shares that apply to hospitals. COMPARISON OF FY 2007 STANDARDIZED AMOUNTS TO PROPOSED FY 2008 SINGLE STANDARDIZED AMOUNT WITH FULL UPDATE AND REDUCED UPDATE Full update (3.3 percent) FY 2007 Base Rate, after removing reclassification budget neutrality, demonstration budget neutrality, wage index transition budget neutrality factors and outlier offset (based on the labor and market share percentage for FY 2008). FY 2008 Update Factor .......................................................................................... FY 2008 DRG Recalibrations and Wage Index Budget Neutrality Factor ............. FY 2008 Reclassification Budget Neutrality Factor ............................................... Adjusted for Blend of FY 2007 DRG Recalibration and Wage Index Budget Neutrality Factors. FY 2008 Outlier Factor ........................................................................................... Rural Demonstration Budget Neutrality Factor ...................................................... Proposed FY 2008 Documentation and Coding Adjustment ................................. Rural Floor Adjustment ........................................................................................... Proposed Rate for FY 2008 (after multiplying FY 2007 base rate by above factors) where the wage index is less than or equal to 1.0000. Proposed Rate for FY 2008 (after multiplying FY 2007 base rate by above factors) where the wage index is greater than 1.0000. Under section 1886(d)(9)(A)(ii) of the Act, the Federal portion of the Puerto Rico payment rate is based on the dischargeweighted average of the national large urban standardized amount (as set forth in Table 1A). The labor-related and nonlabor-related portions of the national average standardized amounts for Puerto Rico hospitals are set forth in Table 1C of section VI. of this Addendum. This table also includes the Puerto Rico standardized amounts. The labor-related share applied to the Puerto Rico standardized amount is 58.7 percent, or 62 percent, depending on which results in higher payments to the hospital. (Section 1886(d)(9)(C)(iv) of the Act, as amended by section 403(b) of Pub. L. 108–173, provides that the labor-related share for hospitals in Puerto Rico will be 62 percent, unless the application of that percentage would result in lower payments to the hospital.) Reduced update (1.3 percent) Labor: $3,609.23 .................... Nonlabor: $1,569.01 .............. Labor: $3,609.23 Nonlabor: $1,569.01 1.033 ...................................... 0.999317 ................................ 0.991938 ................................ Labor: $3,695.75 .................... Nonlabor: $1,606.62 .............. 0.948989 ................................ 0.999899 ................................ 0.976 ...................................... 1.002214 ................................ Labor: $3,051.33 .................... Nonlabor: $1,870.17 .............. Labor: $3,430.29 .................... Nonlabor: $1,491.21 .............. 1.013 0.999317 0.991938 Labor: $3,624.20 Nonlabor: $1,575.51 0.948989 0.999899 0.976 1.002214 Labor: $2,992.26 Nonlabor: $1,833.96 Labor: $3,363.88 Nonlabor: $1,462.34 B. Proposed Adjustments for Area Wage Levels and Cost-of-Living Tables 1A through 1C, as set forth in section VI. of this Addendum, contain the proposed labor-related and nonlabor-related shares that we are using to calculate the proposed prospective payment rates for hospitals located in the 50 States, the District of Columbia, and Puerto Rico for FY 2008. This section addresses two types of adjustments to the standardized amounts that are made in determining the proposed prospective payment rates as described in this Addendum. 1. Proposed Adjustment for Area Wage Levels Sections 1886(d)(3)(E) and 1886(d)(9)(C)(iv) of the Act require that we make an adjustment to the labor-related portion of the national and Puerto Rico prospective payment rates, respectively, to account for area differences in hospital wage levels. This adjustment is made by multiplying the labor-related portion of the adjusted standardized amounts by the appropriate wage index for the area in which the hospital is located. In section III. of the preamble to this proposed rule, we discuss the data and methodology for the proposed FY 2008 wage index. 2. Proposed Adjustment for Cost-of-Living in Alaska and Hawaii Section 1886(d)(5)(H) of the Act authorizes an adjustment to take into account the unique circumstances of hospitals in Alaska and Hawaii. Higher labor-related costs for these two States are taken into account in the adjustment for area wages described above. For FY 2008, we are proposing to adjust the payments for hospitals in Alaska and Hawaii by multiplying the nonlabor-related portion of the standardized amount by the applicable adjustment factor contained in the table below. TABLE OF COST-OF-LIVING ADJUSTMENT FACTORS: ALASKA AND HAWAII HOSPITALS Cost of living adjustment factor mmaher on DSK3CLS3C1PROD with $$_JOB Area Alaska: City of Anchorage and 80-kilometer (50-mile) radius by road ............................................................................................. City of Fairbanks and 80-kilometer (50-mile) radius by road ............................................................................................... City of Juneau and 80-kilometer (50-mile) radius by road ................................................................................................... Alaska-All areas .................................................................................................................................................................... Hawaii: City and County of Honolulu ................................................................................................................................................ County of Hawaii .................................................................................................................................................................. County of Kauai .................................................................................................................................................................... County of Maui and County of Kalawao .............................................................................................................................. (The above factors are based on data obtained from the U.S. Office of Personnel Management.) VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00161 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 1.24 1.24 1.24 1.25 1.25 1.17 1.25 1.25 24840 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules C. Proposed DRG Relative Weights As discussed in section II. of the preamble of this proposed rule, we are proposing to adopt a revised classification system for all hospital discharges, assigning them into proposed MS–DRGs, and have developed proposed relative weights for each MS–DRG that reflect the resource utilization of cases in each proposed MS–DRG relative to Medicare cases in other proposed MS–DRGs. Table 5 of section VI. of this Addendum contains the proposed relative weights that we would use for discharges occurring in FY 2008. These factors have been recalibrated as explained in section II. of the preamble of this proposed rule. D. Calculation of the Proposed Prospective Payment Rates General Formula for Calculation of the Proposed Prospective Payment Rates for FY 2008 In general, the operating prospective payment rate for all hospitals paid under the IPPS located outside of Puerto Rico, except SCHs and MDHs, for FY 2008 equals the Federal rate. The prospective payment rate for SCHs for FY 2008 equals the higher of the applicable Federal rate or the hospital-specific rate as described below. The prospective payment rate for MDHs for FY 2008 equals the higher of the Federal rate, or the Federal rate plus 75 percent of the difference between the Federal rate and the hospital-specific rate as described below. The prospective payment rate for Puerto Rico for FY 2008 equals 25 percent of the Puerto Rico rate plus 75 percent of the applicable national rate. mmaher on DSK3CLS3C1PROD with $$_JOB 1. Federal Rate The Federal rate is determined as follows: Step 1—Select the applicable average standardized amount depending on whether the hospital has submitted qualifying quality data (full update for qualifying hospitals, update minus 2.0 percentage points for nonqualifying hospitals). Step 2—Multiply the labor-related portion of the standardized amount by the applicable wage index for the geographic area in which the hospital is located or the area to which the hospital is reclassified. Step 3—For hospitals in Alaska and Hawaii, multiply the non-labor-related portion of the standardized amount by the applicable cost-of-living adjustment factor. Step 4—Add the amount from Step 2 and the non-labor-related portion of the standardized amount (adjusted, if applicable, under Step 3). Step 5—Multiply the final amount from Step 4 by the relative weight corresponding to the applicable MS–DRG (see Table 5 of section VI. of this Addendum). The Federal rate as determined in Step 5 may then be further adjusted if the hospital qualifies for either the IME or DSH adjustment. In addition, for hospitals that qualify for a low-volume payment adjustment under section 1886(d)(12) of the Act, the payment in Step 5 would be increased by 25 percent. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 2. Hospital-Specific Rate (Applicable Only to SCHs and MDHs) a. Calculation of Hospital-Specific Rate Section 1886(b)(3)(C) of the Act provides that SCHs are paid based on whichever of the following rates yields the greatest aggregate payment: the Federal rate; the updated hospital-specific rate based on FY 1982 costs per discharge; the updated hospital-specific rate based on FY 1987 costs per discharge; or the updated hospital-specific rate based on FY 1996 costs per discharge. As discussed previously, MDHs are required to rebase their hospital-specific rates to their FY 2002 cost reports if doing so results in higher payments. In addition, effective for discharges occurring on or after October 1, 2006, MDHs are to be paid based on the Federal national rate or, if higher, the Federal national rate plus 75 percent (changed from 50 percent) of the difference between the Federal national rate and the greater of the updated hospital-specific rates based on either FY 1982, FY 1987 or FY 2002 costs per discharge. Further, MDHs will no longer be subject to the 12-percent cap on their DSH payment adjustment factor. Hospital-specific rates have been determined for each of these hospitals based on the FY 1982 costs per discharge, the FY 1987 costs per discharge, or, for SCHs, the FY 1996 costs per discharge and for MDHs, the FY 2002 cost per discharge. For a more detailed discussion of the calculation of the hospital-specific rates, we refer the reader to the FY 1984 IPPS interim final rule (48 FR 39772); the April 20, 1990 final rule with comment (55 FR 15150); the FY 1991 IPPS final rule (55 FR 35994); and the FY 2001 IPPS final rule (65 FR 47082). In addition, for both SCHs and MDHs, the hospital-specific rate is adjusted by the budget neutrality adjustment factor as discussed in section IV.C. of the preamble to this proposed rule. The resulting rate will be used in determining the payment rate an SCH or MDH will receive for its discharges beginning on or after October 1, 2007. b. Updating the FY 1982, FY 1987, FY 1996, and FY 2002 Hospital-Specific Rates for FY 2008 We are proposing to increase the hospitalspecific rates by 3.3 percent (the proposed estimated hospital market basket percentage increase) for SCHs and MDHs for FY 2008. Section 1886(b)(3)(C)(iv) of the Act provides that the update factor applicable to the hospital-specific rates for SCHs is equal to the update factor provided under section 1886(b)(3)(B)(iv) of the Act, which, for SCHs in FY 2007, is the market basket rate-ofincrease. Section 1886(b)(3)(D) of the Act provides that the update factor applicable to the hospital-specific rates for MDHs also equals the update factor provided under section 1886(b)(3)(B)(iv) of the Act, which, for FY 2007, is the market basket rate-ofincrease. 3. General Formula for Calculation of Proposed Prospective Payment Rates for Hospitals Located in Puerto Rico Beginning On or After October 1, 2007, and Before October 1, 2008 Section 1886(d)(9)(E)(iv) of the Act provides that, effective for discharges PO 00000 Frm 00162 Fmt 4701 Sfmt 4702 occurring on or after October 1, 2004, hospitals located in Puerto Rico are paid based on a blend of 75 percent of the national prospective payment rate and 25 percent of the Puerto Rico-specific rate. a. Puerto Rico Rate The Puerto Rico prospective payment rate is determined as follows: Step 1—Select the applicable average standardized amount considering the applicable wage index (see Table 1C). Step 2—Multiply the labor-related portion of the standardized amount by the applicable Puerto Rico-specific wage index. Step 3—Add the amount from Step 2 and the nonlabor-related portion of the standardized amount. Step 4—Multiply the amount from Step 3 by the applicable MS–DRG relative weight (see Table 5 of section IV. of the Addendum). Step 5—Multiply the result in Step 4 by 25 percent. b. National Rate The national prospective payment rate is determined as follows: Step 1—Select the applicable average standardized amount. Step 2—Multiply the labor-related portion of the standardized amount by the applicable wage index for the geographic area in which the hospital is located or the area to which the hospital is reclassified. Step 3—Add the amount from Step 2 and the nonlabor-related portion of the national average standardized amount. Step 4—Multiply the amount from Step 3 by the applicable MS–DRG relative weight (see Table 5 of section VI. of the Addendum). Step 5—Multiply the result in Step 4 by 75 percent. The sum of the Puerto Rico rate and the national rate computed above equals the prospective payment for a given discharge for a hospital located in Puerto Rico. This rate may then be further adjusted if the hospital qualifies for either the IME or DSH adjustment. III. Proposed Changes to Payment Rates for Acute Care Hospital Inpatient CapitalRelated Costs for FY 2008 (If you choose to comment on issues in this section, please include the caption ‘‘Capital Payment Rate’’ at the beginning of your comment.) The PPS for acute care hospital inpatient capital-related costs was implemented for cost reporting periods beginning on or after October 1, 1991. Effective with that cost reporting period, hospitals were paid during a 10-year transition period (which extended through FY 2001) to change the payment methodology for Medicare acute care hospital inpatient capital-related costs from a reasonable cost-based methodology to a prospective methodology (based fully on the Federal rate). The basic methodology for determining Federal capital prospective rates is set forth in regulations at § § 412.308 through 412.352. Below we discuss the factors that we are proposing to use to determine the capital Federal rate for FY 2008, which will be effective for discharges occurring on or after October 1, 2007. E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules The 10-year transition period ended with hospital cost reporting periods beginning on or after October 1, 2001 (FY 2002). Therefore, for cost reporting periods beginning in FY 2002, all hospitals (except ‘‘new’’ hospitals under § 412.304(c)(2)) are paid based on 100 percent of the capital Federal rate. For FY 1992, we computed the standard Federal payment rate for capital-related costs under the IPPS by updating the FY 1989 Medicare inpatient capital cost per case by an actuarial estimate of the increase in Medicare inpatient capital costs per case. Each year after FY 1992, we update the capital standard Federal rate, as provided at § 412.308(c)(1), to account for capital input price increases and other factors. The regulations at § 412.308(c)(2) provide that the capital Federal rate is adjusted annually by a factor equal to the estimated proportion of outlier payments under the capital Federal rate to total capital payments under the capital Federal rate. In addition, § 412.308(c)(3) requires that the capital Federal rate be reduced by an adjustment factor equal to the estimated proportion of payments for (regular and special) exceptions under § 412.348. Section 412.308(c)(4)(ii) requires that the capital standard Federal rate be adjusted so that the effects of the annual DRG reclassification and the recalibration of DRG weights and changes in the geographic adjustment factor are budget neutral. For FYs 1992 through 1995, § 412.352 required that the capital Federal rate also be adjusted by a budget neutrality factor so that aggregate payments for inpatient hospital capital costs were projected to equal 90 percent of the payments that would have been made for capital-related costs on a reasonable cost basis during the fiscal year. That provision expired in FY 1996. Section 412.308(b)(2) describes the 7.4 percent reduction to the capital rate that was made in FY 1994, and § 412.308(b)(3) describes the 0.28 percent reduction to the capital rate made in FY 1996 as a result of the revised policy of paying for transfers. In FY 1998, we implemented section 4402 of Pub. L. 105–33, which required that, for discharges occurring on or after October 1, 1997, the budget neutrality adjustment factor in effect on September 30, 1995, be applied to the unadjusted capital standard Federal rate and the unadjusted hospital-specific rate. That factor was 0.8432, which was equivalent to a 15.68 percent reduction to the unadjusted capital payment rates. An additional 2.1 percent reduction to the rates was effective from October 1, 1997 through September 30, 2002, making the total reduction 17.78 percent. As we discussed in the FY 2003 IPPS final rule (67 FR 50102) and implemented in § 412.308(b)(6), the 2.1 percent reduction was restored effective October 1, 2002. To determine the appropriate budget neutrality adjustment factor and the regular exceptions payment adjustment during the 10-year transition period, we developed a dynamic model of Medicare inpatient capital-related costs; that is, a model that projected changes in Medicare inpatient capital-related costs over time. With the expiration of the budget neutrality provision, the capital cost model was only used to VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 estimate the regular exceptions payment adjustment and other factors during the transition period. As we explained in the FY 2002 IPPS final rule (66 FR 39911), beginning in FY 2002, an adjustment for regular exception payments is no longer necessary because regular exception payments were only made for cost reporting periods beginning on or after October 1, 1991, and before October 1, 2001 (see § 412.348(b)). Because payments are no longer being made under the regular exception policy effective with cost reporting periods beginning in FY 2002, we no longer use the capital cost model. The capital cost model and its application during the transition period are described in Appendix B of the FY 2002 IPPS final rule (66 FR 40099). Section 412.374 provides for the use of a blended payment system for payments to Puerto Rico hospitals under the IPPS for acute care hospital inpatient capital-related costs. Accordingly, under the capital PPS, we compute a separate payment rate specific to Puerto Rico hospitals using the same methodology used to compute the national Federal rate for capital-related costs. In accordance with section 1886(d)(9)(A) of the Act, under the IPPS for acute care hospital operating costs, hospitals located in Puerto Rico are paid for operating costs under a special payment formula. Prior to FY 1998, hospitals in Puerto Rico were paid a blended operating rate that consisted of 75 percent of the applicable standardized amount specific to Puerto Rico hospitals and 25 percent of the applicable national average standardized amount. Similarly, prior to FY 1998, hospitals in Puerto Rico were paid a blended capital rate that consisted of 75 percent of the applicable capital Puerto Rico-specific rate and 25 percent of the applicable capital Federal rate. However, effective October 1, 1997, in accordance with section 4406 of Pub. L. 105–33, operating payments to hospitals in Puerto Rico were revised to be based on a blend of 50 percent of the applicable standardized amount specific to Puerto Rico hospitals and 50 percent of the applicable national average standardized amount. In conjunction with this change to the operating blend percentage, effective with discharges occurring on or after October 1, 1997, we also revised the methodology for computing capital payments to hospitals in Puerto Rico to be based on a blend of 50 percent of the Puerto Rico capital rate and 50 percent of the capital Federal rate. As we discussed in the FY 2005 IPPS final rule (69 FR 49185), section 504 of Pub. L. 108–173 increased the national portion of the operating IPPS payments for Puerto Rico hospitals from 50 percent to 62.5 percent and decreased the Puerto Rico portion of the operating IPPS payments from 50 percent to 37.5 percent for discharges occurring on or after April 1, 2004 through September 30, 2004 (see the March 26, 2004 One-Time Notification (Change Request 3158)). In addition, section 504 of Pub. L. 108–173 provided that the national portion of operating IPPS payments for Puerto Rico hospitals is equal to 75 percent and the Puerto Rico portion of operating IPPS payments is equal to 25 percent for discharges occurring on or after October 1, PO 00000 Frm 00163 Fmt 4701 Sfmt 4702 24841 2004. Consistent with that change in operating IPPS payments to hospitals in Puerto Rico, for FY 2005 (as we discussed in the FY 2005 IPPS final rule), we revised the methodology for computing capital payments to hospitals located in Puerto Rico to be based on a blend of 25 percent of the Puerto Rico capital rate and 75 percent of the capital Federal rate for discharges occurring on or after October 1, 2004. A. Determination of Proposed Federal Hospital Inpatient Capital-Related Prospective Payment Rate Update In the FY 2007 IPPS final rule (71 FR 48161), we established a tentative capital Federal rate of $427.38 for FY 2007. In the Federal Register notice establishing the occupational mix adjusted payment rates for FY 2007 (71 FR 59891), we established the final FY 2007 Federal rate of $427.03 for FY 2007. In the discussion that follows, we explain the factors that we are proposing to use to determine the proposed FY 2008 capital Federal rate. However, as discussed in section V. of the preamble of this proposed rule, we are proposing two separate capital Federal rates for FY 2008: a capital Federal rate for rural hospitals and a capital Federal rate for urban hospitals. In particular, we explain why the proposed FY 2008 capital Federal rate for rural hospitals would decrease approximately 2.3 percent, compared to the FY 2007 capital Federal rate, and why the proposed FY 2008 capital Federal rate for urban hospitals would decrease approximately 3.1 percent, compared to the FY 2007 capital Federal rate. Consequently, despite an estimated increase in Medicare fee-for-service discharges in FY 2008 as compared to FY 2007, we estimate aggregate capital payments would decrease by 0.13 percent during this same period. Total payments to hospitals under the IPPS are relatively unaffected by changes in the capital prospective payments. Since capital payments constitute about 10 percent of hospital payments, a 1-percent change in the capital Federal rate yields only about 0.1 percent change in actual payments to hospitals. As noted above, aggregate payments under the capital IPPS are estimated to decrease in FY 2008 compared to FY 2007. 1. Projected Capital Standard Federal Rate Update a. Description of the Update Framework Under § 412.308(c)(1), the capital standard Federal rate is updated on the basis of an analytical framework that takes into account changes in a capital input price index (CIPI) and several other policy adjustment factors. Specifically, we have adjusted the projected CIPI rate-of-increase as appropriate each year for case-mix index-related changes, for intensity, and for errors in previous CIPI forecasts. The proposed update factor for FY 2008 under that framework is 0.8 percent based on the best data available at this time. The proposed update factor under that framework is based on a projected 1.2 percent increase in the CIPI, a 0.0 percent adjustment for intensity, a 0.0 percent adjustment for case-mix, a -0.4 percent adjustment for the FY 2006 DRG E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 24842 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules reclassification and recalibration, and a forecast error correction of 0.0 percent. As discussed below in section III.C. of this Addendum, we believe that the CIPI is the most appropriate input price index for capital costs to measure capital price changes in a given year. We also explain the basis for the FY 2008 CIPI projection in that same section of this Addendum. (However, as discussed in greater detail in section V. of the preamble of this proposed rule, we are proposing a zero percent update factor for urban hospitals instead of the 0.8 percent proposed update factor that we are proposing for rural hospitals. In addition, as also note below, the proposed capital rates would be further adjusted to account for upcoding under the proposed MS–DRGs discussed in section II.D. of the preamble of this proposed rule.) Below we describe the policy adjustments that have been applied in the update framework for FY 2008. The case-mix index is the measure of the average DRG weight for cases paid under the IPPS. Because the DRG weight determines the prospective payment for each case, any percentage increase in the case-mix index corresponds to an equal percentage increase in hospital payments. The case-mix index can change for any of several reasons: <bullet≤ The average resource use of Medicare patients changes (‘‘real’’ case-mix change); <bullet≤ Changes in hospital coding of patient records result in higher weight DRG assignments (‘‘coding effects’’); and <bullet≤ The annual DRG reclassification and recalibration changes may not be budget neutral (‘‘reclassification effect’’). We define real case-mix change as actual changes in the mix (and resource requirements) of Medicare patients as opposed to changes in coding behavior that result in assignment of cases to higher weighted DRGs but do not reflect higher resource requirements. The capital update framework includes the same case-mix index adjustment used in the former operating IPPS update framework (as discussed in the May 18, 2004 IPPS proposed rule for FY 2005 (69 FR 28816)). (We are no longer using an update framework in making a recommendation for updating the operating IPPS standardized amounts as discussed in section II. of Appendix B in the FY 2006 IPPS final rule (70 FR 47707).) Absent the proposed change to the MS– DRGs, for FY 2008, we are projecting a 1.0 percent total increase in the case-mix index. We estimate that the real case-mix increase will also equal 1.0 percent in FY 2008. The net adjustment for change in case-mix is the difference between the projected real increase in case-mix and the projected total increase in case-mix. Therefore, the net adjustment for case-mix change in FY 2008 is 0.0 percentage points. The capital update framework also contains an adjustment for the effects of DRG reclassification and recalibration. This adjustment is intended to remove the effect on total payments of prior year changes to the DRG classifications and relative weights, in order to retain budget neutrality for all casemix index-related changes other than those VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 due to patient severity. Due to the lag time in the availability of data, there is a 2-year lag in data used to determine the adjustment for the effects of DRG reclassification and recalibration. For example, we are adjusting for the effects of the FY 2006 DRG reclassification and recalibration as part of our proposed update for FY 2008. We estimate that FY 2006 DRG reclassification and recalibration resulted in a 0.4 percent change in the case-mix when compared with the case-mix index that would have resulted if we had not made the reclassification and recalibration changes to the DRGs. Therefore, we are proposing to make a -0.4 percent adjustment for DRG reclassification in the proposed update for FY 2008 to maintain budget neutrality. The capital update framework also contains an adjustment for forecast error. The input price index forecast is based on historical trends and relationships ascertainable at the time the update factor is established for the upcoming year. In any given year, there may be unanticipated price fluctuations that may result in differences between the actual increase in prices and the forecast used in calculating the update factors. In setting a prospective payment rate under the framework, we make an adjustment for forecast error only if our estimate of the change in the capital input price index for any year is off by 0.25 percentage points or more. There is a 2-year lag between the forecast and the measurement of the forecast error. A forecast error of 0.10 percentage point was calculated for the FY 2006 update. That is, current historical data indicate that the forecasted FY 2006 CIPI (0.80 percent) used in calculating the FY 2006 update factor slightly understated the actual realized price increases (0.90 percent) by 0.10 percentage point. This slight underprediction was mostly due to the incorporation of newly available source data for fixed asset prices into the market basket. However, because this estimation of the change in the CIPI is less than 0.25 percentage points, it is not reflected in the update recommended under this framework. Therefore, we are proposing to make a 0.0 percent adjustment for forecast error in the update for FY 2008. Under the capital IPPS update framework, we also make an adjustment for changes in intensity. We calculate this adjustment using the same methodology and data that were used in the past under the framework for operating IPPS. The intensity factor for the operating update framework reflects how hospital services are utilized to produce the final product, that is, the discharge. This component accounts for changes in the use of quality-enhancing services, for changes in within-DRG severity, and for expected modification of practice patterns to remove noncost-effective services. We calculate case-mix constant intensity as the change in total charges per admission, adjusted for price level changes (the CPI for hospital and related services) and changes in real case-mix. The use of total charges in the calculation of the intensity factor makes it a total intensity factor; that is, charges for capital services are already built into the calculation of the factor. Therefore, we have PO 00000 Frm 00164 Fmt 4701 Sfmt 4702 incorporated the intensity adjustment from the operating update framework into the capital update framework. Without reliable estimates of the proportions of the overall annual intensity increases that are due, respectively, to ineffective practice patterns and to the combination of quality-enhancing new technologies and within-DRG complexity, we assume, as in the operating update framework, that one-half of the annual increase is due to each of these factors. The capital update framework thus provides an add-on to the input price index rate of increase of one-half of the estimated annual increase in intensity, to allow for within-DRG severity increases and the adoption of quality-enhancing technology. We have developed a Medicare-specific intensity measure based on a 5-year average. Past studies of case-mix change by the RAND Corporation (‘‘Has DRG Creep Crept Up? Decomposing the Case Mix Index Change Between 1987 and 1988’’ by G.M. Carter, J. P. Newhouse, and D.A. Relles, R–4098– HCFA/ProPAC (1991)) suggest that real casemix change was not dependent on total change, but was usually a fairly steady 1.0 to 1.5 percent per year. However, we use 1.4 percent as the upper bound because the RAND study did not take into account that hospitals may have induced doctors to document medical records more completely in order to improve payment. We calculate case-mix constant intensity as the change in total charges per admission, adjusted for price level changes (the CPI for hospital and related services), and changes in real case-mix. As we noted above, in accordance with § 412.308(c)(1)(ii), we began updating the capital standard Federal rate in FY 1996 using an update framework that takes into account, among other things, allowable changes in the intensity of hospital services. For FYs 1996 through 2001, we found that case-mix constant intensity was declining and we established a 0.0 percent adjustment for intensity in each of those years. For FYs 2002 and 2003, we found that case-mix constant intensity was increasing and we established a 0.3 percent adjustment and 1.0 percent adjustment for intensity, respectively. For FYs 2004 and 2005, we found that the charge data appeared to be skewed (as discussed in greater detail below) and we established a 0.0 percent adjustment in each of those years. Furthermore, we stated that we would continue to apply a 0.0 percent adjustment for intensity until any increase in charges can be tied to intensity rather than attempts to maximize outlier payments. As noted above, our intensity measure is based on a 5-year average, and therefore, the intensity adjustment for FY 2008 is based on data from the 5-year period FY 2002 through FY 2006. We found a dramatic increase in hospital charges for each of those 5 years without a corresponding increase in the hospital case-mix index. These findings are similar to the considerable increase in hospitals’ charges, which we found when we were determining the intensity factor in the FY 2004, FY 2005 and FY 2006 update recommendations as discussed in the FY 2004 IPPS final rule (68 FR 45482), the FY 2005 IPPS final rule (69 FR 49285) the FY 2006 IPPS final rule (70 FR 47500), and the E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules FY 2007 IPPS final rule (72 FR 47500), respectively. If hospitals were treating new or different types of cases, which would result in an appropriate increase in charges per discharge, then we would expect hospitals’ case-mix to increase proportionally. As we discussed in the FY 2006 IPPS final rule (70 FR 47500) and the FY 2007 IPPS final rule (71 FR 48157), because our intensity calculation relies heavily upon charge data and we believe that these charge data may be inappropriately skewed, we established a 0.0 percent adjustment for intensity for FY 2006 and FY 2007, respectively. On June 9, 2003, we published revisions to our outlier policy for determining the additional payment for extraordinarily highcost cases (68 FR 34494 through 34515). These revised policies were effective on August 8, 2003, and October 1, 2003. While it does appear that a response to these policy changes is beginning to occur, that is, the change in charges for FYs 2004 and 2005 are somewhat less than the previous 4 years, and the change in charges for FY 2006 is slightly less than FY 2005, they still show a significant annual increase in charges without a corresponding increase in hospital case-mix. The increase in charges in FY 2004, for example, is approximately 12 percent, which, while less than the increase in the previous 3 years, is still much higher than increases in years prior to FY 2001. In addition, this approximate 12-percent increase in charges for FY 2004 significantly exceeds the case-mix increase for the same period. Based on the approximate 12-percent increase in charges for FY 2004, we believe residual effects of hospitals’ charge practices prior to the implementation of the outlier policy revisions established in the June 9, 2003 final rule continue to appear in the data because hospitals may not have had enough time to adopt changes in their behavior in response to the new outlier policy. Thus, we believe that the FY 2004, FY 2005, and FY 2006 charge data may still be skewed. Because the intensity adjustment is based on a 5-year average, and although the new outlier policy was generally effective in FY 2004, we believe the effects of hospitals attempting to maximize outlier payments, while lessening, continue to skew the charge data. Therefore, we are proposing to make a 0.0 percent adjustment for intensity for FY 2008. In the past (FYs 1996 through 2001) when we found intensity to be declining, we believed a zero (rather than negative) intensity adjustment was appropriate. Similarly, we believe that it is appropriate to apply a zero intensity adjustment for FY 2008 until any increase in charges can be tied to intensity rather than to attempts to maximize outlier payments. Above, we described the basis of the components used to develop the proposed 0.8 percent capital update factor under the capital update framework for FY 2008 as shown in the table below. However, as discussed in section V. of the preamble of this proposed rule, we are proposing that the proposed 0.8 percent capital update be applied to rural hospitals only. We are proposing a 0.0 percent update for urban VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 hospitals for reasons also discussed in section V. of the preamble of this proposed rule. CMS PROPOSED FY 2008 UPDATE FACTOR TO THE CAPITAL FEDERAL RATE FOR RURAL HOSPITALS Capital Input Price Index .................... Intensity: Case-Mix Adjustment Factors: Real Across DRG Change .......... Projected Case-Mix Change ....... 1.2 0.0 1.0 -1.0 Subtotal ........................................... 0.0 Effect of FY 2005 Reclassification and Recalibration ............................ Forecast Error Correction ................... -0.4 0.0 Total Update for Rural Hospitals .... 0.8 b. Comparison of CMS and MedPAC Update Recommendation In the past, MedPAC has included update recommendations for capital PPS in a Report to Congress. In its March 2007 Report to Congress, MedPAC did not make an update recommendation for capital IPPS payments for FY 2008. However, in that same report, MedPAC made an update recommendation for hospital inpatient and outpatient services (page 67). MedPAC reviews inpatient and outpatient services together because they are so closely interrelated. For FY 2008, MedPAC recommended an increase in the payment rate for the operating IPPS by the projected increase in the hospital market basket index concurrent with implementation of a quality incentive payment policy. (MedPAC’s Report to the Congress: Medicare Payment Policy, March 2007, Section 2A.) 2. Proposed Outlier Payment Adjustment Factor Section 412.312(c) establishes a unified outlier methodology for inpatient operating and inpatient capital-related costs. A single set of thresholds is used to identify outlier cases for both inpatient operating and inpatient capital-related payments. Section 412.308(c)(2) provides that the standard Federal rate for inpatient capital-related costs be reduced by an adjustment factor equal to the estimated proportion of capital-related outlier payments to total inpatient capitalrelated PPS payments. The outlier thresholds are set so that operating outlier payments are projected to be 5.1 percent of total operating DRG payments. In the Federal Register notice establishing the final occupational mix adjusted payment rates for FY 2007 (71 FR 59890), we estimated that outlier payments for capital would equal 4.32 percent of inpatient capitalrelated payments based on the capital Federal rate in FY 2007. Based on the proposed thresholds as set forth in section II.A.4.c. of this Addendum, we estimate that proposed outlier payments for capital-related costs would equal 5.16 percent for inpatient capital-related payments based on the proposed Federal rate in FY 2008. Therefore, we are proposing to apply an outlier adjustment factor of 0.9484 to the capital PO 00000 Frm 00165 Fmt 4701 Sfmt 4702 24843 Federal rate. Thus, we estimate that the percentage of capital outlier payments to total capital standard payments for FY 2008 will be slightly higher than the percentages for FY 2007. The outlier reduction factors are not built permanently into the capital rates; that is, they are not applied cumulatively in determining the capital Federal rate. The proposed FY 2008 outlier adjustment of 0.9484 is a -0.88 percent change from the FY 2007 outlier adjustment of 0.9568. Therefore, the net change in the proposed outlier adjustment to the proposed capital Federal rate for FY 2008 is 0.9912 (0.9484/0.9568). Thus, the proposed outlier adjustment decreases the proposed FY 2008 capital Federal rate by 0.88 percent compared with the FY 2007 outlier adjustment. 3. Proposed Budget Neutrality Adjustment Factor for Changes in DRG Classifications and Weights and the GAF Section 412.308(c)(4)(ii) requires that the capital Federal rate be adjusted so that aggregate payments for the fiscal year based on the capital Federal rate after any changes resulting from the annual DRG reclassification and recalibration and changes in the GAF are projected to equal aggregate payments that would have been made on the basis of the capital Federal rate without such changes. Because we implemented a separate GAF for Puerto Rico, we apply separate budget neutrality adjustments for the national GAF and the Puerto Rico GAF. We apply the same budget neutrality factor for DRG reclassifications and recalibration nationally and for Puerto Rico. Separate adjustments were unnecessary for FY 1998 and earlier because the GAF for Puerto Rico was implemented in FY 1998. In the past, we used the actuarial capital cost model (described in Appendix B of the FY 2002 IPPS final rule (66 FR 40099)) to estimate the aggregate payments that would have been made on the basis of the capital Federal rate with and without changes in the DRG classifications and weights and in the GAF to compute the adjustment required to maintain budget neutrality for changes in DRG weights and in the GAF. During the transition period, the capital cost model was also used to estimate the regular exception payment adjustment factor. As we explain in section III.A.4. of this Addendum, beginning in FY 2002, an adjustment for regular exception payments is no longer necessary. Therefore, we are no longer using the capital cost model. Instead, we are using historical data based on hospitals’ actual cost experiences to determine the exceptions payment adjustment factor for special exceptions payments. To determine the proposed factors for FY 2008, we compared (separately for the national capital rate and the Puerto Rico capital rate) estimated aggregate capital Federal rate payments based on the FY 2007 DRG relative weights and the FY 2007 GAF to estimated aggregate capital Federal rate payments based on the proposed FY 2008 relative weights and the proposed FY 2008 GAF. As we established in the final FY 2007 occupational mix adjusted payment rates notice (71 FR 59890), the budget neutrality factors were 0.9906 for the national capital E:\FEDREG\03MYP2.LOC 03MYP2 24844 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB rate and 0.9968 for the Puerto Rico capital rate. In making the comparison, we set the exceptions reduction factor to 1.00. To achieve budget neutrality for the changes in the national GAF, based on calculations using updated data, we propose to apply an incremental budget neutrality adjustment of 1.0026 for FY 2008 to the previous cumulative FY 2007 adjustments of 0.9906, yielding a proposed adjustment of 0.9932, through FY 2008 (calculations done on unrounded numbers). For the Puerto Rico VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 GAF, we are proposing to apply a proposed incremental budget neutrality adjustment of 1.0009 for FY 2008 to the previous cumulative FY 2007 adjustment of 0.9968, yielding a proposed cumulative adjustment of 0.9978 through FY 2008 (calculations done on unrounded numbers). We then compared estimated aggregate capital Federal rate payments based on the FY 2007 DRG relative weights and the FY 2007 GAF to estimated aggregate capital Federal rate payments based on the proposed PO 00000 Frm 00166 Fmt 4701 Sfmt 4702 FY 2008 DRG relative weights and the proposed FY 2008 GAF. The proposed incremental adjustment for DRG classifications and changes in relative weights is 0.9992 both nationally and for Puerto Rico. The proposed cumulative adjustments for DRG classifications and changes in relative weights and for changes in the GAF through FY 2008 are 0.9924 nationally and 0.9970 for Puerto Rico. The following table summarizes the adjustment factors for each fiscal year: E:\FEDREG\03MYP2.LOC 03MYP2 VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00167 Fmt 4701 Sfmt 4702 ......................................................................... ......................................................................... ......................................................................... ......................................................................... ......................................................................... ......................................................................... ......................................................................... ......................................................................... ......................................................................... 1 ...................................................................... 2 ...................................................................... ......................................................................... 5 ...................................................................... 6 ...................................................................... 8 ...................................................................... 10 .................................................................... 11 .................................................................... 13 .................................................................... ......................................................................... ......................................................................... ......................................................................... ........................ ........................ ........................ ........................ ........................ ........................ ........................ 0.99944 0.99857 0.99782 3 0.99771 4 0.99666 0.99915 7 0.99896 9 1.00175 9 1.00164 12 0.99967 12 0.99946 14 1.00185 1.00000 15 1.00261 Geographic adjustment factor ........................ ........................ ........................ ........................ ........................ ........................ ........................ 1.00335 0.99991 1.00009 3 1.00009 4 0.99668 0.99662 7 0.99662 9 1.00081 9 1.00081 1.00094 1.00094 0.99892 0.99858 0.99921 DRG reclassifications and recalibration Combined ........................ 0.99800 1.00531 0.99980 0.99940 0.99873 0.99892 1.00279 0.99848 0.99791 3 0.99780 4 0.99335 0.99577 7 0.99558 9 1.00256 9 1.00245 12 1.00061 12 1.00040 14 1.00076 0.99858 15 1.00182 Incremental adjustment 15 1.00000 0.99800 1.00330 1.00310 1.00250 1.00123 1.00015 1.00294 1.00142 0.99933 0.99922 0.99268 0.98848 0.98830 0.99083 0.99072 0.99137 0.99117 0.99198 0.99057 0.99237 Cumulative ........................ ........................ ........................ ........................ ........................ ........................ ........................ 0.99898 0.99910 1.00365 3 1.00365 4 0.98991 1.00809 1.00809 1.00028 1.00028 0.99115 0.99115 1.00762 1.00234 15 1.00093 Geographic adjustment factor ........................ ........................ ........................ ........................ ........................ ........................ ........................ 1.00335 0.99991 1.00009 3 1.00009 4 0.99668 0.99662 0.99662 1.00081 1.00081 1.00094 1.00094 0.99892 0.99858 0.99921 DRG reclassifications and recalibration Combined ........................ ........................ ........................ ........................ ........................ ........................ ........................ 1.00233 0.99901 1.00374 3 1.00374 4 0.99662 1.00468 1.00468 1.00109 1.00109 0.99208 0.99208 1.00653 1.00092 15 1.00014 Incremental adjustment Puerto Rico ........................ ........................ ........................ ........................ ........................ ........................ 1.00000 1.00233 1.00134 1.00508 1.00508 0.99164 0.99628 0.99628 0.99736 0.99736 0.98946 0.98946 0.99592 0.99683 15 0.99697 Cumulative 2 Factors effective for the first half of FY 2001 (October 2000 through March 2001). Factors effective for the second half of FY 2001 (April 2001 through September 2001). 3 Incremental factors are applied to FY 2000 cumulative factors. 4 Incremental factors are applied to the cumulative factors for the first half of FY 2001. 5 Factors effective for the first half of FY 2003 (October 2002 through March 2003). 6 Factors effective for the second half of FY 2003 (April 2003 through September 2003). 7 Incremental factors are applied to FY 2002 cumulative factors. 8 Factors effective for the first half of FY 2004 (October 2003 through March 2004). 9 Incremental factors are applied to the cumulative factors for the second half of FY 2003. 10 Factors effective for the second half of FY 2004 (April 2004 through September 2004). 11 Factors effective for the first quarter of FY 2005 (September 2004 through December 2004). 12 Incremental factors are applied to average of the cumulative factors for the first half (October 1, 2003 through March 31, 2004) and second half (April 1, 2004 through September 30, 2004) of FY 2004. 13 Factors effective for the last three quarters of FY 2005 (January 2005 through September 2005). 14 Incremental factors are applied to average of the cumulative factors for 2005. 15 Proposed factors for FY 2008, as discussed above in section III. of this Addendum. 1 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2001 2002 2003 2003 2004 2004 2005 2005 2006 2007 2008 Fiscal year National BUDGET NEUTRALITY ADJUSTMENT FOR DRG RECLASSIFICATIONS AND RECALIBRATION AND THE GEOGRAPHIC ADJUSTMENT FACTORS mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules E:\FEDREG\03MYP2.LOC 03MYP2 24845 mmaher on DSK3CLS3C1PROD with $$_JOB 24846 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules The methodology used to determine the recalibration and geographic (DRG/GAF) budget neutrality adjustment factor is similar to that used in establishing budget neutrality adjustments under the PPS for operating costs. One difference is that, under the operating PPS, the budget neutrality adjustments for the effect of geographic reclassifications are determined separately from the effects of other changes in the hospital wage index and the DRG relative weights. Under the capital PPS, there is a single DRG/GAF budget neutrality adjustment factor (the national capital rate and the Puerto Rico capital rate are determined separately) for changes in the GAF (including geographic reclassification) and the DRG relative weights. In addition, there is no adjustment for the effects that geographic reclassification has on the other payment parameters, such as the payments for serving low-income patients, indirect medical education payments, or the large urban add-on payments. In the Federal Register notice establishing the final FY 2007 occupational mix adjusted payment rates (71 FR 59890), we calculated a GAF/DRG budget neutrality factor of 0.9986 for FY 2007. For FY 2008, we are proposing to establish a proposed GAF/DRG budget neutrality factor of 1.0018. The GAF/DRG budget neutrality factors are built permanently into the capital rates; that is, they are applied cumulatively in determining the capital Federal rate. This follows from the requirement that estimated aggregate payments each year be no more or less than they would have been in the absence of the annual DRG reclassification and recalibration and changes in the GAF. The incremental change in the proposed adjustment from FY 2007 to FY 2008 is 1.0018. The cumulative change in the proposed capital Federal rate due to this proposed adjustment is 0.9924 (the product of the incremental factors for FYs 1994 through 2007 and the proposed incremental factor of 1.0018 for FY 2008). (We note that averages of the incremental factors that were in effect during FYs 2004 and 2005, respectively, were used in the calculation of the proposed cumulative adjustment of 0.9924 for FY 2008.) This proposed factor accounts for DRG reclassifications and recalibration and for changes in the GAF. It also incorporates the effects on the proposed GAF of FY 2008 geographic reclassification decisions made by the MGCRB compared to FY 2007 decisions. However, it does not account for changes in payments due to changes in the DSH and IME adjustment factors or in the large urban add-on. 4. Exceptions Payment Adjustment Factor Section 412.308(c)(3) requires that the capital standard Federal rate be reduced by an adjustment factor equal to the estimated proportion of additional payments for both regular exceptions and special exceptions under § 412.348 relative to total capital PPS payments. In estimating the proportion of regular exception payments to total capital PPS payments during the transition period, we used the actuarial capital cost model originally developed for determining budget neutrality (described in Appendix B of the FY 2002 IPPS final rule (66 FR 40099)) to VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 determine the exceptions payment adjustment factor, which was applied to both the Federal and hospital-specific capital rates. An adjustment for regular exception payments is no longer necessary in determining the FY 2008 capital Federal rate because, in accordance with § 412.348(b), regular exception payments were only made for cost reporting periods beginning on or after October 1, 1991 and before October 1, 2001. Accordingly, as we explained in the FY 2002 IPPS final rule (66 FR 39949), in FY 2002 and subsequent fiscal years, no payments will be made under the regular exceptions provision. However, in accordance with § 412.308(c), we still need to compute a budget neutrality adjustment for special exception payments under § 412.348(g). We describe our methodology for determining the exceptions adjustment used in calculating the FY 2007 capital Federal rate below. Under the special exceptions provision specified at § 412.348(g)(1), eligible hospitals include SCHs, urban hospitals with at least 100 beds that have a disproportionate share percentage of at least 20.2 percent or qualify for DSH payments under § 412.106(c)(2), and hospitals with a combined Medicare and Medicaid inpatient utilization of at least 70 percent. An eligible hospital may receive special exceptions payments if it meets: (1) a project need requirement as described at § 412.348(g)(2), which, in the case of certain urban hospitals, includes an excess capacity test as described at § 412.348(g)(4); (2) an age of assets test as described at § 412.348(g)(3); and (3) a project size requirement as described at § 412.348(g)(5). Based on information compiled from our fiscal intermediaries, six hospitals have qualified for special exceptions payments under § 412.348(g). Because we have cost reports ending in FY 2006 for all of these hospitals, we calculated the adjustment based on actual cost experience. Using data from cost reports ending in FY 2006 from the December 2006 update of the HCRIS data, we divided the capital special exceptions payment amounts for the six hospitals that qualified for special exceptions by the total capital PPS payment amounts (including special exception payments) for all hospitals. Based on the data from cost reports ending in FY 2006, this ratio is rounded to 0.0003. Because we have not received all cost reports ending in FY 2006, we also divided the FY 2005 special exceptions payments by the total capital PPS payment amounts for all hospitals with cost reports ending in FY 2005. This ratio also rounds to 0.0003. Because special exceptions are budget neutral, we are offsetting the proposed capital Federal rate by 0.03 percent for special exceptions payments for FY 2008. Therefore, the exceptions adjustment factor is equal to 0.9997 (1 - 0.0003) to account for special exceptions payments in FY 2008. In the FY 2007 IPPS final rule (71 FR 48161) we estimated that total (special) exceptions payments for FY 2007 would equal 0.03 percent of aggregate payments based on the capital Federal rate. Therefore, we applied an exceptions adjustment factor of 0.9997 (1 - 0.0003) in determining the FY PO 00000 Frm 00168 Fmt 4701 Sfmt 4702 2007 capital Federal rate. As we stated above, we estimate that exceptions payments in FY 2008 will equal 0.03 percent of aggregate payments based on the proposed FY 2008 capital Federal rate. Therefore, we are proposing to apply an exceptions payment adjustment factor of 0.9997 to the capital Federal rate for FY 2008. The proposed exceptions adjustment factor for FY 2008 is the same as the factor used in determining the FY 2007 capital Federal rate in the FY 2007 IPPS final rule (71 FR 48161) and is the same factor used for the occupational mix adjusted payment rates since the adjustments made to the wage index had no effect on capital exceptions payments (71 FR 59890). The exceptions reduction factors are not built permanently into the capital rates; that is, the factors are not applied cumulatively in determining the capital Federal rate. Therefore, the net change in the proposed exceptions adjustment factor used in determining the proposed FY 2008 capital Federal rate is 1.0000(0.9997/0.9997). 5. Proposed Capital Standard Federal Rate for FY 2008 In the Federal Register notice that established the occupational mix adjusted payment rates for FY 2007 (71 FR 59891), we established a capital Federal rate of $427.03 for FY 2007. As discussed above and in section V. of the preamble of this proposed rule, we are proposing two separate capital Federal rates for FY 2008: a rural capital Federal rate based on an update of 0.8 percent and an urban capital Federal rate based on a 0.0 percent update. However, under the statutory authority at section 1886(d)(3)(A)(vi) of the Act, we are proposing an additional 2.4 percent reduction to the proposed standardized amounts for both capital and operating Federal payment rates. The proposed 2.4 percent reduction is based on our actuary’s analysis to eliminate the effect of changes in coding or classification of discharges that do not reflect real changes in case-mix in light of the proposed MS– DRGs. Although the proposed 2.4 percent reduction is outside the established process for developing the proposed capital Federal payment rate, it nevertheless is a factor in the final prospective payment rate to hospitals for capital-related costs. For that reason, the capital Federal payment rates proposed in this proposed rule were determined by applying the proposed 2.4 percent reduction. As a result of the proposed 0.8 percent update for rural hospitals, the proposed 0.0 percent update for urban hospitals, the proposed 2.4 percent reduction to account for upcoding (for all hospitals), and the other factors as discussed above, we are proposing to establish a capital Federal rate for rural hospitals of $417.26 for FY 2008, and we are proposing to establish a capital Federal rate for urban hospitals of $413.87 for FY 2008. The proposed capital Federal rates for FY 2008 were calculated as follows: <bullet≤ The proposed FY 2008 update factor for rural hospitals is 1.0080, that is, the update is 0.8 percent; and the proposed FY 2008 update factor for urban hospitals is 1.0000, that is, the update is 0.0 percent. <bullet≤ The proposed FY 2008 budget neutrality adjustment factor that is applied to the capital standard Federal payment rate for E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules changes in the DRG relative weights and in the GAF (for all hospitals) is 1.0018. <bullet≤ The proposed FY 2008 outlier adjustment factor is 0.9484. <bullet≤ The proposed FY 2008 (special) exceptions payment adjustment factor is 0.9997. <bullet≤ The proposed FY 2008 reduction for upcoding under the proposed MS-DRGs is -2.40 percent. Because the proposed capital Federal rate has already been adjusted for differences in case-mix, wages, cost-of-living, indirect medical education costs, and payments to hospitals serving a disproportionate share of low-income patients, we are not making additional adjustments in the capital standard Federal rate for these factors, other than the proposed budget neutrality factor for changes in the DRG relative weights and the GAF. We are providing the following charts that show how each of the proposed factors and adjustments for FY 2008 affected the computation of the proposed FY 2008 capital Federal rate for urban hospitals and the proposed FY 2008 capital Federal rate for rural hospitals in comparison to the FY 2007 capital Federal rate. The proposed FY 2008 update factor for urban hospitals of zero percent would have a 0.0 percent net effect on the proposed FY 2008 capital Federal compared to the FY 2007 capital Federal rate. The proposed FY 2008 update factor for rural hospitals has the effect of increasing the proposed capital Federal rate by 0.80 percent compared to the FY 2007 capital Federal rate. The proposed GAF/DRG budget neutrality factor has the effect of increasing the proposed capital Federal rate by 0.18 percent for both urban and rural hospitals. The proposed FY 2008 outlier adjustment factor has the effect of decreasing the proposed capital Federal rate by 0.89 percent compared to the FY 2007 capital Federal rate for both urban and rural hospitals. The proposed FY 24847 2008 exceptions payment adjustment factor remains unchanged from the FY 2007 exceptions payment adjustment factor, and therefore, has a 0.0 percent net effect on the proposed FY 2008 capital Federal rate for both urban and rural hospitals. In addition to the factors historically used to determine the capital Federal rate, for FY 2008, we are proposing an adjustment factor to account for upcoding expected to result if the proposed MS–DRGs are adopted, as discussed above in section III. of this Addendum, in determining the capital Federal rate for FY 2008. The combined effect of all the changes is to decrease the proposed capital Federal rate by 3.09 percent compared to the FY 2007 capital Federal rate for urban hospitals and to decrease the proposed capital Federal rate by 2.29 percent compared to the FY 2007 capital Federal rate for rural hospitals. COMPARISON OF FACTORS AND ADJUSTMENTS: FY 2007 CAPITAL FEDERAL RATE AND PROPOSED FY 2008 CAPITAL FEDERAL RATE FOR URBAN HOSPITALS FY 2007 Update Factor1 ................................................................................................. GAF/DRG Adjustment Factor1 ......................................................................... Outlier Adjustment Factor 2 ............................................................................. Exceptions Adjustment Factor 2 ...................................................................... MS–DRG Upcoding Adjustment Factor 3 ........................................................ Capital Federal Rate ........................................................................................ 1.0110 0.9986 0.9568 0.9997 ........................ $427.03 Proposed FY 20084 1.0000 1.0018 0.9484 0.9997 0.9760 $413.87 Change 0.0000 1.0018 0.9912 1.0000 0.9760 0.9692 Percent change5 0.00 0.18 -0.88 0.00 -2.40 -3.10 1 The proposed update factor for rural hospitals and the proposed GAF/DRG budget neutrality factors are built permanently into the capital rates. Thus, for example, the incremental change from FY 2007 to FY 2008 resulting from the application of the proposed 1.0018 GAF/DRG budget neutrality factor for FY 2008 is 1.0018. 2 The proposed outlier reduction factor and the proposed exceptions adjustment factor are not built permanently into the capital rates; that is, these factors are not applied cumulatively in determining the capital rates. Thus, for example, the net change resulting from the application of the proposed FY 2008 outlier adjustment factor would be 0.9484/0.9568, or 0.9912. 3 Proposed adjustment to FY 2008 IPPS rates to account for upcoding expected to result if the proposed MS-DRGs are adopted, as discussed above in section III. of this Addendum. 4 Proposed factors for FY 2008, as discussed above in section III. of this Addendum. 5 Percent change of individual proposed factors may not sum due to rounding. COMPARISON OF FACTORS AND ADJUSTMENTS: FY 2007 CAPITAL FEDERAL RATE AND PROPOSED FY 2008 CAPITAL FEDERAL RATE FOR RURAL HOSPITALS FY 2007 mmaher on DSK3CLS3C1PROD with $$_JOB Update Factor 1 ............................................................................................... GAF/DRG Adjustment Factor 1 ....................................................................... Outlier Adjustment Factor 2 ............................................................................. Exceptions Adjustment Factor 2 ...................................................................... MS–DRG Upcoding Adjustment Factor 3 ........................................................ Capital Federal Rate ........................................................................................ 1.0110 0.9986 0.9568 0.9997 ........................ $427.03 Proposed FY 20084 1.0080 1.0018 0.9484 0.9997 0.9760 $417.26 Change 1.0080 1.0018 0.9912 1.0000 0.9760 0.9771 Percent change5 0.80 0.18 -0.88 0.00 -2.40 -2.29 1 The proposed update factor for rural hospitals and the proposed GAF/DRG budget neutrality factors are built permanently into the capital rates. Thus, for example, the incremental change from FY 2007 to FY 2008 resulting from the application of the proposed 1.0018 GAF/DRG budget neutrality factor for FY 2008 is 1.0018. 2 The proposed outlier reduction factor and the proposed exceptions adjustment factor are not built permanently into the capital rates; that is, these factors are not applied cumulatively in determining the capital rates. Thus, for example, the net change resulting from the application of the proposed FY 2008 outlier adjustment factor would be 0.9484/0.9568, or 0.9912. 3 Proposed adjustment to FY 2008 IPPS rates to account for upcoding expected to result if the proposed MS–DRGs are adopted, as discussed above in section III. of this Addendum. 4 Proposed factors for FY 2008, as discussed above in section III. of this Addendum. 5 Percent change of individual proposed factors may not sum due to rounding. 6. Proposed Special Capital Rate for Puerto Rico Hospitals Section 412.374 provides for the use of a blended payment system for payments to Puerto Rico hospitals under the PPS for acute VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 care hospital inpatient capital-related costs. Accordingly, under the capital PPS, we compute a separate payment rate specific to Puerto Rico hospitals using the same methodology used to compute the national PO 00000 Frm 00169 Fmt 4701 Sfmt 4702 Federal rate for capital-related costs. Under the broad authority of section 1886(g) of the Act, as discussed in section V. of the preamble of this proposed rule, beginning with discharges occurring on or after October E:\FEDREG\03MYP2.LOC 03MYP2 24848 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB 1, 2004, capital payments to hospitals in Puerto Rico are based on a blend of 25 percent of the Puerto Rico capital rate and 75 percent of the capital Federal rate. The Puerto Rico capital rate is derived from the costs of Puerto Rico hospitals only, while the capital Federal rate is derived from the costs of all acute care hospitals participating in the IPPS (including Puerto Rico). To adjust hospitals’ capital payments for geographic variations in capital costs, we apply a GAF to both portions of the blended capital rate. The GAF is calculated using the operating IPPS wage index and varies, depending on the labor market area or rural area in which the hospital is located. We use the Puerto Rico wage index to determine the GAF for the Puerto Rico part of the capitalblended rate and the national wage index to determine the GAF for the national part of the blended capital rate. Because we implemented a separate GAF for Puerto Rico in FY 1998, we also apply separate budget neutrality adjustments for the national GAF and for the Puerto Rico GAF. However, we apply the same budget neutrality factor for DRG reclassifications and recalibration nationally and for Puerto Rico. As we stated above in section III.A.4. of this Addendum, for Puerto Rico, the proposed GAF budget neutrality factor is 1.0009, while the DRG adjustment is 0.9992, for a combined proposed cumulative adjustment of 1.0001. In computing the payment for a particular Puerto Rico hospital, the Puerto Rico portion of the capital rate (25 percent) is multiplied by the Puerto Rico-specific GAF for the labor market area in which the hospital is located, and the national portion of the capital rate (75 percent) is multiplied by the national GAF for the labor market area in which the hospital is located (which is computed from national data for all hospitals in the United States and Puerto Rico). In FY 1998, we implemented a 17.78 percent reduction to the Puerto Rico capital rate as a result of Pub. L. 105–33. In FY 2003, a small part of that reduction was restored. For FY 2007, before application of the GAF, the special capital rate for Puerto Rico hospitals was $203.06 for discharges occurring on or after October 1, 2006 through September 30, 2007. With the changes we are making to the factors used to determine the capital rate, in addition to the proposed zero percent update for urban hospitals, the proposed FY 2008 special capital rate for rural hospitals in Puerto Rico is $197.21 For urban hospitals in Puerto Rico, the proposed FY 2008 special capital rate is $195.60. B. Calculation of the Proposed Inpatient Capital-Related Prospective Payments for FY 2008 Because the 10-year capital PPS transition period ended in FY 2001, all hospitals (except ‘‘new’’ hospitals under § 412.324(b) and under § 412.304(c)(2)) are paid based on 100 percent of the capital Federal rate in FY 2007. The applicable capital Federal rate was determined by making adjustments as follows: <bullet≤ For outliers, by dividing the capital standard Federal rate by the outlier reduction factor for that fiscal year; and VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 <bullet≤ For the payment adjustments applicable to the hospital, by multiplying the hospital’s GAF, disproportionate share adjustment factor, and IME adjustment factor, when appropriate. For purposes of calculating payments for each discharge during FY 2008, the capital standard Federal rate would be adjusted as follows: (Standard Federal Rate) x (DRG weight) x (GAF) x (COLA for hospitals located in Alaska and Hawaii) x (1 + Disproportionate Share Adjustment Factor + IME Adjustment Factor, if applicable). The result is the adjusted capital Federal rate. (As discussed above and in section V. of the preamble of this proposed rule, we are proposing to eliminate the large urban addon adjustment in existing regulations at § 412.316, beginning in FY 2008.) Hospitals also may receive outlier payments for those cases that qualify under the thresholds established for each fiscal year. Section 412.312(c) provides for a single set of thresholds to identify outlier cases for both inpatient operating and inpatient capital-related payments. The proposed outlier thresholds for FY 2008 are in section II.A.4.c. of this Addendum. For FY 2008, a case qualifies as a cost outlier if the cost for the case plus the IME and DSH payments is greater than the prospective payment rate for the DRG plus the proposed fixed-loss amount of $23,015. An eligible hospital may also qualify for a special exceptions payment under § 412.348(g) for up through the 10th year beyond the end of the capital transition period if it meets: (1) a project need requirement described at § 412.348(g)(2), which in the case of certain urban hospitals includes an excess capacity test as described at § 412.348(g)(4); and (2) a project size requirement as described at § 412.348(g)(5). Eligible hospitals include SCHs, urban hospitals with at least 100 beds that have a DSH patient percentage of at least 20.2 percent or qualify for DSH payments under § 412.106(c)(2), and hospitals that have a combined Medicare and Medicaid inpatient utilization of at least 70 percent. Under § 412.348(g)(8), the amount of a special exceptions payment is determined by comparing the cumulative payments made to the hospital under the capital PPS to the cumulative minimum payment level. This amount is offset by: (1) any amount by which a hospital’s cumulative capital payments exceed its cumulative minimum payment levels applicable under the regular exceptions process for cost reporting periods beginning during which the hospital has been subject to the capital PPS; and (2) any amount by which a hospital’s current year operating and capital payments (excluding 75 percent of operating DSH payments) exceed its operating and capital costs. Under § 412.348(g)(6), the minimum payment level is 70 percent for all eligible hospitals. During the transition period, new hospitals (as defined under § 412.300) were exempt from the capital IPPS for their first 2 years of operation and were paid 85 percent of their reasonable costs during that period. Effective with the third year of operation through the remainder of the transition period, under § 412.324(b), we paid the PO 00000 Frm 00170 Fmt 4701 Sfmt 4702 hospitals under the appropriate transition methodology (if the hold-harmless methodology were applicable, the holdharmless payment for assets in use during the base period would extend for 8 years, even if the hold-harmless payments extend beyond the normal transition period). Under § 412.304(c)(2), for cost reporting periods beginning on or after October 1, 2002, we pay a new hospital 85 percent of its reasonable costs during the first 2 years of operation unless it elects to receive payment based on 100 percent of the capital Federal rate. Effective with the third year of operation, we pay the hospital based on 100 percent of the capital Federal rate (that is, the same methodology used to pay all other hospitals subject to the capital PPS). C. Capital Input Price Index 1. Background Like the operating input price index, the capital input price index (CIPI) is a fixedweight price index that measures the price changes associated with capital costs during a given year. The CIPI differs from the operating input price index in one important aspect—the CIPI reflects the vintage nature of capital, which is the acquisition and use of capital over time. Capital expenses in any given year are determined by the stock of capital in that year (that is, capital that remains on hand from all current and prior capital acquisitions). An index measuring capital price changes needs to reflect this vintage nature of capital. Therefore, the CIPI was developed to capture the vintage nature of capital by using a weighted-average of past capital purchase prices up to and including the current year. We periodically update the base year for the operating and capital input prices to reflect the changing composition of inputs for operating and capital expenses. The CIPI was last rebased to FY 2002 in the FY 2006 IPPS final rule (70 FR 47387). 2. Forecast of the CIPI for FY 2008 Based on the latest forecast by Global Insight, Inc. (first quarter of 2007), we are forecasting the CIPI to increase 1.20 percent in FY 2008. This reflects a projected 1.9 percent increase in vintage-weighted depreciation prices (building and fixed equipment, and movable equipment) and a 3.0 percent increase in other capital expense prices in FY 2008, partially offset by a 2.5 percent decline in vintage-weighted interest expenses in FY 2008. The weighted average of these three factors produces the 1.2 percent increase for the CIPI as a whole in FY 2008. IV. Proposed Changes to Payment Rates for Excluded Hospitals and Hospital Units: Rate-of-Increase Percentages (If you choose to comment on issues in this section, please include the caption ‘‘Excluded Hospitals Rate of Increase’’ at the beginning of your comments.) Historically, hospitals and hospital units excluded from the prospective payment system received payment for inpatient hospital services they furnished on the basis of reasonable costs, subject to a rate-ofincrease ceiling. An annual per discharge E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules limit (the target amount as defined in § 413.40(a)) was set for each hospital or hospital unit based on the hospital’s own cost experience in its base year. The target amount was multiplied by the Medicare discharges and applied as an aggregate upper limit (the ceiling as defined in § 413.40(a)) on total inpatient operating costs for a hospital’s cost reporting period. Prior to October 1, 1997, these payment provisions applied consistently to all categories of excluded providers (rehabilitation hospitals and units (now referred to as IRFs), psychiatric hospitals and units (now referred to as IPFs), LTCHs, children’s hospitals, and cancer hospitals). Payment for children’s hospitals and cancer hospitals that are excluded from the IPPS continues to be subject to the rate-ofincrease ceiling based on the hospital’s own historical cost experience. (We note that, in accordance with § 403.752(a), RNHCIs are also subject to the rate-of-increase limits established under § 413.40. IRFs, IPFs, and LTCHs were paid previously under the reasonable cost methodology. However, the statute was amended to provide for the implementation of prospective payment systems for IRFs, IPFs, and LTCHs. In general, the prospective payment systems for IRFs, IPFs, and LTCHs provide(d) transition periods of varying lengths during which time a portion of the prospective payment is (was) based on cost-based reimbursement rules under Part 413 (certain providers do not receive a transition period or may elect to bypass the transition as applicable under Subparts N, O, and P.) We note that the various transition periods provided for under the IRF PPS, IPF PPS, and LTCH PPS have ended or will soon end. For cost reporting periods beginning on or after October 1, 2002, all IRFs are paid 100 percent of the adjusted Federal rate under the IRF PPS. Therefore, for cost reporting periods beginning on or after October 1, 2002, no portion of an IRF PPS payment is subject to Part 413. Similarly, for cost reporting periods beginning on or after October 1, 2006, all LTCHs are paid 100 percent of the adjusted Federal rate under the LTCH PPS. Therefore, for cost reporting periods beginning on or after October 1, 2006, no portion of the LTCH PPS payment is subject to Part 413. However, except as provided in § 412.426(c), IPFs remain under a blend methodology for cost reporting periods beginning on or after January 1, 2005, and before January 1, 2008. For IPFs paid under the blend methodology, the portion of the IPF PPS payment that is based on reasonable cost principles is subject to the rules of Part 413. In order to calculate the portion of the PPS payment that is based on reasonable cost principles, it is necessary to determine whether the IPF would be considered ‘‘existing’’ for purposes of section 1886(b)(3)(H) of the Act or ‘‘new’’ for purposes of section 1886(b)(7) of the Act. We note that readers should not confuse an IPF that is considered ‘‘new’’ for purposes of section 1886(b)(7) of the Act and § 413.40(f)(2)(ii) with an IPF that is considered ‘‘new’’ under § 412.426(c). Any IPF that, under present or previous ownership or both, has its first cost reporting period as an IPF VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 beginning on or after January 1, 2005, is considered ‘‘new’’ for purposes of § 412.426(c). An IPF that is considered ‘‘new’’ under § 412.426(c) is paid based on 100 percent of the Federal per diem payment amount. Consequently, only those IPFs considered ‘‘new’’ under section 1886(b)(7) of the Act, but not ‘‘new’’ under § 412.426(c) will be paid under a PPS blended payment methodology. An IPF considered ‘‘new’’ for purposes of § 413.40(f)(2)(ii) would have its ‘‘reasonable-cost based’’ portion of its prospective payment subject to § 413.40(f)(2)(ii) and § 413.40(c)(4)(v), as applicable. An IPF considered ‘‘new’’ for purposes of section 1886(b)(7) of the Act has the target amount for its third cost reporting period determined in accordance with sections 1886(b)(7)(A)(ii) and 1886(b)(3)(A)(ii) of the Act. For the fourth and subsequent cost reporting periods, the target amount is calculated in accordance with section 1886(b)(3)(A)(ii) of the Act. An IPF that would be considered ‘‘existing’’ for purposes of section 1886(b)(3)(H) of the Act has the target amount for the ‘‘reasonablecost based’’ portion of its prospective payment determined in accordance with section 1886(b)(3)(A)(ii) of the Act and § 413.40(c)(4)(ii). We are proposing that the applicable percentage increase to update the target amount for the reasonable cost-based portion of the PPS payment of an IPF that is considered existing under section 1886(b)(3)(H) of the Act or new under section 1886(b)(7) of the Act, but not new under § 412.426(c), is 3.4 percent using the first quarter of the 2007 forecast made by Global Insight, Inc. V. Tables This section contains the tables referred to throughout the preamble to this proposed rule and in this Addendum. Tables 1A, 1B, 1C, 1D, 2, 3A, 3B, 4A, 4B, 4C, 4D, 4F, 4G, 4H, 4J, 5, 6A, 6B, 6C, 6D, 6E, 6F, 6J, 6K, 7A, 7B, 8A, 8B, 8C, 9A, 9C, 10, and 11 are presented below. As explained in sections II.D. 2. and II.G.8. of the preamble of this final rule, Table 6G—Additions to the CC Exclusions List, Table 6H, Deletions from the CC Exclusions List, and Table 6I—Complete List of Complication and Comorbidity (CC) Exclusions are available only through the Internet on the CMS Web site at: https:// www.cms.hhs.gov/ AcuteInpatientPPS/. The tables presented below are as follows: Table 1A—National Adjusted Operating Standardized Amounts, Labor/Nonlabor (69.7 Percent Labor Share/30.3 Percent Nonlabor Share If Wage Index Is Greater Than 1) 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) Table 1C—Adjusted Operating Standardized Amounts for Puerto Rico, Labor/ Nonlabor Table 1D—Capital Standard Federal Payment Rate Table 2—Hospital Case-Mix Indexes for Discharges Occurring in Federal Fiscal Year 2006; Hospital Wage Indexes for PO 00000 Frm 00171 Fmt 4701 Sfmt 4702 24849 Federal Fiscal Year 2008; Hospital Average Hourly Wages for Federal Fiscal Years 2006 (2002 Wage Data), 2007 (2003 Wage Data), and 2008 (2004 Wage Data); and 3-Year Average of Hospital Average Hourly Wages Table 3A—FY 2008 and 3-Year Average Hourly Wage for Urban Areas by CBSA Table 3B—FY 2008 and 3-Year Average Hourly Wage for Rural Areas by CBSA Table 4A—Wage Index and Capital Geographic Adjustment Factor (GAF) for Urban Areas by CBSA—FY 2008 Table 4B—Wage Index and Capital Geographic Adjustment Factor (GAF) for Rural Areas by CBSA—FY 2008 Table 4C—Wage Index and Capital Geographic Adjustment Factor (GAF) for Hospitals That Are Reclassified by CBSA—FY 2008 Table 4F—Puerto Rico Wage Index and Capital Geographic Adjustment Factor (GAF) by CBSA—FY 2008 Table 4J—Out-Migration Adjustment—FY 2008 Table 5—List of Proposed Medicare Severity Diagnosis-Related Groups (MS–DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay Table 6A—New Diagnosis Codes Table 6B—New Procedure Codes Table 6C—Invalid Diagnosis Codes Table 6D—Invalid Procedure Codes Table 6E—Revised Diagnosis Code Titles Table 6F—Revised Procedure Code Titles Table 6J—Major Complication and Comorbidity (MCC) List Table 6K—Complications and Comorbidity (CC) List Table 7A—Medicare Prospective Payment System Selected Percentile Lengths of Stay: FY 2006 MedPAR Update— December 2006 GROUPER V24.0 CMS DRGs Table 7B—Medicare Prospective Payment System Selected Percentile Lengths of Stay: FY 2006 MedPAR Update— December 2006 GROUPER V25.0 MS– DRGs Table 8A—Proposed Statewide Average Operating Cost-to-Charge Ratios—March 2007 Table 8B—Proposed Statewide Average Capital Cost-to-Charge Ratios—March 2007 Table 8C—Proposed Statewide Average Total Cost-to-Charge Ratios for LTCHs—March 2007 Table 9A—Revised Hospital Reclassifications and Redesignations—FY 2008 Table 9C—Hospitals Redesignated as Rural under Section 1886(d)(8)(E) of the Act— FY 2008 Table 10—Geometric Mean Plus the Lesser of .75 of the National Adjusted Operating Standardized Payment Amount (Increased to Reflect the Difference Between Costs and Charges) or .75 of One Standard Deviation of Mean Charges by Proposed Medicare Severity Diagnosis-Related Group (MS–DRG)— April 2007 Table 11—Proposed FY 2008 MS–LTC– DRGs, Relative Weights, Geometric Average Length of Stay, and 5/6ths of the Geometric Average Length of Stay E:\FEDREG\03MYP2.LOC 03MYP2 24850 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 1A.—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS; LABOR/NONLABOR (69.7 PERCENT LABOR SHARE/30.3 PERCENT NONLABOR SHARE IF WAGE INDEX GREATER THAN 1) Full update (3.3 percent) Reduced update (1.3 percent) Labor-related Nonlabor-related Labor-related Nonlabor-related $3,430.29 ............................................................................................................. $1,491.21 $3,363.88 $1,462.34 TABLE 1B.—NATIONAL ADJUSTED OPERATING STANDARDIZED AMOUNTS, LABOR/NONLABOR (62 PERCENT LABOR SHARE/ 38 PERCENT NONLABOR SHARE IF WAGE INDEX LESS THAN OR EQUAL TO 1) Full update (3.3 percent) Reduced update (1.3 percent) Labor-related Nonlabor-related Labor-related Nonlabor-related $3,051.33 ............................................................................................................. $1,870.17 $2,992.26 $1,833.96 TABLE 1C.—ADJUSTED OPERATING STANDARDIZED AMOUNTS FOR PUERTO RICO LABOR, LABOR/NONLABOR Rates if wage index greater than 1 Labor Nonlabor Rates if wage index less than or equal to 1 Labor Nonlabor National ............................................................................................................ $3,430.29 $1,491.21 $3,051.33 $1,870.17 Puerto Rico ...................................................................................................... 1,442.56 884.15 1,365.78 960.93 TABLE 1D.—CAPITAL STANDARD FEDERAL PAYMENT RATE Urban rate mmaher on DSK3CLS3C1PROD with $$_JOB National ..................... Puerto Rico ............... VerDate Mar 15 2010 $413.87 195.60 02:00 Aug 26, 2011 Rural rate $417.26 197.21 Jkt 223001 PO 00000 Frm 00172 Fmt 4701 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24851 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 010001 010005 010006 010007 010008 010009 010010 010011 010012 010015 010016 010018 010019 010021 010022 010023 010024 010025 010027 010029 010032 010033 010034 010035 010036 010038 010039 010040 010043 010044 010045 010046 010047 010049 010050 010051 010052 010053 010054 010055 010056 010058 010059 010061 010062 010064 010065 010066 010068 010069 010072 010073 010078 010079 010083 010084 010085 010086 010087 010089 010090 010091 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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............................................................................. ............................................................................. 1.5195 1.1370 1.5127 1.0231 1.0409 0.9710 1.1050 1.6744 1.2346 1.0427 1.5763 1.7123 1.2720 1.1864 0.9503 1.8483 1.6036 1.3014 0.7631 1.5702 0.9327 2.0856 1.0461 1.3138 1.1607 1.2692 1.6579 1.6552 1.0833 1.0847 1.2226 1.5338 0.8958 1.1433 1.0407 0.8299 0.8742 *** 1.0737 1.6104 1.6382 1.0119 1.0247 0.9828 1.0229 1.6966 1.5287 0.8370 *** 1.0243 *** 0.9794 1.6186 1.2223 1.1876 1.3254 1.3296 1.1007 1.9814 1.2937 1.7447 0.9554 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.7598 0.8760 0.7971 0.7598 0.7843 0.8760 0.8737 0.8873 0.9391 0.7641 0.8873 0.8873 0.7971 0.7598 0.9845 0.8366 0.8366 0.8594 0.7598 0.8594 0.7918 0.8873 0.8366 0.8737 0.7598 0.8081 0.9175 0.8129 0.8873 0.8737 0.8737 0.8129 0.7777 0.7598 0.8873 0.8534 0.7722 * 0.8760 0.7598 0.8873 0.8873 0.8760 0.8164 0.7598 0.8873 0.8737 0.7598 * 0.7598 * 0.7598 0.8081 0.9175 0.7950 0.8873 0.8760 0.7598 0.7950 0.8873 0.8544 0.7641 21.6546 22.4906 23.4823 18.2429 20.4591 23.2228 21.4974 27.4850 22.7020 21.5111 25.1502 22.2990 22.0906 18.6785 24.5671 27.6174 20.7265 21.2674 15.3705 22.6976 19.1555 26.3784 16.9686 22.2870 22.9747 21.4509 25.8820 22.8851 22.5944 21.4036 19.8803 21.6965 21.0605 20.2413 22.1584 15.2207 16.4958 19.0108 22.5554 22.3800 23.7144 18.5538 21.3237 21.9370 18.3435 26.1110 21.3785 17.6152 19.0789 21.3609 21.8169 16.4168 21.6857 21.8199 22.3040 24.7127 24.4710 18.6081 22.5225 22.8448 23.6948 18.6912 22.1989 23.6022 23.4975 19.9329 17.9533 23.5626 27.0385 27.6658 24.4059 22.3383 24.6488 23.7048 22.8766 19.7367 25.8404 25.4272 22.0819 22.7635 16.4682 23.9007 19.3311 27.4181 17.7457 24.2425 21.5796 23.7039 26.9919 24.3207 21.9774 22.5009 20.4927 23.4219 26.4851 21.7888 22.9620 18.7701 25.9233 * 23.3624 22.5396 23.7398 19.5092 23.0012 24.1185 21.4805 24.8155 23.0477 19.8692 22.7156 23.1243 24.4989 18.3963 23.5279 22.7337 22.4279 26.3238 24.2609 22.2096 22.4318 25.0811 26.0494 23.1310 23.2171 23.0192 25.1891 21.2159 22.0766 25.8995 22.8588 27.4650 25.5764 27.0786 26.8613 24.6173 23.3445 21.0596 27.4306 27.5972 25.0694 23.6162 17.0501 25.0667 20.5944 28.9456 19.1508 24.2739 24.2867 27.0732 29.2918 24.7653 23.9116 24.4278 23.1687 25.7750 19.7500 22.4234 24.4046 18.0235 36.3510 * 24.4797 22.4131 25.3239 17.0128 24.8195 25.2415 21.6281 27.6143 24.3340 25.1251 24.4131 23.6305 25.9729 19.0009 24.3805 22.1795 24.0017 26.5072 24.1142 21.5581 24.8042 26.2624 26.3950 22.5237 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00173 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 22.3607 23.0412 23.9924 19.8249 19.9260 24.2263 23.5938 27.5387 24.1955 23.3434 25.5445 23.5172 22.7780 19.7966 25.9296 26.8926 22.5299 22.5532 16.2714 23.9196 19.8444 27.5755 17.9500 23.6060 22.9472 24.1203 27.3990 23.9965 22.8203 22.7205 21.0753 23.5002 21.9482 21.5067 23.1653 17.3856 26.9113 19.0108 23.4775 22.4446 24.2816 18.2407 23.0576 23.7777 20.4629 26.1440 22.9445 20.8278 22.0065 22.6678 24.0804 17.9403 23.2222 22.2414 22.9546 25.8381 24.2806 20.7408 23.2180 24.6787 25.3394 21.3015 24852 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 010092 010095 010097 010098 010099 010100 010101 010102 010103 010104 010108 010109 010110 010112 010113 010114 010115 010118 010120 010121 010125 010126 010128 010129 010130 010131 010137 010138 010139 010143 010144 010145 010146 010148 010149 010150 010152 010157 010158 010162 010163 010164 010165 010166 010167 010168 020001 020004 020006 020008 020012 020014 020017 020018 020019 020024 020026 020027 030001 030002 030006 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.5528 0.8469 0.7113 0.9805 0.9668 1.6853 1.1065 0.9355 1.8826 1.8819 1.0930 0.9845 0.7589 0.9638 1.6643 1.3627 0.6881 1.2168 0.9648 *** 1.0630 1.1765 0.8769 1.0370 1.0247 1.3971 1.2222 0.6028 1.5889 1.2118 1.6386 1.4710 1.0814 0.8685 1.2881 1.0284 1.2950 1.1360 1.1924 *** *** 1.1750 *** *** 1.4977 1.1410 1.7970 1.1210 1.3200 1.2398 1.3779 1.1267 1.9205 0.9351 0.8687 1.1749 1.4939 0.9384 1.5465 2.0925 1.6966 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.8534 0.8534 0.8366 * 0.7598 0.8127 0.8737 0.7598 0.8873 0.8873 0.8366 0.7967 0.7901 0.7598 0.7950 0.8873 * 0.8166 0.7598 * 0.8069 0.8366 0.7641 0.7723 0.8873 0.9175 0.8873 0.7711 0.8873 0.8737 0.7950 0.8534 0.8081 0.7598 0.8366 0.8366 0.7950 0.7971 0.7927 * * 0.8043 * * 0.8873 0.9023 1.1840 1.1817 1.1840 1.1840 1.1817 1.1817 1.1840 1.9287 1.9287 1.1817 1.9287 1.9287 1.0115 1.0115 0.9484 24.4592 13.9326 16.7549 14.3076 18.7910 21.2915 21.6593 21.0902 26.1163 24.7394 28.4624 21.6194 17.5957 16.8902 21.4121 22.3752 21.7477 19.7673 20.9450 24.0867 18.4113 23.1381 21.4200 21.3555 23.2488 25.7837 24.7366 13.8476 25.3014 22.0215 20.8209 24.9531 20.8917 20.5589 26.5854 21.6377 22.6202 24.3559 24.3531 * * * * * * * 32.8120 32.0966 36.0540 35.9236 31.8995 32.0894 33.5852 * * 33.0644 * * 29.9840 29.0519 25.8872 26.6796 16.5250 19.4511 * 20.8383 23.8919 24.2575 25.6158 27.8272 27.6471 24.6740 17.6733 26.0038 17.1833 22.3282 25.6152 * 21.4630 20.9019 * 21.5123 23.9327 23.6647 22.1574 23.7528 26.4297 27.5782 16.7602 26.8726 26.2762 22.5133 24.5092 22.6586 23.9246 24.4805 23.6080 22.4075 23.3828 23.5533 33.8777 * * * * * * 35.4232 31.8004 34.3752 36.1250 32.5975 29.4472 35.4119 * * 29.5195 * * 32.4791 30.2200 27.0599 26.9923 16.9952 19.2462 * 20.6723 25.1439 25.0963 26.9801 28.9628 28.3109 27.0236 21.0403 19.8672 20.4001 24.7059 25.7061 * 22.7172 22.1859 * 22.8897 24.4934 24.9854 21.8496 24.5639 27.2704 28.5798 14.5508 28.1771 24.0663 22.3897 25.8279 22.6870 23.5683 26.7486 24.4087 23.7803 25.4582 25.5902 * 34.0293 * 28.8030 29.7218 * * 36.5276 33.5991 37.0215 39.3416 33.9363 30.9718 35.8810 * * 38.6904 * * 33.4166 31.0794 27.8624 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00174 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 26.0268 15.8664 18.4993 14.3076 20.0887 23.5423 23.6319 24.5958 27.5988 26.8460 26.7335 20.0217 20.8809 18.1174 22.7828 24.6261 21.7477 21.2736 21.3550 24.0867 20.8635 23.8544 23.3827 21.7886 23.8766 26.5326 26.9175 15.1016 26.8342 24.0857 21.9331 25.1079 22.1060 22.6789 25.9662 23.2036 22.9411 24.3716 24.4669 33.8777 34.0293 * 28.8030 29.7218 * * 34.9502 32.4852 35.7759 37.1498 32.8387 30.8220 34.9151 * * 33.4491 * * 31.9038 30.0867 26.9763 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24853 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 030007 030009 030010 030011 030012 030013 030014 030016 030017 030018 030019 030022 030023 030024 030027 030030 030033 030036 030037 030038 030040 030043 030055 030060 030061 030062 030064 030065 030067 030068 030069 030071 030073 030074 030077 030078 030080 030083 030084 030085 030087 030088 030089 030092 030093 030094 030099 030100 030101 030102 030103 030105 030106 030107 030108 030109 030110 030111 030112 030113 030114 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.4533 *** 1.4068 1.4906 1.3882 1.4760 1.5924 1.2381 2.0661 1.3196 1.3553 1.5745 1.7864 2.0620 0.9709 1.5755 1.2964 1.4582 2.1468 1.6738 0.9098 1.2683 1.4609 1.0905 1.6820 1.2021 1.9609 1.5921 1.0573 1.1143 1.4255 0.8871 0.8952 0.8727 0.7676 0.9879 1.5499 1.4209 0.9014 1.5899 1.6946 1.3692 1.6385 1.4976 1.2964 1.4055 0.8736 2.0536 1.4386 2.3668 1.7576 2.2412 1.7570 1.9168 2.0343 *** 1.6153 1.0328 1.9764 0.8965 1.3891 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.9386 * 0.9484 0.9484 0.9913 0.9468 1.0115 1.0115 1.0115 1.0115 1.0115 1.0115 1.1558 1.0115 * 1.0115 1.1310 1.0115 1.0115 1.0115 0.9398 0.9386 0.9534 0.9386 1.0115 0.9386 0.9484 1.0115 0.9616 0.9386 0.9386 1.4406 1.4406 1.4406 1.4406 1.4406 0.9484 1.0115 1.4406 0.9484 1.0115 1.0115 1.0115 1.0115 1.0115 1.0115 0.9386 0.9484 1.1205 1.0115 1.0115 1.0115 1.0115 1.0115 1.0115 * 1.0115 0.9484 1.0115 1.4406 0.9484 29.6174 22.3993 24.8275 25.1361 26.3859 25.7050 25.6259 26.7003 26.2452 28.9476 27.3156 26.4404 33.8333 31.6658 20.4032 30.2712 26.6531 30.3521 28.6453 29.5509 24.8145 24.7932 24.5202 24.3523 25.5529 23.8068 25.4922 27.1646 20.4376 20.8846 26.3518 * * * * * 25.2077 27.5353 * 24.5792 26.6594 26.6796 27.1835 27.3203 25.8955 29.5948 26.3236 29.0691 26.1927 29.0942 30.1994 31.3094 34.7221 * * * * * * * * 31.1928 26.5408 28.5684 28.1423 27.3895 27.0111 29.6582 29.1980 30.6007 29.4566 29.5921 30.5710 34.2142 31.9247 * 32.0994 28.7508 30.9834 31.2877 29.9314 27.5322 26.5834 27.1473 24.8373 28.0696 26.6880 28.3853 29.5883 20.7591 23.1394 30.2224 * * * * * 27.1360 27.4983 * 26.8364 29.5962 27.8604 28.9068 31.7512 26.4430 31.5422 27.1402 31.5628 27.8302 31.6285 31.7322 31.2970 32.9840 35.6197 * 16.5906 31.4852 * * * * 33.7190 * 31.1684 29.3385 28.8355 29.3504 29.8251 31.9830 34.7863 31.8047 30.1929 30.3718 35.8265 33.1810 * 34.4162 29.9363 33.0517 34.1070 31.6720 29.5727 27.3802 27.0569 29.6494 27.7958 28.9557 29.7464 31.0784 27.4426 24.0540 29.7783 * * * * * 28.7349 33.5289 * 28.1362 31.2063 29.9743 30.1558 30.6298 27.4271 33.4045 26.7474 35.1381 30.6747 34.2046 32.2839 32.7440 36.4650 35.5345 31.3337 32.6823 29.7956 34.7976 37.4931 * * —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00175 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 31.5810 23.8204 28.1880 27.6326 27.5891 27.3749 28.4291 29.4207 30.8882 30.0509 29.0813 29.2058 34.6818 32.2887 20.4032 32.2545 28.4678 31.6114 31.4095 30.2088 27.3145 26.2787 26.3168 26.3133 27.1919 26.5828 27.9854 29.3868 22.9577 22.7233 28.7287 * * * * * 27.0418 29.3975 * 26.6157 29.3936 28.2304 28.8088 30.0149 26.6702 31.6118 26.7410 31.9181 28.3387 31.6905 31.3999 31.8776 34.9441 35.5697 31.3337 26.5780 30.5019 34.7976 37.4931 * * 24854 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 030115 030117 030118 030119 040001 040002 040004 040007 040010 040011 040014 040015 040016 040017 040018 040019 040020 040021 040022 040026 040027 040029 040036 040039 040041 040042 040045 040047 040050 040051 040053 040054 040055 040062 040067 040069 040071 040072 040074 040075 040076 040077 040078 040080 040081 040084 040085 040088 040091 040100 040105 040109 040114 040118 040119 040126 040132 040134 040137 040138 040141 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.3513 1.1172 1.0947 1.1646 1.0784 1.2054 1.7231 1.7566 1.4680 1.0468 1.3549 0.9946 1.7637 1.0958 1.0813 1.1103 1.5840 1.5369 1.5691 1.5094 1.4822 1.4949 1.6116 1.2751 1.1737 1.3814 1.0416 1.1246 1.2272 0.9636 *** *** 1.5255 1.6634 1.1389 1.0195 1.4618 1.1155 1.1976 *** 1.0003 0.9991 1.5953 1.0440 0.8586 1.1954 0.9761 1.4629 1.1778 1.3421 1.0556 1.1066 1.8067 1.4739 1.4199 *** *** 2.3675 1.3088 1.4228 0.8436 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.0115 0.9386 0.9913 1.0115 0.8876 0.7519 0.8876 0.8965 0.8876 0.7519 0.8721 0.7519 0.8965 0.8719 0.8056 0.8951 0.8951 0.8965 0.8876 0.9110 0.8943 0.8965 0.8965 0.8145 0.8721 0.9291 * 0.7636 0.7519 0.7519 * * 0.8056 0.8056 0.7527 0.8951 0.8721 0.7519 0.8965 * 0.8721 * 0.8721 0.8507 0.7877 0.8965 0.8951 0.7766 0.8131 0.8721 * * 0.8965 0.8507 0.8721 * * 0.8965 0.8965 0.8876 0.8876 * * * * 23.7718 20.1384 25.0286 25.7142 23.0274 20.3970 25.3451 19.2831 22.1228 21.9875 23.6044 23.7328 21.6603 25.6917 25.4052 25.4072 21.1412 24.0704 26.3226 19.5998 22.1531 19.9627 17.2281 21.9163 16.3930 19.1400 20.7823 18.2685 23.3156 23.3082 16.8800 24.4662 24.3824 19.9009 25.2423 18.3253 20.6272 18.2082 24.5377 22.3392 15.1081 24.7225 29.8444 22.6183 23.1320 20.0460 18.2182 22.8801 24.8992 24.7363 21.0103 14.0700 28.1393 27.3412 25.2907 25.7513 24.0901 * * * * 22.9327 21.2020 27.1741 40.1291 24.2315 21.0967 26.4777 20.4279 25.8056 21.9147 24.0026 23.8706 22.6497 25.4046 29.5000 27.7931 21.4252 24.8409 27.6234 21.2712 23.7787 21.1716 * 22.4249 17.6906 21.3342 * 18.0509 23.0448 23.8994 19.0471 24.8060 25.4680 22.4741 25.2699 * 23.5742 * 23.5915 24.1921 16.8437 27.7626 22.9916 22.4860 24.2398 21.3051 * * 26.7581 26.0388 24.3680 15.6985 * 31.9325 25.9979 27.8584 26.1041 * * * * 22.9909 24.9965 28.1077 29.1919 26.5274 22.2391 29.0061 20.1045 26.5895 23.8741 25.6731 24.9108 23.9443 26.1832 27.9883 29.5278 23.8205 25.1455 29.7111 21.4793 26.4923 19.8670 * 22.9939 18.5104 22.0350 * 19.5333 24.9139 25.2283 18.9849 24.9975 25.2804 22.1027 26.2628 * 23.0930 * 26.1923 24.8730 17.2484 26.6430 25.7190 23.5774 23.1902 22.6107 * * 27.7902 26.8888 24.2386 17.3697 22.0041 32.2786 27.7350 28.3338 30.3458 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00176 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) * * * * 23.2119 22.0316 26.7777 31.6848 24.6221 21.2815 26.8567 19.9373 24.8381 22.5732 24.3846 24.1693 22.7533 25.7531 27.5941 27.6084 22.1269 24.6984 27.9661 20.7967 24.1425 20.3330 17.2281 22.4384 17.5655 20.8371 20.7823 18.6002 23.7090 24.1348 18.2674 24.7596 25.0562 21.4210 25.5873 18.3253 22.4189 18.2082 24.6731 23.8545 16.4107 26.4194 25.8628 22.9018 23.5097 21.3761 18.2182 22.8801 26.5373 25.8805 23.2176 15.6131 24.3526 30.5646 26.2747 27.5135 26.8841 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24855 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 040142 040143 040144 040145 040146 040147 050002 050006 050007 050008 050009 050013 050014 050015 050016 050017 050018 050022 050024 050025 050026 050028 050030 050036 050038 050039 050040 050042 050043 050045 050046 050047 050054 050055 050056 050057 050058 050060 050061 050063 050065 050067 050069 050070 050071 050072 050073 050075 050076 050077 050078 050079 050082 050084 050088 050089 050090 050091 050093 050096 050099 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.4686 *** *** 1.7857 *** 1.7126 1.3851 1.6409 1.4954 1.2737 1.8128 1.9755 1.2470 1.3326 1.3291 1.9798 1.1984 1.5660 1.1369 1.8832 1.5092 1.2326 1.2224 1.5126 1.6564 1.6086 1.2745 1.5024 1.6351 1.3005 1.1311 1.7663 1.1907 1.3282 1.3806 1.6643 1.6025 1.4468 *** 1.3855 *** 1.1904 1.7481 1.2855 1.2901 1.3299 1.2899 1.3067 1.9114 1.6174 1.2621 1.5036 1.6860 1.5634 *** 1.3526 1.2774 1.0225 1.5010 1.2246 1.4900 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.9110 * * 0.8507 * 0.8965 1.5308 1.2666 1.4906 1.4766 1.4201 1.4201 1.2853 * 1.1912 1.2999 1.1633 1.1607 1.1607 1.1607 1.1607 1.1607 1.1607 1.1607 1.5378 1.1607 1.1633 1.2666 1.5308 1.1607 1.1607 1.4766 1.1607 1.4766 1.1633 1.1607 1.1633 1.1607 * 1.1633 * 1.1989 1.1607 1.4906 1.5299 1.5299 1.5299 1.5308 1.5299 1.1607 1.1633 1.5299 1.1607 1.1870 * 1.1607 1.4766 1.1633 1.1607 1.1633 1.1607 27.9696 * * * * * 34.1948 30.5373 38.7033 39.1539 39.6393 31.9837 33.0373 30.7940 26.2161 36.6593 22.3472 29.8632 27.5587 36.1622 28.3027 26.6160 24.9707 32.7929 38.7527 31.6734 34.3279 33.9415 43.1589 23.8408 25.6875 40.9874 24.1262 37.5879 27.9330 29.4351 33.8215 27.3282 32.2172 33.3039 34.0280 31.9597 31.2172 45.3382 44.9464 44.2651 45.9765 47.2356 46.4991 32.0245 31.1425 47.8597 37.7783 33.0179 25.7385 33.5324 32.9584 30.8560 33.4118 24.6679 31.0437 21.4222 37.1976 21.4008 * * * 35.5184 33.5751 43.4440 49.3167 43.0584 35.7591 36.0305 32.2188 24.5768 39.6653 23.3204 31.6467 29.4062 33.5466 31.5250 27.3826 27.2945 33.8000 44.2265 35.2630 35.8322 37.3760 45.4887 25.0150 26.1926 55.9367 21.3650 42.9516 30.6126 30.0236 33.1409 29.9762 * 34.0906 34.9110 38.8070 34.6353 47.4099 50.7602 49.4344 49.9730 54.4089 52.3788 34.8660 32.0133 47.3449 38.2878 35.5196 * 33.9593 33.8953 32.1301 36.9481 34.9237 33.4174 23.8619 * * 24.4378 33.7847 * 41.7235 37.1649 44.3636 46.6961 46.2195 42.0547 36.6124 * 30.7245 41.8986 32.0787 33.0584 33.4319 32.7463 33.1265 28.5775 30.8991 36.1357 47.1554 36.6920 35.7021 40.3545 46.5540 27.0633 29.1122 45.1678 24.3196 44.2917 32.7669 31.7448 36.7723 32.0159 * 36.3153 38.2458 40.1284 35.3837 46.4023 49.6475 50.0340 49.0059 49.8285 50.2028 36.5360 30.4267 48.9005 37.6622 39.3825 * 36.6955 37.7343 37.1046 36.8258 35.3586 30.2843 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00177 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 24.1239 37.1976 21.4008 24.4378 33.7847 * 37.3172 33.5394 42.1957 45.1213 43.0446 36.4664 35.2529 31.5274 27.1606 39.4161 25.3874 31.4880 30.1998 34.1066 31.0369 27.5352 27.6427 34.2635 43.4736 34.5165 35.3245 37.2138 45.1118 25.4065 26.9714 47.4628 23.2719 41.4280 30.4544 30.4500 34.5428 29.7243 32.2172 34.5052 35.7018 37.4041 33.8181 46.4528 48.7318 48.1854 48.5022 50.5647 49.9368 34.5322 31.1476 47.9787 37.9070 35.9583 25.7385 34.6956 34.8362 33.3130 35.7320 31.7202 31.6087 24856 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 050100 050101 050102 050103 050104 050107 050108 050110 050111 050112 050113 050114 050115 050116 050117 050118 050121 050122 050124 050125 050126 050127 050128 050129 050131 050132 050133 050135 050136 050137 050138 050139 050140 050144 050145 050146 050148 050149 050150 050152 050153 050155 050158 050159 050167 050168 050169 050172 050173 050174 050175 050177 050179 050180 050188 050189 050191 050192 050193 050194 050195 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.8340 1.2896 1.2784 1.5384 1.4343 1.5161 1.9249 1.2782 1.2607 1.5328 1.2281 1.4308 1.4652 1.7182 *** 1.2267 1.2979 1.5166 1.2868 1.4991 1.4832 1.3323 1.4725 1.8434 1.3349 1.4284 1.5409 1.0356 1.3586 1.4390 1.8383 1.1867 1.3250 *** 1.4358 1.7437 1.0844 1.5003 1.2112 1.4654 1.4478 *** 1.3562 1.4342 1.3285 1.6239 1.4414 *** 1.3511 1.5304 *** *** 1.2436 1.5479 1.4249 1.0036 1.5059 0.9796 1.2019 1.3917 1.5361 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.1607 1.5299 1.1607 1.1633 1.1633 1.1607 1.2999 1.1607 1.1633 1.1633 1.4906 1.1633 1.1607 1.1633 * 1.1989 1.1607 1.1870 1.1633 1.5378 1.1633 1.2999 1.1607 1.1607 1.4766 1.1633 1.2853 1.1633 1.4766 1.1633 1.1633 1.1633 1.1607 * 1.4408 * * 1.1633 1.2853 1.4766 1.5378 * 1.1633 1.1607 1.1870 1.1607 1.1633 * 1.1607 1.4766 * * 1.1989 1.5299 1.5378 1.4408 1.1633 1.1607 1.1607 1.5378 1.5308 29.6949 40.3195 29.1364 34.2529 29.7326 33.1358 35.5711 26.1453 28.1588 36.8026 33.8064 31.1295 30.9288 34.5109 32.4413 35.4044 27.9537 34.2416 28.0288 41.7020 29.3360 26.1222 31.0662 32.2680 40.5321 35.1544 31.3530 24.3927 37.4560 38.4827 46.9557 37.6217 39.6269 33.5109 42.3134 * 27.3005 33.2270 31.7560 43.6487 43.3190 21.8550 35.1326 31.3199 28.5179 33.2506 27.4644 28.5604 30.3582 40.1747 30.5733 25.1442 27.1155 40.2504 39.5110 29.1279 34.2091 27.0424 29.6421 40.9096 48.4358 31.4404 42.4589 32.0617 34.0935 32.3043 32.5846 38.8672 26.8408 28.7875 37.7281 39.4882 34.0309 28.8051 36.8825 34.2020 39.9683 30.6105 33.9812 30.2522 44.9523 31.7619 32.0355 31.1308 34.7359 45.3152 35.9199 31.9527 25.1813 43.3747 39.1496 45.3727 37.8986 40.9725 33.6662 42.2921 * 28.2305 35.8821 33.6583 46.1553 42.8955 16.9516 35.7805 32.5704 31.4798 37.9784 29.4693 * 29.0576 44.4199 33.3061 24.0717 30.4973 42.0358 41.0943 30.1155 37.7805 27.1400 33.9520 44.7107 48.8595 33.3955 47.1051 33.1773 35.6753 33.6194 33.3632 41.2472 28.0669 31.8716 38.9441 42.8855 35.7244 31.3553 37.7999 35.0365 41.6676 34.6208 33.4644 29.9912 47.5179 32.6678 40.6863 33.4220 36.8660 46.4089 39.7742 33.1808 25.3138 46.6589 40.2454 40.6348 38.7381 39.4950 38.2322 47.7276 * * 37.5338 37.9935 51.6554 47.6370 16.7744 39.9584 34.6887 34.0379 40.5914 31.4104 * 31.6677 46.5960 35.0178 * 31.6619 45.8035 43.7368 28.7585 38.1482 27.8369 29.3437 49.0012 53.5569 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00178 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 32.0304 43.3558 31.7561 34.7042 31.9097 33.0279 38.6817 27.0290 29.6669 37.8605 38.6355 33.6736 30.3610 36.4915 33.2948 39.0057 31.1203 33.8813 29.4686 44.7128 31.2865 31.7609 31.8925 34.5472 44.1170 36.9321 32.2800 25.0595 42.5331 39.4249 43.8131 38.1891 39.9745 35.1744 44.2033 * 27.7734 35.8255 34.4495 47.1764 44.7561 18.0647 36.9833 32.9759 31.2291 37.3803 29.5643 28.5604 30.3441 43.8522 32.9399 24.6196 30.0118 42.8295 41.3969 29.3260 36.6461 27.3395 30.8548 44.8981 50.3390 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24857 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 050196 050197 050204 050205 050207 050211 050214 050215 050219 050222 050224 050225 050226 050228 050230 050231 050232 050234 050235 050236 050238 050239 050240 050242 050243 050245 050248 050251 050253 050254 050256 050257 050261 050262 050264 050270 050272 050276 050277 050278 050279 050280 050281 050283 050289 050290 050291 050292 050295 050296 050298 050299 050300 050301 050305 050308 050309 050312 050313 050315 050320 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.0257 2.1096 1.4245 1.4343 *** 1.2807 *** *** 1.2468 1.7017 1.7128 1.4566 1.6579 1.2788 1.5673 1.6215 1.7615 1.1631 1.5179 1.4101 1.5170 1.6079 *** 1.3921 1.6372 1.3931 1.0716 *** *** 1.2481 *** 0.9659 1.3127 2.1485 1.3229 *** 1.3845 1.1469 1.0179 1.5501 1.1687 1.6972 1.3952 1.4814 1.6758 1.7004 1.9448 1.0728 1.4731 1.1731 1.1705 *** 1.4374 1.2925 1.4791 1.5108 1.4575 *** 1.2017 1.2450 1.3087 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.1607 1.5299 1.1633 1.1633 * 1.5308 * * 1.1633 1.1607 1.1607 1.1607 1.1607 1.4766 1.1607 1.1633 1.1912 1.1607 1.1633 1.1607 1.1633 1.1633 * 1.5378 1.1607 1.1607 1.4408 * * 1.2999 * 1.1607 1.1607 1.1633 1.5308 * 1.1607 1.5299 1.1633 1.1633 1.1607 1.2827 1.1633 1.5308 1.4906 1.1633 1.4766 1.1607 1.1607 1.5378 1.1607 * 1.1607 1.3959 1.5308 1.5378 1.2999 * 1.1870 1.1607 1.5308 32.1933 48.9053 28.6423 27.8611 29.5214 41.2166 23.9972 43.7985 22.4065 29.1094 29.3143 29.9656 30.5867 42.4226 32.9555 30.9607 27.4099 29.6561 29.2979 32.1647 31.1764 31.0963 35.5735 44.3130 31.4883 28.6527 35.3864 27.2675 24.0044 27.0041 29.8194 21.3216 27.3234 44.0256 41.1211 32.4812 27.1989 39.3778 32.5213 29.9244 27.6573 35.2030 27.3824 43.0638 41.1774 34.5482 35.3653 26.8879 36.1950 39.0060 27.7416 31.5435 30.7148 31.9995 44.8630 43.0691 34.4145 33.9022 31.8003 28.5933 40.2352 34.0956 50.0728 32.0121 29.3334 30.0062 35.0515 25.4647 48.8112 26.4143 32.3882 32.5010 34.0836 32.4411 43.7939 34.0600 32.1813 26.3004 32.3726 30.5405 33.0686 33.3346 33.1148 36.1154 46.4844 32.9385 27.3866 * 27.8452 23.5381 31.2386 29.6793 20.1829 29.2150 39.9946 47.7024 33.6855 29.4671 41.1406 35.4443 31.8712 29.7118 38.8341 29.4882 44.3122 44.2814 37.3563 38.4365 26.9786 34.7382 39.9842 30.2022 35.1249 30.2874 35.9491 44.9681 43.7413 38.2659 36.8498 35.0478 33.2038 45.7686 32.8081 53.0188 35.3934 30.6295 31.3426 35.0280 * 50.7559 25.8363 33.7497 35.6597 35.1213 35.4589 47.1404 35.8511 33.7123 33.8542 34.8300 37.0848 32.6449 33.6829 35.9031 40.8103 51.0202 36.1250 30.1898 37.5312 31.2316 * 33.0846 32.7134 24.0681 30.8667 41.4804 42.5208 36.0101 29.7379 43.7919 35.0053 34.3775 31.6720 41.4106 31.6589 43.6531 50.1743 40.6183 40.5938 27.3320 38.4514 42.4133 33.7827 32.3683 33.6814 37.1092 48.5337 46.4167 39.4649 * 36.4099 32.7454 46.2016 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00179 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 33.0293 50.6957 32.0132 29.3017 30.2627 36.9044 24.7211 47.7254 24.8922 31.8383 32.5126 33.2219 32.8047 44.4641 34.3224 32.3028 29.2047 32.2029 32.3685 32.6397 32.8238 33.4237 37.5129 47.3613 33.6127 28.7713 36.3536 28.9392 23.7879 30.5672 30.6554 21.8475 29.2674 41.8523 43.7371 34.0808 28.8393 41.5068 34.2959 32.1732 29.7046 38.4388 29.5764 43.6816 45.4605 37.4594 38.0951 27.0736 36.5567 40.4982 30.5459 32.9738 31.6607 35.1038 46.1773 44.3891 37.4701 35.1423 34.5831 31.6158 44.0250 24858 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 050324 050325 050327 050329 050331 050333 050334 050335 050336 050342 050348 050349 050350 050351 050352 050353 050357 050359 050360 050366 050367 050369 050373 050376 050378 050379 050380 050382 050385 050390 050391 050393 050394 050396 050397 050407 050410 050411 050414 050417 050419 050420 050423 050424 050425 050426 050430 050432 050433 050434 050435 050438 050441 050444 050447 050448 050454 050455 050456 050457 050464 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.7816 1.2711 1.7344 1.2920 1.1678 1.0014 1.6310 1.3975 1.2358 1.2392 1.7661 0.9614 1.3638 1.5080 1.3698 1.4800 1.4453 1.1700 1.4970 1.1799 1.4038 1.4156 1.5222 1.5665 0.9465 *** 1.6825 1.3846 1.3037 1.1270 *** 1.4106 1.6045 1.6169 0.7585 1.1110 *** 1.2156 1.3232 1.2775 0.8450 *** 1.0736 1.9922 1.3129 1.4945 0.9735 *** 1.6238 1.0477 1.2739 1.5355 1.9488 1.3278 0.9388 1.3448 1.9034 1.6170 1.2382 1.6418 1.6913 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.1607 1.1653 1.1607 1.1607 * 1.1607 1.4408 1.1653 1.1870 1.1607 1.1607 1.1607 1.1633 1.1633 1.2999 1.1633 1.1607 1.1607 1.4766 1.1632 1.5299 1.1633 1.1633 1.1633 1.1633 * 1.5378 1.1633 1.4766 1.1607 * 1.1633 1.1607 1.1607 1.1607 1.4766 * 1.1633 1.2999 1.1607 * * 1.1607 1.1607 1.2999 1.1607 1.1607 * 1.1607 1.1607 1.1607 1.1633 1.5378 1.2190 1.1607 1.1607 1.4766 1.1607 1.1633 1.4766 1.1989 32.9792 30.6116 33.0087 26.2121 20.2692 23.4009 40.7467 28.9403 28.5659 26.8507 37.7898 17.4791 31.1833 30.8661 33.9362 31.8291 32.3095 25.7739 37.0769 31.1854 38.7727 29.5697 31.9271 32.9393 34.2417 32.9576 42.0781 29.4323 34.5183 26.0066 18.1005 30.0661 27.5061 33.5699 28.1639 37.9066 21.3814 37.8064 34.6672 29.5031 33.3124 24.9401 30.6416 31.0730 42.4177 30.6899 25.0604 30.8030 23.0807 26.1622 28.0305 27.2662 42.9765 30.5504 25.2573 27.9759 43.5311 22.7235 22.5630 45.5828 37.3692 34.5503 31.3730 33.9507 23.2927 * 19.6352 43.9656 30.9928 30.4664 29.2244 31.5156 24.4863 31.0136 30.6599 36.7673 29.4215 32.6763 29.8345 47.4497 33.6714 38.6330 30.6439 35.1380 34.3539 37.9904 * 46.0276 30.4014 36.8107 27.3183 17.2141 34.1743 27.4861 32.4918 28.3671 42.2748 * 38.8294 38.7585 32.9341 * 35.2869 28.3768 34.5680 49.2245 33.2031 23.9045 33.1876 21.3573 32.6255 30.6530 36.3026 44.5694 34.6313 26.7960 30.6201 38.5833 30.4606 21.6261 47.8947 38.3058 36.3466 34.1213 35.9352 33.0376 * 18.6523 47.2949 34.7177 31.5467 30.4210 32.7100 25.4172 31.7899 33.3053 37.0787 30.4196 36.2079 31.3346 52.3803 37.2628 40.1880 32.2454 34.3691 35.2799 40.1809 * 49.5391 32.6664 36.4189 27.9319 * 35.6327 32.1896 37.3957 29.6760 44.6803 * 38.6322 41.8000 35.4935 * 39.9207 31.9703 36.6083 46.6607 34.9839 24.5322 35.2390 21.1315 33.7752 33.0355 35.3864 46.5348 37.6608 29.0758 32.7714 40.2800 34.6359 27.7648 50.0192 41.6239 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00180 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 34.6946 32.1145 34.3186 27.5535 20.2692 20.3799 44.0643 31.6175 30.2591 28.9056 33.8507 22.6502 31.3395 31.6202 35.9203 30.5532 33.9112 29.0474 45.4207 33.8566 39.2564 30.8342 33.8391 34.2228 37.5492 32.9576 45.8231 30.8161 35.9493 27.0754 17.6460 33.2864 29.1045 34.4570 28.7665 41.6942 21.3814 38.4661 38.4949 32.6699 33.3124 32.7471 30.4039 34.1649 46.3205 32.9980 24.4190 33.0678 21.8793 31.2596 30.6062 33.0894 44.7312 34.7182 27.0881 30.3926 40.7576 29.0896 24.0206 47.8408 39.0263 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24859 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 050468 050469 050470 050471 050476 050477 050478 050481 050485 050488 050491 050492 050494 050496 050498 050502 050503 050506 050510 050512 050515 050516 050517 050523 050526 050528 050531 050534 050535 050537 050539 050541 050543 050545 050546 050547 050548 050549 050550 050551 050552 050557 050561 050567 050568 050569 050570 050571 050573 050575 050577 050578 050579 050580 050581 050583 050584 050585 050586 050588 050589 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.5319 1.0269 1.1011 1.7564 1.4491 *** 0.9888 1.4433 1.6549 1.3383 *** 1.2507 1.3609 1.7129 1.3359 1.7107 1.5082 1.6141 1.1758 1.3824 1.3440 1.4933 1.2446 1.2609 1.3227 1.1384 1.0428 1.4831 *** 1.4155 *** 1.5613 0.7511 0.8423 0.6608 0.9307 0.8110 1.5395 *** 1.3357 1.0550 1.6018 1.6005 1.6021 1.1551 1.3174 1.5427 *** 1.6272 1.2410 *** 1.4930 *** 1.2328 1.4907 1.6465 1.3234 *** 1.2846 1.3412 1.1523 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.1633 * 1.1607 1.1633 1.3959 * 1.1607 1.1633 1.1633 1.5308 * 1.1607 1.2853 1.5299 1.2999 1.1633 1.1607 1.1912 1.5299 1.5308 1.1607 1.2999 1.1607 1.5299 1.1607 1.1607 1.1633 1.1607 * 1.2999 * 1.5299 1.1607 1.1633 1.1607 1.4766 1.1607 1.1607 * 1.1607 1.1633 1.1989 1.1633 1.1607 1.1607 * 1.1607 * 1.1607 1.1633 * 1.1633 * 1.1607 1.1633 1.1607 1.1607 * 1.1607 1.1633 1.1607 29.5448 28.9080 24.6755 34.5211 34.6585 34.6995 33.3999 33.7445 31.4233 42.9904 32.1379 27.1540 35.9910 42.2672 33.0298 29.5616 31.6418 36.0164 47.5510 46.9233 38.9978 36.2772 23.9007 35.5452 31.3744 29.6838 26.9420 29.8603 32.3723 31.3844 29.8242 46.1121 26.1103 30.5554 30.2329 33.2204 30.3775 34.9818 30.2301 31.6165 27.1744 31.8048 38.8652 32.9829 24.4061 33.0259 34.0171 33.6156 34.1991 25.2513 30.8841 33.8825 39.4976 31.6256 32.1801 33.3697 24.8180 22.7121 27.4173 32.8212 30.9546 31.1111 30.6502 27.8678 35.4768 38.7856 37.7668 40.2558 36.1394 36.1488 42.6854 34.3598 28.0826 38.1177 48.2468 37.1667 28.7046 34.0994 37.7420 52.5376 50.9264 38.9542 39.8161 20.0213 40.6535 28.1997 31.4941 27.1974 33.1666 34.6143 34.9931 * 52.5908 29.4443 31.3080 33.2245 34.8401 39.2234 35.2792 30.9612 34.0467 33.0711 33.3654 38.0196 35.7063 25.2337 31.6785 34.5161 34.7627 34.7279 25.1457 32.3744 35.2390 42.5081 31.5806 34.0136 34.5747 30.3434 22.2521 26.4782 32.7556 34.5100 35.7762 * 31.0441 36.9130 40.0425 40.1536 41.1616 38.8656 34.6206 44.0641 * 30.7637 40.6396 51.6358 40.8114 31.8871 36.4360 39.8585 49.4515 48.8054 40.2968 42.9590 17.0548 42.4719 33.3951 36.0123 28.3319 36.6525 37.8210 37.4208 * 48.0854 24.4854 35.3180 36.5097 33.8021 41.0903 38.3717 34.9589 37.2494 33.9787 35.3341 38.2536 37.6375 26.0875 * 38.5202 39.0735 35.2835 23.7972 * 31.3598 * 34.1537 37.7567 37.4560 30.7795 29.4264 31.3482 37.7367 37.6873 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00181 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 32.2134 29.7684 28.1043 35.6374 37.8312 37.8017 38.4325 36.2142 34.0200 43.2687 33.1420 28.6534 38.1898 47.5808 36.9608 30.0325 34.1126 37.9166 49.9476 49.0410 39.4969 39.7253 19.9099 39.5900 30.8787 32.5346 27.4850 33.1997 35.0693 34.7283 29.8242 48.9361 26.5566 32.3823 33.2376 33.9238 36.6511 36.2083 31.9521 34.3696 31.2577 33.5504 38.3442 35.4787 25.2903 32.3431 35.7251 35.8473 34.7592 24.6719 31.6437 33.5038 40.8657 32.4723 34.6700 35.0083 28.6016 24.4704 28.3860 34.4128 34.3938 24860 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 050590 050591 050592 050594 050597 050599 050601 050603 050604 050608 050609 050613 050615 050616 050618 050623 050624 050625 050630 050633 050636 050641 050644 050660 050662 050663 050667 050668 050674 050677 050678 050680 050682 050684 050686 050688 050689 050690 050693 050694 050695 050696 050697 050699 050701 050704 050707 050708 050709 050710 050713 050714 050717 050718 050720 050722 050723 050724 050725 050726 050727 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.2935 *** *** *** 1.2589 1.8935 1.5556 1.4451 1.3991 1.2668 1.2823 *** *** 1.5105 0.9805 *** 1.2791 1.7399 *** 1.2279 1.2912 1.2917 0.9882 1.7424 0.8701 1.2772 0.8494 1.2080 1.1203 1.4565 1.3172 1.2341 0.8469 1.1147 1.2077 1.2025 1.5246 0.9979 1.3853 1.0504 *** 2.2819 1.1042 *** 1.3266 1.0008 1.2478 1.5869 1.4175 1.4517 *** 1.3837 1.4243 *** 0.9023 0.9960 1.3624 1.9836 0.8893 1.4929 1.1939 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.2999 * * * 1.1633 1.2999 1.1633 1.1607 1.5378 1.1607 1.1607 * * 1.1607 1.1607 * 1.1633 1.1633 * 1.1912 1.1607 1.1633 1.1633 * 1.5378 1.1633 1.4201 1.4766 1.2999 1.1633 1.1607 1.5299 1.1607 1.1607 1.1607 1.5378 1.5299 1.4766 1.1607 1.1607 * 1.1633 1.2827 * 1.1607 1.1633 1.4906 1.1607 1.1607 1.1607 * 1.5378 1.1633 * 1.1607 1.1607 1.1633 1.1607 1.1633 1.1989 1.1633 32.2142 28.8549 24.4542 34.7946 27.5691 38.1975 34.7409 30.2464 49.9428 23.3630 41.1797 * 33.2909 36.9017 27.4539 32.0627 32.2907 36.3631 30.9410 35.3734 30.5156 21.4612 27.6547 * 32.6362 25.7747 26.3937 31.8065 42.6866 38.7984 30.7219 38.3946 21.7792 26.4234 40.9486 41.9325 42.2018 47.2769 35.0621 28.9544 35.6548 35.9220 25.1984 26.8211 29.6253 25.3488 34.0550 22.5034 25.6119 39.9858 20.2803 33.6676 38.0796 21.4996 30.0811 * 35.0119 34.4267 21.7816 27.8433 24.3026 38.4971 30.6106 27.3606 36.5256 28.8294 32.7835 36.0572 34.0275 55.0821 30.4169 41.7208 42.8108 35.9547 37.7284 31.3182 * 33.9594 38.6591 * 36.8302 32.5576 39.6921 28.8237 * 33.2446 27.7334 24.2771 56.6555 48.0893 38.5770 32.4473 38.2871 17.9077 27.5256 41.0188 44.1510 45.0951 50.9094 34.5797 30.7858 39.6004 37.3837 16.6605 28.9083 31.9529 29.7740 35.7311 30.5860 26.8549 45.8022 21.1273 31.9527 39.3227 25.5140 29.4726 31.4867 38.5446 31.6910 24.3100 30.6479 33.9118 41.6861 34.7108 31.8084 42.0829 31.5618 34.7192 39.7718 35.0261 49.4433 36.3844 39.7400 42.9921 39.0455 36.7844 33.1445 * 35.9335 40.4646 * 38.4914 32.7924 32.3562 30.7956 * 38.2978 17.7021 25.9164 51.6039 47.0699 39.2158 33.7604 37.9841 22.2175 28.8345 39.7765 49.4057 48.8526 49.0219 39.7191 32.1040 49.0312 39.9251 22.1435 21.5729 34.9885 31.6053 43.5546 31.8452 24.5600 44.2474 21.4809 33.6833 38.8757 31.9633 30.3598 33.8005 38.7138 38.4705 30.0558 29.2940 32.7726 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00182 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 37.3399 31.3299 27.4577 37.6368 29.3957 35.1753 36.8583 33.2299 51.2946 29.5731 40.7274 42.8888 36.0526 37.1319 30.7673 32.0627 34.1562 38.5119 30.9410 36.8992 31.9970 29.3375 29.0870 * 34.3623 22.5197 25.5328 44.4443 46.1683 38.8993 32.3831 38.2002 20.5426 27.6181 40.4756 45.3228 45.3622 49.1860 36.4072 30.6710 41.9280 37.7376 20.8109 25.9116 32.5135 29.0130 37.4835 27.9330 25.5795 43.5806 20.8075 33.1222 38.7310 26.0532 29.9464 32.6977 37.6299 34.9427 25.0162 29.3768 30.6197 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24861 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 050728 050729 050730 050732 050733 050734 050735 050736 050737 050738 050739 050740 050741 050742 050744 050745 050746 050747 050748 050749 050750 050751 050752 050753 050754 050755 050756 060001 060003 060004 060006 060008 060009 060010 060011 060012 060013 060014 060015 060016 060018 060020 060022 060023 060024 060027 060028 060030 060031 060032 060034 060036 060041 060043 060044 060049 060054 060064 060065 060071 060075 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. *** *** *** 2.3945 1.6526 *** 1.3420 1.2208 1.4932 1.3746 1.6730 1.3849 1.4970 1.3975 1.9678 1.3654 1.7819 1.3997 1.0732 1.2517 1.4161 3.2977 1.4164 1.7096 1.3352 1.4093 1.9522 1.5646 1.3969 1.2516 1.3325 1.2017 1.4938 1.6914 1.6393 1.4822 1.5070 1.8624 1.7856 1.2375 1.2860 1.6180 1.6508 1.6737 1.8352 1.6708 1.5172 1.4469 1.5587 1.4866 1.6603 1.1013 0.8769 1.1879 1.2127 1.2785 1.4507 1.7291 1.3997 1.1696 1.3332 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 * * * 1.1607 1.2827 * 1.1633 1.1633 1.1633 1.1633 1.1633 1.1633 1.1633 1.1633 1.1613 1.1613 1.1613 1.1613 1.1870 1.1607 1.1989 1.1633 1.1633 1.1633 1.4906 1.1633 1.1612 1.0490 1.0490 1.0490 0.9451 0.9451 1.0490 0.9664 1.0490 0.9451 0.9451 1.0490 1.0490 0.9451 0.9451 0.9451 0.9471 1.0490 1.0490 1.0490 1.0490 0.9664 0.9471 1.0490 1.0490 0.9451 0.9451 0.9451 0.9451 0.9577 1.0141 1.0490 1.0490 0.9451 1.0141 36.0820 34.2580 51.5425 * * * * * * * * * * * * * * * * * * * * * * * * 26.8470 24.2224 29.9649 24.5704 23.3859 28.7645 28.9850 27.2833 26.2469 24.5994 31.2588 30.4533 25.6527 25.7628 22.6748 26.5238 27.7644 29.0130 28.0909 30.0448 26.6251 26.3650 30.4247 29.8445 20.7131 23.4978 18.7897 25.0360 29.0598 22.3490 31.3105 31.1987 25.7248 32.7563 39.3581 36.5432 37.0629 * * * * * * * * * * * * * * * * * * * * * * * * 29.6191 29.4809 32.4609 25.2139 23.0947 31.5210 27.1916 35.1573 27.3885 26.8675 31.0542 32.5285 26.5427 24.1086 24.5992 28.2944 29.5760 30.0279 29.6121 31.6900 27.8642 27.8345 31.0686 30.9359 20.3226 24.6142 18.2143 26.5611 29.3724 24.3389 32.3681 32.4735 27.6657 32.2545 41.8244 38.1758 39.2017 33.6903 40.1993 31.2860 * * * * * * * * * * * * * * * * * * * * * 30.9980 31.3617 32.0087 27.2049 26.5156 32.4188 29.5311 32.0985 28.7720 27.9147 31.9644 32.2927 27.2625 25.3951 25.9131 29.3376 31.1545 32.1201 30.9359 32.1646 29.9492 29.3903 32.7381 32.1087 22.8253 25.9681 21.9824 24.8343 29.9878 25.0987 33.2430 33.8541 28.1744 37.6040 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00183 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 38.7029 36.3888 42.2681 33.6903 40.1993 31.2860 * * * * * * * * * * * * * * * * * * * * * 29.1621 28.3333 31.4835 25.6626 24.3263 30.9671 28.5346 31.3626 27.4499 26.4239 31.4172 31.6808 26.4975 25.0897 24.3728 28.0338 29.4765 30.4150 29.6320 31.3043 28.1539 27.8461 31.4187 30.9310 21.2501 24.7293 19.6548 25.4577 29.4858 23.9190 32.1358 32.5474 27.2773 34.1974 24862 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 060076 060096 060100 060103 060104 060107 060112 060113 060114 060115 060116 060117 060118 070001 070002 070003 070004 070005 070006 070007 070008 070009 070010 070011 070012 070015 070016 070017 070018 070019 070020 070021 070022 070024 070025 070027 070028 070029 070031 070033 070034 070035 070036 070038 070039 070040 080001 080002 080003 080004 080006 080007 090001 090003 090004 090005 090006 090008 090011 100001 100002 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.2672 1.5553 1.6877 1.3574 1.3822 1.4409 1.6546 1.4263 1.3802 0.8095 1.4116 1.5193 1.1985 1.6168 1.7626 1.1121 1.1692 1.3946 1.3747 1.3254 1.1970 1.1839 1.7654 1.4451 1.2709 1.3970 1.4996 1.3568 1.4233 1.3270 1.3297 1.1568 1.6749 1.3613 1.8064 1.4451 1.5984 1.3083 1.2711 1.4708 1.3980 1.2872 1.6067 1.3936 0.9377 0.9996 1.6239 *** 1.5693 1.5151 1.3057 1.3920 1.7712 1.2511 1.9599 1.3874 1.4067 1.3393 2.0566 1.5278 1.4353 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.9451 1.0490 1.0490 1.0490 1.0490 1.0490 1.0490 1.0490 1.0490 0.9451 1.0490 0.9451 0.9451 1.2565 1.2439 1.2439 1.2439 1.2565 1.2993 1.2439 1.2439 1.2439 1.2993 1.2439 1.2439 1.2993 1.2565 1.2565 1.2993 1.2565 1.2439 1.2439 1.2565 1.2439 1.2439 1.2439 1.2993 1.2439 1.2565 1.2993 1.2993 1.2439 1.2439 1.2565 1.2565 1.2439 1.0778 * 1.0778 1.0752 1.0023 1.0358 1.0679 1.0679 1.0679 1.0679 1.0679 1.0679 1.0990 0.9129 1.0245 26.8236 30.0602 32.1537 30.3003 32.0889 26.1883 * * * * * * * 34.0302 31.1530 32.4197 29.2544 32.1668 36.8469 31.7125 26.4806 30.2706 32.5798 29.9105 44.1424 33.4595 31.0904 31.7223 37.6081 31.8148 31.0935 33.2357 35.4120 32.0430 30.9938 31.8018 31.5035 27.7213 28.9189 37.1929 36.3899 27.5585 36.1610 25.7516 31.2269 * 30.0242 27.7932 29.2266 27.4921 25.6160 27.0074 35.0413 29.2660 32.2021 30.7728 29.5590 29.1059 34.0693 24.4060 25.3389 26.5631 32.1310 32.6104 31.6314 32.4232 26.8388 34.9272 * * * * * * 35.8958 33.4398 34.1352 29.4448 33.7813 37.9148 35.9617 28.5506 32.9299 35.3730 31.8987 29.4216 35.3385 31.4930 34.0490 39.7515 34.5125 33.6453 36.9241 39.0462 35.2323 32.4085 29.8513 35.1966 30.9299 30.1915 40.1594 38.3965 30.7440 38.3413 25.7914 36.1369 * 32.0105 29.6800 30.7697 30.1094 27.4749 30.1100 36.6577 31.0419 35.6964 33.0178 29.4912 32.0745 36.7579 26.4631 27.2350 30.7794 37.8250 33.2259 32.9699 35.4406 28.0661 34.6910 32.6081 34.8551 * * * * 37.0362 34.7608 34.1274 29.9492 34.9377 39.3915 36.6407 29.6687 35.2475 36.6948 31.2283 31.9349 36.6708 33.2371 35.6418 41.9173 33.7229 33.6696 38.5585 40.2702 34.7400 34.5858 30.4430 38.0833 31.0636 30.4044 43.7004 39.3798 31.1401 42.3416 35.8029 34.7131 * 33.5308 30.4575 34.2596 32.2239 28.8828 31.1628 38.1321 32.1944 37.3772 33.7415 31.3551 33.7464 37.7551 27.2801 28.7046 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00184 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 28.0379 33.2700 32.6698 31.6641 33.2463 27.0406 34.8011 32.6081 34.8551 * * * * 35.6784 33.1047 33.5632 29.5629 33.6339 38.0389 34.7798 28.2382 32.8064 34.9639 31.0248 33.9311 35.2092 31.9049 33.8503 39.8452 33.3664 32.8254 36.2050 38.3013 34.0483 32.6659 30.7111 34.9177 29.9122 29.8550 40.4535 38.0564 29.7921 39.0119 27.8679 33.8173 * 31.8695 29.3051 31.4914 29.9990 27.4029 29.4879 36.5957 30.9271 35.0391 32.5062 30.1261 31.3882 36.1901 26.0725 27.1080 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24863 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 100004 100006 100007 100008 100009 100012 100014 100015 100017 100018 100019 100020 100022 100023 100024 100025 100026 100027 100028 100029 100030 100032 100034 100035 100038 100039 100040 100043 100044 100045 100046 100047 100048 100049 100050 100051 100052 100053 100054 100055 100057 100061 100062 100063 100067 100068 100069 100070 100071 100072 100073 100075 100076 100077 100079 100080 100081 100084 100086 100087 100088 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 0.9210 1.6439 1.6370 1.7232 1.4531 1.6158 1.4087 1.3031 1.6269 1.6499 1.6615 *** 1.7406 1.5155 1.1735 1.6820 1.5785 *** 1.3559 1.2842 1.2822 1.8033 1.8267 1.5643 1.8187 1.5150 1.7018 1.3790 1.4158 1.3355 1.3033 1.8638 0.9252 1.1600 1.1288 1.3534 1.4455 1.2920 1.3034 1.4156 1.4516 1.5414 1.6808 1.3036 1.4074 1.6613 1.4508 1.7116 1.2756 1.3879 1.7697 1.4457 1.1677 1.3560 1.4994 1.7074 0.9413 1.7880 1.2961 1.8973 1.5785 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 * 0.9383 0.9383 1.0023 1.0023 0.9490 0.9245 0.9174 0.9245 0.9756 0.9385 * 1.0245 0.9245 1.0023 0.8749 0.8749 * 0.9385 1.0023 0.9383 0.9174 1.0023 0.9758 1.0245 1.0245 0.9129 0.9174 0.9990 0.9245 0.9174 0.9758 0.8749 0.8839 1.0023 0.9383 0.8839 1.0023 0.8749 0.9174 0.9383 1.0023 0.8749 0.9174 0.9174 0.9245 0.9174 0.9758 0.9174 0.9245 1.0245 0.9174 1.0023 0.9758 * 1.0245 0.8749 0.9383 1.0245 0.9758 0.9129 16.5974 26.3789 26.5378 27.4314 25.9381 26.3788 24.5862 24.6038 26.1580 28.1481 27.6179 23.9414 29.9345 23.0074 30.2395 22.1580 21.4703 16.1223 26.8661 27.5844 24.0943 25.2450 25.9415 26.9407 29.8583 28.4627 23.6443 25.2273 28.3596 26.9641 26.3673 25.0404 18.8770 22.9809 19.8713 23.1940 22.3920 27.3224 28.0512 23.5332 25.3897 29.2565 25.2340 24.7026 26.1213 25.9202 24.7442 24.8883 24.9682 26.0459 30.3358 25.1691 21.9483 26.0347 * 27.0126 15.6661 26.3393 28.2641 27.1531 25.9182 * 29.1505 28.5702 29.1705 27.4424 28.4600 25.1524 26.0916 27.9654 30.2423 28.6630 27.1257 32.8088 25.2652 29.1894 23.3843 23.4730 18.9432 27.7497 28.8842 24.6314 26.8162 28.1280 29.4803 31.3403 28.2531 26.2429 26.4221 30.3659 29.7375 26.9469 26.7674 19.3226 24.0385 21.5101 28.0946 23.6796 28.5118 28.7646 25.6243 24.8010 31.4413 25.1280 25.5097 26.8628 26.1341 25.7450 26.8461 26.3768 25.7962 30.5845 25.7612 23.4551 30.6925 * 28.2188 16.9756 27.4947 28.5971 29.5823 26.7574 * 29.0886 29.1608 30.3372 27.8595 29.8330 27.4005 27.2172 28.2380 30.6513 30.2983 * 36.7902 25.4238 29.5413 26.7005 25.3313 * 27.5647 30.5354 25.3501 26.9247 27.2895 29.9645 31.6634 29.3708 27.2813 27.0030 33.1112 26.5408 26.7694 29.9682 20.2658 24.5536 25.3238 28.7737 23.4019 31.7384 30.5206 27.3802 26.3122 30.4499 25.9585 26.4124 27.4739 27.6575 27.2096 29.1991 25.3651 27.1887 28.7281 27.6513 24.0435 30.7522 * 29.5332 19.5662 32.7477 29.9082 30.5733 28.0793 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00185 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 16.5974 28.2008 28.1327 29.0485 27.0413 28.2805 25.7596 25.9252 27.5012 29.7097 28.8662 25.5458 33.2230 24.5727 29.6467 24.0623 23.5015 17.4007 27.4069 29.0520 24.7166 26.3589 27.0668 28.7904 30.9762 28.6925 25.7448 26.2279 30.6144 27.7585 26.6960 27.2642 19.5008 23.8777 22.2723 26.7720 23.1671 29.1111 29.0875 25.3794 25.5302 30.3963 25.4595 25.5740 26.8557 26.5514 25.8883 26.9663 25.5845 26.3539 29.8848 26.2369 23.1100 29.1481 * 28.2762 17.4288 28.7729 28.9237 29.1231 26.9516 24864 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 100090 100092 100093 100099 100102 100105 100106 100107 100108 100109 100110 100113 100114 100117 100118 100121 100122 100124 100125 100126 100127 100128 100130 100131 100132 100134 100135 100137 100139 100140 100142 100150 100151 100154 100156 100157 100160 100161 100166 100167 100168 100172 100173 100175 100176 100177 100179 100180 100181 100183 100187 100189 100191 100200 100204 100206 100209 100210 100211 100212 100213 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.4902 1.5151 1.7136 1.0877 1.0972 1.4481 1.0557 1.2356 0.8045 1.2501 1.6562 2.0208 1.3823 1.2128 1.3599 1.1040 1.2270 1.1549 1.1784 1.3316 1.5660 2.2062 1.1799 1.4156 1.2458 0.8562 1.6098 1.2884 0.8318 1.0846 1.2099 1.2678 1.7467 1.5748 1.1336 1.5752 1.1392 1.5169 1.4668 1.3035 1.4079 1.2812 1.6813 0.9372 1.9303 1.3039 1.8024 1.3657 1.0909 1.2321 1.2376 1.3212 1.3259 1.3580 1.5566 1.3050 1.4522 1.6430 1.2007 1.5281 1.5668 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.9129 0.9385 0.8749 0.8839 0.8749 0.9990 0.8749 0.9490 0.8749 0.9245 0.9383 0.9306 1.0023 0.9129 0.9129 0.8839 0.8749 0.8749 1.0023 0.9174 0.9174 0.9174 1.0245 1.0023 0.9174 0.9129 0.9032 0.8839 0.9306 0.9129 0.8749 1.0023 0.9129 1.0023 0.9306 0.9174 0.8749 0.9383 0.9758 1.0245 1.0245 1.0023 0.9174 0.8749 1.0245 0.9385 0.9129 0.9174 1.0023 1.0023 1.0023 1.0245 0.9174 1.0245 0.9306 0.9174 1.0023 1.0245 0.9174 0.8749 0.9758 24.2422 28.4789 21.3524 21.3035 23.8596 26.8091 24.0389 26.1337 22.0750 24.9951 29.1494 26.3806 29.2195 26.4536 28.0569 24.8579 23.4751 22.7023 26.7452 24.4515 24.4485 29.4979 24.2046 29.2462 24.3293 20.9243 24.0024 25.1974 17.5489 26.4720 22.9577 26.1990 28.1322 27.6127 26.7092 27.3851 26.9851 28.8077 27.9618 30.3694 27.1292 18.2735 24.8721 23.5455 31.2694 26.6781 29.5619 27.1804 21.8540 27.4951 27.3653 28.4136 26.6341 29.8963 25.7537 25.2196 26.6245 28.9486 24.7095 24.7566 27.1936 26.5703 27.8341 21.6438 25.8454 26.1015 29.9745 24.7650 27.4760 21.3540 25.5669 29.4788 28.0440 29.2862 27.7198 27.6438 26.2990 24.6285 24.0333 29.7750 29.6247 26.0923 29.2566 26.0268 27.8164 26.0526 20.7367 26.7030 24.8519 18.2197 26.1352 24.8853 26.8492 30.6447 28.2506 27.5706 29.7455 30.7454 28.0545 28.8685 30.2166 27.6739 20.7857 26.5436 23.9665 30.7087 28.0089 29.1111 29.9238 24.3708 29.0270 27.8144 28.8320 28.3710 28.7694 27.4763 27.0295 26.8473 29.8515 24.7533 26.1846 27.9283 27.6128 26.6301 22.5555 26.2362 27.9371 30.9880 24.8062 30.5712 22.6250 26.2294 29.5964 29.2410 30.2549 28.5709 27.0971 27.9335 26.7143 24.8875 31.7723 28.3189 27.4608 30.0299 28.3616 29.7632 27.2007 21.6532 29.1837 26.8344 21.1258 27.8649 25.5354 27.7741 30.6281 29.7317 28.3909 30.3052 30.6896 29.5663 30.1807 31.7804 27.0923 22.2204 28.6368 25.0985 33.3165 29.6265 29.0431 31.0064 23.9591 30.5104 30.7495 29.9369 29.4499 29.6406 27.2798 27.7525 28.5311 32.0804 26.2817 27.7936 29.5190 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00186 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 26.1872 27.6308 21.8792 24.4514 25.9898 29.1998 24.5422 28.1061 21.9874 25.6245 29.4181 27.9265 29.5960 27.6304 27.5184 26.4257 24.9527 23.9085 29.5535 27.4135 26.0307 29.6024 26.1493 28.9648 25.9267 21.1182 26.5344 25.6687 18.9546 26.8242 24.4855 26.9186 29.7879 28.5810 27.6104 29.2294 29.5443 28.8152 28.9923 30.8185 27.2992 20.2640 26.6618 24.2176 31.7296 28.1065 29.2333 29.4502 23.5687 28.9871 28.5855 29.0845 28.2023 29.4299 26.8486 26.6834 27.3559 30.2950 25.2452 26.2582 28.1989 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24865 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 100217 100220 100223 100224 100225 100226 100228 100230 100231 100232 100234 100236 100237 100238 100239 100240 100242 100243 100244 100246 100248 100249 100252 100253 100254 100255 100256 100258 100259 100260 100264 100265 100266 100267 100268 100269 100271 100275 100276 100277 100279 100281 100284 100285 100286 100287 100288 100289 100290 100291 100292 100293 100294 100295 100296 100297 100298 100299 100300 100301 100302 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.2132 1.7260 1.5835 1.2839 1.2937 1.2744 1.3709 1.3733 1.7080 1.2524 1.2976 1.4832 1.9057 1.6522 1.2460 1.0076 1.4479 1.5946 1.4203 1.5758 1.5253 1.2737 1.1792 1.3715 1.5090 1.2936 1.8521 1.5130 1.2828 1.3245 1.3422 1.2694 1.4188 1.3150 1.1556 1.3559 2.3619 1.2874 1.2400 1.4125 1.3368 1.3697 1.0112 1.2699 1.6117 1.3865 1.5054 1.6862 1.1911 1.2462 1.3546 *** *** *** 1.3420 *** 0.8097 1.2650 1.5491 2.4311 1.1202 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.9990 0.9490 0.8749 1.0245 1.0245 0.9129 1.0245 1.0245 0.8749 0.9306 1.0245 0.9758 1.0245 0.9174 0.9758 1.0023 0.8749 0.9174 0.9490 0.9990 0.9174 0.9174 0.9482 1.0245 0.9032 0.9174 0.9174 1.0245 0.9174 0.9990 0.9174 0.9174 0.8749 0.9758 1.0245 1.0245 * 1.0245 1.0245 1.0023 0.9490 1.0245 1.0023 1.0245 0.9756 1.0245 1.0245 1.0245 0.9139 0.9385 0.8749 * * * 1.0023 * 0.9032 0.9758 0.9758 0.8749 0.9383 25.2907 26.0905 24.7015 24.8077 28.4316 29.3317 29.8952 28.1703 25.5175 24.9322 26.3601 26.6585 31.3543 28.4302 27.7592 25.3265 24.0990 26.1131 25.2584 28.9894 27.7798 23.2084 25.8540 25.7121 25.7338 24.4808 28.8856 31.2482 26.0175 27.5188 25.5489 24.1454 23.2340 27.3769 29.2898 26.7450 * 26.0361 30.0576 16.5427 26.8606 28.6660 23.8170 * 29.4284 28.3427 33.8141 29.2915 23.5080 * * * * * * * * * * * * 27.3989 28.3868 25.0332 26.6446 28.5259 28.8165 28.1396 29.8493 25.7037 28.5537 27.4456 28.9955 31.7848 30.1094 28.6893 27.3523 25.6083 27.4534 26.6876 29.3310 28.8082 24.9876 27.8256 27.4927 26.1406 26.5571 30.3081 31.2203 27.4809 26.7129 26.8216 25.7432 23.0208 28.7259 29.0668 26.6047 * 26.8943 29.7606 20.4791 28.6383 29.6698 22.3134 * 28.3645 28.1051 28.7902 29.6376 27.1011 28.4722 26.7063 32.7963 30.7557 26.1983 * * * * * * * 27.7642 29.3570 26.1109 28.0429 30.8876 29.7725 30.1621 31.9424 26.6772 28.3856 28.8835 28.2984 33.1739 31.4171 29.7638 29.6971 26.1976 28.3866 28.2865 30.1050 30.2111 26.4639 27.1607 28.7770 27.4880 27.3842 30.2061 33.8699 29.0586 27.5087 28.0330 26.3305 24.2518 28.9660 30.5747 27.8403 * 28.6334 30.5728 30.6239 29.2235 30.9112 25.2610 41.9448 27.9816 29.7774 31.2667 31.8991 29.0093 28.1498 27.7643 * * * 29.3841 32.1504 19.0284 34.3125 * * * —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00187 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 26.8865 28.0175 25.3046 26.4939 29.2153 29.3198 29.3737 29.9630 25.9675 27.3012 27.5798 27.9868 32.0770 30.0491 28.7444 27.5087 25.3020 27.3439 26.8118 29.4942 28.9505 24.9121 26.9474 27.3720 26.4891 26.1577 29.8124 32.1188 27.5346 27.2404 26.7861 25.4668 23.5319 28.3534 29.6377 27.0868 * 27.2552 30.1330 22.8795 28.2854 29.8011 23.6819 41.9448 28.5432 28.7085 31.1545 30.3057 26.4993 28.2965 27.2417 32.7963 30.7557 26.1983 29.3841 32.1504 19.0284 34.3125 * * * 24866 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 110001 110002 110003 110004 110005 110006 110007 110008 110010 110011 110015 110016 110018 110020 110023 110024 110025 110026 110027 110028 110029 110030 110031 110032 110033 110034 110035 110036 110038 110039 110040 110041 110042 110043 110044 110045 110046 110050 110051 110054 110059 110064 110069 110071 110073 110074 110075 110076 110078 110079 110080 110082 110083 110086 110087 110089 110091 110092 110095 110100 110101 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.3403 1.3617 1.2936 1.3585 1.2330 1.5291 1.5859 1.3085 2.2306 1.2246 1.0603 1.2635 1.1624 1.3217 1.2996 1.4914 1.4742 1.1095 1.0927 1.7897 1.8272 1.3175 1.2896 1.1833 1.4729 1.7212 1.7465 1.8415 1.5058 1.3686 1.0915 1.2635 1.0549 1.7583 1.1546 1.0610 1.1568 1.0878 1.1326 1.3876 1.1627 1.5562 1.3180 1.1303 1.0754 1.5617 1.2369 1.4782 2.0225 1.4284 *** 1.9490 1.8986 1.2924 1.4777 1.1256 1.2981 1.0712 1.4672 0.9766 1.0211 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.8587 0.9845 0.7864 0.8967 0.9845 1.0543 0.8671 0.9845 0.9845 0.9845 0.9845 0.8594 0.9845 0.9845 0.9845 0.8987 0.9768 0.7864 0.7864 0.9600 0.9845 0.9845 0.9845 0.7864 0.9845 0.9600 0.9845 0.8987 0.8458 0.9600 0.9845 0.9845 0.9845 0.8987 0.7864 0.9845 0.9845 0.8587 0.7864 0.9845 0.7864 0.9023 0.9571 0.7864 0.7864 1.0543 0.8987 0.9845 0.9845 0.9845 * 0.9845 0.9845 0.7864 0.9845 0.7864 0.9845 0.7864 0.8671 0.8653 0.7931 25.3102 25.3897 21.4002 23.9911 22.8999 28.6090 23.8729 27.1711 29.7142 26.0899 26.6610 21.7610 28.2431 26.8501 27.3029 25.7205 26.1311 21.2827 20.2175 28.1619 24.8893 26.4770 24.7874 21.9407 28.3210 26.9986 27.4583 26.8789 21.2138 24.7248 19.7509 23.4073 28.6873 26.6323 20.9654 24.9821 23.8292 26.1319 19.4276 25.7085 20.5565 24.2739 24.1669 18.0224 18.6336 27.1207 22.0935 26.3506 29.5779 23.1024 22.3213 29.8366 27.8245 21.1508 28.0471 21.9509 26.5523 18.5527 23.4846 16.5600 16.4269 26.4338 26.4715 22.7066 24.9978 28.1209 28.3839 26.6396 29.2947 31.7185 28.0598 28.1274 22.7263 26.8016 28.3822 29.8061 27.0225 31.0703 21.8018 22.6058 30.4641 27.3618 29.6841 27.1989 23.2586 30.3415 27.2338 28.9408 26.6664 22.2720 26.3503 20.9487 24.8864 34.9954 27.8477 23.3039 24.4275 26.7464 27.5985 20.1756 28.9254 23.2137 24.1219 26.2085 21.3963 18.5753 27.9190 23.7585 28.7871 29.9625 26.8412 18.4714 30.8320 30.4287 21.6898 28.1633 23.9026 29.5337 20.8911 26.3075 16.2575 19.4257 26.5634 26.2215 24.2076 25.1820 27.2810 * 26.3115 30.9741 33.2379 28.5710 28.8247 24.3540 30.1831 27.5540 29.4091 27.9321 30.2808 22.8797 25.5227 31.4549 29.2101 29.9483 29.5494 25.1864 32.4147 28.7910 30.1817 27.4572 22.9667 26.2463 23.9465 26.1928 33.4345 28.8534 24.3743 27.7578 * 27.0646 21.4871 29.4622 24.7765 26.9345 29.9100 21.1989 22.2470 32.6801 24.8206 29.4324 30.5184 28.0337 * 30.1059 34.0590 22.9935 31.0389 24.3270 27.0969 21.4146 28.0497 20.8152 23.2580 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00188 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 26.1061 26.0373 22.7653 24.7375 26.2179 28.4953 25.6309 29.1802 31.5593 27.5776 27.9582 22.9370 28.3506 27.6137 28.8898 26.8777 29.1365 21.9817 22.6306 30.0483 27.2811 28.7919 27.2201 23.4269 30.4690 27.6793 28.9116 27.0225 22.1527 25.8073 21.5965 24.8269 32.3594 27.7746 22.8665 25.7221 25.2689 26.9504 20.4304 28.1271 22.7757 25.1478 26.8648 20.2203 19.7421 29.0878 23.5710 28.2022 30.0314 25.8338 20.3904 30.2637 30.7532 21.9527 29.1236 23.4297 27.7297 20.2698 25.9749 17.8654 19.5226 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24867 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 110104 110105 110107 110109 110111 110112 110113 110115 110121 110122 110124 110125 110128 110129 110130 110132 110135 110136 110142 110143 110146 110149 110150 110153 110161 110163 110164 110165 110166 110168 110172 110177 110179 110183 110184 110186 110187 110189 110190 110191 110192 110193 110194 110198 110200 110201 110203 110205 110209 110212 110214 110215 110219 110220 110221 110222 110223 110224 110225 110226 120001 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.0874 1.3393 1.9642 1.0213 1.1558 0.9103 0.9648 1.6873 1.0432 1.5380 1.0505 1.2986 1.2616 1.5741 0.9401 0.9896 1.2755 *** 0.9496 1.4028 1.0440 *** 1.3057 1.1345 1.5056 1.4445 1.6473 1.3818 *** 1.8211 1.3224 1.7871 *** 1.2702 1.2372 1.3737 1.2184 1.1273 1.0375 1.3326 1.3983 *** 0.9362 1.3960 1.9208 1.4602 0.9675 1.1514 0.5322 1.1996 *** 1.2923 1.4243 *** *** *** *** *** 1.1643 1.1727 1.7822 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.7864 0.7864 0.9753 0.7864 0.9600 0.7864 0.9600 0.9845 0.8458 0.8458 0.7864 0.9571 0.8987 0.9023 0.7864 0.7864 0.7864 * 0.8066 0.9845 0.9129 * 0.9845 0.9571 0.9845 0.8671 0.9753 0.9845 * 0.9845 0.9845 0.9600 * 0.9845 0.9845 0.9023 0.9845 0.9845 0.8106 0.9845 0.9845 * 0.7864 0.9845 0.9023 0.9753 0.9845 0.8378 0.7864 0.8208 * 0.9845 0.9845 * * * * * 0.9845 0.9845 1.1289 18.7951 21.1077 26.2526 21.4279 29.2189 24.2464 19.1752 32.0198 21.6637 23.7589 22.7058 22.4238 24.4596 23.3631 18.7549 19.2307 20.4412 15.8573 18.1980 27.7055 23.9067 27.1477 22.6624 24.5368 29.3201 26.0764 27.0600 26.8378 26.8070 27.0022 29.1703 26.7504 26.0759 29.6132 26.5240 25.0298 24.2933 26.7654 14.2518 26.8277 26.7852 27.3341 18.4776 31.7748 22.3249 28.2232 26.8768 19.7408 19.0450 40.5120 * 25.7886 27.0362 * * * * * * * 34.7715 20.3777 23.1405 28.9352 23.0376 25.1270 22.7672 21.3417 31.5074 26.2336 25.1934 22.9212 23.7834 25.7839 25.9625 19.1284 20.2502 22.5346 18.8212 21.3935 28.6583 27.0987 28.4040 25.3742 25.7467 30.4885 28.2169 28.8946 27.0977 * 28.5700 31.1234 28.8356 * 28.6208 28.3545 27.4925 25.2139 26.1418 23.3204 27.7760 28.8267 27.9161 19.1920 31.0557 24.9236 31.0841 29.7888 22.0207 21.1534 * 37.1450 27.5566 28.8814 37.5741 28.0500 35.6189 * * * * 34.1385 21.8924 23.3989 30.0994 21.5988 25.6830 26.4049 21.9483 32.7917 23.4538 25.4416 22.9564 24.7325 25.4173 30.0382 20.4320 21.2623 23.7098 * 21.6229 29.9107 29.0166 * 26.9867 29.3255 31.4996 27.7657 29.9927 28.7885 * 29.7626 31.3978 29.7970 * 28.3576 28.9228 28.2840 26.9609 26.2773 24.5194 30.8738 30.0811 * 21.0803 32.8394 27.2957 32.0685 32.3439 23.9713 21.2405 * * 29.5222 32.1875 * * * 25.3054 33.6431 29.5367 * 39.6365 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00189 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 20.4307 22.5523 28.5415 22.0288 26.4544 24.5402 20.8449 32.1142 23.8292 24.7892 22.8635 23.6383 25.2192 26.3966 19.4659 20.2550 22.3469 17.2827 20.4888 28.7952 26.6342 27.8380 24.9549 26.5464 30.4387 27.3535 28.6570 27.5696 26.8070 28.4639 30.5995 28.4770 26.0759 28.8287 28.0035 26.9603 25.5777 26.3807 20.0516 28.4664 28.6170 27.6234 19.6202 31.8698 24.7898 30.4669 29.6045 21.9556 20.5449 40.5120 37.1450 27.7244 29.3856 37.5741 28.0500 35.6189 25.3054 33.6431 29.5367 * 36.0758 24868 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 120002 120004 120005 120006 120007 120010 120011 120014 120016 120019 120022 120025 120026 120027 120028 120029 130002 130003 130005 130006 130007 130013 130014 130018 130021 130024 130025 130028 130049 130062 130063 130065 130066 130067 130068 140001 140002 140007 140008 140010 140011 140012 140013 140015 140016 140018 140019 140024 140026 140029 140030 140032 140033 140034 140040 140043 140045 140046 140048 140049 140051 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.2099 1.3321 1.3153 1.2715 1.7204 1.8846 1.5402 1.2834 *** 1.1324 1.9143 *** 1.4053 1.3450 1.2954 *** 1.4431 1.3979 *** 1.7739 1.8211 1.3826 1.2242 1.6969 *** 1.1828 1.2433 1.4838 1.6070 *** 1.3933 1.9742 2.0918 0.5728 2.6786 1.1037 1.3394 1.3528 1.4476 1.5346 1.1266 1.1597 1.4751 1.4264 1.0141 1.4726 0.9079 *** 1.1365 1.5607 1.5584 1.2249 0.7961 1.1477 1.2142 1.2818 *** 1.5062 1.2927 1.4736 1.5046 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.0751 1.1289 1.0751 1.1289 1.1289 1.1289 1.1289 1.0751 * 1.0751 1.1289 * 1.1289 1.1289 1.1289 * 0.8780 0.9620 * 0.9501 0.9501 0.9501 0.9501 0.9158 * 0.8301 0.7879 0.9158 1.0220 * 0.9501 0.9352 0.9679 0.9352 0.9679 0.8717 0.8885 1.0455 1.0455 1.0455 0.8355 1.0455 0.9374 0.8885 * 1.0455 0.8355 * 0.8643 1.0455 1.0455 0.8885 1.0455 0.8885 0.9217 0.8898 * 0.8885 1.0455 1.0455 1.0455 29.9913 28.6527 29.3405 31.2285 30.4247 30.1659 34.1643 28.6416 19.6039 30.3809 26.6100 30.2367 30.3293 28.6717 30.3794 * 23.6078 27.6345 25.7523 25.3221 24.9562 27.9209 24.3885 26.4125 16.1658 23.3347 20.1452 26.3443 26.9749 20.6642 22.5904 * * * * 22.3170 24.6954 28.3482 28.5297 35.1024 22.4091 28.6564 23.3065 23.0600 18.1242 27.7548 18.9228 17.5249 23.0470 28.6565 29.7771 24.0573 25.6068 23.0033 22.2969 26.7996 20.6548 23.2127 28.2222 27.4009 27.7901 32.3784 30.0668 31.1985 31.6785 30.2473 29.5714 37.1792 30.3463 * 30.4257 29.9527 * 32.4566 28.7905 32.4847 * 24.7871 28.6158 * 27.2158 28.7246 30.9609 27.2543 27.3439 * 23.6212 21.1998 27.2195 27.3597 25.6467 26.0955 21.9792 * * * 22.3001 27.0165 30.7378 29.1767 31.8806 23.8575 29.0336 23.9269 24.4687 * 26.3533 21.3438 * 25.9669 30.2688 30.2776 26.7310 27.9993 24.0470 23.2293 27.3469 * 24.7334 29.3877 29.0976 30.9696 34.2093 31.3533 33.6910 34.2215 30.8768 30.8509 39.1930 30.9833 * 33.0105 32.5281 * 33.3760 29.5804 34.0426 44.6372 25.0585 28.6132 * 28.0040 30.4947 36.1511 27.5904 28.3984 * 24.8040 22.7959 28.3768 29.0154 29.1889 27.7566 30.4515 28.9875 21.3846 * 22.2001 27.4774 31.4003 31.7996 38.1652 25.8844 31.8902 25.0217 24.6395 * 30.4549 22.3154 * 26.0469 34.0184 31.6814 27.5346 29.5213 24.4638 24.5572 29.8613 * 25.6221 31.1842 26.9354 31.8207 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00190 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 32.2039 30.0073 31.4352 32.3967 30.5121 30.1898 36.8947 30.0254 19.6039 31.2828 29.5900 30.2367 32.1741 29.0480 32.3412 44.6372 24.5110 28.2893 25.7523 26.8672 27.9564 31.7450 26.3556 27.3763 16.1658 23.9295 21.4284 27.4425 27.8217 24.9258 25.3649 26.6732 28.9875 21.3846 * 22.2725 26.4099 30.1858 29.7868 34.8498 24.1276 29.7936 24.0534 24.0656 18.1242 28.1330 20.8677 17.5249 25.0148 30.9961 30.5817 26.1088 27.5598 23.8456 23.3448 28.0415 20.6548 24.5832 29.5804 27.8062 30.1641 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24869 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 140052 140053 140054 140058 140059 140061 140062 140063 140064 140065 140066 140067 140068 140075 140077 140080 140082 140083 140084 140088 140089 140091 140093 140094 140095 140100 140101 140103 140105 140109 140110 140113 140114 140115 140116 140117 140118 140119 140120 140122 140124 140125 140127 140130 140133 140135 140137 140141 140143 140145 140147 140148 140150 140151 140152 140155 140158 140160 140161 140162 140164 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.2921 1.8971 1.4490 1.2533 1.0745 *** 1.3499 1.4129 1.1958 1.4079 1.0941 1.8444 1.2095 1.3302 1.0119 1.4034 1.5858 0.9164 1.3044 1.9222 1.2577 1.7612 1.2233 1.0630 1.1848 1.4123 1.2093 1.1489 2.4503 1.2813 1.1015 1.6269 1.4992 1.1220 1.2809 1.5470 1.5344 1.8434 1.2653 1.4641 1.2574 1.1737 1.5914 1.2375 1.2957 1.4311 1.0306 *** 1.1599 1.0894 1.1116 1.7302 1.7104 0.8042 1.1878 1.3645 1.3840 1.2239 1.0974 1.5875 1.8228 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.8885 0.8947 1.0455 0.8885 0.8885 * 1.0455 1.0455 0.9217 1.0455 0.8885 0.9374 1.0455 1.0455 0.8885 1.0455 1.0455 1.0455 1.0455 1.0455 0.8355 0.9320 0.9250 1.0455 1.0455 1.0455 1.0455 1.0455 1.0455 * 1.0455 0.9320 1.0455 1.0455 1.0455 1.0455 1.0455 1.0455 0.9374 1.0455 1.0455 0.8885 0.9488 1.0455 1.0455 0.8355 0.8885 * 1.0455 0.8885 0.8355 0.8947 1.0455 1.0455 1.0455 1.0455 1.0455 0.9659 1.0455 0.9488 0.8885 23.5662 24.8455 31.8564 22.8423 22.4652 20.8063 34.7704 27.8306 22.0407 29.4678 21.9771 25.3986 27.3956 27.9325 19.1363 23.2575 25.6645 26.2972 29.2515 32.4978 23.3401 26.8518 25.3127 27.9273 27.6799 37.0820 28.5365 23.3258 27.4531 19.5675 27.9844 26.7969 28.3014 25.1498 31.9902 26.8802 29.7570 36.1419 22.7375 28.4188 36.1327 20.4014 24.1658 29.5247 28.0339 22.3264 21.4699 21.7872 26.2954 23.4608 19.8541 24.7031 35.2711 23.4879 27.6086 28.9724 27.0986 24.5373 23.1647 27.4471 23.7457 25.9617 27.4518 33.1406 24.6058 22.6743 * 34.1230 28.6559 23.8639 30.1856 22.1524 28.3506 28.3938 26.2626 20.3999 28.8791 28.3429 26.8919 30.5036 30.5450 24.1066 27.8536 28.3298 27.3841 28.7617 41.3374 29.4081 23.6406 29.5274 * 28.6364 29.5452 28.2151 26.0383 34.5537 27.7201 32.5518 34.2118 23.9724 30.5653 35.7563 22.7571 25.6668 32.6209 31.0269 23.3196 23.4174 * 27.4499 26.0875 21.0686 25.5677 52.0970 27.0312 30.2209 29.5734 27.3721 25.8684 25.2898 29.4121 24.6009 26.9889 28.4493 33.1984 25.2553 21.6222 * 35.0300 30.3699 25.7536 31.2501 22.0209 29.8952 26.2136 35.9501 21.6458 29.8040 30.4657 28.2249 30.7227 32.1232 24.9116 28.2076 28.6735 27.1458 30.7468 37.4204 28.9681 24.0915 29.6559 * 30.2949 30.2650 29.2174 26.1931 34.3854 28.9000 32.3262 32.2183 25.9262 30.3888 36.8811 26.5780 27.8334 32.3345 30.3222 24.6627 31.4330 * 26.1598 25.2020 21.1816 27.0025 35.5387 26.0771 29.8651 32.7948 30.9913 28.2651 28.8243 32.1785 25.9708 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00191 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 25.4996 26.9022 32.7274 24.2520 22.2387 20.8063 34.6455 28.9237 23.9574 30.2861 22.0493 27.9255 27.3581 29.4586 20.4041 27.0165 28.1091 27.1579 30.1514 31.7009 24.1079 27.6623 27.3134 27.4606 28.9831 38.7591 28.9900 23.6943 28.8375 19.5675 28.9917 28.8697 28.5888 25.7916 33.6663 27.8446 31.5081 34.0198 24.2579 29.7745 36.2568 23.2030 25.8831 31.5415 29.7591 23.4674 24.5875 21.7872 26.6232 24.9373 20.6906 25.7602 41.0090 25.5353 29.2052 30.4667 28.4461 26.1623 25.7885 29.6154 24.8069 24870 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 140165 140166 140167 140172 140174 140176 140177 140179 140180 140181 140182 140184 140185 140186 140187 140189 140190 140191 140197 140199 140200 140202 140206 140207 140208 140209 140210 140211 140213 140217 140223 140224 140228 140231 140233 140234 140239 140240 140242 140250 140251 140252 140258 140275 140276 140280 140281 140285 140286 140288 140289 140290 140291 140292 140294 140300 140301 140303 150001 150002 150003 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. *** 1.1618 1.1617 1.3657 1.5727 1.2302 0.9043 1.2690 1.1754 1.1327 1.5032 1.2950 1.4647 1.5405 1.5457 1.1672 *** 1.3320 1.2420 1.0545 1.4398 1.5519 1.2672 1.2156 1.6599 1.5590 1.0674 1.3080 1.2474 1.5469 1.4766 1.3766 1.5676 1.4308 1.6659 1.0449 1.5972 1.4146 1.5035 1.2383 1.3945 1.4015 1.5168 1.3109 1.8663 1.4652 1.7579 *** 1.1525 1.5216 1.3073 1.3588 1.6125 1.1018 1.1266 1.1893 1.1592 2.2098 1.1317 1.4425 1.7495 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 * 0.8355 0.8355 1.0455 1.0455 1.0455 1.0455 1.0455 1.0455 1.0455 1.0455 0.8355 0.8885 1.0455 0.8885 0.8355 * 1.0455 1.0455 * 1.0455 1.0455 1.0455 1.0455 1.0455 0.9374 0.8355 1.0455 1.0455 1.0455 1.0455 1.0455 0.9659 1.0455 1.0455 0.8643 0.9659 1.0455 1.0455 1.0455 1.0455 1.0455 1.0455 0.8898 1.0455 0.8898 1.0455 * 1.0455 1.0455 0.8885 1.0455 1.0455 1.0455 0.8355 1.0455 1.0455 1.0455 0.9723 1.0455 0.8682 16.6304 23.1005 22.8911 29.8568 27.8131 31.3490 22.5610 27.6376 28.3629 25.0101 28.2211 21.1802 23.8531 30.6951 23.2892 23.7198 19.8296 25.8678 23.0684 22.0315 26.3379 29.7870 30.6561 24.1048 29.4708 24.5376 19.2640 29.7054 30.2945 31.5324 30.4923 28.2177 25.6419 30.6410 28.6305 23.6928 29.0092 28.7310 32.0522 28.5971 27.1687 33.3351 30.2639 26.1473 29.8325 23.4447 30.4838 20.7576 29.1543 29.3988 22.6211 31.7341 29.8958 27.6285 23.4503 34.8568 31.7073 * 29.6844 25.0063 25.3458 * 26.4800 22.8703 32.1220 30.5905 32.9794 26.4340 29.3657 27.8887 25.0226 30.1755 25.2327 25.2423 29.8022 24.8332 22.5965 * 28.5836 24.0463 * 28.8435 32.7915 29.7953 26.0535 29.5380 26.3230 20.6954 30.3286 31.6926 32.1277 31.7267 29.6181 27.9456 30.0236 29.7093 24.5476 31.1879 31.5637 34.6120 29.6305 28.0622 34.4268 34.2333 27.8186 31.6359 24.9401 33.3903 * 30.3237 31.5197 23.8452 31.8135 31.9052 28.5094 24.0750 35.1494 49.9507 29.6470 28.9075 26.6222 26.7585 * 26.2861 24.9899 33.3088 30.2862 32.6124 25.5687 30.0402 29.4333 28.8391 31.5975 26.6072 26.5377 38.6436 25.5863 24.6993 * 31.2506 24.9086 * 30.7340 32.9414 29.0219 28.2239 30.9464 29.5947 19.2050 31.2117 32.1006 37.4373 33.4712 30.0109 28.2837 34.5759 31.5127 25.7284 29.9224 29.6215 35.2330 30.9236 28.5295 35.9410 33.0067 28.5054 31.5673 26.6521 35.4009 * 30.9916 31.5935 25.6053 32.5219 33.4588 31.4636 26.1581 41.7895 36.3852 * 31.8065 27.6466 26.9767 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00192 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 16.6304 25.2805 23.5834 31.7850 29.6018 32.3400 24.9308 29.0241 28.5589 26.2494 29.8792 24.4269 25.2109 32.7202 24.5665 23.6830 19.8296 28.4103 23.9560 22.0315 28.6128 31.9574 29.8266 26.0077 29.9911 26.7186 19.6893 30.4786 31.3680 33.6828 31.9196 29.2702 27.2857 31.7645 29.9816 24.6519 30.0310 29.9537 33.9219 29.7408 27.9306 34.5696 32.5344 27.4336 31.0394 24.9136 33.0950 20.7576 30.1576 30.8906 24.0376 32.0520 31.8392 29.0642 24.6191 37.1471 36.8862 29.6470 30.1183 26.6689 26.3732 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24871 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 150004 150005 150006 150007 150008 150009 150010 150011 150012 150013 150015 150017 150018 150021 150022 150023 150024 150026 150027 150029 150030 150033 150034 150035 150037 150038 150042 150044 150045 150046 150047 150048 150049 150051 150052 150056 150057 150058 150059 150060 150061 150062 150064 150065 150069 150072 150074 150075 150076 150079 150082 150084 150086 150088 150089 150090 150091 150097 150100 150101 150102 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.4758 1.2795 1.3972 1.3722 1.3877 1.4332 1.4964 1.2442 1.5635 *** 1.3255 1.8579 1.7216 1.8099 1.0830 1.5634 1.4799 1.3156 1.0482 1.4693 1.1962 1.5588 1.4551 1.5978 1.3215 1.1335 1.3921 1.3933 1.0745 1.4897 1.7148 1.3885 1.3621 1.6351 1.0751 1.9411 2.0977 1.5682 1.5558 *** 1.1276 1.1339 1.2004 1.2639 1.1735 1.1652 1.4434 1.0984 1.2878 1.1099 1.6791 1.8404 1.1730 1.2755 1.6030 1.6395 1.1639 1.1292 1.6890 1.0674 1.0330 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.0455 0.9723 0.9488 0.9468 1.0455 0.9045 0.9468 0.9723 0.9649 * 0.8876 0.9046 0.9488 0.9046 0.8750 0.8828 0.9723 0.9488 * 0.9649 0.9723 0.9723 1.0455 0.9246 0.9723 0.9723 0.8828 0.9045 0.9046 0.8828 0.9046 0.9654 * 0.9723 * 0.9723 0.9723 0.9649 0.9723 * 0.8599 * 0.8599 0.9723 0.9654 0.8700 0.9723 0.9046 0.9488 * 0.8599 0.9723 0.9654 0.9723 0.8599 1.0455 0.9046 0.9723 0.8599 0.9046 0.9246 26.8458 27.2369 26.4062 26.6073 26.6928 22.2147 26.8523 24.3490 27.3029 21.8465 26.2434 25.2342 26.3289 29.6967 22.6773 23.7159 27.1589 28.1127 17.4862 26.9680 26.9534 27.9995 26.0465 26.6620 28.5451 28.8054 23.0102 23.7066 25.2225 21.9369 25.8348 27.1817 22.3370 23.7061 20.6339 28.2842 24.8605 27.5341 28.5715 24.8544 22.2822 24.6088 23.7707 25.9461 25.2656 20.5111 25.2586 24.0745 28.1874 21.4067 25.5860 29.3905 23.9404 23.6253 25.0449 26.2899 30.6209 25.0367 24.3530 29.1657 24.5923 28.7336 29.5371 25.6265 29.4971 27.5703 25.4496 27.2272 25.3178 30.0348 * 28.0931 26.3973 27.3689 28.9196 23.1041 26.9095 28.1655 28.6517 * 28.7187 29.1493 28.6838 28.6429 26.9700 31.0935 29.3156 22.8786 25.2137 26.9818 24.5593 25.5194 27.1233 * 26.5655 * 28.8727 28.9529 29.1444 31.4987 * 21.3711 * 25.4987 27.9283 26.2028 21.2120 25.9321 25.1568 29.3249 * 28.3494 31.1720 25.1992 27.2103 24.7233 30.4835 30.4234 27.7468 25.7997 29.0301 25.7424 30.9613 30.5354 27.1359 30.0493 27.0507 25.7590 28.4110 26.7670 31.2245 * 27.3806 26.3375 28.6052 30.0025 23.8966 27.7498 28.4136 30.4957 * 29.9297 29.3548 29.7732 28.0423 27.8888 29.0142 33.0091 25.1381 25.2653 27.5333 26.5855 25.8493 28.1517 * 28.9114 * 29.3498 30.3290 29.1247 31.3363 * 22.6744 * 28.7959 30.2038 26.0888 21.7638 28.5642 25.7242 30.1109 * 26.4526 33.1783 26.6732 29.1480 24.8038 30.6398 32.1616 29.1332 26.9731 30.5475 25.8716 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00193 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 28.8233 29.1851 26.4178 28.8173 27.1181 24.5202 27.4598 25.4609 29.5420 21.8465 27.2242 26.0050 27.4720 29.5365 23.1998 25.8885 27.8886 29.1720 17.4862 28.4268 28.5129 28.8056 27.6123 27.1974 29.5229 30.3929 23.6707 24.7681 26.5864 24.4151 25.7349 27.5020 22.3370 26.4833 20.6339 28.8452 27.8808 28.6422 30.4971 24.8544 22.1017 24.6088 26.0974 27.9980 25.8557 21.1631 26.5896 24.9786 29.2163 21.4067 26.8041 31.1870 25.3038 26.6296 24.8594 29.1396 31.1002 27.3211 25.6241 29.5655 25.4594 24872 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 150104 150106 150109 150112 150113 150115 150122 150124 150125 150126 150128 150129 150130 150132 150133 150134 150136 150146 150147 150149 150150 150151 150152 150153 150154 150155 150156 150157 150158 150160 150161 150162 150163 160001 160005 160008 160013 160014 160016 160020 160024 160026 160028 160029 160030 160031 160032 160033 160034 160039 160040 160045 160047 160048 160050 160057 160058 160064 160066 160067 160069 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.0855 1.0158 1.4646 1.4973 1.2888 1.4221 1.3185 *** 1.5108 1.4163 1.4408 1.1548 1.6136 *** 1.2465 1.0184 *** 1.1375 1.5119 1.0014 1.3168 *** *** 2.4179 2.5731 *** *** 1.6752 1.2386 2.0084 1.4704 1.7757 1.1085 1.2040 1.2097 1.0520 1.2954 *** 1.5631 1.1531 1.5664 *** 1.3103 1.6376 1.3828 0.7988 1.0670 1.7494 1.0217 0.9129 1.2918 1.6888 1.3942 *** 1.0566 1.2586 1.9687 1.6018 0.9354 1.3642 1.5288 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.9723 * 0.8682 0.9723 0.9723 0.8599 0.9723 * 1.0455 1.0455 0.9723 0.9723 * * 0.9046 0.9045 * 0.9046 1.0455 0.8599 0.9046 * * 0.9723 0.9723 * * 0.9723 0.9723 0.9723 0.9723 0.9723 0.9045 0.9227 0.8480 0.8480 0.8659 * 0.9227 * 0.9162 * 0.9419 0.9428 0.9982 * 0.8715 0.8898 * * 0.8891 0.8689 0.9419 * * 0.9142 0.9428 0.8891 * 0.8891 0.8874 25.5872 20.9387 23.5865 26.5643 24.8760 19.3411 26.0173 21.3933 26.7666 26.9887 26.4976 29.9099 21.7400 25.6257 22.7292 23.8525 26.2704 29.3383 22.8456 23.6360 25.5331 38.1445 44.7145 * * * * * * * * * * 25.1220 21.8949 20.7200 23.7163 20.5882 23.3619 19.5554 26.2392 24.7424 26.2948 27.9277 26.7068 19.7368 23.4727 24.6768 19.3503 22.1180 23.9053 25.4153 25.2072 19.5831 24.5402 23.0937 27.1646 28.6139 22.7709 23.4060 25.3402 28.2552 * 25.3367 28.0068 24.7960 22.0747 * * 27.6535 28.9454 28.7810 29.7398 * 27.6560 25.1322 26.3249 * 29.5256 27.2339 23.7026 27.0542 * * 32.1022 29.8514 45.0121 25.9681 * * * * * * 24.5108 23.1034 22.1402 24.0956 * 24.5338 * 27.4158 * 27.8535 28.7324 28.7786 * 25.4662 26.5315 * * 25.9032 26.6463 26.0227 * * 25.1272 28.4167 28.7668 * 24.8137 27.4473 28.7782 * 26.8460 29.8515 25.9794 22.5784 29.1651 * 29.3573 29.4277 29.4982 31.4309 * * 24.2528 21.6507 * 30.3340 26.1631 24.9628 26.7708 * * 35.0601 29.8867 * * 32.3095 * * * * * 25.7253 24.7751 22.4752 24.4092 * 27.1450 * 29.3740 * 30.0834 30.6688 30.9401 * 26.2923 27.2044 * * 26.8096 27.5279 28.1257 * * 25.6262 28.9914 28.4201 * 26.0201 27.6151 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00194 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 27.5175 20.9387 25.2374 28.1779 25.2152 21.2668 27.6449 21.3933 27.9334 28.4460 28.2798 30.3982 21.7400 26.6249 24.0310 23.7520 26.2704 29.7675 25.6991 24.1402 26.4923 38.1445 44.7145 33.7419 29.8697 45.0121 25.9681 32.3095 * * * * * 25.1337 23.2876 21.7844 24.0732 20.5882 24.9572 19.5554 27.6163 24.7424 28.2015 29.0932 28.8516 19.7368 25.1089 26.1333 19.3503 22.1180 25.5667 26.5336 26.4461 19.5831 24.5402 24.6658 28.2022 28.5965 22.7709 24.7707 26.8148 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24873 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 160079 160080 160081 160082 160083 160089 160091 160101 160104 160110 160112 160117 160118 160122 160124 160126 160146 160147 160153 160154 170001 170006 170009 170010 170012 170013 170014 170015 170016 170017 170019 170020 170022 170023 170027 170033 170039 170040 170049 170052 170058 170068 170070 170074 170075 170085 170086 170093 170094 170098 170103 170104 170105 170109 170110 170114 170120 170122 170123 170133 170137 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.4776 1.2820 *** 1.7712 1.6609 1.2895 *** 1.0822 1.6559 1.5339 1.2909 1.3812 *** 1.0949 1.1525 1.0265 1.3905 1.2917 1.7355 0.9478 1.1452 1.3255 1.0521 1.2446 1.6138 1.6219 1.0198 *** 1.6404 1.0741 1.1990 1.5979 1.1485 1.4202 1.3965 1.3534 0.9441 1.9811 1.5233 *** 1.1011 1.2238 *** 1.2234 0.8299 0.6104 1.5817 *** 0.9370 *** 1.2881 1.4659 1.0954 1.0332 0.8843 0.9064 1.3879 1.6841 1.6957 1.0455 1.2780 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.8689 0.8898 * 0.9162 0.9162 0.9142 * 0.9162 0.8898 0.8891 0.8480 0.8874 * 0.8480 0.8480 * 0.9220 0.9227 0.9220 * 0.7989 0.9040 0.9321 0.7989 0.8761 0.8761 0.9321 * 0.8561 0.9009 * 0.8761 * 0.8761 0.7989 0.8761 0.9009 0.9321 0.9321 * 0.9321 0.9141 * 0.7989 0.7989 * 0.8561 * 0.7989 * 0.9009 0.9321 0.7989 0.9321 0.7989 * 0.9040 0.9009 0.9009 0.9321 0.7989 23.7234 23.1837 23.1930 26.4398 28.2193 22.6551 17.9862 25.1000 24.9134 24.9434 23.0672 25.0278 19.7764 22.5872 23.1690 19.8323 22.9897 26.6438 28.9881 * 21.9131 21.9019 29.2588 24.0008 24.7392 25.0419 23.5960 20.2368 25.9482 24.7771 22.0251 23.1800 22.2878 23.9808 22.5103 20.7864 21.5203 28.2856 24.7895 18.5291 23.3398 22.6087 16.0162 21.0565 16.5444 * 24.0812 16.5553 21.3887 20.1242 22.8707 26.9671 21.4422 23.2626 22.9195 18.9158 21.0499 25.3982 27.2239 22.9309 23.8862 24.7372 25.8252 * 27.4718 27.3004 23.2149 * 25.0503 28.1891 26.6633 24.7957 25.4659 * 23.9177 22.5482 * 22.6949 28.6303 29.9378 * 23.1260 24.2068 30.9025 23.9707 26.1367 25.2476 23.8135 * 25.8061 26.9657 * 23.2757 * 24.0561 23.1766 21.9709 26.9852 28.4458 25.2070 * 22.9210 23.0635 * 23.7829 19.7760 * 26.1362 * 21.5295 * 23.8042 26.2990 21.9606 23.1088 23.3260 * 22.0253 26.6605 27.6653 23.1226 24.7096 26.1612 27.2360 * 28.7814 28.3914 23.2885 * 25.4729 29.8108 28.8124 25.2879 27.3401 * 24.4983 24.2654 * 25.9575 29.8976 30.6170 * 23.8847 27.1291 29.6048 25.5578 27.1174 26.7123 24.1592 * 26.7533 25.7301 * 24.1120 * 23.9805 23.4023 24.1874 26.0906 30.2460 26.4091 * 26.5943 23.8790 * 23.1854 19.9316 * 26.3581 * 16.5371 * 24.1990 27.5482 22.7400 23.8520 23.9496 * 22.2797 28.3325 28.4687 25.2821 25.4425 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00195 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 24.8785 25.4030 23.1930 27.5576 27.9723 23.0561 17.9862 25.2118 27.8792 26.8746 24.4324 25.9559 19.7764 23.6840 23.3247 19.8323 23.8222 28.4670 29.8519 * 22.9700 24.4623 29.9146 24.5520 25.9599 25.6576 23.8605 20.2368 26.1670 25.8416 22.0251 23.5234 22.2878 24.0052 23.0164 22.2849 24.6284 29.0254 25.4878 18.5291 24.2597 23.1876 16.0162 22.7215 18.7462 * 25.5514 16.5553 19.6987 20.1242 23.6448 26.9346 22.0339 23.4043 23.4209 18.9158 21.7557 26.7103 27.7816 23.8233 24.7034 24874 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 170142 170143 170144 170145 170146 170147 170150 170166 170175 170176 170180 170182 170183 170185 170186 170187 170188 170190 170191 170192 170193 170194 170195 170196 180001 180002 180004 180005 180006 180007 180009 180010 180011 180012 180013 180016 180017 180018 180019 180020 180021 180024 180025 180026 180027 180028 180029 180035 180036 180037 180038 180040 180043 180044 180045 180046 180047 180048 180049 180050 180051 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.4027 *** *** 1.0836 1.5040 *** 1.1592 0.9974 1.4188 1.5962 *** 1.4423 1.9419 1.2362 2.6637 1.4879 1.9751 1.0179 1.7210 1.9138 1.4210 1.0788 2.2822 2.3751 1.2529 1.0605 1.0975 1.1216 *** 1.5270 1.7023 1.8869 1.5431 1.4916 1.5075 1.3308 1.3241 1.3149 1.0936 1.0484 0.9695 1.1161 1.1404 1.0693 1.2463 0.9145 1.3855 1.6206 1.2432 1.3242 1.5454 1.9659 1.1551 1.7151 1.3294 0.9468 *** 1.2958 1.4452 1.1562 1.2881 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.8455 * * 0.7989 0.9321 * 0.8165 0.7989 0.8761 0.9321 * 0.9321 0.9009 0.9321 0.9009 0.7989 0.9321 0.8455 0.7989 0.9009 0.8761 0.9321 0.9321 0.9009 0.9654 0.8095 0.7812 0.8706 * 0.9027 0.8845 0.9027 0.8815 0.9045 0.9408 0.9045 0.7983 0.7812 0.9654 0.7812 0.7812 0.9045 0.9045 * 0.8116 * 0.8815 0.9654 0.8845 0.9045 0.8801 0.9045 0.7812 0.8706 0.9654 0.9027 * 0.9045 0.8815 0.7840 0.8223 22.5778 20.4459 24.6259 21.5756 29.1358 21.4753 18.5744 19.2842 23.9304 26.2366 25.1368 25.7443 24.5539 26.7797 31.7896 23.3702 29.9751 22.8729 21.3069 27.9704 24.7429 27.9903 * * 25.4217 22.9727 19.5437 24.5561 14.8011 22.7606 25.3837 24.7256 22.7364 24.6642 22.9512 23.1832 20.8630 19.0992 24.1342 21.9494 18.5966 32.1824 19.1543 18.2120 23.8763 24.7967 23.0536 29.8438 25.1154 25.7361 24.6348 26.2125 19.0617 23.0971 25.8349 27.2244 21.8036 21.6571 23.3407 22.6473 21.3312 23.9527 * * 23.2162 29.8858 22.4973 20.9448 21.0762 25.6281 27.2332 32.5010 27.3503 25.8340 27.8139 32.8392 22.8493 30.6844 22.9540 22.1197 26.2724 20.6821 29.9014 30.1001 * 27.6917 25.7862 22.0797 24.9779 * 25.7042 26.4101 25.6153 25.5463 25.6000 23.7075 24.8408 21.8885 20.9857 24.0283 24.6953 20.7950 31.1159 22.6897 * 20.8303 * 25.6479 31.0794 25.2972 26.3132 26.0440 27.9979 20.9326 24.4569 27.4732 27.1034 * 23.9230 22.4769 26.3604 23.5299 24.5814 * * 23.3953 29.0538 24.3378 19.5537 22.6927 26.7215 29.0423 17.4887 29.0642 26.1875 28.1777 30.2636 24.1467 32.2575 26.2542 24.3772 27.8171 24.8461 27.6979 29.5948 33.9653 29.7401 26.5375 20.8790 25.6139 * 27.1922 27.3217 27.5042 24.9907 26.7267 24.8114 24.7149 21.9702 23.3022 24.6269 25.9626 22.0692 26.3521 28.5920 * 21.7638 * 26.1493 32.3484 25.6952 27.8489 27.2813 28.5206 20.6423 25.8053 29.4298 27.0962 * 24.3681 24.3690 25.9528 24.3892 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00196 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 23.7373 20.4459 24.6259 22.7060 29.3514 22.5659 19.7042 21.0426 25.4230 27.5653 26.4266 27.4067 25.5204 27.6777 31.6204 23.4567 31.0138 24.0445 22.6585 27.3379 23.2169 28.5234 29.8108 33.9653 27.6436 25.1104 20.8280 25.0800 14.8011 25.2358 26.4312 25.9590 24.4167 25.6686 23.8153 24.2505 21.5929 21.1380 24.2636 24.2590 20.5351 29.7116 23.5032 18.2120 22.0496 24.7967 24.9987 31.1163 25.3661 26.6113 25.9999 27.6117 20.2174 24.4867 27.6399 27.1405 21.8036 23.3115 23.3958 24.9966 23.1284 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24875 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 180053 180055 180056 180063 180064 180066 180067 180069 180070 180078 180079 180080 180087 180088 180092 180093 180095 180101 180102 180103 180104 180105 180106 180115 180116 180117 180124 180127 180128 180130 180132 180134 180138 180139 180141 180143 180144 180146 180147 180148 180149 190001 190002 190003 190004 190005 190006 190007 190008 190009 190010 190011 190013 190014 190015 190017 190019 190020 190025 190026 190027 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 0.9917 1.1922 1.1792 1.1034 1.1673 1.0846 2.0226 1.0877 1.1704 1.1538 1.1904 1.2800 1.2583 1.6703 1.1856 1.6485 1.0480 1.1642 1.5957 2.1735 1.5681 0.8867 0.8975 0.9142 1.2136 0.9574 1.3107 1.3506 0.9287 1.6785 1.4706 0.9988 1.2338 0.9711 1.7986 1.6391 *** *** *** *** 0.9790 1.1333 1.6405 1.4815 1.5567 4.8105 1.4353 1.1757 1.7630 1.2905 *** 0.9928 1.4551 1.1835 1.3255 1.3888 1.7979 1.2332 1.3044 1.6216 1.6703 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.7812 * 0.8469 * 0.8132 0.9408 0.9027 0.8706 0.8052 0.8706 0.8076 0.8043 0.7812 0.9045 0.9027 0.8127 0.7812 0.9027 0.8116 0.9027 0.8116 0.7812 0.7812 0.7812 0.8116 0.7812 0.9408 0.9045 0.7812 0.9045 0.8815 * 0.9045 0.7812 0.9045 0.9027 * * * * 0.7812 0.7591 0.8323 0.8323 0.7980 0.8732 0.8323 0.7591 0.7980 0.7982 * 0.7872 0.7787 0.7591 0.8732 0.7775 0.7982 0.8014 0.7591 0.7982 0.7787 19.1578 20.7237 22.8910 17.9741 16.2638 24.9543 25.4080 22.3673 20.1308 26.2636 19.7791 21.7380 18.4331 27.5767 22.5679 20.5422 17.9677 25.4796 18.4388 26.9407 24.9441 19.7615 17.8020 20.9831 22.7353 21.1854 23.1917 23.4765 20.8406 26.0278 23.7652 18.6779 27.3400 23.5363 25.3042 25.1613 * * * * * 19.7516 22.0056 23.4977 23.3290 22.3208 22.2467 19.7528 24.0111 19.8404 21.6889 19.7319 20.8626 22.4596 22.8875 21.5033 23.7168 21.6136 20.8950 22.5087 21.2526 21.3044 * 24.3074 * 17.1009 22.2713 26.0238 26.3701 20.6741 27.6806 20.2100 21.5818 20.8841 28.0916 23.7909 20.5807 17.9146 27.4506 21.0896 28.4583 25.6157 21.6002 20.2884 20.5539 23.5354 22.8469 24.8292 24.6774 22.6056 27.8900 24.5105 * 28.1901 23.3569 25.3357 28.1924 29.5052 * * * * 22.1394 23.3368 25.8294 25.3473 22.6029 22.7979 21.8205 24.6074 21.1005 * 21.4052 21.4573 22.7151 23.7789 24.5390 24.0468 22.1967 23.5007 23.7702 24.3006 22.1656 * 24.5323 * 20.1789 23.7855 27.9851 26.5123 20.2176 28.2744 23.5989 23.7258 22.0260 28.6098 23.7858 21.4392 21.5629 28.1621 25.2335 28.7043 25.9724 23.1861 20.7179 20.3082 25.8909 24.7355 25.4651 26.3498 23.8117 29.1689 25.3772 * 29.3488 24.7565 27.7799 30.8722 * 39.8522 31.1601 30.1239 * 22.1542 24.6968 26.7813 25.0771 24.2903 24.8816 23.1401 26.3623 24.0685 * 21.6962 23.7328 22.6381 25.1756 24.7505 25.4650 23.4576 24.6432 24.1540 26.7106 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00197 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 20.9703 20.7237 23.9076 17.9741 17.8235 23.6483 26.5261 25.1423 20.3429 27.4277 21.2535 22.3548 20.4628 28.1048 23.3986 20.8528 18.9607 27.0742 21.3174 28.0357 25.5137 21.5257 19.6699 20.6168 24.0619 22.8804 24.5479 24.8205 22.4352 27.7419 24.5770 18.6779 28.3067 23.8893 26.1558 28.2377 29.5052 39.8522 31.1601 30.1239 * 21.3054 23.3287 25.3494 24.6162 23.0170 23.2624 21.5662 24.9673 21.5282 21.6889 20.9421 22.0203 22.6119 23.9762 23.6069 24.4147 22.4009 22.9599 23.4852 24.0302 24876 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 190034 190036 190037 190039 190040 190041 190043 190044 190045 190046 190048 190050 190053 190054 190060 190064 190065 190077 190078 190079 190081 190086 190088 190090 190095 190098 190099 190102 190106 190109 190111 190114 190115 190116 190118 190122 190124 190125 190128 190131 190133 190135 190140 190144 190145 190146 190149 190151 190152 190158 190160 190161 190162 190164 190167 190175 190176 190177 190182 190183 190184 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.2388 1.7113 0.6483 1.6431 1.3443 1.4784 *** 1.3215 1.6092 1.4988 1.0173 1.0982 1.1453 1.3652 1.4952 1.6402 1.6040 0.9332 1.0564 1.2248 0.8766 1.3003 1.0986 1.0652 *** 1.7622 1.0523 1.5318 1.1180 1.2707 1.6579 1.0545 1.2581 1.1767 0.9130 1.3212 *** 1.6008 1.1165 1.2880 0.9001 *** 0.9712 1.1643 0.9240 1.5652 1.0427 0.9491 1.5642 *** 1.6099 1.2439 *** 1.1710 1.2685 1.3812 1.7573 1.7189 *** 1.1704 1.0119 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.7779 0.8732 0.7787 0.8732 0.8732 0.8615 * 0.7850 0.8732 0.8732 * 0.7635 0.7691 0.7676 0.7787 0.8014 0.8014 * 0.7775 0.8732 0.7591 0.7766 0.8615 0.7591 * 0.8615 0.8014 0.8323 0.7982 * 0.8615 0.7591 0.8615 0.7675 0.8615 0.8014 * 0.7872 0.8014 0.8014 0.7692 * 0.7625 0.8615 0.7681 0.8732 * 0.7591 0.8732 * 0.7872 0.7787 * 0.8204 0.8323 0.8732 0.8732 0.8732 * 0.7980 0.7766 19.6943 24.8152 18.6393 25.6665 26.7428 24.6734 17.3477 19.5567 25.3854 24.2128 19.6288 19.1076 16.4968 20.1108 23.6278 23.3617 23.7450 18.8409 21.3786 21.2546 15.6146 19.8823 22.3480 20.2045 18.0174 24.6353 20.4597 25.2267 21.7228 18.6524 24.4998 15.8031 26.6295 20.3845 19.7024 23.7082 24.6675 23.9649 27.9136 25.1917 13.6266 26.8238 17.6936 21.7547 18.9678 26.1792 18.8819 18.6293 27.6099 26.3042 21.6740 19.1022 25.0328 22.8599 24.3185 27.1531 25.6997 27.4621 28.4799 19.8084 23.9608 20.7334 25.4164 19.4071 24.4386 28.6297 28.5376 * 20.9993 25.8238 23.8552 * 21.0259 17.9788 23.1471 23.7393 23.1358 22.1880 * 22.2431 24.0985 20.0121 22.0610 23.8562 23.1241 * 25.6854 22.0610 27.3126 23.5376 * 25.5729 17.2678 28.2066 22.3710 22.8809 22.0072 26.0032 25.5463 28.3257 27.8465 18.2045 27.7540 18.9652 22.9181 19.9265 27.4824 * 18.7467 28.1334 26.4787 22.9325 22.6187 25.2953 25.2560 26.4669 26.0547 25.8826 27.7792 27.1682 22.6928 24.9476 21.2104 25.6548 20.7258 26.1249 28.0162 28.9554 * 21.2561 27.1982 24.7362 * 20.9111 18.5781 22.7018 22.6278 23.7283 23.1207 * 22.2313 23.8184 21.4422 22.2872 23.1624 24.3261 * 25.7430 23.2316 26.9670 26.6201 * 26.5701 19.1533 26.0782 23.3978 21.2519 22.2352 27.7799 24.8247 29.6644 28.6764 22.4265 30.5687 23.0383 23.7865 20.8537 28.7186 * 18.8350 30.8510 30.6477 24.7806 22.9017 * 26.6165 25.3251 27.4234 26.2601 28.2738 29.8646 22.0098 24.1551 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00198 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 20.5402 25.3040 19.5618 25.3976 27.7945 27.3327 17.3477 20.6002 26.1752 24.2695 19.6288 20.3638 17.7244 22.0096 23.3255 23.4081 23.0049 18.8409 21.9581 23.0907 18.9706 21.4347 23.1091 22.5629 18.0174 25.3592 21.9191 26.4739 23.8308 18.6524 25.5474 17.4110 26.9661 22.0626 21.3058 22.6295 26.1591 24.7613 28.6603 27.2755 19.4499 28.1641 19.9091 22.8277 19.9351 27.4154 18.8819 18.7414 28.8848 27.6762 22.9867 21.4139 25.1543 24.9924 25.3437 26.8723 25.9478 27.8343 28.5185 21.4396 24.3727 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24877 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 190185 190190 190191 190196 190197 190199 190200 190201 190202 190203 190204 190205 190206 190208 190218 190236 190241 190242 190245 190246 190247 190248 190249 190250 190251 190252 190253 190254 190255 190256 190257 190258 190259 190260 190261 190262 190263 190264 190265 190266 190267 190268 190270 190272 190273 200001 200002 200008 200009 200012 200013 200018 200019 200020 200021 200024 200025 200027 200028 200031 200032 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. *** 0.9347 1.3282 0.9301 1.3888 0.9962 *** 1.2434 1.4035 *** 1.5156 1.6777 1.5774 0.8622 1.1036 1.4949 1.2210 1.1667 1.7065 1.6693 *** *** 1.8972 2.1200 1.2888 *** *** *** 0.7428 0.7572 1.6034 1.0329 1.8027 *** 1.6302 *** 2.4724 *** 0.7095 1.9489 1.1620 1.3593 1.7989 1.5539 1.6476 1.3871 1.0767 1.3366 1.9757 1.3501 *** 1.2572 1.2471 1.2349 1.2518 1.5842 1.1474 *** *** 1.2585 1.1124 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 * 0.7666 0.8323 0.8323 0.7872 0.8014 * 0.7787 0.8014 * 0.8732 0.8323 0.8732 0.7591 0.8615 0.8615 0.7980 0.8014 0.7872 0.7666 * * 0.8014 0.8732 0.8014 * * * 0.8323 0.8732 0.7641 0.8615 0.8323 * 0.7872 * 0.8323 * 0.7872 0.8014 0.8732 0.8323 0.8732 0.8323 0.8014 0.9860 0.8412 1.0008 1.0008 * * 0.8412 1.0008 1.0179 1.0008 0.9601 1.0008 * * 0.8412 0.8728 24.7912 16.1195 23.5734 24.7135 24.3735 14.1409 27.5681 24.5877 24.7944 26.8795 28.3684 24.4540 26.0139 24.2588 25.0356 23.6824 23.9700 23.0072 27.1786 * * * * * * * * * * * * * * * * * * * * * * * * * * 25.1144 25.7478 27.4412 31.1056 25.7623 24.4131 23.6337 25.1367 31.7083 24.5519 26.0080 26.0573 26.3118 24.3271 21.9489 25.5227 25.6394 24.3327 24.1923 24.0385 25.8071 27.3304 28.8173 25.1010 27.6084 28.1832 28.1033 26.6832 26.7401 28.7308 26.7262 24.7142 25.2123 24.8461 25.5751 * 32.7499 23.2220 20.0468 31.5101 21.4464 23.6924 22.8060 32.9290 22.2412 * * 31.3715 * * * * * * * * * * * * * 25.2542 25.7212 27.7137 30.7510 * * 23.5632 25.6649 32.6436 27.1381 27.5410 26.3124 * * 21.2370 26.3322 28.9749 26.6988 26.1592 25.8459 26.4794 31.9843 27.4772 24.4557 29.6583 29.9743 30.5137 28.2453 29.2352 27.9789 28.1014 26.4588 25.7878 25.0011 26.7636 22.7824 * * 25.2505 33.3274 23.8397 * 23.8029 * 16.1597 25.9565 26.5480 26.1129 26.5073 29.3937 27.0423 30.3709 26.1353 26.5809 22.6214 * * * * * * 25.8813 27.1134 29.1729 32.5792 * * 22.5017 27.7886 34.0918 29.2049 29.7792 28.5747 * * 22.2140 26.8986 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00199 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 26.4361 22.8823 24.6307 24.8783 25.5487 22.9932 27.9970 24.7118 27.4867 28.2126 28.9471 26.4792 27.2855 27.1350 26.6009 24.9853 25.0872 24.3286 26.5208 22.7824 32.7499 23.2220 22.1285 32.3417 22.5827 23.6924 23.3045 32.9290 18.3000 25.9565 26.5480 28.3727 26.5073 29.3937 27.0423 30.3709 26.1353 26.5809 22.6214 * * * * * * 25.4247 26.1897 28.1437 31.4767 25.7623 24.4131 23.1550 26.2301 32.8280 27.0894 27.8456 27.0014 26.3118 24.3271 21.8009 26.2491 24878 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 200033 200034 200037 200039 200040 200041 200050 200052 200063 210001 210002 210003 210004 210005 210006 210007 210008 210009 210010 210011 210012 210013 210015 210016 210017 210018 210019 210022 210023 210024 210025 210027 210028 210029 210030 210032 210033 210034 210035 210037 210038 210039 210040 210043 210044 210045 210048 210049 210051 210054 210055 210056 210057 210058 210060 210061 220001 220002 220003 220006 220008 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.8739 1.3348 1.2314 1.3026 1.2321 1.1532 1.2564 1.0964 1.1435 1.3542 1.9660 1.6629 1.4235 1.2775 1.0872 1.8897 1.3824 1.6952 *** 1.3763 1.6038 1.2768 1.2773 1.7524 1.1893 1.1888 1.7923 1.3936 1.4340 1.7289 1.2738 1.5328 1.0549 1.2581 1.2162 1.1541 1.1657 1.3012 1.2771 1.1898 1.2283 1.1414 1.2135 1.2986 1.3219 0.9653 1.2738 1.2021 1.3641 1.2925 1.1649 1.2979 1.3579 1.0861 1.1807 1.2431 1.2013 1.3849 1.1827 *** 1.2815 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.9860 0.9601 0.8412 0.9601 1.0008 0.8412 0.9860 0.8412 0.9601 0.9443 1.0108 1.0679 1.0990 1.0990 1.0108 1.0108 1.0108 1.0108 * 1.0108 1.0108 1.0108 1.0108 1.0990 0.8917 1.0990 0.8917 1.0990 1.0178 1.0108 0.8917 0.8917 0.9273 1.0108 0.8917 1.0752 1.0108 1.0108 1.0679 0.8917 1.0108 1.0679 1.0108 1.0178 1.0108 0.8917 1.0108 1.0108 1.0679 1.0679 1.0679 1.0108 1.0990 1.0108 1.0679 0.8917 1.1256 1.1256 * * 1.1256 28.6479 26.2926 23.2333 25.1196 25.5405 24.5532 26.4992 21.8726 25.0167 27.7561 26.4992 29.8684 34.2392 28.7557 25.4081 30.2548 25.2833 26.2360 25.7775 27.5031 27.4103 25.1348 28.2029 32.2081 23.2167 29.1870 26.1824 33.8015 30.4656 29.5579 26.0771 26.0111 25.9221 27.9741 29.5635 26.1829 29.0420 28.4308 26.1083 27.0973 29.5980 27.6940 29.3514 27.5657 28.8700 15.6380 28.4638 26.9656 29.2998 26.2295 29.9708 28.6091 32.2883 29.7841 28.5087 23.6662 29.0014 30.3598 22.0549 30.8599 30.1043 29.3108 27.0582 24.1732 25.1179 25.9893 24.9670 27.6825 22.5159 25.8623 28.2858 32.3005 34.1109 33.6056 28.9554 25.9005 31.8767 24.3341 27.7900 * 30.8575 30.3078 28.5328 29.9261 32.3506 25.1890 29.5533 27.3731 35.4727 32.1812 30.6359 23.8552 24.6343 26.3469 31.0266 26.9763 27.0727 28.5534 30.2908 28.6484 27.3287 29.8121 30.4991 28.3559 26.6524 29.7339 14.2223 27.5043 26.0900 29.8892 27.4328 30.6941 30.0810 31.6787 31.0873 27.1764 23.1645 30.6070 32.4356 * 30.7673 31.3385 31.6996 27.0093 24.9410 26.6405 28.5564 26.6764 29.5020 24.3571 27.9736 29.3435 36.0667 30.7342 31.7115 29.5819 27.3618 30.7107 28.8840 30.2658 * 31.5191 31.1748 28.9896 32.2753 33.5480 26.8569 29.6505 28.7828 37.3067 32.9572 32.9413 24.8558 24.4810 26.7453 31.8522 32.2035 27.9355 29.2497 32.3804 27.3876 27.8387 32.3190 32.4126 29.2360 32.6967 30.3340 16.3687 26.0631 27.0156 30.4320 27.7592 31.4895 32.3482 32.8280 31.6688 29.9635 25.0234 31.2364 33.6641 * 33.6421 34.5830 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00200 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 29.9418 26.8000 24.1296 25.6397 26.8006 25.4292 27.9403 22.9652 26.3217 28.4858 31.3519 31.5420 33.1029 29.1061 26.2241 30.9321 26.1400 28.0854 25.7775 30.0101 29.7268 27.5055 30.1829 32.6959 25.0995 29.4657 27.4738 35.4764 31.9405 31.0661 24.7696 25.0054 26.3458 30.2804 29.6025 27.1027 28.9509 30.4301 27.3991 27.4523 30.5512 30.2663 28.9742 28.8479 29.6364 15.4676 27.2649 26.6995 29.8760 27.1401 30.7115 30.4741 32.2611 30.9534 28.5560 23.9963 30.2908 32.2134 22.0549 31.7227 32.0429 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24879 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 220010 220011 220012 220015 220016 220017 220019 220020 220024 220025 220028 220029 220030 220031 220033 220035 220036 220046 220049 220050 220051 220052 220058 220060 220062 220063 220065 220066 220067 220070 220071 220073 220074 220075 220076 220077 220080 220082 220083 220084 220086 220088 220089 220090 220095 220098 220100 220101 220105 220108 220110 220111 220116 220119 220126 220133 220135 220153 220154 220162 220163 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.2469 1.1289 1.5401 1.1911 1.1228 1.2759 1.0827 1.2031 1.2986 1.0403 *** 1.1325 1.1318 1.6575 1.2129 1.4185 1.5118 1.4766 1.2129 1.0822 1.3072 1.1348 0.9616 1.1736 0.5719 1.2562 1.2427 1.3446 1.1851 1.1334 1.8646 1.1771 1.3059 1.5111 *** 1.6760 1.2069 1.2848 1.0840 1.2047 1.8174 1.8786 *** 1.1952 1.1079 1.1442 1.3485 1.2852 1.2082 1.1274 2.0174 1.2048 1.9490 1.0935 1.1449 *** 1.3229 *** 0.9781 1.6507 1.5700 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.1256 1.1256 1.2617 1.0236 1.0236 1.1710 1.1256 1.1256 1.0236 1.1256 * 1.1256 1.0236 1.1710 1.1256 1.1256 1.1710 1.0071 1.1256 1.0236 0.9739 1.1710 1.1256 1.1710 1.1256 1.1256 1.0236 1.0236 1.1710 1.1256 1.1710 1.1256 1.1710 1.1710 * 1.0955 1.1256 1.1256 1.1710 1.1256 1.1710 1.1710 * 1.1256 1.1256 1.1256 1.1710 1.1256 1.1256 1.1710 1.1710 1.1710 1.1710 1.1710 1.1710 * 1.2617 * 1.1710 * 1.1256 29.7998 34.4064 35.7872 28.3397 28.0608 29.7108 23.2544 26.5305 27.3488 23.0637 32.0980 28.6970 24.4289 34.8183 28.2539 28.6238 31.5184 28.1396 27.7518 26.3768 29.8380 29.8577 24.9642 32.3362 24.2779 27.3968 26.5513 27.1317 29.8911 31.9283 32.2936 31.3566 28.4930 29.1588 29.7507 30.2684 28.9835 26.9841 32.9143 32.5711 34.3667 28.5462 31.1708 30.8685 27.4273 28.8314 29.6912 33.1690 31.9421 30.6252 36.6084 31.1850 32.9988 30.1056 28.7805 33.6003 33.9866 * 28.6461 * 33.6484 30.7804 34.7655 37.8763 29.6315 30.4813 31.6170 24.4009 28.5288 28.7342 25.6478 31.7122 30.6935 26.8849 36.8477 31.8249 31.4470 33.1436 30.4460 30.4740 28.3434 30.2552 32.4130 25.7247 32.5477 25.0766 30.2866 27.6009 27.8073 30.2222 33.1299 36.5065 34.2989 30.5607 30.9175 27.5148 31.7325 29.9595 30.0611 34.5118 30.9527 34.2388 35.8255 32.6305 32.9011 28.0673 30.5869 31.9859 35.3464 33.2625 32.6131 39.2167 33.6167 36.4149 30.9965 31.4882 29.4855 36.0203 * * * 34.4874 31.9799 36.5621 39.7533 32.4890 31.3113 33.2998 25.7854 31.0989 31.9477 30.4365 39.3268 31.6352 28.1322 38.9417 32.3475 29.7381 35.9106 31.4997 32.4636 29.0272 30.1012 31.6356 27.8893 34.7327 25.4179 32.9101 30.0468 28.9742 32.4000 34.2574 37.4053 36.0252 31.4701 31.3628 * 33.0291 31.1248 30.8211 34.5698 31.6948 34.5669 37.4460 34.7959 33.8958 30.1157 31.5393 34.6575 37.5665 32.8161 33.8841 41.0472 34.8506 38.8221 32.0844 32.5432 34.8935 37.5164 19.8073 28.7843 * 37.4931 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00201 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 30.8557 35.2403 37.8795 30.2084 29.9507 31.5458 24.4946 28.7645 29.2908 26.1068 34.1946 30.3488 26.5391 36.9168 30.8015 29.8711 33.5792 30.0722 30.2579 27.9399 30.0680 31.2805 26.1882 33.2257 24.9410 30.2203 28.0391 27.9354 30.8641 33.1431 35.4736 33.8940 30.1999 30.4689 28.6235 31.6979 30.0444 29.3136 33.9822 31.7155 34.3947 33.3973 32.8331 32.6221 28.5485 30.3882 32.1939 35.4542 32.6900 32.3642 39.0591 33.2566 35.9865 31.1223 30.9197 32.6268 35.8937 19.8073 28.7087 * 35.2930 24880 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 220171 220174 220175 220176 230002 230003 230004 230005 230006 230013 230015 230017 230019 230020 230021 230022 230024 230027 230029 230030 230031 230034 230035 230036 230037 230038 230040 230041 230042 230046 230047 230053 230054 230055 230058 230059 230060 230065 230066 230069 230070 230071 230072 230075 230077 230078 230080 230081 230082 230085 230087 230089 230092 230093 230095 230096 230097 230099 230100 230101 230103 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.7192 1.2036 1.2654 1.6837 1.2951 1.2255 1.7409 1.2575 1.0740 1.3227 1.1463 1.7002 1.6505 1.7492 1.5950 1.3120 1.6703 1.0649 1.6011 1.2717 1.3725 1.3787 1.2605 1.4572 1.3454 1.7903 1.2075 1.6026 *** 1.9037 1.4047 1.6336 1.8873 1.2628 1.1265 1.5531 1.2198 *** 1.3087 1.1594 1.6381 0.8679 1.3914 1.3793 1.9012 1.0892 1.3068 1.1913 1.6774 1.1930 *** 1.3349 1.3637 1.2101 1.3066 1.1221 1.7992 1.2069 1.1878 1.2004 *** FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.1256 1.1256 * 1.1341 1.0138 0.9472 0.9935 0.9372 * 1.0272 0.9196 1.0505 1.0272 1.0138 1.0151 0.9933 1.0138 * 1.0272 0.8979 1.0040 0.8899 0.9380 0.9399 1.0138 0.9472 0.9380 0.9399 * 1.0504 1.0092 1.0138 0.9339 0.8899 0.8899 0.9472 0.8899 * 0.9935 1.0138 0.9127 1.0272 0.9472 1.0090 1.0272 0.8899 0.9399 0.8899 * 1.0505 * 1.0138 1.0138 0.8959 0.8899 1.0151 0.9380 1.0138 0.8899 0.8899 * 30.4036 31.7572 * * 29.1410 26.1278 26.7206 24.1902 23.8835 23.7822 24.6571 29.5178 28.4575 29.2869 24.9551 23.3000 30.0813 23.5511 29.0935 22.3174 25.4679 26.7967 21.2317 28.3622 26.2000 26.3480 24.2349 26.1760 26.2037 30.3591 28.1351 29.8703 24.9905 25.4143 24.0657 25.5350 25.5015 28.4631 27.4928 29.5556 24.2342 26.3907 24.4933 27.6193 27.6157 23.9902 21.2314 23.0788 22.2165 22.7313 16.9168 28.7015 26.3584 26.4967 21.3916 28.7681 26.5773 26.4882 21.8895 24.3772 21.6609 32.7414 30.0406 * * 32.9010 27.5824 29.3934 25.8768 * 24.6511 26.2782 31.8821 32.3401 28.5646 26.5659 25.6683 32.1483 * 32.3538 23.8082 29.7232 24.4845 24.8822 29.3754 28.9244 28.2012 25.5154 27.8853 * 31.6235 31.1771 32.5711 25.7591 27.4349 25.9291 27.9091 28.2874 32.6255 30.6184 30.2663 25.6778 28.3064 26.2838 28.2540 29.8538 25.6809 24.1573 24.7374 * 23.4959 * 31.0522 28.6829 25.5804 22.8681 30.6024 28.2526 29.0221 24.1881 25.4839 * 35.9925 30.9354 * * 34.0440 28.4694 31.2926 27.7463 * 27.2066 27.2542 32.5376 34.3193 29.4792 28.6153 30.1226 32.5866 * 32.3835 25.1077 30.0088 24.4133 24.9648 29.9622 28.5469 29.1247 26.3754 27.9569 * 32.2914 31.7053 32.1537 26.0031 28.4779 27.1214 28.5859 27.0286 * 30.2070 31.3407 26.8296 29.6710 27.4723 30.8862 30.5516 25.7228 24.5418 26.4321 * 25.4277 * 32.8429 29.3419 27.4458 25.1829 31.7385 29.8946 29.3700 25.2112 28.4355 * —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00202 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 33.0852 30.8546 * * 32.0073 27.4073 29.2276 25.8963 23.8835 25.1217 26.0748 31.3890 31.6359 29.1157 26.7251 26.2395 31.6095 23.5511 31.2335 23.7832 28.2704 25.2367 23.8027 29.2264 27.9089 27.9594 25.4050 27.3833 26.2037 31.4688 30.3603 31.5469 25.5906 27.1071 25.7327 27.3987 26.9332 29.9929 29.5125 30.4158 25.5681 28.1425 26.0939 28.9422 29.3453 25.1288 23.3433 24.7713 22.2165 23.9142 16.9168 30.6482 28.2028 26.5307 23.1772 30.4262 28.2263 28.3176 23.7860 26.1552 21.6609 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24881 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 230104 230105 230106 230108 230110 230117 230118 230119 230120 230121 230130 230132 230133 230135 230141 230142 230143 230144 230146 230151 230153 230156 230165 230167 230169 230172 230174 230176 230180 230184 230186 230189 230190 230193 230195 230197 230204 230207 230208 230212 230216 230217 230222 230223 230227 230230 230235 230236 230239 230241 230244 230254 230257 230259 230264 230269 230270 230273 230275 230277 230279 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.5972 1.8553 1.1795 1.1243 1.2976 1.8708 1.0456 1.3915 1.1881 1.2797 1.7334 1.4190 1.3873 1.4715 1.6569 1.2441 *** 2.3494 1.3935 1.3152 *** 1.6276 1.6917 1.6184 *** 1.1867 1.2752 1.2857 1.1332 *** *** *** 0.8738 1.2840 1.4440 1.5802 1.3301 1.3447 1.1990 0.9926 1.5508 1.3812 1.3799 1.2979 1.4986 1.5219 1.0691 1.5046 1.2710 1.2149 1.4355 1.5080 0.9510 1.2666 1.8606 1.5016 1.2640 1.5123 0.4718 1.4037 0.4947 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.0138 0.9399 0.9472 0.8899 0.8899 1.0505 0.8899 1.0138 * 0.9933 1.0272 1.1078 0.8899 1.0138 1.1078 1.0138 * 1.0504 1.0138 1.0272 * 1.0504 1.0138 1.0053 * * 0.9472 1.0138 0.8899 * * * 1.0505 1.0040 1.0092 1.1078 1.0092 1.0272 0.9380 1.0504 1.0040 0.9933 0.9399 1.0272 1.0092 1.0053 * 0.9472 0.8899 1.0040 1.0138 1.0272 1.0092 1.0504 1.0092 1.0272 1.0138 1.0138 0.9127 1.0272 1.0138 30.5570 27.2705 24.3980 18.4064 28.7704 29.4775 22.3636 30.2441 24.1485 24.5220 26.6076 30.5318 24.3174 25.8407 28.6326 26.9433 21.4083 * 26.3432 28.2243 22.8644 31.1909 28.9636 27.4562 31.8442 25.7402 27.6920 27.3605 24.7358 23.6706 26.2282 23.0100 29.9603 23.3565 28.2892 30.0367 29.1466 24.5201 21.9651 29.7981 27.5230 28.6074 26.9724 29.2854 29.5798 27.9607 21.8777 28.4754 22.1040 27.4890 26.4326 28.1216 27.8198 26.8677 19.2398 28.8187 27.8488 29.9307 23.1095 29.1973 24.7673 32.4634 32.4583 25.3243 20.2539 27.0040 32.7994 23.6110 30.7488 * 26.4940 30.1608 32.3939 23.9442 25.9583 31.6152 27.8377 * * 26.8156 27.4546 * 32.3755 29.6376 29.8071 * * 30.0563 28.1498 26.0707 34.6295 * * 30.7875 25.1626 29.5656 32.0063 31.5615 25.4268 23.7523 31.9818 29.0147 30.1136 29.9341 28.6745 30.8218 29.8763 * 31.3110 21.0814 27.6106 29.6283 29.2653 29.6712 27.4217 22.7768 31.3226 28.5372 31.9862 23.8104 29.8372 27.2816 32.4102 30.5507 27.8566 24.4337 25.7173 33.0575 24.8873 31.9681 * 26.8351 31.2720 35.5753 25.0634 23.6004 33.8730 29.7407 * * 27.2610 29.8352 * 33.9016 31.4221 31.0585 * * 29.7361 25.8188 24.9693 * * * 33.8238 26.4717 30.9245 33.6990 32.2850 25.2547 24.3741 32.8564 29.2047 31.9706 30.6473 29.8419 33.6697 31.1701 * 30.8531 22.1569 28.5505 30.0355 29.5865 30.6373 27.5982 28.5389 31.3773 28.8505 31.5372 25.2117 31.4001 27.9709 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00203 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 31.7987 30.1271 25.9485 20.8956 27.1019 31.7174 23.5918 31.0533 24.1485 25.9742 29.4071 32.8039 24.4534 25.1117 31.3710 28.1855 21.4083 * 26.8176 28.4827 22.8644 32.4963 30.0161 29.4605 31.8442 25.7402 29.1540 27.0655 25.2513 25.2502 26.2282 23.0100 31.5782 25.0021 29.6342 31.9260 31.0158 25.0743 23.3710 31.5064 28.5834 30.2655 29.2057 29.2657 31.2203 29.6591 21.8777 30.2122 21.7756 27.9009 28.6450 28.9731 29.3897 27.2972 23.0403 30.6050 28.4218 31.1375 24.0696 30.1455 26.6920 24882 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 230283 230289 230291 230292 230294 230295 230296 230297 230299 230300 240001 240002 240004 240006 240010 240013 240014 240016 240017 240018 240019 240020 240021 240022 240027 240029 240030 240031 240036 240038 240040 240043 240044 240047 240050 240052 240053 240056 240057 240059 240061 240063 240064 240066 240069 240071 240075 240076 240078 240080 240083 240084 240088 240093 240100 240101 240103 240104 240106 240109 240115 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. *** *** *** *** *** *** *** 1.6725 0.7569 2.9372 1.5321 1.8802 1.5917 1.0930 2.0488 *** 1.0233 1.2758 1.1862 1.2795 1.0510 1.0696 1.0320 1.0296 0.9334 0.9036 1.3356 *** 1.6917 1.5420 1.0727 1.2145 1.0574 1.5016 1.1126 1.2197 1.4802 1.2486 1.8365 1.1404 1.8183 1.6444 1.1841 1.5085 1.2060 1.1294 1.1560 1.0348 1.7539 1.9135 1.2282 1.1715 1.2868 1.4141 1.3062 1.1577 *** 1.1355 1.6068 0.8676 1.5324 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 * * * * * * * 1.0092 1.0092 1.0092 1.0961 1.0151 1.0961 1.0761 1.0761 * 1.0961 * * 1.0085 1.0151 1.0961 * 0.9212 * * 1.0390 * 1.0961 1.0961 1.0151 0.9212 0.9883 1.0151 1.0961 0.9212 1.0961 1.0961 1.0961 1.0961 1.0761 1.0961 1.0020 1.0961 1.0761 1.0761 1.0390 1.0961 1.0961 1.0961 * 1.0151 1.0390 1.0961 0.9212 0.9212 * 1.0961 1.0961 * 1.0961 26.2622 29.7721 30.9656 31.8943 * * * * * * 31.5753 28.9860 30.8072 30.1949 31.3733 28.3860 29.8623 26.7814 24.4417 25.6236 28.6723 31.2443 27.1236 25.2066 18.2482 25.3568 24.7154 26.7778 28.0812 31.0779 27.4895 21.8684 22.0973 28.8289 26.4854 26.4256 29.5315 31.6623 30.6258 29.7916 30.6383 32.3487 29.9662 33.4532 28.9496 28.0586 26.1956 29.8561 32.3235 31.6828 26.6582 26.8141 28.0825 25.5805 27.6299 25.5355 22.7077 31.4306 29.3455 16.5051 31.3869 33.5531 * * * 31.6195 27.1298 * * * * 33.1499 31.6000 32.7010 31.0777 33.4668 * 29.8905 * 24.3596 28.1432 33.7546 31.3874 * 26.1920 * * 26.5508 * 32.7028 31.9891 27.5074 23.3489 25.0988 28.6406 27.5553 28.7206 31.4324 33.1728 30.7703 31.0911 33.1799 33.7895 34.3757 35.3441 29.3718 28.6950 27.5039 30.6936 32.5785 32.5725 * 26.5975 28.0603 27.2928 30.8391 25.6963 * 31.6511 30.5927 * 32.0107 * * * * * * 34.2091 * * * 34.9488 33.5414 32.0885 34.0824 33.9391 * 31.5902 * * 29.6619 32.9757 33.4700 * 27.4384 * * 27.1291 * 34.2927 33.2977 29.2269 24.2153 26.8667 29.7813 31.2060 29.4594 33.1815 33.9981 33.6438 33.3840 32.1083 35.3585 27.2367 36.1920 31.1575 31.7403 29.1165 33.0908 35.5096 34.9990 * 26.6137 30.7452 29.1386 31.5746 26.8837 * 34.8590 33.3656 * 33.7716 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00204 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 27.8105 29.7721 30.9656 31.8943 31.6195 27.1298 34.2091 * * * 33.2343 31.3640 31.8534 31.7954 32.9198 28.3860 30.4899 26.7814 24.4015 27.8174 31.6807 32.0413 27.1236 26.3075 18.2482 25.3568 26.1210 26.7778 31.6446 32.1250 28.0678 23.1696 24.6227 29.0973 28.4938 28.2281 31.4253 32.9754 31.6657 31.4927 31.9962 33.8590 30.4831 35.0530 29.8505 29.4814 27.5981 31.3206 33.5022 33.0567 26.6582 26.6743 28.9706 27.3669 30.0094 26.0839 22.7077 32.7610 31.1028 16.5051 32.4047 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24883 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 240117 240123 240128 240132 240141 240143 240152 240162 240166 240187 240196 240206 240207 240210 240211 240213 250001 250002 250004 250006 250007 250009 250010 250012 250015 250017 250018 250019 250020 250021 250023 250025 250027 250031 250034 250035 250036 250037 250038 250039 250040 250042 250043 250044 250045 250048 250049 250050 250051 250057 250058 250059 250060 250061 250067 250069 250072 250077 250078 250079 250081 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.1786 *** *** 1.2801 1.1202 0.8966 *** *** 1.1548 1.3295 0.8200 0.8831 1.1958 1.2897 0.9769 1.3950 1.9054 0.9546 1.9123 1.1113 1.2347 1.2422 0.9918 0.9475 1.1234 1.0264 0.8932 1.5216 0.9941 *** 0.8676 1.0998 0.9597 1.3175 1.5394 0.8591 1.0384 0.9020 0.9401 0.9692 1.4830 1.2092 1.0145 1.0512 0.8706 1.6243 0.8732 1.1890 0.8083 1.1224 1.2423 0.9230 0.7986 0.9038 1.0777 1.4806 1.6976 0.9345 1.6953 0.8536 1.3342 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.9805 * * 1.0961 1.0961 * * * 0.9212 1.0961 1.0961 1.4406 1.0961 1.0961 0.9598 1.0961 0.8273 0.7971 0.8951 0.8951 0.8618 0.8432 0.7915 0.9291 0.7915 0.7915 0.7915 0.8618 0.7915 * 0.8223 0.7915 0.7915 0.8273 0.8951 0.7915 0.8544 * 0.8273 * 0.8223 0.8951 0.7915 0.7971 * 0.8273 0.7915 0.7915 0.7915 0.7915 0.7915 0.7915 0.7915 0.7915 0.7915 0.8166 0.8273 0.7915 0.8223 0.8273 0.8166 23.6230 21.7500 21.5791 31.7139 26.4016 21.7416 29.6196 22.2722 25.7509 27.8811 30.7720 * 31.7665 32.1564 18.8503 32.7532 22.7827 23.3844 24.1065 24.0191 25.8710 22.2323 19.4402 20.2922 20.7555 21.3950 16.6292 23.9741 21.4019 20.3564 16.2418 20.5258 17.3481 21.4326 24.3189 17.2046 19.1975 17.4012 18.9050 17.3155 23.2285 23.4135 19.8097 23.3862 26.3831 22.9765 17.7005 19.1467 10.6095 20.1900 18.1704 19.2976 16.8247 12.8174 21.6911 22.8162 24.6587 14.7632 20.9354 38.0032 24.7031 24.5750 * 23.3334 32.1233 31.4468 * * * 27.6987 27.8844 31.5965 * 32.5589 32.7123 22.5430 33.8680 23.5222 23.4063 24.7907 24.4282 24.8929 23.0352 21.4322 21.5540 22.0067 22.7660 17.1276 25.7376 22.1851 * 18.0108 22.5621 24.4937 24.8139 26.1887 20.1622 20.3625 * 22.2571 * 24.5962 25.6807 18.8979 24.0508 * 25.2092 19.1044 20.8084 14.3741 22.7601 19.2502 23.8997 28.1431 17.8267 23.1193 22.6353 25.8399 18.3735 22.1243 45.5166 23.9995 27.6916 * * 34.6782 32.3861 * * * 29.6615 29.6502 34.1199 * 34.9881 34.4858 29.3644 35.9799 24.5227 25.4201 25.8710 25.9197 27.7647 23.4128 21.8643 23.3688 22.2776 33.6797 17.9011 26.2315 23.7217 * 18.4674 23.1721 26.9874 55.6623 27.0455 19.6892 19.7915 * 26.9582 * 27.3356 26.1154 20.8820 24.9245 * 24.7651 20.4694 21.1669 13.9457 24.3633 18.9952 26.7379 25.4705 18.7359 25.2181 22.4221 25.5321 19.0379 22.8399 43.0813 25.6789 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00205 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 25.3192 21.7500 22.4504 32.8020 30.2635 21.7416 29.6196 22.2722 27.8068 28.5206 32.1844 * 33.1636 33.1223 22.2558 34.2403 23.6272 24.0840 24.9580 24.8139 26.1856 22.8968 20.9156 21.7206 21.6577 25.4557 17.2147 25.3074 22.4960 20.3564 17.5916 22.1086 22.7342 27.5006 25.8383 19.0949 19.8090 17.4012 22.1495 17.3155 25.0598 25.0557 19.8715 24.1146 26.3831 24.3109 19.2002 20.4034 12.9300 22.3987 18.8123 23.0872 22.9625 16.2197 23.3708 22.6169 25.3433 17.4294 21.9357 42.6359 24.7909 24884 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 250082 250084 250085 250093 250094 250095 250096 250097 250099 250100 250101 250102 250104 250105 250107 250112 250117 250120 250122 250123 250124 250125 250126 250127 250128 250134 250136 250138 250141 250146 250149 250151 250152 250153 250155 250156 250157 250160 250161 260001 260002 260004 260005 260006 260008 260009 260011 260012 260013 260015 260017 260018 260020 260021 260022 260023 260024 260025 260027 260032 260034 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.4651 1.2101 1.0005 1.1880 1.7339 1.0360 1.1761 1.6174 1.2805 1.4738 *** 1.5948 1.4895 0.9250 0.5882 0.9900 1.1064 *** 1.1114 1.3317 0.8188 1.2236 0.9502 0.8851 0.9292 0.8844 1.0311 1.3295 1.5450 0.7934 0.8346 0.4710 0.8555 *** *** *** *** 1.4401 2.1565 1.6521 *** 0.9694 1.5541 1.4864 *** 1.1616 1.5006 *** *** 1.0081 1.3305 1.0396 1.7371 1.3993 1.4087 1.3563 1.1337 1.3611 1.6424 1.8499 0.9779 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.7959 0.7915 0.7915 0.7915 0.8223 0.7915 0.8273 0.8014 0.8273 0.8166 * 0.8273 0.8166 * * 0.7915 0.8223 * 0.7915 0.8618 0.8273 0.8618 0.7915 1.4406 0.8308 0.8273 0.8273 0.8273 0.9291 * 0.7915 0.7915 0.8273 * * * * 0.8308 0.8273 0.9318 * 0.8145 0.8885 0.8145 * 0.9321 0.8706 * * 0.8507 0.8706 * 0.8885 0.8885 0.8480 0.8885 0.8145 0.8885 0.9321 0.8885 0.9321 19.6966 18.5775 19.7008 21.3237 22.7312 21.3511 22.6298 20.1687 19.5797 24.2209 19.3543 24.2868 22.6591 18.1195 17.8999 21.2824 23.3673 23.4277 24.5854 24.5115 17.2181 27.7077 21.7112 * 17.6269 25.8369 23.0637 23.8861 27.6158 18.6486 15.0641 17.2205 25.7837 29.0461 * * * * * 25.9250 26.4879 16.9422 26.5773 26.7587 18.9522 22.1816 22.7062 20.3061 20.5007 22.5409 22.7022 17.0434 26.0407 27.6329 22.8085 21.2077 18.4829 22.4645 25.3348 23.9478 24.1143 23.0287 19.6492 22.5513 23.0984 24.1422 21.7488 24.9187 21.8139 21.1269 25.6846 * 24.6652 23.4303 * * 24.3069 22.2450 24.6370 27.2795 26.6221 20.4394 27.5158 24.4126 * 17.7624 22.2167 22.9468 24.3018 28.5922 * 16.8796 18.8846 26.9334 * 22.5728 * * * * 27.9230 * 20.3217 27.7855 30.3440 * 24.2360 25.6387 * * 24.6139 23.5713 * 27.4730 29.3646 23.3393 24.3192 19.4952 22.2451 26.3590 25.6763 25.0573 23.5384 19.1096 24.2875 23.9098 24.7709 23.6079 26.3717 22.0204 21.9028 27.0283 * 25.4029 24.4287 * * 26.3311 23.7325 26.6502 27.4403 27.9144 20.5596 26.8377 25.6980 * 21.7827 21.0199 25.2250 25.2632 30.5462 * 17.2245 22.8221 26.4561 * * 16.8646 29.6366 * * 29.5231 * 21.3539 27.9465 27.3734 * 25.7517 27.5729 * * 25.0595 24.9740 * 29.3071 31.7013 24.8696 25.4291 19.2179 24.0348 29.3205 25.8890 27.1644 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00206 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 22.0708 19.1057 22.2560 22.7648 23.8832 22.2424 24.6250 21.3427 20.8103 25.6565 19.3543 24.7878 23.5414 18.1195 17.8999 23.9682 23.1044 24.9393 26.3821 26.3804 19.3903 27.3634 23.8290 * 19.2616 22.9407 23.7174 24.4952 28.9990 18.6486 16.4086 18.4859 26.3576 29.0461 22.5728 16.8646 29.6366 * * 27.7476 26.4879 19.5722 27.4311 28.2406 18.9522 24.0687 25.2802 20.3061 20.5007 24.0549 23.7836 17.0434 27.6646 29.4504 23.6522 23.5894 19.0576 22.9414 26.9768 25.1792 25.5181 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24885 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 260035 260036 260040 260047 260048 260050 260052 260053 260057 260059 260061 260062 260064 260065 260067 260068 260070 260073 260074 260077 260078 260080 260081 260085 260086 260091 260094 260095 260096 260097 260102 260104 260105 260107 260108 260110 260113 260115 260116 260119 260122 260127 260137 260138 260141 260142 260147 260159 260160 260162 260163 260164 260166 260175 260176 260177 260178 260179 260180 260183 260186 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. *** *** 1.6639 1.4482 1.1759 1.1594 1.3110 1.0761 1.0699 1.1568 1.1351 1.2507 1.3834 1.7778 0.9311 1.7969 0.9563 *** 1.2375 1.6221 1.2835 0.9195 1.5691 1.5670 0.9570 1.5269 1.7017 1.3903 1.4990 1.2006 0.9518 1.5655 1.8539 1.2949 1.8342 1.6392 1.1068 1.1392 1.0986 1.3299 *** 0.9486 1.7247 1.9895 1.8510 1.0871 0.9229 *** 1.0728 1.3823 1.1437 1.3771 1.2260 1.0782 1.7016 1.2061 1.8406 1.5483 1.5417 1.6671 1.5449 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 * * 0.9196 0.8706 0.9321 0.8831 0.8885 * 0.9321 0.8272 0.8145 0.9321 0.8545 0.9196 * 0.8545 0.8145 * 0.8545 0.8885 0.8145 0.8145 0.8885 0.9321 * 0.8885 0.8943 0.9321 0.9321 0.8440 0.9321 0.8885 0.8885 0.9321 0.8885 0.8885 0.8355 0.8885 0.8145 0.8507 * * 0.9318 0.9321 0.8545 0.8145 0.8145 * 0.8145 0.8885 0.8145 * 0.9321 0.9321 0.8885 0.9321 0.8545 0.8885 0.8885 0.8885 0.8706 17.8741 22.1913 23.3566 24.4185 24.3906 23.6849 24.5165 21.6607 19.3335 19.7243 21.5264 26.4539 19.0543 23.0015 17.6256 24.9504 18.4779 21.6214 24.8655 25.5782 19.0802 14.7774 26.3969 25.6302 19.1702 27.2407 23.2544 25.5668 27.5592 21.3957 24.2368 26.2867 28.8849 26.7781 24.9880 23.7978 20.9644 21.9858 18.5076 24.9937 20.8015 21.8533 22.7431 28.5610 22.4886 20.3993 18.5153 23.7427 21.0544 25.1423 20.1949 19.7068 27.0237 22.6171 27.4244 26.1178 22.2251 26.1419 26.7461 26.0418 25.3148 * * 24.3938 25.4978 27.6117 25.0506 26.0052 * 20.9639 22.6922 22.4766 28.1661 22.2395 27.1014 * 26.0295 24.6331 * 25.6218 26.7466 20.1983 17.9107 28.1182 26.6718 * 28.0537 24.1473 24.2698 29.7312 25.0624 27.2145 28.6247 29.8848 25.8177 26.6374 24.7656 21.2072 23.1396 21.3503 27.9769 * * 24.3273 30.4410 24.1555 21.5923 21.4235 22.6276 23.8257 27.0236 21.6408 * 29.1225 25.1817 29.3034 27.0185 25.4782 26.6069 28.2931 27.5577 26.9797 * * 28.5815 26.6318 28.2868 26.2320 27.6348 * 21.5895 22.3875 22.8581 28.4951 23.5352 29.3548 * 27.3717 21.9646 * 28.0454 27.7359 21.1532 18.6028 29.1725 28.0298 * 28.5213 23.8642 27.3917 30.7246 25.5604 26.7618 28.0218 29.4761 27.8030 27.0748 * 21.8850 24.6379 20.7451 31.5417 * * 28.2386 30.7179 25.5660 21.7584 22.1878 23.9520 25.5072 28.4645 21.5551 * 28.4735 24.6035 31.1025 28.7735 27.1192 28.1578 29.3792 29.2666 28.8584 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00207 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 17.8741 22.1913 25.2261 25.5311 26.7437 25.0309 26.0327 21.6607 20.6144 21.6445 22.2790 27.7044 21.5798 26.5318 17.6256 26.1290 21.9639 21.6214 26.1516 26.6839 20.1475 17.0061 27.9063 26.7543 19.1702 27.9452 23.7598 25.6438 29.3745 24.1093 26.1063 27.6808 29.4215 26.7722 26.2654 24.2985 21.3616 23.3009 20.1801 28.0654 20.8015 21.8533 25.0868 29.9246 24.0282 21.2691 20.7802 23.4461 23.4620 26.9318 21.0992 19.7068 28.1987 24.1897 29.3195 27.3063 25.2033 26.9703 28.1552 27.6346 27.0989 24886 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 260190 260191 260193 260195 260198 260200 260207 260209 260210 260211 260213 260214 260215 260216 260217 270002 270003 270004 270011 270012 270014 270017 270021 270023 270032 270036 270049 270051 270057 270060 270074 270081 270086 270087 280003 280009 280013 280020 280021 280023 280030 280032 280040 280054 280057 280060 280061 280065 280077 280081 280105 280108 280111 280117 280119 280123 280125 280127 280128 280129 280130 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.1940 1.3655 1.1900 1.2147 0.9613 1.2655 1.1543 1.1051 1.2690 1.5777 *** 1.2355 0.8925 1.1874 1.9096 1.1595 1.3079 1.6792 1.0335 1.5539 1.9641 1.3145 *** 1.5491 1.0285 *** 1.7523 1.5590 1.2521 *** 0.9141 0.9750 1.0637 1.2165 1.7455 1.8639 1.7316 1.7365 1.1556 1.3658 1.8923 1.2987 1.6382 1.1439 0.8567 1.6740 1.3931 1.2398 1.3381 1.7001 1.2700 1.0629 1.1871 1.1227 0.8644 0.9968 1.5933 1.7915 2.9058 1.9022 1.3728 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.9321 0.8885 0.9321 0.8145 0.8885 0.8885 0.9196 0.8706 0.8885 0.9321 * 0.9321 * 0.9321 0.8145 0.8337 0.8765 0.8877 0.8337 0.8765 0.8737 0.8737 * 0.8737 0.8337 * 0.8877 0.8337 0.8337 * 1.4406 0.8573 0.8765 0.8337 0.9836 0.9603 0.9419 0.9836 * 0.9603 0.9419 0.9603 0.9419 * * 0.9419 0.9049 0.9747 0.8905 0.9419 0.9419 * 0.8848 * 1.4406 0.8966 0.8848 0.9836 0.9836 0.9419 0.9419 26.4505 23.3856 26.2979 22.3959 27.5996 24.8624 19.7294 23.2430 25.3781 33.9109 * * * * * 22.7322 26.4843 23.5454 22.1394 25.2873 26.2025 27.5483 21.7056 26.7576 19.6212 20.4241 26.3996 26.6619 24.2980 17.7564 * 17.4862 * * 29.3921 26.7678 26.1908 26.5068 22.0489 22.3230 30.7481 23.6462 26.9827 23.5665 20.4830 26.2139 24.9482 26.0135 25.5624 26.0541 26.7555 23.2503 23.4770 24.1521 * * 21.7657 * * * * 27.9137 24.6973 26.8922 22.6870 28.0021 28.2453 22.6109 25.0098 26.8745 40.9821 * * * * * 24.0534 28.8700 26.1319 22.7061 25.2914 25.8231 26.5404 * 25.5682 20.3469 * 27.1634 26.5621 25.5811 * * 19.5612 21.0808 25.9772 30.6124 27.0705 27.0250 27.3284 * 26.7980 29.5102 24.3995 28.7207 * * 27.7496 26.0208 28.0581 27.0860 28.7464 27.8599 * 24.5617 * * 15.4047 22.1345 29.3684 28.5422 * * 30.5095 26.3196 28.1060 24.0387 27.2554 27.4813 22.9594 25.0733 30.6046 35.9066 34.8944 * * * * 25.2902 29.2082 26.7037 24.4678 26.5782 27.4790 27.4092 * 26.2592 20.4332 * 28.6651 24.8924 27.1840 * * 20.0422 20.7990 24.8182 29.8995 29.3561 27.9514 32.3886 * 29.5116 30.6995 24.7535 29.5254 * * 30.3288 26.4808 27.9710 28.2199 31.1636 24.0173 * 27.4621 * * 22.2049 23.2889 25.6815 28.8725 27.8784 30.5784 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00208 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 28.3280 24.8420 27.0944 23.0815 27.6065 26.8911 22.0277 24.4643 27.6608 37.0319 34.8944 * * * * 24.0315 28.2134 25.4969 23.0847 25.7174 26.5061 27.1700 21.7056 26.1753 20.1360 20.4241 27.4207 25.9335 25.7302 17.7564 * 18.9880 20.9439 25.3750 29.9681 27.7370 27.0724 28.7653 22.0489 26.0300 30.3315 24.2695 28.4311 23.5665 20.4830 28.0764 25.8452 27.3272 26.9868 28.6498 26.1446 23.2503 25.3069 24.1521 * 17.7468 22.4198 27.2620 28.7209 27.8784 30.5784 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24887 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 290001 290002 290003 290005 290006 290007 290008 290009 290010 290012 290016 290019 290020 290021 290022 290027 290032 290039 290041 290042 290044 290045 290046 290047 290049 290051 290052 300001 300003 300005 300006 300010 300011 300012 300014 300017 300018 300019 300020 300023 300029 300034 310001 310002 310003 310005 310006 310008 310009 310010 310011 310012 310013 310014 310015 310016 310017 310018 310019 310020 310021 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.8544 0.9059 1.8294 1.4257 1.1856 1.6373 1.2052 1.7177 *** 1.3586 *** 1.4100 0.9879 1.7397 1.6627 0.8977 1.4275 1.5604 1.3801 *** *** 1.5925 1.3247 1.4996 1.3670 1.6067 0.8797 1.5438 2.1029 1.4046 *** *** 1.2842 1.3771 1.1567 1.3103 1.4114 1.2727 1.1629 1.3399 1.7610 1.9071 1.7811 1.8123 1.1430 1.3201 1.2212 1.3025 1.3174 1.2786 1.2517 1.6584 1.3584 1.9437 1.9917 1.3455 1.3323 1.1951 1.5537 1.5411 1.6686 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.1062 0.9688 1.1431 1.1431 1.0851 1.1431 0.9688 1.1062 * 1.1431 * 1.0851 0.9688 1.1431 1.1431 0.9688 1.1062 1.1431 1.1431 * * 1.1431 1.1431 1.1431 0.9688 0.9688 0.9688 1.1266 1.1266 1.1266 * * 1.1266 1.1266 1.1266 1.1266 1.1266 1.1266 1.1266 1.1266 1.1266 1.1266 1.3215 1.2993 1.3215 1.1681 1.3215 1.3215 1.2993 1.0879 1.0749 1.3215 1.2993 1.0778 1.2993 1.3215 1.2993 1.2993 1.3215 1.3215 1.1578 31.1981 18.3469 28.1625 27.6697 27.9501 37.5559 27.9714 29.8019 23.9655 31.0843 26.1925 28.6158 21.6993 33.2116 29.4422 15.1448 31.7105 31.2941 33.9877 * * 30.9612 * * * * * 27.5032 33.3560 25.6699 23.3200 27.5028 28.4044 30.5198 27.5151 29.6957 29.7209 25.9656 28.6723 28.6309 29.0806 29.7484 35.3612 37.3461 32.8935 29.0084 27.4545 31.2579 32.7384 28.5852 30.8612 34.6882 30.6248 29.7204 36.4776 33.9862 30.9233 30.3381 29.6592 30.6722 31.3410 36.3129 17.3876 30.3373 28.3366 31.7301 38.1938 27.3019 36.2724 * 32.3966 * 29.3650 23.2103 32.7894 29.9717 23.9959 31.6711 32.1423 34.2436 * 37.1662 33.1512 * * * * * 29.2260 34.7900 27.8000 * * 30.9403 30.4972 29.7667 29.9560 29.4270 27.5672 30.8491 31.0040 29.8117 30.7676 41.7460 37.9183 36.2346 32.1319 28.4771 32.6788 33.6940 33.9552 31.2907 38.3590 31.0447 30.0793 36.8818 35.6155 32.2434 30.3234 30.3518 33.5516 32.1929 35.5076 24.0115 32.8160 31.4494 31.9783 39.6409 30.8413 32.3330 * 35.7987 * 30.5954 27.7976 36.5004 33.3048 23.9599 34.3860 34.9629 37.4249 22.4809 * 34.4159 38.6235 33.4701 26.1159 * * 29.8127 37.0864 27.8412 * * 31.8926 31.2638 29.1829 31.6688 31.7886 28.2267 31.0585 31.2712 31.4416 31.6879 39.3376 37.9222 39.0744 33.6294 28.7318 33.3151 33.6147 33.6979 33.3167 39.8553 35.6324 32.9002 39.2914 38.2693 35.7519 32.9700 30.6364 38.4379 31.6553 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00209 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 34.2980 19.4175 30.4044 28.9962 30.5921 38.4737 28.7097 32.7004 23.9655 33.1284 26.1925 29.5666 23.8850 34.2290 30.8956 21.2093 32.5896 32.8645 35.3803 22.4809 37.1662 32.9841 38.6235 33.4701 26.1159 * * 28.8790 35.1213 27.1335 23.3200 27.5028 30.4452 30.7723 28.8585 30.4410 30.3782 27.2944 30.2190 30.3856 30.1530 30.7462 38.8070 37.7187 36.1389 31.6189 28.2233 32.4229 33.3544 32.1224 31.8219 37.6612 32.2990 30.9524 37.5855 36.0382 32.9534 31.1742 30.2332 35.7904 31.7275 24888 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 310022 310024 310025 310026 310027 310028 310029 310031 310032 310034 310037 310038 310039 310040 310041 310042 310044 310045 310047 310048 310049 310050 310051 310052 310054 310057 310058 310060 310061 310063 310064 310069 310070 310073 310074 310075 310076 310077 310078 310081 310083 310084 310086 310088 310090 310091 310092 310093 310096 310105 310108 310110 310111 310112 310113 310115 310116 310118 310119 310120 310122 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.2932 1.2738 1.3587 1.1830 1.3922 1.1686 1.9312 3.0093 1.3412 1.3882 1.3836 1.9989 1.2659 1.3296 1.3039 *** 1.3429 1.6626 1.3101 1.3620 *** 1.2631 1.4207 1.3148 1.3494 1.3560 1.1001 1.2254 1.2038 1.3573 1.5574 1.2293 1.4396 1.9339 1.4038 1.3460 1.6950 *** *** 1.2439 1.2968 1.2502 1.2173 1.1945 1.2500 1.1866 1.4214 1.2379 2.0679 1.2685 1.3924 1.3064 1.2383 1.3378 1.2461 1.3278 1.2564 1.2957 1.9246 1.1067 *** FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.0522 1.1681 1.3215 1.3215 1.1681 1.1681 1.0522 1.1131 1.0752 1.1131 1.3215 1.2993 1.2993 1.3215 1.1131 * 1.0879 1.3215 1.2095 1.1578 * 1.2993 1.1681 1.1131 1.2993 1.0652 1.3215 1.0024 1.0652 1.1681 1.2095 1.0752 1.2993 1.1131 1.3215 1.1131 1.2993 * * 1.0778 1.2993 1.1131 1.0522 1.2095 1.1681 1.0752 1.0879 1.2993 1.2993 1.3215 1.2993 1.0879 1.1131 1.1131 1.1131 1.0024 1.3215 1.3215 1.2993 1.1681 * 28.2024 30.9171 31.1274 27.5171 28.8314 31.3849 30.7707 33.9685 27.5232 29.9162 35.0329 33.4822 28.8292 34.1113 32.8085 30.7357 31.3205 34.1060 32.7880 30.2025 27.8565 27.3033 33.7168 30.8036 34.1860 29.5221 28.0815 25.1575 28.2129 31.4884 33.4440 28.1681 33.2310 32.0328 29.4834 31.6869 36.4280 32.6644 29.8014 26.6136 28.2392 32.9001 29.3058 26.4966 30.8941 27.7204 29.4998 28.0401 34.4275 31.9769 30.1002 31.2164 30.7475 30.4192 29.6079 29.6020 25.6976 28.8797 37.7876 31.4111 * 30.4043 33.3415 34.3687 29.1588 29.7793 32.2977 32.9246 37.0668 30.7865 31.7012 38.5415 35.9190 31.4278 33.8535 32.8390 34.4986 31.9678 36.7862 34.1520 32.9681 * 29.1732 35.0121 32.5778 34.4431 31.1268 27.1555 27.3415 31.6648 31.9247 35.7607 31.7642 34.3225 32.6733 40.3494 31.5226 38.0643 34.6085 30.5761 30.1561 30.3580 33.5941 29.5566 29.9929 32.8191 29.3969 29.7958 29.1288 34.1524 30.1069 33.0172 33.2246 31.8393 31.2372 31.0436 29.5320 29.2748 31.1803 43.1238 29.2535 * 31.1924 33.8601 32.2621 30.1373 31.5949 33.9891 33.6690 38.5892 33.0210 32.7508 38.2849 36.3324 33.2087 37.7941 33.9785 * 33.7598 38.4412 37.6016 33.9471 * 32.3677 38.1175 33.5833 36.9103 31.8882 30.4060 27.8235 39.0527 33.8500 38.6296 34.4614 36.3246 34.2852 39.6126 32.5325 37.5145 * * 31.0670 31.9125 32.6073 29.8937 30.3513 33.4603 31.9736 32.7029 30.2858 35.0725 32.5642 34.2946 33.4787 34.8278 32.2812 33.6769 32.8144 29.8219 31.2285 41.5679 33.3847 41.9008 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00210 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 29.9525 32.7346 32.6290 28.9603 30.0511 32.5798 32.4532 36.5339 30.4618 31.4426 37.2929 35.3010 31.1027 35.2736 33.1810 32.5359 32.3234 36.4048 34.9123 32.4207 27.8565 29.5223 35.6230 32.3042 35.1809 30.8455 28.5493 26.8641 32.6386 32.3995 36.0384 31.6133 34.6566 33.0130 36.4273 31.9056 37.3322 33.6290 30.1919 29.3003 30.1899 33.0241 29.5898 28.9184 32.3294 29.6731 30.6404 29.1452 34.5578 31.5185 32.4532 32.6988 32.5301 31.3132 31.5139 30.7156 28.1707 30.4796 40.9083 31.2917 41.9008 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24889 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 310123 310124 310125 310126 310127 320001 320002 320003 320004 320005 320006 320009 320011 320013 320014 320016 320017 320018 320019 320021 320022 320030 320033 320037 320038 320046 320057 320058 320059 320060 320061 320062 320063 320065 320067 320069 320070 320074 320079 320083 320084 320085 330001 330002 330003 330004 330005 330006 330008 330009 330010 330011 330013 330014 330016 330019 330023 330024 330025 330027 330028 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. *** *** *** 1.5770 2.1663 1.6846 1.4659 1.1337 1.3346 1.3975 1.3191 1.5658 1.1525 1.1100 1.0803 1.1846 1.1945 1.4713 1.5781 1.6048 1.1613 1.0965 1.1954 1.2522 1.2773 *** 0.8707 0.7716 0.8741 0.9480 0.8805 0.8907 1.3149 1.3098 0.8747 1.1001 0.9497 1.1777 1.0738 2.5853 0.9586 1.7001 *** 1.4716 1.3901 1.2791 1.5858 1.2547 1.1969 1.2178 0.9609 1.3855 1.8823 1.3016 *** 1.2360 1.5534 1.8516 1.0757 1.3299 1.4253 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 * * * 1.1681 1.0652 0.9740 1.0689 1.0376 0.8965 0.9740 0.9740 0.9740 0.9302 1.0376 0.8965 0.8965 0.9740 0.8990 0.9740 0.9740 0.8965 0.8965 1.0376 0.9740 0.8965 * 1.4406 1.4406 1.4406 1.4406 1.4406 1.4406 0.9527 0.9527 0.8965 0.8965 1.4406 0.9740 0.9740 0.9740 0.8965 0.8990 * 1.3215 0.8672 1.0644 0.9586 1.3215 0.9586 1.3215 0.8482 0.9072 0.8672 1.3215 * 1.3215 1.2380 1.3215 0.9586 1.2993 1.3215 * * * * * 26.9434 30.5158 28.1402 24.9481 23.8264 24.2812 22.8293 24.2279 28.9276 24.5310 23.5040 25.0286 23.2360 31.5192 27.2357 23.7160 22.1971 27.6393 23.3999 20.1533 24.3534 * * * * * * 24.4696 26.6603 23.7745 20.9167 * 22.2175 25.2105 28.2114 17.2511 24.8752 33.4718 31.1924 22.9945 26.0445 29.0124 31.5370 21.8198 35.4986 19.6920 21.8008 24.5162 38.8123 28.4391 34.8266 31.6208 37.8398 20.2776 39.0717 34.2709 * * * * * 29.6182 32.0477 27.6222 24.7803 24.7543 26.9080 32.0116 25.6693 22.8283 27.2806 25.0835 31.6357 26.5109 27.8067 26.9918 23.9595 21.0378 31.7114 24.9657 21.7022 * * * * * * * 25.0031 27.3163 24.9865 22.4128 * 31.1333 26.1188 26.6921 17.5788 27.9944 * 30.9600 24.4326 28.0594 30.3200 33.6284 23.4429 36.2820 20.7476 25.1308 26.4578 42.1759 22.0493 38.5368 35.9428 42.7691 21.2565 42.8000 36.6498 37.1088 41.8807 36.2250 * * 30.0055 33.1322 31.4451 26.2118 28.7944 28.0944 27.1448 27.9505 30.3766 28.7043 27.1469 33.3482 25.9235 35.0213 28.8474 25.3696 24.4482 30.1473 25.2866 32.7170 * * * * * * * 26.0095 25.7921 24.6963 23.9847 * 28.4393 27.6850 31.4628 22.7674 27.4093 * 32.1948 25.2199 29.9032 31.5013 34.1959 25.1985 34.8184 19.2838 27.4732 26.8359 45.7594 23.0754 39.7366 35.4371 43.2449 23.2412 45.1871 36.2872 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00211 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 37.1088 41.8807 36.2250 * * 28.9118 31.9531 29.2080 25.3020 25.7110 26.5127 26.7952 25.9804 26.8594 26.9250 25.3042 30.1538 25.0329 30.9859 27.7575 24.3630 22.6073 29.8085 24.5732 25.2881 24.3534 * * * * * * 25.1843 26.5970 24.5130 22.4801 * 27.5521 26.3851 28.8401 19.1162 26.8652 33.4718 31.4363 24.2253 27.9539 30.2919 33.1177 23.4724 35.5246 19.8627 24.7762 25.9711 42.1079 24.0041 37.6971 34.4826 41.1310 21.5971 42.3247 35.6905 24890 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 330029 330030 330033 330036 330037 330041 330043 330044 330045 330046 330047 330049 330053 330055 330056 330057 330058 330059 330061 330062 330064 330065 330066 330067 330072 330073 330074 330075 330078 330079 330080 330084 330085 330086 330088 330090 330091 330094 330095 330096 330097 330100 330101 330102 330103 330104 330106 330107 330108 330111 330115 330119 330125 330126 330127 330128 330132 330133 330135 330136 330140 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 0.4640 1.2459 1.1944 1.1736 1.1939 1.3232 1.3836 1.3066 1.3331 1.3803 1.1860 1.5206 1.0498 1.5727 1.4393 1.7325 1.2589 1.5266 1.1887 2.5188 1.1807 1.0348 1.2793 1.4313 1.3663 1.0847 1.2115 1.1310 1.4633 1.3908 1.1615 1.0885 1.1343 1.3317 1.0150 1.4726 1.3639 1.2532 *** 1.2270 1.0476 1.0853 1.9268 1.3805 1.1459 1.3468 1.7224 1.2622 1.1634 1.0675 1.1809 1.7982 1.7876 1.3169 1.3510 1.2215 1.1465 1.3487 1.1424 1.5153 1.8341 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.9586 0.8899 0.8645 1.3215 0.8899 1.3215 1.2791 0.8440 1.2791 1.3215 0.8482 1.2380 0.8899 1.3215 1.3215 0.8672 0.8899 1.3215 1.3215 * 1.3215 0.9586 0.8672 1.2380 1.3215 0.8899 0.8899 0.9912 0.9586 0.9431 1.3215 0.8440 0.9577 1.3215 1.2791 0.8440 0.9586 0.9231 * 0.8440 * 1.3215 1.3215 0.9586 0.8440 1.3215 1.2993 1.2791 0.8440 0.9586 0.9912 1.3215 0.8899 1.2993 1.3215 1.3215 0.8561 1.3215 1.0853 0.9577 0.9912 19.1589 22.9937 22.5680 28.9409 20.6904 36.0286 34.7480 24.1907 36.1893 44.8494 24.0678 29.2904 18.5289 38.4839 37.8444 24.4680 21.3727 39.7387 33.2848 21.0464 36.4276 23.9128 24.7941 26.4243 36.4336 20.1490 21.4274 22.4188 23.3981 22.5237 39.1724 21.5455 23.9568 29.1784 31.3973 23.6174 23.8063 23.0001 31.9873 22.0337 20.3189 34.4621 38.7503 24.8184 21.1452 32.8818 41.4561 31.3888 22.2607 20.9387 23.3043 39.1114 26.7119 31.6370 44.6103 37.7166 17.4946 36.6962 29.0837 24.2010 25.7573 23.2039 24.6175 24.5510 29.1884 22.3689 37.4883 39.1643 26.5669 38.1269 50.3152 24.3932 29.8350 20.6272 41.5934 36.0136 26.4989 22.2524 41.7343 36.0587 * 38.0437 25.3043 29.1780 27.8900 37.8505 22.5592 22.6629 23.1592 25.8073 24.6054 39.1417 22.5573 25.3285 32.7675 34.0789 25.5351 25.9378 25.7116 * 22.7189 * 38.3333 40.1929 25.3879 22.8242 33.7537 43.8210 34.9047 23.2919 20.3473 25.2373 39.0528 27.2920 35.2257 45.3680 39.5197 21.0479 39.3837 27.9132 25.8531 27.6183 24.0652 24.7514 24.8008 30.3728 21.9242 36.9921 37.6666 28.2003 40.0305 47.4949 24.9779 34.8972 21.8755 42.1979 38.8876 27.7098 21.7018 44.9131 37.8810 * 38.2307 24.3986 25.8149 29.2544 39.6955 23.0765 23.5142 23.4332 27.2852 24.9934 38.9393 25.6859 26.6208 35.4708 35.3841 26.8715 27.0011 26.9119 * 23.4149 * 39.6209 43.7932 26.6873 24.5566 34.3166 45.9263 35.7373 23.9344 40.4318 23.0235 42.2871 28.0831 36.5676 45.2974 41.7780 21.7624 38.5211 32.0511 26.6667 29.3429 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00212 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 21.4784 24.0792 23.9488 29.5020 21.6478 36.8224 37.1976 26.3311 38.1670 47.5038 24.4959 31.4643 20.3411 40.8295 37.5779 26.2555 21.7824 42.1510 35.7856 21.0464 37.5268 24.5180 26.6311 27.8289 37.9159 21.9326 22.5510 23.0114 25.5265 24.0663 39.0845 23.2864 25.3039 32.6068 33.6057 25.3561 25.6211 25.1924 31.9873 22.7206 20.3189 37.5339 40.9960 25.6615 22.8013 33.6767 43.7752 34.0849 23.1799 24.2734 23.8663 40.1393 27.3803 35.2858 45.0865 39.6521 20.0513 38.1371 29.6957 25.5991 27.5920 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24891 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 330141 330144 330151 330152 330153 330154 330157 330158 330159 330160 330162 330163 330164 330166 330167 330169 330171 330175 330177 330180 330181 330182 330184 330185 330188 330189 330191 330193 330194 330195 330196 330197 330198 330199 330201 330202 330203 330204 330205 330208 330209 330211 330212 330213 330214 330215 330218 330219 330221 330222 330223 330224 330225 330226 330229 330230 330231 330232 330233 330234 330235 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.3225 1.0373 1.1211 1.2983 1.7286 1.7054 1.3498 1.5257 1.3649 1.5299 1.2873 1.1299 1.4611 1.0839 1.7102 1.3871 *** 1.1110 0.9871 1.2281 1.2689 2.3122 1.4040 1.2787 1.2378 1.3891 1.2684 1.3149 1.7330 1.7148 1.2484 1.0598 1.3670 1.1951 1.5880 1.2474 1.4679 1.3409 1.1766 1.1551 *** 1.1593 *** 1.1110 1.9082 1.3064 1.0749 1.7271 1.3239 1.2884 1.0004 1.3202 1.2316 1.3388 1.1912 1.0097 1.0931 1.1619 1.4121 2.3848 1.1939 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.2791 0.8440 0.8440 1.3215 0.8672 * 0.9577 1.3215 0.9912 1.3215 1.3215 0.9586 0.8899 0.8440 1.2993 1.3215 * 0.8681 0.8440 0.8672 1.2993 1.2993 1.3215 1.2791 0.9586 0.8672 0.8672 1.3215 1.3215 1.3215 1.3215 0.8440 1.2993 1.3215 1.3215 1.3215 0.9912 1.3215 1.0853 1.3215 * 0.8440 * 0.8440 1.3215 0.8774 0.9912 0.9586 1.3215 0.8672 0.8440 1.0644 1.2993 0.8899 0.8440 1.3215 1.3215 0.8672 1.3215 1.3215 0.9577 34.8902 20.9935 19.1841 36.5136 24.5219 * 25.2312 32.2990 28.9094 34.1960 32.1783 24.0200 28.8481 19.4360 34.4748 39.3361 30.0122 22.2067 19.6100 22.1920 38.5351 39.6038 34.4044 32.3466 23.9210 21.6229 24.0232 37.1807 43.9910 40.0206 33.2171 23.4290 30.5485 35.0059 39.3682 38.0129 26.5882 37.6849 32.1618 29.6282 29.7988 22.9966 27.2232 22.5191 37.8500 22.6744 24.1106 29.3644 36.5539 23.9746 19.4229 25.7850 29.2719 21.8977 20.6095 33.3175 36.9619 24.4531 45.5132 40.6314 23.3866 39.4701 22.9561 21.7665 37.6721 26.4386 * 26.5686 38.2033 28.2774 36.6208 34.9460 27.1933 27.7217 20.4680 36.7653 45.3774 30.4005 23.8509 20.6338 24.3761 41.4104 40.9014 35.8102 36.3155 25.1153 22.3484 25.5656 39.9327 45.5639 39.7802 36.7178 26.8921 33.4930 38.6407 37.2064 37.4150 32.1207 39.6393 31.9510 32.1256 30.2038 24.4470 * 24.4049 41.8719 23.7361 26.9638 29.8889 39.2080 25.8507 23.3669 27.9231 32.3585 24.5646 21.9356 37.1298 40.6697 26.3313 47.3497 48.2306 27.7031 38.2473 23.3863 19.7949 38.2040 28.4427 * 27.1422 41.6972 31.7829 39.4136 37.6198 28.3889 27.4988 20.7114 39.1206 46.4890 35.1552 23.3990 22.9802 25.4142 42.2619 40.8712 39.0405 37.9564 27.5982 22.4386 26.4297 38.9508 46.8833 41.7863 38.2483 25.9860 34.8948 40.3929 42.6689 37.4138 34.0475 41.9936 33.9404 33.5256 * 25.8735 * 27.4887 41.2768 23.9564 26.9959 32.5646 40.0488 27.7182 26.1256 29.0864 35.7735 24.8456 23.0562 38.6523 44.9376 27.4623 52.7025 49.3194 29.4294 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00213 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 37.6083 22.4512 20.1954 37.4693 26.4924 * 26.3135 37.3734 29.5878 36.7564 34.8798 26.5653 28.0125 20.1915 36.7231 43.5617 31.6496 23.1608 21.0952 23.9988 40.7706 40.4724 36.4609 35.6879 25.5241 22.1392 25.3758 38.7084 45.5303 40.5425 36.0767 25.4379 33.0511 37.9482 39.7174 37.6069 30.8848 39.7972 32.7289 31.7765 30.0002 24.4782 27.2232 24.8464 40.2400 23.4614 26.0466 30.5813 38.6287 25.9131 22.8479 27.6364 32.4753 23.8231 21.8540 36.3361 40.8957 26.1064 48.3771 45.8234 26.7553 24892 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 330236 330238 330239 330240 330241 330242 330245 330246 330247 330249 330250 330259 330261 330263 330264 330265 330267 330268 330270 330273 330276 330277 330279 330285 330286 330290 330304 330306 330307 330314 330316 330331 330332 330333 330338 330339 330340 330350 330353 330354 330357 330372 330385 330386 330389 330390 330393 330394 330395 330396 330397 330399 330401 330403 330404 330405 330406 340001 340002 340003 340004 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.5608 1.2614 1.2560 1.2133 1.8038 1.3307 1.8750 1.3359 0.8986 1.3518 1.3308 1.4194 1.2665 1.0289 1.2912 1.1849 1.3602 0.9192 2.0325 1.3982 1.0979 1.1791 1.5215 1.9980 1.3653 1.7316 1.3060 1.4126 1.3336 *** 1.2421 1.2559 1.2705 *** *** 0.7038 1.2556 1.4768 1.2410 2.1053 1.2623 1.2696 1.1071 1.2194 1.7372 1.2371 1.7369 1.6366 1.4366 1.5239 1.4326 1.0763 1.3610 0.9812 0.8616 0.8688 0.8701 1.5147 1.8220 1.1852 1.4192 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.3215 0.8899 0.8440 1.3215 0.9912 1.3215 0.8440 1.2791 1.3215 0.9912 0.9589 1.2993 1.3215 0.8440 1.0853 0.8899 1.3215 0.8440 1.3215 1.3215 0.8440 0.9715 0.9586 0.8899 1.2791 1.3215 1.3215 1.3215 0.9715 * 1.3215 1.2993 1.2993 * * 0.8672 1.2791 1.3215 1.3215 * 1.3215 1.2993 1.3215 1.1578 1.3215 1.3215 1.2791 0.9072 1.3215 1.3215 1.3215 1.3215 1.2791 0.8899 1.3215 1.3215 0.8672 0.9512 0.9209 0.8608 0.9083 35.6347 20.8639 21.5397 39.9450 29.0882 33.6926 22.8003 34.6329 32.2300 22.9834 25.1664 31.9152 30.7942 22.4675 30.0139 20.4635 31.5478 20.9720 42.2111 30.4720 22.2353 25.3582 25.2130 27.9018 33.3552 36.9981 34.5761 35.6640 27.5699 25.5597 34.8623 36.1630 33.3050 26.1917 31.3761 22.6569 33.9358 36.6250 37.6549 * 35.5975 32.6721 46.3221 27.9943 34.7669 36.0573 34.8095 25.2229 37.3096 35.0297 38.4741 32.3688 40.6249 23.1886 * * * 25.0041 27.3349 23.3066 25.4474 40.2386 21.7435 22.3854 43.5753 30.2304 37.4870 26.1811 37.1611 35.4980 25.3246 27.1606 35.1514 33.7834 23.8738 30.4701 21.6477 32.8541 25.3567 57.3596 37.0157 24.3300 26.4535 27.4539 30.1928 35.5895 39.4690 36.2845 36.3552 29.2529 26.2719 34.8567 39.8402 35.1646 * 37.7497 23.5786 37.9000 41.1339 45.9692 * 38.2286 36.1840 48.6175 29.9366 37.1862 36.3842 38.0619 27.3388 36.3921 37.4998 37.5682 34.7394 37.8559 25.5163 * * * 28.3988 28.4860 24.1602 26.6404 42.8923 21.7652 23.6653 40.4972 32.6139 36.8969 27.4329 35.7391 39.0193 23.8548 29.0058 36.5831 40.2554 24.1312 30.1809 23.9070 34.9869 23.8791 55.2076 34.5032 26.0917 30.9561 29.4540 31.1219 36.8535 40.3862 37.3516 38.7631 29.5522 28.1362 37.1744 41.2652 37.0082 * * 24.3064 36.0162 43.9324 45.0917 * 40.3814 35.1250 49.0841 33.3181 38.6409 35.5521 39.2461 28.4575 37.5757 39.4882 41.4413 37.1175 40.4446 25.2928 * * * 29.5669 29.6875 26.0869 27.5270 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00214 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 39.6820 21.4610 22.5395 41.3029 30.7098 35.9769 25.5153 35.8256 35.4567 24.0420 27.1464 34.5776 34.7041 23.5399 30.2033 21.9772 33.1372 23.3606 51.3946 34.0363 24.2198 27.3784 27.4527 29.7572 35.2974 38.9177 36.1507 36.9884 28.8425 26.6009 35.6156 39.1610 35.2111 26.1917 34.6182 23.5064 35.9189 40.6020 43.0066 * 37.9050 34.7426 47.9726 30.4738 36.8607 35.9765 37.4154 27.0150 37.0853 37.3251 39.1429 34.7258 39.6483 24.6329 * * * 27.7156 28.5183 24.5118 26.5361 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24893 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 340005 340008 340010 340011 340012 340013 340014 340015 340016 340017 340018 340020 340021 340023 340024 340025 340027 340028 340030 340032 340035 340036 340037 340038 340039 340040 340041 340042 340045 340047 340049 340050 340051 340053 340055 340060 340061 340064 340068 340069 340070 340071 340072 340073 340075 340084 340085 340087 340090 340091 340096 340097 340098 340099 340104 340106 340107 340109 340113 340114 340115 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 0.9877 1.1889 1.3717 1.1370 1.2498 1.2487 1.5497 1.3640 1.2883 1.3186 *** 1.2004 1.3001 1.3623 1.1037 1.3303 1.1601 1.5219 2.0869 1.4485 1.0891 1.3731 1.1089 1.2278 1.2800 1.9806 1.1961 1.2712 *** 1.8383 1.8540 1.1120 1.2212 1.4963 1.2461 1.1427 1.8071 1.0727 1.2508 1.8779 1.2886 1.0909 1.2076 1.6001 1.2345 1.1990 1.1471 1.2862 1.3672 1.5781 1.2035 1.2771 1.4524 1.3064 0.9032 1.1107 1.2094 1.2629 1.9347 1.5707 1.6239 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 * 0.9348 0.9373 0.8608 0.8608 0.9348 0.9083 0.9348 0.8608 0.9209 * 0.8751 0.9348 0.9386 0.8779 0.9209 0.9272 0.9926 0.9814 0.9512 0.8608 0.9373 0.8770 0.8861 0.9348 0.9272 0.8977 0.8608 * 0.9083 0.9814 0.9600 0.8819 0.9512 0.8977 0.9111 0.9814 0.8608 0.9172 0.9603 0.9111 0.9373 0.8608 0.9603 0.8977 0.9512 0.8858 0.8608 0.9373 0.9083 0.8858 0.8608 0.9512 0.8608 0.8770 0.8608 0.9017 0.8785 0.9512 0.9603 0.9603 22.3814 26.6314 24.5666 19.9484 22.7189 23.0261 25.1872 26.2276 23.0359 23.8229 23.7243 23.7995 26.0995 24.4896 22.2522 21.2276 23.6326 26.3298 29.0122 26.7475 23.5476 25.2077 21.6411 14.0713 27.1275 26.3325 23.6600 23.0236 23.1918 25.0605 30.4827 24.2533 23.4091 27.7261 24.1057 22.8657 27.5594 22.9143 21.8830 27.4473 24.9033 25.4537 23.1163 30.2061 26.0226 21.2580 23.9793 22.0070 23.4541 25.8266 25.2169 24.2127 27.3308 20.3683 15.7521 22.4894 22.9698 23.4419 28.2568 26.6813 25.0212 * 26.7443 27.2105 19.7441 23.2288 23.9492 27.4888 28.0585 25.6454 25.7780 * 26.4465 29.4864 26.4225 23.6638 23.5881 25.5973 28.0323 29.6630 26.5958 23.9669 27.2691 25.6262 22.4829 27.4457 27.6626 24.3595 25.0110 * 27.4022 30.6791 26.0365 23.9612 27.8577 26.0647 22.9097 27.0089 23.4233 22.6814 29.3439 25.3226 26.3921 25.2493 30.9849 25.1551 21.1363 26.5164 22.4287 26.4031 27.1285 24.9036 26.2228 28.2493 21.8564 16.1204 26.0892 24.1762 25.4464 28.5587 28.3222 26.7592 * 27.7190 28.7525 22.0042 24.7564 26.3599 27.8361 28.3916 27.3478 27.4678 * 27.5449 29.3819 26.3102 26.3988 24.0074 26.3812 30.7692 30.7705 28.7619 24.6257 27.3834 29.0640 24.2103 27.8213 28.7422 26.8306 25.6323 * 28.4974 29.6812 27.5249 24.4546 28.9350 26.5750 25.1769 29.8565 23.9696 23.6737 29.2259 26.6539 27.9724 24.1322 32.2694 25.1432 23.1513 27.9544 25.4716 26.7407 28.8018 26.5426 29.7729 29.6697 23.9712 17.6322 26.1296 26.6468 26.6306 30.3822 28.1306 27.2771 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00215 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 22.3814 27.0539 26.8565 20.5589 23.5968 24.4158 26.8911 27.5637 25.3411 25.6896 23.7243 25.9051 28.3674 25.7592 24.1337 22.9989 25.2702 28.3795 29.8384 27.4144 24.0393 26.6507 25.6376 19.1095 27.4756 27.6117 25.0114 24.5577 23.1918 27.0298 30.2355 25.9399 23.9484 28.1745 25.5722 23.6611 28.1789 23.4392 22.7405 28.6869 25.6456 26.6149 24.1635 31.1640 25.4400 21.8365 26.0796 23.2830 25.6220 27.2994 25.5725 26.6118 28.4313 22.0909 16.5484 24.8414 24.6193 25.1776 29.0843 27.7302 26.3716 24894 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 340116 340119 340120 340121 340123 340124 340126 340127 340129 340130 340131 340132 340133 340137 340138 340141 340142 340143 340144 340145 340147 340148 340151 340153 340155 340156 340158 340159 340160 340166 340168 340171 340173 340177 340178 340179 340182 340183 350002 350003 350006 350009 350010 350011 350014 350015 350017 350019 350030 350061 350063 350070 360001 360002 360003 360006 360008 360009 360010 360011 360012 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.7637 1.3184 1.0120 1.1179 1.3434 1.0382 1.2877 1.1542 1.2616 1.3513 1.5011 1.1993 1.0170 *** 0.8420 1.6591 1.1639 1.5072 1.2446 1.1838 1.3000 1.4008 1.1664 1.8779 1.4283 0.8549 1.1124 1.2301 1.3374 1.2904 0.3793 1.1735 1.2951 1.0970 *** *** *** 1.0771 1.8102 1.1838 1.5606 1.1335 0.9681 1.9833 0.9073 1.6832 1.2724 1.6835 0.9605 1.4521 0.8930 1.8146 1.4375 1.2626 1.7692 1.9028 1.3248 1.6042 1.2239 1.2624 1.3983 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.8977 0.9512 0.8608 0.9338 0.9111 0.9373 0.9373 0.9603 0.9348 0.9512 0.9272 0.8608 0.8850 * 0.9603 0.9338 0.8608 0.8977 0.9348 0.9348 0.9373 0.9083 0.8661 0.9512 0.9814 1.4406 0.9338 0.9814 0.8608 0.9512 0.9338 0.9512 0.9603 * * * * 0.9512 0.7329 0.7329 0.7329 0.8189 0.7313 0.8189 0.7313 0.7329 0.7313 0.7729 0.7313 * 1.4406 0.8189 0.9654 0.8843 0.9654 1.0048 0.8706 0.9312 0.8810 0.9840 1.0048 25.3213 24.2287 23.0915 21.7576 26.1083 20.8018 25.0189 25.7831 25.4902 25.2941 27.9358 21.3521 22.5558 21.0642 21.3670 27.3355 22.9907 25.3633 27.2686 23.7131 25.4534 23.5880 22.0052 26.4896 30.4940 * 26.4849 23.2991 20.7525 26.0558 17.3249 28.2734 27.5072 24.7471 28.7218 * * * 22.0283 21.8061 19.4985 23.0873 19.1964 23.1947 17.7565 20.1161 21.0243 22.1960 18.9978 22.0515 * 25.2836 23.9101 24.5789 27.5029 28.1698 24.5714 23.1012 23.1178 25.5340 27.5470 27.5881 25.6226 25.9134 23.1343 26.0637 22.2988 26.9866 26.4746 25.7976 26.1717 27.4750 23.5856 23.4678 22.1741 * 29.3878 26.6886 28.0082 26.1865 25.8459 26.9162 25.3660 22.7736 27.6509 30.3443 * 27.7816 24.2588 21.7923 27.1132 * 27.8539 28.3502 26.7155 * 34.1895 27.8071 * 22.4307 23.9639 21.2726 23.8681 20.1290 23.8400 19.1684 20.9046 22.4359 23.2018 20.2722 * * 25.2365 25.8669 24.5155 28.9672 30.1363 26.2632 25.0007 23.7825 27.6036 30.1416 29.3675 29.4442 25.5502 23.8832 28.5642 23.5464 28.2229 28.2146 26.7596 28.1587 28.8528 24.3442 24.8551 28.9661 * 29.3158 27.7501 27.9782 27.0139 26.7457 28.2605 25.8316 23.2142 28.5972 31.6013 * 27.9252 24.8366 23.4619 28.5388 * 27.4705 30.2808 * * * * * 23.7161 24.9963 22.4602 24.5724 20.4189 24.1118 17.5803 21.3324 21.6164 23.9585 22.5960 * * 26.2446 28.8621 25.4859 30.7793 30.9800 27.5658 27.0599 24.7338 31.5555 31.0504 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00216 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 27.4184 26.4327 24.8610 22.9461 26.9157 22.2123 26.7660 26.8344 26.0411 26.5937 28.1009 23.1134 23.5976 23.0832 21.3670 28.6960 25.8989 27.1350 26.8084 25.4570 26.9066 24.9275 22.6702 27.6009 30.8281 * 27.3725 24.1490 22.0119 27.2672 17.3249 27.8496 28.7935 25.7127 28.7218 34.1895 27.8071 * 22.7683 23.6034 21.0489 23.8525 19.9339 23.7255 18.1595 20.8688 21.6690 23.1800 20.6212 22.0515 * 25.5900 26.1633 24.8654 29.0933 29.7938 26.1301 25.0987 23.9116 28.1828 29.6648 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24895 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 360013 360014 360016 360017 360019 360020 360024 360025 360026 360027 360029 360032 360035 360036 360037 360038 360039 360040 360041 360044 360046 360047 360048 360049 360051 360052 360054 360055 360056 360058 360059 360062 360064 360065 360066 360068 360069 360070 360071 360072 360074 360075 360076 360077 360078 360079 360080 360081 360082 360084 360085 360086 360087 360089 360090 360091 360092 360094 360095 360096 360098 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.0938 1.1288 1.4363 1.7059 1.2999 1.6208 *** 1.4533 1.3236 1.6124 1.0866 1.2094 1.7332 1.2090 1.4254 1.5417 1.4955 1.1428 1.4963 1.1371 1.2025 1.0860 1.7551 *** 1.6982 1.6085 1.3922 1.4135 1.6196 1.0570 1.5019 1.4828 1.5894 1.2185 1.5174 1.8821 1.2464 1.6601 1.1154 1.5235 1.3006 1.1470 1.4896 1.5217 1.2784 1.7865 1.1298 1.3482 1.3502 1.6070 2.0277 1.6599 1.3509 1.1462 1.5838 1.3280 1.2657 *** 1.4017 1.0892 1.3635 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.9312 0.9840 0.9654 1.0048 0.9238 0.9238 * 0.9276 0.9283 0.9238 0.9276 0.8701 1.0048 0.9238 0.9365 0.9654 0.9840 0.9093 0.9365 0.8824 0.9654 * 0.9276 * 0.9283 0.9283 0.8706 0.8996 0.9654 0.8701 0.9365 1.0048 0.8996 0.9276 0.9312 0.9276 * 0.8921 0.8736 1.0048 0.9276 0.9365 0.9654 0.9365 0.9238 0.9654 0.8701 0.9276 0.9365 0.8854 1.0048 0.9283 0.9365 0.8701 0.9276 0.9365 1.0048 * 0.9276 0.8775 0.9365 26.8130 25.3861 26.1283 27.2910 25.5926 24.4343 23.5793 25.5633 23.5898 25.4894 22.7785 23.2638 27.5220 27.6094 24.3982 22.8009 24.0218 24.0942 24.1080 21.8411 25.0775 21.7248 28.8107 25.8367 25.7556 24.5405 23.0376 26.3112 23.1024 23.4429 25.3516 28.6518 22.2393 26.3036 27.3362 25.8414 24.2444 24.8863 22.0786 24.4332 24.9055 26.8453 25.9369 25.6505 26.1313 26.0935 20.8309 27.5695 27.1197 25.8415 29.0081 22.1859 25.4040 22.7951 26.7717 27.5067 25.6618 26.6348 26.1275 24.6317 24.8447 27.0893 27.1017 27.8031 29.8525 26.9178 23.6400 * 27.4533 25.5379 27.4454 24.3216 25.0034 30.0172 27.8343 29.0046 25.4274 23.9783 24.8569 26.1522 21.5619 25.4673 * 29.3415 26.2222 26.8501 26.2066 22.9359 27.3941 26.5318 23.8119 29.3624 31.7422 25.2336 28.0405 27.1436 26.2065 * 27.2389 23.4619 25.9589 25.8959 26.8925 28.1013 28.4449 25.7885 27.2437 21.4526 29.8366 29.2561 27.3917 31.5800 25.4218 29.6579 25.3465 29.0199 25.8657 25.4954 * 26.4635 25.9275 25.5973 29.8398 27.0725 29.6279 31.7064 27.2984 25.6319 * 27.1537 25.2930 28.2908 26.4202 25.9909 31.3158 29.3509 30.0437 31.0557 24.7864 25.5333 26.6728 24.3827 26.2408 * 29.4798 * 28.1154 26.8786 24.8241 30.0124 30.3674 24.5004 30.6157 33.1325 27.7775 29.7142 29.7605 26.6926 * 27.8858 26.4057 27.2266 27.5322 26.1643 29.0117 28.2382 27.4681 30.1207 22.7007 29.5312 28.7914 28.5391 33.1242 27.1112 28.4514 25.5599 30.7505 27.6802 25.4045 * 29.3772 26.8627 26.6025 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00217 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 27.9263 26.5476 27.8538 29.6400 26.6159 24.5731 23.5793 26.7665 24.8033 27.0616 24.5304 24.7561 29.6736 28.2916 27.6733 26.2991 24.2787 24.8327 25.6861 22.5765 25.5991 21.7248 29.2208 26.0185 26.9160 25.8857 23.5843 27.8965 26.6370 23.9275 28.4896 31.3394 24.9757 28.0320 28.0751 26.2580 24.2444 26.6566 23.9592 25.9252 26.1110 26.5899 27.7066 27.4520 26.4451 27.8332 21.7293 28.9628 28.4294 27.2562 31.3481 24.8912 27.8631 24.5871 28.8607 27.0162 25.5161 26.6348 27.2940 25.8201 25.7083 24896 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 360100 360101 360106 360107 360109 360112 360113 360115 360116 360118 360121 360123 360125 360128 360130 360131 360132 360133 360134 360137 360141 360142 360143 360144 360145 360147 360148 360150 360151 360152 360153 360155 360156 360159 360161 360163 360170 360172 360174 360175 360177 360179 360180 360185 360187 360189 360192 360195 360197 360203 360210 360211 360212 360218 360230 360234 360236 360239 360241 360242 360245 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.2005 1.3623 *** 1.1250 1.0690 1.9961 1.3136 1.2841 1.1939 1.5237 1.3620 1.4133 1.1982 *** 1.4718 1.3051 1.3639 1.6035 1.7956 1.7463 1.6594 1.0704 1.2891 1.3643 1.6714 1.2484 1.0883 1.2297 1.6221 1.5017 0.9767 1.4479 1.1512 1.2592 1.3686 1.9114 1.3066 1.3796 1.2817 1.2427 1.1565 1.5926 2.2538 1.1979 1.5392 1.1090 1.2914 1.0872 1.1400 1.2433 1.1676 1.5603 1.3255 1.1995 1.5565 1.3350 1.2597 1.3159 *** 1.8997 0.5512 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.8921 0.9365 * 0.9276 0.8701 0.9276 0.9654 0.9365 0.9654 0.9214 0.9276 0.9365 0.8701 * 0.9365 0.8921 0.9654 0.9283 0.9654 0.9365 0.8996 * 0.9365 0.9365 0.9365 0.8701 0.8701 0.9238 0.8921 1.0048 0.8701 0.9365 0.8796 0.9840 0.8996 0.9654 1.0048 0.9365 0.9283 0.9840 * 0.9654 0.9365 0.8775 0.9283 1.0048 0.9365 0.9365 0.9840 0.8701 1.0048 0.8701 0.9365 1.0048 0.9365 0.9654 0.9654 0.9283 * * 0.9238 23.0561 26.6209 24.1588 25.9697 25.4184 28.6784 25.6493 24.0052 18.0655 27.7289 24.5593 22.6523 22.1096 21.0067 22.9762 24.0496 25.9453 24.6208 29.2974 26.9522 27.7085 22.1610 24.6306 25.7079 25.8268 24.1953 26.1947 24.7667 24.8629 27.9147 19.0226 25.3909 24.0509 33.1613 24.3792 26.9728 24.3620 26.3501 24.9990 26.5949 24.4712 28.8645 26.1514 23.7173 24.8173 24.2136 26.7577 26.1281 27.0896 22.1414 27.8415 22.5449 25.2756 27.4288 27.0223 24.3625 35.8143 25.2474 24.7001 * 19.1884 25.4523 27.6030 * 24.6095 26.3131 30.5715 26.6556 25.9841 25.1717 27.3884 27.4442 27.1920 24.1388 * 25.6570 25.3719 27.7724 29.8684 27.7339 26.1250 29.7937 * 28.3057 28.2473 27.1908 25.5854 26.0837 25.1217 25.3780 29.9425 19.8499 26.9127 24.3281 29.1529 25.4433 28.9742 28.5474 27.5669 26.8586 28.1531 * 30.0311 29.6633 25.6800 24.9353 26.3756 26.4616 25.0922 28.7580 24.4433 28.2976 25.7053 25.6080 29.8662 28.8018 25.9360 25.6728 27.2939 23.0662 * 20.6504 23.6159 29.7806 * 26.0530 30.1363 31.1515 30.2863 26.1795 26.4955 28.5629 28.3823 28.0320 25.9042 * 26.3962 26.6628 29.4046 31.7499 28.5138 27.6882 31.1769 * 27.3743 28.9166 28.1802 27.5529 26.3390 31.2684 26.5001 31.5364 20.2124 28.9551 25.0839 28.6161 27.0861 30.0503 30.2417 28.8276 28.3284 28.3038 * 29.8291 31.4318 26.1053 25.7593 27.5194 27.5979 27.6148 28.9190 25.3724 29.1231 26.5443 27.2263 30.0072 30.0644 31.0655 29.5312 30.7698 25.7293 * 20.3411 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00218 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 24.0347 28.0278 24.1588 25.5447 27.2357 30.1229 27.4972 25.4590 23.3907 27.8928 26.7820 25.8332 23.9896 21.0067 25.2266 25.3527 27.6748 28.7264 28.4864 26.9252 29.5398 22.1610 26.8209 27.6777 27.1029 25.7869 26.2100 26.9639 25.5913 29.7871 19.7383 27.1136 24.5014 30.0443 25.6054 28.6581 27.8461 27.5898 26.7426 27.6954 24.4712 29.5971 29.1118 25.1940 25.1880 26.0228 26.9455 26.2465 28.2666 24.0021 28.4261 24.7611 26.0408 29.0783 28.6832 27.0902 29.3312 27.7358 24.4913 * 20.0849 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24897 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 360247 360253 360259 360260 360261 360262 360263 360264 360265 360266 360267 360268 360269 360270 360271 360273 370001 370002 370004 370006 370007 370008 370011 370013 370014 370015 370016 370018 370019 370020 370022 370023 370025 370026 370028 370029 370030 370032 370034 370036 370037 370039 370040 370041 370047 370048 370049 370051 370054 370056 370057 370060 370064 370065 370072 370078 370080 370083 370084 370089 370091 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 0.3793 2.4484 1.3020 *** 1.3730 1.3188 1.8192 *** *** 2.1280 *** *** 1.7180 1.1022 1.4810 1.6114 1.6364 1.2199 1.1269 1.2605 1.0754 1.4647 0.9837 1.5640 1.0060 1.0124 1.6367 1.5049 1.2516 1.3456 1.2128 1.3507 1.2923 1.4292 1.8835 1.1365 1.0204 1.4524 1.2252 1.1122 1.6252 1.0449 0.9665 0.8802 1.3864 1.0417 1.3124 1.0579 1.2325 1.8614 0.9753 0.9969 0.8912 1.0064 0.8029 1.5669 0.8703 0.8972 0.9999 1.3096 1.5724 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.0048 0.9654 0.9276 * 0.8845 0.9276 0.9312 * * 1.0048 * * 0.9654 0.8701 0.9654 0.8701 0.8504 0.7702 0.9040 0.8504 0.7702 0.8764 0.8764 0.8764 0.8535 0.8504 0.8764 0.8504 0.7702 0.7702 0.8071 0.7792 0.8504 0.8764 0.8764 0.7702 0.7702 0.8764 0.7702 0.7702 0.8764 0.8504 0.8056 0.8504 0.8764 0.7702 0.8764 0.7702 0.7702 0.8406 0.8504 0.8504 * 0.7799 0.7962 0.8504 0.7702 0.7753 0.7702 0.7702 0.8504 19.8891 30.4276 25.1338 27.3903 22.5431 27.1680 20.8884 * * * * * * * * * 27.7245 20.1479 25.3919 20.1063 17.6547 24.2978 19.7821 24.9294 25.3576 23.6694 25.4062 23.5336 21.4474 18.5046 19.6495 21.5762 23.5659 23.0848 26.6153 23.9956 23.3037 23.4843 18.2341 17.7575 23.9685 21.8220 22.4048 22.3496 20.4657 19.2464 23.2171 17.2618 21.5044 22.0312 19.7284 18.7592 14.2053 20.0227 9.9615 25.4068 18.0665 16.8836 16.6513 20.4699 23.3357 19.3677 33.2371 25.9878 * 22.3614 28.6995 25.1652 36.0754 36.6265 * * * * * * * 26.0194 22.0476 26.7434 22.4802 19.4036 25.3352 21.9649 26.5364 25.9393 24.7547 26.7938 25.3573 22.0221 20.8723 24.6099 23.5170 23.9873 25.8428 27.8621 26.8508 24.1483 24.8626 19.5099 19.2318 24.9553 23.0254 22.8356 22.6731 24.1991 21.4543 23.8844 19.8329 22.4652 24.3986 19.8683 19.9025 * 21.2343 11.7942 27.8611 19.9595 19.2568 19.6230 20.6153 24.1438 * 34.3298 27.2896 * 25.6328 30.1562 25.4813 * * 31.7532 34.0914 34.0503 24.8569 * * * 26.9066 23.6850 26.8511 23.9928 20.3673 26.6546 22.3379 27.2662 26.4459 25.5786 29.8253 24.6848 25.2799 22.7512 22.2254 23.9997 24.5531 25.3460 28.5594 28.5284 25.8183 26.3171 20.4074 19.8132 25.5152 23.5733 26.7367 22.9777 24.4738 22.0594 22.8742 19.3164 25.2122 25.5420 22.1308 23.3793 * 23.5785 13.0903 26.6945 22.3662 20.9831 20.7278 22.1503 25.8676 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00219 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 19.6148 32.7134 26.1978 27.3903 23.5171 28.7641 23.9900 36.0754 36.6265 31.7532 34.0914 34.0503 24.8569 * * * 26.8618 21.9862 26.3097 22.1048 19.1460 25.4718 21.3301 26.2290 25.9300 24.6931 27.2541 24.5166 22.9578 20.7432 22.0686 23.0468 24.0379 24.7668 27.6903 26.4589 24.4349 24.8715 19.4048 18.9467 24.8480 22.8098 23.9154 22.6684 23.0657 20.9179 23.3160 18.8224 22.9823 23.9740 20.5333 20.5008 14.2053 21.6442 11.6655 26.6513 20.0726 18.9413 19.1519 21.0632 24.4372 24898 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 370093 370094 370097 370099 370100 370103 370105 370106 370112 370113 370114 370123 370125 370138 370139 370148 370149 370153 370156 370158 370166 370169 370170 370171 370172 370173 370174 370176 370177 370178 370179 370180 370183 370190 370192 370196 370199 370200 370201 370202 370203 370206 370210 370211 370212 370213 370214 370215 370216 370217 370218 370220 370222 370223 370224 380001 380002 380004 380005 380007 380008 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.6188 1.4242 1.3209 1.0704 0.9275 1.0056 1.9411 1.4000 0.9491 1.1449 1.5828 *** *** 1.0409 0.9462 1.5477 1.2424 1.1462 0.9979 0.9453 0.8427 0.8651 0.9077 0.8795 0.8593 0.9221 0.7942 1.2142 *** 0.8842 0.8038 1.0055 0.9349 1.4248 1.9859 *** 0.7713 1.0426 1.6779 1.4321 2.0656 1.5795 2.1553 1.0823 1.7647 *** 0.9301 2.4404 2.0143 *** 2.3290 2.0085 1.8273 0.8874 1.0183 1.3085 1.2471 1.7236 1.4094 2.0573 *** FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.8764 0.8764 0.8406 0.7702 0.7803 0.7702 0.8764 0.8764 0.8056 0.8719 0.8504 * * 0.7702 0.7702 0.8764 0.8764 0.7702 0.7824 0.8764 0.8504 0.7866 1.4406 1.4406 1.4666 1.4406 1.4406 0.8504 * 0.7702 * 1.4406 0.8504 0.8504 0.8764 * 0.8764 0.7702 0.8764 0.8504 0.8764 0.8764 0.8504 0.8764 0.8764 * 0.7824 0.8764 0.8504 * 0.8504 0.8764 0.8764 0.8764 0.8764 1.1233 0.9950 1.1233 1.0304 1.1233 * 26.9774 23.1191 22.3267 20.5075 14.7711 17.8018 23.8978 26.5867 15.4471 25.3565 21.7880 25.4733 17.1361 18.3113 18.5226 25.2348 22.3537 19.8349 19.4743 18.5578 23.1682 15.8002 * * * * * 25.0509 14.7193 14.6070 23.5794 * 21.8147 33.1137 31.4930 22.6824 26.0450 17.6317 23.3550 25.1181 23.5190 26.0912 21.2682 26.5345 21.0758 29.3777 * 32.3589 * * * * * * * 30.0103 27.1861 30.5172 30.2210 33.9969 25.8356 26.0459 24.5555 26.3168 24.9971 17.9732 18.8933 26.7973 27.8979 16.0592 26.9720 23.0006 * * 20.2528 19.4287 27.0904 23.3493 23.2778 25.2562 20.7641 25.1107 16.8252 * * * * * 24.7655 * 16.0179 * * 24.7103 29.1568 27.6367 22.3498 23.3989 20.5175 23.8090 26.1132 22.8869 26.0353 23.3786 27.8737 19.1720 * 20.6217 31.5652 27.2429 26.8677 * * * * * 29.5842 30.3385 32.6901 30.9087 33.9601 * 27.4328 26.5223 26.7940 26.7160 19.3931 19.4227 26.6370 28.5947 16.7860 26.4599 25.9816 * * 22.1656 20.5120 28.1920 23.3403 24.1577 23.0030 21.5187 24.7202 16.6722 * * * * * 24.9681 * 16.0702 * * 23.8398 34.8952 19.0636 20.8286 23.7422 21.7857 24.2461 25.7745 25.7761 27.5742 27.2693 28.6515 20.3497 * 21.0658 32.4081 25.8238 * 30.3422 * * * * 32.0772 31.5214 34.5430 33.2838 35.1698 * —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00220 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 26.8140 24.7218 25.2222 23.9172 17.4549 18.7231 25.8992 27.7396 16.1368 26.2279 23.5714 25.4733 17.1361 20.1240 19.5050 26.9001 23.0323 22.4430 22.5278 20.2564 24.3416 16.4248 * * * * * 24.9283 14.7193 15.5699 23.5794 * 23.4249 32.5860 24.5970 21.9381 24.3360 19.8245 23.8017 25.6728 24.0066 26.5857 23.9762 27.7373 20.1566 29.3777 20.8579 32.1113 26.4842 26.8677 30.3422 * * * * 30.5857 29.7041 32.6119 31.5051 34.3879 25.8356 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24899 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 380009 380010 380014 380017 380018 380020 380021 380022 380023 380025 380027 380029 380033 380037 380038 380039 380040 380047 380050 380051 380052 380056 380060 380061 380071 380075 380081 380082 380089 380090 380091 380100 390001 390002 390003 390004 390006 390008 390009 390010 390011 390012 390013 390016 390019 390022 390023 390024 390025 390026 390027 390028 390030 390031 390032 390035 390036 390037 390039 390041 390042 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 2.0468 *** 1.9254 1.8307 1.9127 1.4175 1.4799 1.3427 1.1613 1.2130 1.2891 1.2598 1.7477 1.3213 1.3172 *** 1.4149 1.8758 1.4603 1.6397 1.2960 1.1337 1.4638 1.6749 1.3167 1.3427 0.6765 1.2728 1.3127 1.3031 1.3581 1.6492 1.5910 1.2796 1.1972 1.5727 1.9184 1.1369 1.8139 1.1864 *** 1.2254 1.3340 1.2391 1.1019 *** 1.2530 1.0208 0.4785 1.2151 1.7286 1.6335 1.1566 1.2252 1.2843 1.1523 1.4372 1.4045 1.1412 1.2811 1.3531 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.1233 * 1.0708 1.1233 1.0304 1.1008 1.1233 1.0322 * 1.1233 1.0713 1.0404 1.1008 1.1233 1.1233 * 0.9950 1.0592 1.0151 1.0404 0.9950 1.0404 1.1233 1.1233 1.1233 1.0304 0.9950 1.1233 1.1233 1.0713 1.1233 1.1233 0.8366 0.8388 0.8366 0.9240 0.9130 0.8421 0.8507 0.8388 * 1.0906 0.9130 0.8701 1.0024 * 1.0906 1.0906 1.0906 1.0906 1.0906 0.8388 1.0024 0.9419 0.8388 1.0906 0.8388 0.8388 0.8366 0.8388 0.8388 31.7042 30.2957 29.9648 32.2447 28.0701 28.3563 29.3295 29.2642 26.5439 33.2105 25.5161 26.9967 30.8767 30.5818 34.2303 32.3959 32.0103 29.8627 25.6190 29.7219 24.9476 25.1475 30.7041 29.8217 30.2304 29.0368 21.8850 32.3002 33.4214 34.4536 33.8950 * 22.5309 22.4388 21.6477 24.3249 25.1216 22.2680 25.5482 23.5390 21.9279 28.5076 24.0044 21.9549 23.4636 29.0710 31.7149 35.3960 17.2977 29.5157 35.8381 25.7246 22.1581 22.6828 22.7205 26.2647 24.6032 24.7820 20.3787 21.5925 25.6328 32.4016 34.4208 33.6078 34.2605 30.9923 29.6053 29.2164 30.1742 * 35.5084 26.4982 28.7994 33.4828 32.4033 34.5971 38.0989 31.2286 31.0584 27.1814 30.8891 25.6085 27.7253 32.0101 32.3699 31.7761 33.8962 26.8149 35.6708 34.6015 33.0990 39.9703 * 23.6075 24.7867 23.3672 24.4068 26.8581 22.8042 26.7462 24.5785 21.4856 30.7542 25.0037 23.2095 24.0538 30.3565 35.4452 33.5186 19.1362 31.8512 35.5692 27.1869 23.6063 26.2654 23.9466 28.4564 21.6358 25.4290 22.0208 22.9814 28.3633 34.5626 * 33.1920 35.3727 31.8162 34.6178 32.6143 29.6225 * 36.4904 28.0232 29.4458 34.0066 32.7927 35.1114 * 32.9082 32.8186 29.7312 32.8537 28.6112 29.1649 33.8855 34.5222 31.0905 31.6899 28.9626 35.7815 35.4845 35.5491 40.5058 * 24.3387 25.0846 24.6385 25.3218 28.7849 22.6293 26.7227 24.8175 20.2276 32.3118 26.2309 24.3473 25.7506 29.6304 34.7747 39.7191 20.3840 31.8294 39.2148 27.1447 24.6318 27.2007 24.5233 29.5405 24.4924 25.2295 23.2288 24.2252 28.0982 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00221 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 32.8910 32.1520 32.2199 33.9499 30.3574 30.5328 30.3295 29.6961 26.5439 35.1203 26.6747 28.4963 32.8324 31.9695 34.6434 34.9720 32.0782 31.2890 27.5470 31.1839 26.2863 27.4834 32.2257 32.2741 31.0383 31.4887 25.5794 34.6173 34.5150 34.3699 38.1381 * 23.5011 24.1306 23.2157 24.7131 27.0024 22.5687 26.3592 24.2866 21.2239 30.5163 25.0972 23.2182 24.3568 29.6954 34.0474 35.9814 18.9796 31.0655 36.9324 26.6793 23.4864 25.3401 23.7226 28.1286 23.5132 25.1463 21.8618 22.9571 27.3600 24900 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 390043 390044 390045 390046 390048 390049 390050 390052 390054 390055 390056 390057 390058 390061 390062 390063 390065 390066 390067 390068 390070 390071 390072 390073 390074 390075 390076 390079 390080 390081 390084 390086 390090 390091 390093 390095 390096 390097 390100 390101 390102 390103 390104 390107 390108 390109 390110 390111 390112 390113 390114 390115 390116 390117 390118 390119 390121 390122 390123 390125 390127 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.2012 1.6708 1.5821 1.6479 1.0778 1.5920 2.0718 1.1793 *** *** 1.0633 1.3240 1.3199 1.4182 1.1297 1.8004 1.2577 1.4268 1.8076 1.3351 1.4180 1.0299 1.0763 1.7429 *** *** 1.4123 1.8385 1.3296 1.2598 1.0968 1.6536 1.9853 1.1455 1.1582 1.1970 1.5973 1.2470 1.7090 1.2975 1.4439 0.8439 1.0870 1.5261 1.2329 1.1589 1.6020 2.1643 1.2290 1.2888 1.5631 1.4526 1.2416 1.1678 1.1725 1.3029 *** 1.0760 1.1933 1.2622 1.3278 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.8366 1.0778 0.8366 0.9589 0.9130 1.0024 0.8388 0.8410 * * 0.8366 1.0906 0.9240 0.9589 0.8366 0.8507 1.0108 0.9130 0.9240 0.9589 1.0906 0.8366 0.8366 0.8366 * * 1.0906 0.8779 1.0906 1.0752 0.8366 0.8366 0.8388 0.8775 0.8388 0.8366 1.0778 1.0906 0.9589 0.9307 0.8388 0.8388 0.8366 0.8388 1.0906 * 0.8388 1.0906 0.8366 0.8775 0.8388 1.0906 1.0906 0.8366 0.8366 0.8366 * 0.8415 1.0906 0.8366 1.0906 22.2549 27.1505 23.0712 27.2630 24.9759 27.1366 26.6931 23.3474 22.8087 25.6945 19.5537 27.9583 27.4799 28.4538 21.4051 24.7614 25.2188 24.2087 26.3287 25.8291 30.9500 21.8367 24.9389 26.3698 22.8545 24.6359 27.9004 23.3053 27.2616 30.3840 19.8606 22.5317 25.2014 21.5586 21.4401 23.6240 27.0763 25.6660 27.7208 21.9418 24.8898 20.6775 19.6428 24.1386 27.2661 19.9156 23.9808 32.6510 19.2126 22.2591 24.0473 27.7333 30.2722 20.3946 21.5001 22.2746 23.1408 22.5786 28.6269 20.9456 30.9374 23.2378 28.7758 23.9343 29.6574 28.5342 29.6121 27.2599 24.9510 24.4435 * 23.5077 29.7982 26.9546 29.1318 21.2999 26.4998 27.6249 25.9645 29.7234 26.7358 33.3185 24.6462 25.3029 25.7822 23.6500 * 31.8500 22.5607 28.7063 31.7569 23.2039 23.5141 27.3528 21.7010 22.6082 22.6150 28.8258 26.1741 30.0132 23.1497 24.8369 20.5741 19.2326 24.1159 27.8171 * 27.7311 34.2990 20.2380 23.3686 26.9620 29.6905 32.2513 20.7821 20.5614 23.0928 25.4826 23.1866 32.4528 22.4033 31.9091 24.2078 29.4037 24.6486 29.9620 28.3118 30.7411 27.3478 25.1446 27.4795 * 23.5637 30.8283 27.7268 30.0565 21.0708 26.8353 29.5649 25.4393 30.6094 29.0944 34.4930 24.8460 26.2548 26.4077 25.4092 * 32.7649 24.4435 29.2639 33.6236 24.3329 25.0983 27.0118 23.3559 22.6016 24.6271 28.6039 27.9853 30.0428 24.8352 24.4585 20.4440 19.6622 24.6567 28.5901 * 25.3386 34.8737 21.5428 24.2583 27.9174 30.8033 33.2549 21.5035 21.8906 24.3227 * 23.3220 34.0037 22.8792 33.6955 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00222 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 23.2254 28.4744 23.8977 28.9961 27.3366 29.2421 27.1027 24.4778 24.7386 25.6945 22.1096 29.5698 27.3837 29.1849 21.2582 26.0645 27.4343 25.2120 28.8535 27.1392 32.9334 23.7235 25.5020 26.2014 23.9492 24.6359 30.8669 23.4342 28.4487 31.9438 22.4562 23.7475 26.5228 22.1984 22.2273 23.6286 28.1713 26.5901 29.3272 23.3524 24.7139 20.5654 19.5081 24.3173 27.9019 19.9156 25.6176 33.9658 20.3235 23.3082 26.3014 29.4301 31.9771 20.9015 21.3374 23.2316 24.2748 23.0325 31.6497 22.0898 32.1928 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24901 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 390128 390130 390131 390132 390133 390135 390136 390137 390138 390139 390142 390145 390146 390147 390150 390151 390153 390154 390156 390157 390160 390162 390163 390164 390166 390168 390169 390173 390174 390176 390178 390179 390180 390181 390183 390184 390185 390189 390191 390192 390193 390194 390195 390196 390197 390198 390199 390200 390201 390203 390204 390211 390215 390217 390219 390220 390222 390223 390224 390225 390226 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.2537 1.2868 1.3320 1.4492 1.7198 *** *** 1.4877 1.1925 1.3707 1.5236 1.5372 1.2178 1.3587 1.1283 1.3568 1.3449 1.2257 1.3797 1.2706 1.2523 1.4945 1.2309 2.1785 1.1701 1.5196 1.4291 1.1808 1.7023 1.0556 1.3607 1.4433 1.4073 1.1003 1.1425 1.1043 1.2679 1.1536 1.1480 0.9891 *** 1.1200 1.6265 1.6615 1.3824 1.0937 1.1706 *** 1.3000 1.6186 1.2999 1.2565 *** 1.2441 1.3184 1.1219 1.2934 2.0315 *** 1.2235 1.7791 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.8388 0.8366 0.8388 1.0906 1.0778 * * 0.8366 0.9130 1.0906 1.0906 0.8388 0.8385 0.8388 0.8388 1.0990 1.0906 0.8366 1.0752 0.8388 0.8388 1.1578 0.8388 0.8388 0.8388 0.8388 0.8366 0.8366 1.0906 0.8388 0.8996 1.0906 1.0752 0.8366 0.8366 0.8388 0.8366 0.8366 * 0.8366 * 1.0024 1.0906 * 1.0024 0.8507 0.8366 * 0.8366 1.0906 1.0906 0.8996 * 0.8388 0.8388 1.0906 1.0752 1.0906 * 0.9589 1.0906 23.1539 24.0685 22.6306 27.7250 28.7162 24.4738 22.1415 23.4877 24.2769 30.4246 32.5786 23.8041 25.2460 25.0971 24.1855 27.1539 30.0585 20.6982 31.2571 22.7493 21.4877 30.0900 22.1741 26.4971 24.9810 24.5820 27.2242 22.8220 32.6265 * 20.7270 27.2222 32.4375 24.4573 25.6554 22.5519 23.0202 22.3722 20.8761 21.2619 20.1024 25.4235 31.0019 * 25.7739 18.7222 21.3157 23.7471 26.3658 28.9054 28.6829 23.1450 28.0403 24.3610 25.1705 41.6138 28.7488 27.6407 18.7624 24.9391 28.5890 24.1628 23.0592 23.0577 29.6396 31.1083 * 23.9813 24.2878 25.3410 34.1447 33.8224 24.6672 22.6752 26.8522 22.8228 29.9254 32.8234 22.8391 32.2688 21.5923 24.0208 35.5057 23.2055 26.3087 20.9272 26.1365 26.5514 23.9927 34.2069 23.9779 22.6006 28.0688 34.9832 25.9871 27.0122 22.7451 25.4256 22.6796 * 20.5459 * 27.5890 34.2980 * 26.8270 20.5979 22.3224 * 27.0054 29.4930 29.5251 25.1689 * 23.5879 25.4886 28.9128 30.9464 30.2523 * 27.5803 32.6658 24.1382 23.2426 23.5768 31.1131 32.9942 * * 26.1444 27.4226 34.0800 34.5755 25.6972 25.1795 28.6585 22.7669 31.4053 33.2401 23.3554 32.8981 22.1101 22.9688 34.5792 22.8331 27.1941 23.3249 26.9801 26.2631 25.6446 35.2897 24.1240 23.1440 30.1208 35.5103 26.6009 27.8354 23.9729 27.1111 23.6210 * 23.6172 * 26.3138 34.5552 * 27.2431 20.4340 23.0031 * 27.3536 29.1367 30.3378 26.5027 * 24.1877 26.1182 30.7413 31.7312 34.3250 * 27.2537 32.6482 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00223 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 23.8227 23.4688 23.1072 29.5021 31.0177 24.4738 23.0891 24.6484 25.7127 32.9175 33.7216 24.7296 24.3869 26.8141 23.2856 29.5922 32.1631 22.2878 32.1217 22.1488 22.8164 33.2581 22.7280 26.6933 23.1376 25.9244 26.6871 24.1667 34.0693 24.0542 22.1434 28.5190 34.3001 25.6297 26.8138 23.0650 25.2264 22.9386 20.8761 21.8230 20.1024 26.4431 33.3460 * 26.6095 19.9083 22.2033 23.7471 26.9243 29.1780 29.5558 24.9525 28.0403 24.0510 25.5759 32.7167 30.5055 30.7316 18.7624 26.6140 31.2951 24902 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 390228 390231 390233 390236 390237 390246 390256 390258 390263 390265 390266 390267 390268 390270 390272 390278 390279 390285 390286 390287 390288 390289 390290 390301 390302 390303 390304 390305 390306 390307 390308 390309 390310 390311 390312 390313 400001 400002 400003 400004 400005 400006 400007 400009 400010 400011 400012 400013 400014 400015 400016 400017 400018 400019 400021 400022 400024 400026 400028 400032 400044 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.3964 1.4024 1.3811 0.9656 1.6150 1.1274 1.9049 1.5061 1.5329 1.5078 1.1594 1.2788 1.3895 1.6237 0.5351 0.5328 *** 1.4982 1.1892 *** *** *** 1.8483 *** 2.0384 *** 1.2294 *** *** 1.9734 *** *** *** 2.0736 1.1713 1.1482 1.2869 1.8475 1.3852 1.2261 1.1254 1.1848 1.2016 1.0096 0.9284 1.0610 1.4671 1.2470 1.3721 1.3247 1.3936 0.9861 1.1698 1.4381 1.4346 1.4165 0.8885 1.0798 1.0991 1.1384 1.2888 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.8388 1.0906 0.9307 0.8366 0.8366 0.8366 0.9240 1.0906 1.0024 0.8388 0.8996 0.8388 0.8625 0.8366 1.0906 1.0906 * 1.0906 1.0906 * * * 1.0906 * 1.0906 * 1.0906 * * 0.8996 * * * 1.0906 1.0906 0.9419 0.4517 0.4161 0.4161 0.4517 0.4517 0.4517 0.4517 0.2946 0.3298 0.4517 0.4517 0.4517 0.3659 0.4517 0.4517 0.4517 0.4517 0.4517 0.4605 0.4161 0.3659 0.2946 0.4161 0.4517 0.4161 23.3078 29.2653 24.8690 21.9169 26.9533 20.1581 26.3619 29.4626 26.0170 23.4836 20.3918 23.1051 25.0021 24.1496 * 23.6843 17.0012 35.0426 28.1761 37.6569 29.7287 28.8826 37.9040 30.9836 * * * * * * * * * * * * 13.1847 16.7582 12.8329 14.3108 10.7207 9.2265 9.2463 9.3116 10.0962 8.5534 8.3802 10.3347 12.2169 15.6349 14.7607 10.2734 11.6165 12.8029 14.1534 15.9246 12.4648 5.8200 10.9808 10.2652 13.7509 23.9845 30.9339 25.6904 22.1144 27.4944 25.1956 28.0617 30.4142 28.5864 24.0675 20.8789 24.2428 25.6643 24.9510 * 26.6664 * 36.7163 29.5281 39.3176 30.9701 30.7583 38.3776 * * 27.5580 30.4832 * * * * * * * * * 13.9386 15.3833 13.9258 12.0923 10.3505 8.1841 11.8203 9.3834 9.8132 9.6641 12.3362 11.1414 10.5286 13.7043 16.6472 10.3123 11.9184 12.8380 14.4549 14.9089 10.8439 9.9262 11.3260 10.3736 14.6420 24.2239 32.8332 27.2575 23.1290 28.4317 26.0175 28.8967 31.7149 29.9800 24.5237 22.2224 24.8302 26.7336 26.5010 * 28.6253 * 37.6664 31.3380 42.2395 * * 41.1403 * * * 32.1625 29.3209 40.3778 24.5413 36.1732 37.8919 44.3970 * * * 14.9133 12.9440 15.6771 12.5936 11.1153 8.4089 12.0726 9.5111 10.7991 8.5501 10.1144 11.4213 9.9385 22.1997 16.1412 9.9191 12.3935 14.7123 13.9215 15.2620 12.6216 7.1176 10.6709 10.7136 10.5388 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00224 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 23.8473 30.9979 25.9600 22.3772 27.5813 23.4881 27.8208 30.6070 28.2983 24.0290 21.1790 24.0574 25.8427 25.2638 * 26.2989 17.0012 36.3989 29.6274 39.3145 30.3388 29.8023 39.1280 30.9836 * 27.5580 31.3744 29.3209 40.3778 24.5413 36.1732 37.8919 44.3970 * * * 14.0366 14.8789 14.1320 12.8944 10.7266 8.6005 11.0856 9.4052 10.2159 8.9390 10.1137 10.9909 10.8298 17.0460 15.8512 10.1746 11.9802 13.3471 14.1634 15.3447 11.9950 7.2041 10.9928 10.4544 12.6107 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24903 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 400048 400061 400079 400087 400098 400102 400103 400104 400105 400106 400109 400110 400111 400112 400113 400114 400115 400117 400118 400120 400121 400122 400123 400124 400125 400126 400127 400128 410001 410004 410005 410006 410007 410008 410009 410010 410011 410012 410013 420002 420004 420005 420006 420007 420009 420010 420011 420015 420016 420018 420019 420020 420023 420026 420027 420030 420033 420036 420037 420038 420039 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.1731 2.0008 1.2350 1.1993 1.3670 1.3166 1.7536 1.1995 1.1555 1.1079 1.4454 1.2255 1.1570 1.2217 1.2935 1.1422 1.0297 1.1097 1.2474 1.3545 1.0490 1.9135 1.2192 2.7654 1.2125 1.2050 1.7568 1.0765 1.3006 1.2498 1.2488 1.3443 1.6516 1.2351 1.2438 1.1857 1.3917 1.6858 1.2112 1.5894 1.9971 1.1309 *** 1.6214 1.3837 1.1456 1.1700 1.3589 0.9742 1.8381 1.0975 1.2772 1.6934 1.8820 1.5860 1.2464 1.1208 1.2394 1.3000 1.2507 1.1499 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.4517 0.4517 0.3298 0.4517 0.4517 0.4517 0.3659 0.4517 0.4517 0.4517 0.4517 0.3203 0.3298 0.4517 0.4161 0.4517 0.4517 0.4517 0.4517 0.4517 0.4517 0.4517 0.3659 0.4517 0.4121 0.4605 0.4517 0.4517 1.1256 1.1256 1.1256 1.0654 1.1256 1.0654 1.0654 1.1256 1.1256 1.1256 1.1794 0.9512 0.9144 0.8791 * 0.9386 0.9386 0.8791 0.9664 0.9664 0.8791 0.8791 0.8933 0.9144 0.9664 0.8791 0.9386 0.9144 0.9664 0.9348 0.9664 0.9664 0.9334 10.4266 18.9123 12.7825 10.6849 12.8230 10.2677 9.3859 9.3854 14.0219 11.4507 14.2111 12.3449 14.5029 19.3945 9.6778 11.5478 13.7392 12.7600 12.5743 12.7955 8.2197 11.2324 12.3041 16.1812 11.6386 9.8008 * * 28.0816 27.4209 30.1606 29.4395 31.8548 29.6092 29.4094 32.8599 30.3787 32.6009 35.4624 28.2848 27.2620 23.1943 24.0811 25.2650 25.5079 23.4562 21.4029 26.2154 17.1229 24.8024 22.5312 25.8883 26.7263 27.4814 25.1692 26.0079 31.8759 22.8294 29.4156 24.2259 25.1148 9.6416 18.1303 9.5296 11.0377 13.8034 10.5879 10.6971 11.4322 15.6626 13.4097 14.4386 11.1812 14.1718 10.1512 10.5305 10.1379 12.0713 9.5929 12.8692 13.4069 9.7427 8.9478 12.8317 17.2139 11.9787 14.1062 17.8303 * 29.0877 29.4953 28.1141 30.1855 33.2896 30.9505 31.7300 32.0704 33.8781 33.6072 35.8075 29.5592 28.1455 25.0420 26.3293 26.8165 27.0147 25.1452 22.1787 24.1685 21.6266 25.6687 22.5489 28.4344 27.4589 27.8986 26.4472 27.8435 30.4162 23.8742 29.8321 24.6642 28.2220 9.6856 18.0103 10.2856 11.4156 13.7875 12.1755 11.7480 12.8402 16.9039 12.9264 14.8196 9.9275 10.0679 13.4904 10.9503 10.8905 9.6200 11.2873 12.2614 14.0810 9.1824 9.5819 12.5605 17.9135 12.7755 16.5721 20.7788 12.3508 30.0107 33.5477 31.7260 32.8447 32.0716 32.5870 32.8406 32.7383 30.2382 37.0294 41.0799 30.5925 28.9237 26.3939 27.7699 28.8268 29.9490 25.5677 24.5883 26.3714 22.2776 27.5522 25.4922 29.5695 29.9819 27.2418 28.1687 28.4401 31.6349 24.6494 30.8503 26.6292 28.9841 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00225 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 9.9021 18.3237 10.6551 11.0321 13.3736 10.9323 10.5154 11.2160 15.5355 12.5584 14.4933 11.1279 12.5939 13.2997 10.3752 10.8232 11.5296 10.9990 12.5587 13.4541 9.0004 10.3492 12.5624 17.1102 12.1173 12.5521 19.5311 12.3508 29.0623 30.0869 29.9813 30.8317 32.4071 31.0405 31.3626 32.5468 31.4189 34.4552 37.4473 29.4848 28.1331 24.9179 26.0549 26.9868 27.4958 24.7554 22.7258 25.5781 20.2191 26.0434 23.3958 27.8470 28.0277 27.5412 26.6066 27.4508 31.2973 23.7914 30.0400 25.1611 27.4319 24904 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 420043 420048 420049 420051 420053 420054 420055 420056 420057 420062 420064 420065 420066 420067 420068 420069 420070 420071 420072 420073 420078 420079 420080 420082 420083 420085 420086 420087 420089 420091 420093 420098 420099 420101 430005 430008 430012 430013 430014 430015 430016 430027 430031 430047 430048 430060 430064 430077 430081 430082 430083 430084 430085 430089 430090 430091 430092 430093 430094 430095 430096 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.1016 1.2711 1.2515 1.6594 1.1285 1.1334 1.0786 1.3295 1.1850 1.0478 1.1882 1.4437 1.0105 1.3630 1.3719 1.1737 1.2994 1.4292 1.0662 1.3854 1.9217 1.4849 1.4418 1.5165 1.4762 1.5565 1.4540 1.8324 1.3997 1.4226 *** 1.1883 *** 1.1332 1.3007 1.1443 1.3092 1.1862 1.4176 1.2647 1.6466 1.7919 *** 1.0090 1.2827 0.8255 1.0259 1.8114 0.8795 0.8113 0.8773 0.9092 0.8887 1.8601 1.4726 2.1556 1.8602 0.8372 1.6473 2.4550 1.8925 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.8923 0.8791 0.8791 0.8791 0.8791 0.8791 0.8791 0.8791 0.8791 0.9348 0.8791 0.9144 0.8791 0.8987 0.9144 0.8791 0.8875 0.9386 0.8791 0.8791 0.9664 0.9144 0.8987 0.9600 0.9386 0.9172 0.8791 0.9144 0.9144 0.8791 * 0.8791 * 0.8791 0.8343 0.8880 0.9395 0.9395 0.8343 0.8343 0.9558 0.9558 * * 0.8343 0.8343 0.8343 0.8690 1.4406 1.4406 1.4406 1.4406 1.4406 0.9220 0.9558 0.8690 0.8343 0.8690 0.8398 0.9558 0.8343 23.0555 24.1923 23.9722 24.8026 22.2825 24.8931 21.9764 21.6963 23.4312 25.9526 23.3610 24.5715 23.9049 25.0345 23.4248 20.5546 23.4355 24.9418 18.6742 24.5813 28.9112 25.4935 28.4735 29.8528 27.1322 26.8692 25.8869 24.3609 26.0074 26.9214 27.4767 * * * 22.3272 23.3790 24.0850 25.1378 26.4964 22.7947 27.8453 26.2139 16.0346 18.8982 23.0782 * 17.5376 25.1763 * * * * * 22.5625 25.8460 24.3021 20.9486 29.5244 18.9099 28.1749 21.6997 24.0971 25.9610 26.0953 25.9056 23.2246 25.6779 24.0965 27.7250 24.9313 26.7467 24.3540 25.5483 25.1062 25.8561 25.6857 22.3445 24.7899 25.2862 17.8019 25.5204 29.5135 27.5439 28.6060 31.2671 26.4932 27.8386 28.0485 25.4697 28.1855 26.0592 28.0765 30.7532 * * 22.4111 24.4277 24.0326 25.9828 26.8752 23.6296 28.9376 26.6044 * * 24.1969 13.2618 18.3125 25.8572 * * * * * 22.3335 26.4862 25.1105 21.6478 27.5326 22.9091 31.3409 21.6713 25.7926 26.8917 25.6953 26.6341 24.4642 25.6413 25.1550 25.5489 25.4571 25.9555 24.5219 26.8333 26.7458 26.5058 27.5799 23.7228 27.5115 27.6368 21.6507 26.1111 30.6777 28.6353 31.5679 33.6740 28.9023 29.2277 27.9384 27.3264 29.5860 26.8712 32.8212 29.4620 30.2160 * 23.8690 26.0865 25.2032 27.6885 27.9285 26.5781 32.8752 27.5745 * * 25.1698 13.5646 16.4884 27.2106 * * * * * 23.2471 29.0203 24.7273 21.9206 26.0248 23.2862 32.2291 24.6038 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00226 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 24.3478 25.7298 25.2614 25.7969 23.3619 25.3982 23.7646 24.9908 24.6270 26.2258 24.0703 25.6653 25.3096 25.8193 25.6023 22.2320 25.3139 25.9945 19.2795 25.4567 29.7053 27.2411 29.4702 31.5607 27.5471 27.9683 27.3327 25.7075 27.9479 26.6184 29.1829 30.0328 30.2160 * 22.8727 24.5248 24.4263 26.2696 27.1026 24.3440 29.8586 26.8174 16.0346 18.8982 24.1626 13.4165 17.3474 26.0775 * * * * * 22.7179 27.2004 24.7229 21.5139 27.6517 21.6352 30.5974 22.6697 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24905 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 440001 440002 440003 440006 440007 440008 440009 440010 440011 440012 440015 440016 440017 440018 440019 440020 440024 440025 440026 440029 440030 440031 440032 440033 440034 440035 440039 440040 440041 440046 440047 440048 440049 440050 440051 440052 440053 440054 440056 440057 440058 440059 440060 440061 440063 440064 440065 440067 440068 440070 440072 440073 440081 440082 440083 440084 440091 440102 440104 440105 440109 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.1421 1.7517 1.3294 1.5106 1.0215 1.0651 1.2224 0.9454 1.3473 1.5819 1.8656 1.0064 1.8252 1.1288 1.7505 1.0946 1.2187 1.1305 0.6838 1.3902 1.3259 1.1820 1.2192 1.0331 1.6264 1.4158 2.1833 0.9032 0.9123 1.2556 0.9027 1.8381 1.6379 1.3564 0.9547 0.9974 1.2683 1.1306 1.1615 1.0901 1.1778 1.4611 1.1303 1.1231 1.5848 1.0103 1.2648 1.1058 1.1547 0.9790 1.1053 1.4655 1.1997 2.1152 0.9664 1.1855 1.7522 1.1442 1.7686 0.8903 0.9695 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.7916 0.8951 0.9675 0.9675 0.8142 0.8432 0.7916 0.7916 0.8043 0.7916 0.8043 0.8060 0.7916 0.7916 0.8043 0.8760 0.8967 0.8608 0.9675 0.9675 0.7931 0.7941 0.7916 0.7952 0.8043 0.9408 0.9675 0.7916 * 0.9675 0.8254 0.9291 0.9291 0.7916 0.7987 0.7916 0.9675 0.7916 0.8043 0.7944 0.7916 0.7916 0.8432 0.7916 0.7916 0.8967 0.9675 0.7916 0.8967 0.8025 0.8951 0.9408 0.7985 0.9675 0.7916 0.7950 0.8967 0.7916 0.8967 0.7916 0.7986 19.3100 24.6664 25.9209 28.5951 25.8236 23.4301 21.5970 17.1803 22.5068 22.3029 23.7422 22.1645 22.9364 23.3445 25.2553 23.9475 23.2717 20.6798 26.8986 28.0779 22.1217 19.6684 18.5277 20.7917 23.5403 24.3752 28.4678 17.8509 17.9409 26.1341 21.4280 27.7560 25.3043 23.1363 21.9108 21.1133 25.4345 21.4400 22.1067 16.4451 22.9263 26.3551 23.3014 21.8274 22.3256 22.0955 22.3247 23.1089 24.5972 19.4372 27.1442 23.9198 19.7878 27.9724 17.3329 16.3738 25.6797 17.5261 25.3739 22.3438 18.6720 21.2398 25.7434 28.4862 29.7146 19.9754 23.2126 23.9279 19.3669 23.6154 24.0169 25.0430 23.0350 25.0588 23.2107 25.3592 24.0995 23.9745 22.5407 28.0349 30.1204 23.7670 20.8964 19.7150 21.1087 24.6994 25.9613 29.8611 20.8637 * 27.9539 21.7892 29.4789 26.4772 24.4616 23.9253 22.8016 27.1197 23.5137 22.7820 16.6346 24.3522 28.3565 24.1024 23.9678 24.2566 23.7176 24.6169 24.4772 24.8146 20.0938 23.9563 26.3570 20.7125 30.6115 25.6099 18.6043 26.5687 20.7363 26.5741 22.9372 20.8924 21.5725 26.3607 28.3551 31.5513 18.8253 27.3717 23.8117 19.6194 23.6692 23.7854 26.0583 24.5792 24.6678 25.0764 26.0762 24.7759 24.7683 22.4856 26.8138 31.2276 22.1894 22.3877 21.0368 22.7949 25.5041 26.2444 30.1798 20.8737 * 29.7354 22.9125 29.3276 28.8751 24.9749 23.4849 22.6093 27.8161 23.7916 23.2296 17.2159 26.0692 27.9440 25.0943 23.7344 23.9625 26.1228 25.8517 24.6523 26.1066 21.9133 25.6126 27.6130 20.7679 32.5266 23.6295 18.8661 28.1980 21.6734 27.9739 27.5434 21.4586 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00227 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 20.7286 25.6113 27.6394 29.9422 20.7863 24.8406 23.1545 18.7378 23.2732 23.3703 24.9717 23.2189 24.2288 23.9420 25.5315 24.2798 24.0292 21.9261 27.2465 29.8852 22.7002 20.9813 19.7420 21.5084 24.6078 25.5503 29.5492 19.8795 17.9409 27.9631 22.0779 28.8736 26.9261 24.2258 23.1289 22.1794 26.7570 22.9255 22.7142 16.7756 24.4594 27.5537 24.2363 23.1104 23.5403 23.9663 24.2948 24.0976 25.1512 20.5428 25.4529 25.9554 20.4353 30.3207 22.2394 17.9487 26.8419 19.9750 26.6317 24.0199 20.4120 24906 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 440110 440111 440114 440115 440120 440125 440130 440131 440132 440133 440135 440137 440141 440144 440145 440147 440148 440149 440150 440151 440152 440153 440156 440159 440161 440162 440166 440168 440173 440174 440175 440176 440180 440181 440182 440183 440184 440185 440186 440187 440189 440192 440193 440194 440197 440200 440203 440217 440218 440222 440224 440225 440226 440227 440228 450002 450005 450007 450008 450010 450011 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.1525 1.2969 *** 1.0086 1.5948 1.6036 1.1054 1.2045 1.2396 1.7133 0.9959 1.0781 0.9681 1.3047 1.0761 *** 1.1126 *** 1.3903 1.1741 1.9279 1.0815 1.6521 1.5137 1.8708 *** *** 0.9651 1.4388 0.8951 1.0345 1.2746 1.2911 0.9192 0.9950 1.5965 0.9643 1.1499 0.9668 1.0856 1.3576 1.0840 1.3501 1.3057 1.3661 0.9726 *** 1.3238 2.1944 1.0509 0.8974 0.7984 1.5497 1.3258 1.4433 1.4197 1.0714 1.3062 1.2938 1.6531 1.6897 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.8043 0.9675 * 0.8254 0.8043 0.8043 0.7916 0.9291 0.7916 0.9675 0.7916 0.8679 0.7916 0.9408 * * 0.9408 * 0.9675 0.9408 0.9291 0.7916 0.8967 0.9291 0.9675 * * 0.9291 0.8043 0.8226 0.9408 0.7916 0.7952 0.8277 0.8060 0.9291 0.7916 0.8967 0.9675 0.7916 0.8590 0.9408 0.9675 0.9675 0.9675 0.9675 * 0.9291 0.9675 0.9291 0.9675 0.8043 0.8043 0.9675 0.9291 0.9144 0.8587 0.8916 0.8308 0.8488 0.9177 21.3287 28.5705 24.0146 21.7830 25.5961 22.4196 23.4517 24.9599 21.5085 26.2422 26.6615 20.6663 21.3314 23.3828 20.7875 31.4012 24.6412 20.4563 26.8308 23.9808 26.5513 22.2846 26.9689 22.8645 28.6971 21.1418 31.0779 22.8768 22.8846 22.0974 22.7299 23.6659 23.3808 22.7151 22.3612 27.1515 22.3475 23.9052 25.7445 21.3252 27.5435 25.7495 24.4299 26.6527 27.1534 17.7491 19.3864 28.5968 24.6465 29.7292 * * * * * 25.7171 23.5576 20.7321 22.9669 23.7529 24.8831 20.9179 29.0975 * 23.1409 25.7161 22.8097 23.9955 25.6666 23.9410 29.2829 28.1925 22.2538 24.2406 23.9241 * 33.1756 23.9810 * 28.1012 27.1729 27.1877 23.6473 27.7309 26.9098 28.7074 27.6837 35.3064 28.1215 23.1167 25.4829 24.4848 22.9631 24.9841 24.8857 24.3302 29.1982 24.5786 25.3817 27.3733 24.0723 28.2621 27.3917 24.3622 29.4706 29.4275 21.1860 23.7451 28.8641 23.7257 28.4664 * 24.8328 26.5831 * * 28.0936 24.4933 23.0026 24.4701 25.5503 26.7418 22.5922 28.8328 * 23.7906 24.7561 23.6317 25.1259 26.9643 24.0684 30.7751 27.7163 22.9527 24.9849 25.2267 * 35.3815 22.6179 * 29.4367 28.2182 27.6451 24.7378 28.5630 25.8246 29.9892 24.8692 * 29.4005 24.0604 26.2049 24.7857 24.1236 22.3062 26.0287 25.0070 30.6570 23.3803 26.7453 28.9113 25.8192 28.8947 29.6238 25.2113 30.8500 30.3318 23.8598 17.9024 29.9206 18.7271 29.0064 * 27.8866 28.3236 30.7783 28.3673 28.8502 24.5392 23.9736 24.5969 26.5222 28.5316 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00228 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 21.8673 28.8339 24.0146 22.9173 25.3527 22.9327 24.1967 25.8558 23.2162 28.6805 27.5263 21.8983 23.5732 24.2122 20.7875 33.3203 23.6901 20.4563 28.1239 26.4231 27.1413 23.4975 27.7803 25.2919 29.1536 24.4630 32.7296 26.9610 23.3811 24.7272 23.9708 23.6112 23.4471 24.6007 23.9818 28.9837 23.4120 25.4013 27.3826 23.7538 28.1761 27.6362 24.6709 29.0988 28.9141 20.9517 20.1678 29.1168 22.2602 29.0426 * 26.2413 27.4254 30.7783 28.3673 27.4825 24.1596 22.5788 24.0254 25.2850 26.6971 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24907 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 450015 450018 450020 450021 450023 450024 450028 450029 450031 450032 450033 450034 450035 450037 450039 450040 450042 450044 450046 450047 450050 450051 450052 450053 450054 450055 450056 450058 450059 450064 450068 450072 450073 450076 450078 450079 450080 450082 450083 450085 450087 450090 450092 450094 450096 450097 450098 450099 450101 450102 450104 450107 450108 450113 450119 450121 450123 450124 450126 450128 450130 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.5327 1.5156 0.9414 1.8775 1.4776 1.6726 1.6122 1.6195 1.4016 1.2877 1.6325 1.5788 1.4933 1.6443 1.4633 1.8073 1.7896 1.7520 1.6190 0.8462 0.8661 1.9226 0.9462 0.9303 1.7987 1.0496 1.7616 1.5924 1.3101 1.4743 2.1568 1.2060 0.8869 1.6718 0.9157 1.6354 1.2459 1.1501 1.8302 1.0618 1.4149 1.2358 1.1888 *** *** 1.4833 0.9764 1.2850 1.6845 1.7567 1.1914 1.5656 1.2022 *** 1.3063 *** 1.2264 1.8765 1.3815 1.2607 1.1616 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.9795 1.0048 * 0.9795 0.8204 0.9144 0.9577 0.8484 0.9795 0.8615 0.9577 0.8587 1.0048 0.8875 0.9681 0.8678 0.8598 0.9795 0.8460 0.9577 * 0.9795 0.8204 * 0.8308 0.8204 0.9518 0.8916 0.9518 0.9681 1.0048 1.0048 0.8204 * 0.8204 0.9795 0.8875 0.8204 0.9190 0.8204 0.9681 0.8855 0.8204 * * 1.0048 * 0.9141 0.8598 0.9190 0.8916 0.9144 0.8916 * 0.9140 * 0.8587 0.9518 1.0048 0.9140 0.8916 27.4012 26.7999 18.3047 29.1350 22.0558 24.4195 26.8250 23.2995 27.9626 27.0748 28.4781 24.1589 26.2838 24.2684 24.7347 24.9590 24.1181 29.4308 23.4907 19.8221 23.3044 28.0411 19.7774 21.9082 24.2782 22.1979 27.0530 25.9653 26.6535 23.8748 27.9633 24.0166 21.7337 * 15.8968 28.1096 22.9836 22.0442 25.8214 22.0840 29.1587 19.4245 23.2071 25.2434 24.1618 26.4965 22.6626 26.6796 23.6905 24.5503 23.8469 25.9326 19.4935 54.6663 25.7008 25.7051 21.2154 27.4198 28.3032 23.3633 21.5226 29.9193 30.2383 * 29.5658 25.4450 26.9113 29.1438 25.0602 29.0824 21.5084 29.2468 26.5313 28.0668 26.6207 26.7503 25.4734 26.6382 31.0381 24.8947 21.8824 * 28.8829 22.6448 * 27.5399 22.9245 28.3092 26.6926 26.8325 26.8355 29.5876 25.8619 26.9446 * 21.4716 30.2420 27.9191 23.9025 27.4955 24.3637 30.0095 21.3837 24.9917 * 26.5103 29.0142 * 31.3495 25.4409 25.6318 24.6169 27.6064 21.6557 * 27.8027 29.1296 24.9674 28.2571 29.3768 25.1122 24.3295 29.4897 30.7798 * 31.2631 25.5456 28.1995 30.7386 26.9317 30.3520 25.5763 29.9792 27.6906 28.8961 28.3379 28.2052 26.8399 26.5414 29.4295 25.5895 23.8397 * 29.9034 22.9956 * 26.5580 23.6359 31.5925 26.9903 27.3949 28.2780 30.5075 27.0747 26.0900 * 20.0665 30.8882 26.2251 24.1995 32.6432 25.6398 31.2651 21.8819 26.0863 * 28.1877 29.8695 * 31.8214 26.7429 26.4138 28.8008 27.8167 19.3203 * 31.0620 27.7456 26.2404 30.9581 29.6165 26.3380 24.3816 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00229 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 28.9233 29.2592 18.3047 29.9537 24.3102 26.5982 28.7980 25.0099 29.1122 24.5156 29.1869 26.1014 27.7041 26.4148 26.5789 25.7395 25.7894 29.9719 24.6756 21.9016 23.3044 28.9706 21.3913 21.9082 26.0520 22.9294 28.7714 26.5543 26.9660 26.2937 29.3731 25.6777 24.8080 * 18.9487 29.6870 25.5990 23.3896 28.5954 24.0602 30.1449 20.8844 24.7978 25.2434 26.1057 28.4563 22.6626 29.8896 25.2714 25.5264 25.7423 27.1281 20.1279 54.6663 28.0085 27.5362 24.0842 28.8840 29.1427 24.9423 23.4123 24908 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 450131 450132 450133 450135 450137 450143 450144 450147 450148 450151 450152 450154 450155 450162 450163 450165 450176 450177 450178 450184 450187 450188 450191 450192 450193 450194 450196 450200 450201 450203 450209 450210 450211 450213 450214 450219 450221 450222 450224 450229 450231 450234 450235 450236 450237 450239 450241 450243 450253 450270 450271 450272 450276 450280 450283 450289 450292 450293 450296 450299 450306 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. *** 1.5741 1.5650 1.7036 1.7292 0.9894 1.0806 1.5058 1.2596 *** 1.2210 1.3960 1.1128 1.3172 1.0672 1.1659 1.3543 1.1710 0.9841 1.5603 1.1820 0.9378 1.1685 1.1362 2.0914 1.3698 1.4362 1.5832 0.9691 1.1773 1.9557 0.9541 1.3229 1.9199 1.2475 0.9710 1.1296 1.6669 1.3681 1.6513 1.6695 1.0260 1.0130 1.0590 1.6297 0.9810 1.0075 0.9797 0.9225 1.1797 1.2059 1.2098 *** 1.4750 1.0410 1.4241 1.2711 0.8636 1.1007 1.6637 0.9556 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 * 0.9959 1.0016 0.9681 0.9681 0.9518 0.8762 0.8204 0.9681 * 0.8308 0.8204 0.8204 0.8678 0.8257 0.8916 0.9140 0.8204 0.9527 1.0048 1.0048 0.8204 0.9518 0.8475 1.0048 0.8417 0.9681 0.8204 0.8204 0.9646 0.9141 0.8354 0.8875 0.8916 1.0048 0.8204 0.8204 1.0048 0.9190 0.8244 0.9141 0.8204 0.8204 0.8593 0.8916 0.8308 0.8204 0.8204 1.0048 0.8475 0.9646 0.9518 * 0.9795 0.9681 1.0048 0.9795 0.8204 1.0048 0.9177 0.8244 23.7098 28.6954 26.8344 26.0755 30.4254 21.8705 21.3289 23.9771 25.3498 22.2915 22.7463 21.2021 18.0588 30.9903 23.1400 24.3242 20.9297 21.3322 24.7301 26.7821 25.6787 20.4070 26.0298 22.5880 32.2964 24.8972 24.7557 23.5344 20.9810 24.1675 26.0958 19.9832 23.8230 23.9676 25.9598 21.7934 20.3186 27.4426 24.1956 21.4459 25.2852 18.4451 21.5138 22.0788 24.8901 21.1945 18.7958 15.4636 20.6124 14.4325 21.7719 25.7392 16.6319 28.7233 20.9679 28.5665 25.0411 21.3135 27.9690 26.4933 15.9855 25.9494 30.1620 28.4647 27.8983 31.4950 23.4592 26.2881 24.3562 27.0894 23.9558 23.3428 21.7237 21.7604 33.3285 24.1267 28.6490 23.1284 23.7624 27.8405 28.5399 28.3243 23.0595 26.5863 24.1186 34.4545 22.9605 24.0161 23.5012 23.2510 26.5237 27.5668 21.8722 28.4581 25.9169 27.4357 21.9207 19.3793 30.0314 26.8302 24.4450 27.1674 20.6889 23.5212 23.5426 25.7939 21.2586 20.8732 15.4510 24.2435 15.2190 22.7035 26.2576 * 29.9730 22.7938 32.2645 26.3242 23.6413 30.4324 27.5797 21.4558 * 31.9964 31.0158 30.1366 31.9628 23.6800 29.4336 24.7217 29.6769 26.1922 23.1056 22.9324 24.8023 32.9269 24.7829 29.1799 24.4427 24.4026 27.1083 29.7402 27.7355 23.2229 28.3929 26.5577 36.4769 24.3528 23.4570 25.6410 23.2742 27.8762 30.4681 22.5708 28.3715 26.8539 28.1262 23.9627 21.3691 30.3786 28.4367 25.1327 26.9773 20.4622 21.8936 22.9579 30.5876 19.1354 21.3480 17.2294 24.1019 19.8112 24.1257 27.0499 * 31.6561 24.1724 33.6901 26.8105 24.0753 31.5551 28.4163 22.9398 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00230 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 24.6979 30.2610 28.7726 28.0785 31.3189 23.0239 25.2664 24.3816 27.2881 24.2420 23.0676 21.9516 21.2754 32.4564 24.0364 27.3444 22.7685 23.1595 26.5644 28.3456 27.2563 22.2784 27.0034 24.4507 34.4405 24.0549 24.1008 24.1113 22.5445 26.2137 27.9965 21.5253 26.9028 25.6070 27.1815 22.5466 20.3727 29.2826 26.4253 23.6486 26.4819 19.9270 22.3093 22.8801 26.8886 20.4357 20.3076 16.0640 23.0154 16.4138 22.9106 26.3724 16.6319 30.1306 22.6240 31.5939 26.0606 22.9676 30.0325 27.4987 19.7033 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24909 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 450315 450324 450330 450340 450346 450347 450348 450351 450352 450353 450358 450362 450369 450370 450372 450373 450374 450378 450379 450381 450388 450389 450393 450395 450399 450400 450403 450411 450417 450418 450419 450422 450424 450431 450438 450446 450447 450451 450460 450462 450465 450469 450475 450484 450488 450489 450497 450498 450508 450514 450518 450530 450537 450539 450547 450558 450563 450565 450571 450573 450578 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.8055 1.5715 1.2148 1.3764 1.4306 1.1980 1.0409 1.2643 1.1040 *** 1.9691 *** 1.0332 1.1948 1.3682 0.8647 0.9938 1.4683 1.3342 0.9328 1.6608 1.1532 0.5363 1.0563 0.8955 1.0787 1.3144 1.0097 0.8612 *** 1.2715 1.2225 1.3427 1.5890 1.1315 0.6348 1.2629 1.1286 0.9637 1.7172 1.1120 1.4925 1.0926 1.3680 1.1517 0.9935 1.0139 0.9453 1.5948 *** 1.4362 1.2781 1.4003 1.1997 0.9677 1.8248 1.5242 1.2509 1.6017 1.1244 0.9614 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.9795 0.9681 1.0048 0.8663 0.8587 1.0048 0.8204 0.9646 0.9795 * 1.0048 * 0.8204 0.8445 0.9795 0.8204 * 1.0048 0.9795 * 0.8916 0.9681 0.9681 1.0048 0.8204 0.8204 0.9795 0.8204 * * 0.9681 0.9795 1.0048 0.9518 1.0048 1.0048 0.9681 0.8741 0.8252 0.9795 1.0048 0.9681 0.8875 0.8875 0.8875 0.8204 0.8599 0.8204 0.8875 * 0.8587 1.0048 0.9795 0.8275 0.8399 0.8244 0.9681 0.8685 0.8663 0.8319 0.8204 * 24.9128 25.5820 24.0637 22.2468 27.2203 18.7675 25.6859 24.8012 24.4454 30.4280 25.4372 18.4848 20.0832 28.3359 22.2213 23.2283 30.7684 30.6071 22.0482 25.8674 23.8764 18.4551 24.8656 18.2074 23.1739 29.3063 19.6086 20.0351 26.8434 31.0405 30.6659 28.3149 25.2477 21.9350 14.3132 23.5047 23.3043 20.5811 27.8923 22.4183 28.7890 23.5596 25.3527 23.9144 21.4771 18.8344 17.7822 23.9572 22.6552 24.1194 28.7451 27.5856 21.0442 21.6542 26.1551 28.7289 23.8846 22.7703 20.1479 20.2696 37.1721 25.1633 26.0771 25.0344 23.6072 28.7667 21.6787 26.5388 26.2281 27.0248 31.4926 * 19.9148 25.5834 30.8886 24.8286 * 30.3883 33.7521 * 27.4328 25.6732 21.9347 27.5189 20.3528 23.6358 29.0359 20.9372 * 28.4362 31.9966 34.4331 28.2463 26.3263 27.8659 17.0691 25.4200 24.6201 22.4227 29.6069 26.2759 26.3262 23.0942 26.7242 22.3981 23.4806 22.0918 18.6563 28.4471 26.3704 28.1755 29.1349 27.7757 23.1829 23.7820 26.9407 30.8332 26.7942 25.2108 22.0797 22.5167 * 26.6082 27.1088 25.6777 23.8975 30.6500 21.0437 29.2557 27.2978 28.2683 32.5905 * 22.9249 26.3438 30.9228 27.0704 * 32.2274 35.3777 * 27.9807 26.9621 * 26.7686 22.1687 26.2840 29.8626 21.5711 * * 34.2413 31.3421 30.7204 27.3917 26.5110 17.2849 26.5230 27.7093 24.9806 30.1441 27.0808 26.3408 24.4820 28.3900 23.7940 25.2611 23.1798 20.2424 27.2884 26.9571 28.0142 29.9698 28.7442 24.2118 34.3322 28.0643 32.0505 28.1669 27.4577 22.1565 25.0487 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00231 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 37.1721 25.5438 26.2637 24.9272 23.2898 28.8612 20.5420 27.1709 26.1097 26.5977 31.5502 25.4372 20.4404 23.8025 30.0232 24.8199 23.2283 31.1285 33.1813 22.0482 27.1010 25.5400 19.7864 26.4980 20.1538 24.2918 29.4101 20.7282 20.0351 27.5264 32.4898 32.1009 29.0895 26.3384 25.2161 16.0873 25.1012 25.1820 22.7331 29.2303 25.3172 27.1795 23.6936 26.8376 23.3805 23.4854 21.3680 18.8921 26.5810 25.3918 26.7922 29.2956 28.0479 22.7454 25.8915 27.0629 30.6110 26.2638 25.0804 21.5134 22.6269 24910 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 450580 450584 450586 450587 450591 450596 450597 450604 450605 450610 450615 450617 450620 450623 450626 450630 450634 450638 450639 450641 450643 450644 450646 450647 450651 450653 450654 450656 450658 450659 450661 450662 450665 450668 450669 450670 450672 450674 450675 450677 450678 450683 450684 450686 450688 450690 450694 450697 450698 450702 450709 450711 450713 450715 450716 450718 450723 450730 450733 450742 450743 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.0846 1.1129 0.9359 1.2013 1.2535 1.2190 0.9772 1.3487 0.9394 1.5913 0.9880 1.5099 1.0016 1.1755 *** 1.5447 1.7057 1.6763 1.4439 1.0317 1.3269 1.5884 1.4235 1.8302 1.4808 1.1658 0.9021 1.4166 0.9853 1.4617 1.1887 1.5737 *** 1.5281 1.2115 1.4063 1.8206 1.0675 1.3872 1.2672 1.5041 1.1582 1.2927 1.5920 1.1942 1.3072 1.1612 1.4207 0.8996 1.7092 1.3571 1.4822 1.5798 1.2415 1.3493 1.3798 1.4651 1.3611 *** 1.1915 1.4606 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.8204 0.8204 0.8204 0.8204 1.0048 0.9646 0.8204 0.8204 0.8460 1.0048 0.8204 1.0048 0.8204 * * 1.0048 0.9795 1.0048 0.9681 0.8599 0.8484 1.0048 0.9144 0.9795 0.9795 0.8204 0.8204 0.8875 0.8204 1.0048 0.9959 0.9577 * 0.9144 0.9795 1.0048 0.9681 1.0048 0.9681 0.9681 0.9795 0.9795 1.0048 0.8678 0.9795 0.9190 0.8204 0.8916 0.8339 0.8875 1.0048 0.9140 0.9518 0.9795 1.0048 0.9518 0.9795 0.9795 * 0.9795 0.9795 21.1574 21.0808 16.1003 20.4512 23.9992 25.3317 23.1711 20.9514 22.2205 26.8710 20.3028 26.5026 17.7138 28.3552 26.8374 29.6796 28.1705 29.6184 29.2669 17.5845 21.1205 29.0186 23.8908 30.7334 32.4822 23.2603 19.9992 23.8280 20.5398 30.1727 23.2989 28.0913 18.6054 26.2375 27.4507 25.1575 27.6359 28.4416 28.7765 27.3728 30.1500 24.6609 27.6789 23.2367 27.9057 28.2531 23.5789 23.7155 18.6494 25.6147 25.4855 28.0104 27.2801 28.0365 30.8440 27.3408 28.0812 29.9430 26.4977 26.1189 27.3213 22.3886 20.5257 18.9107 23.1202 25.7031 27.4011 24.7853 24.4743 20.9276 27.7317 21.8442 28.0225 18.6183 * * 29.1462 28.7312 30.6572 30.4019 19.4389 22.7355 29.7918 25.6313 30.6924 30.4484 25.2144 21.5002 25.5050 22.2293 31.5024 30.2610 29.0535 * 28.8635 27.9796 25.9638 30.1191 28.7101 28.9005 25.9555 31.1563 27.4925 29.3025 24.2331 26.8599 26.5528 23.9961 24.8667 20.0955 26.8384 26.8146 26.7472 28.8285 17.3991 32.3960 27.3215 28.5103 31.3324 * 27.2023 28.3362 23.8964 22.5149 20.6563 25.0153 27.0806 29.8448 24.2555 25.9097 23.9323 28.3923 24.1786 28.8304 20.3650 * * 29.8420 30.3207 32.4988 32.6237 20.2439 24.3088 30.8220 26.8036 32.4230 31.9155 26.1733 22.5409 28.1462 24.7846 34.2303 30.0728 29.0508 * 30.6109 30.2655 26.4296 31.7990 29.8969 30.9547 27.5747 33.3407 21.1727 30.2122 26.1607 26.9879 26.1729 24.0008 26.4094 21.5692 26.3694 28.4214 27.5782 29.4951 17.0201 33.7175 28.1558 30.1696 32.7866 * 30.0561 28.4726 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00232 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 22.4730 21.3615 18.6521 22.8383 25.5834 27.4270 24.0721 23.8485 22.2907 27.6892 22.0818 27.8233 18.9167 28.3552 26.8374 29.5559 29.0783 30.8669 30.7769 19.0709 22.7006 29.9124 25.4367 31.2795 31.5983 24.8551 21.4221 25.7173 22.5182 31.8885 27.8676 28.7285 18.6054 28.5359 28.6146 25.8782 29.9252 29.0121 29.5677 26.9441 31.5042 24.2963 29.1272 24.5665 27.2206 27.0373 23.8662 25.0094 20.0851 26.2786 26.8732 27.4494 28.5529 19.5798 32.3165 27.6252 28.9691 31.3503 26.4977 27.8905 28.0740 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24911 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 450746 450747 450749 450751 450754 450755 450758 450760 450761 450763 450766 450770 450771 450774 450775 450779 450780 450788 450795 450796 450797 450801 450803 450804 450808 450809 450811 450813 450820 450822 450824 450825 450827 450828 450829 450830 450831 450832 450833 450834 450838 450839 450840 450841 450844 450845 450847 450848 450850 450851 450852 450853 450854 450855 450856 450857 450860 450861 450862 450863 450864 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 0.9236 1.2814 0.9915 *** 0.9278 0.9399 *** 1.0571 0.8818 1.0706 1.9343 1.2426 1.6724 1.6316 1.2937 1.2690 2.0333 1.5557 1.1878 1.7361 1.9643 1.4991 1.1833 1.9178 1.3363 1.5657 1.8168 1.1710 1.3272 1.2882 2.4916 1.3904 1.3898 1.3232 *** 1.0196 1.4011 1.2713 1.3228 1.5862 1.1487 0.9901 1.2907 1.9217 1.3103 1.8427 1.2704 1.3004 1.1195 2.5569 *** 1.9527 *** 1.5585 1.9086 *** 1.9631 *** 1.4583 *** 2.0626 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.8204 0.9190 0.8204 * 0.8204 0.8499 * 0.9144 * * 0.9795 0.9518 0.9795 1.0048 1.0048 0.9681 0.8916 0.8460 1.0048 0.9141 1.0048 0.8204 1.0048 1.0048 0.9518 0.9518 0.9140 0.8916 1.0048 0.9795 0.9518 0.9140 0.8488 0.8204 * 0.9527 1.0048 1.0048 0.9795 0.9177 0.8319 0.8615 0.9795 0.9577 1.0048 0.9144 1.0048 1.0048 1.0016 0.9795 * 0.9795 * 0.9577 0.8916 * 1.0048 * 1.0048 * 0.9190 12.4748 22.2870 17.8227 19.3267 20.8968 18.0092 25.6547 24.6349 15.7483 22.4905 30.0441 20.3656 31.3924 24.9683 24.4006 26.9908 23.9516 25.4172 23.7510 27.9734 20.5379 23.0373 30.6093 26.0981 23.8067 26.3659 25.8491 25.5949 30.5288 31.1430 26.7803 20.2959 20.9704 22.3667 19.5014 28.1617 22.7885 26.6628 26.0044 21.2204 15.8026 22.9711 31.1914 18.9468 28.7296 27.7461 27.6854 27.8100 22.1335 30.1213 30.0191 * * * * * * * * * * 20.6343 23.8314 20.0487 18.7456 22.1819 19.8988 28.7342 24.7489 * * 30.8004 24.1647 30.7105 27.2080 28.1428 29.9674 26.7611 26.2840 25.2007 36.4073 24.8950 24.6328 28.9235 27.8775 21.9793 26.4223 27.2584 20.1710 31.4666 32.2968 31.2375 20.6457 23.7554 24.4740 20.6016 28.5902 23.3880 26.5229 27.0133 20.9607 19.5754 25.8222 30.1743 20.9410 30.7887 29.4933 28.5548 29.5355 21.9266 32.6950 * 36.1169 27.1868 30.8855 39.0865 30.4632 24.0171 34.9290 31.2224 24.8825 23.3765 22.7521 25.8165 22.1526 21.4208 24.7752 22.1950 28.2792 25.1612 * * 30.2340 23.7634 32.0501 25.7438 29.7897 31.8378 27.0062 28.3742 32.9739 37.8715 24.8592 25.3647 30.3031 29.1013 23.0296 27.3070 31.1988 22.9211 33.9016 32.2138 33.3605 25.1439 24.1907 24.8207 19.5826 27.7967 23.9437 27.3292 27.9622 27.4845 18.9504 27.2151 32.2544 20.9412 33.7961 29.9243 29.7336 30.5537 31.9567 35.1080 * 37.1028 * 32.6866 37.7287 * 29.1020 * 31.8086 * 24.5033 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00233 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 18.2376 23.8624 19.9050 19.9009 22.6387 20.0118 27.5628 24.8383 15.7483 22.4905 30.3516 22.8145 31.3870 25.9776 27.3080 29.6435 25.8978 26.7014 27.3766 34.0484 23.1190 24.3609 29.9076 27.7076 22.9175 26.7163 27.9792 22.7699 32.1404 31.9065 30.5401 21.9852 23.0383 24.1285 19.9024 28.1873 23.3300 26.8495 27.0354 22.7773 18.1883 25.2472 31.2220 20.3774 31.3320 29.0929 28.6773 29.3300 24.7538 32.6759 30.0191 36.6720 27.1868 31.8325 38.3752 30.4632 26.9520 34.9290 31.4626 24.8825 24.0201 24912 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 450865 450866 450867 450868 450869 450870 450871 450872 450873 450874 450875 450876 450877 450878 450879 450880 450881 450882 450883 450884 450885 450886 450888 450889 450890 450891 450893 450894 450895 460001 460003 460004 460005 460006 460007 460008 460009 460010 460011 460013 460014 460015 460017 460018 460019 460020 460021 460023 460026 460030 460033 460035 460036 460037 460039 460041 460042 460043 460044 460047 460049 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.0659 *** 1.1897 1.8341 2.0520 *** 1.8013 1.3856 *** 1.5449 1.6403 2.0787 1.5503 2.5581 1.2943 1.6579 *** *** 2.5235 0.9913 1.4982 1.9390 1.4581 1.5257 2.0977 1.3643 1.2518 1.7048 *** 1.8847 1.5181 1.7332 1.4390 1.3709 1.3738 1.4054 1.9494 2.0931 1.3207 1.4115 1.1337 1.3650 1.3070 0.9383 1.1647 1.0141 1.6947 1.1933 1.0465 1.1799 0.9138 0.9491 1.4454 0.8447 1.0810 1.3613 1.3920 1.2796 1.3114 1.6716 1.9965 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.9518 * 0.9518 0.9959 0.9140 * 0.9518 0.9681 * 0.9795 0.9141 0.8678 0.9144 0.8916 0.8484 0.9681 * * 0.9795 0.8925 0.9795 0.9670 0.9670 0.9795 0.9795 0.9795 0.9795 0.9795 * 0.9488 0.9482 0.9482 0.9482 0.9482 0.9546 0.9482 0.9482 0.9482 0.9388 0.9488 0.9482 0.9219 0.8631 0.8267 0.8267 0.8267 1.1205 0.9488 0.9388 0.8267 0.8267 0.8267 * * 0.9219 0.9482 0.9482 0.9488 0.9482 0.9482 0.9482 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 27.0757 26.1372 26.4498 23.5633 25.4787 25.6686 26.5672 26.2833 27.4648 23.4023 25.2448 24.1412 25.6576 23.0388 20.3756 19.9901 19.5669 26.3420 25.3094 24.1547 23.4679 22.0249 17.5723 27.2866 21.1035 28.5657 25.2744 22.9949 28.2089 26.6795 25.7920 24.5165 29.1763 15.2959 28.2289 27.9579 22.6253 37.4364 * * * * * * * * * * * * * * * * * * * * * * * 28.7150 31.4135 28.2040 25.0239 27.1392 27.1308 29.5907 27.2885 29.0063 24.4402 27.7381 28.2647 27.2506 24.3030 22.0517 24.3756 18.5159 28.0291 26.9512 26.9295 23.5942 25.3422 20.6322 * * 29.5651 26.4640 24.9454 28.2008 27.4928 28.2336 26.6702 30.1175 * 29.8401 25.3483 26.1586 * 28.6667 27.2839 14.8808 34.6069 23.2771 28.4327 26.1823 31.4363 35.5585 35.9522 24.5455 27.8226 35.2632 27.8171 34.1144 * * * * * * * 18.4129 30.0024 32.3411 29.6502 26.0927 28.3673 28.0016 31.5474 28.3813 30.4873 24.9677 29.2708 29.5924 29.1301 26.1574 22.7973 23.2172 29.5332 29.5906 28.6509 27.9463 24.3597 26.6541 21.9077 * * 30.4903 26.3798 26.8365 28.6673 28.7017 30.0498 28.5026 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00234 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 29.6697 15.2959 29.0248 26.8245 24.9890 37.4364 28.6667 27.2839 14.8808 34.6069 23.2771 28.4327 26.1823 31.4363 35.5585 35.9522 24.5455 27.8226 35.2632 27.8171 34.1144 * * * * * * * 18.4129 28.5948 29.8766 28.1059 24.8850 27.0130 26.9924 29.1767 27.3950 29.0186 24.2736 27.3700 27.3264 27.3608 24.4631 21.8331 22.4666 21.7927 28.1994 26.9991 26.3205 23.8093 24.7026 20.1162 27.2866 21.1035 29.5979 26.0597 24.8864 28.3617 27.6432 27.9926 26.6084 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24913 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 460051 460052 460054 470001 470003 470005 470006 470010 470011 470012 470018 470024 490001 490002 490003 490004 490005 490007 490009 490011 490012 490013 490017 490018 490019 490020 490021 490022 490023 490024 490027 490031 490032 490033 490037 490038 490040 490041 490042 490043 490044 490045 490046 490047 490048 490050 490052 490053 490057 490059 490060 490063 490066 490067 490069 490071 490073 490075 490077 490079 490084 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.2358 1.6310 1.5970 1.2954 1.9062 1.3073 1.2524 *** 1.1764 1.1947 1.1133 1.2025 1.0892 1.0509 *** 1.3087 1.6418 2.1943 2.0098 1.5283 1.0128 1.3401 1.5004 1.3289 1.1905 1.2411 1.4774 1.4247 1.3034 1.7719 1.0552 *** 1.9589 1.1071 1.2023 1.2572 1.4793 1.5146 1.2796 1.2498 1.4529 1.2636 1.5194 1.2301 1.4151 1.4886 1.6969 1.2119 1.6179 1.6454 1.0540 1.8510 1.3614 1.2603 1.6015 1.3203 2.0908 1.4310 1.4141 1.2496 1.1764 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.9482 0.9488 0.9219 1.0782 1.0401 1.0401 * * 1.0401 1.0401 * 1.0401 0.8095 0.8095 * 0.9353 1.0679 0.8785 0.9555 0.8785 0.8095 0.8490 0.8785 0.9353 1.0679 0.9238 0.8490 1.0679 1.0679 0.9441 0.8095 * 0.9238 1.0679 0.8095 0.8095 1.0679 0.8785 0.9190 1.0679 0.8785 1.0679 0.8785 * 0.8490 1.0679 0.8785 0.8095 0.8785 0.9238 0.8095 1.0679 0.8785 0.9238 0.9238 0.9238 1.0679 0.8486 0.9555 0.9083 0.8240 25.5881 25.3163 25.8668 27.7329 26.4919 29.8255 26.9651 26.1273 28.3911 24.3425 28.3419 25.2427 21.9953 19.5613 27.3456 25.4597 28.5744 26.2481 29.0740 24.5687 19.2276 22.4771 24.6845 24.5196 25.9761 24.8001 24.6440 28.0749 29.7774 23.0982 18.9409 22.0579 25.1381 30.0909 21.3035 22.3976 32.8738 24.5738 21.8749 30.8871 20.8352 28.8279 25.6328 22.5423 25.0097 30.5037 22.8889 21.8432 26.1128 28.7276 22.4201 30.3632 24.7146 22.9188 26.8791 28.4381 31.7743 23.8191 26.0800 23.4728 24.5965 27.0160 26.1629 24.9926 28.3017 28.1137 30.7872 * * 28.1330 26.0225 * 27.0394 23.2174 20.8609 * 27.1676 29.8215 27.6572 30.4722 26.4766 21.0605 24.7521 25.8216 26.2510 25.9885 27.3142 25.7938 32.2676 30.3416 26.1125 24.0288 * 25.2654 31.2922 24.7711 21.8509 32.6564 26.0897 24.4650 33.7096 23.3527 32.0937 26.6517 * 26.2828 31.3885 23.5973 23.3315 26.6898 27.3611 23.6113 31.3619 27.8250 24.9021 27.3181 29.7186 33.1829 25.2022 26.6806 25.3103 24.9007 27.8836 27.1991 25.7860 29.7537 30.1959 33.1968 * * 29.6899 27.0128 * 26.6344 24.0349 21.7073 * 27.8236 30.5335 29.3084 29.9383 27.4750 22.9898 25.5532 27.5878 27.3895 25.8263 29.4572 26.5838 30.1180 30.9919 30.6195 22.9996 * 28.5886 31.8266 25.2813 22.6326 34.1837 27.1598 25.3578 35.8792 23.3777 30.3765 27.9583 * 26.7581 32.3078 25.0037 23.7979 27.5153 30.8668 24.3180 31.6067 29.6170 25.9475 29.1513 31.6505 36.6050 26.3059 28.1502 25.2294 25.7656 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00235 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 26.8632 26.2809 25.5261 28.6008 28.2585 31.2956 26.9651 26.1273 28.7438 25.8090 28.3419 26.3232 23.1144 20.6687 27.3456 26.8453 29.6408 27.7570 29.8425 26.2046 21.0346 24.2689 26.0263 26.0937 25.9276 27.1534 25.6856 30.1134 30.3865 26.5180 21.9117 22.0579 26.3873 31.1174 23.7322 22.2914 33.2336 25.9088 23.9261 33.5666 22.5138 30.3674 26.7669 22.5423 26.0497 31.4093 23.8192 22.9784 26.7785 28.9526 23.4563 31.1276 27.4591 24.5479 27.7948 29.9219 33.5942 25.1154 26.9962 24.6362 25.0947 24914 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 490088 490089 490090 490092 490093 490094 490097 490098 490101 490104 490105 490106 490107 490108 490109 490110 490111 490112 490113 490114 490115 490116 490117 490118 490119 490120 490122 490123 490126 490127 490130 490133 490134 490135 490136 490137 500001 500002 500003 500005 500007 500008 500011 500012 500014 500015 500016 500019 500021 500024 500025 500026 500027 500030 500031 500033 500036 500037 500039 500041 500044 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.1004 1.1026 1.1074 1.0927 1.4711 0.9852 1.0622 1.2549 1.4013 0.7733 0.7178 0.9111 1.3335 1.0684 0.8787 1.3524 1.1951 1.7156 1.3105 1.1475 1.1533 1.1776 1.1522 1.6600 1.3035 1.3981 1.5549 1.1545 1.1651 1.1307 1.2696 *** 0.7623 0.7016 1.4665 1.2895 1.6372 1.4278 1.3314 1.7732 1.3448 1.8942 1.3613 1.7433 1.6985 1.4709 1.6475 1.2779 1.2936 1.7694 1.8307 1.3949 1.5119 1.6945 1.2753 1.3149 1.3431 1.0254 1.4951 1.4362 1.9634 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.8490 0.9441 0.8095 0.9238 0.8785 0.9238 0.9238 0.8095 1.0679 0.9238 0.8095 0.9353 1.0679 0.8490 0.9238 0.8422 0.8095 0.9238 1.0679 0.8095 0.8095 0.8095 0.8095 0.9238 0.8785 0.8785 1.0679 0.8095 0.8095 0.8095 0.8785 * 0.8095 0.9441 0.9238 0.8785 1.1351 1.0565 1.1202 1.1351 1.1202 1.1351 1.1351 1.0565 1.1351 1.1351 1.1202 1.0705 1.1202 1.1060 1.1351 1.1351 1.1351 1.1264 1.1325 1.0565 1.0565 1.0565 1.1202 1.1233 1.0565 22.4186 22.6461 22.2907 23.8655 25.0751 26.5726 23.8005 21.7231 30.4285 17.3295 24.7922 23.0199 29.7000 22.4345 21.9877 22.5974 22.0199 26.6453 29.5698 20.9116 21.4666 22.9017 18.0277 27.4050 25.2549 24.4434 31.0449 23.9233 22.2859 20.4289 22.8512 26.5684 * * * * 29.3707 25.3347 29.6341 32.0972 28.0476 31.8837 30.6508 30.6856 33.7536 32.0592 31.4222 28.6669 30.1690 30.7917 34.7252 33.2937 34.2175 32.7446 31.2186 29.4627 27.0072 26.9969 29.8808 26.7829 30.3164 24.1471 24.9438 25.1157 23.3439 25.6531 28.2165 26.5322 23.2782 31.2377 * 25.5329 23.8334 32.2672 22.9076 22.7854 24.2887 22.1476 27.1932 31.8177 22.5255 22.4058 24.2258 19.6398 27.6749 26.5756 25.8795 32.0743 24.3490 23.6690 21.3735 23.9982 * * * * * 31.1605 27.6400 30.6939 33.5117 29.2869 32.6052 31.4514 30.0509 36.1380 34.5877 31.4905 30.5594 30.7927 32.6171 37.7952 32.8369 34.6164 32.4426 32.8833 30.6292 28.7096 28.1056 32.2245 30.3627 29.0214 24.8101 25.7992 26.3608 25.7387 26.7886 28.9146 27.1435 25.1610 32.3688 17.0546 26.3828 25.7350 33.5401 23.3193 24.2291 24.9849 22.8937 29.0813 32.4544 22.1360 23.7163 24.3840 18.1119 29.0567 27.8859 26.0093 33.3710 24.2251 24.0884 23.4863 25.3343 * 33.2227 25.9889 * * 33.0888 29.1442 32.1259 34.8686 30.5261 33.5666 32.6218 33.8239 36.5850 35.6715 32.9165 31.6230 32.4667 36.1640 40.6368 34.5879 39.2906 34.9165 33.2375 31.9177 30.5911 31.2642 33.5585 34.1983 31.0921 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00236 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 23.7857 24.4734 24.4717 24.2720 25.8819 27.8967 25.8270 23.3955 31.3628 17.1727 25.5156 23.7423 31.8912 22.8875 22.9552 24.0081 22.3629 27.6671 31.3269 21.8649 22.5107 23.8562 18.6014 28.0590 26.6077 25.4236 32.1670 24.1637 23.3590 21.6178 24.0812 26.5684 33.2227 25.9889 * * 31.2052 27.3385 30.7329 33.4895 29.3452 32.7102 31.5867 31.3893 35.5229 34.1465 31.9509 30.2717 31.1930 33.1799 37.5370 33.5879 36.0226 33.4025 32.4927 30.6609 28.8233 28.7442 31.9341 30.2983 30.1178 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24915 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 500049 500050 500051 500052 500053 500054 500058 500060 500064 500072 500077 500079 500084 500088 500108 500119 500122 500124 500129 500134 500138 500139 500141 500143 500147 500148 500150 510001 510002 510006 510007 510008 510012 510013 510018 510022 510023 510024 510026 510028 510029 510030 510031 510033 510038 510039 510046 510047 510048 510050 510053 510055 510058 510059 510062 510067 510068 510070 510071 510072 510077 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.3525 1.4984 1.7936 1.4374 1.2887 1.9955 1.6535 1.3750 1.7330 1.2310 1.4551 1.3757 1.3885 1.3961 1.6412 1.3894 1.3587 1.4290 1.5751 0.4907 0.8731 1.5216 1.3178 0.4729 0.8772 1.1794 1.2175 1.9235 1.2868 1.3373 1.7217 1.3063 0.9607 1.1241 1.0603 1.8404 1.2851 1.8413 0.9974 *** 1.3222 1.0974 1.4320 1.7286 1.0547 1.2513 1.3473 1.1464 1.1744 1.6023 1.1036 1.5345 1.3454 0.7138 1.1596 1.1080 1.1378 1.2252 1.3169 1.1600 1.0539 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.0565 1.1233 1.1351 1.1351 1.0565 1.0565 1.0565 1.1351 1.1351 1.0826 1.0565 1.1202 1.1351 1.1351 1.1202 1.0565 * 1.1351 1.1202 1.1351 * 1.1060 1.1351 1.1060 * 1.0565 1.1233 0.8388 0.9190 0.8244 0.8845 0.9259 0.7568 0.7568 0.8294 0.8397 0.7893 0.8388 0.7568 * 0.8397 0.8244 0.8397 0.8238 0.7568 0.7568 0.7744 0.8388 0.7568 0.7568 0.7568 0.8845 0.8238 0.8397 0.8294 0.7568 * 0.8294 0.7744 0.7568 0.8706 27.1819 29.9791 31.9406 * 28.4130 30.8067 30.4699 34.1523 31.5371 33.4863 29.4199 29.6623 29.3484 33.4302 29.4244 30.9999 30.1396 31.5438 30.7536 26.8607 * 31.6591 30.5456 22.1419 24.5744 22.2161 * 23.4477 25.9597 23.5727 25.2835 24.6959 18.2845 20.8782 20.5556 24.2125 20.4908 24.0444 16.6192 21.7135 22.4556 21.5583 21.7637 23.0305 17.2832 19.5468 21.2540 24.0954 17.5096 19.9766 20.8608 30.7868 22.6976 21.9551 23.3216 21.2099 23.1011 23.2382 23.1685 20.1997 23.6584 27.7170 32.6751 32.5764 * 28.2901 31.6595 30.7487 37.4869 31.6112 31.2000 31.6153 31.3280 30.2411 35.3770 31.8483 29.7028 * 32.3505 32.1102 27.2428 * 33.9739 31.3308 23.6766 * 26.4206 * 25.2973 23.8921 24.9627 24.7264 26.3554 18.8984 22.7882 22.4597 26.9511 20.6435 25.5634 17.9908 * 22.7104 24.3936 23.2624 22.6189 20.6565 19.8751 22.1712 27.1214 18.8576 21.0772 22.3318 28.4615 23.9015 22.1435 26.2296 25.0437 * 23.5639 23.4508 20.5146 24.5010 29.8189 33.7695 34.7579 * 30.2803 32.4524 30.7029 38.7650 32.3570 32.5263 33.2185 32.5802 32.7883 36.7929 34.3853 31.2216 * 34.4763 34.4437 28.1308 * 35.2459 33.7520 25.3064 * 37.7820 * 25.8670 23.7257 24.8754 26.7129 27.5208 20.8441 22.8762 22.8896 26.8298 21.0931 26.6600 19.0716 * 24.0871 23.7105 24.0220 24.0772 20.9131 20.4713 22.7403 27.6830 22.7921 21.8994 21.5331 29.4112 25.1425 20.8799 26.5027 25.2094 * 23.9714 23.2773 19.4366 25.9500 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00237 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 28.3097 32.1377 33.0980 * 28.9863 31.6451 30.6482 36.8212 31.8420 32.3947 31.3933 31.1943 30.8053 35.2125 31.9453 30.6353 30.1396 32.8201 32.4983 27.5250 * 33.5975 31.9219 23.6837 24.5744 30.2226 * 24.9189 24.4599 24.4761 25.5735 26.2143 19.3184 22.1595 21.9850 25.9931 20.7442 25.4522 17.8791 21.7135 23.0837 23.2332 22.9918 23.2692 19.6268 19.9553 22.0415 26.2412 19.5218 20.9834 21.5796 29.5183 23.9213 21.6736 25.3360 23.8467 23.1011 23.5982 23.3001 20.0240 24.6968 24916 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 510082 510085 510086 510089 510090 520002 520004 520008 520009 520011 520013 520017 520019 520021 520027 520028 520030 520033 520034 520035 520037 520038 520040 520041 520044 520045 520048 520049 520051 520057 520059 520060 520062 520063 520064 520066 520068 520070 520071 520075 520076 520078 520083 520087 520088 520089 520091 520094 520095 520096 520097 520098 520100 520102 520103 520107 520109 520113 520116 520132 520136 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.1114 1.2935 1.1756 *** 1.8498 1.3411 1.3936 1.5354 1.7192 1.3034 1.4596 1.1205 1.3648 1.3025 1.3706 1.3493 1.7235 1.2657 1.2320 1.3589 1.8171 1.2386 1.2129 1.0714 1.3514 1.6541 1.5682 2.1341 1.5581 1.1719 1.3032 1.3697 1.2461 1.1387 1.5995 1.4385 *** 1.7753 1.1682 1.5608 1.2408 1.5176 1.7380 1.7746 1.4249 1.5701 1.2952 *** 1.2940 1.3768 1.3988 2.0280 1.2790 1.1731 1.5503 1.2785 1.0385 1.3265 1.2670 *** 1.7254 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 0.7568 0.8397 0.7568 * 0.8845 1.0011 0.9704 1.0296 0.9635 0.9635 0.9635 0.9635 0.9635 1.0455 1.0296 1.1002 1.0011 0.9635 0.9635 0.9718 1.0011 1.0296 1.0296 1.1181 0.9718 0.9635 0.9635 0.9635 1.0296 0.9819 1.0287 0.9635 1.0296 1.0296 1.0296 0.9813 * 0.9635 1.0296 0.9635 1.1002 1.0296 1.1181 0.9704 0.9892 1.1181 0.9635 * 1.1002 0.9824 0.9635 1.1181 0.9813 1.0296 1.0296 0.9721 0.9635 0.9635 1.0296 * 1.0296 19.1878 23.7174 17.5933 27.7061 * 24.9950 25.4639 29.8353 26.1503 25.2747 26.6225 24.6677 26.7433 26.6935 27.6771 25.4164 27.0184 25.0853 23.9850 24.7767 29.7234 26.6470 27.2325 22.7595 26.0191 26.0030 25.1724 25.9256 28.4880 25.3745 28.0907 23.8817 28.2215 27.4100 28.6101 27.1657 24.8184 24.8935 27.6202 27.1699 26.1697 27.5989 28.8407 27.3374 26.9936 30.0448 24.6320 25.7567 26.7863 24.5758 26.3321 30.6150 26.2161 26.8234 27.9147 28.3431 23.3271 27.4135 26.9902 23.1941 27.7703 19.9081 26.3877 19.8735 * * 27.7705 27.6530 30.7553 27.4044 26.6268 29.0018 28.4699 28.6971 28.4182 31.4284 26.7260 29.4678 28.0662 26.1094 27.3276 30.1799 29.3134 29.1262 23.5495 27.3685 27.3336 26.8080 26.9851 31.9949 27.7528 29.5801 24.8638 28.8510 29.0993 30.3225 29.2088 * 27.6771 30.0262 29.2920 27.3335 29.9837 30.8826 28.5810 30.7450 33.8793 25.4593 * 30.4216 27.8896 29.1479 32.5785 29.3243 29.1680 30.3165 28.9878 24.7228 31.4708 27.9688 25.0006 30.6522 20.3265 26.2593 19.2574 * * 29.0603 28.9833 33.8038 28.8585 27.2708 30.1823 29.3257 29.8641 29.1110 32.4107 28.0802 30.5699 29.0213 26.8901 28.1023 32.2126 29.6455 31.2019 25.3745 28.2371 29.3743 29.1861 28.0930 31.3100 29.1146 30.4575 26.3170 32.8572 30.3381 31.5710 31.0608 * 28.0835 30.6902 30.1577 27.4423 31.6930 32.7720 30.5643 30.6626 33.4077 27.3437 * 32.0328 29.5966 30.0078 36.5735 29.6404 30.7969 32.6253 29.4173 25.0675 33.3448 30.2148 27.3413 32.2056 —————————— 1 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. 2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00238 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Average hourly wage** (3 years) 19.7900 25.5454 18.9116 27.7061 * 27.3244 27.3808 31.4979 27.4835 26.4030 28.6557 27.4741 28.5157 28.1498 30.5705 26.7497 29.0605 27.5155 25.6373 26.7456 30.7297 28.5972 29.0313 23.9555 27.2569 27.5624 26.9820 26.9956 30.6580 27.4372 29.3881 25.0791 30.1180 28.9449 30.0467 29.1271 24.8184 26.9326 29.4705 28.8340 26.9220 29.7364 30.8982 28.8727 29.5642 32.4828 25.8208 25.7567 29.8101 27.4533 28.4894 33.3161 28.4022 28.9921 30.3606 28.9353 24.3755 30.7246 28.3943 25.0303 30.1520 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24917 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2006; HOSPITAL WAGE INDEXES FOR FEDERAL FISCAL YEAR 2008; HOSPITAL AVERAGE HOURLY WAGES FOR FEDERAL FISCAL YEARS 2006 (2002 WAGE DATA), 2007 (2003 WAGE DATA, AND 2008 (2004 WAGE DATA); AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index 2 Provider No. 520138 520139 520140 520152 520160 520170 520173 520177 520178 520189 520193 520194 520195 520196 520197 520198 520199 520200 520201 520202 530002 530006 530007 530008 530009 530010 530011 530012 530014 530015 530017 530023 530025 530032 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 1.8836 1.2882 0.3793 1.0909 1.8643 1.4772 1.0835 1.6145 1.0240 1.2031 1.6998 1.7148 0.3556 1.6798 *** 1.4193 2.2788 0.9180 0.6866 1.4519 1.1242 1.1836 *** 1.1673 0.9239 1.3065 1.1127 1.7049 1.5650 1.1585 1.1052 *** 1.2406 1.0164 FY 2008 wage index Average hourly wage FY 2006 Average hourly wage FY 2007 Average hourly wage FY 2008 1 1.0296 1.0296 * * 0.9635 1.0296 0.9635 1.0296 * 1.0455 0.9635 1.0296 1.0296 0.9635 * 0.9635 1.0296 * * 1.0011 0.9214 0.9214 * 0.9214 0.9214 0.9214 0.9214 0.9277 0.9219 0.9352 0.9214 * 0.9214 0.9214 28.4394 26.5110 28.4433 24.9392 25.7588 27.2221 28.0995 30.7317 20.2666 28.4720 26.0885 24.9408 36.6973 35.1043 * * * * * * 26.8356 24.9318 20.4391 23.8589 26.8316 25.8482 24.8245 25.2526 24.5947 27.6876 25.3362 21.3813 28.6938 25.7728 30.8016 28.8870 31.0043 29.7308 27.9548 30.4309 29.2429 31.4555 * 28.0014 27.8113 30.1668 36.3116 36.9266 * * * * * * 28.3063 27.2421 * 24.0090 24.6719 25.9852 27.8772 26.9582 26.7156 29.8310 29.8503 * 24.4392 23.9004 31.6560 30.4880 31.0603 * 29.7288 31.4684 31.0590 32.5695 * 29.0284 29.2005 31.4969 36.2864 31.1197 30.1026 28.5962 36.5679 * * * 29.2066 29.2091 * 26.5170 25.9366 27.4111 27.8600 28.7554 28.5771 31.1119 31.1044 * 29.3697 24.6562 Average hourly wage** (3 years) 30.2955 28.6146 30.2033 27.4042 27.8043 29.7182 29.4644 31.6043 20.2666 28.4995 27.7864 28.9141 36.4358 34.0263 30.1026 28.5962 36.5679 * * * 28.1166 27.0634 20.4391 24.7922 25.7848 26.4398 26.9105 26.9872 26.7011 29.5109 28.7212 21.3813 27.4106 24.7327 1 2 Based on salaries adjusted occupational mix, according to the calculation in section II.D.6. of the preamble to this final rule. The transfer-adjusted case-mix index is based on the billed DRG on the FY 2006 MedPAR. * Denotes wage data not available for the provider for that year. ** Based on the sum of the salaries and hours computed for Federal FYs 2006, 2007, and 2008. *** Denotes MedPAR data not available for the provider for FY 2006. TABLE 3A.—FY 2008 AND 3-YEAR* AVERAGE HOURLY WAGE FOR UURBAN AREAS BY CBSA [*Based on the salaries and hours computed for Federal FYs 2006, 2007, and 2008.] mmaher on DSK3CLS3C1PROD with $$_JOB CBSA code 10180 10380 10420 10500 10580 10740 10780 10900 11020 11100 11180 11260 11300 11340 11460 11500 11540 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Mar 15 2010 FY 2008 average hourly wage Urban area Abilene, TX ............................................................................................................................................... Aguadilla-Isabela-San Sebasti[aacute]n, PR ............................................................................................ Akron, OH ................................................................................................................................................. Albany, GA ................................................................................................................................................ Albany-Schenectady-Troy, NY .................................................................................................................. Albuquerque, NM ...................................................................................................................................... Alexandria, LA ........................................................................................................................................... Allentown-Bethlehem-Easton, PA-NJ ....................................................................................................... Altoona, PA ............................................................................................................................................... Amarillo, TX .............................................................................................................................................. Ames, IA ................................................................................................................................................... Anchorage, AK .......................................................................................................................................... Anderson, IN ............................................................................................................................................. Anderson, SC ............................................................................................................................................ Ann Arbor, MI ............................................................................................................................................ Anniston-Oxford, AL .................................................................................................................................. Appleton, WI ............................................................................................................................................. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00239 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 3-Year average hourly wage 25.5538 10.2251 27.1423 26.5075 26.8799 30.1918 24.6475 31.0725 25.8968 28.3367 30.9401 36.4624 27.8019 28.1687 32.5597 24.7339 29.3844 24.1331 11.4341 25.9140 25.8661 25.7658 28.6362 23.5445 29.5625 25.4011 27.1348 28.8517 35.0341 26.0238 26.6066 31.5914 23.2894 27.6794 24918 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 3A.—FY 2008 AND 3-YEAR* AVERAGE HOURLY WAGE FOR UURBAN AREAS BY CBSA—Continued [*Based on the salaries and hours computed for Federal FYs 2006, 2007, and 2008.] CBSA code mmaher on DSK3CLS3C1PROD with $$_JOB 11700 12020 12060 12100 12220 12260 12420 12540 12580 12620 12700 12940 12980 13020 13140 13380 13460 13644 13740 13780 13820 13900 13980 14020 14060 14260 14484 14500 14540 14740 14860 15180 15260 15380 15500 15540 15764 15804 15940 15980 16180 16220 16300 16580 16620 16700 16740 16820 16860 16940 16974 17020 17140 17300 17420 17460 17660 17780 17820 17860 17900 17980 18020 18140 18580 18700 19060 19124 19140 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Mar 15 2010 FY 2008 average hourly wage Urban area Asheville, NC ............................................................................................................................................ Athens-Clarke County, GA ....................................................................................................................... Atlanta-Sandy Springs-Marietta, GA ......................................................................................................... Atlantic City, NJ ........................................................................................................................................ Auburn-Opelika, AL ................................................................................................................................... Augusta-Richmond County, GA-SC ......................................................................................................... Austin-Round Rock, TX ............................................................................................................................ Bakersfield, CA ......................................................................................................................................... Baltimore-Towson, MD ............................................................................................................................. Bangor, ME ............................................................................................................................................... Barnstable Town, MA ............................................................................................................................... Baton Rouge, LA ...................................................................................................................................... Battle Creek, MI ........................................................................................................................................ Bay City, MI .............................................................................................................................................. Beaumont-Port Arthur, TX ........................................................................................................................ Bellingham, WA ........................................................................................................................................ Bend, OR .................................................................................................................................................. Bethesda-Gaithersburg-Frederick, MD ..................................................................................................... Billings, MT ............................................................................................................................................... Binghamton, NY ........................................................................................................................................ Birmingham-Hoover, AL ............................................................................................................................ Bismarck, ND ............................................................................................................................................ Blacksburg-Christiansburg-Radford, VA ................................................................................................... Bloomington, IN ........................................................................................................................................ Bloomington-Normal, IL ............................................................................................................................ Boise City-Nampa, ID ............................................................................................................................... Boston-Quincy, MA ................................................................................................................................... Boulder, CO .............................................................................................................................................. Bowling Green, KY ................................................................................................................................... Bremerton-Silverdale, WA ........................................................................................................................ Bridgeport-Stamford-Norwalk, CT ............................................................................................................. Brownsville-Harlingen, TX ......................................................................................................................... Brunswick, GA .......................................................................................................................................... Buffalo-Niagara Falls, NY ......................................................................................................................... Burlington, NC ........................................................................................................................................... Burlington-South Burlington, VT ............................................................................................................... Cambridge-Newton-Framingham, MA ...................................................................................................... Camden, NJ .............................................................................................................................................. Canton-Massillon, OH ............................................................................................................................... Cape Coral-Fort Myers, FL ....................................................................................................................... Carson City, NV ........................................................................................................................................ Casper, WY ............................................................................................................................................... Cedar Rapids, IA ...................................................................................................................................... Champaign-Urbana, IL .............................................................................................................................. Charleston, WV ......................................................................................................................................... Charleston-North Charleston, SC ............................................................................................................. Charlotte-Gastonia-Concord, NC-SC ........................................................................................................ Charlottesville, VA ..................................................................................................................................... Chattanooga, TN-GA ................................................................................................................................ Cheyenne, WY .......................................................................................................................................... Chicago-Naperville-Joliet, IL ..................................................................................................................... Chico, CA .................................................................................................................................................. Cincinnati-Middletown, OH-KY-IN ............................................................................................................. Clarksville, TN-KY ..................................................................................................................................... Cleveland, TN ........................................................................................................................................... Cleveland-Elyria-Mentor, OH .................................................................................................................... Coeur d’Alene, ID ..................................................................................................................................... College Station-Bryan, TX ........................................................................................................................ Colorado Springs, CO ............................................................................................................................... Columbia, MO ........................................................................................................................................... Columbia, SC ............................................................................................................................................ Columbus, GA-AL ..................................................................................................................................... Columbus, IN ............................................................................................................................................ Columbus, OH .......................................................................................................................................... Corpus Christi, TX .................................................................................................................................... Corvallis, OR ............................................................................................................................................. Cumberland, MD-WV ................................................................................................................................ Dallas-Plano-Irving, TX ............................................................................................................................. Dalton, GA ................................................................................................................................................ 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00240 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 3-Year average hourly wage 28.5462 32.6801 30.5185 37.4892 25.0667 29.7570 29.5055 35.1655 31.3329 30.5654 39.1116 24.8394 31.1266 27.9569 26.6188 34.9165 32.8324 32.4256 27.5180 28.1230 27.5033 22.5429 25.0343 28.9114 29.4126 29.4529 36.2971 31.3644 25.0757 33.5585 39.9455 29.6861 30.2808 29.7130 26.6539 29.7238 34.6193 32.6154 27.6520 29.4170 29.0596 28.7554 26.9340 28.8897 26.0301 28.3391 29.4846 29.6186 27.7965 28.5771 32.4104 34.8348 29.9257 25.4889 25.3391 29.0283 29.0137 28.4460 29.3600 26.4878 27.2473 27.9688 29.8515 31.1465 26.2244 33.1920 24.6964 30.3645 26.6179 27.3747 28.9702 28.9861 34.9547 23.9196 28.5673 27.8771 32.3553 29.4975 29.0449 37.3016 24.3027 28.7337 27.3833 25.3168 33.4025 31.4061 32.2302 26.3023 26.2431 26.3180 21.8622 23.9362 26.4833 27.2841 27.5811 34.5496 29.5797 24.0238 31.9341 37.7175 28.6894 29.1365 28.1438 25.6456 28.0154 32.8465 31.0734 26.5054 27.9198 29.0305 26.9872 25.8161 28.0705 25.1455 27.1402 28.2167 29.3212 26.6064 26.7011 31.4301 32.3528 28.3705 24.5649 24.1812 27.5817 27.8488 26.5695 27.9536 24.9744 26.4178 25.7747 28.2562 29.5977 25.0629 32.2199 24.8721 29.5263 26.1939 24919 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 3A.—FY 2008 AND 3-YEAR* AVERAGE HOURLY WAGE FOR UURBAN AREAS BY CBSA—Continued [*Based on the salaries and hours computed for Federal FYs 2006, 2007, and 2008.] Urban area FY 2008 average hourly wage 3-Year average hourly wage Danville, IL ................................................................................................................................................ Danville, VA .............................................................................................................................................. Davenport-Moline-Rock Island, IA-IL ........................................................................................................ Dayton, OH ............................................................................................................................................... Decatur, AL ............................................................................................................................................... Decatur, IL ................................................................................................................................................ Deltona-Daytona Beach-Ormond Beach, FL ............................................................................................ Denver-Aurora, CO ................................................................................................................................... Des Moines-West Des Moines, IA ............................................................................................................ Detroit-Livonia-Dearborn, MI ..................................................................................................................... Dothan, AL ................................................................................................................................................ Dover, DE ................................................................................................................................................. Dubuque, IA .............................................................................................................................................. Duluth, MN-WI .......................................................................................................................................... Durham, NC .............................................................................................................................................. Eau Claire, WI ........................................................................................................................................... Edison, NJ ................................................................................................................................................. El Centro, CA ............................................................................................................................................ Elizabethtown, KY ..................................................................................................................................... Elkhart-Goshen, IN ................................................................................................................................... Elmira, NY ................................................................................................................................................. El Paso, TX ............................................................................................................................................... Erie, PA ..................................................................................................................................................... Eugene-Springfield, OR ............................................................................................................................ Evansville, IN-KY ...................................................................................................................................... Fairbanks, AK ........................................................................................................................................... Fajardo, PR ............................................................................................................................................... Fargo, ND-MN ........................................................................................................................................... Farmington, NM ........................................................................................................................................ Fayetteville, NC ......................................................................................................................................... Fayetteville-Springdale-Rogers, AR-MO ................................................................................................... Flagstaff, AZ .............................................................................................................................................. Flint, MI ..................................................................................................................................................... Florence, SC ............................................................................................................................................. Florence-Muscle Shoals, AL ..................................................................................................................... Fond du Lac, WI ....................................................................................................................................... Fort Collins-Loveland, CO ........................................................................................................................ Fort Lauderdale-Pompano Beach-Deerfield Beach, FL ........................................................................... Fort Smith, AR-OK .................................................................................................................................... Fort Walton Beach-Crestview-Destin, FL ................................................................................................. Fort Wayne, IN .......................................................................................................................................... Fort Worth-Arlington, TX ........................................................................................................................... Fresno, CA ................................................................................................................................................ Gadsden, AL ............................................................................................................................................. Gainesville, FL .......................................................................................................................................... Gainesville, GA ......................................................................................................................................... Gary, IN ..................................................................................................................................................... Glens Falls, NY ......................................................................................................................................... Goldsboro, NC .......................................................................................................................................... Grand Forks, ND-MN ................................................................................................................................ Grand Junction, CO .................................................................................................................................. Grand Rapids-Wyoming, MI ..................................................................................................................... Great Falls, MT ......................................................................................................................................... Greeley, CO .............................................................................................................................................. Green Bay, WI .......................................................................................................................................... Greensboro-High Point, NC ...................................................................................................................... Greenville, NC ........................................................................................................................................... Greenville-Mauldin-Easley, SC ................................................................................................................. Guayama, PR ........................................................................................................................................... Gulfport-Biloxi, MS .................................................................................................................................... Hagerstown-Martinsburg, MD-WV ............................................................................................................ Hanford-Corcoran, CA .............................................................................................................................. Harrisburg-Carlisle, PA ............................................................................................................................. Harrisonburg, VA ...................................................................................................................................... Hartford-West Hartford-East Hartford, CT ................................................................................................ Hattiesburg, MS ........................................................................................................................................ Hickory-Lenoir-Morganton, NC ................................................................................................................. 1Hinesville-Fort Stewart, GA ..................................................................................................................... Holland-Grand Haven, MI ......................................................................................................................... 28.6735 26.3059 27.2960 28.7758 24.4009 25.1642 27.7363 32.5162 28.4004 31.1509 22.9355 32.2239 27.5076 31.4670 30.4233 29.1319 34.3248 28.4214 26.7267 29.2579 25.8434 28.3459 26.3706 34.1215 26.2541 33.9363 12.7755 24.6368 28.7944 30.7692 27.5150 35.8265 34.3384 26.5418 24.6505 30.6626 29.6510 31.1393 24.9728 26.8666 28.0400 29.9000 34.2325 25.1998 28.8449 29.2101 28.6613 26.4297 28.7525 23.9585 30.0980 29.0748 26.4350 30.9980 29.4038 28.2420 28.7422 29.9557 09.1324 26.7144 28.7017 33.0694 28.6428 27.8236 33.9586 23.3662 27.8269 .................... 28.1052 27.3133 25.1154 25.9226 27.1442 24.0134 24.0538 27.0490 31.4369 27.5531 30.3767 22.3197 29.9990 26.4788 30.1024 29.2561 27.8408 32.9557 26.8331 25.6686 28.0411 24.6042 26.9978 25.6869 32.3046 25.6720 32.8387 12.1173 24.1979 25.7110 28.3815 26.2034 34.6818 32.0516 25.8347 23.6965 29.5642 28.4242 30.0154 23.7472 25.7305 27.6656 28.3094 32.2418 23.7672 27.7112 27.2811 27.6146 25.3758 26.8565 23.1800 28.4996 27.9448 25.6359 29.1621 28.1020 26.8372 27.6117 28.7860 09.2033 25.8323 27.6848 30.9554 27.5304 26.8453 32.5097 22.3924 26.5087 .................... 26.9690 CBSA code mmaher on DSK3CLS3C1PROD with $$_JOB 19180 19260 19340 19380 19460 19500 19660 19740 19780 19804 20020 20100 20220 20260 20500 20740 20764 20940 21060 21140 21300 21340 21500 21660 21780 21820 21940 22020 22140 22180 22220 22380 22420 22500 22520 22540 22660 22744 22900 23020 23060 23104 23420 23460 23540 23580 23844 24020 24140 24220 24300 24340 24500 24540 24580 24660 24780 24860 25020 25060 25180 25260 25420 25500 25540 25620 25860 25980 26100 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00241 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 24920 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 3A.—FY 2008 AND 3-YEAR* AVERAGE HOURLY WAGE FOR UURBAN AREAS BY CBSA—Continued [*Based on the salaries and hours computed for Federal FYs 2006, 2007, and 2008.] CBSA code mmaher on DSK3CLS3C1PROD with $$_JOB 26180 26300 26380 26420 26580 26620 26820 26900 26980 27060 27100 27140 27180 27260 27340 27500 27620 27740 27780 27860 27900 28020 28100 28140 28420 28660 28700 28740 28940 29020 29100 29140 29180 29340 29404 29420 29460 29540 29620 29700 29740 29820 29940 30020 30140 30300 30340 30460 30620 30700 30780 30860 30980 31020 31084 31140 31180 31340 31420 31460 31540 31700 31900 32420 32580 32780 32820 32900 33124 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Mar 15 2010 FY 2008 average hourly wage Urban area Honolulu, HI .............................................................................................................................................. Hot Springs, AR ........................................................................................................................................ Houma-Bayou Cane-Thibodaux, LA ......................................................................................................... Houston- Sugar Land-Baytown, TX .......................................................................................................... Huntington-Ashland, WV-KY-OH .............................................................................................................. Huntsville, AL ............................................................................................................................................ Idaho Falls, ID ........................................................................................................................................... Indianapolis-Carmel, IN ............................................................................................................................ Iowa City, IA .............................................................................................................................................. Ithaca, NY ................................................................................................................................................. Jackson, MI ............................................................................................................................................... Jackson, MS ............................................................................................................................................. Jackson, TN .............................................................................................................................................. Jacksonville, FL ........................................................................................................................................ Jacksonville, NC ....................................................................................................................................... Janesville, WI ............................................................................................................................................ Jefferson City, MO .................................................................................................................................... Johnson City, TN ...................................................................................................................................... Johnstown, PA .......................................................................................................................................... Jonesboro, AR .......................................................................................................................................... Joplin, MO ................................................................................................................................................. Kalamazoo-Portage, MI ............................................................................................................................ Kankakee-Bradley, IL ................................................................................................................................ Kansas City, MO-KS ................................................................................................................................. Kennewick-Richland-Pasco, WA .............................................................................................................. Killeen-Temple-Fort Hood, TX .................................................................................................................. Kingsport-Bristol-Bristol, TN-VA ................................................................................................................ Kingston, NY ............................................................................................................................................. Knoxville, TN ............................................................................................................................................. Kokomo, IN ............................................................................................................................................... La Crosse, WI-MN .................................................................................................................................... Lafayette, IN .............................................................................................................................................. Lafayette, LA ............................................................................................................................................. Lake Charles, LA ...................................................................................................................................... Lake County-Kenosha County, IL-WI ....................................................................................................... 2Lake Havasu City-Kingman, AZ .............................................................................................................. Lakeland, FL ............................................................................................................................................. Lancaster, PA ........................................................................................................................................... Lansing-East Lansing, MI ......................................................................................................................... Laredo, TX ................................................................................................................................................ Las Cruces, NM ........................................................................................................................................ Las Vegas-Paradise, NV .......................................................................................................................... Lawrence, KS ............................................................................................................................................ Lawton, OK ............................................................................................................................................... Lebanon, PA ............................................................................................................................................. Lewiston, ID-WA ....................................................................................................................................... Lewiston-Auburn, ME ................................................................................................................................ Lexington-Fayette, KY .............................................................................................................................. Lima, OH ................................................................................................................................................... Lincoln, NE ................................................................................................................................................ Little Rock-North Little Rock-Conway, AR ................................................................................................ Logan, UT-ID ............................................................................................................................................ Longview, TX ............................................................................................................................................ Longview, WA ........................................................................................................................................... Los Angeles-Long Beach-Glendale, CA ................................................................................................... Louisville-Jefferson County, KY-IN ........................................................................................................... Lubbock, TX .............................................................................................................................................. Lynchburg, VA .......................................................................................................................................... Macon, GA ................................................................................................................................................ Madera, CA ............................................................................................................................................... Madison, WI .............................................................................................................................................. Manchester-Nashua, NH .......................................................................................................................... Mansfield, OH ........................................................................................................................................... Mayaguez, PR .......................................................................................................................................... McAllen-Edinburg-Mission, TX .................................................................................................................. Medford, OR ............................................................................................................................................. Memphis, TN-MS-AR ................................................................................................................................ Merced, CA ............................................................................................................................................... Miami-Miami Beach-Kendall, FL ............................................................................................................... 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00242 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 3-Year average hourly wage 34.9939 28.2398 24.7338 31.1464 27.4177 28.4420 28.6678 30.1383 29.2276 29.5522 29.3419 24.9313 26.6283 28.2991 25.6323 30.4182 26.9868 24.0384 23.6933 24.5409 28.8838 32.5642 36.1982 28.8920 30.5712 25.7516 24.1118 29.5032 24.9295 29.3510 30.0801 26.9108 25.7276 24.1373 31.8873 28.9023 27.3993 29.5748 31.1620 26.2982 26.4505 35.4313 25.4425 26.0576 25.4393 28.6132 28.8104 27.9807 28.7195 30.4893 27.7885 28.4774 27.2722 34.1983 36.0596 28.0357 26.8986 26.2578 30.2300 26.0875 34.6597 30.9773 28.5629 11.3424 28.3334 31.9390 28.7998 37.0756 31.0677 32.9065 26.5588 23.6332 29.7094 26.7237 26.8784 27.2911 28.9656 28.3307 28.8425 28.0558 24.1807 25.9384 27.3023 24.5577 28.8010 25.3369 23.4502 24.1218 23.3826 26.2169 31.2112 31.8459 27.7054 30.0865 25.4181 23.5801 27.8057 24.3432 28.2549 28.4068 25.7887 24.7355 23.1806 30.9559 27.6036 26.4643 28.7392 29.4193 24.3954 25.6128 33.5557 24.7034 24.4695 25.2120 28.2893 27.4892 26.6659 26.9710 29.5435 27.0599 27.0281 26.0005 30.2983 34.6113 27.0524 25.6168 25.3812 28.6691 25.2903 32.2701 30.1064 27.8928 11.2954 26.4909 30.8468 27.5984 33.9058 29.1861 24921 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 3A.—FY 2008 AND 3-YEAR* AVERAGE HOURLY WAGE FOR UURBAN AREAS BY CBSA—Continued [*Based on the salaries and hours computed for Federal FYs 2006, 2007, and 2008.] CBSA code mmaher on DSK3CLS3C1PROD with $$_JOB 33140 33260 33340 33460 33540 33660 33700 33740 33780 33860 34060 34100 34580 34620 34740 34820 34900 34940 34980 35004 35084 35300 35380 35644 35660 35980 36084 36100 36140 36220 36260 36420 36500 36540 36740 36780 36980 37100 37340 37380 37460 37620 37700 37764 37860 37900 37964 38060 38220 38300 38340 38540 38660 38860 38900 38940 39100 39140 39300 39340 39380 39460 39540 39580 39660 39740 39820 39900 40060 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Mar 15 2010 FY 2008 average hourly wage Urban area Michigan City-La Porte, IN ........................................................................................................................ Midland, TX ............................................................................................................................................... Milwaukee-Waukesha-West Allis, WI ....................................................................................................... Minneapolis-St. Paul-Bloomington, MN-WI .............................................................................................. Missoula, MT ............................................................................................................................................. Mobile, AL ................................................................................................................................................. Modesto, CA ............................................................................................................................................. Monroe, LA ............................................................................................................................................... Monroe, MI ................................................................................................................................................ Montgomery, AL ........................................................................................................................................ Morgantown, WV ...................................................................................................................................... Morristown, TN .......................................................................................................................................... Mount Vernon-Anacortes, WA .................................................................................................................. Muncie, IN ................................................................................................................................................. Muskegon-Norton Shores, MI ................................................................................................................... Myrtle Beach-Conway-North Myrtle Beach, SC ....................................................................................... Napa, CA .................................................................................................................................................. Naples-Marco Island, FL ........................................................................................................................... Nashville-Davidson-Murfreesboro-Franklin, .............................................................................................. Nassau-Suffolk, NY ................................................................................................................................... Newark-Union, NJ-PA ............................................................................................................................... New Haven-Milford, CT ............................................................................................................................ New Orleans-Metairie-Kenner, LA ............................................................................................................ New York-White Plains-Wayne, NY-NJ .................................................................................................... Niles-Benton Harbor, MI ........................................................................................................................... Norwich-New London, CT ......................................................................................................................... Oakland-Fremont-Hayward, CA ................................................................................................................ Ocala, FL .................................................................................................................................................. Ocean City, NJ .......................................................................................................................................... Odessa, TX ............................................................................................................................................... Ogden-Clearfield, UT ................................................................................................................................ Oklahoma City, OK ................................................................................................................................... Olympia, WA ............................................................................................................................................. Omaha-Council Bluffs, NE-IA ................................................................................................................... Orlando-Kissimmee, FL ............................................................................................................................ Oshkosh-Neenah, WI ................................................................................................................................ Owensboro, KY ......................................................................................................................................... Oxnard-Thousand Oaks-Ventura, CA ....................................................................................................... Palm Bay-Melbourne-Titusville, FL ........................................................................................................... 2Palm Coast, FL ....................................................................................................................................... Panama City-Lynn Haven, FL .................................................................................................................. Parkersburg-Marietta-Vienna, WV-OH ..................................................................................................... Pascagoula, MS ........................................................................................................................................ Peabody, MA (Formerly, Essex County, MA) .......................................................................................... Pensacola-Ferry Pass-Brent, FL .............................................................................................................. Peoria, IL ................................................................................................................................................... Philadelphia, PA ........................................................................................................................................ Phoenix-Mesa-Scottsdale, AZ .................................................................................................................. Pine Bluff, AR ........................................................................................................................................... Pittsburgh, PA ........................................................................................................................................... Pittsfield, MA ............................................................................................................................................. Pocatello, ID .............................................................................................................................................. Ponce, PR ................................................................................................................................................. Portland-South Portland-Biddeford, ME ................................................................................................... Portland-Vancouver-Beaverton, OR-WA .................................................................................................. Port St. Lucie, FL ...................................................................................................................................... Poughkeepsie-Newburgh-Middletown, NY ............................................................................................... Prescott, AZ .............................................................................................................................................. Providence-New Bedford-Fall River, RI-MA ............................................................................................. Provo-Orem, UT ........................................................................................................................................ Pueblo, CO ............................................................................................................................................... Punta Gorda, FL ....................................................................................................................................... Racine, WI ................................................................................................................................................ Raleigh-Cary, NC ...................................................................................................................................... Rapid City, SD .......................................................................................................................................... Reading, PA .............................................................................................................................................. Redding, CA .............................................................................................................................................. Reno-Sparks, NV ...................................................................................................................................... Richmond, VA ........................................................................................................................................... 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00243 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 3-Year average hourly wage 27.2497 31.0460 31.9156 33.9752 26.9875 24.6422 36.8586 24.4029 29.3700 25.9300 26.0745 22.9428 31.5880 24.8038 30.7959 26.8331 42.8545 30.2428 29.9892 39.6471 36.2090 37.0244 27.0691 40.9653 28.3260 35.7729 47.2281 26.6182 33.3167 30.8710 28.0897 27.1668 35.5354 29.1986 29.0828 29.1236 27.2813 35.2562 29.0897 27.0971 25.7289 25.5355 26.4838 31.6602 25.1925 29.0576 33.8074 31.3564 25.2804 26.0038 31.2160 28.3768 12.8969 31.0222 34.8208 30.9663 33.6441 30.7280 33.0234 29.4108 27.0881 29.6415 29.7218 29.0544 26.9357 29.1969 39.7597 34.2896 28.6347 26.8086 28.6440 30.3227 32.3063 26.3725 23.3322 35.0384 23.5967 28.3176 24.5421 25.0602 22.9786 30.3305 24.8594 29.3584 26.0529 38.8227 29.5403 28.8467 37.9525 34.7675 35.4080 25.9597 39.1524 26.5609 34.4608 45.3887 25.7575 31.8219 29.4945 26.7604 26.2084 32.8563 27.9651 28.0089 27.4235 25.9999 33.6195 28.3339 27.5184 24.1673 24.2911 24.5080 30.7561 23.7365 26.9647 32.4521 29.9787 25.1908 25.3862 30.0714 27.2635 13.5329 29.7900 33.1815 29.5522 32.2649 29.1556 31.8841 28.0315 25.6375 28.1419 27.6179 28.3348 25.9831 28.3935 36.7887 33.6154 27.1477 24922 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 3A.—FY 2008 AND 3-YEAR* AVERAGE HOURLY WAGE FOR UURBAN AREAS BY CBSA—Continued [*Based on the salaries and hours computed for Federal FYs 2006, 2007, and 2008.] CBSA code mmaher on DSK3CLS3C1PROD with $$_JOB 40140 40220 40340 40380 40420 40484 40580 40660 40900 40980 41060 41100 41140 41180 41420 41500 41540 41620 41660 41700 41740 41780 41884 41900 41940 41980 42020 42044 42060 42100 42140 42220 42260 42340 42540 42644 42680 43100 43300 43340 43580 43620 43780 43900 44060 44100 44140 44180 44220 44300 44700 44940 45060 45104 45220 45300 45460 45500 45780 45820 45940 46060 46140 46220 46340 46540 46660 46700 47020 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Mar 15 2010 FY 2008 average hourly wage Urban area Riverside-San Bernardino-Ontario, CA ..................................................................................................... Roanoke, VA ............................................................................................................................................. Rochester, MN .......................................................................................................................................... Rochester, NY ........................................................................................................................................... Rockford, IL ............................................................................................................................................... Rockingham County-Strafford County, NH ............................................................................................... Rocky Mount, NC ...................................................................................................................................... Rome, GA ................................................................................................................................................. Sacramento—Arden-Arcade—Roseville, CA ............................................................................................ Saginaw-Saginaw Township North, MI ..................................................................................................... St. Cloud, MN ........................................................................................................................................... St. George, UT .......................................................................................................................................... St. Joseph, MO-KS ................................................................................................................................... St. Louis, MO-IL ........................................................................................................................................ Salem, OR ................................................................................................................................................ Salinas, CA ............................................................................................................................................... Salisbury, MD ............................................................................................................................................ Salt Lake City, UT ..................................................................................................................................... San Angelo, TX ......................................................................................................................................... San Antonio, TX ........................................................................................................................................ San Diego-Carlsbad-San Marcos, CA ...................................................................................................... Sandusky, OH ........................................................................................................................................... San Francisco-San Mateo-Redwood City, CA ......................................................................................... San Germ[aacute]n-Cabo Rojo, PR ......................................................................................................... San Jose-Sunnyvale-Santa Clara, CA ..................................................................................................... San Juan-Caguas-Guaynabo, PR ............................................................................................................ San Luis Obispo-Paso Robles, CA .......................................................................................................... Santa Ana-Anaheim-Irvine, CA ................................................................................................................. Santa Barbara-Santa Maria-Goleta, CA ................................................................................................... Santa Cruz-Watsonville, CA ..................................................................................................................... Santa Fe, NM ............................................................................................................................................ Santa Rosa-Petaluma, CA ........................................................................................................................ Sarasota-Bradenton-Venice, FL ............................................................................................................... Savannah, GA ........................................................................................................................................... Scranton-Wilkes-Barre, PA ....................................................................................................................... Seattle-Bellevue-Everett, WA ................................................................................................................... Sebastian-Vero Beach, FL ........................................................................................................................ Sheboygan, WI ......................................................................................................................................... Sherman-Denison, TX .............................................................................................................................. Shreveport-Bossier City, LA ..................................................................................................................... Sioux City, IA-NE-SD ................................................................................................................................ Sioux Falls, SD ......................................................................................................................................... South Bend-Mishawaka, IN-MI ................................................................................................................. Spartanburg, SC ....................................................................................................................................... Spokane, WA ............................................................................................................................................ Springfield, IL ............................................................................................................................................ Springfield, MA .......................................................................................................................................... Springfield, MO ......................................................................................................................................... Springfield, OH .......................................................................................................................................... State College, PA ..................................................................................................................................... Stockton, CA ............................................................................................................................................. Sumter, SC ............................................................................................................................................... Syracuse, NY ............................................................................................................................................ Tacoma, WA ............................................................................................................................................. Tallahassee, FL ........................................................................................................................................ Tampa-St. Petersburg-Clearwater, FL ...................................................................................................... Terre Haute, IN ......................................................................................................................................... Texarkana, TX-Texarkana, AR ................................................................................................................. Toledo, OH ................................................................................................................................................ Topeka, KS ............................................................................................................................................... Trenton-Ewing, NJ .................................................................................................................................... Tucson, AZ ................................................................................................................................................ Tulsa, OK .................................................................................................................................................. Tuscaloosa, AL ......................................................................................................................................... Tyler, TX ................................................................................................................................................... Utica-Rome, NY ........................................................................................................................................ Valdosta, GA ............................................................................................................................................. Vallejo-Fairfield, CA .................................................................................................................................. Victoria, TX ............................................................................................................................................... 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00244 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 3-Year average hourly wage 33.2757 29.2663 33.3540 27.5839 29.9396 31.1882 27.9510 29.6009 40.2929 28.2929 34.2927 29.5906 27.3734 27.5406 32.2483 44.6611 27.6293 29.3945 26.8517 27.6376 34.4952 27.1537 45.7716 14.2741 47.5716 14.0009 36.9259 35.8808 35.4727 48.5637 33.1322 44.2225 30.2493 27.8554 25.8844 35.1860 30.0922 28.0832 26.4564 26.7055 28.5808 29.6276 29.9084 28.9299 32.1950 27.7341 31.7303 28.5068 26.3899 26.7336 36.3757 27.5115 30.7252 33.9097 27.9967 28.2629 27.3665 25.2054 28.7526 26.5384 33.2291 29.4005 26.3616 26.4544 28.4878 27.1982 25.4416 44.6372 25.1770 32.0240 26.3177 32.6100 26.7250 29.2179 30.1242 26.4642 28.2852 38.4229 27.0559 31.6151 28.1994 28.2406 26.4397 30.6937 42.1515 26.4517 28.0053 25.0303 26.4378 33.2115 26.6087 44.5272 13.8608 45.1683 13.3929 33.8666 33.9972 33.4432 45.3017 31.9531 41.4919 28.7208 27.1733 24.7507 33.6677 28.6105 26.7407 26.2405 25.8214 27.2053 28.1066 28.9199 27.1549 31.1767 26.2610 30.1941 25.6242 25.0448 25.2069 34.0601 25.3139 28.8799 31.9619 26.3266 27.2055 25.3379 24.1254 27.8529 25.8360 31.9683 27.5680 25.0135 25.5476 26.8718 25.5595 25.1421 43.5597 24.3401 24923 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 3A.—FY 2008 AND 3-YEAR* AVERAGE HOURLY WAGE FOR UURBAN AREAS BY CBSA—Continued [*Based on the salaries and hours computed for Federal FYs 2006, 2007, and 2008.] CBSA code 47220 47260 47300 47380 47580 47644 47894 47940 48140 48260 48300 48424 48540 48620 48660 48700 48864 48900 49020 49180 49340 49420 49500 49620 49660 49700 49740 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... FY 2008 average hourly wage Urban area Vineland-Millville-Bridgeton, NJ ................................................................................................................ Virginia Beach-Norfolk-Newport News, VA-NC ........................................................................................ Visalia-Porterville, CA ............................................................................................................................... Waco, TX .................................................................................................................................................. Warner Robins, GA ................................................................................................................................... Warren-Troy-Farmington Hills, MI ............................................................................................................ Washington-Arlington-Alexandria, DC-VA-MD-WV .................................................................................. Waterloo-Cedar Falls, IA .......................................................................................................................... Wausau, WI .............................................................................................................................................. Weirton-Steubenville, WV-OH .................................................................................................................. Wenatchee, WA ........................................................................................................................................ West Palm Beach-Boca Raton-Boynton Beach, ...................................................................................... Wheeling, WV-OH ..................................................................................................................................... Wichita, KS ............................................................................................................................................... Wichita Falls, TX ....................................................................................................................................... Williamsport, PA ........................................................................................................................................ Wilmington, DE-MD-NJ ............................................................................................................................. Wilmington, NC ......................................................................................................................................... Winchester, VA-WV .................................................................................................................................. Winston-Salem, NC .................................................................................................................................. Worcester, MA .......................................................................................................................................... Yakima, WA .............................................................................................................................................. Yauco, PR ................................................................................................................................................. York-Hanover, PA ..................................................................................................................................... Youngstown-Warren-Boardman, OH-PA .................................................................................................. Yuba City, CA ........................................................................................................................................... Yuma, AZ .................................................................................................................................................. 3-Year average hourly wage 33.0209 27.2314 31.6337 26.6527 29.8152 31.1213 33.1020 27.0404 30.5699 24.4652 34.9702 29.7173 21.7311 27.9249 26.3114 24.6486 33.0781 28.9440 30.5335 28.1564 35.1528 31.6557 09.9275 28.8489 27.8858 32.6357 29.3504 30.4618 26.0029 30.0704 25.4923 26.8109 29.5882 32.0904 25.5291 29.0605 23.3430 31.3439 28.7189 20.9330 26.7367 24.9937 23.9556 31.3150 28.2419 29.6408 26.9277 32.7168 29.7156 11.1279 27.7627 25.9934 31.5710 27.3749 1 This area has no average hourly wage because there are no short-term, acute care hospitals in the area. This is a new CBSA for fiscal year 2008. To calculate the 3-year average hourly wage for this new area, we included the hospitals’ data from their previous geographic location for fiscal year 2006 and fiscal year 2007. 2 TABLE 3B.—FY 2008 AND 3-YEAR* AVERAGE HOURLY WAGE FOR RURAL AREAS BY CBSA [*Based on the sum of the salaries and hours computed for Federal fiscal years 2006, 2007, and 2008] Nonurban area FY 2008 average hourly wage 3-Year average hourly wage Alabama .................................................................................................................................................... Alaska ....................................................................................................................................................... Arizona ...................................................................................................................................................... Arkansas ................................................................................................................................................... California ................................................................................................................................................... Colorado .................................................................................................................................................... Connecticut ............................................................................................................................................... Delaware ................................................................................................................................................... Florida ....................................................................................................................................................... Georgia ..................................................................................................................................................... Hawaii ....................................................................................................................................................... Idaho ......................................................................................................................................................... Illinois ........................................................................................................................................................ Indiana ...................................................................................................................................................... Iowa ........................................................................................................................................................... Kansas ...................................................................................................................................................... Kentucky ................................................................................................................................................... Louisiana ................................................................................................................................................... Maine ........................................................................................................................................................ Maryland ................................................................................................................................................... Massachusetts 1 ....................................................................................................................................... Michigan .................................................................................................................................................... Minnesota .................................................................................................................................................. Mississippi ................................................................................................................................................. Missouri ..................................................................................................................................................... Montana .................................................................................................................................................... Nebraska ................................................................................................................................................... Nevada ...................................................................................................................................................... New Hampshire ........................................................................................................................................ New Jersey 1 ............................................................................................................................................ 23.5521 36.6306 27.8285 23.2785 35.9780 29.2965 36.3353 30.2968 26.6274 24.3756 33.3239 24.4240 25.8984 26.6535 26.2882 24.6946 24.2146 23.5312 26.0760 27.6395 .................... 27.5837 28.5541 24.5289 25.0101 25.8421 27.1777 30.0298 33.8547 .................... 22.3676 33.8985 26.2195 22.1149 33.1876 27.4981 34.8991 28.8250 25.5376 23.0319 31.5165 23.6078 24.5999 25.3496 25.1297 23.6039 23.0381 22.3366 25.2175 26.7366 .................... 26.4032 27.0433 23.0377 23.6921 25.3487 25.6347 27.4114 32.1650 .................... mmaher on DSK3CLS3C1PROD with $$_JOB CBSA code 01 02 03 04 05 06 07 08 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00245 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 24924 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 3B.—FY 2008 AND 3-YEAR* AVERAGE HOURLY WAGE FOR RURAL AREAS BY CBSA—Continued [*Based on the sum of the salaries and hours computed for Federal fiscal years 2006, 2007, and 2008] Nonurban area FY 2008 average hourly wage 3-Year average hourly wage New Mexico .............................................................................................................................................. New York .................................................................................................................................................. North Carolina ........................................................................................................................................... North Dakota ............................................................................................................................................. Ohio ........................................................................................................................................................... Oklahoma .................................................................................................................................................. Oregon ...................................................................................................................................................... Pennsylvania ............................................................................................................................................. Puerto Rico 1 ............................................................................................................................................ Rhode Island 1 .......................................................................................................................................... South Carolina .......................................................................................................................................... South Dakota ............................................................................................................................................ Tennessee ................................................................................................................................................ Texas ........................................................................................................................................................ Utah ........................................................................................................................................................... Vermont ..................................................................................................................................................... Virginia ...................................................................................................................................................... Washington ............................................................................................................................................... West Virginia ............................................................................................................................................. Wisconsin .................................................................................................................................................. Wyoming ................................................................................................................................................... 27.7898 25.8757 26.6830 22.6664 26.9698 23.8387 30.7212 25.8767 .................... .................... 27.2502 25.8592 24.3749 25.4299 25.6240 30.2045 25.0426 31.5068 23.4572 29.8668 28.5623 25.6380 24.4927 25.3984 21.5961 25.8025 22.7968 28.9514 24.5786 .................... .................... 25.7842 24.7950 23.4834 24.0807 24.2425 28.6321 23.8317 30.3826 22.6937 28.3189 27.0729 CBSA code 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 49 50 51 52 53 1 ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. All counties within the State or territory are classified as urban. TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008 Wage index CBSA code Urban area (constituent counties) 10180 ....... Abilene, TX ....................................................................................................................................................... Callahan County, TX. Jones County, TX. Taylor County, TX. Aguadilla-Isabela-San Sebasti[aacute]n, PR .................................................................................................... Aguada Municipio, PR. Aguadilla Municipio, PR. A[ntilde]asco Municipio, PR. Isabela Municipio, PR. Lares Municipio, PR. Moca Municipio, PR. Rinc[oacute]n Municipio, PR. San Sebasti[aacute]n Municipio, PR. Akron, OH ......................................................................................................................................................... Portage County, OH. Summit County, OH. Albany, GA ........................................................................................................................................................ Baker County, GA. Dougherty County, GA. Lee County, GA. Terrell County, GA. Worth County, GA. Albany-Schenectady-Troy, NY .......................................................................................................................... Albany County, NY. Rensselaer County, NY. Saratoga County, NY. Schenectady County, NY. Schoharie County, NY. Albuquerque, NM .............................................................................................................................................. Bernalillo County, NM. Sandoval County, NM. Torrance County, NM. Valencia County, NM. Alexandria, LA ................................................................................................................................................... Grant Parish, LA. Rapides Parish, LA. Allentown-Bethlehem-Easton, PA-NJ ............................................................................................................... Warren County, NJ. Carbon County, PA. 10380 ....... 10420 ....... 10500 ....... 10580 ....... 10740 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 10780 ....... 10900 ....... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00246 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 0.8244 0.8761 0.3298 0.4678 0.8854 0.9200 0.8671 0.9070 0.8672 0.9070 0.9740 0.9821 0.7982 0.8570 1.0024 1.0016 24925 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 11020 ....... 11100 ....... 11180 ....... 11260 ....... 11300 ....... 11340 ....... 11460 ....... 11500 ....... 11540 ....... 11700 ....... 12020 ....... 12060 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 12100 ....... 12220 ....... 12260 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) Lehigh County, PA. Northampton County, PA. 2 Altoona, PA .................................................................................................................................................... Blair County, PA. Amarillo, TX ...................................................................................................................................................... Armstrong County, TX. Carson County, TX. Potter County, TX. Randall County, TX. Ames, IA ........................................................................................................................................................... Story County, IA. Anchorage, AK .................................................................................................................................................. Anchorage Municipality, AK. Matanuska-Susitna Borough, AK. Anderson, IN ..................................................................................................................................................... Madison County, IN. Anderson, SC .................................................................................................................................................... Anderson County, SC. Ann Arbor, MI .................................................................................................................................................... Washtenaw County, MI. Anniston-Oxford, AL .......................................................................................................................................... Calhoun County, AL. 2 Appleton, WI ................................................................................................................................................... Calumet County, WI. Outagamie County, WI. Asheville, NC .................................................................................................................................................... Buncombe County, NC. Haywood County, NC. Henderson County, NC. Madison County, NC. Athens-Clarke County, GA ................................................................................................................................ Clarke County, GA. Madison County, GA. Oconee County, GA. Oglethorpe County, GA. 1 Atlanta-Sandy Springs-Marietta, GA .............................................................................................................. Barrow County, GA. Bartow County, GA. Butts County, GA. Carroll County, GA. Cherokee County, GA. Clayton County, GA. Cobb County, GA. Coweta County, GA. Dawson County, GA. DeKalb County, GA. Douglas County, GA. Fayette County, GA. Forsyth County, GA. Fulton County, GA. Gwinnett County, GA. Haralson County, GA. Heard County, GA. Henry County, GA. Jasper County, GA. Lamar County, GA. Meriwether County, GA. Newton County, GA. Paulding County, GA. Pickens County, GA. Pike County, GA. Rockdale County, GA. Spalding County, GA. Walton County, GA. Atlantic City, NJ ................................................................................................................................................ Atlantic County, NJ. Auburn-Opelika, AL ........................................................................................................................................... Lee County, AL. Augusta-Richmond County, GA-SC .................................................................................................................. Burke County, GA. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00247 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 0.8366 0.8850 0.9141 0.9403 0.9982 0.9988 1.1840 1.1226 0.8969 0.9282 0.9087 0.9365 1.0504 1.0342 0.8042 0.8614 0.9635 0.9749 0.9209 0.9451 1.0543 1.0369 0.9845 0.9894 1.2095 1.1391 0.8086 0.8646 0.9600 0.9724 24926 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 12420 ....... 12540 ....... 12580 ....... 12620 ....... 12700 ....... 12940 ....... 12980 ....... 13020 ....... 13140 ....... 13380 ....... 13460 ....... 13644 ....... 13740 ....... 13780 ....... 13820 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 13900 ....... 13980 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) Columbia County, GA. McDuffie County, GA. Richmond County, GA. Aiken County, SC. Edgefield County, SC. 1 Austin-Round Rock, TX .................................................................................................................................. Bastrop County, TX. Caldwell County, TX. Hays County, TX. Travis County, TX. Williamson County, TX. 2 Bakersfield, CA ............................................................................................................................................... Kern County, CA. 1 Baltimore-Towson, MD ................................................................................................................................... Anne Arundel County, MD. Baltimore County, MD. Carroll County, MD. Harford County, MD. Howard County, MD. Queen Anne’s County, MD. Baltimore City, MD. Bangor, ME ....................................................................................................................................................... Penobscot County, ME. Barnstable Town, MA ........................................................................................................................................ Barnstable County, MA. Baton Rouge, LA .............................................................................................................................................. Ascension Parish, LA. East Baton Rouge Parish, LA. East Feliciana Parish, LA. Iberville Parish, LA. Livingston Parish, LA. Pointe Coupee Parish, LA. St. Helena Parish, LA. West Baton Rouge Parish, LA. West Feliciana Parish, LA. Battle Creek, MI ................................................................................................................................................ Calhoun County, MI. Bay City, MI ...................................................................................................................................................... Bay County, MI. Beaumont-Port Arthur, TX ................................................................................................................................ Hardin County, TX. Jefferson County, TX. Orange County, TX. Bellingham, WA ................................................................................................................................................ Whatcom County, WA. Bend, OR .......................................................................................................................................................... Deschutes County, OR. 1 Bethesda-Gaithersburg-Frederick, MD .......................................................................................................... Frederick County, MD. Montgomery County, MD. Billings, MT ....................................................................................................................................................... Carbon County, MT. Yellowstone County, MT. Binghamton, NY ................................................................................................................................................ Broome County, NY. Tioga County, NY. 1 Birmingham-Hoover, AL ................................................................................................................................. Bibb County, AL. Blount County, AL. Chilton County, AL. Jefferson County, AL. St. Clair County, AL. Shelby County, AL. Walker County, AL. Bismarck, ND .................................................................................................................................................... Burleigh County, ND. Morton County, ND. 2 Blacksburg-Christiansburg-Radford, VA ........................................................................................................ Giles County, VA. Montgomery County, VA. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00248 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 0.9518 0.9667 1.1607 1.1074 1.0108 1.0074 0.9860 0.9904 1.2617 1.1726 0.8014 0.8593 1.0042 1.0029 0.9399 0.9584 0.8587 0.9009 1.1264 1.0849 1.0592 1.0402 1.0990 1.0668 0.8877 0.9217 0.9072 0.9355 0.8873 0.9214 0.7329 0.8083 0.8095 0.8653 24927 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 14020 ....... 14060 ....... 14260 ....... 14484 ....... 14500 ....... 14540 ....... 14740 ....... 14860 ....... 15180 ....... 15260 ....... 15380 ....... 15500 ....... 15540 ....... 15764 ....... 15804 ....... 15940 ....... 15980 ....... 16180 ....... 16220 ....... 16300 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 16580 ....... 16620 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) Pulaski County, VA. Radford City, VA. Bloomington, IN ................................................................................................................................................ Greene County, IN. Monroe County, IN. Owen County, IN. Bloomington-Normal, IL .................................................................................................................................... McLean County, IL. Boise City-Nampa, ID ....................................................................................................................................... Ada County, ID. Boise County, ID. Canyon County, ID. Gem County, ID. Owyhee County, ID. 1 Boston-Quincy, MA ........................................................................................................................................ Norfolk County, MA. Plymouth County, MA. Suffolk County, MA. Boulder, CO ...................................................................................................................................................... Boulder County, CO. Bowling Green, KY ........................................................................................................................................... Edmonson County, KY. Warren County, KY. Bremerton-Silverdale, WA ................................................................................................................................. Kitsap County, WA. Bridgeport-Stamford-Norwalk, CT ..................................................................................................................... Fairfield County, CT. Brownsville-Harlingen, TX ................................................................................................................................. Cameron County, TX. Brunswick, GA .................................................................................................................................................. Brantley County, GA. Glynn County, GA. McIntosh County, GA. 1 Buffalo-Niagara Falls, NY ............................................................................................................................... Erie County, NY. Niagara County, NY. 2 Burlington, NC ................................................................................................................................................ Alamance County, NC. 2 Burlington-South Burlington, VT ..................................................................................................................... Chittenden County, VT. Franklin County, VT. Grand Isle County, VT. 1 Cambridge-Newton-Framingham, MA ............................................................................................................ Middlesex County, MA. 1 Camden, NJ ................................................................................................................................................... Burlington County, NJ. Camden County, NJ. Gloucester County, NJ. Canton-Massillon, OH ....................................................................................................................................... Carroll County, OH. Stark County, OH. Cape Coral-Fort Myers, FL ............................................................................................................................... Lee County, FL. 2 Carson City, NV ............................................................................................................................................. Carson City, NV. Casper, WY ....................................................................................................................................................... Natrona County, WY. Cedar Rapids, IA .............................................................................................................................................. Benton County, IA. Jones County, IA. Linn County, IA. Champaign-Urbana, IL ...................................................................................................................................... Champaign County, IL. Ford County, IL. Piatt County, IL. Charleston, WV ................................................................................................................................................. Boone County, WV. Clay County, WV. Kanawha County, WV. Lincoln County, WV. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00249 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 0.9327 0.9534 0.9488 0.9646 0.9501 0.9656 1.1710 1.1142 1.0118 1.0081 0.8089 0.8648 1.0826 1.0559 1.2886 1.1896 0.9577 0.9708 0.9768 0.9841 0.9586 0.9715 0.8608 0.9024 1.0401 1.0273 1.1168 1.0786 1.0522 1.0355 0.8921 0.9248 0.9490 0.9648 0.9688 0.9785 0.9277 0.9499 0.8689 0.9083 0.9320 0.9529 0.8397 0.8872 24928 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 16700 ....... 16740 ....... 16820 ....... 16860 ....... 16940 ....... 16974 ....... 17020 ....... 17140 ....... 17300 ....... 17420 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 17460 ....... 17660 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) Putnam County, WV. Charleston-North Charleston, SC ..................................................................................................................... Berkeley County, SC. Charleston County, SC. Dorchester County, SC. 1 Charlotte-Gastonia-Concord, NC-SC ............................................................................................................. Anson County, NC. Cabarrus County, NC. Gaston County, NC. Mecklenburg County, NC. Union County, NC. York County, SC. Charlottesville, VA ............................................................................................................................................. Albemarle County, VA. Fluvanna County, VA. Greene County, VA. Nelson County, VA. Charlottesville City, VA. Chattanooga, TN-GA ........................................................................................................................................ Catoosa County, GA. Dade County, GA. Walker County, GA. Hamilton County, TN. Marion County, TN. Sequatchie County, TN. Cheyenne, WY .................................................................................................................................................. Laramie County, WY. 1 Chicago-Naperville-Joliet, IL .......................................................................................................................... Cook County, IL. DeKalb County, IL. DuPage County, IL. Grundy County, IL. Kane County, IL. Kendall County, IL. McHenry County, IL. Will County, IL. 2 Chico, CA ....................................................................................................................................................... Butte County, CA. 1 Cincinnati-Middletown, OH-KY-IN .................................................................................................................. Dearborn County, IN. Franklin County, IN. Ohio County, IN. Boone County, KY. Bracken County, KY. Campbell County, KY. Gallatin County, KY. Grant County, KY. Kenton County, KY. Pendleton County, KY. Brown County, OH. Butler County, OH. Clermont County, OH. Hamilton County, OH. Warren County, OH. Clarksville, TN-KY ............................................................................................................................................. Christian County, KY. Trigg County, KY. Montgomery County, TN. Stewart County, TN. Cleveland, TN ................................................................................................................................................... Bradley County, TN. Polk County, TN. 1 Cleveland-Elyria-Mentor, OH ......................................................................................................................... Cuyahoga County, OH. Geauga County, OH. Lake County, OH. Lorain County, OH. Medina County, OH. Coeur d’Alene, ID ............................................................................................................................................. Kootenai County, ID. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00250 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 0.9144 0.9406 0.9512 0.9663 0.9555 0.9693 0.8967 0.9281 0.9219 0.9458 1.0455 1.0309 1.1607 1.1074 0.9654 0.9762 0.8223 0.8746 0.8174 0.8710 0.9365 0.9561 0.9360 0.9557 24929 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued Wage index CBSA code Urban area (constituent counties) 17780 ....... College Station-Bryan, TX ................................................................................................................................ Brazos County, TX. Burleson County, TX. Robertson County, TX. Colorado Springs, CO ....................................................................................................................................... El Paso County, CO. Teller County, CO. Columbia, MO ................................................................................................................................................... Boone County, MO. Howard County, MO. 2 Columbia, SC ................................................................................................................................................. Calhoun County, SC. Fairfield County, SC. Kershaw County, SC. Lexington County, SC. Richland County, SC. Saluda County, SC. Columbus, GA-AL ............................................................................................................................................. Russell County, AL. Chattahoochee County, GA. Harris County, GA. Marion County, GA. Muscogee County, GA. Columbus, IN .................................................................................................................................................... Bartholomew County, IN. 1 Columbus, OH ................................................................................................................................................ Delaware County, OH. Fairfield County, OH. Franklin County, OH. Licking County, OH. Madison County, OH. Morrow County, OH. Pickaway County, OH. Union County, OH. Corpus Christi, TX ............................................................................................................................................. Aransas County, TX. Nueces County, TX. San Patricio County, TX. Corvallis, OR ..................................................................................................................................................... Benton County, OR. 2 Cumberland, MD-WV (MD Hospitals) ............................................................................................................ Allegany County, MD. Mineral County, WV. Cumberland, MD-WV (WV Hospitals) ............................................................................................................... Allegany County, MD. Mineral County, WV. 1 Dallas-Plano-Irving, TX .................................................................................................................................. Collin County, TX. Dallas County, TX. Delta County, TX. Denton County, TX. Ellis County, TX. Hunt County, TX. Kaufman County, TX. Rockwall County, TX. Dalton, GA ........................................................................................................................................................ Murray County, GA. Whitfield County, GA. Danville, IL ........................................................................................................................................................ Vermilion County, IL. Danville, VA ...................................................................................................................................................... Pittsylvania County, VA. Danville City, VA. Davenport-Moline-Rock Island, IA-IL ................................................................................................................ Henry County, IL. Mercer County, IL. Rock Island County, IL. Scott County, IA. Dayton, OH ....................................................................................................................................................... Greene County, OH. 17820 ....... 17860 ....... 17900 ....... 17980 ....... 18020 ....... 18140 ....... 18580 ....... 18700 ....... 19060 ....... 19060 ....... 19124 ....... 19140 ....... 19180 ....... 19260 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 19340 ....... 19380 ....... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00251 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 0.9177 0.9429 0.9471 0.9635 0.8545 0.8979 0.8791 0.9155 0.9023 0.9320 0.9630 0.9745 1.0048 1.0033 0.8460 0.8918 1.0708 1.0480 0.8917 0.9245 0.7967 0.8559 0.9795 0.9859 0.8587 0.9009 0.9250 0.9480 0.8486 0.8937 0.8898 0.9232 0.9283 0.9503 24930 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 19460 ....... 19500 ....... 19660 ....... 19740 ....... 19780 ....... 19804 ....... 20020 ....... 20100 ....... 20220 ....... 20260 ....... 20500 ....... 20740 ....... 20764 ....... 20940 ....... 21060 ....... 21140 ....... 21300 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 21340 ....... 21500 ....... 21660 ....... 21780 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) Miami County, OH. Montgomery County, OH. Preble County, OH. Decatur, AL ....................................................................................................................................................... Lawrence County, AL. Morgan County, AL. 2 Decatur, IL ...................................................................................................................................................... Macon County, IL. Deltona-Daytona Beach-Ormond Beach, FL .................................................................................................... Volusia County, FL. 1 Denver-Aurora, CO ........................................................................................................................................ Adams County, CO. Arapahoe County, CO. Broomfield County, CO. Clear Creek County, CO. Denver County, CO. Douglas County, CO. Elbert County, CO. Gilpin County, CO. Jefferson County, CO. Park County, CO. Des Moines-West Des Moines, IA .................................................................................................................... Dallas County, IA. Guthrie County, IA. Madison County, IA. Polk County, IA. Warren County, IA. 1 Detroit-Livonia-Dearborn, MI .......................................................................................................................... Wayne County, MI. 2 Dothan, AL ..................................................................................................................................................... Geneva County, AL. Henry County, AL. Houston County, AL. Dover, DE ......................................................................................................................................................... Kent County, DE. Dubuque, IA ...................................................................................................................................................... Dubuque County, IA. Duluth, MN-WI .................................................................................................................................................. Carlton County, MN. St. Louis County, MN. Douglas County, WI. Durham, NC ...................................................................................................................................................... Chatham County, NC. Durham County, NC. Orange County, NC. Person County, NC. 2 Eau Claire, WI ................................................................................................................................................ Chippewa County, WI. Eau Claire County, WI. 1 Edison, NJ ...................................................................................................................................................... Middlesex County, NJ. Monmouth County, NJ. Ocean County, NJ. Somerset County, NJ. 2 El Centro, CA ................................................................................................................................................. Imperial County, CA. Elizabethtown, KY ............................................................................................................................................. Hardin County, KY. Larue County, KY. Elkhart-Goshen, IN ........................................................................................................................................... Elkhart County, IN. 2 Elmira, NY ...................................................................................................................................................... Chemung County, NY. El Paso, TX ....................................................................................................................................................... El Paso County, TX. Erie, PA ............................................................................................................................................................. Erie County, PA. Eugene-Springfield, OR .................................................................................................................................... Lane County, OR. 2 Evansville, IN-KY (IN Hospitals) .................................................................................................................... 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00252 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 0.7927 0.8529 0.8355 0.8842 0.8948 0.9267 1.0490 1.0333 0.9162 0.9418 1.0091 1.0062 0.7598 0.8285 1.0396 1.0270 0.8874 0.9215 1.0151 1.0103 0.9814 0.9872 0.9635 0.9749 1.1131 1.0761 1.1607 1.1074 0.8622 0.9035 0.9438 0.9612 0.8440 0.8903 0.9144 0.9406 0.8507 0.8952 1.1008 1.0680 0.8599 0.9018 24931 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 21780 ....... 21820 ....... 21940 ....... 22020 ....... 22020 ....... 22140 ....... 22180 ....... 22220 ....... 22380 ....... 22420 ....... 22500 ....... 22520 ....... 22540 ....... 22660 ....... 22744 ....... 22900 ....... 23020 ....... 23060 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 23104 ....... 23420 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) Gibson County, IN. Posey County, IN. Vanderburgh County, IN. Warrick County, IN. Henderson County, KY. Webster County, KY. Evansville, IN-KY (KY Hospitals) ...................................................................................................................... Gibson County, IN. Posey County, IN. Vanderburgh County, IN. Warrick County, IN. Henderson County, KY. Webster County, KY. 2 Fairbanks, AK ................................................................................................................................................. Fairbanks North Star Borough, AK. Fajardo, PR ....................................................................................................................................................... Ceiba Municipio, PR. Fajardo Municipio, PR. Luquillo Municipio, PR. 2 Fargo, ND-MN (MN Hospitals) ....................................................................................................................... Clay County, MN. Cass County, ND. Fargo, ND-MN (ND Hospitals) .......................................................................................................................... Clay County, MN. Cass County, ND. Farmington, NM ................................................................................................................................................ San Juan County, NM. Fayetteville, NC ................................................................................................................................................. Cumberland County, NC. Hoke County, NC. Fayetteville-Springdale-Rogers, AR-MO ........................................................................................................... Benton County, AR. Madison County, AR. Washington County, AR. McDonald County, MO. Flagstaff, AZ ...................................................................................................................................................... Coconino County, AZ. Flint, MI ............................................................................................................................................................. Genesee County, MI. 2 Florence, SC .................................................................................................................................................. Darlington County, SC. Florence County, SC. Florence-Muscle Shoals, AL ............................................................................................................................. Colbert County, AL. Lauderdale County, AL. Fond du Lac, WI ............................................................................................................................................... Fond du Lac County, WI. Fort Collins-Loveland, CO ................................................................................................................................. Larimer County, CO. 1 Fort Lauderdale-Pompano Beach-Deerfield Beach, FL ................................................................................. Broward County, FL. Fort Smith, AR-OK ............................................................................................................................................ Crawford County, AR. Franklin County, AR. Sebastian County, AR. Le Flore County, OK. Sequoyah County, OK. 2 Fort Walton Beach-Crestview-Destin, FL ....................................................................................................... Okaloosa County, FL. Fort Wayne, IN .................................................................................................................................................. Allen County, IN. Wells County, IN. Whitley County, IN. 1 Fort Worth-Arlington, TX ................................................................................................................................ Johnson County, TX. Parker County, TX. Tarrant County, TX. Wise County, TX. 2 Fresno, CA ..................................................................................................................................................... Fresno County, CA. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00253 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 0.8469 0.8924 1.1817 1.1211 0.4121 0.5449 0.9212 0.9453 0.8189 0.8721 0.9289 0.9507 0.9926 0.9949 0.8876 0.9216 1.1558 1.1042 1.1078 1.0726 0.8791 0.9155 0.7971 0.8562 0.9892 0.9926 0.9577 0.9708 1.0245 1.0167 0.8056 0.8624 0.8749 0.9125 0.9046 0.9336 0.9646 0.9756 1.1607 1.1074 24932 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued Wage index CBSA code Urban area (constituent counties) 23460 ....... Gadsden, AL ..................................................................................................................................................... Etowah County, AL. Gainesville, FL .................................................................................................................................................. Alachua County, FL. Gilchrist County, FL. Gainesville, GA ................................................................................................................................................. Hall County, GA. Gary, IN ............................................................................................................................................................. Jasper County, IN. Lake County, IN. Newton County, IN. Porter County, IN. Glens Falls, NY ................................................................................................................................................. Warren County, NY. Washington County, NY. Goldsboro, NC .................................................................................................................................................. Wayne County, NC. 2 Grand Forks, ND-MN (MN Hospitals) ............................................................................................................ Polk County, MN. Grand Forks County, ND. Grand Forks, ND-MN (ND Hospitals) ............................................................................................................... Polk County, MN. Grand Forks County, ND. Grand Junction, CO .......................................................................................................................................... Mesa County, CO. Grand Rapids-Wyoming, MI .............................................................................................................................. Barry County, MI. Ionia County, MI. Kent County, MI. Newaygo County, MI. Great Falls, MT ................................................................................................................................................. Cascade County, MT. Greeley, CO ...................................................................................................................................................... Weld County, CO. 2 Green Bay, WI ................................................................................................................................................ Brown County, WI. Kewaunee County, WI. Oconto County, WI. Greensboro-High Point, NC .............................................................................................................................. Guilford County, NC. Randolph County, NC. Rockingham County, NC. Greenville, NC ................................................................................................................................................... Greene County, NC. Pitt County, NC. Greenville-Mauldin-Easley, SC ......................................................................................................................... Greenville County, SC. Laurens County, SC. Pickens County, SC. Guayama, PR ................................................................................................................................................... Arroyo Municipio, PR. Guayama Municipio, PR. Patillas Municipio, PR. Gulfport-Biloxi, MS ............................................................................................................................................ Hancock County, MS. Harrison County, MS. Stone County, MS. Hagerstown-Martinsburg, MD-WV .................................................................................................................... Washington County, MD. Berkeley County, WV. Morgan County, WV. 2 Hanford-Corcoran, CA .................................................................................................................................... Kings County, CA. Harrisburg-Carlisle, PA ..................................................................................................................................... Cumberland County, PA. Dauphin County, PA. Perry County, PA. Harrisonburg, VA .............................................................................................................................................. Rockingham County, VA. Harrisonburg City, VA. 23540 ....... 23580 ....... 23844 ....... 24020 ....... 24140 ....... 24220 ....... 24220 ....... 24300 ....... 24340 ....... 24500 ....... 24540 ....... 24580 ....... 24660 ....... 24780 ....... 24860 ....... 25020 ....... 25060 ....... 25180 ....... 25260 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 25420 ....... 25500 ....... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00254 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 0.8129 0.8677 0.9306 0.9519 0.9423 0.9601 0.9246 0.9477 0.8526 0.8965 0.9276 0.9498 0.9212 0.9453 0.7729 0.8383 1.0141 1.0096 0.9380 0.9571 0.8765 0.9137 1.0000 1.0000 0.9635 0.9749 0.9111 0.9382 0.9272 0.9496 0.9664 0.9769 0.2946 0.4330 0.8618 0.9032 0.9259 0.9486 1.1607 1.1074 0.9240 0.9473 0.8976 0.9287 24933 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 25540 ....... 25620 ....... 25860 ....... 25980 ....... 26100 ....... 26180 ....... 26300 ....... 26380 ....... 26420 ....... 26580 ....... 26620 ....... 26820 ....... 26900 ....... 26980 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 27060 ....... 27100 ....... 27140 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) 1 2 Hartford-West Hartford-East Hartford, CT ................................................................................................... Hartford County, CT. Litchfield County, CT. Middlesex County, CT. Tolland County, CT. 2 Hattiesburg, MS .............................................................................................................................................. Forrest County, MS. Lamar County, MS. Perry County, MS. Hickory-Lenoir-Morganton, NC ......................................................................................................................... Alexander County, NC. Burke County, NC. Caldwell County, NC. Catawba County, NC. Hinesville-Fort Stewart, GA ............................................................................................................................... Liberty County, GA. Long County, GA. Holland-Grand Haven, MI ................................................................................................................................. Ottawa County, MI. Honolulu, HI ...................................................................................................................................................... Honolulu County, HI. Hot Springs, AR ................................................................................................................................................ Garland County, AR. Houma-Bayou Cane-Thibodaux, LA ................................................................................................................. Lafourche Parish, LA. Terrebonne Parish, LA. 1 Houston-Sugar Land-Baytown, TX ................................................................................................................ Austin County, TX. Brazoria County, TX. Chambers County, TX. Fort Bend County, TX. Galveston County, TX. Harris County, TX. Liberty County, TX. Montgomery County, TX. San Jacinto County, TX. Waller County, TX. Huntington-Ashland, WV-KY-OH ...................................................................................................................... Boyd County, KY. Greenup County, KY. Lawrence County, OH. Cabell County, WV. Wayne County, WV. Huntsville, AL .................................................................................................................................................... Limestone County, AL. Madison County, AL. Idaho Falls, ID ................................................................................................................................................... Bonneville County, ID. Jefferson County, ID. 1 Indianapolis-Carmel, IN .................................................................................................................................. Boone County, IN. Brown County, IN. Hamilton County, IN. Hancock County, IN. Hendricks County, IN. Johnson County, IN. Marion County, IN. Morgan County, IN. Putnam County, IN. Shelby County, IN. Iowa City, IA ...................................................................................................................................................... Johnson County, IA. Washington County, IA. Ithaca, NY ......................................................................................................................................................... Tompkins County, NY. Jackson, MI ....................................................................................................................................................... Jackson County, MI. Jackson, MS ..................................................................................................................................................... Copiah County, MS. Hinds County, MS. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00255 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 1.2439 1.1612 0.7915 0.8520 0.8977 0.9288 0.7864 0.8483 0.9066 0.9351 1.1289 1.0866 0.9110 0.9382 0.7980 0.8568 1.0048 1.0033 0.8845 0.9194 0.9175 0.9427 0.9352 0.9552 0.9723 0.9809 0.9428 0.9605 0.9715 0.9804 0.9465 0.9630 0.8273 0.8782 24934 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 27180 ....... 27260 ....... 27340 ....... 27500 ....... 27620 ....... 27740 ....... 27780 ....... 27860 ....... 27900 ....... 28020 ....... 28100 ....... 28140 ....... 28420 ....... 28660 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 28700 ....... 28700 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) Madison County, MS. Rankin County, MS. Simpson County, MS. Jackson, TN ...................................................................................................................................................... Chester County, TN. Madison County, TN. 1 Jacksonville, FL .............................................................................................................................................. Baker County, FL. Clay County, FL. Duval County, FL. Nassau County, FL. St. Johns County, FL. 2 Jacksonville, NC ............................................................................................................................................. Onslow County, NC. Janesville, WI .................................................................................................................................................... Rock County, WI. Jefferson City, MO ............................................................................................................................................ Callaway County, MO. Cole County, MO. Moniteau County, MO. Osage County, MO. 2 Johnson City, TN ............................................................................................................................................ Carter County, TN. Unicoi County, TN. Washington County, TN. 2 Johnstown, PA ............................................................................................................................................... Cambria County, PA. Jonesboro, AR .................................................................................................................................................. Craighead County, AR. Poinsett County, AR. Joplin, MO ......................................................................................................................................................... Jasper County, MO. Newton County, MO. Kalamazoo-Portage, MI .................................................................................................................................... Kalamazoo County, MI. Van Buren County, MI. Kankakee-Bradley, IL ........................................................................................................................................ Kankakee County, IL. 1 Kansas City, MO-KS ...................................................................................................................................... Franklin County, KS. Johnson County, KS. Leavenworth County, KS. Linn County, KS. Miami County, KS. Wyandotte County, KS. Bates County, MO. Caldwell County, MO. Cass County, MO. Clay County, MO. Clinton County, MO. Jackson County, MO. Lafayette County, MO. Platte County, MO. Ray County, MO. 2 Kennewick-Richland-Pasco, WA .................................................................................................................... Benton County, WA. Franklin County, WA. Killeen-Temple-Fort Hood, TX .......................................................................................................................... Bell County, TX. Coryell County, TX. Lampasas County, TX. 2 Kingsport-Bristol-Bristol, TN-VA (TN Hospitals) ............................................................................................. Hawkins County, TN. Sullivan County, TN. Bristol City, VA. Scott County, VA. Washington County, VA. 2 Kingsport-Bristol-Bristol, TN-VA (VA Hospitals) ............................................................................................. Hawkins County, TN. Sullivan County, TN. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00256 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 0.8590 0.9012 0.9129 0.9395 0.8608 0.9024 0.9813 0.9872 0.8706 0.9095 0.7916 0.8521 0.8366 0.8850 0.8507 0.8952 0.9318 0.9528 1.0505 1.0343 1.1678 1.1121 0.9321 0.9530 1.0565 1.0384 0.8308 0.8808 0.7916 0.8521 0.8095 0.8653 24935 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 28740 ....... 28940 ....... 29020 ....... 29100 ....... 29140 ....... 29180 ....... 29340 ....... 29404 ....... 29420 ....... 29460 ....... 29540 ....... 29620 ....... 29700 ....... 29740 ....... 29820 ....... 29940 ....... 30020 ....... 30140 ....... 30300 ....... 30300 ....... 30340 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 30460 ....... 30620 ....... 30700 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) Bristol City, VA. Scott County, VA. Washington County, VA. Kingston, NY ..................................................................................................................................................... Ulster County, NY. Knoxville, TN ..................................................................................................................................................... Anderson County, TN. Blount County, TN. Knox County, TN. Loudon County, TN. Union County, TN. Kokomo, IN ....................................................................................................................................................... Howard County, IN. Tipton County, IN. La Crosse, WI-MN ............................................................................................................................................ Houston County, MN. La Crosse County, WI. Lafayette, IN ...................................................................................................................................................... Benton County, IN. Carroll County, IN. Tippecanoe County, IN. Lafayette, LA ..................................................................................................................................................... Lafayette Parish, LA. St. Martin Parish, LA. Lake Charles, LA .............................................................................................................................................. Calcasieu Parish, LA. Cameron Parish, LA. Lake County-Kenosha County, IL-WI ............................................................................................................... Lake County, IL. Kenosha County, WI. 2 Lake Havasu City-Kingman, AZ ..................................................................................................................... Mohave County, AZ. Lakeland, FL ..................................................................................................................................................... Polk County, FL. Lancaster, PA ................................................................................................................................................... Lancaster County, PA. Lansing-East Lansing, MI ................................................................................................................................. Clinton County, MI. Eaton County, MI. Ingham County, MI. Laredo, TX ........................................................................................................................................................ Webb County, TX. 2 Las Cruces, NM ............................................................................................................................................. Dona Ana County, NM. 1 Las Vegas-Paradise, NV ................................................................................................................................ Clark County, NV. Lawrence, KS .................................................................................................................................................... Douglas County, KS. Lawton, OK ....................................................................................................................................................... Comanche County, OK. 2 Lebanon, PA ................................................................................................................................................... Lebanon County, PA. Lewiston, ID-WA (ID Hospitals) ........................................................................................................................ Nez Perce County, ID. Asotin County, WA. 2 Lewiston, ID-WA (WA Hospitals) ................................................................................................................... Nez Perce County, ID. Asotin County, WA. Lewiston-Auburn, ME ........................................................................................................................................ Androscoggin County, ME. Lexington-Fayette, KY ...................................................................................................................................... Bourbon County, KY. Clark County, KY. Fayette County, KY. Jessamine County, KY. Scott County, KY. Woodford County, KY. Lima, OH ........................................................................................................................................................... Allen County, OH. Lincoln, NE ........................................................................................................................................................ 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00257 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 0.9518 0.9667 0.8042 0.8614 0.9468 0.9633 0.9704 0.9796 0.8682 0.9078 0.8323 0.8819 0.7787 0.8426 1.0287 1.0196 0.9386 0.9575 0.8839 0.9190 0.9589 0.9717 1.0053 1.0036 0.8484 0.8935 0.8965 0.9279 1.1431 1.0959 0.8208 0.8735 0.8406 0.8879 0.8366 0.8850 0.9231 0.9467 1.0565 1.0384 0.9295 0.9512 0.9027 0.9323 0.9312 0.9524 0.9836 0.9887 24936 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 30780 ....... 30860 ....... 30980 ....... 31020 ....... 31084 ....... 31140 ....... 31180 ....... 31340 ....... 31420 ....... 31460 ....... 31540 ....... 31700 ....... 31900 ....... 32420 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 32580 ....... 32780 ....... 32820 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) Lancaster County, NE. Seward County, NE. Little Rock-North Little Rock-Conway, AR ........................................................................................................ Faulkner County, AR. Grant County, AR. Lonoke County, AR. Perry County, AR. Pulaski County, AR. Saline County, AR. Logan, UT-ID .................................................................................................................................................... Franklin County, ID. Cache County, UT. Longview, TX .................................................................................................................................................... Gregg County, TX. Rusk County, TX. Upshur County, TX. Longview, WA ................................................................................................................................................... Cowlitz County, WA. 1 Los Angeles-Long Beach-Glendale, CA ........................................................................................................ Los Angeles County, CA. 1 Louisville-Jefferson County, KY-IN ................................................................................................................ Clark County, IN. Floyd County, IN. Harrison County, IN. Washington County, IN. Bullitt County, KY. Henry County, KY. Jefferson County, KY. Meade County, KY. Nelson County, KY. Oldham County, KY. Shelby County, KY. Spencer County, KY. Trimble County, KY. Lubbock, TX ...................................................................................................................................................... Crosby County, TX. Lubbock County, TX. Lynchburg, VA .................................................................................................................................................. Amherst County, VA. Appomattox County, VA. Bedford County, VA. Campbell County, VA. Bedford City, VA. Lynchburg City, VA. Macon, GA ........................................................................................................................................................ Bibb County, GA. Crawford County, GA. Jones County, GA. Monroe County, GA. Twiggs County, GA. 2 Madera, CA .................................................................................................................................................... Madera County, CA. Madison, WI ...................................................................................................................................................... Columbia County, WI. Dane County, WI. Iowa County, WI. 2 Manchester-Nashua, NH ................................................................................................................................ Hillsborough County, NH. Merrimack County, NH. Mansfield, OH ................................................................................................................................................... Richland County, OH. Mayag[uuml]ez, PR ........................................................................................................................................... Hormigueros Municipio, PR. Mayag[uuml]ez Municipio, PR. McAllen-Edinburg-Mission, TX .......................................................................................................................... Hidalgo County, TX. Medford, OR ..................................................................................................................................................... Jackson County, OR. 1 Memphis, TN-MS-AR ..................................................................................................................................... Crittenden County, AR. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00258 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 0.8965 0.9279 0.9219 0.9458 0.8875 0.9215 1.1033 1.0696 1.1633 1.1091 0.9045 0.9336 0.8678 0.9075 0.8490 0.8940 0.9752 0.9829 1.1607 1.1074 1.1181 1.0794 1.1266 1.0851 0.9214 0.9455 0.3659 0.5023 0.9140 0.9403 1.0304 1.0207 0.9291 0.9509 24937 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 32900 ....... 33124 ....... 33140 ....... 33260 ....... 33340 ....... 33460 ....... 33540 ....... 33660 ....... 33700 ....... 33740 ....... 33780 ....... 33860 ....... 34060 ....... 34100 ....... 34580 ....... 34620 ....... 34740 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 34820 ....... 34900 ....... 34940 ....... 34980 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) DeSoto County, MS. Marshall County, MS. Tate County, MS. Tunica County, MS. Fayette County, TN. Shelby County, TN. Tipton County, TN. Merced, CA ....................................................................................................................................................... Merced County, CA. 1 Miami-Miami Beach-Kendall, FL .................................................................................................................... Miami-Dade County, FL. Michigan City-La Porte, IN ................................................................................................................................ LaPorte County, IN. Midland, TX ....................................................................................................................................................... Midland County, TX. 1 Milwaukee-Waukesha-West Allis, WI ............................................................................................................. Milwaukee County, WI. Ozaukee County, WI. Washington County, WI. Waukesha County, WI. 1 Minneapolis-St. Paul-Bloomington, MN-WI .................................................................................................... Anoka County, MN. Carver County, MN. Chisago County, MN. Dakota County, MN. Hennepin County, MN. Isanti County, MN. Ramsey County, MN. Scott County, MN. Sherburne County, MN. Washington County, MN. Wright County, MN. Pierce County, WI. St. Croix County, WI. Missoula, MT ..................................................................................................................................................... Missoula County, MT. Mobile, AL ......................................................................................................................................................... Mobile County, AL. Modesto, CA ..................................................................................................................................................... Stanislaus County, CA. Monroe, LA ....................................................................................................................................................... Ouachita Parish, LA. Union Parish, LA. Monroe, MI ........................................................................................................................................................ Monroe County, MI. Montgomery, AL ................................................................................................................................................ Autauga County, AL. Elmore County, AL. Lowndes County, AL. Montgomery County, AL. Morgantown, WV .............................................................................................................................................. Monongalia County, WV. Preston County, WV. 2 Morristown, TN ............................................................................................................................................... Grainger County, TN. Hamblen County, TN. Jefferson County, TN. 2 Mount Vernon-Anacortes, WA ....................................................................................................................... Skagit County, WA. 2 Muncie, IN ...................................................................................................................................................... Delaware County, IN. Muskegon-Norton Shores, MI ........................................................................................................................... Muskegon County, MI. 2 Myrtle Beach-Conway-North Myrtle Beach, SC ............................................................................................. Horry County, SC. Napa, CA .......................................................................................................................................................... Napa County, CA. Naples-Marco Island, FL ................................................................................................................................... Collier County, FL. 1 Nashville-Davidson-Murfreesboro-Franklin, TN ............................................................................................. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00259 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 1.1961 1.1305 1.0023 1.0016 0.8791 0.9155 1.0016 1.0011 1.0296 1.0202 1.0961 1.0649 0.8737 0.9117 0.7950 0.8546 1.1989 1.1323 0.7872 0.8489 0.9475 0.9637 0.8366 0.8850 0.8411 0.8883 0.7916 0.8521 1.0565 1.0384 0.8599 0.9018 0.9935 0.9955 0.8791 0.9155 1.3825 1.2483 0.9756 0.9832 0.9675 0.9776 24938 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 35004 ....... 35084 ....... 35300 ....... 35380 ....... 35644 ....... 35660 ....... 35980 ....... 36084 ....... 36100 ....... 36140 ....... 36220 ....... 36260 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 36420 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) Cannon County, TN. Cheatham County, TN. Davidson County, TN. Dickson County, TN. Hickman County, TN. Macon County, TN. Robertson County, TN. Rutherford County, TN. Smith County, TN. Sumner County, TN. Trousdale County, TN. Williamson County, TN. Wilson County, TN. 1 Nassau-Suffolk, NY ........................................................................................................................................ Nassau County, NY. Suffolk County, NY. 1 Newark-Union, NJ-PA .................................................................................................................................... Essex County, NJ. Hunterdon County, NJ. Morris County, NJ. Sussex County, NJ. Union County, NJ. Pike County, PA. 2 New Haven-Milford, CT .................................................................................................................................. New Haven County, CT. 1 New Orleans-Metairie-Kenner, LA ................................................................................................................. Jefferson Parish, LA. Orleans Parish, LA. Plaquemines Parish, LA. St. Bernard Parish, LA. St. Charles Parish, LA. St. John the Baptist Parish, LA. St. Tammany Parish, LA. 1 New York-White Plains-Wayne, NY-NJ ......................................................................................................... Bergen County, NJ. Hudson County, NJ. Passaic County, NJ. Bronx County, NY. Kings County, NY. New York County, NY. Putnam County, NY. Queens County, NY. Richmond County, NY. Rockland County, NY. Westchester County, NY. Niles-Benton Harbor, MI ................................................................................................................................... Berrien County, MI. 2 Norwich-New London, CT .............................................................................................................................. New London County, CT. 1 Oakland-Fremont-Hayward, CA ..................................................................................................................... Alameda County, CA. Contra Costa County, CA. 2 Ocala, FL ........................................................................................................................................................ Marion County, FL. Ocean City, NJ .................................................................................................................................................. Cape May County, NJ. Odessa, TX ....................................................................................................................................................... Ector County, TX. Ogden-Clearfield, UT ........................................................................................................................................ Davis County, UT. Morgan County, UT. Weber County, UT. 1 Oklahoma City, OK ........................................................................................................................................ Canadian County, OK. Cleveland County, OK. Grady County, OK. Lincoln County, OK. Logan County, OK. McClain County, OK. Oklahoma County, OK. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00260 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 1.2791 1.1836 1.1681 1.1123 1.2439 1.1612 0.8732 0.9113 1.3215 1.2103 0.9138 0.9401 1.2439 1.1612 1.5299 1.3380 0.8749 0.9125 1.0749 1.0507 0.9959 0.9972 0.9061 0.9347 0.8764 0.9136 24939 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued Wage index CBSA code Urban area (constituent counties) 36500 ....... Olympia, WA ..................................................................................................................................................... Thurston County, WA. Omaha-Council Bluffs, NE-IA ........................................................................................................................... Harrison County, IA. Mills County, IA. Pottawattamie County, IA. Cass County, NE. Douglas County, NE. Sarpy County, NE. Saunders County, NE. Washington County, NE. 1 Orlando-Kissimmee, FL .................................................................................................................................. Lake County, FL. Orange County, FL. Osceola County, FL. Seminole County, FL. 2 Oshkosh-Neenah, WI ..................................................................................................................................... Winnebago County, WI. Owensboro, KY ................................................................................................................................................. Daviess County, KY. Hancock County, KY. McLean County, KY. 2 Oxnard-Thousand Oaks-Ventura, CA ............................................................................................................ Ventura County, CA. Palm Bay-Melbourne-Titusville, FL ................................................................................................................... Brevard County, FL. 2 Palm Coast, FL .............................................................................................................................................. Flager County, FL. 2 Panama City-Lynn Haven, FL ........................................................................................................................ Bay County, FL. 2 Parkersburg-Marietta-Vienna, WV-OH (OH Hospitals) .................................................................................. Washington County, OH. Pleasants County, WV. Wirt County, WV. Wood County, WV. Parkersburg-Marietta-Vienna, WV-OH (WV Hospitals) .................................................................................... Washington County, OH. Pleasants County, WV. Wirt County, WV. Wood County, WV. Pascagoula, MS ................................................................................................................................................ George County, MS. Jackson County, MS. Peabody, MA .................................................................................................................................................... Essex County, MA. 2 Pensacola-Ferry Pass-Brent, FL .................................................................................................................... Escambia County, FL. Santa Rosa County, FL. Peoria, IL ........................................................................................................................................................... Marshall County, IL. Peoria County, IL. Stark County, IL. Tazewell County, IL. Woodford County, IL. 1 Philadelphia, PA ............................................................................................................................................. Bucks County, PA. Chester County, PA. Delaware County, PA. Montgomery County, PA. Philadelphia County, PA. 1 Phoenix-Mesa-Scottsdale, AZ ........................................................................................................................ Maricopa County, AZ. Pinal County, AZ. Pine Bluff, AR ................................................................................................................................................... Cleveland County, AR. Jefferson County, AR. Lincoln County, AR. 1 Pittsburgh, PA ................................................................................................................................................ Allegheny County, PA. Armstrong County, PA. 36540 ....... 36740 ....... 36780 ....... 36980 ....... 37100 ....... 37340 ....... 37380 ....... 37460 ....... 37620 ....... 37620 ....... 37700 ....... 37764 ....... 37860 ....... 37900 ....... 37964 ....... 38060 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 38220 ....... 38300 ....... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00261 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 1.1463 1.0980 0.9419 0.9598 0.9383 0.9573 0.9635 0.9749 0.8801 0.9163 1.1607 1.1074 0.9385 0.9575 0.8749 0.9125 0.8749 0.9125 0.8701 0.9091 0.8238 0.8757 0.8544 0.8978 1.0214 1.0146 0.8749 0.9125 0.9374 0.9567 1.0906 1.0612 1.0115 1.0079 0.8155 0.8696 0.8388 0.8866 24940 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 38340 ....... 38540 ....... 38660 ....... 38860 ....... 38900 ....... 38940 ....... 39100 ....... 39140 ....... 39300 ....... 39340 ....... 39380 ....... 39460 ....... 39540 ....... 39580 ....... 39660 ....... 39740 ....... 39820 ....... 39900 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 40060 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) Beaver County, PA. Butler County, PA. Fayette County, PA. Washington County, PA. Westmoreland County, PA. Pittsfield, MA ..................................................................................................................................................... Berkshire County, MA. Pocatello, ID ...................................................................................................................................................... Bannock County, ID. Power County, ID. Ponce, PR ......................................................................................................................................................... Juana D[iacute]az Municipio, PR. Ponce Municipio, PR. Villalba Municipio, PR. Portland-South Portland-Biddeford, ME ............................................................................................................ Cumberland County, ME. Sagadahoc County, ME. York County, ME. 1 Portland-Vancouver-Beaverton, OR-WA ........................................................................................................ Clackamas County, OR. Columbia County, OR. Multnomah County, OR. Washington County, OR. Yamhill County, OR. Clark County, WA. Skamania County, WA. Port St. Lucie, FL .............................................................................................................................................. Martin County, FL. St. Lucie County, FL. Poughkeepsie-Newburgh-Middletown, NY ....................................................................................................... Dutchess County, NY. Orange County, NY. Prescott, AZ ...................................................................................................................................................... Yavapai County, AZ. 1 Providence-New Bedford-Fall River, RI-MA .................................................................................................. Bristol County, MA. Bristol County, RI. Kent County, RI. Newport County, RI. Providence County, RI. Washington County, RI. Provo-Orem, UT ................................................................................................................................................ Juab County, UT. Utah County, UT. 2 Pueblo, CO ..................................................................................................................................................... Pueblo County, CO. Punta Gorda, FL ............................................................................................................................................... Charlotte County, FL. 2 Racine, WI ...................................................................................................................................................... Racine County, WI. Raleigh-Cary, NC .............................................................................................................................................. Franklin County, NC. Johnston County, NC. Wake County, NC. Rapid City, SD .................................................................................................................................................. Meade County, SD. Pennington County, SD. Reading, PA ...................................................................................................................................................... Berks County, PA. Redding, CA ...................................................................................................................................................... Shasta County, CA. Reno-Sparks, NV .............................................................................................................................................. Storey County, NV. Washoe County, NV. 1 Richmond, VA ................................................................................................................................................ Amelia County, VA. Caroline County, VA. Charles City County, VA. Chesterfield County, VA. Cumberland County, VA. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00262 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 1.0071 1.0049 0.9158 0.9415 0.4161 0.5486 1.0008 1.0005 1.1233 1.0829 0.9990 0.9993 1.0853 1.0577 0.9913 0.9940 1.0654 1.0443 0.9488 0.9646 0.9451 0.9621 0.9562 0.9698 0.9635 0.9749 0.9373 0.9566 0.8690 0.9083 0.9419 0.9598 1.2826 1.1858 1.1062 1.0716 0.9238 0.9472 24941 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 40140 ....... 40220 ....... 40340 ....... 40380 ....... 40420 ....... 40484 ....... 40580 ....... 40660 ....... 40900 ....... 40980 ....... 41060 ....... 41100 ....... 41140 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 41180 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) Dinwiddie County, VA. Goochland County, VA. Hanover County, VA. Henrico County, VA. King and Queen County, VA. King William County, VA. Louisa County, VA. New Kent County, VA. Powhatan County, VA. Prince George County, VA. Sussex County, VA. Colonial Heights City, VA. Hopewell City, VA. Petersburg City, VA. Richmond City, VA. 1, 2 Riverside-San Bernardino-Ontario, CA .................................................................................................. Riverside County, CA. San Bernardino County, CA. Roanoke, VA ..................................................................................................................................................... Botetourt County, VA. Craig County, VA. Franklin County, VA. Roanoke County, VA. Roanoke City, VA. Salem City, VA. Rochester, MN .................................................................................................................................................. Dodge County, MN. Olmsted County, MN. Wabasha County, MN. 1 Rochester, NY ................................................................................................................................................ Livingston County, NY. Monroe County, NY. Ontario County, NY. Orleans County, NY. Wayne County, NY. Rockford, IL ....................................................................................................................................................... Boone County, IL. Winnebago County, IL. 2 Rockingham County-Strafford County, NH .................................................................................................... Rockingham County, NH. Strafford County, NH. Rocky Mount, NC .............................................................................................................................................. Nash County, NC. Rome, GA ......................................................................................................................................................... Floyd County, GA. 1 Sacramento--Arden-Arcade--Roseville, CA ................................................................................................... El Dorado County, CA. Placer County, CA. Sacramento County, CA. Yolo County, CA. Saginaw-Saginaw Township North, MI ............................................................................................................. Saginaw County, MI. St. Cloud, MN ................................................................................................................................................... Benton County, MN. Stearns County, MN. St. George, UT .................................................................................................................................................. Washington County, UT. St. Joseph, MO-KS ........................................................................................................................................... Doniphan County, KS. Andrew County, MO. Buchanan County, MO. DeKalb County, MO. 1 St. Louis, MO-IL ............................................................................................................................................. Bond County, IL. Calhoun County, IL. Clinton County, IL. Jersey County, IL. Macoupin County, IL. Madison County, IL. Monroe County, IL. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00263 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 1.1607 1.1074 0.9441 0.9614 1.0761 1.0515 0.8899 0.9232 0.9659 0.9765 1.1266 1.0851 0.9017 0.9316 0.9549 0.9689 1.2999 1.1968 0.9127 0.9394 1.1063 1.0716 0.9546 0.9687 0.8831 0.9184 0.8885 0.9222 24942 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 41420 ....... 41500 ....... 41540 ....... 41620 ....... 41660 ....... 41700 ....... 41740 ....... 41780 ....... 41884 ....... 41900 ....... 41940 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 41980 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) St. Clair County, IL. Crawford County, MO. Franklin County, MO. Jefferson County, MO. Lincoln County, MO. St. Charles County, MO. St. Louis County, MO. Warren County, MO. Washington County, MO. St. Louis City, MO. Salem, OR ........................................................................................................................................................ Marion County, OR. Polk County, OR. Salinas, CA ....................................................................................................................................................... Monterey County, CA. 2 Salisbury, MD ................................................................................................................................................. Somerset County, MD. Wicomico County, MD. Salt Lake City, UT ............................................................................................................................................. Salt Lake County, UT. Summit County, UT. Tooele County, UT. San Angelo, TX ................................................................................................................................................. Irion County, TX. Tom Green County, TX. 1 San Antonio, TX ............................................................................................................................................. Atascosa County, TX. Bandera County, TX. Bexar County, TX. Comal County, TX. Guadalupe County, TX. Kendall County, TX. Medina County, TX. Wilson County, TX. 1, 2 San Diego-Carlsbad-San Marcos, CA ................................................................................................... San Diego County, CA. Sandusky, OH ................................................................................................................................................... Erie County, OH. 1 San Francisco-San Mateo-Redwood City, CA ............................................................................................... Marin County, CA. San Francisco County, CA. San Mateo County, CA. San Germ[aacute]n-Cabo Rojo, PR ................................................................................................................. Cabo Rojo Municipio, PR. Lajas Municipio, PR. Sabana Grande Municipio, PR. San Germ[aacute]n Municipio, PR. 1 San Jose-Sunnyvale-Santa Clara, CA ........................................................................................................... San Benito County, CA. Santa Clara County, CA. 1 San Juan-Caguas-Guaynabo, PR .................................................................................................................. Aguas Buenas Municipio, PR. Aibonito Municipio, PR. Arecibo Municipio, PR. Barceloneta Municipio, PR. Barranquitas Municipio, PR. Bayam[oacute]n Municipio, PR. Caguas Municipio, PR. Camuy Municipio, PR. Can[oacute]vanas Municipio, PR. Carolina Municipio, PR. Cata[ntilde]o Municipio, PR. Cayey Municipio, PR. Ciales Municipio, PR. Cidra Municipio, PR. Comer[iacute]o Municipio, PR. Corozal Municipio, PR. Dorado Municipio, PR. Florida Municipio, PR. Guaynabo Municipio, PR. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00264 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 1.0404 1.0275 1.4408 1.2841 0.8917 0.9245 0.9482 0.9642 0.8663 0.9064 0.8916 0.9244 1.1607 1.1074 0.8760 0.9133 1.4766 1.3059 0.4605 0.5880 1.5378 1.3427 0.4517 0.5803 24943 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 42020 ....... 42044 ....... 42060 ....... 42100 ....... 42140 ....... 42220 ....... 42260 ....... 42340 ....... 42540 ....... 42644 ....... 42680 ....... 43100 ....... 43300 ....... 43340 ....... 43580 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 43620 ....... 43780 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) Gurabo Municipio, PR. Hatillo Municipio, PR. Humacao Municipio, PR. Juncos Municipio, PR. Las Piedras Municipio, PR. Lo[iacute]za Municipio, PR. Manat[iacute] Municipio, PR. Maunabo Municipio, PR. Morovis Municipio, PR. Naguabo Municipio, PR. Naranjito Municipio, PR. Orocovis Municipio, PR. Quebradillas Municipio, PR. R[iacute]o Grande Municipio, PR. San Juan Municipio, PR. San Lorenzo Municipio, PR. Toa Alta Municipio, PR. Toa Baja Municipio, PR. Trujillo Alto Municipio, PR. Vega Alta Municipio, PR. Vega Baja Municipio, PR. Yabucoa Municipio, PR. San Luis Obispo-Paso Robles, CA ................................................................................................................... San Luis Obispo County, CA. 1, 2 Santa Ana-Anaheim-Irvine, CA .............................................................................................................. Orange County, CA. 2 Santa Barbara-Santa Maria-Goleta, CA ........................................................................................................ Santa Barbara County, CA. Santa Cruz-Watsonville, CA ............................................................................................................................. Santa Cruz County, CA. Santa Fe, NM .................................................................................................................................................... Santa Fe County, NM. Santa Rosa-Petaluma, CA ................................................................................................................................ Sonoma County, CA. Sarasota-Bradenton-Venice, FL ........................................................................................................................ Manatee County, FL. Sarasota County, FL. Savannah, GA ................................................................................................................................................... Bryan County, GA. Chatham County, GA. Effingham County, GA. 2 Scranton--Wilkes-Barre, PA ........................................................................................................................... Lackawanna County, PA. Luzerne County, PA. Wyoming County, PA. 1 Seattle-Bellevue-Everett, WA ......................................................................................................................... King County, WA. Snohomish County, WA. Sebastian-Vero Beach, FL ................................................................................................................................ Indian River County, FL. 2 Sheboygan, WI ............................................................................................................................................... Sheboygan County, WI. Sherman-Denison, TX ....................................................................................................................................... Grayson County, TX. Shreveport-Bossier City, LA .............................................................................................................................. Bossier Parish, LA. Caddo Parish, LA. De Soto Parish, LA. Sioux City, IA-NE-SD ........................................................................................................................................ Woodbury County, IA. Dakota County, NE. Dixon County, NE. Union County, SD. Sioux Falls, SD ................................................................................................................................................. Lincoln County, SD. McCook County, SD. Minnehaha County, SD. Turner County, SD. South Bend-Mishawaka, IN-MI ......................................................................................................................... St. Joseph County, IN. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00265 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 1.1912 1.1273 1.1607 1.1074 1.1607 1.1074 1.5667 1.3600 1.0689 1.0467 1.4266 1.2755 0.9758 0.9834 0.8987 0.9295 0.8366 0.8850 1.1351 1.0907 0.9708 0.9799 0.9635 0.9749 0.8535 0.8972 0.8615 0.9029 0.9220 0.9459 0.9558 0.9695 0.9649 0.9758 24944 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 43900 ....... 44060 ....... 44100 ....... 44140 ....... 44180 ....... 44220 ....... 44300 ....... 44700 ....... 44940 ....... 45060 ....... 45104 ....... 45220 ....... 45300 ....... 45460 ....... 45500 ....... 45500 ....... 45780 ....... 45820 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 45940 ....... 46060 ....... 46140 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) Cass County, MI. Spartanburg, SC ............................................................................................................................................... Spartanburg County, SC. 2 Spokane, WA ................................................................................................................................................. Spokane County, WA. Springfield, IL .................................................................................................................................................... Menard County, IL. Sangamon County, IL. Springfield, MA .................................................................................................................................................. Franklin County, MA. Hampden County, MA. Hampshire County, MA. Springfield, MO ................................................................................................................................................. Christian County, MO. Dallas County, MO. Greene County, MO. Polk County, MO. Webster County, MO. 2 Springfield, OH ............................................................................................................................................... Clark County, OH. State College, PA ............................................................................................................................................. Centre County, PA. Stockton, CA ..................................................................................................................................................... San Joaquin County, CA. Sumter, SC ....................................................................................................................................................... Sumter County, SC. Syracuse, NY .................................................................................................................................................... Madison County, NY. Onondaga County, NY. Oswego County, NY. Tacoma, WA ..................................................................................................................................................... Pierce County, WA. Tallahassee, FL ................................................................................................................................................ Gadsden County, FL. Jefferson County, FL. Leon County, FL. Wakulla County, FL. 1 Tampa-St. Petersburg-Clearwater, FL ........................................................................................................... Hernando County, FL. Hillsborough County, FL. Pasco County, FL. Pinellas County, FL. Terre Haute, IN ................................................................................................................................................. Clay County, IN. Sullivan County, IN. Vermillion County, IN. Vigo County, IN. Texarkana, TX-Texarkana, AR (AR Hospitals) ................................................................................................. Miller County, AR. Bowie County, TX. 2 Texarkana, TX-Texarkana, AR (TX Hospitals) .............................................................................................. Miller County, AR. Bowie County, TX. Toledo, OH ........................................................................................................................................................ Fulton County, OH. Lucas County, OH. Ottawa County, OH. Wood County, OH. Topeka, KS ....................................................................................................................................................... Jackson County, KS. Jefferson County, KS. Osage County, KS. Shawnee County, KS. Wabaunsee County, KS. Trenton-Ewing, NJ ............................................................................................................................................ Mercer County, NJ. Tucson, AZ ........................................................................................................................................................ Pima County, AZ. Tulsa, OK .......................................................................................................................................................... Creek County, OK. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00266 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 0.9334 0.9539 1.0565 1.0384 0.8947 0.9266 1.0236 1.0161 0.9196 0.9442 0.8701 0.9091 0.8625 0.9037 1.1735 1.1158 0.8875 0.9215 0.9912 0.9940 1.1060 1.0714 0.9032 0.9327 0.9174 0.9427 0.8828 0.9182 0.8131 0.8679 0.8204 0.8732 0.9276 0.9498 0.8561 0.8991 1.0720 1.0488 0.9484 0.9644 0.8504 0.8950 24945 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 46220 ....... 46340 ....... 46540 ....... 46660 ....... 46700 ....... 47020 ....... 47220 ....... 47260 ....... 47300 ....... 47380 ....... 47580 ....... 47644 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 47894 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) Okmulgee County, OK. Osage County, OK. Pawnee County, OK. Rogers County, OK. Tulsa County, OK. Wagoner County, OK. Tuscaloosa, AL ................................................................................................................................................. Greene County, AL. Hale County, AL. Tuscaloosa County, AL. Tyler, TX ........................................................................................................................................................... Smith County, TX. Utica-Rome, NY ................................................................................................................................................ Herkimer County, NY. Oneida County, NY. Valdosta, GA ..................................................................................................................................................... Brooks County, GA. Echols County, GA. Lanier County, GA. Lowndes County, GA. Vallejo-Fairfield, CA .......................................................................................................................................... Solano County, CA. 2 Victoria, TX ..................................................................................................................................................... Calhoun County, TX. Goliad County, TX. Victoria County, TX. Vineland-Millville-Bridgeton, NJ ........................................................................................................................ Cumberland County, NJ. 1 Virginia Beach-Norfolk-Newport News, VA-NC ............................................................................................. Currituck County, NC. Gloucester County, VA. Isle of Wight County, VA. James City County, VA. Mathews County, VA. Surry County, VA. York County, VA. Chesapeake City, VA. Hampton City, VA. Newport News City, VA. Norfolk City, VA. Poquoson City, VA. Portsmouth City, VA. Suffolk City, VA. Virginia Beach City, VA. Williamsburg City, VA. 2 Visalia-Porterville, CA ..................................................................................................................................... Tulare County, CA. Waco, TX .......................................................................................................................................................... McLennan County, TX. Warner Robins, GA ........................................................................................................................................... Houston County, GA. 1 Warren-Troy-Farmington Hills, MI .................................................................................................................. Lapeer County, MI. Livingston County, MI. Macomb County, MI. Oakland County, MI. St. Clair County, MI. 1 Washington-Arlington-Alexandria, DC-VA-MD-WV ........................................................................................ District of Columbia, DC. Calvert County, MD. Charles County, MD. Prince George’s County, MD. Arlington County, VA. Clarke County, VA. Fairfax County, VA. Fauquier County, VA. Loudoun County, VA. Prince William County, VA. Spotsylvania County, VA. Stafford County, VA. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00267 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 0.8534 0.8971 0.9190 0.9438 0.8774 0.9143 0.8208 0.8735 1.4400 1.2837 0.8204 0.8732 1.0653 1.0443 0.8785 0.9151 1.1607 1.1074 0.8598 0.9017 0.9619 0.9737 1.0040 1.0027 1.0679 1.0460 24946 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 47940 ....... 48140 ....... 48260 ....... 48260 ....... 48300 ....... 48424 ....... 48540 ....... 48540 ....... 48620 ....... 48660 ....... 48700 ....... 48864 ....... 48900 ....... 49020 ....... 49180 ....... mmaher on DSK3CLS3C1PROD with $$_JOB 49340 ....... 49420 ....... 49500 ....... VerDate Mar 15 2010 Wage index Urban area (constituent counties) Warren County, VA. Alexandria City, VA. Fairfax City, VA. Falls Church City, VA. Fredericksburg City, VA. Manassas City, VA. Manassas Park City, VA. Jefferson County, WV. Waterloo-Cedar Falls, IA ................................................................................................................................... Black Hawk County, IA. Bremer County, IA. Grundy County, IA. Wausau, WI ...................................................................................................................................................... Marathon County, WI. 2 Weirton-Steubenville, WV-OH (OH Hospitals) ............................................................................................... Jefferson County, OH. Brooke County, WV. Hancock County, WV. Weirton-Steubenville, WV-OH (WV Hospitals) ................................................................................................. Jefferson County, OH. Brooke County, WV. Hancock County, WV. Wenatchee, WA ................................................................................................................................................ Chelan County, WA. Douglas County, WA. 1 West Palm Beach-Boca Raton-Boynton Beach, FL ...................................................................................... Palm Beach County, FL. 2 Wheeling, WV-OH (OH Hospitals) ................................................................................................................. Belmont County, OH. Marshall County, WV. Ohio County, WV. 2 Wheeling, WV-OH (WV Hospitals) ................................................................................................................. Belmont County, OH. Marshall County, WV. Ohio County, WV. Wichita, KS ....................................................................................................................................................... Butler County, KS. Harvey County, KS. Sedgwick County, KS. Sumner County, KS. Wichita Falls, TX ............................................................................................................................................... Archer County, TX. Clay County, TX. Wichita County, TX. 2 Williamsport, PA ............................................................................................................................................. Lycoming County, PA. Wilmington, DE-MD-NJ ..................................................................................................................................... New Castle County, DE. Cecil County, MD. Salem County, NJ. Wilmington, NC ................................................................................................................................................. Brunswick County, NC. New Hanover County, NC. Pender County, NC. Winchester, VA-WV .......................................................................................................................................... Frederick County, VA. Winchester City, VA. Hampshire County, WV. Winston-Salem, NC ........................................................................................................................................... Davie County, NC. Forsyth County, NC. Stokes County, NC. Yadkin County, NC. Worcester, MA .................................................................................................................................................. Worcester County, MA. 2 Yakima, WA .................................................................................................................................................... Yakima County, WA. Yauco, PR ......................................................................................................................................................... Gu[aacute]nica Municipio, PR. Guayanilla Municipio, PR. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00268 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 GAF 0.8891 0.9227 1.0011 1.0008 0.8701 0.9091 0.7893 0.8504 1.1281 1.0860 0.9587 0.9715 0.8701 0.9091 0.7568 0.8263 0.9009 0.9310 0.8488 0.8938 0.8366 0.8850 1.0752 1.0509 0.9338 0.9542 0.9850 0.9897 0.9083 0.9363 1.1341 1.0900 1.0565 1.0384 0.3203 0.4586 24947 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA—FY 2008—Continued CBSA code 49620 ....... 49660 ....... 49700 ....... 49740 ....... 1 2 Wage index Urban area (constituent counties) Pe[ntilde]uelas Municipio, PR. Yauco Municipio, PR. York-Hanover, PA ............................................................................................................................................. York County, PA. Youngstown-Warren-Boardman, OH-PA .......................................................................................................... Mahoning County, OH. Trumbull County, OH. Mercer County, PA. 2 Yuba City, CA ................................................................................................................................................. Sutter County, CA. Yuba County, CA. Yuma, AZ .......................................................................................................................................................... Yuma County, AZ. GAF 0.9307 0.9520 0.8996 0.9301 1.1607 1.1074 0.9468 0.9633 Large urban area. Hospitals geographically located in the area are assigned the statewide rural wage index for FY 2008. TABLE 4B.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT (GAF) FOR RURAL AREAS BY CBSA—FY 2008 Nonurban area Wage index GAF Alabama ............................................................................................................................................................ Alaska ............................................................................................................................................................... Arizona .............................................................................................................................................................. Arkansas ........................................................................................................................................................... California ........................................................................................................................................................... Colorado ............................................................................................................................................................ Connecticut ....................................................................................................................................................... Delaware ........................................................................................................................................................... Florida ............................................................................................................................................................... Georgia ............................................................................................................................................................. Hawaii ............................................................................................................................................................... Idaho ................................................................................................................................................................. Illinois ................................................................................................................................................................ Indiana .............................................................................................................................................................. Iowa ................................................................................................................................................................... Kansas .............................................................................................................................................................. Kentucky ........................................................................................................................................................... Louisiana ........................................................................................................................................................... Maine ................................................................................................................................................................ Maryland ........................................................................................................................................................... Massachusetts .................................................................................................................................................. Michigan ............................................................................................................................................................ Minnesota .......................................................................................................................................................... Mississippi ......................................................................................................................................................... Missouri ............................................................................................................................................................. Montana ............................................................................................................................................................ Nebraska ........................................................................................................................................................... Nevada .............................................................................................................................................................. New Hampshire ................................................................................................................................................ New Jersey 1 ..................................................................................................................................................... New Mexico ...................................................................................................................................................... New York .......................................................................................................................................................... North Carolina ................................................................................................................................................... North Dakota ..................................................................................................................................................... Ohio ................................................................................................................................................................... Oklahoma .......................................................................................................................................................... Oregon .............................................................................................................................................................. Pennsylvania ..................................................................................................................................................... Puerto Rico 1 ..................................................................................................................................................... Rhode Island 1 .................................................................................................................................................. South Carolina .................................................................................................................................................. South Dakota .................................................................................................................................................... Tennessee ........................................................................................................................................................ Texas ................................................................................................................................................................ Utah ................................................................................................................................................................... Vermont ............................................................................................................................................................. Virginia .............................................................................................................................................................. Washington ....................................................................................................................................................... 0.7598 1.1817 0.9386 0.7519 1.1607 0.9451 1.2439 0.9825 0.8749 0.7864 1.0751 0.7879 0.8355 0.8599 0.8480 0.7989 0.7812 0.7591 0.8412 0.8917 0.9739 0.8899 0.9212 0.7915 0.8145 0.8337 0.8848 0.9688 1.1266 ................ 0.8965 0.8440 0.8608 0.7313 0.8701 0.7702 0.9950 0.8366 ................ ................ 0.8791 0.8343 0.7916 0.8204 0.8267 1.0401 0.8095 1.0565 0.8285 1.1211 0.9575 0.8226 1.1074 0.9621 1.1612 0.9880 0.9125 0.8483 1.0508 0.8494 0.8842 0.9018 0.8932 0.8575 0.8444 0.8280 0.8883 0.9245 0.9821 0.9232 0.9453 0.8520 0.8689 0.8829 0.9196 0.9785 1.0851 ................ 0.9279 0.8903 0.9024 0.8071 0.9091 0.8363 0.9966 0.8850 ................ ................ 0.9155 0.8833 0.8521 0.8732 0.8778 1.0273 0.8653 1.0384 mmaher on DSK3CLS3C1PROD with $$_JOB CBSA code 01 02 03 04 05 06 07 08 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 49 50 ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00269 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 24948 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4B.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT (GAF) FOR RURAL AREAS BY CBSA—FY 2008— Continued Wage index CBSA code Nonurban area 51 ............. 52 ............. 53 ............. West Virginia ..................................................................................................................................................... Wisconsin .......................................................................................................................................................... Wyoming ........................................................................................................................................................... 1 GAF 0.7568 0.9635 0.9214 0.8263 0.9749 0.9455 All counties in the State or Territory are classified as urban. TABLE 4C.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR HOSPITALS THAT ARE RECLASSIFIED BY CBSA—FY 2008 mmaher on DSK3CLS3C1PROD with $$_JOB CBSA code 10420 10500 10580 10740 10780 10900 11100 11180 11260 11460 11500 12060 12420 12580 12620 12940 13020 13644 13780 13820 13900 13980 14020 14484 14540 14740 14860 15380 15540 15764 15940 16180 16620 16700 16740 16820 16860 16974 17140 17300 17460 17780 17860 17980 18140 18700 19124 19340 19380 19460 19740 19804 20100 20260 20500 20764 21060 21500 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Mar 15 2010 Wage index Area Akron, OH ......................................................................................................................................................... Albany, GA ........................................................................................................................................................ Albany-Schenectady-Troy, NY .......................................................................................................................... Albuquerque, NM .............................................................................................................................................. Alexandria, LA ................................................................................................................................................... Allentown-Bethlehem-Easton, PAN-J ............................................................................................................... Amarillo, TX ...................................................................................................................................................... Ames, IA ........................................................................................................................................................... Anchorage, AK .................................................................................................................................................. Ann Arbor, MI .................................................................................................................................................... Anniston-Oxford, AL .......................................................................................................................................... Atlanta-Sandy Springs-Marietta, GA ................................................................................................................. Austin-Round Rock, TX .................................................................................................................................... Baltimore-Towson, MD ...................................................................................................................................... Bangor, ME ....................................................................................................................................................... Baton Rouge, LA .............................................................................................................................................. Bay City, MI ...................................................................................................................................................... Bethesda-Gaithersburg-Frederick, MD ............................................................................................................. Binghamton, NY ................................................................................................................................................ Birmingham-Hoover, AL .................................................................................................................................... Bismarck, ND .................................................................................................................................................... Blacksburg-Christiansburg-Radford, VA ........................................................................................................... Bloomington, IN ................................................................................................................................................ Boston-Quincy, MA ........................................................................................................................................... Bowling Green, KY ........................................................................................................................................... Bremerton-Silverdale, WA ................................................................................................................................. Bridgeport-Stamford-Norwalk, CT ..................................................................................................................... Buffalo-Niagara Falls, NY ................................................................................................................................. Burlington-South Burlington, VT ....................................................................................................................... Cambridge-Newton-Framingham, MA .............................................................................................................. Canton-Massillon, OH ....................................................................................................................................... Carson City, NV ................................................................................................................................................ Charleston, WV ................................................................................................................................................. Charleston-North Charleston, SC ..................................................................................................................... Charlotte-Gastonia-Concord, NC-SC ................................................................................................................ Charlottesville, VA ............................................................................................................................................. Chattanooga, TN-GA ........................................................................................................................................ Chicago-Naperville-Joliet, IL ............................................................................................................................. Cincinnati-Middletown, OH-KY-IN ..................................................................................................................... Clarksville, TN-KY ............................................................................................................................................. Cleveland-Elyria-Mentor, OH ............................................................................................................................ College Station-Bryan, TX ................................................................................................................................ Columbia, MO ................................................................................................................................................... Columbus, GA-AL ............................................................................................................................................. Columbus, OH .................................................................................................................................................. Corvallis, OR ..................................................................................................................................................... Dallas-Plano-Irving, TX ..................................................................................................................................... Davenport-Moline-Rock Island, IA-IL ................................................................................................................ Dayton, OH ....................................................................................................................................................... Decatur, AL ....................................................................................................................................................... Denver-Aurora, CO ........................................................................................................................................... Detroit-Livonia-Dearborn, MI ............................................................................................................................. Dover, DE ......................................................................................................................................................... Duluth, MN–WI .................................................................................................................................................. Durham, NC ...................................................................................................................................................... Edison, NJ ......................................................................................................................................................... Elizabethtown, KY ............................................................................................................................................. Erie, PA ............................................................................................................................................................. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00270 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 0.8854 0.8671 0.8672 0.9740 0.7982 1.0024 0.9141 0.9227 1.1840 1.0138 0.8042 0.9845 0.9518 1.0108 0.9860 0.8014 0.9399 1.0990 0.8779 0.8737 0.7329 0.7744 0.8828 1.1256 0.8089 1.0826 1.2380 0.9586 0.9589 1.1266 0.8810 0.9688 0.8294 0.9144 0.9348 0.9353 0.8967 1.0455 0.9654 0.8116 0.9238 0.9177 0.8545 0.8594 0.9840 1.0322 0.9681 0.8898 0.9283 0.7927 1.0490 1.0091 1.0023 1.0020 0.9603 1.1131 0.7983 0.8440 GAF 0.9200 0.9070 0.9070 0.9821 0.8570 1.0016 0.9403 0.9464 1.1226 1.0094 0.8614 0.9894 0.9667 1.0074 0.9904 0.8593 0.9584 1.0668 0.9147 0.9117 0.8083 0.8394 0.9182 1.0844 0.8648 1.0559 1.1574 0.9715 0.9717 1.0851 0.9169 0.9785 0.8798 0.9406 0.9549 0.9552 0.9281 1.0309 0.9762 0.8668 0.9472 0.9429 0.8979 0.9014 0.9890 1.0219 0.9780 0.9232 0.9503 0.8529 1.0333 1.0062 1.0016 1.0014 0.9726 1.0761 0.8570 0.8903 24949 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4C.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR HOSPITALS THAT ARE RECLASSIFIED BY CBSA—FY 2008—Continued mmaher on DSK3CLS3C1PROD with $$_JOB CBSA code 21660 21780 21780 22020 22020 22180 22220 22380 22420 22520 22540 22660 22744 23020 23060 23104 23540 23844 24300 24340 24500 24540 24580 24580 24660 24780 24860 25060 25420 25540 25540 25860 26100 26180 26420 26580 26620 26820 26900 26980 27060 27140 27180 27260 27620 27780 27860 27900 28020 28100 28140 28420 28420 28700 28700 28700 28740 28940 29180 29404 29460 29540 29620 29740 29820 30020 30460 30620 30700 30780 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Mar 15 2010 Wage index Area Eugene-Springfield, OR .................................................................................................................................... Evansville, IN-KY (KY Hospitals) ...................................................................................................................... Evansville, IN-KY (IN Hospitals) ....................................................................................................................... Fargo, ND-MN (ND Hospitals) .......................................................................................................................... Fargo, ND-MN (SD Hospitals) .......................................................................................................................... Fayetteville, NC ................................................................................................................................................. Fayetteville-Springdale-Rogers, AR-MO ........................................................................................................... Flagstaff, AZ ...................................................................................................................................................... Flint, MI ............................................................................................................................................................. Florence-Muscle Shoals, AL ............................................................................................................................. Fond du Lac, WI ............................................................................................................................................... Fort Collins-Loveland, CO ................................................................................................................................. Fort Lauderdale-Pompano Beach-Deerfield Beach, FL ................................................................................... Fort Walton Beach-Crestview-Destin, FL ......................................................................................................... Fort Wayne, IN .................................................................................................................................................. Fort Worth-Arlington, TX ................................................................................................................................... Gainesville, FL .................................................................................................................................................. Gary, IN ............................................................................................................................................................. Grand Junction, CO .......................................................................................................................................... Grand Rapids-Wyoming, MI .............................................................................................................................. Great Falls, MT ................................................................................................................................................. Greeley, CO ...................................................................................................................................................... Green Bay, WI (MI Hospitals) ........................................................................................................................... Green Bay, WI (WI Hospitals) .......................................................................................................................... Greensboro-High Point, NC .............................................................................................................................. Greenville, NC ................................................................................................................................................... Greenville-Mauldin-Easley, SC ......................................................................................................................... Gulfport-Biloxi, MS ............................................................................................................................................ Harrisburg-Carlisle, PA ..................................................................................................................................... Hartford-West Hartford-East Hartford, CT (CT Hospitals) ................................................................................ Hartford-West Hartford-East Hartford, CT (MA Hospitals) ............................................................................... Hickory-Lenoir-Morganton, NC ......................................................................................................................... Holland-Grand Haven, MI ................................................................................................................................. Honolulu, HI ...................................................................................................................................................... Houston-Sugar Land-Baytown, TX ................................................................................................................... Huntington-Ashland, WV-KY-OH ...................................................................................................................... Huntsville, AL .................................................................................................................................................... Idaho Falls, ID ................................................................................................................................................... Indianapolis-Carmel, IN ..................................................................................................................................... Iowa City, IA ...................................................................................................................................................... Ithaca, NY ......................................................................................................................................................... Jackson, MS ..................................................................................................................................................... Jackson, TN ...................................................................................................................................................... Jacksonville, FL ................................................................................................................................................ Jefferson City, MO ............................................................................................................................................ Johnstown, PA .................................................................................................................................................. Jonesboro, AR .................................................................................................................................................. Joplin, MO ......................................................................................................................................................... Kalamazoo-Portage, MI .................................................................................................................................... Kankakee-Bradley, IL ........................................................................................................................................ Kansas City, MO-KS ......................................................................................................................................... Kennewick-Richland-Pasco, WA (ID Hospitals) ............................................................................................... Kennewick-Richland-Pasco, WA (WA Hospitals) ............................................................................................. Kingsport-Bristol-Bristol, TN-VA (KY Hospitals) ............................................................................................... Kingsport-Bristol-Bristol, TN-VA (TN Hospitals) ............................................................................................... Kingsport-Bristol-Bristol, TN-VA (VA Hospitals) ............................................................................................... Kingston, NY ..................................................................................................................................................... Knoxville, TN ..................................................................................................................................................... Lafayette, LA ..................................................................................................................................................... Lake County-Kenosha County, IL-WI ............................................................................................................... Lakeland, FL ..................................................................................................................................................... Lancaster, PA ................................................................................................................................................... Lansing-East Lansing, MI ................................................................................................................................. Las Cruces, NM ................................................................................................................................................ Las Vegas-Paradise, NV ................................................................................................................................... Lawton, OK ....................................................................................................................................................... Lexington-Fayette, KY ...................................................................................................................................... Lima, OH ........................................................................................................................................................... Lincoln, NE ........................................................................................................................................................ Little Rock-North Little Rock-Conway, AR ........................................................................................................ 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00271 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 1.0713 0.8127 0.8599 0.8189 0.8343 0.9600 0.8719 1.1310 1.0272 0.7971 0.9721 0.9577 1.0245 0.8749 0.9046 0.9646 0.9306 0.9246 1.0141 0.9380 0.8765 0.9746 0.9339 0.9635 0.9111 0.9272 0.9386 0.8223 0.9130 1.2439 1.0955 0.8819 0.9066 1.1289 1.0048 0.8706 0.8760 0.9352 0.9723 0.9142 0.9715 0.8273 0.8432 0.9129 0.8706 0.8366 0.8507 0.9040 1.0151 1.1678 0.9321 0.9620 1.0565 0.7840 0.7916 0.8095 0.9231 0.8042 0.8323 1.0287 0.8839 0.9589 0.9933 0.8965 1.1205 0.8071 0.8815 0.9312 0.9603 0.8720 GAF 1.0483 0.8676 0.9018 0.8721 0.8833 0.9724 0.9104 1.0880 1.0185 0.8562 0.9808 0.9708 1.0167 0.9125 0.9336 0.9756 0.9519 0.9477 1.0096 0.9571 0.9137 0.9825 0.9542 0.9749 0.9382 0.9496 0.9575 0.8746 0.9396 1.1612 1.0645 0.9175 0.9351 1.0866 1.0033 0.9095 0.9133 0.9552 0.9809 0.9404 0.9804 0.8782 0.8898 0.9395 0.9095 0.8850 0.8952 0.9332 1.0103 1.1121 0.9530 0.9738 1.0384 0.8465 0.8521 0.8653 0.9467 0.8614 0.8819 1.0196 0.9190 0.9717 0.9954 0.9279 1.0810 0.8635 0.9173 0.9524 0.9726 0.9105 24950 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4C.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR HOSPITALS THAT ARE RECLASSIFIED BY CBSA—FY 2008—Continued mmaher on DSK3CLS3C1PROD with $$_JOB CBSA code 30860 30980 31084 31140 31340 31420 31540 31700 32780 32820 33124 33340 33460 33540 33660 33700 33740 33860 34060 34740 34820 34980 35004 35084 35300 35380 35644 35980 36084 36140 36220 36420 36500 36740 37700 37860 37900 37964 38220 38300 38300 38340 38540 38860 38900 38940 39100 39140 39340 39580 39740 39820 39900 40060 40220 40340 40380 40420 40484 40660 40900 40980 41060 41100 41140 41180 41620 41620 41700 41884 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Mar 15 2010 Wage index Area Logan, UT-ID .................................................................................................................................................... Longview, TX .................................................................................................................................................... Los Angeles-Long Beach-Santa Ana, CA ........................................................................................................ Louisville-Jefferson County, KY-IN ................................................................................................................... Lynchburg, VA .................................................................................................................................................. Macon, GA ........................................................................................................................................................ Madison, WI ...................................................................................................................................................... Manchester-Nashua, NH ................................................................................................................................... Medford, OR ..................................................................................................................................................... Memphis, TN-MS-AR ........................................................................................................................................ Miami-Miami Beach-Kendall, FL ....................................................................................................................... Milwaukee-Waukesha-West Allis, WI ............................................................................................................... Minneapolis-St. Paul-Bloomington, MN-WI ....................................................................................................... Missoula, MT ..................................................................................................................................................... Mobile, AL ......................................................................................................................................................... Modesto, CA ..................................................................................................................................................... Monroe, LA ....................................................................................................................................................... Montgomery, AL ................................................................................................................................................ Morgantown, WV .............................................................................................................................................. Muskegon-Norton Shores, MI ........................................................................................................................... Myrtle Beach-Conway-North Myrtle Beach, SC ............................................................................................... Nashville-Davidson-Murfreesboro-Franklin, TN ................................................................................................ Nassau-Suffolk, NY ........................................................................................................................................... Newark-Union, NJPA ........................................................................................................................................ New Haven-Milford, CT ..................................................................................................................................... New Orleans-Metairie-Kenner, LA .................................................................................................................... New York-White Plains-Wayne, NY-NJ ............................................................................................................ Norwich-New London, CT ................................................................................................................................. Oakland-Fremont-Hayward, CA ........................................................................................................................ Ocean City, NJ .................................................................................................................................................. Odessa, TX ....................................................................................................................................................... Oklahoma City, OK ........................................................................................................................................... Olympia, WA ..................................................................................................................................................... Orlando-Kissimmee, FL .................................................................................................................................... Pascagoula, MS ................................................................................................................................................ Pensacola-Ferry Pass-Brent, FL ....................................................................................................................... Peoria, IL ........................................................................................................................................................... Philadelphia, PA ................................................................................................................................................ Pine Bluff, AR ................................................................................................................................................... Pittsburgh, PA (PA and WV Hospitals) ............................................................................................................. Pittsburgh, PA (OH Hospitals) .......................................................................................................................... Pittsfield, MA ..................................................................................................................................................... Pocatello, ID ...................................................................................................................................................... Portland-South Portland-Biddeford, ME ............................................................................................................ Portland-Vancouver-Beaverton, OR-WA .......................................................................................................... Port St. Lucie, FL .............................................................................................................................................. Poughkeepsie-Newburgh-Middletown, NY ....................................................................................................... Prescott, AZ ...................................................................................................................................................... Provo-Orem, UT ................................................................................................................................................ Raleigh-Cary, NC .............................................................................................................................................. Reading, PA ...................................................................................................................................................... Redding, CA ...................................................................................................................................................... Reno-Sparks, NV .............................................................................................................................................. Richmond, VA ................................................................................................................................................... Roanoke, VA ..................................................................................................................................................... Rochester, MN .................................................................................................................................................. Rochester, NY ................................................................................................................................................... Rockford, IL ....................................................................................................................................................... Rockingham County, NH .................................................................................................................................. Rome, GA ......................................................................................................................................................... Sacramento-Arden-Arcade-Roseville, CA ......................................................................................................... Saginaw-Saginaw Township North, MI ............................................................................................................. St. Cloud, MN ................................................................................................................................................... St. George, UT .................................................................................................................................................. St. Joseph, MO-KS ........................................................................................................................................... St. Louis, MO-IL ................................................................................................................................................ Salt Lake City, UT (UT Hospitals) .................................................................................................................... Salt Lake City, UT (NV Hospitals) .................................................................................................................... San Antonio, TX ................................................................................................................................................ San Francisco-San Mateo-Redwood City, CA ................................................................................................. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00272 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 0.9219 0.8875 1.1607 0.9045 0.8490 0.9571 1.1002 1.1266 1.0151 0.8951 1.0023 1.0296 1.0961 0.8737 0.7950 1.1989 0.7766 0.8366 0.8244 0.9472 0.8791 0.9407 1.2565 1.1578 1.2439 0.8732 1.2993 1.1794 1.5299 1.0358 0.9527 0.8764 1.1325 0.9245 0.8544 0.8127 0.9217 1.0777 0.7959 0.8388 0.8701 1.0401 0.9158 0.9601 1.1233 0.9990 1.0644 0.9534 0.9388 0.9373 0.9419 1.2666 1.0851 0.9238 0.9190 1.0761 0.8899 0.9659 1.0179 0.9391 1.2853 0.8979 1.0390 0.9546 0.8831 0.8885 0.9482 0.9688 0.8916 1.4766 GAF 0.9458 0.9215 1.1074 0.9336 0.8940 0.9704 1.0676 1.0851 1.0103 0.9269 1.0016 1.0202 1.0649 0.9117 0.8546 1.1323 0.8410 0.8850 0.8761 0.9635 0.9155 0.9590 1.1692 1.1055 1.1612 0.9113 1.1964 1.1196 1.3380 1.0244 0.9674 0.9136 1.0889 0.9477 0.8978 0.8676 0.9457 1.0526 0.8553 0.8866 0.9091 1.0273 0.9415 0.9725 1.0829 0.9993 1.0437 0.9678 0.9577 0.9566 0.9598 1.1757 1.0575 0.9472 0.9438 1.0515 0.9232 0.9765 1.0122 0.9579 1.1875 0.9289 1.0265 0.9687 0.9184 0.9222 0.9642 0.9785 0.9244 1.3059 24951 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4C.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR HOSPITALS THAT ARE RECLASSIFIED BY CBSA—FY 2008—Continued Wage index mmaher on DSK3CLS3C1PROD with $$_JOB CBSA code Area 41940 ....... 41980 ....... 42044 ....... 42140 ....... 42220 ....... 42260 ....... 42340 ....... 42644 ....... 42680 ....... 43300 ....... 43340 ....... 43580 ....... 43620 ....... 43780 ....... 43900 ....... 44060 ....... 44180 ....... 44940 ....... 45060 ....... 45104 ....... 45220 ....... 45300 ....... 45500 ....... 45780 ....... 45820 ....... 46140 ....... 46220 ....... 46340 ....... 46700 ....... 47260 ....... 47894 ....... 47940 ....... 48140 ....... 48620 ....... 48700 ....... 48864 ....... 48900 ....... 49180 ....... 49660 ....... 03 ............. 04 ............. 05 ............. 07 ............. 10 ............. 14 ............. 16 ............. 17 ............. 22 ............. 23 ............. 25 ............. 26 ............. 29 ............. 30 ............. 33 ............. 34 ............. 36 ............. 37 ............. 38 ............. 39 ............. 39 ............. 44 ............. 45 ............. 47 ............. 49 ............. 50 ............. 52 ............. 53 ............. San Jose-Sunnyvale-Santa Clara, CA .............................................................................................................. San Juan-Caguas-Guaynabo, PR .................................................................................................................... Santa Ana-Anaheim-Irvine, CA ......................................................................................................................... Santa Fe, NM .................................................................................................................................................... Santa Rosa-Petaluma, CA ................................................................................................................................ Sarasota-Bradenton-Venice, FL ........................................................................................................................ Savannah, GA ................................................................................................................................................... Seattle-Bellevue-Everett, WA ............................................................................................................................ Sebastian-Vero Beach, FL ................................................................................................................................ Sherman-Denison, TX ....................................................................................................................................... Shreveport-Bossier City, LA .............................................................................................................................. Sioux City, IA-NE-SD ........................................................................................................................................ Sioux Falls, SD ................................................................................................................................................. South Bend-Mishawaka, IN-MI ......................................................................................................................... Spartanburg, SC ............................................................................................................................................... Spokane, WA .................................................................................................................................................... Springfield, MO ................................................................................................................................................. Sumter, SC ....................................................................................................................................................... Syracuse, NY .................................................................................................................................................... Tacoma, WA ..................................................................................................................................................... Tallahassee, FL ................................................................................................................................................ Tampa-St. Petersburg-Clearwater, FL .............................................................................................................. Texarkana, TX-Texarkana, AR ......................................................................................................................... Toledo, OH ........................................................................................................................................................ Topeka, KS ....................................................................................................................................................... Tulsa, OK .......................................................................................................................................................... Tuscaloosa, AL ................................................................................................................................................. Tyler, TX ........................................................................................................................................................... Vallejo-Fairfield, CA .......................................................................................................................................... Virginia Beach-Norfolk-Newport News, VA ....................................................................................................... Washington-Arlington-Alexandria DC-VA ......................................................................................................... Waterloo-Cedar Falls, IA ................................................................................................................................... Wausau, WI ...................................................................................................................................................... Wichita, KS ....................................................................................................................................................... Williamsport, PA ................................................................................................................................................ Wilmington, DE-MD-NJ ..................................................................................................................................... Wilmington, NC ................................................................................................................................................. Winston-Salem, NC ........................................................................................................................................... Youngstown-Warren-Boardman, OH-PA .......................................................................................................... Rural Arizona .................................................................................................................................................... Rural Arkansas ................................................................................................................................................. Rural California ................................................................................................................................................. Rural Connecticut ............................................................................................................................................. Rural Florida ..................................................................................................................................................... Rural Illinois ...................................................................................................................................................... Rural Iowa ......................................................................................................................................................... Rural Kansas .................................................................................................................................................... Rural Massachusetts ........................................................................................................................................ Rural Michigan .................................................................................................................................................. Rural Mississippi ............................................................................................................................................... Rural Missouri ................................................................................................................................................... Rural Nevada .................................................................................................................................................... Rural New Hampshire ....................................................................................................................................... Rural New York ................................................................................................................................................. Rural North Carolina ......................................................................................................................................... Rural Ohio ......................................................................................................................................................... Rural Oklahoma ................................................................................................................................................ Rural Oregon .................................................................................................................................................... Rural Pennsylvania (PA Hospitals) ................................................................................................................... Rural Pennsylvania (NY Hospitals) ................................................................................................................... Rural Tennessee ............................................................................................................................................... Rural Texas ....................................................................................................................................................... Rural Vermont ................................................................................................................................................... Rural Virginia .................................................................................................................................................... Rural Washington ............................................................................................................................................. Rural Wisconsin ................................................................................................................................................ Rural Wyoming ................................................................................................................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00273 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 1.5378 0.4517 1.1607 1.0376 1.3959 0.9758 0.8987 1.1202 0.9482 0.8535 0.8615 0.8848 0.9395 0.9488 0.9334 1.0220 0.8943 0.8791 0.9577 1.1060 0.8458 0.9174 0.8131 0.9276 0.8455 0.8504 0.8166 0.9190 1.4200 0.8785 1.0679 0.8891 1.0011 0.8761 0.8366 1.0752 0.9172 0.9083 0.8775 0.9386 0.7591 1.1607 1.2439 0.8749 0.8355 0.8480 0.7989 0.9739 0.8899 0.7915 0.8145 0.8780 1.0782 0.8440 0.8608 0.8701 0.7702 0.9950 0.8366 0.8440 0.7916 0.8204 0.9431 0.8095 1.0565 0.9635 0.9049 GAF 1.3427 0.5803 1.1074 1.0256 1.2566 0.9834 0.9295 1.0808 0.9642 0.8972 0.9029 0.9196 0.9582 0.9646 0.9539 1.0150 0.9264 0.9155 0.9708 1.0714 0.8916 0.9427 0.8679 0.9498 0.8914 0.8950 0.8705 0.9438 1.2714 0.9151 1.0460 0.9227 1.0008 0.9134 0.8850 1.0509 0.9425 0.9363 0.9144 0.9575 0.8280 1.1074 1.1612 0.9125 0.8842 0.8932 0.8575 0.9821 0.9232 0.8520 0.8689 0.9148 1.0529 0.8903 0.9024 0.9091 0.8363 0.9966 0.8850 0.8903 0.8521 0.8732 0.9607 0.8653 1.0384 0.9749 0.9339 24952 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4F.—PUERTO RICO WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) BY CBSA—FY 2008 CBSA code 10380 21940 25020 32420 38660 41900 41980 49500 ......... ......... ......... ......... ......... ......... ......... ......... Wage index Area Aguadilla-Isabela-San Sebasti[aacute]n, PR ........................................................................... Fajardo, PR .............................................................................................................................. Guayama, PR ........................................................................................................................... Mayag[uuml]ez, PR .................................................................................................................. Ponce, PR ................................................................................................................................ San Germ[aacute]n-Cabo Rojo, PR ......................................................................................... San Juan-Caguas-Guaynabo, PR ............................................................................................ Yauco, PR ................................................................................................................................ The following list represents all hospitals that are eligible to have their wage index increased by the outmigration adjustment listed in this table. Hospitals cannot receive the outmigration adjustment if they are reclassified under section 1886(d)(10) of the Act or redesignated under section 1886(d)(8) of the Act. Hospitals that have already been reclassified under section 1886(d)(10) of the Act or redesignated under section 1886(d)(8(B)) of the Act are designated with an asterisk. We will automatically assume that hospitals that have already been reclassified under section 0.7690 0.9543 0.6904 0.8532 0.9692 1.0616 1.0437 0.7478 1886(d)(10) of the Act or redesignated under section 1886(d)(8) of the Act wish to retain their reclassification/ redesignation status and waive the application of the outmigration adjustment. Section 1886(d)(10) hospitals that wish to receive the outmigration adjustment, rather than their reclassification, should follow the termination/withdrawal procedures specified in 42 CFR 412.273 and section III.I.3. of the preamble of this proposed rule. Otherwise, they will be deemed to have waived the outmigration adjustment. Hospitals redesignated under section 1886(d)(8) of the Act will GAF 0.8354 0.9685 0.7759 0.8970 0.9788 1.0418 1.0297 0.8195 Wage index—reclassified hospitals GAF—reclassified hospitals ........................ ........................ ........................ ........................ ........................ ........................ 1.0437 ........................ ........................ ........................ ........................ ........................ ........................ ........................ 1.0297 ........................ be deemed to have waived the outmigration adjustment, unless they explicitly notify CMS that they elect to receive the outmigration adjustment instead within 45 days from the publication of this proposed rule. These notifications should be sent to the following address: Centers for Medicare and Medicaid Services, Center for Medicare Management, Attention: Wage Index Adjustment Waivers, Division of Acute Care, Room C40806, 7500 Security Boulevard, Baltimore, MD 21244–1850. TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2008 Reclassified for FY 2008 mmaher on DSK3CLS3C1PROD with $$_JOB Provider No. 010005 010008 010009 010010 010012 010015 010022 010025 010029 010032 010035 010038 010045 010047 010052 010054 010061 010065 010078 010083 010085 010091 010100 010101 010109 010110 010125 010128 010129 010138 010143 010146 010150 010158 010164 ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Out-migration Adjustment * ............................ * * * ............................ * * * ............................ * ............................ * ............................ ............................ * ............................ * ............................ * * ............................ * * ............................ ............................ ............................ ............................ ............................ ............................ * ............................ * * * PO 00000 Frm 00274 0.0322 0.0245 0.0177 0.0322 0.0182 0.0043 0.1106 0.0188 0.0281 0.0320 0.0263 0.0038 0.0216 0.0179 0.0124 0.0177 0.0566 0.0124 0.0038 0.0125 0.0177 0.0043 0.0125 0.0209 0.0369 0.0303 0.0471 0.0043 0.0125 0.0113 0.0263 0.0038 0.0179 0.0067 0.0209 Fmt 4742 Sfmt 4742 Qualifying county name MARSHALL ............................................................... CRENSHAW ............................................................. MORGAN .................................................................. MARSHALL ............................................................... DE KALB ................................................................... CLARKE .................................................................... CHEROKEE .............................................................. CHAMBERS .............................................................. LEE ............................................................................ RANDOLPH .............................................................. CULLMAN ................................................................. CALHOUN ................................................................. FAYETTE .................................................................. BUTLER .................................................................... TALLAPOOSA ........................................................... MORGAN .................................................................. JACKSON ................................................................. TALLAPOOSA ........................................................... CALHOUN ................................................................. BALDWIN .................................................................. MORGAN .................................................................. CLARKE .................................................................... BALDWIN .................................................................. TALLADEGA ............................................................. PICKENS ................................................................... BULLOCK .................................................................. WINSTON ................................................................. CLARKE .................................................................... BALDWIN .................................................................. SUMTER ................................................................... CULLMAN ................................................................. CALHOUN ................................................................. BUTLER .................................................................... FRANKLIN ................................................................. TALLADEGA ............................................................. E:\FEDREG\03MYP2.LOC 03MYP2 County code 01470 01200 01510 01470 01240 01120 01090 01080 01400 01550 01210 01070 01280 01060 01610 01510 01350 01610 01070 01010 01510 01120 01010 01600 01530 01050 01660 01120 01010 01590 01210 01070 01060 01290 01600 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24953 TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2008—Continued Reclassified for FY 2008 Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 030040 030067 040014 040019 040039 040047 040067 040071 040076 040081 040100 050002 050007 050009 050013 050014 050042 050043 050069 050070 050073 050075 050084 050089 050090 050099 050101 050113 050118 050122 050129 050133 050136 050140 050150 050167 050168 050173 050174 050193 050195 050197 050211 050224 050226 050230 050245 050264 050272 050279 050283 050289 050291 050298 050300 050305 050313 050320 050325 050327 050335 050336 050348 050366 050367 050385 050426 050444 050476 050488 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Out-migration Adjustment ............................ ............................ * * * ............................ ............................ * * ............................ * ............................ ............................ * * * * ............................ * ............................ * ............................ ............................ * * * * ............................ * ............................ * * * * * ............................ * * * * ............................ * ............................ * * * * ............................ * * ............................ ............................ * * * ............................ ............................ ............................ ............................ * ............................ ............................ * ............................ * * * ............................ * ............................ PO 00000 Frm 00275 0.0012 0.0230 0.0163 0.0254 0.0172 0.0117 0.0008 0.0149 0.1001 0.0358 0.0163 0.0009 0.0140 0.0196 0.0196 0.0147 0.0184 0.0009 0.0006 0.0140 0.0169 0.0009 0.0135 0.0005 0.0085 0.0005 0.0169 0.0140 0.0135 0.0135 0.0005 0.0186 0.0085 0.0005 0.0357 0.0135 0.0006 0.0006 0.0085 0.0006 0.0009 0.0140 0.0009 0.0006 0.0006 0.0006 0.0005 0.0009 0.0005 0.0005 0.0009 0.0140 0.0085 0.0005 0.0005 0.0009 0.0135 0.0009 0.0046 0.0005 0.0046 0.0135 0.0006 0.0025 0.0169 0.0085 0.0006 0.0229 0.0275 0.0009 Fmt 4742 Sfmt 4742 Qualifying county name SANTA CRUZ ........................................................... LAPAZ ....................................................................... WHITE ....................................................................... ST. FRANCIS ............................................................ GREENE ................................................................... RANDOLPH .............................................................. COLUMBIA ................................................................ JEFFERSON ............................................................. HOT SPRING ............................................................ PIKE .......................................................................... WHITE ....................................................................... ALAMEDA ................................................................. SAN MATEO ............................................................. NAPA ......................................................................... NAPA ......................................................................... AMADOR ................................................................... TEHAMA ................................................................... ALAMEDA ................................................................. ORANGE ................................................................... SAN MATEO ............................................................. SOLANO ................................................................... ALAMEDA ................................................................. SAN JOAQUIN .......................................................... SAN BERNARDINO .................................................. SONOMA .................................................................. SAN BERNARDINO .................................................. SOLANO ................................................................... SAN MATEO ............................................................. SAN JOAQUIN .......................................................... SAN JOAQUIN .......................................................... SAN BERNARDINO .................................................. YUBA ......................................................................... SONOMA .................................................................. SAN BERNARDINO .................................................. NEVADA .................................................................... SAN JOAQUIN .......................................................... ORANGE ................................................................... ORANGE ................................................................... SONOMA .................................................................. ORANGE ................................................................... ALAMEDA ................................................................. SAN MATEO ............................................................. ALAMEDA ................................................................. ORANGE ................................................................... ORANGE ................................................................... ORANGE ................................................................... SAN BERNARDINO .................................................. ALAMEDA ................................................................. SAN BERNARDINO .................................................. SAN BERNARDINO .................................................. ALAMEDA ................................................................. SAN MATEO ............................................................. SONOMA .................................................................. SAN BERNARDINO .................................................. SAN BERNARDINO .................................................. ALAMEDA ................................................................. SAN JOAQUIN .......................................................... ALAMEDA ................................................................. TUOLUMNE .............................................................. SAN BERNARDINO .................................................. TUOLUMNE .............................................................. SAN JOAQUIN .......................................................... ORANGE ................................................................... CALAVERAS ............................................................. SOLANO ................................................................... SONOMA .................................................................. ORANGE ................................................................... MERCED ................................................................... LAKE ......................................................................... ALAMEDA ................................................................. E:\FEDREG\03MYP2.LOC 03MYP2 County code 03110 03055 04720 04610 04270 04600 04130 04340 04290 04540 04720 05000 05510 05380 05380 05020 05620 05000 05400 05510 05580 05000 05490 05460 05590 05460 05580 05510 05490 05490 05460 05680 05590 05460 05390 05490 05400 05400 05590 05400 05000 05510 05000 05400 05400 05400 05460 05000 05460 05460 05000 05510 05590 05460 05460 05000 05490 05000 05650 05460 05650 05490 05400 05040 05580 05590 05400 05340 05160 05000 24954 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2008—Continued Reclassified for FY 2008 Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 050494 050512 050517 050526 050528 050541 050543 050547 050548 050551 050567 050570 050580 050584 050586 050589 050603 050609 050618 050667 050678 050680 050690 050693 050707 050720 050744 050745 050746 050747 050748 050754 050756 060001 060003 060010 060027 060030 060103 060116 080001 080003 100014 100017 100045 100047 100068 100072 100077 100118 100232 100236 100252 100290 110023 110029 110040 110041 110100 110101 110142 110146 110150 110187 110190 110205 130024 130049 130066 130067 ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Out-migration Adjustment * ............................ * * * * * * * * * * * * * * * * * * * * * * ............................ * ............................ ............................ ............................ ............................ ............................ ............................ ............................ * * ............................ * ............................ * * * * * * * * * * * * * * * ............................ * * * * ............................ ............................ ............................ * * * ............................ ............................ ............................ * ............................ * PO 00000 Frm 00276 0.0357 0.0009 0.0005 0.0006 0.0229 0.0140 0.0006 0.0085 0.0006 0.0006 0.0006 0.0006 0.0006 0.0005 0.0005 0.0006 0.0006 0.0006 0.0005 0.0196 0.0006 0.0169 0.0085 0.0006 0.0140 0.0006 0.0006 0.0006 0.0006 0.0006 0.0135 0.0140 0.0005 0.0045 0.0075 0.0087 0.0075 0.0087 0.0075 0.0075 0.0018 0.0018 0.0059 0.0059 0.0059 0.0026 0.0059 0.0059 0.0026 0.0179 0.0057 0.0026 0.0146 0.0390 0.0416 0.0056 0.1727 0.0624 0.0789 0.0067 0.0202 0.0438 0.0227 0.0643 0.0242 0.0514 0.0422 0.0319 0.0319 0.0697 Fmt 4742 Sfmt 4742 Qualifying county name NEVADA .................................................................... ALAMEDA ................................................................. SAN BERNARDINO .................................................. ORANGE ................................................................... MERCED ................................................................... SAN MATEO ............................................................. ORANGE ................................................................... SONOMA .................................................................. ORANGE ................................................................... ORANGE ................................................................... ORANGE ................................................................... ORANGE ................................................................... ORANGE ................................................................... SAN BERNARDINO .................................................. SAN BERNARDINO .................................................. ORANGE ................................................................... ORANGE ................................................................... ORANGE ................................................................... SAN BERNARDINO .................................................. NAPA ......................................................................... ORANGE ................................................................... SOLANO ................................................................... SONOMA .................................................................. ORANGE ................................................................... SAN MATEO ............................................................. ORANGE ................................................................... ORANGE ................................................................... ORANGE ................................................................... ORANGE ................................................................... ORANGE ................................................................... SAN JOAQUIN .......................................................... SAN MATEO ............................................................. SAN BERNARDINO .................................................. WELD ........................................................................ BOULDER ................................................................. LARIMER .................................................................. BOULDER ................................................................. LARIMER .................................................................. BOULDER ................................................................. BOULDER ................................................................. NEW CASTLE ........................................................... NEW CASTLE ........................................................... VOLUSIA ................................................................... VOLUSIA ................................................................... VOLUSIA ................................................................... CHARLOTTE ............................................................. VOLUSIA ................................................................... VOLUSIA ................................................................... CHARLOTTE ............................................................. FLAGLER .................................................................. PUTNAM ................................................................... CHARLOTTE ............................................................. OKEECHOBEE ......................................................... SUMTER ................................................................... GORDON .................................................................. HALL ......................................................................... JACKSON ................................................................. HABERSHAM ............................................................ JEFFERSON ............................................................. COOK ........................................................................ EVANS ...................................................................... CAMDEN ................................................................... BALDWIN .................................................................. LUMPKIN .................................................................. MACON ..................................................................... GILMER ..................................................................... BONNER ................................................................... KOOTENAI ................................................................ KOOTENAI ................................................................ BINGHAM .................................................................. E:\FEDREG\03MYP2.LOC 03MYP2 County code 05390 05000 05460 05400 05340 05510 05400 05590 05400 05400 05400 05400 05400 05460 05460 05400 05400 05400 05460 05380 05400 05580 05590 05400 05510 05400 05400 05400 05400 05400 05490 05510 05460 06610 06060 06340 06060 06340 06060 06060 08010 08010 10630 10630 10630 10070 10630 10630 10070 10170 10530 10070 10460 10590 11500 11550 11610 11540 11620 11311 11441 11170 11030 11701 11710 11471 13080 13270 13270 13050 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24955 TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2008—Continued Reclassified for FY 2008 Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 130068 140001 140026 140043 140058 140110 140160 140161 140167 140234 150006 150015 150022 150030 150072 150076 150088 150091 150102 150113 150133 150146 160013 160032 160080 170137 170150 180012 180017 180049 180064 180066 180070 180079 190003 190015 190017 190034 190044 190050 190053 190054 190078 190086 190088 190099 190106 190116 190133 190140 190144 190145 190184 190190 190191 190246 190257 200024 200032 200034 200050 210001 210023 210028 210043 220002 220010 220011 220029 220033 ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Out-migration Adjustment ............................ ............................ ............................ * * * * * * ............................ * ............................ ............................ * ............................ * * * * * * * ............................ ............................ * * ............................ * * * ............................ * ............................ ............................ * * * ............................ ............................ ............................ ............................ ............................ ............................ * * * * ............................ ............................ ............................ * ............................ * ............................ * ............................ ............................ * ............................ * * ............................ ............................ ............................ ............................ * * * * * PO 00000 Frm 00277 0.0319 0.0362 0.0288 0.0055 0.0125 0.0288 0.0302 0.0193 0.1054 0.0288 0.0085 0.0085 0.0151 0.0186 0.0101 0.0210 0.0111 0.0047 0.0103 0.0111 0.0167 0.0081 0.0179 0.0235 0.0066 0.0387 0.0176 0.0081 0.0035 0.0497 0.0320 0.0450 0.0240 0.0264 0.0085 0.0231 0.0184 0.0188 0.0259 0.0044 0.0100 0.0085 0.0184 0.0050 0.0410 0.0189 0.0101 0.0084 0.0101 0.0034 0.0410 0.0090 0.0075 0.0075 0.0184 0.0075 0.0050 0.0092 0.0316 0.0092 0.0223 0.0184 0.0070 0.0356 0.0070 0.0235 0.0461 0.0235 0.0461 0.0461 Fmt 4742 Sfmt 4742 Qualifying county name KOOTENAI ................................................................ FULTON .................................................................... LA SALLE .................................................................. WHITESIDE .............................................................. MORGAN .................................................................. LA SALLE .................................................................. STEPHENSON .......................................................... LIVINGSTON ............................................................. IROQUOIS ................................................................ LA SALLE .................................................................. LA PORTE ................................................................ LA PORTE ................................................................ MONTGOMERY ........................................................ HENRY ...................................................................... CASS ......................................................................... MARSHALL ............................................................... MADISON .................................................................. HUNTINGTON .......................................................... STARKE .................................................................... MADISON .................................................................. KOSCIUSKO ............................................................. NOBLE ...................................................................... MUSCATINE ............................................................. JASPER .................................................................... CLINTON ................................................................... DOUGLAS ................................................................. COWLEY ................................................................... HARDIN ..................................................................... BARREN ................................................................... MADISON .................................................................. MONTGOMERY ........................................................ LOGAN ...................................................................... GRAYSON ................................................................ HARRISON ............................................................... IBERIA ....................................................................... TANGIPAHOA ........................................................... ST. LANDRY ............................................................. VERMILION ............................................................... ACADIA ..................................................................... BEAUREGARD ......................................................... JEFFRSON DAVIS ................................................... IBERIA ....................................................................... ST. LANDRY ............................................................. LINCOLN ................................................................... WEBSTER ................................................................. AVOYELLES ............................................................. ALLEN ....................................................................... MOREHOUSE ........................................................... ALLEN ....................................................................... FRANKLIN ................................................................. WEBSTER ................................................................. LA SALLE .................................................................. CALDWELL ............................................................... CALDWELL ............................................................... ST. LANDRY ............................................................. CALDWELL ............................................................... LINCOLN ................................................................... ANDROSCOGGIN .................................................... OXFORD ................................................................... ANDROSCOGGIN .................................................... HANCOCK ................................................................ WASHINGTON .......................................................... ANNE ARUNDEL ...................................................... ST. MARYS ............................................................... ANNE ARUNDEL ...................................................... MIDDLESEX .............................................................. ESSEX ...................................................................... MIDDLESEX .............................................................. ESSEX ...................................................................... ESSEX ...................................................................... E:\FEDREG\03MYP2.LOC 03MYP2 County code 13270 14370 14580 14988 14770 14580 14970 14610 14460 14580 15450 15450 15530 15320 15080 15490 15470 15340 15740 15470 15420 15560 16690 16490 16220 17220 17170 18460 18040 18750 18860 18700 18420 18480 19220 19520 19480 19560 19000 19050 19260 19220 19480 19300 19590 19040 19010 19330 19010 19200 19590 19290 19100 19100 19480 19100 19300 20000 20080 20000 20040 21210 21010 21180 21010 22090 22040 22090 22040 22040 24956 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2008—Continued Reclassified for FY 2008 Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 220035 220049 220063 220070 220080 220082 220084 220098 220101 220105 220171 220174 230003 230005 230013 230015 230019 230021 230022 230029 230035 230037 230047 230069 230071 230072 230075 230078 230092 230093 230096 230099 230121 230130 230151 230174 230195 230204 230207 230208 230217 230222 230223 230227 230254 230257 230264 230269 230277 230279 240018 240044 240064 240069 240071 240117 240211 250023 250040 250117 250128 250160 260059 260064 260097 270081 280077 280123 290002 310002 ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Out-migration Adjustment * * * * * * * * * * * * * ............................ * ............................ * * * * * * * * * * ............................ * * ............................ * * * * * * * * * * * * * * * * * * * * ............................ ............................ * * * ............................ ............................ * * * ............................ ............................ ............................ * ............................ ............................ ............................ ............................ * * PO 00000 Frm 00278 0.0461 0.0235 0.0235 0.0235 0.0461 0.0235 0.0235 0.0235 0.0235 0.0235 0.0235 0.0461 0.0217 0.0473 0.0023 0.0297 0.0023 0.0099 0.0212 0.0023 0.0096 0.0211 0.0018 0.0208 0.0023 0.0217 0.0048 0.0099 0.0221 0.0060 0.0297 0.0230 0.0695 0.0023 0.0023 0.0217 0.0018 0.0018 0.0023 0.0096 0.0048 0.0037 0.0023 0.0018 0.0023 0.0018 0.0018 0.0023 0.0023 0.0208 0.0873 0.0671 0.0130 0.0301 0.0377 0.0593 0.0386 0.0430 0.0022 0.0430 0.0393 0.0393 0.0127 0.0092 0.0295 0.0236 0.0057 0.0118 0.0280 0.0264 Fmt 4742 Sfmt 4742 Qualifying county name ESSEX ...................................................................... MIDDLESEX .............................................................. MIDDLESEX .............................................................. MIDDLESEX .............................................................. ESSEX ...................................................................... MIDDLESEX .............................................................. MIDDLESEX .............................................................. MIDDLESEX .............................................................. MIDDLESEX .............................................................. MIDDLESEX .............................................................. MIDDLESEX .............................................................. ESSEX ...................................................................... OTTAWA ................................................................... LENAWEE ................................................................. OAKLAND ................................................................. ST. JOSEPH ............................................................. OAKLAND ................................................................. BERRIEN .................................................................. BRANCH ................................................................... OAKLAND ................................................................. MONTCALM .............................................................. HILLSDALE ............................................................... MACOMB .................................................................. LIVINGSTON ............................................................. OAKLAND ................................................................. OTTAWA ................................................................... CALHOUN ................................................................. BERRIEN .................................................................. JACKSON ................................................................. MECOSTA ................................................................. ST. JOSEPH ............................................................. MONROE .................................................................. SHIAWASSEE ........................................................... OAKLAND ................................................................. OAKLAND ................................................................. OTTAWA ................................................................... MACOMB .................................................................. MACOMB .................................................................. OAKLAND ................................................................. MONTCALM .............................................................. CALHOUN ................................................................. MIDLAND .................................................................. OAKLAND ................................................................. MACOMB .................................................................. OAKLAND ................................................................. MACOMB .................................................................. MACOMB .................................................................. OAKLAND ................................................................. OAKLAND ................................................................. LIVINGSTON ............................................................. GOODHUE ................................................................ WINONA .................................................................... ITASCA ..................................................................... STEELE ..................................................................... RICE .......................................................................... MOWER .................................................................... PINE .......................................................................... PEARL RIVER .......................................................... JACKSON ................................................................. PEARL RIVER .......................................................... PANOLA .................................................................... PANOLA .................................................................... LACLEDE .................................................................. AUDRAIN .................................................................. JOHNSON ................................................................. MUSSELSHELL ........................................................ DODGE ..................................................................... GAGE ........................................................................ LYON ......................................................................... ESSEX ...................................................................... E:\FEDREG\03MYP2.LOC 03MYP2 County code 22040 22090 22090 22090 22040 22090 22090 22090 22090 22090 22090 22040 23690 23450 23620 23740 23620 23100 23110 23620 23580 23290 23490 23460 23620 23690 23120 23100 23370 23530 23740 23570 23770 23620 23620 23690 23490 23490 23620 23580 23120 23550 23620 23490 23620 23490 23490 23620 23620 23460 24240 24840 24300 24730 24650 24490 24570 25540 25290 25540 25530 25530 26520 26030 26500 27320 28260 28330 29090 31200 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24957 TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2008—Continued Reclassified for FY 2008 Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 310009 310010 310013 310018 310021 310031 310032 310038 310039 310044 310054 310057 310061 310070 310076 310083 310092 310093 310096 310108 310110 310119 310127 320003 320011 320018 320085 330004 330008 330010 330027 330033 330047 330073 330094 330103 330106 330126 330132 330135 330167 330175 330181 330182 330191 330198 330205 330224 330225 330235 330259 330264 330331 330332 330372 330386 340020 340021 340024 340027 340037 340038 340039 340068 340069 340070 340071 340073 340085 340096 ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Out-migration Adjustment * * * * ............................ * * * * * * ............................ ............................ * * * * * * * ............................ * ............................ * ............................ ............................ ............................ * * ............................ * ............................ ............................ * * ............................ * * * * * ............................ * * * * * * * * * * * * * * ............................ * ............................ * ............................ * * * * * * * ............................ ............................ PO 00000 Frm 00279 0.0264 0.0159 0.0264 0.0264 0.0159 0.0130 0.0027 0.0368 0.0368 0.0159 0.0264 0.0130 0.0130 0.0368 0.0264 0.0264 0.0159 0.0264 0.0264 0.0368 0.0159 0.0264 0.0130 0.0480 0.0337 0.0025 0.0025 0.0615 0.0102 0.0042 0.0148 0.0205 0.0042 0.0122 0.0463 0.0121 0.0148 0.0675 0.0121 0.0675 0.0148 0.0241 0.0148 0.0148 0.0017 0.0148 0.0675 0.0615 0.0148 0.0281 0.0148 0.0675 0.0148 0.0148 0.0148 0.0687 0.0143 0.0162 0.0171 0.0125 0.0162 0.0253 0.0101 0.0094 0.0083 0.0417 0.0168 0.0083 0.0250 0.0250 Fmt 4742 Sfmt 4742 Qualifying county name ESSEX ...................................................................... MERCER ................................................................... ESSEX ...................................................................... ESSEX ...................................................................... MERCER ................................................................... BURLINGTON ........................................................... CUMBERLAND ......................................................... MIDDLESEX .............................................................. MIDDLESEX .............................................................. MERCER ................................................................... ESSEX ...................................................................... BURLINGTON ........................................................... BURLINGTON ........................................................... MIDDLESEX .............................................................. ESSEX ...................................................................... ESSEX ...................................................................... MERCER ................................................................... ESSEX ...................................................................... ESSEX ...................................................................... MIDDLESEX .............................................................. MERCER ................................................................... ESSEX ...................................................................... BURLINGTON ........................................................... SAN MIGUEL ............................................................ RIO ARRIBA ............................................................. DONA ANA ............................................................... DONA ANA ............................................................... ULSTER .................................................................... WYOMING ................................................................ MONTGOMERY ........................................................ NASSAU .................................................................... CHENANGO .............................................................. MONTGOMERY ........................................................ GENESEE ................................................................. COLUMBIA ................................................................ CATTARAUGUS ....................................................... NASSAU .................................................................... ORANGE ................................................................... CATTARAUGUS ....................................................... ORANGE ................................................................... NASSAU .................................................................... CORTLAND ............................................................... NASSAU .................................................................... NASSAU .................................................................... WARREN .................................................................. NASSAU .................................................................... ORANGE ................................................................... ULSTER .................................................................... NASSAU .................................................................... CAYUGA ................................................................... NASSAU .................................................................... ORANGE ................................................................... NASSAU .................................................................... NASSAU .................................................................... NASSAU .................................................................... SULLIVAN ................................................................. LEE ............................................................................ CLEVELAND ............................................................. SAMPSON ................................................................ LENOIR ..................................................................... CLEVELAND ............................................................. BEAUFORT ............................................................... IREDELL ................................................................... COLUMBUS .............................................................. WAKE ........................................................................ ALAMANCE ............................................................... HARNETT ................................................................. WAKE ........................................................................ DAVIDSON ................................................................ DAVIDSON ................................................................ E:\FEDREG\03MYP2.LOC 03MYP2 County code 31200 31260 31200 31200 31260 31150 31190 31270 31270 31260 31200 31150 31150 31270 31200 31200 31260 31200 31200 31270 31260 31200 31150 32230 32190 32060 32060 33740 33900 33380 33400 33080 33380 33290 33200 33040 33400 33540 33040 33540 33400 33210 33400 33400 33750 33400 33540 33740 33400 33050 33400 33540 33400 33400 33400 33710 34520 34220 34810 34530 34220 34060 34480 34230 34910 34000 34420 34910 34280 34280 24958 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2008—Continued Reclassified for FY 2008 Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 340104 340114 340124 340126 340129 340133 340138 340144 340145 340151 340173 360002 360010 360013 360025 360036 360040 360044 360065 360071 360086 360096 360107 360125 360156 360175 360185 360187 360245 370014 370015 370023 370065 370072 370083 370100 370149 370156 370169 370172 370214 380022 390008 390016 390030 390031 390044 390052 390065 390066 390086 390096 390113 390122 390138 390146 390150 390151 390181 390183 390201 390313 420007 420019 420027 420030 420039 420043 420062 420069 ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Out-migration Adjustment * * * * * ............................ * * * ............................ * ............................ * * * * ............................ ............................ * ............................ * * * * ............................ * * * * * * ............................ ............................ ............................ ............................ ............................ * ............................ ............................ ............................ ............................ * ............................ * * * * ............................ * * * * * ............................ * ............................ * * * * * * * ............................ * * * ............................ * * PO 00000 Frm 00280 0.0162 0.0083 0.0168 0.0084 0.0101 0.0242 0.0083 0.0101 0.0337 0.0053 0.0083 0.0142 0.0075 0.0135 0.0073 0.0168 0.0392 0.0123 0.0077 0.0035 0.0187 0.0071 0.0095 0.0137 0.0095 0.0175 0.0071 0.0187 0.0137 0.0363 0.0369 0.0090 0.0097 0.0260 0.0051 0.0101 0.0292 0.0122 0.0164 0.0260 0.0122 0.0069 0.0055 0.0055 0.0163 0.0163 0.0191 0.0044 0.0489 0.0364 0.0044 0.0191 0.0049 0.0049 0.0212 0.0019 0.0019 0.0212 0.0163 0.0163 0.1091 0.0163 0.0037 0.0142 0.0145 0.0051 0.0148 0.0132 0.0096 0.0023 Fmt 4742 Sfmt 4742 Qualifying county name CLEVELAND ............................................................. WAKE ........................................................................ HARNETT ................................................................. WILSON .................................................................... IREDELL ................................................................... MARTIN ..................................................................... WAKE ........................................................................ IREDELL ................................................................... LINCOLN ................................................................... HALIFAX ................................................................... WAKE ........................................................................ ASHLAND ................................................................. TUSCARAWAS ......................................................... SHELBY .................................................................... ERIE .......................................................................... WAYNE ..................................................................... KNOX ........................................................................ DARKE ...................................................................... HURON ..................................................................... VAN WERT ............................................................... CLARK ...................................................................... COLUMBIANA ........................................................... SANDUSKY ............................................................... ASHTABULA ............................................................. SANDUSKY ............................................................... CLINTON ................................................................... COLUMBIANA ........................................................... CLARK ...................................................................... ASHTABULA ............................................................. BRYAN ...................................................................... MAYES ...................................................................... STEPHENS ............................................................... CRAIG ....................................................................... LATIMER ................................................................... PUSHMATAHA ......................................................... CHOCTAW ................................................................ POTTAWATOMIE ..................................................... GARVIN ..................................................................... MCINTOSH ............................................................... LATIMER ................................................................... GARVIN ..................................................................... LINN .......................................................................... LAWRENCE .............................................................. LAWRENCE .............................................................. SCHUYLKILL ............................................................ SCHUYLKILL ............................................................ BERKS ...................................................................... CLEARFIELD ............................................................ ADAMS ...................................................................... LEBANON ................................................................. CLEARFIELD ............................................................ BERKS ...................................................................... CRAWFORD ............................................................. CRAWFORD ............................................................. FRANKLIN ................................................................. WARREN .................................................................. GREENE ................................................................... FRANKLIN ................................................................. SCHUYLKILL ............................................................ SCHUYLKILL ............................................................ MONROE .................................................................. SCHUYLKILL ............................................................ SPARTANBURG ....................................................... CHESTER ................................................................. ANDERSON .............................................................. COLLETON ............................................................... UNION ....................................................................... CHEROKEE .............................................................. CHESTERFIELD ....................................................... CLARENDON ............................................................ E:\FEDREG\03MYP2.LOC 03MYP2 County code 34220 34910 34420 34970 34480 34580 34910 34480 34540 34410 34910 36020 36800 36760 36220 36860 36430 36190 36400 36820 36110 36140 36730 36030 36730 36130 36140 36110 36030 37060 37480 37680 37170 37380 37630 37110 37620 37240 37450 37380 37240 38210 39450 39450 39650 39650 39110 39230 39000 39460 39230 39110 39260 39260 39350 39740 39370 39350 39650 39650 39550 39650 42410 42110 42030 42140 42430 42100 42120 42130 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24959 TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2008—Continued Reclassified for FY 2008 Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 420083 430008 430048 430094 440007 440008 440016 440024 440030 440031 440033 440035 440047 440051 440057 440060 440067 440070 440081 440084 440109 440115 440137 440144 440148 440174 440180 440181 440182 440185 450032 450039 450052 450059 450064 450087 450090 450099 450135 450137 450144 450163 450192 450194 450210 450224 450236 450270 450283 450347 450348 450370 450389 450395 450419 450438 450451 450460 450497 450539 450547 450563 450565 450573 450596 450639 450641 450672 450675 450677 ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Out-migration Adjustment * ............................ * ............................ ............................ * ............................ * ............................ ............................ ............................ * ............................ ............................ ............................ * * ............................ ............................ ............................ ............................ ............................ ............................ * * ............................ ............................ ............................ ............................ * * * * * * * ............................ * * * ............................ ............................ ............................ ............................ ............................ * ............................ ............................ * * * ............................ * * * * ............................ ............................ ............................ ............................ ............................ * ............................ ............................ * * ............................ * * * PO 00000 Frm 00281 0.0037 0.0537 0.0055 0.0055 0.0226 0.0449 0.0144 0.0230 0.0015 0.0025 0.0036 0.0309 0.0338 0.0071 0.0028 0.0338 0.0015 0.0109 0.0069 0.0034 0.0070 0.0338 0.0763 0.0226 0.0306 0.0310 0.0036 0.0361 0.0144 0.0230 0.0253 0.0024 0.0276 0.0074 0.0024 0.0024 0.0651 0.0143 0.0024 0.0024 0.0558 0.0053 0.0271 0.0213 0.0150 0.0195 0.0389 0.0271 0.0655 0.0379 0.0058 0.0241 0.0619 0.0452 0.0024 0.0241 0.0537 0.0048 0.0395 0.0071 0.0195 0.0024 0.0481 0.0115 0.0744 0.0024 0.0395 0.0024 0.0024 0.0024 Fmt 4742 Sfmt 4742 Qualifying county name SPARTANBURG ....................................................... BROOKINGS ............................................................. LAWRENCE .............................................................. LAWRENCE .............................................................. COFFEE .................................................................... HENDERSON ........................................................... CARROLL ................................................................. BRADLEY .................................................................. HAMBLEN ................................................................. ROANE ...................................................................... CAMPBELL ............................................................... MONTGOMERY ........................................................ GIBSON .................................................................... MCNAIRY .................................................................. CLAIBORNE .............................................................. GIBSON .................................................................... HAMBLEN ................................................................. DECATUR ................................................................. SEVIER ..................................................................... MONROE .................................................................. HARDIN ..................................................................... GIBSON .................................................................... BEDFORD ................................................................. COFFEE .................................................................... DE KALB ................................................................... HAYWOOD ............................................................... CAMPBELL ............................................................... HARDEMAN .............................................................. CARROLL ................................................................. BRADLEY .................................................................. HARRISON ............................................................... TARRANT ................................................................. BOSQUE ................................................................... COMAL ...................................................................... TARRANT ................................................................. TARRANT ................................................................. COOKE ..................................................................... GRAY ........................................................................ TARRANT ................................................................. TARRANT ................................................................. ANDREWS ................................................................ KLEBERG ................................................................. HILL ........................................................................... CHEROKEE .............................................................. PANOLA .................................................................... WOOD ....................................................................... HOPKINS .................................................................. HILL ........................................................................... VAN ZANDT .............................................................. WALKER ................................................................... FALLS ....................................................................... COLORADO .............................................................. HENDERSON ........................................................... POLK ......................................................................... TARRANT ................................................................. COLORADO .............................................................. SOMERVELL ............................................................ TYLER ....................................................................... MONTAGUE .............................................................. HALE ......................................................................... WOOD ....................................................................... TARRANT ................................................................. PALO PINTO ............................................................. JASPER .................................................................... HOOD ........................................................................ TARRANT ................................................................. MONTAGUE .............................................................. TARRANT ................................................................. TARRANT ................................................................. TARRANT ................................................................. E:\FEDREG\03MYP2.LOC 03MYP2 County code 42410 43050 43400 43400 44150 44380 44080 44050 44310 44720 44060 44620 44260 44540 44120 44260 44310 44190 44770 44610 44350 44260 44010 44150 44200 44370 44060 44340 44080 44050 45620 45910 45160 45320 45910 45910 45340 45563 45910 45910 45010 45743 45651 45281 45842 45974 45654 45651 45947 45949 45500 45312 45640 45850 45910 45312 45893 45942 45800 45582 45974 45910 45841 45690 45653 45910 45800 45910 45910 45910 24960 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2008—Continued Reclassified for FY 2008 Provider No. 450698 450747 450755 450770 450779 450813 450838 450872 450880 450884 450886 450888 460017 460039 490019 490084 490110 500003 500007 500019 500039 500041 510018 510047 520028 520035 520044 520057 520059 520060 520071 520076 520095 520096 520102 520116 ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... ....................................................................... Out-migration Adjustment ............................ * ............................ * * * ............................ * * ............................ ............................ ............................ ............................ * * ............................ ............................ * * ............................ * * * * * ............................ ............................ ............................ * * * * * ............................ * * 0.0135 0.0127 0.0295 0.0182 0.0024 0.0127 0.0115 0.0024 0.0024 0.0050 0.0024 0.0024 0.0364 0.0364 0.1081 0.0145 0.0327 0.0164 0.0164 0.0140 0.0101 0.0020 0.0187 0.0270 0.0297 0.0083 0.0083 0.0184 0.0189 0.0048 0.0174 0.0159 0.0184 0.0189 0.0242 0.0174 Qualifying county name County code LAMB ......................................................................... ANDERSON .............................................................. HOCKLEY ................................................................. MILAM ....................................................................... TARRANT ................................................................. ANDERSON .............................................................. JASPER .................................................................... TARRANT ................................................................. TARRANT ................................................................. UPSHUR ................................................................... TARRANT ................................................................. TARRANT ................................................................. BOX ELDER .............................................................. BOX ELDER .............................................................. CULPEPER ............................................................... ESSEX ...................................................................... MONTGOMERY ........................................................ SKAGIT ..................................................................... SKAGIT ..................................................................... LEWIS ....................................................................... KITSAP ...................................................................... COWLITZ .................................................................. JACKSON ................................................................. MARION .................................................................... GREEN ...................................................................... SHEBOYGAN ............................................................ SHEBOYGAN ............................................................ SAUK ......................................................................... RACINE ..................................................................... GREEN LAKE ........................................................... JEFFERSON ............................................................. DODGE ..................................................................... SAUK ......................................................................... RACINE ..................................................................... WALWORTH ............................................................. JEFFERSON ............................................................. 45751 45000 45652 45795 45910 45000 45690 45910 45910 45943 45910 45910 46010 46010 49230 49280 49600 50280 50280 50200 50170 50070 51170 51240 52220 52580 52580 52550 52500 52230 52270 52130 52550 52500 52630 52270 TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY FY 2008 proposed rule postacute DRG FY 2008 proposed rule special pay DRG MDC TYPE MS–DRG title 1 ............ 2 ............ NO .............. NO .............. NO .............. NO .............. PRE PRE SURG ......... SURG ......... 3 ............ YES ............ NO .............. PRE SURG ......... 4 ............ YES ............ NO .............. PRE SURG ......... 5 ............ 6 ............ 7 ............ 8 ............ 9 ............ 10 .......... 11 .......... 12 .......... 13 .......... NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. PRE PRE PRE PRE PRE PRE PRE PRE PRE SURG SURG SURG SURG SURG SURG SURG SURG SURG 20 .......... mmaher on DSK3CLS3C1PROD with $$_JOB MS– DRG NO .............. NO .............. 01 Heart transplant or implant of heart assist system w MCC Heart transplant or implant of heart assist system w/o MCC. ECMO or trach w MV 96+ hrs or PDX exc face, mouth & neck w maj O.R. Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R. Liver transplant w MCC or intestinal transplant .................. Liver transplant w/o MCC .................................................... Lung transplant .................................................................... Simultaneous pancreas/kidney transplant ........................... Bone marrow transplant ....................................................... Pancreas transplant ............................................................. Tracheostomy for face, mouth & neck diagnoses w MCC .. Tracheostomy for face, mouth & neck diagnoses w CC ..... Tracheostomy for face, mouth & neck diagnoses w/o CC/ MCC. Intracranial vascular procedures w PDX hemorrhage w MCC. VerDate Mar 15 2010 .............. .............. .............. .............. .............. .............. .............. .............. .............. 02:00 Aug 26, 2011 Jkt 223001 ......... ......... ......... ......... ......... ......... ......... ......... ......... SURG ......... PO 00000 Frm 00282 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC Geometric mean length of stay Arithmetic mean length of stay 23.6378 11.2998 30.5 16.0 44.2 22.8 18.6118 36.2 43.2 11.5312 26.2 31.3 10.3032 4.7075 7.6379 5.0633 6.1059 3.6839 4.8010 2.9948 1.8882 17.0 8.7 14.6 10.2 18.1 9.1 13.0 9.0 6.1 22.6 10.0 17.3 11.9 21.6 10.2 16.3 10.9 7.3 8.2109 15.4 19.2 Weights 03MYP2 24961 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued MS– DRG FY 2008 proposed rule postacute DRG FY 2008 proposed rule special pay DRG 21 .......... 22 .......... NO .............. NO .............. NO .............. NO .............. 23 .......... NO .............. 24 .......... 25 .......... MS–DRG title 01 01 SURG ......... SURG ......... NO .............. 01 SURG ......... NO .............. NO .............. 01 SURG ......... YES ............ NO .............. 01 SURG ......... 26 .......... 27 .......... YES ............ YES ............ NO .............. NO .............. 01 01 SURG ......... SURG ......... 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ YES ............ YES ............ 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 SURG SURG SURG SURG SURG SURG SURG SURG SURG SURG SURG SURG SURG SURG SURG 52 53 54 55 56 57 58 59 60 61 62 63 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... NO .............. NO .............. YES ............ YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO NO NO NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 01 01 01 01 01 01 01 01 01 01 01 01 MED MED MED MED MED MED MED MED MED MED MED MED 64 .......... 65 .......... 66 .......... YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. 01 01 01 MED ........... MED ........... MED ........... 67 .......... NO .............. NO .............. 01 MED ........... 68 .......... NO .............. NO .............. 01 MED ........... 69 .......... 70 .......... 71 .......... mmaher on DSK3CLS3C1PROD with $$_JOB TYPE NO .............. YES ............ YES ............ NO .............. NO .............. NO .............. 01 01 01 MED ........... MED ........... MED ........... Intracranial vascular procedures w PDX hemorrhage w CC Intracranial vascular procedures w PDX hemorrhage w/o CC/MCC. Craniotomy w major device implant or acute complex CNS PDX w MCC. Craniotomy w major device implant or acute complex CNS PDX w/o MCC. Craniotomy & endovascular intracranial procedures w MCC. Craniotomy & endovascular intracranial procedures w CC Craniotomy & endovascular intracranial procedures w/o CC/MCC. Spinal procedures w MCC ................................................... Spinal procedures w CC ...................................................... Spinal procedures w/o CC/MCC .......................................... Ventricular shunt procedures w MCC .................................. Ventricular shunt procedures w CC ..................................... Ventricular shunt procedures w/o CC/MCC ........................ Carotid artery stent procedure w MCC ................................ Carotid artery stent procedure w CC ................................... Carotid artery stent procedure w/o CC/MCC ...................... Extracranial procedures w MCC .......................................... Extracranial procedures w CC ............................................. Extracranial procedures w/o CC/MCC ................................. Periph & cranial nerve & other nerv syst proc w MCC ....... Periph & cranial nerve & other nerv syst proc w CC .......... Periph & cranial nerve & other nerv syst proc w/o CC/ MCC. Spinal disorders & injuries w CC/MCC ................................ Spinal disorders & injuries w/o CC/MCC ............................. Nervous system neoplasms w MCC ................................... Nervous system neoplasms w/o MCC ................................ Degenerative nervous system disorders w MCC ................ Degenerative nervous system disorders w/o MCC ............. Multiple sclerosis & cerebellar ataxia w MCC ..................... Multiple sclerosis & cerebellar ataxia w CC ........................ Multiple sclerosis & cerebellar ataxia w/o CC/MCC ............ Acute ischemic stroke w use of thrombolytic agent w MCC Acute ischemic stroke w use of thrombolytic agent w CC .. Acute ischemic stroke w use of thrombolytic agent w/o CC/MCC. Intracranial hemorrhage or cerebral infarction w MCC ....... Intracranial hemorrhage or cerebral infarction w CC .......... Intracranial hemorrhage or cerebral infarction w/o CC/ MCC. Nonspecific cva & precerebral occlusion w/o infarct w MCC. Nonspecific cva & precerebral occlusion w/o infarct w/o MCC. Transient ischemia ............................................................... Nonspecific cerebrovascular disorders w MCC ................... Nonspecific cerebrovascular disorders w CC ...................... VerDate Mar 15 2010 02:00 Aug 26, 2011 MDC Jkt 223001 ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... PO 00000 Frm 00283 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC Geometric mean length of stay Arithmetic mean length of stay 6.1724 4.1017 13.4 7.9 15.6 9.7 5.1123 9.8 13.7 Weights 03MYP2 3.4316 6.1 8.7 4.9933 10.7 13.8 2.9515 2.0380 6.7 3.6 8.4 4.7 4.9251 2.5965 1.5278 3.8505 1.7502 1.2661 3.2158 2.0186 1.5746 3.0383 1.5518 1.0172 3.8181 2.1436 1.6878 10.9 5.7 2.7 9.2 3.9 2.3 4.8 2.0 1.3 6.0 2.6 1.5 10.4 5.6 2.5 14.7 7.7 3.7 13.2 5.8 3.1 7.3 3.0 1.6 8.7 3.8 1.9 14.0 7.5 3.7 1.5118 0.9105 1.6182 1.0567 1.6121 0.8403 1.6022 0.9288 0.7126 2.9195 1.9977 1.5581 4.9 3.2 5.5 3.9 6.2 4.0 5.8 4.3 3.4 7.4 5.4 4.0 6.8 4.0 7.4 5.1 8.2 5.0 8.0 5.2 4.1 9.8 6.4 4.6 1.9072 1.1841 0.8588 5.9 4.5 3.2 7.9 5.4 3.8 1.5069 4.8 6.2 0.8855 2.8 3.6 0.7372 1.8674 1.1698 2.5 6.3 4.6 3.1 8.2 5.8 24962 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued MS– DRG FY 2008 proposed rule special pay DRG MDC TYPE .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. YES ............ YES ............ YES ............ NO .............. NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 MED MED MED MED MED MED MED MED MED MED MED MED MED MED MED MED MED MED MED MED MED MED MED 95 .......... 96 .......... NO .............. NO .............. NO .............. NO .............. 01 01 MED ........... MED ........... 97 .......... NO .............. NO .............. 01 MED ........... 98 .......... NO .............. NO .............. 01 MED ........... 99 .......... NO .............. NO .............. 01 MED ........... 100 ........ 101 ........ 102 ........ 103 ........ 113 ........ 114 ........ 15 .......... 116 ........ 117 ........ 121 ........ 122 ........ 123 ........ 124 ........ 125 ........ 129 ........ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 01 01 01 01 02 02 02 02 02 02 02 02 02 02 03 MED ........... MED ........... MED ........... MED ........... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... MED ........... MED ........... MED ........... MED ........... MED ........... SURG ......... 130 131 132 133 mmaher on DSK3CLS3C1PROD with $$_JOB 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 FY 2008 proposed rule postacute DRG NO NO NO NO NO NO NO NO .............. .............. .............. .............. 03 03 03 03 SURG SURG SURG SURG ........ ........ ........ ........ VerDate Mar 15 2010 .............. .............. .............. .............. 02:00 Aug 26, 2011 Jkt 223001 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... PO 00000 ......... ......... ......... ......... MS–DRG title Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC Arithmetic mean length of stay 0.8275 1.3298 0.8482 1.7156 0.9367 1.7374 1.0221 0.8041 1.0699 0.6932 2.0060 1.3451 0.8999 2.0578 1.1911 0.8097 1.5966 0.9494 0.6755 1.6189 0.9082 0.6805 3.5061 3.0 4.8 3.4 6.1 3.5 5.6 3.8 2.9 3.6 2.7 3.9 3.8 2.3 6.0 4.1 2.7 4.3 3.0 2.0 4.9 3.6 2.6 10.3 3.8 6.4 4.4 7.7 4.2 7.2 4.6 3.5 4.9 3.4 6.4 5.3 3.1 8.2 5.3 3.4 6.1 3.8 2.5 6.8 4.5 3.2 12.9 2.3341 1.9369 7.7 5.1 9.4 6.3 3.0776 9.6 12.0 1.8380 7.0 8.7 Weights Nonspecific cerebrovascular disorders w/o CC/MCC ......... Cranial & peripheral nerve disorders w MCC ...................... Cranial & peripheral nerve disorders w/o MCC ................... Viral meningitis w CC/MCC ................................................. Viral meningitis w/o CC/MCC .............................................. Hypertensive encephalopathy w MCC ................................ Hypertensive encephalopathy w CC ................................... Hypertensive encephalopathy w/o CC/MCC ....................... Nontraumatic stupor & coma w MCC .................................. Nontraumatic stupor & coma w/o MCC ............................... Traumatic stupor & coma, coma ≤1 hr w MCC ................... Traumatic stupor & coma, coma ≤1 hr w CC ...................... Traumatic stupor & coma, coma ≤1 hr w/o CC/MCC ......... Traumatic stupor & coma, coma <1 hr w MCC .................. Traumatic stupor & coma, coma <1 hr w CC ..................... Traumatic stupor & coma, coma <1 hr w/o CC/MCC ......... Concussion w MCC ............................................................. Concussion w CC ................................................................ Concussion w/o CC/MCC .................................................... Other disorders of nervous system w MCC ........................ Other disorders of nervous system w CC ........................... Other disorders of nervous system w/o CC/MCC ............... Bacterial & tuberculous infections of nervous system w MCC. Bacterial & tuberculous infections of nervous system w CC Bacterial & tuberculous infections of nervous system w/o CC/MCC. Non-bacterial infect of nervous sys exc viral meningitis w MCC. Non-bacterial infect of nervous sys exc viral meningitis w CC. Non-bacterial infect of nervous sys exc viral meningitis w/o CC/MCC. Seizures w MCC .................................................................. Seizures w/o MCC ............................................................... Headaches w MCC .............................................................. Headaches w/o MCC ........................................................... Orbital procedures w CC/MCC ............................................ Orbital procedures w/o CC/MCC ......................................... Extraocular procedures except orbit .................................... Intraocular procedures w CC/MCC ...................................... Intraocular procedures w/o CC/MCC ................................... Acute major eye infections w CC/MCC ............................... Acute major eye infections w/o CC/MCC ............................ Neurological eye disorders .................................................. Other disorders of the eye w MCC ...................................... Other disorders of the eye w/o MCC ................................... Major head & neck procedures w CC/MCC or major device. Major head & neck procedures w/o CC/MCC ..................... Cranial/facial procedures w CC/MCC .................................. Cranial/facial procedures w/o CC/MCC ............................... Other ear, nose, mouth & throat O.R. procedures w CC/ MCC. Frm 00284 Geometric mean length of stay 03MYP2 1.3644 5.2 6.4 1.5034 0.7674 1.0425 0.6534 1.6088 0.8349 1.0782 1.0167 0.6329 1.0166 0.5585 0.7168 1.1057 0.6561 1.9117 4.8 3.0 3.6 2.5 3.9 2.0 3.3 2.2 1.5 4.7 3.4 2.4 4.0 2.7 3.6 6.4 3.7 5.1 3.2 5.6 2.7 4.5 3.5 2.0 5.9 4.1 2.9 5.3 3.5 5.1 1.1754 1.8374 1.0808 1.7401 2.5 3.9 2.1 4.1 3.2 5.6 2.6 6.4 24963 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued FY 2008 proposed rule postacute DRG FY 2008 proposed rule special pay DRG 134 ........ NO .............. NO .............. 135 136 137 138 139 146 147 148 149 150 151 152 153 154 155 156 157 158 159 163 164 165 166 167 168 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 mmaher on DSK3CLS3C1PROD with $$_JOB MS– DRG NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ YES ............ YES ............ NO .............. YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ VerDate Mar 15 2010 .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 02:00 Aug 26, 2011 MDC TYPE MS–DRG title 03 SURG ......... 03 03 03 03 03 03 03 03 03 03 03 03 03 03 03 03 03 03 03 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... Other ear, nose, mouth & throat O.R. procedures w/o CC/ MCC. Sinus & mastoid procedures w CC/MCC ............................ Sinus & mastoid procedures w/o CC/MCC ......................... Mouth procedures w CC/MCC ............................................. Mouth procedures w/o CC/MCC .......................................... Salivary gland procedures ................................................... Ear, nose, mouth & throat malignancy w MCC ................... Ear, nose, mouth & throat malignancy w CC ...................... Ear, nose, mouth & throat malignancy w/o CC/MCC .......... Dysequilibrium ...................................................................... Epistaxis w MCC .................................................................. Epistaxis w/o MCC ............................................................... Otitis media & URI w MCC .................................................. Otitis media & URI w/o MCC ............................................... Nasal trauma & deformity w MCC ....................................... Nasal trauma & deformity w CC .......................................... Nasal trauma & deformity w/o CC/MCC .............................. Dental & Oral Diseases w MCC .......................................... Dental & Oral Diseases w CC ............................................. Dental & Oral Diseases w/o CC/MCC ................................. Major chest procedures w MCC .......................................... Major chest procedures w CC ............................................. Major chest procedures w/o CC/MCC ................................. Other resp system O.R. procedures w MCC ...................... Other resp system O.R. procedures w CC ......................... Other resp system O.R. procedures w/o CC/MCC ............. Pulmonary embolism w MCC .............................................. Pulmonary embolism w/o MCC ........................................... Respiratory infections & inflammations w MCC .................. Respiratory infections & inflammations w CC ..................... Respiratory infections & inflammations w/o CC/MCC ......... Respiratory neoplasms w MCC ........................................... Respiratory neoplasms w CC .............................................. Respiratory neoplasms w/o CC/MCC .................................. Major chest trauma w MCC ................................................. Major chest trauma w CC .................................................... Major chest trauma w/o CC/MCC ........................................ Pleural effusion w MCC ....................................................... Pleural effusion w CC .......................................................... Pleural effusion w/o CC/MCC .............................................. Pulmonary edema & respiratory failure ............................... Chronic obstructive pulmonary disease w MCC ................. Chronic obstructive pulmonary disease w CC .................... Chronic obstructive pulmonary disease w/o CC/MCC ........ Simple pneumonia & pleurisy w MCC ................................. Simple pneumonia & pleurisy w CC .................................... Simple pneumonia & pleurisy w/o CC/MCC ........................ Interstitial lung disease w MCC ........................................... Interstitial lung disease w CC .............................................. Interstitial lung disease w/o CC/MCC .................................. Pneumothorax w MCC ......................................................... Pneumothorax w CC ............................................................ Pneumothorax w/o CC/MCC ............................................... Bronchitis & asthma w CC/MCC ......................................... Bronchitis & asthma w/o CC/MCC ...................................... Respiratory signs & symptoms ............................................ Jkt 223001 PO 00000 Frm 00285 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC Geometric mean length of stay Arithmetic mean length of stay 0.7834 1.8 2.3 1.8091 0.9299 1.3963 0.7922 0.8585 2.2573 1.1662 0.7281 0.6154 1.3003 0.5760 0.9462 0.6048 1.3989 0.8749 0.6360 1.4922 0.8634 0.6046 5.0199 2.5482 1.7780 3.7734 2.0778 1.3566 1.6160 1.0969 2.0518 1.5058 1.0484 1.7205 1.2288 0.8973 1.5059 0.9082 0.6322 1.6338 1.1228 0.8350 1.3833 1.3448 1.0024 0.7484 1.4737 1.0280 0.7461 1.5597 1.1041 0.8423 1.7928 1.0158 0.7356 0.8324 0.6040 0.6685 4.0 1.7 3.7 1.9 1.5 7.1 4.2 2.5 2.2 4.0 2.3 3.7 2.8 4.9 3.6 2.5 5.0 3.4 2.4 12.7 7.0 4.5 10.6 6.7 4.1 6.4 4.9 7.6 6.3 4.8 6.1 4.6 3.3 5.7 3.8 2.7 6.0 4.4 3.3 4.9 5.3 4.3 3.4 5.7 4.5 3.6 6.0 4.5 3.5 6.7 4.0 3.2 3.6 2.9 2.2 6.1 2.3 5.4 2.4 1.9 10.2 5.8 3.5 2.7 5.5 2.9 4.7 3.4 6.5 4.6 3.2 6.9 4.5 3.1 15.4 8.5 5.4 13.4 8.3 5.5 7.6 5.6 9.5 7.7 5.8 8.0 6.0 4.3 7.2 4.7 3.3 7.7 5.6 4.2 6.3 6.6 5.2 4.1 7.0 5.4 4.2 7.5 5.5 4.3 8.5 5.2 4.1 4.5 3.5 2.9 Weights 03MYP2 24964 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued MS– DRG FY 2008 proposed rule postacute DRG FY 2008 proposed rule special pay DRG 205 ........ 206 ........ 207 ........ YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. 208 ........ NO .............. 215 ........ 216 ........ NO .............. YES ............ 217 ........ MS–DRG title 04 04 04 MED ........... MED ........... MED ........... NO .............. 04 MED ........... NO .............. NO .............. 05 05 SURG ......... SURG ......... YES ............ NO .............. 05 SURG ......... 218 ........ YES ............ NO .............. 05 SURG ......... 219 ........ YES ............ YES ............ 05 SURG ......... 220 ........ YES ............ YES ............ 05 SURG ......... 221 ........ YES ............ YES ............ 05 SURG ......... 222 ........ NO .............. NO .............. 05 SURG ......... 223 ........ NO .............. NO .............. 05 SURG ......... 224 ........ NO .............. NO .............. 05 SURG ......... 225 ........ NO .............. NO .............. 05 SURG ......... 226 227 228 229 230 231 232 233 234 235 236 237 238 239 ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ NO .............. NO .............. YES ............ YES ............ YES ............ NO .............. NO .............. YES ............ YES ............ YES ............ YES ............ NO .............. NO .............. YES ............ NO NO NO NO NO NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 05 05 05 05 05 05 05 05 05 05 05 05 05 05 SURG SURG SURG SURG SURG SURG SURG SURG SURG SURG SURG SURG SURG SURG 240 ........ YES ............ NO .............. 05 SURG ......... 241 ........ YES ............ NO .............. 05 SURG ......... 242 243 244 245 246 ........ ........ ........ ........ ........ YES ............ YES ............ YES ............ NO .............. NO .............. NO NO NO NO NO .............. .............. .............. .............. .............. 05 05 05 05 05 SURG SURG SURG SURG SURG 247 ........ NO .............. NO .............. 05 SURG ......... 248 ........ NO .............. NO .............. 05 SURG ......... 249 ........ NO .............. NO .............. 05 SURG ......... 250 ........ mmaher on DSK3CLS3C1PROD with $$_JOB TYPE NO .............. NO .............. 05 SURG ......... Other respiratory system diagnoses w MCC ....................... Other respiratory system diagnoses w/o MCC .................... Respiratory system diagnosis w ventilator support 96+ hours. Respiratory system diagnosis w ventilator support <96 hours. Other heart assist system implant ....................................... Cardiac valve & oth maj cardiothoracic proc w card cath w MCC. Cardiac valve & oth maj cardiothoracic proc w card cath w CC. Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC. Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC. Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC. Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC. Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC. Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC. Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC. Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/ o MCC. Cardiac defibrillator implant w/o cardiac cath w MCC ........ Cardiac defibrillator implant w/o cardiac cath w/o MCC ..... Other cardiothoracic procedures w MCC ............................ Other cardiothoracic procedures w CC ............................... Other cardiothoracic procedures w/o CC/MCC ................... Coronary bypass w PTCA w MCC ...................................... Coronary bypass w PTCA w/o MCC ................................... Coronary bypass w cardiac cath w MCC ............................ Coronary bypass w cardiac cath w/o MCC ......................... Coronary bypass w/o cardiac cath w MCC ......................... Coronary bypass w/o cardiac cath w/o MCC ...................... Major cardiovascular procedures w MCC ........................... Major cardiovascular procedures w/o MCC ........................ Amputation for circ sys disorders exc upper limb & toe w MCC. Amputation for circ sys disorders exc upper limb & toe w CC. Amputation for circ sys disorders exc upper limb & toe w/o CC/MCC. Permanent cardiac pacemaker implant w MCC .................. Permanent cardiac pacemaker implant w CC ..................... Permanent cardiac pacemaker implant w/o CC/MCC ......... AICD lead & generator procedures ..................................... PercutAneous cardiovascular proc w drugeluting stent w MCC. PercutAneous cardiovascular proc w drugeluting stent w/o MCC. PercutAneous cardiovasc proc w non drugeluting stent w MCC. PercutAneous cardiovasc proc w non drugeluting stent w/ o MCC. Perc cardiovasc proc w/o coronary artery stent or AMI w MCC. VerDate Mar 15 2010 02:00 Aug 26, 2011 MDC Jkt 223001 PO 00000 ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Frm 00286 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC Geometric mean length of stay Arithmetic mean length of stay 1.2260 0.7438 5.1817 4.4 2.7 13.0 5.8 3.5 15.3 Weights 03MYP2 2.2694 5.3 7.4 11.3007 10.1554 6.3 16.5 12.2 19.3 6.7770 11.2 12.6 5.3817 8.5 9.2 8.0521 12.0 14.7 5.2148 7.7 8.8 4.2664 6.1 6.5 8.7087 10.8 13.3 6.4941 5.0 6.6 8.0293 9.2 11.5 6.0000 4.6 5.8 6.6475 4.9179 7.6611 4.9100 3.8738 7.8839 5.7100 7.1576 4.6250 5.8085 3.5360 5.1414 2.8491 4.4948 6.2 1.8 12.4 8.1 5.8 10.8 8.1 12.9 8.3 10.0 6.1 8.3 3.4 13.6 9.4 2.8 15.1 9.3 6.7 13.2 9.0 14.7 9.0 11.9 6.7 11.6 4.9 16.9 2.6343 9.4 11.4 1.6041 6.2 7.4 3.7363 2.5922 2.0181 3.1597 3.3910 7.1 3.9 2.2 2.1 4.4 9.1 5.2 3.0 3.3 6.3 2.0829 1.7 2.2 2.9777 4.7 6.5 1.7813 1.9 2.5 2.8561 5.3 7.5 24965 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued MS– DRG FY 2008 proposed rule postacute DRG FY 2008 proposed rule special pay DRG 251 ........ NO .............. NO .............. 252 253 254 255 ........ ........ ........ ........ NO .............. NO .............. NO .............. YES ............ NO NO NO NO .............. .............. .............. .............. 256 ........ YES ............ 257 ........ MS–DRG title 05 SURG ......... 05 05 05 05 SURG SURG SURG SURG NO .............. 05 SURG ......... YES ............ NO .............. 05 SURG ......... 258 ........ 259 ........ 260 ........ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. 05 05 05 SURG ......... SURG ......... SURG ......... 261 ........ NO .............. NO .............. 05 SURG ......... 262 ........ NO .............. NO .............. 05 SURG ......... 263 264 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 mmaher on DSK3CLS3C1PROD with $$_JOB TYPE NO .............. YES ............ YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 05 SURG ......... SURG ......... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... Perc cardiovasc proc w/o coronary artery stent or AMI w/o MCC. Other vascular procedures w MCC ..................................... Other vascular procedures w CC ........................................ Other vascular procedures w/o CC/MCC ............................ Upper limb & toe amputation for circ system disorders w MCC. Upper limb & toe amputation for circ system disorders w CC. Upper limb & toe amputation for circ system disorders w/o CC/MCC. Cardiac pacemaker device replacement w MCC ................ Cardiac pacemaker device replacement w/o MCC ............. Cardiac pacemaker revision except device replacement w MCC. Cardiac pacemaker revision except device replacement w CC. Cardiac pacemaker revision except device replacement w/ o CC/MCC. Vein ligation & stripping ....................................................... Other circulatory system O.R. procedures .......................... Acute myocardial infarction, discharged alive w MCC ........ Acute myocardial infarction, discharged alive w CC ........... Acute myocardial infarction, discharged alive w/o CC/MCC Acute myocardial infarction, expired w MCC ...................... Acute myocardial infarction, expired w CC ......................... Acute myocardial infarction, expired w/o CC/MCC ............. Circulatory disorders except AMI, w card cath w MCC ...... Circulatory disorders except AMI, w card cath w/o MCC ... Acute & subacute endocarditis w MCC ............................... Acute & subacute endocarditis w CC .................................. Acute & subacute endocarditis w/o CC/MCC ...................... Heart failure & shock w MCC .............................................. Heart failure & shock w CC ................................................. Heart failure & shock w/o CC/MCC ..................................... Deep vein thrombophlebitis w CC/MCC .............................. Deep vein thrombophlebitis w/o CC/MCC ........................... Cardiac arrest, unexplained w MCC .................................... Cardiac arrest, unexplained w CC ....................................... Cardiac arrest, unexplained w/o CC/MCC .......................... Peripheral vascular disorders w MCC ................................. Peripheral vascular disorders w CC .................................... Peripheral vascular disorders w/o CC/MCC ........................ Atherosclerosis w MCC ....................................................... Atherosclerosis w/o MCC .................................................... Hypertension w MCC ........................................................... Hypertension w/o MCC ........................................................ Cardiac congenital & valvular disorders w MCC ................. Cardiac congenital & valvular disorders w/o MCC .............. Cardiac arrhythmia & conduction disorders w MCC ........... Cardiac arrhythmia & conduction disorders w CC .............. Cardiac arrhythmia & conduction disorders w/o CC/MCC .. Angina pectoris .................................................................... ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ VerDate Mar 15 2010 .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 02:00 Aug 26, 2011 MDC Jkt 223001 PO 00000 ......... ......... ......... ......... Frm 00287 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC Weights 03MYP2 Geometric mean length of stay Arithmetic mean length of stay 1.6341 2.1 3.0 2.9234 2.2669 1.5412 2.4736 5.7 4.3 2.1 8.0 8.8 6.3 2.9 10.5 1.5502 6.2 7.9 0.9882 3.9 5.2 2.9077 1.6063 2.9653 5.5 1.9 7.3 7.6 2.6 10.3 1.3133 2.8 4.0 0.9197 1.9 2.5 1.5146 2.4755 1.9690 1.2675 0.9121 1.7404 1.0037 0.6679 2.0464 1.0939 3.1146 1.9306 1.2534 1.4850 1.0216 0.7317 0.9403 0.5995 1.3021 0.7673 0.4932 1.4537 0.9234 0.6535 1.0240 0.5972 1.0693 0.5937 1.4448 0.7582 1.3406 0.8421 0.5917 0.5209 3.5 6.1 6.4 4.2 2.7 3.4 2.3 1.7 5.3 2.5 10.4 7.7 5.6 5.3 4.3 3.1 4.6 3.8 2.0 1.5 1.2 5.4 4.3 3.1 3.3 2.1 4.0 2.3 4.7 2.8 4.3 3.2 2.3 1.9 5.5 9.2 7.8 5.1 3.4 5.5 3.5 2.3 7.1 3.2 12.8 9.2 6.9 6.8 5.2 3.8 5.6 4.4 3.3 2.0 1.5 7.1 5.3 3.8 4.4 2.6 5.3 2.9 6.5 3.5 5.8 4.0 2.8 2.3 24966 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued MS– DRG FY 2008 proposed rule postacute DRG FY 2008 proposed rule special pay DRG MDC TYPE MS–DRG title Syncope & collapse ............................................................. Chest pain ............................................................................ Other circulatory system diagnoses w MCC ....................... Other circulatory system diagnoses w CC .......................... Other circulatory system diagnoses w/o CC/MCC .............. Stomach, esophageal & duodenal proc w MCC ................. Stomach, esophageal & duodenal proc w CC .................... Stomach, esophageal & duodenal proc w/o CC/MCC ........ Major small & large bowel procedures w MCC ................... Major small & large bowel procedures w CC ...................... Major small & large bowel procedures w/o CC/MCC .......... Rectal resection w MCC ...................................................... Rectal resection w CC ......................................................... Rectal resection w/o CC/MCC ............................................. Peritoneal adhesiolysis w MCC ........................................... Peritoneal adhesiolysis w CC .............................................. Peritoneal adhesiolysis w/o CC/MCC .................................. Appendectomy w complicated principal diag w MCC ......... Appendectomy w complicated principal diag w CC ............ Appendectomy w complicated principal diag w/o CC/MCC Appendectomy w/o complicated principal diag w MCC ...... Appendectomy w/o complicated principal diag w CC ......... Appendectomy w/o complicated principal diag w/o CC/ MCC. Minor small & large bowel procedures w MCC ................... Minor small & large bowel procedures w CC ...................... Minor small & large bowel procedures w/o CC/MCC .......... Anal & stomal procedures w MCC ...................................... Anal & stomal procedures w CC ......................................... Anal & stomal procedures w/o CC/MCC ............................. Inguinal & femoral hernia procedures w MCC .................... Inguinal & femoral hernia procedures w CC ....................... Inguinal & femoral hernia procedures w/o CC/MCC ........... Hernia procedures except inguinal & femoral w MCC ........ Hernia procedures except inguinal & femoral w CC ........... Hernia procedures except inguinal & femoral w/o CC/MCC Other digestive system O.R. procedures w MCC ............... Other digestive system O.R. procedures w CC .................. Other digestive system O.R. procedures w/o CC/MCC ...... Major esophageal disorders w MCC ................................... Major esophageal disorders w CC ...................................... Major esophageal disorders w/o CC/MCC .......................... Major gastrointestinal disorders & peritoneal infections w MCC. ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ NO .............. NO .............. YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 05 05 05 05 05 06 06 06 06 06 06 06 06 06 06 06 06 06 06 06 06 06 06 MED ........... MED ........... MED ........... MED ........... MED ........... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 368 369 370 371 mmaher on DSK3CLS3C1PROD with $$_JOB 312 313 314 315 316 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. YES ............ NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 06 06 06 06 06 06 06 06 06 06 06 06 06 06 06 06 06 06 06 SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... MED ........... MED ........... MED ........... MED ........... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00288 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC Geometric mean length of stay Arithmetic mean length of stay 0.7198 0.5588 1.7436 0.9947 0.6650 5.9079 2.8426 1.4776 5.1551 2.5597 1.6155 4.6624 2.4296 1.5965 4.2165 2.2499 1.4712 3.3316 1.8705 1.2680 2.3828 1.3623 0.9442 2.5 1.7 5.3 3.7 2.4 13.9 8.2 3.4 13.3 8.6 5.5 12.7 8.0 5.0 12.2 7.8 4.5 9.1 6.2 3.6 5.4 3.4 1.9 3.2 2.1 7.3 4.8 3.1 17.7 10.5 4.6 16.4 10.0 6.1 15.2 9.1 5.7 14.7 9.4 5.7 10.9 7.2 4.3 7.3 4.4 2.3 3.1864 1.6018 1.1496 2.1945 1.2723 0.7728 2.3797 1.2299 0.7910 2.5720 1.3793 0.9375 3.8336 2.1324 1.4045 1.6379 1.0821 0.8138 1.8831 9.4 6.3 4.5 6.2 4.2 2.4 5.9 3.5 1.9 6.6 4.0 2.3 10.0 6.3 3.6 5.1 3.9 2.9 6.9 12.1 7.3 5.0 8.4 5.6 3.1 8.1 4.7 2.5 8.7 5.1 2.9 13.7 8.3 4.7 6.7 4.8 3.4 9.0 Weights 03MYP2 24967 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued MS– DRG FY 2008 proposed rule postacute DRG FY 2008 proposed rule special pay DRG 372 ........ YES ............ NO .............. 373 ........ YES ............ NO .............. 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 405 406 407 408 ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ YES ............ YES ............ NO .............. NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO 409 ........ 410 ........ 411 412 413 414 TYPE MS–DRG title 06 MED ........... 06 MED ........... .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 06 06 06 06 06 06 06 06 06 06 06 06 06 06 06 06 06 06 06 06 06 06 07 07 07 07 MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... SURG ......... SURG ......... SURG ......... SURG ......... NO .............. NO .............. 07 SURG ......... NO .............. NO .............. 07 SURG ......... ........ ........ ........ ........ NO .............. NO .............. NO .............. YES ............ NO NO NO NO .............. .............. .............. .............. 07 07 07 07 SURG SURG SURG SURG 415 ........ 416 ........ YES ............ YES ............ NO .............. NO .............. 07 07 SURG ......... SURG ......... 417 418 419 420 421 422 423 424 425 NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. 07 07 07 07 07 07 07 07 07 SURG SURG SURG SURG SURG SURG SURG SURG SURG NO .............. NO .............. NO .............. 07 07 07 MED ........... MED ........... MED ........... Major gastrointestinal disorders & peritoneal infections w CC. Major gastrointestinal disorders & peritoneal infections w/o CC/MCC. Digestive malignancy w MCC .............................................. Digestive malignancy w CC ................................................. Digestive malignancy w/o CC/MCC ..................................... G.I. hemorrhage w MCC ...................................................... G.I. hemorrhage w CC ......................................................... G.I. hemorrhage w/o CC/MCC ............................................ Complicated peptic ulcer w MCC ........................................ Complicated peptic ulcer w CC ........................................... Complicated peptic ulcer w/o CC/MCC ............................... Uncomplicated peptic ulcer w MCC .................................... Uncomplicated peptic ulcer w/o MCC ................................. Inflammatory bowel disease w MCC ................................... Inflammatory bowel disease w CC ...................................... Inflammatory bowel disease w/o CC/MCC .......................... G.I. obstruction w MCC ....................................................... G.I. obstruction w CC .......................................................... G.I. obstruction w/o CC/MCC .............................................. Esophagitis, gastroent & misc digest disorders w MCC ..... Esophagitis, gastroent & misc digest disorders w/o MCC .. Other digestive system diagnoses w MCC ......................... Other digestive system diagnoses w CC ............................ Other digestive system diagnoses w/o CC/MCC ................ Pancreas, liver & shunt procedures w MCC ....................... Pancreas, liver & shunt procedures w CC .......................... Pancreas, liver & shunt procedures w/o CC/MCC .............. Biliary tract proc except only cholecyst w or w/o c.d.e. w MCC. Biliary tract proc except only cholecyst w or w/o c.d.e. w CC. Biliary tract proc except only cholecyst w or w/o c.d.e. w/o CC/MCC. Cholecystectomy w c.d.e. w MCC ....................................... Cholecystectomy w c.d.e. w CC .......................................... Cholecystectomy w c.d.e. w/o CC/MCC .............................. Cholecystectomy except by laparoscope w/o c.d.e. w MCC. Cholecystectomy except by laparoscope w/o c.d.e. w CC Cholecystectomy except by laparoscope w/o c.d.e. w/o CC/MCC. Laparoscopic cholecystectomy w/o c.d.e. w MCC .............. Laparoscopic cholecystectomy w/o c.d.e. w CC ................. Laparoscopic cholecystectomy w/o c.d.e. w/o CC/MCC ..... Hepatobiliary diagnostic procedures w MCC ...................... Hepatobiliary diagnostic procedures w CC ......................... Hepatobiliary diagnostic procedures w/o CC/MCC ............. Other hepatobiliary or pancreas O.R. procedures w MCC Other hepatobiliary or pancreas O.R. procedures w CC .... Other hepatobiliary or pancreas O.R. procedures w/o CC/ MCC. Cirrhosis & alcoholic hepatitis w MCC ................................ Cirrhosis & alcoholic hepatitis w CC ................................... Cirrhosis & alcoholic hepatitis w/o CC/MCC ....................... ........ ........ ........ ........ ........ ........ ........ ........ ........ mmaher on DSK3CLS3C1PROD with $$_JOB 432 ........ 433 ........ 434 ........ .............. .............. .............. .............. .............. .............. .............. .............. .............. NO .............. NO .............. NO .............. VerDate Mar 15 2010 02:00 Aug 26, 2011 MDC Jkt 223001 PO 00000 ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Frm 00289 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC Weights 03MYP2 Geometric mean length of stay Arithmetic mean length of stay 1.2657 5.8 7.0 0.8644 4.3 5.1 2.0243 1.2489 0.8688 1.6119 1.0451 0.7745 1.7245 1.1612 0.8139 1.2971 0.8274 1.8700 1.0592 0.8063 1.5834 0.9405 0.6490 1.1256 0.6920 1.5389 0.9667 0.6878 5.7069 2.7512 1.7634 4.2285 6.7 4.7 3.2 5.2 3.9 3.0 5.7 4.4 3.1 4.6 3.2 6.7 4.6 3.6 5.7 4.1 3.0 4.1 2.8 5.0 3.9 2.7 13.3 7.2 4.3 12.1 9.0 6.1 4.1 6.6 4.8 3.5 7.4 5.4 3.7 5.9 3.9 9.0 5.8 4.4 7.6 5.1 3.6 5.5 3.6 7.0 5.0 3.4 17.8 9.6 5.6 14.9 2.4974 8.3 10.0 1.7031 5.8 6.8 3.9469 2.4190 1.7392 3.6536 10.9 7.6 5.2 10.0 13.1 8.9 6.1 12.1 2.0589 1.3309 6.7 4.2 7.8 4.9 2.5133 1.6868 1.1458 4.1023 1.9241 1.1906 4.2038 2.4168 1.6595 6.6 4.5 2.5 10.1 5.6 3.4 11.4 7.8 4.7 8.4 5.7 3.2 14.1 7.9 4.5 15.4 10.3 5.9 1.6308 0.9191 0.6679 5.2 3.8 2.8 6.9 4.9 3.6 24968 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued MS– DRG FY 2008 proposed rule postacute DRG FY 2008 proposed rule special pay DRG 435 ........ 436 ........ 437 ........ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. 438 439 440 441 442 443 444 445 446 453 454 455 456 ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ NO .............. NO .............. NO .............. YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO NO NO NO NO NO NO NO NO NO NO NO NO 457 ........ 458 ........ TYPE MS–DRG title 07 07 07 MED ........... MED ........... MED ........... .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 07 07 07 07 07 07 07 07 07 08 08 08 08 MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... SURG ......... SURG ......... SURG ......... SURG ......... NO .............. NO .............. 08 SURG ......... NO .............. NO .............. 08 SURG ......... 459 ........ 460 ........ 461 ........ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. 08 08 08 SURG ......... SURG ......... SURG ......... 462 ........ NO .............. NO .............. 08 SURG ......... 463 ........ YES ............ NO .............. 08 SURG ......... 464 ........ YES ............ NO .............. 08 SURG ......... 465 ........ YES ............ NO .............. 08 SURG ......... 466 467 468 469 YES YES YES YES NO NO NO NO 08 08 08 08 SURG SURG SURG SURG Malignancy of hepatobiliary system or pancreas w MCC ... Malignancy of hepatobiliary system or pancreas w CC ...... Malignancy of hepatobiliary system or pancreas w/o CC/ MCC. Disorders of pancreas except malignancy w MCC ............. Disorders of pancreas except malignancy w CC ................ Disorders of pancreas except malignancy w/o CC/MCC .... Disorders of liver except malig,cirr,alc hepa w MCC .......... Disorders of liver except malig,cirr,alc hepa w CC ............. Disorders of liver except malig,cirr,alc hepa w/o CC/MCC Disorders of the biliary tract w MCC ................................... Disorders of the biliary tract w CC ...................................... Disorders of the biliary tract w/o CC/MCC .......................... Combined anterior/posterior spinal fusion w MCC .............. Combined anterior/posterior spinal fusion w CC ................. Combined anterior/posterior spinal fusion w/o CC/MCC ..... Spinal fusion exc cerv w spinal curv, malig or 9+ fusions w MCC. Spinal fusion exc cerv w spinal curv, malig or 9+ fusions w CC. Spinal fusion exc cerv w spinal curv, malig or 9+ fusions w/o CC/MCC. Spinal fusion except cervical w MCC .................................. Spinal fusion except cervical w/o MCC ............................... Bilateral or multiple major joint procs of lower extremity w MCC. Bilateral or multiple major joint procs of lower extremity w/ o MCC. Wnd debrid & skn grft exc hand, for musculoconn tiss dis w MCC. Wnd debrid & skn grft exc hand, for musculoconn tiss dis w CC. Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w/o CC/MCC. Revision of hip or knee replacement w MCC ...................... Revision of hip or knee replacement w CC ......................... Revision of hip or knee replacement w/o CC/MCC ............ Major joint replacement or reattachment of lower extremity w MCC. Major joint replacement or reattachment of lower extremity w/o MCC. Cervical spinal fusion w MCC .............................................. Cervical spinal fusion w CC ................................................. Cervical spinal fusion w/o CC/MCC .................................... Amputation for musculoskeletal sys & conn tissue dis w MCC. Amputation for musculoskeletal sys & conn tissue dis w CC. Amputation for musculoskeletal sys & conn tissue dis w/o CC/MCC. Biopsies of musculoskeletal system & connective tissue w MCC. Biopsies of musculoskeletal system & connective tissue w CC. ........ ........ ........ ........ ............ ............ ............ ............ .............. .............. .............. .............. MDC ......... ......... ......... ......... YES ............ NO .............. 08 SURG ......... 471 472 473 474 ........ ........ ........ ........ NO .............. NO .............. NO .............. YES ............ NO NO NO NO .............. .............. .............. .............. 08 08 08 08 SURG SURG SURG SURG 475 ........ YES ............ NO .............. 08 SURG ......... 476 ........ YES ............ NO .............. 08 SURG ......... 477 ........ YES ............ YES ............ 08 SURG ......... 478 ........ mmaher on DSK3CLS3C1PROD with $$_JOB 470 ........ YES ............ YES ............ 08 SURG ......... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 ......... ......... ......... ......... Frm 00290 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC Geometric mean length of stay Arithmetic mean length of stay 1.7244 1.1881 0.9486 5.8 4.6 3.3 7.7 5.9 4.4 1.7775 1.0709 0.7280 1.5813 0.9918 0.7215 1.5675 1.0589 0.7631 10.1153 6.5111 4.8831 8.2061 5.7 4.3 3.2 5.2 4.1 3.1 5.2 3.9 2.7 12.7 7.0 4.2 12.2 7.8 5.5 3.9 7.1 5.2 3.9 6.7 4.9 3.3 15.9 8.7 4.9 15.7 5.5526 6.8 8.3 4.5646 4.2 4.8 5.8259 3.4246 4.4292 8.2 3.8 7.0 10.0 4.4 8.4 3.0007 3.9 4.3 Weights 03MYP2 4.6953 14.0 18.3 2.5929 8.4 11.0 1.5985 4.9 6.5 4.3570 2.9233 2.2405 3.2932 8.2 5.3 3.7 7.5 10.2 6.3 4.1 8.9 1.9422 3.8 4.0 4.3150 2.5303 1.8721 3.3888 7.0 2.9 1.6 10.6 10.1 4.4 2.0 13.5 1.9833 7.2 9.2 1.1111 4.0 5.2 3.3833 9.9 12.8 2.0553 4.9 7.0 24969 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued MS– DRG FY 2008 proposed rule postacute DRG FY 2008 proposed rule special pay DRG 479 ........ YES ............ YES ............ 480 481 482 483 ........ ........ ........ ........ YES ............ YES ............ YES ............ NO .............. YES ............ YES ............ YES ............ NO .............. 484 ........ NO .............. 485 486 487 488 489 490 NO NO NO NO NO NO ........ ........ ........ ........ ........ ........ .............. .............. .............. .............. .............. .............. MDC TYPE MS–DRG title 08 SURG ......... 08 08 08 08 SURG SURG SURG SURG NO .............. 08 SURG ......... NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. 08 08 08 08 08 08 SURG SURG SURG SURG SURG SURG Biopsies of musculoskeletal system & connective tissue w/ o CC/MCC. Hip & femur procedures except major joint w MCC ............ Hip & femur procedures except major joint w CC ............... Hip & femur procedures except major joint w/o CC/MCC .. Major joint & limb reattachment proc of upper extremity w CC/MCC. Major joint & limb reattachment proc of upper extremity w/ o CC/MCC. Knee procedures w pdx of infection w MCC ....................... Knee procedures w pdx of infection w CC .......................... Knee procedures w pdx of infection w/o CC/MCC .............. Knee procedures w/o pdx of infection w CC/MCC .............. Knee procedures w/o pdx of infection w/o CC/MCC ........... Back & neck procedures except spinal fusion w CC/MCC or disc devices. Back & neck procedures except spinal fusion w/o CC/ MCC. Lower extrem & humer proc except hip,foot,femur w MCC Lower extrem & humer proc except hip, foot, femur w CC Lower extrem & humer proc except hip, foot, femur w/o CC/MCC. Local excision & removal int fix devices exc hip & femur w MCC. Local excision & removal int fix devices exc hip & femur w CC. Local excision & removal int fix devices exc hip & femur w/o CC/MCC. Local excision & removal int fix devices of hip & femur w CC/MCC. Local excision & removal int fix devices of hip & femur w/o CC/MCC. Soft tissue procedures w MCC ............................................ Soft tissue procedures w CC ............................................... Soft tissue procedures w/o CC/MCC ................................... Foot procedures w MCC ...................................................... Foot procedures w CC ......................................................... Foot procedures w/o CC/MCC ............................................ Major thumb or joint procedures .......................................... Major shoulder or elbow joint procedures w CC/MCC ........ Major shoulder or elbow joint procedures w/o CC/MCC ..... Arthroscopy .......................................................................... Shoulder, elbow or forearm proc, exc major joint proc w MCC. Shoulder, elbow or forearm proc, exc major joint proc w CC. Shoulder, elbow or forearm proc, exc major joint proc w/o CC/MCC. Hand or wrist proc, except major thumb or joint proc w CC/MCC. Hand or wrist proc, except major thumb or joint proc w/o CC/MCC. Other musculoskelet sys & conn tiss O.R. proc w MCC .... Other musculoskelet sys & conn tiss O.R. proc w CC ....... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... NO .............. NO .............. 08 SURG ......... 492 ........ 493 ........ 494 ........ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ 08 08 08 SURG ......... SURG ......... SURG ......... 495 ........ YES ............ NO .............. 08 SURG ......... 496 ........ YES ............ NO .............. 08 SURG ......... 497 ........ YES ............ NO .............. 08 SURG ......... 498 ........ NO .............. NO .............. 08 SURG ......... 499 ........ NO .............. NO .............. 08 SURG ......... 500 501 502 503 504 505 506 507 508 509 510 ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. 08 08 08 08 08 08 08 08 08 08 08 SURG SURG SURG SURG SURG SURG SURG SURG SURG SURG SURG 511 ........ NO .............. NO .............. 08 SURG ......... 512 ........ NO .............. NO .............. 08 SURG ......... 513 ........ NO .............. NO .............. 08 SURG ......... 514 ........ NO .............. NO .............. 08 SURG ......... 515 ........ 516 ........ mmaher on DSK3CLS3C1PROD with $$_JOB 491 ........ YES ............ YES ............ YES ............ YES ............ 08 08 SURG ......... SURG ......... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... Frm 00291 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC Geometric mean length of stay Arithmetic mean length of stay 1.4543 1.9 2.9 2.8506 1.8267 1.4721 2.1725 8.2 5.7 4.6 3.6 9.7 6.3 5.0 4.6 1.6673 2.2 2.5 3.2946 2.1122 1.5140 1.6962 1.0796 1.6543 10.4 7.0 5.1 4.3 2.6 3.4 12.7 8.4 5.8 5.7 3.1 4.9 Weights 03MYP2 0.9538 1.8 2.3 2.7254 1.7402 1.2067 7.1 4.5 2.9 8.9 5.5 3.4 3.2333 9.0 11.7 1.7033 4.7 6.2 1.1384 2.4 3.3 2.0669 6.0 8.4 0.9152 2.4 3.3 3.0695 1.4828 0.9295 2.1343 1.4821 0.9794 0.9900 1.6307 1.0467 1.0441 2.0281 8.4 4.6 2.3 6.9 5.1 2.6 2.3 3.8 1.7 2.0 5.0 11.5 6.1 3.0 8.9 6.5 3.4 3.2 5.3 2.1 2.9 6.6 1.2889 3.1 3.9 0.9269 1.7 2.1 1.3544 3.7 5.1 0.8233 2.0 2.6 3.0667 1.8221 8.4 4.5 11.1 6.1 24970 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued MS– DRG FY 2008 proposed rule postacute DRG FY 2008 proposed rule special pay DRG 517 ........ YES ............ YES ............ 533 534 535 536 537 ........ ........ ........ ........ ........ YES ............ YES ............ YES ............ YES ............ NO .............. NO NO NO NO NO .............. .............. .............. .............. .............. 538 ........ NO .............. NO .............. 08 MED ........... 539 540 541 542 YES YES YES YES NO NO NO NO .............. .............. .............. .............. 08 08 08 08 MED MED MED MED ........ ........ ........ ........ ............ ............ ............ ............ MDC TYPE MS–DRG title 08 SURG ......... 08 08 08 08 08 MED MED MED MED MED Other musculoskelet sys & conn tiss O.R. proc w/o CC/ MCC. Fractures of femur w MCC .................................................. Fractures of femur w/o MCC ............................................... Fractures of hip & pelvis w MCC ......................................... Fractures of hip & pelvis w/o MCC ...................................... Sprains, strains, & dislocations of hip, pelvis & thigh w CC/MCC. Sprains, strains, & dislocations of hip, pelvis & thigh w/o CC/MCC. Osteomyelitis w MCC .......................................................... Osteomyelitis w CC ............................................................. Osteomyelitis w/o CC/MCC ................................................. Pathological fractures & musculoskelet & conn tiss malig w MCC. Pathological fractures & musculoskelet & conn tiss malig w CC. Pathological fractures & musculoskelet & conn tiss malig w/o CC/MCC. Connective tissue disorders w MCC ................................... Connective tissue disorders w CC ...................................... Connective tissue disorders w/o CC/MCC .......................... Septic arthritis w MCC ......................................................... Septic arthritis w CC ............................................................ Septic arthritis w/o CC/MCC ................................................ Medical back problems w MCC ........................................... Medical back problems w/o MCC ........................................ Bone diseases & arthropathies w MCC .............................. Bone diseases & arthropathies w/o MCC ........................... Signs & symptoms of musculoskeletal system & conn tissue w MCC. Signs & symptoms of musculoskeletal system & conn tissue w/o MCC. Tendonitis, myositis & bursitis w MCC ................................ Tendonitis, myositis & bursitis w/o MCC ............................. Aftercare, musculoskeletal system & connective tissue w MCC. Aftercare, musculoskeletal system & connective tissue w CC. Aftercare, musculoskeletal system & connective tissue w/o CC/MCC. Fx, sprn, strn & disl except femur, hip, pelvis & thigh w MCC. Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o MCC. Other musculoskeletal sys & connective tissue diagnoses w MCC. Other musculoskeletal sys & connective tissue diagnoses w CC. Other musculoskeletal sys & connective tissue diagnoses w/o CC/MCC. Skin graft &/or debrid for skn ulcer or cellulitis w MCC ...... Skin graft &/or debrid for skn ulcer or cellulitis w CC ......... Skin graft &/or debrid for skn ulcer or cellulitis w/o CC/ MCC. Skin graft &/or debrid exc for skin ulcer or cellulitis w MCC Skin graft &/or debrid exc for skin ulcer or cellulitis w CC .. Skin graft &/or debrid exc for skin ulcer or cellulitis w/o CC/MCC. Other skin, subcut tiss & breast proc w MCC ..................... Other skin, subcut tiss & breast proc w CC ........................ ........... ........... ........... ........... ........... ........... ........... ........... ........... YES ............ NO .............. 08 MED ........... 544 ........ YES ............ NO .............. 08 MED ........... 545 546 547 548 549 550 551 552 553 554 555 ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. YES ............ YES ............ NO .............. NO .............. NO .............. NO NO NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 08 08 08 08 08 08 08 08 08 08 08 MED MED MED MED MED MED MED MED MED MED MED 556 ........ NO .............. NO .............. 08 MED ........... 557 ........ 558 ........ 559 ........ YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. 08 08 08 MED ........... MED ........... MED ........... 560 ........ YES ............ NO .............. 08 MED ........... 561 ........ YES ............ NO .............. 08 MED ........... 562 ........ YES ............ NO .............. 08 MED ........... 563 ........ YES ............ NO .............. 08 MED ........... 564 ........ NO .............. NO .............. 08 MED ........... 565 ........ NO .............. NO .............. 08 MED ........... 566 ........ NO .............. NO .............. 08 MED ........... 573 ........ 574 ........ 575 ........ YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. 09 09 09 SURG ......... SURG ......... SURG ......... 576 ........ 577 ........ 578 ........ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. 09 09 09 SURG ......... SURG ......... SURG ......... 579 ........ 580 ........ mmaher on DSK3CLS3C1PROD with $$_JOB 543 ........ YES ............ YES ............ NO .............. NO .............. 09 09 SURG ......... SURG ......... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... PO 00000 Frm 00292 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC Geometric mean length of stay Arithmetic mean length of stay 1.3195 2.1 2.9 1.4317 0.6905 1.3683 0.6743 0.8451 5.5 3.4 5.1 3.5 3.9 7.2 4.2 6.6 4.1 4.7 0.5424 2.6 3.1 2.0095 1.3085 0.9229 1.8245 8.4 6.2 4.6 7.1 10.8 7.6 5.8 9.0 1.1004 5.0 6.2 0.7580 3.9 4.6 2.2353 1.0595 0.7387 1.8774 1.1402 0.7637 1.5024 0.7526 1.0922 0.6166 0.9488 6.7 4.4 3.2 7.2 5.2 3.7 5.8 3.5 4.8 3.0 3.6 9.2 5.6 4.0 9.5 6.4 4.6 7.5 4.2 6.1 3.7 4.9 0.5771 2.5 3.2 1.5172 0.7900 1.6221 5.7 3.6 5.6 7.2 4.3 7.7 0.9149 3.8 4.9 0.5701 2.2 2.8 1.3859 5.3 6.8 0.6597 3.2 3.8 1.4031 5.4 7.2 0.8829 4.0 5.1 Weights 03MYP2 0.6423 3.0 3.8 3.2955 1.9279 1.1628 11.3 7.9 5.0 14.9 10.1 6.2 3.2274 1.5681 0.9412 7.8 4.1 2.5 12.2 6.0 3.5 2.9032 1.6213 9.1 5.7 12.0 7.5 24971 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued MS– DRG FY 2008 proposed rule special pay DRG MDC TYPE ........ ........ ........ ........ YES ............ NO .............. NO .............. NO .............. NO NO NO NO .............. .............. .............. .............. 09 09 09 09 SURG SURG SURG SURG 585 ........ NO .............. NO .............. 09 SURG ......... 592 593 594 595 596 597 598 599 600 601 602 603 604 605 606 607 614 615 616 ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 09 09 09 09 09 09 09 09 09 09 09 09 09 09 09 09 10 10 10 MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... SURG ......... SURG ......... SURG ......... 617 ........ YES ............ NO .............. 10 SURG ......... 618 ........ YES ............ NO .............. 10 SURG ......... 619 620 621 622 ........ ........ ........ ........ NO .............. NO .............. NO .............. YES ............ NO NO NO NO .............. .............. .............. .............. 10 10 10 10 SURG SURG SURG SURG 623 ........ YES ............ NO .............. 10 SURG ......... 624 ........ YES ............ NO .............. 10 SURG ......... 625 ........ 626 ........ 627 ........ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. 10 10 10 SURG ......... SURG ......... SURG ......... 628 629 630 637 638 639 640 641 642 643 644 mmaher on DSK3CLS3C1PROD with $$_JOB 581 582 583 584 FY 2008 proposed rule postacute DRG YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ YES ............ NO .............. YES ............ YES ............ NO NO NO NO NO NO NO NO NO NO NO 10 10 10 10 10 10 10 10 10 10 10 SURG ......... SURG ......... SURG ......... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ VerDate Mar 15 2010 .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 ......... ......... ......... ......... ......... ......... ......... ......... MS–DRG title Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC Arithmetic mean length of stay 0.9588 0.9881 0.7441 1.2819 3.0 2.1 1.5 2.7 4.1 2.8 1.8 4.5 Weights Other skin, subcut tiss & breast proc w/o CC/MCC ............ Mastectomy for malignancy w CC/MCC .............................. Mastectomy for malignancy w/o CC/MCC ........................... Breast biopsy, local excision & other breast procedures w CC/MCC. Breast biopsy, local excision & other breast procedures w/ o CC/MCC. Skin ulcers w MCC .............................................................. Skin ulcers w CC ................................................................. Skin ulcers w/o CC/MCC ..................................................... Major skin disorders w MCC ............................................... Major skin disorders w/o MCC ............................................ Malignant breast disorders w MCC ..................................... Malignant breast disorders w CC ........................................ Malignant breast disorders w/o CC/MCC ............................ Non-malignant breast disorders w CC/MCC ....................... Non-malignant breast disorders w/o CC/MCC .................... Cellulitis w MCC ................................................................... Cellulitis w/o MCC ................................................................ Trauma to the skin, subcut tiss & breast w MCC ............... Trauma to the skin, subcut tiss & breast w/o MCC ............ Minor skin disorders w MCC ............................................... Minor skin disorders w/o MCC ............................................ Adrenal & pituitary procedures w CC/MCC ......................... Adrenal & pituitary procedures w/o CC/MCC ...................... Amputat of lower limb for endocrine, nutrit, & metabol dis w MCC. Amputat of lower limb for endocrine, nutrit, & metabol dis w CC. Amputat of lower limb for endocrine, nutrit, & metabol dis w/o CC/MCC. O.R. procedures for obesity w MCC ................................... O.R. procedures for obesity w CC ...................................... O.R. procedures for obesity w/o CC/MCC .......................... Skin grafts & wound debrid for endoc, nutrit & metab dis w MCC. Skin grafts & wound debrid for endoc, nutrit & metab dis w CC. Skin grafts & wound debrid for endoc, nutrit & metab dis w/o CC/MCC. Thyroid, parathyroid & thyroglossal procedures w MCC ..... Thyroid, parathyroid & thyroglossal procedures w CC ........ Thyroid, parathyroid & thyroglossal procedures w/o CC/ MCC. Other endocrine, nutrit & metab O.R. proc w MCC ............ Other endocrine, nutrit & metab O.R. proc w CC ............... Other endocrine, nutrit & metab O.R. proc w/o CC/MCC ... Diabetes w MCC .................................................................. Diabetes w CC ..................................................................... Diabetes w/o CC/MCC ......................................................... Nutritional & misc metabolic disorders w MCC ................... Nutritional & misc metabolic disorders w/o MCC ................ Inborn errors of metabolism ................................................. Endocrine disorders w MCC ................................................ Endocrine disorders w CC ................................................... Frm 00293 Geometric mean length of stay 03MYP2 0.7975 1.5 1.9 1.7628 1.0687 0.7221 1.7504 0.8037 1.6544 1.0084 0.6089 0.9421 0.6207 1.3689 0.7698 1.1521 0.6584 1.0928 0.6163 2.4677 1.3907 3.9552 7.1 5.5 4.1 6.1 3.8 5.9 4.3 2.6 4.2 3.1 5.7 4.0 4.2 2.8 4.2 2.9 5.3 2.8 13.8 9.3 6.7 5.0 8.3 4.8 8.1 5.6 3.6 5.4 3.8 7.2 4.8 5.4 3.5 5.9 3.8 7.4 3.4 16.6 2.0973 7.7 9.4 1.3024 5.4 6.7 3.7048 2.0768 1.5791 3.2426 6.4 3.4 2.1 10.8 9.3 4.3 2.4 14.2 1.8784 7.3 9.2 1.1114 4.8 6.1 2.2742 1.1509 0.7404 5.0 2.2 1.3 7.5 3.3 1.6 3.3711 2.2663 1.5036 1.3914 0.8349 0.5768 1.1366 0.6856 1.0612 1.6611 1.0256 8.0 7.4 4.0 4.8 3.5 2.5 4.2 3.1 3.8 6.2 4.5 12.0 9.2 5.5 6.3 4.5 3.1 5.7 3.9 5.2 8.0 5.5 24972 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued MS– DRG FY 2008 proposed rule postacute DRG FY 2008 proposed rule special pay DRG MDC TYPE MS–DRG title Endocrine disorders w/o CC/MCC ....................................... Kidney transplant ................................................................. Major bladder procedures w MCC ....................................... Major bladder procedures w CC .......................................... Major bladder procedures w/o CC/MCC ............................. Kidney & ureter procedures for neoplasm w MCC ............. Kidney & ureter procedures forneoplasm w CC .................. Kidney & ureter procedures for neoplasm w/o CC/MCC .... Kidney & ureter procedures for non-neoplasm w MCC ...... Kidney & ureter procedures for non-neoplasm w CC ......... Kidney & ureter procedures for non-neoplasm w/o CC/ MCC. Minor bladder procedures w MCC ....................................... Minor bladder procedures w CC .......................................... Minor bladder procedures w/o CC/MCC ............................. Prostatectomy w MCC ......................................................... Prostatectomy w CC ............................................................ Prostatectomy w/o CC/MCC ................................................ Transurethral procedures w MCC ....................................... Transurethral procedures w CC .......................................... Transurethral procedures w/o CC/MCC .............................. Urethral procedures w CC/MCC .......................................... Urethral procedures w/o CC/MCC ....................................... Other kidney & urinary tract procedures w MCC ................ Other kidney & urinary tract procedures w CC ................... Other kidney & urinary tract procedures w/o CC/MCC ....... Renal failure w MCC ............................................................ Renal failure w CC ............................................................... Renal failure w/o CC/MCC .................................................. Admit for renal dialysis ........................................................ Kidney & urinary tract neoplasms w MCC .......................... Kidney & urinary tract neoplasms w CC ............................. Kidney & urinary tract neoplasms w/o CC/MCC ................. Kidney & urinary tract infections w MCC ............................. Kidney & urinary tract infections w/o MCC .......................... Urinary stones w esw lithotripsy w CC/MCC ....................... Urinary stones w esw lithotripsy w/o CC/MCC .................... Urinary stones w/o esw lithotripsy w MCC .......................... Urinary stones w/o esw lithotripsy w/o MCC ....................... Kidney & urinary tract signs & symptoms w MCC .............. Kidney & urinary tract signs & symptoms w/o MCC ........... Urethral stricture .................................................................. Other kidney & urinary tract diagnoses w MCC .................. Other kidney & urinary tract diagnoses w CC ..................... Other kidney & urinary tract diagnoses w/o CC/MCC ......... Major male pelvic procedures w CC/MCC .......................... Major male pelvic procedures w/o CC/MCC ....................... Penis procedures w CC/MCC .............................................. Penis procedures w/o CC/MCC ........................................... Testes procedures w CC/MCC ............................................ Testes procedures w/o CC/MCC ......................................... Transurethral prostatectomy w CC/MCC ............................. ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ YES ............ NO .............. YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. YES ............ YES ............ YES ............ NO NO NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 10 11 11 11 11 11 11 11 11 11 11 MED ........... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... 662 663 664 665 666 667 668 669 670 671 672 673 674 675 682 683 684 685 686 687 688 689 690 691 692 693 694 695 696 697 698 699 700 707 708 709 710 711 712 713 mmaher on DSK3CLS3C1PROD with $$_JOB 645 652 653 654 655 656 657 658 659 660 661 ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 12 12 12 12 12 12 12 SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00294 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC Geometric mean length of stay Arithmetic mean length of stay 0.7361 2.9875 5.6554 2.9409 1.9932 3.3280 1.8514 1.3628 3.2759 1.8525 1.2497 3.2 6.7 14.1 9.0 6.0 8.4 5.2 3.4 8.5 5.0 2.8 3.9 7.9 17.5 10.3 6.7 10.8 6.2 3.9 11.6 6.7 3.6 2.5929 1.3800 0.9462 2.8312 1.5177 0.8075 2.1963 1.1980 0.7731 1.4041 0.7515 2.8645 2.1903 1.3402 1.6772 1.1655 0.7764 0.8496 1.7101 1.0483 0.7032 1.2389 0.7621 1.4666 1.0647 1.2714 0.6729 1.1689 0.6054 0.7231 1.4706 0.9845 0.7059 1.7114 1.1515 1.9087 1.2258 1.9149 0.8141 1.1007 7.3 3.6 1.7 9.3 4.2 2.1 6.3 3.1 1.9 4.0 1.9 6.0 4.5 1.7 5.5 4.8 3.3 2.4 6.0 4.0 2.6 5.2 3.6 3.0 1.8 3.9 2.0 4.3 2.6 2.4 5.3 4.0 2.9 3.8 2.1 3.8 1.5 5.4 2.2 2.9 10.5 5.2 2.2 12.2 6.4 2.9 8.6 4.4 2.6 5.8 2.6 10.1 7.3 2.6 7.4 6.0 4.1 3.5 8.1 5.3 3.3 6.6 4.4 4.2 2.3 5.2 2.6 5.7 3.2 3.3 6.9 5.1 3.6 4.9 2.4 6.7 1.9 8.0 3.0 4.1 Weights 03MYP2 24973 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued MS– DRG FY 2008 proposed rule postacute DRG FY 2008 proposed rule special pay DRG 714 ........ 715 ........ NO .............. NO .............. NO .............. NO .............. 716 ........ NO .............. 717 ........ 718 ........ 722 723 724 725 726 727 728 729 730 734 ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ TYPE MS–DRG title 12 12 SURG ......... SURG ......... NO .............. 12 SURG ......... NO .............. NO .............. 12 SURG ......... NO .............. NO .............. 12 SURG ......... NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 12 12 12 12 12 12 12 12 12 13 MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... SURG ......... Transurethral prostatectomy w/o CC/MCC .......................... Other male reproductive system O.R. proc for malignancy w CC/MCC. Other male reproductive system O.R. proc for malignancy w/o CC/MCC. Other male reproductive system O.R. proc exc malignancy w CC/MCC. Other male reproductive system O.R. proc exc malignancy w/o CC/MCC. Malignancy, male reproductive system w MCC .................. Malignancy, male reproductive system w CC ..................... Malignancy, male reproductive system w/o CC/MCC ......... Benign prostatic hypertrophy w MCC .................................. Benign prostatic hypertrophy w/o MCC ............................... Inflammation of the male reproductive system w MCC ...... Inflammation of the male reproductive system w/o MCC ... Other male reproductive system diagnoses w CC/MCC ..... Other male reproductive system diagnoses w/o CC/MCC .. Pelvic evisceration, rad hysterectomy & rad vulvectomy w CC/MCC. Pelvic evisceration, rad hysterectomy & rad vulvectomy w/ o CC/MCC. Uterine & adnexa proc for ovarian or adnexal malignancy w MCC. Uterine & adnexa proc for ovarian or adnexal malignancy w CC. Uterine & adnexa proc for ovarian or adnexal malignancy w/o CC/MCC. Uterine, adnexa proc for non-ovarian/adnexal malig w MCC. Uterine, adnexa proc for non-ovarian/adnexal malig w CC Uterine, adnexa proc for non-ovarian/adnexal malig w/o CC/MCC. Uterine & adnexa proc for non-malignancy w CC/MCC ..... Uterine & adnexa proc for non-malignancy w/o CC/MCC .. D&C, conization, laparascopy & tubal interruption w CC/ MCC. D&C, conization, laparascopy & tubal interruption w/o CC/ MCC. Vagina, cervix & vulva procedures w CC/MCC ................... Vagina, cervix & vulva procedures w/o CC/MCC ................ Female reproductive system reconstructive procedures ..... Other female reproductive system O.R. procedures w CC/ MCC. Other female reproductive system O.R. procedures w/o CC/MCC. Malignancy, female reproductive system w MCC ............... Malignancy, female reproductive system w CC .................. Malignancy, female reproductive system w/o CC/MCC ...... Infections, female reproductive system w MCC .................. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. MDC 735 ........ NO .............. NO .............. 13 SURG ......... 736 ........ NO .............. NO .............. 13 SURG ......... 737 ........ NO .............. NO .............. 13 SURG ......... 738 ........ NO .............. NO .............. 13 SURG ......... 739 ........ NO .............. NO .............. 13 SURG ......... 740 ........ 741 ........ NO .............. NO .............. NO .............. NO .............. 13 13 SURG ......... SURG ......... 742 ........ 743 ........ 744 ........ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. 13 13 13 SURG ......... SURG ......... SURG ......... 745 ........ NO .............. NO .............. 13 SURG ......... 746 747 748 749 NO NO NO NO NO NO NO NO .............. .............. .............. .............. 13 13 13 13 SURG SURG SURG SURG ........ ........ ........ ........ .............. .............. .............. .............. ......... ......... ......... ......... NO .............. NO .............. 13 SURG ......... 754 755 756 757 mmaher on DSK3CLS3C1PROD with $$_JOB 750 ........ NO NO NO NO NO NO NO NO 13 13 13 13 MED MED MED MED ........ ........ ........ ........ VerDate Mar 15 2010 .............. .............. .............. .............. .............. .............. .............. .............. 02:00 Aug 26, 2011 Jkt 223001 ........... ........... ........... ........... PO 00000 Frm 00295 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC Geometric mean length of stay Arithmetic mean length of stay 0.6342 1.8234 1.7 3.9 2.0 6.2 1.0017 1.3 1.5 1.8454 5.2 7.7 0.7902 2.1 2.8 1.4829 1.0428 0.6146 1.0622 0.6648 1.2681 0.6875 1.0808 0.5860 2.2946 5.6 4.2 2.5 4.3 2.8 5.1 3.3 3.8 2.5 5.9 7.5 5.5 3.4 5.6 3.5 6.6 4.1 5.2 3.3 7.7 1.0226 3.0 3.5 4.1656 11.6 13.9 1.9738 6.3 7.4 1.1607 3.6 4.0 2.8464 7.9 10.2 1.3873 0.9624 4.4 2.8 5.2 3.2 1.3758 0.8461 1.4153 3.6 2.1 4.1 4.7 2.4 5.9 0.7416 2.1 2.6 1.2205 0.8192 0.7966 2.5201 3.0 1.7 1.5 7.1 4.2 1.9 1.8 9.9 0.9713 2.6 3.3 1.8553 1.0847 0.6339 1.6992 6.4 4.2 2.5 6.8 8.9 5.7 3.3 8.9 Weights 03MYP2 24974 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued MS– DRG FY 2008 proposed rule postacute DRG FY 2008 proposed rule special pay DRG 758 ........ 759 ........ 760 ........ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. 761 ........ NO .............. 765 766 767 768 769 770 774 775 776 777 778 779 780 781 782 789 790 ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 791 792 793 794 795 799 800 801 802 ........ ........ ........ ........ ........ ........ ........ ........ ........ NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. MDC TYPE MS–DRG title 13 13 13 MED ........... MED ........... MED ........... NO .............. 13 MED ........... NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 15 15 SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. 15 15 15 15 15 16 16 16 16 MED ........... MED ........... MED ........... MED ........... MED ........... SURG ......... SURG ......... SURG ......... SURG ......... Infections, female reproductive system w CC ..................... Infections, female reproductive system w/o CC/MCC ......... Menstrual & other female reproductive system disorders w CC/MCC. Menstrual & other female reproductive system disorders w/o CC/MCC. Cesarean section w CC/MCC .............................................. Cesarean section w/o CC/MCC ........................................... Vaginal delivery w sterilization &/or D&C ............................ Vaginal delivery w O.R. proc except steril &/or D&C .......... Postpartum & post abortion diagnoses w O.R. procedure .. Abortion w D&C, aspiration curettage or hysterotomy ........ Vaginal delivery w complicating diagnoses ......................... Vaginal delivery w/o complicating diagnoses ...................... Postpartum & post abortion diagnoses w/o O.R. procedure Ectopic pregnancy ............................................................... Threatened abortion ............................................................. Abortion w/o D&C ................................................................ False labor ........................................................................... Other antepartum diagnoses w medical complications ....... Other antepartum diagnoses w/o medical complications .... Neonates, died or transferred to another acute care facility Extreme immaturity or respiratory distress syndrome, neonate. Prematurity w major problems ............................................. Prematurity w/o major problems .......................................... Full term neonate w major problems ................................... Neonate w other significant problems ................................. Normal newborn ................................................................... Splenectomy w MCC ........................................................... Splenectomy w CC .............................................................. Splenectomy w/o CC/MCC .................................................. Other O.R. proc of the blood & blood forming organs w MCC. Other O.R. proc of the blood & blood forming organs w CC. Other O.R. proc of the blood & blood forming organs w/o CC/MCC. Major hematol/immun diag exc sickle cell crisis & coagul w MCC. Major hematol/immun diag exc sickle cell crisis & coagul w CC. Major hematol/immun diag exc sickle cell crisis & coagul w/o CC/MCC. Red blood cell disorders w MCC ......................................... Red blood cell disorders w/o MCC ...................................... Coagulation disorders .......................................................... Reticuloendothelial & immunity disorders w MCC .............. Reticuloendothelial & immunity disorders w CC ................. Reticuloendothelial & immunity disorders w/o CC/MCC ..... Lymphoma & leukemia w major O.R. procedure w MCC ... Lymphoma & leukemia w major O.R. procedure w CC ...... NO .............. NO .............. 16 SURG ......... 804 ........ NO .............. NO .............. 16 SURG ......... 808 ........ YES ............ NO .............. 16 MED ........... 809 ........ YES ............ NO .............. 16 MED ........... 810 ........ YES ............ NO .............. 16 MED ........... 811 812 813 814 815 816 820 821 mmaher on DSK3CLS3C1PROD with $$_JOB 803 ........ NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO 16 16 16 16 16 16 17 17 MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... SURG ......... SURG ......... ........ ........ ........ ........ ........ ........ ........ ........ VerDate Mar 15 2010 .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00296 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC Geometric mean length of stay Arithmetic mean length of stay 1.0758 0.7668 0.7794 4.9 3.8 3.0 6.2 4.6 3.8 0.5041 2.0 2.5 0.9644 0.6422 0.6419 1.6334 1.9655 0.7598 0.5412 0.3953 0.6480 0.7237 0.3775 0.6006 0.2935 0.5771 0.4359 1.4246 4.6977 4.1 3.0 2.5 4.7 3.3 1.6 2.6 2.1 2.6 1.8 2.0 1.7 1.3 2.7 1.7 * * 5.3 3.2 2.9 5.8 5.7 2.7 3.2 2.3 3.6 2.1 2.8 2.6 2.7 3.8 2.8 * * 3.2084 1.9359 3.2957 1.1665 0.1579 4.8444 2.5219 1.6365 3.6564 * * * * * 10.8 6.5 3.8 9.2 * * * * * 14.3 8.4 4.9 12.8 1.6759 4.8 6.6 0.9952 2.4 3.3 1.9239 6.2 8.1 1.0868 4.0 5.1 0.8426 3.1 4.0 1.1761 0.7332 1.3307 1.5585 0.9778 0.7021 5.6599 2.2223 4.0 2.8 3.8 5.4 3.9 2.7 13.8 5.4 5.6 3.7 5.2 7.2 4.9 3.4 18.4 7.8 Weights 03MYP2 24975 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued MS– DRG FY 2008 proposed rule postacute DRG FY 2008 proposed rule special pay DRG 822 ........ NO .............. NO .............. 823 ........ NO .............. NO .............. 824 ........ 825 ........ NO .............. NO .............. 826 ........ TYPE MS–DRG title 17 SURG ......... 17 SURG ......... NO .............. NO .............. 17 17 SURG ......... SURG ......... NO .............. NO .............. 17 SURG ......... 827 ........ NO .............. NO .............. 17 SURG ......... 828 ........ NO .............. NO .............. 17 SURG ......... 829 ........ NO .............. NO .............. 17 SURG ......... 830 ........ NO .............. NO .............. 17 SURG ......... 834 835 836 837 NO NO NO NO NO NO NO NO .............. .............. .............. .............. 17 17 17 17 MED MED MED MED Lymphoma & leukemia w major O.R. procedure w/o CC/ MCC. Lymphoma & non-acute leukemia w other O.R. proc w MCC. Lymphoma & non-acute leukemia w other O.R. proc w CC Lymphoma & non-acute leukemia w other O.R. proc w/o CC/MCC. Myeloprolif disord or poorly diff neopl w maj O.R. proc w MCC. Myeloprolif disord or poorly diff neopl w maj O.R. proc w CC. Myeloprolif disord or poorly diff neopl w maj O.R. proc w/o CC/MCC. Myeloprolif disord or poorly diff neopl w other O.R. proc w CC/MCC. Myeloprolif disord or poorly diff neopl w other O.R. proc w/ o CC/MCC. Acute leukemia w/o major O.R. procedure w MCC ............ Acute leukemia w/o major O.R. procedure w CC ............... Acute leukemia w/o major O.R. procedure w/o CC/MCC ... Chemo w acute leukemia as sdx or w high dose chemo agent w MCC. Chemo w acute leukemia as sdx or w high dose chemo agent w CC. Chemo w acute leukemia as sdx or w high dose chemo agent w/o CC/MCC. Lymphoma & non-acute leukemia w MCC .......................... Lymphoma & non-acute leukemia w CC ............................. Lymphoma & non-acute leukemia w/o CC/MCC ................. Other myeloprolif dis or poorly diff neopl diag w MCC ....... Other myeloprolif dis or poorly diff neopl diag w CC .......... Other myeloprolif dis or poorly diff neopl diag w/o CC/ MCC. Chemotherapy w/o acute leukemia as secondary diagnosis w MCC. Chemotherapy w/o acute leukemia as secondary diagnosis w CC. Chemotherapy w/o acute leukemia as secondary diagnosis w/o CC/MCC. Radiotherapy ........................................................................ Infectious & parasitic diseases w O.R. procedure w MCC Infectious & parasitic diseases w O.R. procedure w CC .... Infectious & parasitic diseases w O.R. procedure w/o CC/ MCC. Postoperative or post-traumatic infections w O.R. proc w MCC. Postoperative or post-traumatic infections w O.R. proc w CC. Postoperative or post-traumatic infections w O.R. proc w/o CC/MCC. Postoperative & post-traumatic infections w MCC .............. Postoperative & post-traumatic infections w/o MCC ........... Fever of unknown origin ...................................................... Viral illness w MCC .............................................................. Viral illness w/o MCC ........................................................... ........ ........ ........ ........ .............. .............. .............. .............. MDC ........... ........... ........... ........... NO .............. NO .............. 17 MED ........... 839 ........ NO .............. NO .............. 17 MED ........... 840 841 842 843 844 845 ........ ........ ........ ........ ........ ........ YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. 17 17 17 17 17 17 MED MED MED MED MED MED 846 ........ NO .............. NO .............. 17 MED ........... 847 ........ NO .............. NO .............. 17 MED ........... 848 ........ NO .............. NO .............. 17 MED ........... 849 853 854 855 ........ ........ ........ ........ NO .............. YES ............ YES ............ YES ............ NO NO NO NO .............. .............. .............. .............. 17 18 18 18 MED ........... SURG ......... SURG ......... SURG ......... 856 ........ YES ............ NO .............. 18 SURG ......... 857 ........ YES ............ NO .............. 18 SURG ......... 858 ........ YES ............ NO .............. 18 SURG ......... 862 863 864 865 866 mmaher on DSK3CLS3C1PROD with $$_JOB 838 ........ YES ............ YES ............ NO .............. NO .............. NO .............. NO NO NO NO NO 18 18 18 18 18 MED MED MED MED MED ........ ........ ........ ........ ........ VerDate Mar 15 2010 .............. .............. .............. .............. .............. 02:00 Aug 26, 2011 Jkt 223001 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... PO 00000 Frm 00297 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC Weights 03MYP2 Geometric mean length of stay Arithmetic mean length of stay 1.2363 2.7 3.7 4.0550 12.1 15.4 2.1337 1.3321 6.6 3.3 8.9 4.8 5.0473 13.2 17.4 2.0842 5.8 7.6 1.2241 3.0 3.8 2.6852 6.9 10.5 1.0340 2.5 3.7 3.9520 1.8790 1.1326 5.7668 9.2 5.4 3.4 17.2 15.0 8.4 5.1 22.7 2.3625 6.3 9.2 1.2331 4.8 6.0 2.3808 1.4326 0.9558 1.9072 1.1252 0.8433 7.1 5.1 3.3 6.3 4.5 3.3 9.8 6.7 4.3 8.8 6.0 4.3 2.1956 5.8 8.5 0.9758 2.7 3.3 0.7495 2.3 2.9 1.2491 5.4321 2.9346 1.8472 4.3 13.4 9.5 5.8 6.0 17.4 11.5 7.6 4.9141 13.4 17.4 2.0895 7.3 9.3 1.3418 5.0 6.3 1.8740 0.9224 0.8171 1.5687 0.6691 6.6 4.4 3.2 4.9 2.8 8.6 5.4 4.1 6.8 3.5 24976 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued MS– DRG FY 2008 proposed rule postacute DRG FY 2008 proposed rule special pay DRG 867 ........ 868 ........ 869 ........ YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. 870 871 872 876 880 881 882 883 884 885 886 887 894 895 ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. NO NO NO NO NO NO NO NO NO NO NO NO NO NO 896 ........ 897 ........ 901 902 903 904 905 906 907 908 909 913 914 915 916 917 918 919 920 921 922 923 927 MS–DRG title 18 18 18 MED ........... MED ........... MED ........... .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 18 18 18 19 19 19 19 19 19 19 19 19 20 20 MED ........... MED ........... MED ........... SURG ......... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... YES ............ NO .............. 20 MED ........... YES ............ NO .............. 20 MED ........... ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 22 SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... SURG ......... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... SURG ......... 928 ........ 929 ........ 933 ........ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. 22 22 22 SURG ......... SURG ......... MED ........... 934 ........ 935 ........ 939 ........ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. 22 22 23 MED ........... MED ........... SURG ......... 940 ........ mmaher on DSK3CLS3C1PROD with $$_JOB TYPE NO .............. NO .............. 23 SURG ......... Other infectious & parasitic diseases diagnoses w MCC ... Other infectious & parasitic diseases diagnoses w CC ...... Other infectious & parasitic diseases diagnoses w/o CC/ MCC. Septicemia w MV 96+ hours ............................................... Septicemia w/o MV 96+ hours w MCC ............................... Septicemia w/o MV 96+ hours w/o MCC ............................ O.R. procedure w principal diagnoses of mental illness ..... Acute adjustment reaction & psychosocial dysfunction ...... Depressive neuroses ........................................................... Neuroses except depressive ............................................... Disorders of personality & impulse control .......................... Organic disturbances & mental retardation ......................... Psychoses ............................................................................ Behavioral & developmental disorders ................................ Other mental disorder diagnoses ........................................ Alcohol/drug abuse or dependence, left ama ...................... Alcohol/drug abuse or dependence w rehabilitation therapy. Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC. Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC. Wound debridements for injuries w MCC ............................ Wound debridements for injuries w CC ............................... Wound debridements for injuries w/o CC/MCC .................. Skin grafts for injuries w CC/MCC ....................................... Skin grafts for injuries w/o CC/MCC .................................... Hand procedures for injuries ............................................... Other O.R. procedures for injuries w MCC ......................... Other O.R. procedures for injuries w CC ............................ Other O.R. procedures for injuries w/o CC/MCC ................ Traumatic injury w MCC ...................................................... Traumatic injury w/o MCC ................................................... Allergic reactions w MCC .................................................... Allergic reactions w/o MCC ................................................. Poisoning & toxic effects of drugs w MCC .......................... Poisoning & toxic effects of drugs w/o MCC ....................... Complications of treatment w MCC ..................................... Complications of treatment w CC ........................................ Complications of treatment w/o CC/MCC ............................ Other injury, poisoning & toxic effect diag w MCC ............. Other injury, poisoning & toxic effect diag w/o MCC .......... Extensive burns or full thickness burns w MV 96+ hrs w skin graft. Full thickness burn w skin graft or inhal inj w CC/MCC ...... Full thickness burn w skin graft or inhal inj w/o CC/MCC ... Extensive burns or full thickness burns w MV 96+ hrs w/o skin graft. Full thickness burn w/o skin grft or inhal inj ........................ Non-extensive burns ............................................................ O.R. proc w diagnoses of other contact w health services w MCC. O.R. proc w diagnoses of other contact w health services w CC. VerDate Mar 15 2010 02:00 Aug 26, 2011 MDC Jkt 223001 PO 00000 Frm 00298 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC Geometric mean length of stay Arithmetic mean length of stay 2.5039 1.1589 0.8295 7.5 4.7 3.6 10.2 6.1 4.4 5.8269 1.8811 1.1304 2.4818 0.6104 0.5320 0.5791 0.8908 0.8407 0.8183 0.7095 0.8075 0.3712 .7771 13.0 5.8 4.8 6.8 2.4 3.1 3.1 4.6 4.2 5.6 4.0 3.1 2.1 8.2 15.7 7.8 5.9 11.2 3.2 4.2 4.5 7.4 5.5 7.6 5.9 4.6 2.9 10.5 1.2975 5.0 6.8 0.5935 3.3 4.1 3.6765 1.7433 1.0239 2.9545 1.0711 0.9899 3.6201 1.8922 1.1253 1.3122 0.6590 1.1882 0.4531 1.4901 0.5940 1.4806 0.9200 0.6150 1.4653 0.6493 12.7968 9.3 5.7 3.5 7.3 3.6 2.2 8.4 5.3 2.8 4.5 2.7 3.3 1.7 3.9 2.1 4.5 3.4 2.4 4.2 2.4 23.1 14.5 8.0 4.9 12.4 4.8 3.3 12.0 7.2 3.7 6.1 3.4 4.6 2.1 5.4 2.7 6.3 4.5 3.0 6.1 3.3 29.0 4.7844 1.8538 2.6367 12.2 5.6 2.7 16.2 7.8 5.9 1.3929 1.2000 2.6958 4.8 3.7 7.5 7.0 5.6 11.0 1.7409 4.5 6.5 Weights 03MYP2 24977 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 5.—LIST OF PROPOSED MEDICARE SEVERITY-DIAGNOSIS RELATED GROUPS (MS–DRGS), RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY—Continued MS– DRG FY 2008 proposed rule postacute DRG FY 2008 proposed rule special pay DRG 941 ........ NO .............. NO .............. 945 946 947 948 949 950 951 955 956 ........ ........ ........ ........ ........ ........ ........ ........ ........ YES ............ YES ............ YES ............ YES ............ NO .............. NO .............. NO .............. NO .............. YES ............ NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ 957 ........ NO .............. 958 ........ NO .............. 959 ........ 963 964 965 969 970 974 975 976 977 981 ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ MDC TYPE MS–DRG title 23 SURG ......... 23 23 23 23 23 23 23 24 24 MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... MED ........... SURG ......... SURG ......... NO .............. 24 SURG ......... NO .............. 24 SURG ......... NO .............. NO .............. 24 SURG ......... NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. NO .............. YES ............ NO NO NO NO NO NO NO NO NO NO .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. 24 24 24 25 25 25 25 25 25 .......... MED ........... MED ........... MED ........... SURG ......... SURG ......... MED ........... MED ........... MED ........... MED ........... SURG ......... 982 ........ YES ............ NO .............. .......... SURG ......... 983 ........ YES ............ NO .............. .......... SURG ......... 984 ........ NO .............. NO .............. .......... SURG ......... 985 ........ NO .............. NO .............. .......... SURG ......... 986 ........ NO .............. NO .............. .......... SURG ......... 987 ........ YES ............ NO .............. .......... SURG ......... 988 ........ YES ............ NO .............. .......... SURG ......... 989 ........ YES ............ NO .............. .......... SURG ......... 998 ........ 999 ........ NO .............. NO .............. NO .............. NO .............. .......... .......... ** ................ ** ................ O.R. proc w diagnoses of other contact w health services w/o CC/MCC. Rehabilitation w CC/MCC .................................................... Rehabilitation w/o CC/MCC ................................................. Signs & symptoms w MCC .................................................. Signs & symptoms w/o MCC ............................................... Aftercare w CC/MCC ........................................................... Aftercare w/o CC/MCC ........................................................ Other factors influencing health status ................................ Craniotomy for multiple significant trauma .......................... Limb reattachment, hip & femur proc for multiple significant trauma. Other O.R. procedures for multiple significant trauma w MCC. Other O.R. procedures for multiple significant trauma w CC. Other O.R. procedures for multiple significant trauma w/o CC/MCC. Other multiple significant trauma w MCC ............................ Other multiple significant trauma w CC ............................... Other multiple significant trauma w/o CC/MCC ................... HIV w extensive O.R. procedure w MCC ............................ HIV w extensive O.R. procedure w/o MCC ......................... HIV w major related condition w MCC ................................ HIV w major related condition w CC ................................... HIV w major related condition w/o CC/MCC ....................... HIV w or w/o other related condition ................................... Extensive O.R. procedure unrelated to principal diagnosis w MCC. Extensive O.R. procedure unrelated to principal diagnosis w CC. Extensive O.R. procedure unrelated to principal diagnosis w/o CC/MCC. Prostatic O.R. procedure unrelated to principal diagnosis w MCC. Prostatic O.R. procedure unrelated to principal diagnosis w CC. Prostatic O.R. procedure unrelated to principal diagnosis w/o CC/MCC. Non-extensive O.R. proc unrelated to principal diagnosis w MCC. Non-extensive O.R. proc unrelated to principal diagnosis w CC. Non-extensive O.R. proc unrelated to principal diagnosis w/o CC/MCC. Principal diagnosis invalid as discharge diagnosis ............. Ungroupable ......................................................................... Geometric mean length of stay Weights Arithmetic mean length of stay 1.0979 2.4 3.1 1.1456 0.9009 1.0303 0.6298 0.7746 0.5018 0.6104 5.1127 3.3955 9.3 7.3 3.9 2.8 2.5 2.4 2.1 8.6 7.9 11.1 8.1 5.1 3.4 4.2 3.4 3.7 12.3 9.7 6.8026 11.6 16.9 4.3582 8.8 11.6 3.1511 5.8 7.8 2.7874 1.6288 1.2426 5.6577 3.0430 2.2553 1.5844 1.0710 1.0477 5.0683 6.7 5.5 3.8 13.6 8.2 6.5 5.8 4.2 3.8 12.5 9.6 6.9 4.7 19.0 11.8 9.4 8.0 5.6 5.2 15.8 3.1457 8.2 10.3 2.0435 4.1 5.6 3.3812 11.8 14.6 2.1002 7.5 9.9 1.2417 3.6 5.2 3.5163 10.4 13.6 1.8823 6.1 8.1 1.1151 3.0 4.3 0.0000 0.0000 0.0 0.0 0.0 0.0 MS–DRGs 998 and 999 contain cases that could not be assigned to valid DRGs. Note: If there is no value or asterisk in either the geometric mean length of stay or the arithmetic mean length of stay columns, the volume of cases is insufficient to determine a meaningful computation of these statistics. TABLE 6A.—NEW DIAGNOSIS CODES Description 040.41 ........ Infant botulism ....................................................................................................................................................... 040.42 ........ Wound botulism .................................................................................................................................................... 058.10 ........ Roseola infantum, unspecified .............................................................................................................................. Y CC Y CC N 058.11 ........ Roseola infantum due to human herpes virus 6 .................................................................................................. N 058.12 ........ mmaher on DSK3CLS3C1PROD with $$_JOB Diagnosis code Roseola infantum due to human herpes virus 7 .................................................................................................. N VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00299 Fmt 4742 CC Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 MDC MS–DRG 15 18 18 791 1, 793 1 867, 868, 869 867, 868, 869 15 18 15 18 15 791 1, 793 865, 866 791 1, 793 865, 866 791 1, 793 1 1 1 24978 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6A.—NEW DIAGNOSIS CODES—Continued Diagnosis code Description 058.21 ........ Human herpes virus 6 encephalitis ...................................................................................................................... 058.29 ........ 058.81 058.82 058.89 079.83 CC Other human herpes virus encephalitis ................................................................................................................ Y MCC Y MCC ........ ........ ........ ........ Human herpes virus 6 infection ............................................................................................................................ Human herpes virus 7 infection ............................................................................................................................ Other human herpes virus infection ...................................................................................................................... Parvovirus B19 ...................................................................................................................................................... N N N Y CC Y CC 200.30 ........ Marginal zone lymphoma, unspecified site, extranodal and solid organ sites ..................................................... 200.31 ........ Marginal zone lymphoma, lymph nodes of head, face, and neck ........................................................................ Y CC 200.32 ........ Marginal zone lymphoma, intrathoracic lymph nodes .......................................................................................... Y CC 200.33 ........ Marginal zone lymphoma, intraabdominal lymph nodes ...................................................................................... Y CC 200.34 ........ Marginal zone lymphoma, lymph nodes of axilla and upper limb ........................................................................ Y CC 200.35 ........ Marginal zone lymphoma, lymph nodes of inguinal region and lower limb ......................................................... Y CC 200.36 ........ Marginal zone lymphoma, intrapelvic lymph nodes .............................................................................................. Y CC 200.37 ........ Marginal zone lymphoma, spleen ......................................................................................................................... Y CC 200.38 ........ Marginal zone lymphoma, lymph nodes of multiple sites ..................................................................................... Y CC 200.40 ........ Mantle cell lymphoma, unspecified site, extranodal and solid organ sites .......................................................... Y CC 200.41 ........ Mantle cell lymphoma, lymph nodes of head, face, and neck ............................................................................. Y CC 200.42 ........ Mantle cell lymphoma, intrathoracic lymph nodes ................................................................................................ Y CC 200.43 ........ Mantle cell lymphoma, intra-abdominal lymph nodes .......................................................................................... Y CC 200.44 ........ Mantle cell lymphoma, lymph nodes of axilla and upper limb ............................................................................. Y CC MDC 18 1 15 25 1 865, 866 23, 24, 97, 98, 99 791 1, 793 1 974, 975, 976 23, 24,97, 98, 99 15 25 9 9 9 18 791 1, 793 1 974, 975, 976 606, 607 606, 607 606, 607 865, 866 17 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 mmaher on DSK3CLS3C1PROD with $$_JOB 25 VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00300 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 MS–DRG 821, 822, 824, 825, 841, 842 975, 976 821, 822, 824, 825, 841, 842 975, 976 821, 822, 824, 825, 841, 842 975, 976 821, 822, 824, 825, 841, 842 975, 976 821, 822, 824, 825, 841, 842 975, 976 821, 822, 824, 825, 841, 842 975, 976 821, 822, 824, 825, 841, 842 975, 976 821, 822, 824, 825, 841, 842 975, 976 821, 822, 824, 825, 841, 842 975, 976 821, 822, 824, 825, 841, 842 975, 976 821, 822, 824, 825, 841, 842 975, 976 821,822, 824, 825, 841, 842 975, 976 821, 822, 824, 825, 841, 842 975, 976 821, 822, 824, 825, 841, 842 975, 976 24979 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6A.—NEW DIAGNOSIS CODES—Continued Description 200.45 ........ Mantle cell lymphoma, lymph nodes of inguinal region and lower limb ............................................................... Y 200.46 ........ Mantle cell lymphoma, intrapelvic lymph nodes ................................................................................................... Y CC 200.47 ........ Mantle cell lymphoma, spleen .............................................................................................................................. Y CC 200.48 ........ Mantle cell lymphoma, lymph nodes of multiple sites .......................................................................................... Y CC 200.50 ........ Primary central nervous system lymphoma, unspecified site, extranodal and solid organ sites ......................... Y CC 200.51 ........ Primary central nervous system lymphoma, lymph nodes of head, face, and neck ........................................... Y CC 200.52 ........ Primary central nervous system lymphoma, intrathoracic lymph nodes .............................................................. Y CC 200.53 ........ Primary central nervous system lymphoma, intra-abdominal lymph nodes ......................................................... Y CC 200.54 ........ Primary central nervous system lymphoma, lymph nodes of axilla and upper limb ............................................ Y CC 200.55 ........ Primary central nervous system lymphoma, lymph nodes of inguinal region and lower limb ............................. Y CC 200.56 ........ Primary central nervous system lymphoma, intrapelvic lymph nodes ................................................................. Y CC 200.57 ........ Primary central nervous system lymphoma, spleen ............................................................................................. Y CC 200.58 ........ Primary central nervous system lymphoma, lymph nodes of multiple sites ........................................................ Y CC 200.60 ........ Anaplastic large cell lymphoma, unspecified site, extranodal and solid organ sites ........................................... Y CC 200.61 ........ Anaplastic large cell lymphoma, lymph nodes of head, face, and neck .............................................................. Y CC 200.62 ........ Anaplastic large cell lymphoma, intrathoracic lymph nodes ................................................................................. Y CC 200.63 ........ Anaplastic large cell lymphoma, intra-abdominal lymph nodes ........................................................................... Y CC 200.64 ........ mmaher on DSK3CLS3C1PROD with $$_JOB Diagnosis code Anaplastic large cell lymphoma, lymph nodes of axilla and upper limb .............................................................. Y CC VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00301 Fmt 4742 CC Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 MDC 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 MS–DRG 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 24980 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6A.—NEW DIAGNOSIS CODES—Continued Diagnosis code Description 200.65 ........ Anaplastic large cell lymphoma, lymph nodes of inguinal region and lower limb ................................................ Y CC 200.66 ........ Anaplastic large cell lymphoma, intrapelvic lymph nodes .................................................................................... Y CC 200.67 ........ Anaplastic large cell lymphoma, spleen ............................................................................................................... Y CC 200.68 ........ Anaplastic large cell lymphoma, lymph nodes of multiple sites ........................................................................... Y CC 200.70 ........ Large cell lymphoma, unspecified site, extranodal and solid organ sites ............................................................ Y CC 200.71 ........ Large cell lymphoma, lymph nodes of head, face, and neck ............................................................................... Y CC 200.72 ........ Large cell lymphoma, intrathoracic lymph nodes ................................................................................................. Y CC 200.73 ........ Large cell lymphoma, intra- abdominal lymph nodes ........................................................................................... Y CC 200.74 ........ Large cell lymphoma, lymph nodes of axilla and upper limb ............................................................................... Y CC 200.75 ........ Large cell lymphoma, lymph nodes of inguinal region and lower limb ................................................................ Y CC 200.76 ........ Large cell lymphoma, intrapelvic lymph nodes ..................................................................................................... Y CC 200.77 ........ Large cell lymphoma, spleen ................................................................................................................................ Y CC 200.78 ........ Large cell lymphoma, lymph nodes of multiple sites ............................................................................................ Y CC 202.70 ........ Peripheral T cell lymphoma, unspecified site, extranodal and solid organ sites ................................................. Y CC 202.71 ........ Peripheral T cell lymphoma, lymph nodes of head, face, and neck .................................................................... Y CC 202.72 ........ Peripheral T cell lymphoma, intrathoracic lymph nodes ....................................................................................... Y CC 202.73 ........ Peripheral T cell lymphoma, intra-abdominal lymph nodes ................................................................................. Y CC CC MDC 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 25 17 mmaher on DSK3CLS3C1PROD with $$_JOB 25 VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00302 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 MS–DRG 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 24981 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6A.—NEW DIAGNOSIS CODES—Continued Description 202.74 ........ Peripheral T cell lymphoma, lymph nodes of axilla and upper limb .................................................................... Y CC 202.75 ........ Peripheral T cell lymphoma, lymph nodes of inguinal region and lower limb ...................................................... Y CC 202.76 ........ Peripheral T cell lymphoma, intrapelvic lymph nodes .......................................................................................... Y CC 202.77 ........ Peripheral T cell lymphoma, spleen ..................................................................................................................... Y CC 202.78 ........ Peripheral T cell lymphoma, lymph nodes of multiple sites ................................................................................. Y CC 233.30 ........ Carcinoma in situ, unspecified female genital organ ............................................................................................ N 25 13 233.31 ........ Carcinoma in situ,vagina ....................................................................................................................................... N 13 233.32 ........ Carcinoma in situ,vulva ......................................................................................................................................... N 13 233.39 ........ Carcinoma in situ, other female genital organ ...................................................................................................... N 13 255.41 ........ Glucocorticoid deficiency ...................................................................................................................................... 10 Mineralocorticoid deficiency .................................................................................................................................. 10 643, 644, 645 258.01 258.02 258.03 284.81 ........ ........ ........ ........ Multiple endocrine neoplasia [MEN] type I ........................................................................................................... Multiple endocrine neoplasia [MEN] type IIA ........................................................................................................ Multiple endocrine neoplasia [MEN] type IIB ........................................................................................................ Red cell aplasia (acquired)(adult)(with thymoma) ................................................................................................ 284.89 ........ Other specified aplastic anemias .......................................................................................................................... 288.66 ........ 315.34 ........ 331.5 .......... Bandemia .............................................................................................................................................................. Speech and language developmental delay due to hearing loss ........................................................................ Idiopathic normal pressure hydrocephalus (INPH) ............................................................................................... 10 10 10 16 25 16 25 16 19 1 643, 644, 643, 644, 643, 644, 808, 809, 977 808, 809, 977 814, 815, 886 56, 57 359.21 ........ 359.22 ........ 359.23 ........ 359.24 ........ 359.29 ........ 364.81 ........ 364.89 ........ 388.45 ........ 389.05 ........ 389.06 ........ 389.13 ........ 389.17 ........ 389.20 ........ 389.21 ........ 389.22 ........ 414.2 .......... 415.12 ........ Myotonic muscular dystrophy ............................................................................................................................... Myotonia congenital .............................................................................................................................................. Myotonic chondrodystrophy .................................................................................................................................. Drug induced myotonia ......................................................................................................................................... Other specified myotonic disorder ........................................................................................................................ Floppy iris syndrome ............................................................................................................................................. Other disorders of iris and ciliary body ................................................................................................................. Acquired auditory processing disorder ................................................................................................................. Conductive hearing loss, unilateral ....................................................................................................................... Conductive hearing loss, bilateral ......................................................................................................................... Neural hearing loss, unilateral .............................................................................................................................. Sensory hearing loss, unilateral ............................................................................................................................ Mixed hearing loss, unspecified ............................................................................................................................ Mixed hearing loss, unilateral ............................................................................................................................... Mixed hearing loss, bilateral ................................................................................................................................. Chronic total occlusion of coronary artery ............................................................................................................ Septic pulmonary embolism .................................................................................................................................. 423.3 .......... Cardiac tamponade ............................................................................................................................................... 1 1 1 1 1 2 2 19 3 3 3 3 3 3 3 5 4 15 5 91, 92, 93 91, 92, 93 91, 92, 93 91, 92, 93 91, 92, 93 124, 125 124, 125 886 154, 155, 156 154, 155, 156 154, 155, 156 154, 155, 156 154, 155, 156 154, 155, 156 154, 155, 156 302, 303 175,176 791 1, 793 1 314, 315, 316 440.4 .......... 449 ............. Chronic total occlusion of artery of the extremities .............................................................................................. Septic arterial embolism ........................................................................................................................................ 488 ............. Influenza due to identified avian influenza virus ................................................................................................... Y CC Y CC N N N Y MCC Y MCC N N Y CC N N N N N N N N N N N N N N N N Y MCC Y CC N Y CC N 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 820, 823, 840, 974, 739, 744, 755, 739, 744, 755, 739, 744, 755, 739, 744, 755, 643, 255.42 ........ mmaher on DSK3CLS3C1PROD with $$_JOB Diagnosis code 5 5 15 3 299, 300, 301 299, 300, 301 791 1, 793 1 152, 153 VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00303 Fmt 4742 CC Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 MDC 17 25 17 25 17 25 17 25 17 MS–DRG 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 821, 824, 841, 975, 740, 745, 756 740, 745, 756 740, 745, 756 740, 745, 756 644, 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 822, 825, 842 976 741, 754, 741, 754, 741, 754, 741, 754, 645 645 645 645 810 810 816 24982 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6A.—NEW DIAGNOSIS CODES—Continued Diagnosis code Description 525.71 ........ Osseointegration failure of dental implant ............................................................................................................ 525.72 ........ Post-osseointegration biological failure of dental implant .................................................................................... 525.73 ........ MDC MS–DRG N PRE3 N PRE3 Post-osseointegration mechanical failure of dental implant ................................................................................. N PRE3 525.79 ........ Other endosseous dental implant failure .............................................................................................................. N PRE3 569.43 ........ 624.01 ........ Anal sphincter tear (healed) (old) ......................................................................................................................... Vulvar intraepithelial neoplasia I [VIN I] ................................................................................................................ N N 6 13 624.02 ........ Vulvar intraepithelial neoplasia II [VIN II] .............................................................................................................. N 13 624.09 ........ Other dystrophy of vulva ....................................................................................................................................... N 13 629.82 ........ Acquired absence of both uterus and cervix ........................................................................................................ N 13 629.83 ........ Acquired absence of uterus, with remaining cervical stump ................................................................................ N 13 629.84 ........ Acquired absence of cervix with remaining uterus ............................................................................................... N 13 664.60 ........ N 14 787.20 787.21 787.22 787.23 787.24 787.29 789.51 789.59 ........ ........ ........ ........ ........ ........ ........ ........ Dysphagia, unspecified ......................................................................................................................................... Dysphagia, oral phase .......................................................................................................................................... Dysphagia, oropharyngeal phase ......................................................................................................................... Dysphagia, pharyngeal phase .............................................................................................................................. Dysphagia, pharyngoesophageal phase ............................................................................................................... Other dysphagia .................................................................................................................................................... Malignant ascites .................................................................................................................................................. Other ascites ......................................................................................................................................................... V12.53 V12.54 V13.22 V16.52 V17.40 V17.41 V17.49 V18.11 V18.19 V25.04 V26.41 V26.49 V26.81 V26.89 V49.85 V68.01 V68.09 V72.12 ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ ........ Personal history of sudden cardiac arrest ............................................................................................................ Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits ................. Personal history of cervical dysplasia ................................................................................................................... Family history of malignant neoplasm, bladder .................................................................................................... Family history of cardiovascular diseases, unspecified ........................................................................................ Family history of sudden cardiac death (SCD) ..................................................................................................... Family history of other cardiovascular diseases ................................................................................................... Family history of multiple endocrine neoplasia [MEN] syndrome ........................................................................ Family history of other endocrine and metabolic diseases .................................................................................. Counseling and instruction in natural family planning to avoid pregnancy .......................................................... Procreative counseling and advice using natural family planning ........................................................................ Other procreative management, counseling and advice ...................................................................................... Encounter for assisted reproductive fertility procedure cycle ............................................................................... Other specified procreative management ............................................................................................................. Dual sensory impairment ...................................................................................................................................... Disability examination ........................................................................................................................................... Other issue of medical certificates ........................................................................................................................ Encounter for hearing conservation and treatment .............................................................................................. Y CC Y CC Y CC N N N N N N Y Y CC N N N N N N N N N N N N N N N N N N 14 733.45 ........ Anal sphincter tear complicating delivery, not associated with third-degree perineal laceration, unspecified as to episode of care or not applicable. Anal sphincter tear complicating delivery, not associated with third-degree perineal laceration, delivered, with or without mention of antepartum condition. Anal sphincter tear complicating delivery, not associated with third-degree perineal laceration, postpartum condition or complication. Aseptic necrosis of bone, jaw ............................................................................................................................... 11, 12, 13, 157, 158, 159 11, 12, 13, 157, 158, 159 11, 12, 13, 157, 158, 159 11, 12, 13, 157, 158, 159 393, 394, 395 742, 743, 760, 761 742, 743, 760, 761 742, 743, 760, 761 742, 743, 760, 761 742, 743, 760, 761 742, 743, 760, 761 765, 766, 767, 768, 774, 775 765, 766, 767, 768, 774, 775 769, 776 V73.81 ........ V84.81 ........ V84.89 ........ Special screening examination, Human papilloma virus (HPV) ........................................................................... Genetic susceptibility to multiple endocrine neoplasia [MEN] .............................................................................. Genetic susceptibility to other disease ................................................................................................................. N N N 664.61 ........ 664.64 ........ CC 14 8 553, 554 6 6 6 6 6 6 23 23 391, 391, 391, 391, 391, 391, 947, 947, 392 392 392 392 392 392 948 948 23 23 17 23 23 23 23 23 23 23 23 23 23 23 23 23 23 15 23 23 23 23 951 951 843, 844, 845 951 951 951 951 951 951 951 951 951 951 951 951 951 951 795 2 951 951 951 951 MCC—Major Complication or Comorbidity in MS–DRGs. 1 Secondary diagnosis of major problem. 2 On ‘‘Only secondary diagnosis’’ list. TABLE 6B.—NEW PROCEDURE CODES Description 00.19 .......... mmaher on DSK3CLS3C1PROD with $$_JOB Procedure code Disruption of blood brain barrier via infusion [BBBD] ........................................................................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00304 Fmt 4742 O.R. Sfmt 4742 E:\FEDREG\03MYP2.LOC N 03MYP2 MDC MS–DRG Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24983 TABLE 6B.—NEW PROCEDURE CODES—Continued Procedure code 01.10 01.16 01.17 32.41 Description O.R. .......... .......... .......... .......... Intracranial pressure monitoring ........................................................................................................................... Intracranial oxygen monitoring .............................................................................................................................. Brain temperature monitoring ............................................................................................................................... Thoracoscopic lobectomy of lung ......................................................................................................................... 32.49 .......... Other lobectomy of lung ........................................................................................................................................ Y 33.20 .......... Thoracoscopic lung biopsy ................................................................................................................................... Y 34.06 .......... 34.20 .......... 34.52 .......... Thoracoscopic drainage of pleural cavity ............................................................................................................. Thoracoscopic pleural biopsy ............................................................................................................................... Thoracoscopic decortication of lung ..................................................................................................................... Y Y Y 70.53 .......... ............................................................................................................................................................................... Repair of cystocele and rectocele with graft or prosthesis .................................................................................. Y 70.54 .......... Repair of cystocele with graft or prosthesis ......................................................................................................... Y 70.55 .......... Repair of rectocele with graft or prosthesis .......................................................................................................... Y 70.63 .......... 70.64 .......... Vaginal construction with graft or prosthesis ........................................................................................................ Vaginal reconstruction with graft or prosthesis ..................................................................................................... Y Y 70.78 .......... Vaginal suspension and fixation with graft or prosthesis ..................................................................................... ............................................................................................................................................................................... Other operations on cul-de-sac with graft or prosthesis ...................................................................................... Insertion of biological graft .................................................................................................................................... Insertion of synthetic graft or prosthesis ............................................................................................................... Intra-operative fluorescence vascular angiography .............................................................................................. Y N N N 70.93 70.94 70.95 88.59 .......... .......... .......... .......... MS–DRG 4 21 24 4 21 24 4 5 8 11 17 N N N Y MDC 163, 164, 165 907, 908, 909 957, 958, 959 163, 164, 165 907, 908, 909 957, 958, 959 166, 167, 168 264 515, 516, 517 673, 674, 675 823, 824, 825, 829, 830 166, 167, 168 166, 167, 168 163, 164, 165 820, 821, 822, 826, 827, 828 907, 908, 909 957, 958, 959 329, 330, 331 653, 654, 655 748 662, 663, 664 748 329, 330, 331 748 748 748 907, 908, 909 957, 958, 959 662, 663, 664 748 746, 747 4 4 4 17 21 24 6 11 13 11 13 6 13 13 13 21 24 11 13 13 Y TABLE 6C.—INVALID DIAGNOSIS CODES Diagnosis code Description 233.3 .......... Carcinoma in situ,other and unspecified female genital organs .......................................................................... N 13 255.4 .......... 258.0 .......... 284.8 .......... Corticoadrenal insufficiency .................................................................................................................................. Polyglandular activity in multiple endocrine adenomatosis .................................................................................. Other specified aplastic anemias .......................................................................................................................... ............................................................................................................................................................................... Myotonic disorders ................................................................................................................................................ Other disorders of iris and ciliary body ................................................................................................................. Mixed conductive and sensorineural hearing loss ................................................................................................ Dystrophy of vulva ................................................................................................................................................ Dysphagia ............................................................................................................................................................. Ascites ................................................................................................................................................................... Family history of other cardiovascular diseases ................................................................................................... Family history of other endocrine and metabolic diseases .................................................................................. Procreative management, general counseling and advice ................................................................................... Other specified procreative management ............................................................................................................. Issue of medical certificates .................................................................................................................................. Genetic susceptibility to other disease ................................................................................................................. Y N Y 10 10 16 25 1 2 3 13 6 23 23 23 23 23 23 23 359.2 364.8 389.2 624.0 787.2 789.5 V17.4 V18.1 V26.4 V26.8 V68.0 V84.8 .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... CC N N N N N Y N N N N N N mmaher on DSK3CLS3C1PROD with $$_JOB The DRG assignments listed are based on the current code assignment in the CMS DRGs. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00305 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 MDC CMS DRG 354, 355, 363, 366, 367 300, 301 300, 301 574 490 34, 35 46, 47, 48 73, 74 358, 359, 369 182, 183, 184 463, 464 467 467 467 467 467 467 24984 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6D.—INVALID PROCEDURE CODES Procedure code Description 32.4 ........ Lobectomy of lung ....................................................................................................................... OR Y MDC CMS DRG 4 21 24 75 442,443 486 The DRG assignments listed are based on the current code assignment in the CMS DRGs. TABLE 6E.—REVISED DIAGNOSIS CODE TITLES Diagnosis code Description 005.1 ......... Botulism food poisoning ........................................................................................................................................ 359.3 ......... 389.14 ....... 389.18 ........ 389.7 ......... Periodic paralysis .................................................................................................................................................. Central hearing loss .............................................................................................................................................. Sensorineural hearing loss, bilateral ..................................................................................................................... Deaf, nonspeaking, not elsewhere classifiable ..................................................................................................... CC Y CC N N N N MDC MS–DRG 18 867, 868, 869 1 3 3 3 91, 92, 93 154, 155, 156 154, 155,156 154, 155, 156 TABLE 6F.—REVISED PROCEDURE CODE TITLES Procedure code 00.74 00.75 00.76 00.77 34.24 53.41 Description OR MDC MS–DRG ........ ........ ........ ........ ........ ........ Hip bearing surface, metal-on-polyethylene ................................................................................ Hip bearing surface, metal-on-metal ........................................................................................... Hip bearing surface, ceramic-on-ceramic .................................................................................... Hip bearing surface, ceramic-on-polyethylene ............................................................................ Other pleural biopsy ..................................................................................................................... Repair of umbilical hernia with graft or prosthesis ...................................................................... N N N N N Y 53.61 ........ Incisional hernia repair with graft or prosthesis ........................................................................... Y 6 21 24 53.69 ........ Repair of other hernia of anterior abdominal wall with graft or prosthesis ................................. Y 06 99.14 ........ Injection or infusion of gamma globulin ....................................................................................... N Note: Diagnoses codes 42741 (Ventricular fibrillation), 4275 (Cardiac arrest), 78551 (Cardiogenic shock), 78559 (Other shock without mention of trauma) and 7991 (Respiratory arrest) are assigned as a major 6 353, 354, 355 987, 988, 989 353, 354, 355 907, 908, 909 957, 958, 959 987, 988, 989 353, 354, 355 987, 988, 989 CC only for patients discharged alive, otherwise they will be assigned as a non CC. TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST Code title 0031 ................................................. 00321 ............................................... 00322 ............................................... 0063 ................................................. 0064 ................................................. 0065 ................................................. 01160 ............................................... 01161 ............................................... 01162 ............................................... 01163 ............................................... 01164 ............................................... 01165 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB Diagnosis code Salmonella septicemia. Salmonella meningitis. Salmonella pneumonia. Amebic liver abscess. Amebic lung abscess. Amebic brain abscess. Tuberculous pneumonia (any form), unspecified examination. Tuberculous pneumonia (any form), bacteriological or histological examination not done. Tuberculous pneumonia (any form), bacteriological or histological examination results unknown (at present). Tuberculous pneumonia (any form), tubercle bacilli found (in sputum) by microscopy. Tuberculous pneumonia (any form), tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculous pneumonia (any form), tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculous pneumonia (any form), tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculous meningitis, unspecified examination. Tuberculous meningitis, bacteriological or histological examination not done. 01166 ............................................... 01300 ............................................... 01301 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00306 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24985 TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued Diagnosis code Code title 01302 01303 01304 01305 01306 ............................................... ............................................... ............................................... ............................................... ............................................... 01310 01311 01312 01313 01314 01315 01316 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01320 01321 01322 01323 01324 01325 01326 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01330 01331 01332 01333 01334 01335 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01336 ............................................... 01340 01341 01342 01343 01344 01345 01346 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01350 01351 01352 01353 01354 01355 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01356 ............................................... 01360 01361 01362 01363 01364 01365 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01366 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 01380 01381 01382 01383 01384 ............................................... ............................................... ............................................... ............................................... ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Tuberculous meningitis, bacteriological or histological examination results unknown (at present). Tuberculous meningitis, tubercle bacilli found (in sputum) by microscopy. Tuberculous meningitis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculous meningitis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculous meningitis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculoma of meninges, unspecified examination. Tuberculoma of meninges, bacteriological or histological examination not done. Tuberculoma of meninges, bacteriological or histological examination results unknown (at present). Tuberculoma of meninges, tubercle bacilli found (in sputum) by microscopy. Tuberculoma of meninges, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculoma of meninges, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculoma of meninges, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculoma of brain, unspecified examination. Tuberculoma of brain, bacteriological or histological examination not done. Tuberculoma of brain, bacteriological or histological examination results unknown (at present). Tuberculoma of brain, tubercle bacilli found (in sputum) by microscopy. Tuberculoma of brain, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculoma of brain, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculoma of brain, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculous abscess of brain, unspecified examination. Tuberculous abscess of brain, bacteriological or histological examination not done. Tuberculous abscess of brain, bacteriological or histological examination results unknown (at present). Tuberculous abscess of brain, tubercle bacilli found (in sputum) by microscopy. Tuberculous abscess of brain, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculous abscess of brain, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculous abscess of brain, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculoma of spinal cord, unspecified examination. Tuberculoma of spinal cord, bacteriological or histological examination not done. Tuberculoma of spinal cord, bacteriological or histological examination results unknown (at present). Tuberculoma of spinal cord, tubercle bacilli found (in sputum) by microscopy. Tuberculoma of spinal cord, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculoma of spinal cord, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculoma of spinal cord, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculous abscess of spinal cord, unspecified examination. Tuberculous abscess of spinal cord, bacteriological or histological examination not done. Tuberculous abscess of spinal cord, bacteriological or histological examination results unknown (at present). Tuberculous abscess of spinal cord, tubercle bacilli found (in sputum) by microscopy. Tuberculous abscess of spinal cord, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculous abscess of spinal cord, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculous abscess of spinal cord, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculous encephalitis or myelitis, unspecified examination. Tuberculous encephalitis or myelitis, bacteriological or histological examination not done. Tuberculous encephalitis or myelitis, bacteriological or histological examination results unknown (at present). Tuberculous encephalitis or myelitis, tubercle bacilli found (in sputum) by microscopy. Tuberculous encephalitis or myelitis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculous encephalitis or myelitis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculous encephalitis or myelitis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Other specified tuberculosis of central nervous system, unspecified examination. Other specified tuberculosis of central nervous system, bacteriological or histological examination not done. Other specified tuberculosis of central nervous system, bacteriological or histological examination results unknown (at present). Other specified tuberculosis of central nervous system, tubercle bacilli found (in sputum) by microscopy. Other specified tuberculosis of central nervous system, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Jkt 223001 PO 00000 Frm 00307 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 24986 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued Diagnosis code Code title 01385 ............................................... Other specified tuberculosis of central nervous system, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Other specified tuberculosis of central nervous system, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Unspecified tuberculosis of central nervous system, unspecified examination. Unspecified tuberculosis of central nervous system, bacteriological or histological examination not done. Unspecified tuberculosis of central nervous system, bacteriological or histological examination results unknown (at present). Unspecified tuberculosis of central nervous system, tubercle bacilli found (in sputum) by microscopy. Unspecified tuberculosis of central nervous system, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Unspecified tuberculosis of central nervous system, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Unspecified tuberculosis of central nervous system, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculous peritonitis, unspecified examination. Tuberculous peritonitis, bacteriological or histological examination not done. Tuberculous peritonitis, bacteriological or histological examination results unknown (at present). Tuberculous peritonitis, tubercle bacilli found (in sputum) by microscopy. Tuberculous peritonitis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculous peritonitis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculous peritonitis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Acute miliary tuberculosis, unspecified examination. Acute miliary tuberculosis, bacteriological or histological examination not done. Acute miliary tuberculosis, bacteriological or histological examination results unknown (at present). Acute miliary tuberculosis, tubercle bacilli found (in sputum) by microscopy. Acute miliary tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Acute miliary tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Acute miliary tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Other specified miliary tuberculosis, unspecified examination. Other specified miliary tuberculosis, bacteriological or histological examination not done. Other specified miliary tuberculosis, bacteriological or histological examination results unknown (at present). Other specified miliary tuberculosis, tubercle bacilli found (in sputum) by microscopy. Other specified miliary tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Other specified miliary tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Other specified miliary tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Unspecified miliary tuberculosis, unspecified examination. Unspecified miliary tuberculosis, bacteriological or histological examination not done. Unspecified miliary tuberculosis, bacteriological or histological examination results unknown (at present). Unspecified miliary tuberculosis, tubercle bacilli found (in sputum) by microscopy. Unspecified miliary tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Unspecified miliary tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Unspecified miliary tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Bubonic plague. Cellulocutaneous plague. Septicemic plague. Primary pneumonic plague. Secondary pneumonic plague. Pneumonic plague, unspecified. Other specified types of plague. Plague, unspecified. Pulmonary anthrax. Anthrax septicemia. Meningococcal meningitis. Meningococcal encephalitis. Meningococcemia. Waterhouse-friderichsen syndrome, meningococcal. Meningococcal carditis, unspecified. Meningococcal pericarditis. Meningococcal endocarditis. Meningococcal myocarditis. Tetanus. 01386 ............................................... 01390 01391 01392 01393 01394 ............................................... ............................................... ............................................... ............................................... ............................................... 01395 ............................................... 01396 ............................................... 01400 01401 01402 01403 01404 01405 01406 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01800 01801 01802 01803 01804 01805 01806 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01880 01881 01882 01883 01884 01885 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01886 ............................................... 01890 01891 01892 01893 01894 01895 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01896 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 0200 ................................................. 0201 ................................................. 0202 ................................................. 0203 ................................................. 0204 ................................................. 0205 ................................................. 0208 ................................................. 0209 ................................................. 0221 ................................................. 0223 ................................................. 0360 ................................................. 0361 ................................................. 0362 ................................................. 0363 ................................................. 03640 ............................................... 03641 ............................................... 03642 ............................................... 03643 ............................................... 037 ................................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00308 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24987 TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued mmaher on DSK3CLS3C1PROD with $$_JOB Diagnosis code Code title 0380 ................................................. 03810 ............................................... 03811 ............................................... 03819 ............................................... 0382 ................................................. 0383 ................................................. 03840 ............................................... 03841 ............................................... 03842 ............................................... 03843 ............................................... 03844 ............................................... 03849 ............................................... 0388 ................................................. 0389 ................................................. 0400 ................................................. 04082 ............................................... 042 ................................................... 04500 ............................................... 04501 ............................................... 04502 ............................................... 04503 ............................................... 04510 ............................................... 04511 ............................................... 04512 ............................................... 04513 ............................................... 0520 ................................................. 0521 ................................................. 0522 ................................................. 0530 ................................................. 05314 ............................................... 0543 ................................................. 0545 ................................................. 05472 ............................................... 05474 ............................................... 0550 ................................................. 0551 ................................................. 05601 ............................................... 05821 ............................................... 05829 ............................................... 0620 ................................................. 0621 ................................................. 0622 ................................................. 0623 ................................................. 0624 ................................................. 0625 ................................................. 0628 ................................................. 0629 ................................................. 0630 ................................................. 0631 ................................................. 0632 ................................................. 0638 ................................................. 0639 ................................................. 064 ................................................... 06640 ............................................... 06641 ............................................... 06642 ............................................... 06649 ............................................... 0700 ................................................. 07020 ............................................... 07021 ............................................... 07022 ............................................... 07023 ............................................... 07041 ............................................... 07042 ............................................... 07043 ............................................... 07044 ............................................... 07049 ............................................... 0706 ................................................. 07071 ............................................... 0721 ................................................. 0722 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Streptococcal septicemia. Staphylococcal septicemia, unspecified. Staphylococcus aureus septicemia. Other staphylococcal septicemia. Pneumococcal septicemia. Septicemia due to anaerobes. Septicemia due to gram-negative organism, unspecified. Septicemia due to hemophilus influenzae (h. influenzae). Septicemia due to escherichia coli (e. coli). Septicemia due to pseudomonas. Septicemia due to serratia. Other septicemia due to gram-negative organisms. Other specified septicemias. Unspecified septicemia. Gas gangrene. Toxic shock syndrome. Human immunodeficiency virus (hiv) disease. Acute paralytic poliomyelitis specified as bulbar, unspecified type of poliovirus. Acute paralytic poliomyelitis specified as bulbar, poliovirus type i. Acute paralytic poliomyelitis specified as bulbar, poliovirus type ii. Acute paralytic poliomyelitis specified as bulbar, poliovirus type iii. Acute poliomyelitis with other paralysis, unspecified type of poliovirus. Acute poliomyelitis with other paralysis, poliovirus type i. Acute poliomyelitis with other paralysis, poliovirus type ii. Acute poliomyelitis with other paralysis, poliovirus type iii. Postvaricella encephalitis. Varicella (hemorrhagic) pneumonitis. Postvaricella myelitis. Herpes zoster with meningitis. Herpes zoster myelitis. Herpetic meningoencephalitis. Herpetic septicemia. Herpes simplex meningitis. Herpes simplex myelitis. Postmeasles encephalitis. Postmeasles pneumonia. Encephalomyelitis due to rubella. Human herpes virus 6 encephalitis. Other human herpes virus encephalitis. Japanese encephalitis. Western equine encephalitis. Eastern equine encephalitis. St. Louis encephalitis. Australian encephalitis. California virus encephalitis. Other specified mosquito-borne viral encephalitis. Mosquito-borne viral encephalitis, unspecified. Russian spring-summer (taiga) encephalitis. Louping ill. Central european encephalitis. Other specified tick-borne viral encephalitis. Tick-borne viral encephalitis, unspecified. Viral encephalitis transmitted by other and unspecified arthropods. West Nile Fever, unspecified. West Nile Fever with encephalitis. West Nile Fever with other neurologic manifestation. West Nile Fever with other complications. Viral hepatitis a with hepatic coma. Viral hepatitis b with hepatic coma, acute or unspecified, without mention of hepatitis delta. Viral hepatitis b with hepatic coma, acute or unspecified, with hepatitis delta. Chronic viral hepatitis b with hepatic coma without hepatitis delta. Chronic viral hepatitis b with hepatic coma with hepatitis delta. Acute hepatitis C with hepatic coma. Hepatitis delta without mention of active hepatitis b disease, with hepatic coma, hepatitis delta with hepatitis b carrier state. Hepatitis e with hepatic coma. Chronic hepatitis c with hepatic coma. Other specified viral hepatitis with hepatic coma. Unspecified viral hepatitis with hepatic coma. Unspecified viral hepatitis C with hepatic coma. Mumps meningitis. Mumps encephalitis. Jkt 223001 PO 00000 Frm 00309 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 24988 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued mmaher on DSK3CLS3C1PROD with $$_JOB Diagnosis code Code title 0730 ................................................. 0840 ................................................. 09041 ............................................... 09042 ............................................... 09181 ............................................... 0942 ................................................. 09481 ............................................... 09487 ............................................... 09882 ............................................... 09883 ............................................... 09884 ............................................... 10081 ............................................... 1124 ................................................. 1125 ................................................. 11281 ............................................... 11283 ............................................... 1142 ................................................. 11501 ............................................... 11503 ............................................... 11504 ............................................... 11505 ............................................... 11511 ............................................... 11513 ............................................... 11514 ............................................... 11515 ............................................... 11591 ............................................... 11593 ............................................... 11594 ............................................... 11595 ............................................... 1177 ................................................. 1300 ................................................. 1303 ................................................. 1304 ................................................. 1308 ................................................. 1362 ................................................. 1363 ................................................. 24201 ............................................... 24211 ............................................... 24221 ............................................... 24231 ............................................... 24241 ............................................... 24281 ............................................... 24291 ............................................... 25010 ............................................... 25011 ............................................... 25012 ............................................... 25013 ............................................... 25020 ............................................... 25021 ............................................... 25022 ............................................... 25023 ............................................... 25030 ............................................... 25031 ............................................... 25032 ............................................... 25033 ............................................... 260 ................................................... 261 ................................................... 262 ................................................... 27701 ............................................... 27702 ............................................... 28242 ............................................... 28262 ............................................... 28264 ............................................... 28311 ............................................... 28481 ............................................... 28489 ............................................... 2860 ................................................. 2861 ................................................. 2866 ................................................. 3200 ................................................. 3201 ................................................. 3202 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Ornithosis with pneumonia. Falciparum malaria (malignant tertian). Congenital syphilitic encephalitis. Congenital syphilitic meningitis. Acute syphilitic meningitis (secondary). Syphilitic meningitis. Syphilitic encephalitis. Syphilitic ruptured cerebral aneurysm. Gonococcal meningitis. Gonococcal pericarditis. Gonococcal endocarditis. Leptospiral meningitis (aseptic). Candidiasis of lung. Disseminated candidiasis. Candidal endocarditis. Candidal meningitis. Coccidioidal meningitis. Histoplasma capsulatum meningitis. Histoplasma capsulatum pericarditis. Histoplasma capsulatum endocarditis. Histoplasma capsulatum pneumonia. Histoplasma duboisii meningitis. Histoplasma duboisii pericarditis. Histoplasma duboisii endocarditis. Histoplasma duboisii pneumonia. Histoplasmosis meningitis, unspecified. Histoplasmosis pericarditis, unspecified. Histoplasmosis endocarditis. Histoplasmosis pneumonia, unspecified. Zygomycosis (phycomycosis or mucormycosis). Meningoencephalitis due to toxoplasmosis. Myocarditis due to toxoplasmosis. Pneumonitis due to toxoplasmosis. Multisystemic disseminated toxoplasmosis. Specific infections by free-living amebae. Pneumocystosis. Toxic diffuse goiter with mention of thyrotoxic crisis or storm. Toxic uninodular goiter with mention of thyrotoxic crisis or storm. Toxic multinodular goiter with mention of thyrotoxic crisis or storm. Toxic nodular goiter, unspecified type, with mention of thyrotoxic crisis or storm. Thyrotoxicosis from ectopic thyroid nodule with mention of thyrotoxic crisis or storm. Thyrotoxicosis of other specified origin with mention of thyrotoxic crisis or storm. Thyrotoxicosis without mention of goiter or other cause, with mention of thyrotoxic crisis or storm. Diabetes with ketoacidosis, type II or unspecified type, not stated as uncontrolled. Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled. Diabetes with ketoacidosis, type II or unspecified type, uncontrolled. Diabetes with ketoacidosis, type I [juvenile type], uncontrolled. Diabetes with hyperosmolarity, type II or unspecified type, not stated as uncontrolled. Diabetes with hyperosmolarity, type I [juvenile type], not stated as uncontrolled. Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled. Diabetes with hyperosmolarity, type I [juvenile type], uncontrolled. Diabetes with other coma, type II or unspecified type, not stated as uncontrolled. Diabetes with other coma, type I [juvenile type], not stated as uncontrolled. Diabetes with other coma, type II or unspecified type, uncontrolled. Diabetes with other coma, type I [juvenile type], uncontrolled. Kwashiorkor. Nutritional marasmus. Other severe protein-calorie malnutrition. Cystic fibrosis with meconium ileus. Cystic fibrosis with pulmonary manifestations. Sickle-Cell thalassemia with crisis. Hb-ss disease with crisis. Sickle-Cell/Hb-C disease with crisis. Hemolytic-uremic syndrome. Red cell aplasia (acquired)(adult)(with thymoma). Other specified aplastic anemias. Congenital factor viii disorder. Congenital factor ix disorder. Defibrination syndrome. Hemophilus meningitis. Pneumococcal meningitis. Streptococcal meningitis. Jkt 223001 PO 00000 Frm 00310 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued mmaher on DSK3CLS3C1PROD with $$_JOB Diagnosis code Code title 3203 ................................................. 3207 ................................................. 32081 ............................................... 32082 ............................................... 32089 ............................................... 3209 ................................................. 3210 ................................................. 3211 ................................................. 3212 ................................................. 3213 ................................................. 3214 ................................................. 3218 ................................................. 3220 ................................................. 3221 ................................................. 3229 ................................................. 32301 ............................................... 32302 ............................................... 3231 ................................................. 3232 ................................................. 32341 ............................................... 32342 ............................................... 32351 ............................................... 32352 ............................................... 32361 ............................................... 32362 ............................................... 32363 ............................................... 32371 ............................................... 32372 ............................................... 32381 ............................................... 32382 ............................................... 3239 ................................................. 3240 ................................................. 3241 ................................................. 3249 ................................................. 325 ................................................... 33181 ............................................... 33392 ............................................... 3361 ................................................. 3432 ................................................. 34400 ............................................... 34401 ............................................... 34402 ............................................... 34403 ............................................... 34404 ............................................... 34409 ............................................... 34481 ............................................... 3453 ................................................. 34830 ............................................... 34831 ............................................... 34839 ............................................... 3484 ................................................. 3485 ................................................. 34982 ............................................... 35801 ............................................... 41001 ............................................... 41011 ............................................... 41021 ............................................... 41031 ............................................... 41041 ............................................... 41051 ............................................... 41061 ............................................... 41071 ............................................... 41081 ............................................... 41091 ............................................... 41412 ............................................... 4150 ................................................. 41511 ............................................... 41512 ............................................... 41519 ............................................... 4210 ................................................. 4211 ................................................. 4219 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Staphylococcal meningitis. Meningitis in other bacterial diseases classified elsewhere. Anaerobic meningitis. Meningitis due to gram-negative bacteria, not elsewhere classified. Meningitis due to other specified bacteria. Meningitis due to unspecified bacterium. Cryptococcal meningitis. Meningitis in other fungal diseases. Meningitis due to viruses not elsewhere classified. Meningitis due to trypanosomiasis. Meningitis in sarcoidosis. Meningitis due to other nonbacterial organisms classified elsewhere. Nonpyogenic meningitis. Eosinophilic meningitis. Meningitis, unspecified. Encephalitis and encephalomyelitis in viral diseases classified elsewhere. Myelitis in viral diseases classified elsewhere. Encephalitis, myelitis, and encephalomyelitis in rickettsial diseases classified elsewhere. Encephalitis, myelitis, and encephalomyelitis in protozoal diseases classified elsewhere. Other encephalitis and encephalomyelitis due to infection classified elsewhere. Other myelitis due to infection classified elsewhere. Encephalitis and encephalomyelitis following immunization procedures. Myelitis following immunization procedures. Infectious acute disseminated encephalomyelitis (ADEM). Other postinfectious encephalitis and encephalomyelitis. Postinfectious myelitis. Toxic encephalitis and encephalomyelitis. Toxic myelitis. Other causes of encephalitis and encephalomyelitis. Other causes of myelitis. Unspecified causes of encephalitis, myelitis, and encephalomyelitis. Intracranial abscess. Intraspinal abscess. Intracranial and intraspinal abscess of unspecified site. Phlebitis and thrombophlebitis of intracranial venous sinuses. Reye’s syndrome. Neuroleptic malignant syndrome. Vascular myelopathies. Congenital quadriplegia. Quadriplegia, unspecified. Quadriplegia, C1–C4, complete. Quadriplegia, C1–C4, incomplete. Quadriplegia, C5–C7, complete. Quadriplegia, C5–C7, incomplete. Other quadriplegia. Locked-in state. Grand mal status, epileptic. Encephalopathy, unspecified. Metabolic encephalopathy. Other encephalopathy. Compression of brain. Cerebral edema. Toxic encephalopathy. Myasthenia gravis with (acute) exacerbation. Acute myocardial infarction of anterolateral wall, initial episode of care. Acute myocardial infarction of other anterior wall, initial episode of care. Acute myocardial infarction of inferolateral wall, initial episode of care. Acute myocardial infarction of inferoposterior wall, initial episode of care. Acute myocardial infarction of other inferior wall, initial episode of care. Acute myocardial infarction of other lateral wall, initial episode of care. True posterior wall infarction, initial episode of care. Subendocardial infarction, initial episode of care. Acute myocardial infarction of other specified sites, initial episode of care. Acute myocardial infarction of unspecified site, initial episode of care. Dissection of coronary artery. Acute cor pulmonale. Iatrogenic pulmonary embolism and infarction. Septic pulmonary embolism. Other pulmonary embolism and infarction. Acute and subacute bacterial endocarditis. Acute and subacute infective endocarditis in diseases classified elsewhere. Acute endocarditis, unspecified. Jkt 223001 PO 00000 Frm 00311 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 24989 24990 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued mmaher on DSK3CLS3C1PROD with $$_JOB Diagnosis code Code title 4220 ................................................. 42290 ............................................... 42291 ............................................... 42292 ............................................... 42293 ............................................... 42299 ............................................... 42741 ............................................... 42742 ............................................... 4275 ................................................. 42821 ............................................... 42823 ............................................... 42831 ............................................... 42833 ............................................... 42841 ............................................... 42843 ............................................... 4295 ................................................. 4296 ................................................. 430 ................................................... 431 ................................................... 4320 ................................................. 4321 ................................................. 43301 ............................................... 43311 ............................................... 43321 ............................................... 43331 ............................................... 43381 ............................................... 43391 ............................................... 43401 ............................................... 43411 ............................................... 43491 ............................................... 44100 ............................................... 44101 ............................................... 44102 ............................................... 44103 ............................................... 4411 ................................................. 4413 ................................................. 4415 ................................................. 4416 ................................................. 44321 ............................................... 44322 ............................................... 44323 ............................................... 44324 ............................................... 44329 ............................................... 4466 ................................................. 452 ................................................... 4530 ................................................. 4532 ................................................. 4560 ................................................. 45620 ............................................... 46401 ............................................... 46411 ............................................... 46421 ............................................... 46431 ............................................... 46451 ............................................... 4800 ................................................. 4801 ................................................. 4802 ................................................. 4803 ................................................. 4808 ................................................. 4809 ................................................. 481 ................................................... 4820 ................................................. 4821 ................................................. 4822 ................................................. 48230 ............................................... 48231 ............................................... 48232 ............................................... 48239 ............................................... 48240 ............................................... 48241 ............................................... 48249 ............................................... 48281 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Acute myocarditis in diseases classified elsewhere. Acute myocarditis, unspecified. Idiopathic myocarditis. Septic myocarditis. Toxic myocarditis. Other acute myocarditis. Ventricular fibrillation. Ventricular flutter. Cardiac arrest. Acute systolic heart failure. Acute on chronic systolic heart failure. Acute diastolic heart failure. Acute on chronic diastolic heart failure. Acute combined systolic and diastolic heart failure. Acute on chronic combined systolic and diastolic heart failure. Rupture of chordae tendineae. Rupture of papillary muscle. Subarachnoid hemorrhage. Intracerebral hemorrhage. Nontraumatic extradural hemorrhage. Subdural hemorrhage. Occlusion and stenosis of basilar artery with cerebral infarction. Occlusion and stenosis of carotid artery with cerebral infarction. Occlusion and stenosis of vertebral artery with cerebral infarction. Occlusion and stenosis of multiple and bilateral precerebral arteries with cerebral infarction. Occlusion and stenosis of other specified precerebral artery with cerebral infarction. Occlusion and stenosis of unspecified precerebral artery with cerebral infarction. Cerebral thrombosis with cerebral infarction. Cerebral embolism with cerebral infarction. Cerebral artery occlusion, unspecified with cerebral infarction. Dissection of aorta, unspecified site. Dissection of aorta, thoracic. Dissection of aorta, abdominal. Dissection of aorta, thoracoabdominal. Thoracic aneurysm, ruptured. Abdominal aneurysm, ruptured. Aortic aneurysm of unspecified site, ruptured. Thoracoabdominal aneurysm, ruptured. Dissection of carotid artery. Dissection of iliac artery. Dissection of renal artery. Dissection of vertebral artery. Dissection of other artery. Thrombotic microangiopathy. Portal vein thrombosis. Budd-chiari syndrome. Embolism and thrombosis of vena cava. Esophageal varices with bleeding. Esophageal varices in diseases classified elsewhere, with bleeding. Acute laryngitis with obstruction. Acute tracheitis with obstruction. Acute laryngotracheitis with obstruction. Acute epiglottitis with obstruction. Supraglottitis unspecified with obstruction. Pneumonia due to adenovirus. Pneumonia due to respiratory syncytial virus. Pneumonia due to parainfluenza virus. Pneumonia due to sars-associated coronavirus. Pneumonia due to other virus not elsewhere classified. Viral pneumonia, unspecified. Pneumococcal pneumonia [streptococcus pneumoniae pneumonia]. Pneumonia due to klebsiella pneumoniae. Pneumonia due to pseudomonas. Pneumonia due to hemophilus influenzae (h. influenzae). Pneumonia due to streptococcus, unspecified. Pneumonia due to streptococcus, group a. Pneumonia due to streptococcus, group b. Pneumonia due to other streptococcus. Pneumonia due to staphylococcus, unspecified. Pneumonia due to staphylococcus aureus. Other staphylococcus pneumonia. Pneumonia due to anaerobes. Jkt 223001 PO 00000 Frm 00312 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued mmaher on DSK3CLS3C1PROD with $$_JOB Diagnosis code Code title 48282 ............................................... 48283 ............................................... 48284 ............................................... 48289 ............................................... 4829 ................................................. 4830 ................................................. 4831 ................................................. 4838 ................................................. 4841 ................................................. 4843 ................................................. 4845 ................................................. 4846 ................................................. 4847 ................................................. 4848 ................................................. 485 ................................................... 486 ................................................... 4870 ................................................. 5061 ................................................. 5070 ................................................. 5071 ................................................. 5078 ................................................. 5100 ................................................. 5109 ................................................. 5111 ................................................. 5118 ................................................. 5120 ................................................. 5130 ................................................. 5131 ................................................. 5184 ................................................. 5185 ................................................. 51881 ............................................... 51884 ............................................... 5192 ................................................. 53021 ............................................... 5304 ................................................. 5307 ................................................. 53082 ............................................... 53084 ............................................... 53100 ............................................... 53101 ............................................... 53110 ............................................... 53111 ............................................... 53120 ............................................... 53121 ............................................... 53131 ............................................... 53140 ............................................... 53141 ............................................... 53150 ............................................... 53151 ............................................... 53160 ............................................... 53161 ............................................... 53171 ............................................... 53191 ............................................... 53200 ............................................... 53201 ............................................... 53210 ............................................... 53211 ............................................... 53220 ............................................... 53221 ............................................... 53231 ............................................... 53240 ............................................... 53241 ............................................... 53250 ............................................... 53251 ............................................... 53260 ............................................... 53261 ............................................... 53271 ............................................... 53291 ............................................... 53300 ............................................... 53301 ............................................... 53310 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Pneumonia due to escherichia coli [e.coli]. Pneumonia due to other gram-negative bacteria. Pneumonia due to legionnaires’ disease. Pneumonia due to other specified bacteria. Bacterial pneumonia, unspecified. Pneumonia due to mycoplasma pneumoniae. Pneumonia due to chlamydia. Pneumonia due to other specified organism. Pneumonia in cytomegalic inclusion disease. Pneumonia in whooping cough. Pneumonia in anthrax. Pneumonia in aspergillosis. Pneumonia in other systemic mycoses. Pneumonia in other infectious diseases classified elsewhere. Bronchopneumonia, organism unspecified. Pneumonia, organism unspecified. Influenza with pneumonia. Acute pulmonary edema due to fumes and vapors. Pneumonitis due to inhalation of food or vomitus. Pneumonitis due to inhalation of oils and essences. Pneumonitis due to other solids and liquids. Empyema with fistula. Empyema without mention of fistula. Pleurisy with effusion, with mention of a bacterial cause other than tuberculosis. Other specified forms of pleural effusion, except tuberculous. Spontaneous tension pneumothorax. Abscess of lung. Abscess of mediastinum. Acute edema of lung, unspecified. Pulmonary insufficiency following trauma and surgery. Acute respiratory failure. Acute and chronic respiratory failure. Mediastinitis. Ulcer of esophagus with bleeding. Perforation of esophagus. Gastroesophageal laceration-hemorrhage syndrome. Esophageal hemorrhage. Tracheoesophageal fistula. Acute gastric ulcer with hemorrhage, without mention of obstruction. Acute gastric ulcer with hemorrhage, with obstruction. Acute gastric ulcer with perforation, without mention of obstruction. Acute gastric ulcer with perforation, with obstruction. Acute gastric ulcer with hemorrhage and perforation, without mention of obstruction. Acute gastric ulcer with hemorrhage and perforation, with obstruction. Acute gastric ulcer without mention of hemorrhage or perforation, with obstruction. Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction. Chronic or unspecified gastric ulcer with hemorrhage, with obstruction. Chronic or unspecified gastric ulcer with perforation, without mention of obstruction. Chronic or unspecified gastric ulcer with perforation, with obstruction. Chronic or unspecified gastric ulcer with hemorrhage and perforation, without mention of obstruction. Chronic or unspecified gastric ulcer with hemorrhage and perforation, with obstruction. Chronic gastric ulcer without mention of hemorrhage or perforation, with obstruction. Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, with obstruction. Acute duodenal ulcer with hemorrhage, without mention of obstruction. Acute duodenal ulcer with hemorrhage, with obstruction. Acute duodenal ulcer with perforation, without mention of obstruction. Acute duodenal ulcer with perforation, with obstruction. Acute duodenal ulcer with hemorrhage and perforation, without mention of obstruction. Acute duodenal ulcer with hemorrhage and perforation, with obstruction. Acute duodenal ulcer without mention of hemorrhage or perforation, with obstruction. Chronic or unspecified duodenal ulcer with hemorrhage, without mention of obstruction. Chronic or unspecified duodenal ulcer with hemorrhage, with obstruction. Chronic or unspecified duodenal ulcer with perforation, without mention of obstruction. Chronic or unspecified duodenal ulcer with perforation, with obstruction. Chronic or unspecified duodenal ulcer with hemorrhage and perforation, without mention of obstruction. Chronic or unspecified duodenal ulcer with hemorrhage and perforation, with obstruction. Chronic duodenal ulcer without mention of hemorrhage or perforation, with obstruction. Duodenal ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, with obstruction. Acute peptic ulcer of unspecified site with hemorrhage, without mention of obstruction. Acute peptic ulcer of unspecified site with hemorrhage, with obstruction. Acute peptic ulcer of unspecified site with perforation, without mention of obstruction. Jkt 223001 PO 00000 Frm 00313 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 24991 24992 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued Diagnosis code mmaher on DSK3CLS3C1PROD with $$_JOB 53311 53320 53321 53331 53340 53341 53350 53351 53360 53361 53371 53391 Code title ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 53400 ............................................... 53401 ............................................... 53410 ............................................... 53411 ............................................... 53420 ............................................... 53421 ............................................... 53431 ............................................... 53440 ............................................... 53441 ............................................... 53450 ............................................... 53451 ............................................... 53460 ............................................... 53461 ............................................... 53471 ............................................... 53491 ............................................... 53501 ............................................... 53511 ............................................... 53521 ............................................... 53531 ............................................... 53541 ............................................... 53551 ............................................... 53561 ............................................... 53783 ............................................... 53784 ............................................... 5400 ................................................. 5401 ................................................. 55000 ............................................... 55001 ............................................... 55002 ............................................... 55003 ............................................... 55100 ............................................... 55101 ............................................... 55102 ............................................... 55103 ............................................... 5511 ................................................. 55120 ............................................... 55121 ............................................... 55129 ............................................... 5513 ................................................. 5518 ................................................. 5519 ................................................. 5570 ................................................. 5602 ................................................. 56202 ............................................... 56203 ............................................... 56212 ............................................... 56213 ............................................... 5670 ................................................. 5671 ................................................. 56721 ............................................... 56722 ............................................... 56723 ............................................... 56729 ............................................... 56731 ............................................... 56738 ............................................... 56739 ............................................... 56781 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Acute peptic ulcer of unspecified site with perforation, with obstruction. Acute peptic ulcer of unspecified site with hemorrhage and perforation, without mention of obstruction. Acute peptic ulcer of unspecified site with hemorrhage and perforation, with obstruction. Acute peptic ulcer of unspecified site without mention of hemorrhage and perforation, with obstruction. Chronic or unspecified peptic ulcer of unspecified site with hemorrhage, without mention of obstruction. Chronic or unspecified peptic ulcer of unspecified site with hemorrhage, with obstruction. Chronic or unspecified peptic ulcer of unspecified site with perforation, without mention of obstruction. Chronic or unspecified peptic ulcer of unspecified site with perforation, with obstruction. Chronic or unspecified peptic ulcer of unspecified site with hemorrhage and perforation, without mention of obstruction. Chronic or unspecified peptic ulcer of unspecified site with hemorrhage and perforation, with obstruction. Chronic peptic ulcer of unspecified site without mention of hemorrhage or perforation, with obstruction. Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, with obstruction. Acute gastrojejunal ulcer with hemorrhage, without mention of obstruction. Acute gastrojejunal ulcer, with hemorrhage, with obstruction. Acute gastrojejunal ulcer with perforation, without mention of obstruction. Acute gastrojejunal ulcer with perforation, with obstruction. Acute gastrojejunal ulcer with hemorrhage and perforation, without mention of obstruction. Acute gastrojejunal ulcer with hemorrhage and perforation, with obstruction. Acute gastrojejunal ulcer without mention of hemorrhage or perforation, with obstruction. Chronic or unspecified gastrojejunal ulcer with hemorrhage, without mention of obstruction. Chronic or unspecified gastrojejunal ulcer, with hemorrhage, with obstruction. Chronic or unspecified gastrojejunal ulcer with perforation, without mention of obstruction. Chronic or unspecified gastrojejunal ulcer with perforation, with obstruction. Chronic or unspecified gastrojejunal ulcer with hemorrhage and perforation, without mention of obstruction. Chronic or unspecified gastrojejunal ulcer with hemorrhage and perforation, with obstruction. Chronic gastrojejunal ulcer without mention of hemorrhage or perforation, with obstruction. Gastrojejunal ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation, with obstruction. Acute gastritis with hemorrhage. Atrophic gastritis with hemorrhage. Gastric mucosal hypertrophy with hemorrhage. Alcoholic gastritis with hemorrhage. Other specified gastritis with hemorrhage. Unspecified gastritis and gastroduodenitis with hemorrhage. Duodenitis with hemorrhage. Angiodysplasia of stomach and duodenum with hemorrhage. Dielulafoy lesion (hemorrhagic) of stomach and duodenum. Acute appendicitis with generalized peritonitis. Acute appendicitis with peritoneal abscess. Unilateral or unspecified inguinal hernia, with gangrene. Recurrent unilateral or unspecified inguinal hernia, with gangrene. Bilateral inguinal hernia, with gangrene. Recurrent bilateral inguinal hernia, with gangrene. Unilateral or unspecified femoral hernia with gangrene. Recurrent unilateral or unspecified femoral hernia with gangrene. Bilateral femoral hernia with gangrene. Recurrent bilateral femoral hernia with gangrene. Umbilical hernia with gangrene. Unspecified ventral hernia with gangrene. Incisional ventral hernia, with gangrene. Other ventral hernia with gangrene. Diaphragmatic hernia with gangrene. Hernia of other specified sites, with gangrene. Hernia of unspecified site, with gangrene. Acute vascular insufficiency of intestine. Volvulus. Diverticulosis of small intestine with hemorrhage. Diverticulitis of small intestine with hemorrhage. Diverticulosis of colon with hemorrhage. Diverticulitis of colon with hemorrhage. Peritonitis in infectious diseases classified elsewhere. Pneumococcal peritonitis. Peritonitis (acute) generalized. Peritoneal abscess. Spontaneous bacterial peritonitis. Other suppurative peritonitis. Psoas muscle abscess. Other retroperitoneal abscess. Other retroperitoneal infections. Choleperitonitis. Jkt 223001 PO 00000 Frm 00314 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued mmaher on DSK3CLS3C1PROD with $$_JOB Diagnosis code Code title 56789 ............................................... 5679 ................................................. 56881 ............................................... 56983 ............................................... 56985 ............................................... 56986 ............................................... 570 ................................................... 5720 ................................................. 5721 ................................................. 5722 ................................................. 5724 ................................................. 5734 ................................................. 57481 ............................................... 5754 ................................................. 5762 ................................................. 5763 ................................................. 5770 ................................................. 5800 ................................................. 5804 ................................................. 58081 ............................................... 58089 ............................................... 5809 ................................................. 5834 ................................................. 5836 ................................................. 5845 ................................................. 5846 ................................................. 5847 ................................................. 5848 ................................................. 5849 ................................................. 5856 ................................................. 59011 ............................................... 5902 ................................................. 5966 ................................................. 6145 ................................................. 63430 ............................................... 63431 ............................................... 63432 ............................................... 63450 ............................................... 63451 ............................................... 63452 ............................................... 63461 ............................................... 63462 ............................................... 63530 ............................................... 63531 ............................................... 63532 ............................................... 63550 ............................................... 63551 ............................................... 63552 ............................................... 63560 ............................................... 63561 ............................................... 63562 ............................................... 63630 ............................................... 63631 ............................................... 63632 ............................................... 63650 ............................................... 63651 ............................................... 63652 ............................................... 63660 ............................................... 63661 ............................................... 63662 ............................................... 63730 ............................................... 63731 ............................................... 63732 ............................................... 63750 ............................................... 63751 ............................................... 63752 ............................................... 63760 ............................................... 63761 ............................................... 63762 ............................................... 6383 ................................................. 6385 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Other specified peritonitis. Unspecified peritonitis. Hemoperitoneum (nontraumatic). Perforation of intestine. Angiodysplasia of intestine with hemorrhage. Dieulafoy lesion (hemorrhagic) of intestine. Acute and subacute necrosis of liver. Abscess of liver. Portal pyemia. Hepatic coma. Hepatorenal syndrome. Hepatic infarction. Calculus of gallbladder and bile duct with acute and chronic cholecystitis, with obstruction. Perforation of gallbladder. Obstruction of bile duct. Perforation of bile duct. Acute pancreatitis. Acute glomerulonephritis with lesion of proliferative glomerulonephritis. Acute glomerulonephritis with lesion of rapidly progressive glomerulonephritis. Acute glomerulonephritis in diseases classified elsewhere. Acute glomerulonephritis with other specified pathological lesion in kidney. Acute glomerulonephritis with unspecified pathological lesion in kidney. Nephritis and nephropathy, not specified as acute or chronic, with lesion of rapidly progressive glomerulonephritis. Nephritis and nephropathy, not specified as acute or chronic, with lesion of renal cortical necrosis. Acute renal failure with lesion of tubular necrosis. Acute renal failure with lesion of renal cortical necrosis. Acute renal failure with lesion of renal medullary (papillary) necrosis. Acute renal failure with other specified pathological lesion in kidney. Acute renal failure, unspecified. End stage renal disease. Acute pyelonephritis with lesion of renal medullary necrosis. Renal and perinephric abscess. Rupture of bladder, nontraumatic. Acute or unspecified pelvic peritonitis, female. Spontaneous abortion, unspecified, complicated by renal failure. Spontaneous abortion, incomplete, complicated by renal failure. Spontaneous abortion, complete, complicated by renal failure. Spontaneous abortion, unspecified, complicated by shock. Spontaneous abortion, incomplete, complicated by shock. Spontaneous abortion, complete, complicated by shock. Spontaneous abortion, incomplete, complicated by embolism. Spontaneous abortion, complete, complicated by embolism. Legally induced abortion, unspecified, complicated by renal failure. Legally induced abortion, incomplete, complicated by renal failure. Legally induced abortion, complete, complicated by renal failure. Legally induced abortion, unspecified, complicated by shock. Legally induced abortion, incomplete, complicated by shock. Legally induced abortion, complete, complicated by shock. Legally induced abortion, unspecified, complicated by embolism. Legally induced abortion, incomplete, complicated by embolism. Legally induced abortion, complete, complicated by embolism. Illegal abortion, unspecified, complicated by renal failure. Illegal abortion, incomplete, complicated by renal failure. Illegal abortion, complete, complicated by renal failure. Illegal abortion, unspecified, complicated by shock. Illegal abortion, incomplete, complicated by shock. Illegal abortion, complete, complicated by shock. Illegal abortion, unspecified, complicated by embolism. Illegal abortion, incomplete, complicated by embolism. Illegal abortion, complete, complicated by embolism. Legally unspecified type of abortion, unspecified, complicated by renal failure. Legally unspecified abortion, incomplete, complicated by renal failure. Legally unspecified abortion, complete, complicated by renal failure. Legally unspecified type of abortion, unspecified, complicated by shock. Legally unspecified abortion, incomplete, complicated by shock. Legally unspecified abortion, complete, complicated by shock. Legally unspecified type of abortion, unspecified, complicated by embolism. Legally unspecified abortion, incomplete, complicated by embolism. Legally unspecified abortion, complete, complicated by embolism. Failed attempted abortion complicated by renal failure. Failed attempted abortion complicated by shock. Jkt 223001 PO 00000 Frm 00315 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 24993 24994 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued Code title 6386 ................................................. 6393 ................................................. 6395 ................................................. 6396 ................................................. 64111 ............................................... 64113 ............................................... 64121 ............................................... 64131 ............................................... 64133 ............................................... 64211 ............................................... 64212 ............................................... 64242 ............................................... 64251 ............................................... 64252 ............................................... 64253 ............................................... 64254 ............................................... 64261 ............................................... 64262 ............................................... 64263 ............................................... 64264 ............................................... 64271 ............................................... 64272 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB Diagnosis code Failed attempted abortion complicated by embolism. Renal failure following abortion or ectopic and molar pregnancies. Shock following abortion or ectopic and molar pregnancies. Embolism following abortion or ectopic and molar pregnancies. Hemorrhage from placenta previa, with delivery. Hemorrhage from placenta previa, antepartum. Premature separation of placenta, with delivery. Antepartum hemorrhage associated with coagulation defects, with delivery. Antepartum hemorrhage associated with coagulation defects. Hypertension secondary to renal disease, with delivery. Hypertension secondary to renal disease, with delivery, with mention of postpartum complication. Mild or unspecified pre-eclampsia, with delivery, with mention of postpartum complication. Severe pre-eclampsia, with delivery. Severe pre-eclampsia, with delivery, with mention of postpartum complication. Severe pre-eclampsia, antepartum. Severe pre-eclampsia, postpartum. Eclampsia, with delivery. Eclampsia, with delivery, with mention of postpartum complication. Eclampsia, antepartum. Eclampsia, postpartum. Pre-eclampsia or eclampsia superimposed on pre-existing hypertension, with delivery. Pre-eclampsia or eclampsia superimposed on pre-existing hypertension, with delivery, with mention of postpartum complication. Pre-eclampsia or eclampsia superimposed on pre-existing hypertension, antepartum. Pre-eclampsia or eclampsia superimposed on pre-existing hypertension, postpartum. Threatened premature labor, antepartum. Early onset of delivery, delivered, with or without mention of antepartum condition. Diabetes mellitus of mother, with delivery. Diabetes mellitus of mother, with delivery, with mention of postpartum complication. Cervical incompetence, with delivery. Cervical incompetence, delivered, with mention of postpartum complication. Cervical incompetence, antepartum condition or complication. Cervical incompetence, postpartum condition or complication. Infection of amniotic cavity, delivered. Infection of amniotic cavity, antepartum. Generalized infection during labor, delivered. Generalized infection during labor, antepartum. Rupture of uterus before onset of labor, with delivery. Rupture of uterus before onset of labor, antepartum. Rupture of uterus, with delivery. Obstetric shock, with delivery, with or without mention of antepartum condition. Obstetric shock, with delivery, with mention of postpartum complication. Antepartum obstetric shock. Postpartum obstetric shock. Maternal hypotension syndrome, with delivery, with or without mention of antepartum condition. Maternal hypotension syndrome, with delivery, with mention of postpartum complication. Acute renal failure with delivery, with mention of postpartum complication. Acute renal failure following labor and delivery, postpartum condition or complication. Major puerperal infection, delivered, with mention of postpartum complication. Major puerperal infection, postpartum. Deep phlebothrombosis, antepartum, with delivery. Deep phlebothrombosis, antepartum. Deep phlebothrombosis, postpartum, with delivery. Deep phlebothrombosis, postpartum. Obstetrical air embolism, with delivery, with or without mention of antepartum condition. Obstetrical air embolism, with delivery, with mention of postpartum complication. Obstetrical air embolism, antepartum condition or complication. Obstetrical air embolism, postpartum condition or complication. Amniotic fluid embolism, with delivery, with or without mention of antepartum condition. Amniotic fluid embolism, with delivery, with mention of postpartum complication. Amniotic fluid embolism, antepartum condition or complication. Amniotic fluid embolism, postpartum condition or complication. Obstetrical blood-clot embolism, with delivery, with or without mention of antepartum condition. Obstetrical blood-clot embolism, with mention of postpartum complication. Obstetrical blood-clot embolism, antepartum. Obstetrical blood-clot embolism, postpartum. Obstetrical pyemic and septic embolism, with delivery, with or without mention of antepartum condition. Obstetrical pyemic and septic embolism, with delivery, with mention of postpartum complicaton. Obstetrical pyemic and septic embolism, antepartum. Obstetrical pyemic and septic embolism, postpartum. Other obstetrical pulmonary embolism, with delivery, with or without mention of antepartum condition. Other obstetrical pulmonary embolism, with delivery, with mention of postpartum complication. 64273 64274 64403 64421 64801 64802 65451 65452 65453 65454 65841 65843 65931 65933 66501 66503 66511 66911 66912 66913 66914 66921 66922 66932 66934 67002 67004 67131 67133 67142 67144 67301 67302 67303 67304 67311 67312 67313 67314 67321 67322 67323 67324 67331 67332 67333 67334 67381 67382 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00316 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued mmaher on DSK3CLS3C1PROD with $$_JOB Diagnosis code Code title 67383 ............................................... 67384 ............................................... 67401 ............................................... 67450 ............................................... 67451 ............................................... 67452 ............................................... 67453 ............................................... 67454 ............................................... 70702 ............................................... 70703 ............................................... 70704 ............................................... 70705 ............................................... 70706 ............................................... 70707 ............................................... 72886 ............................................... 7400 ................................................. 7401 ................................................. 7402 ................................................. 7422 ................................................. 7450 ................................................. 74510 ............................................... 74511 ............................................... 74519 ............................................... 7452 ................................................. 7453 ................................................. 7457 ................................................. 74601 ............................................... 7461 ................................................. 7462 ................................................. 7467 ................................................. 74681 ............................................... 74682 ............................................... 74684 ............................................... 74686 ............................................... 74711 ............................................... 7473 ................................................. 74781 ............................................... 74783 ............................................... 7485 ................................................. 7503 ................................................. 75161 ............................................... 75555 ............................................... 7566 ................................................. 75670 ............................................... 75671 ............................................... 75679 ............................................... 75832 ............................................... 7594 ................................................. 7670 ................................................. 7685 ................................................. 7687 ................................................. 769 ................................................... 7700 ................................................. 77012 ............................................... 77014 ............................................... 77016 ............................................... 77018 ............................................... 7702 ................................................. 7703 ................................................. 7707 ................................................. 77084 ............................................... 77086 ............................................... 77087 ............................................... 7711 ................................................. 7712 ................................................. 7713 ................................................. 77181 ............................................... 77213 ............................................... 77214 ............................................... 7722 ................................................. 7724 ................................................. 7733 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Other obstetrical pulmonary embolism, antepartum. Other obstetrical pulmonary embolism, postpartum. Cerebrovascular disorders, with delivery, with or without mention of antepartum condition. Peripartum cardiomyopathy, unspecified as to episode of care or not applicable. Peripartum cardiomyopathy, delivered, with or without mention of antepartum condition. Peripartum cardiomyopathy, delivered, with mention of postpartum condition. Peripartum cardiomyopathy, antepartum condition or complication. Peripartum cardiomyopathy, postpartum condition or complication. Decubitus ulcer, upper back. Decubitus ulcer, lower back. Decubitus ulcer, hip. Decubitus ulcer, buttock. Decubitus ulcer, ankle. Decubitus ulcer, heel. Necrotizing fasciitis. Anencephalus. Craniorachischisis. Iniencephaly. Congenital reduction deformities of brain. Common truncus. Complete transposition of great vessels. Double outlet right ventricle. Other transposition of great vessels. Tetralogy of fallot. Common ventricle. Cor biloculare. Atresia of pulmonary valve, congenital. Tricuspid atresia and stenosis, congenital. Ebstein’s anomaly. Hypoplastic left heart syndrome. Subaortic stenosis, congenital. Cor triatriatum. Congenital obstructive anomalies of heart, not elsewhere classified. Congenital heart block. Interruption of aortic arch. Congenital anomalies of pulmonary artery. Congenital anomalies of cerebrovascular system. Persistent fetal circulation. Congenital agenesis, hypoplasia, and dysplasia of lung. Congenital tracheoesophageal fistula, esophageal atresia and stenosis. Biliary atresia, congenital. Acrocephalosyndactyly. Congenital anomalies of diaphragm. Anomaly of abdominal wall, unspecified. Prune belly syndrome. Other congenital anomalies of abdominal wall. Velo-cardio-facial syndrome. Conjoined twins. Subdural and cerebral hemorrhage due to birth trauma. Severe birth asphyxia. Hypoxic-ischemic encephalopathy (HIE). Respiratory distress syndrome in newborn. Congenital pneumonia. Meconium aspiration with respiratory symptoms. Aspiration of clear amniotic fluid with respiratory symptoms. Aspiration of blood with respiratory symptoms. Other fetal and newborn aspiration with respiratory symptoms. Interstitial emphysema and related conditions of newborn. Pulmonary hemorrhage of fetus or newborn. Chronic respiratory disease arising in the perinatal period. Respiratory failure of newborn. Aspiration of postnatal stomach contents with respiratory symptoms. Respiratory arrest of newborn. Congenital cytomegalovirus infection. Other congenital infections specific to the perinatal period. Tetanus neonatorum. Septicemia [sepsis] of newborn. Intraventricular hemorrhage grade iii. Intraventricular hemorrhage grade iv. Subarachnoid hemorrhage of newborn. Gastrointestinal hemorrhage of fetus or newborn. Hydrops fetalis due to isoimmunization. Jkt 223001 PO 00000 Frm 00317 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 24995 24996 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued Diagnosis code Code title 7734 ................................................. 7744 ................................................. 7747 ................................................. 7757 ................................................. 7761 ................................................. 7762 ................................................. 7767 ................................................. 7775 ................................................. 7776 ................................................. 7780 ................................................. 7790 ................................................. 7792 ................................................. 7797 ................................................. 77985 ............................................... 78551 ............................................... 78552 ............................................... 78559 ............................................... 7991 ................................................. 80003 ............................................... 80004 ............................................... Kernicterus of fetus or newborn due to isoimmunization. Perinatal jaundice due to hepatocellular damage. Kernicterus of fetus or newborn not due to isoimmunization. Late metabolic acidosis of newborn. Transient neonatal thrombocytopenia. Disseminated intravascular coagulation in newborn. Transient neonatal neutropenia. Necrotizing enterocolitis in fetus or newborn. Perinatal intestinal perforation. Hydrops fetalis not due to isoimmunization. Convulsions in newborn. Cerebral depression, coma, and other abnormal cerebral signs in fetus or newborn. Preventricular leukomalacia. Cardiac arrest of newborn. Cardiogenic shock. Septic shock. Other shock without mention of trauma. Respiratory arrest. Closed fracture of vault of skull without mention of intracranial injury, with moderate (1–24 hours) loss of consciousness. Closed fracture of vault of skull without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Closed fracture of vault of skull without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Closed fracture of vault of skull with cerebral laceration and contusion, with state of consciousness unspecified. Closed fracture of vault of skull with cerebral laceration and contusion, with no loss of consciousness. Closed fracture of vault of skull with cerebral laceration and contusion, with brief (less than one hour) loss of consciousness. Closed fracture of vault of skull with cerebral laceration and contusion, with moderate (1–24 hours) loss of consciousness. Closed fracture of vault of skull with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Closed fracture of vault of skull with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Closed fracture of vault of skull with cerebral laceration and contusion, with loss of consciousness of unspecified duration. Closed fracture of vault of skull with cerebral laceration and contusion, with concussion, unspecified. Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with state of consciousness unspecified. Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness. Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with brief (less than one hour) loss of consciousness. Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with moderate (1–24 hours) loss of consciousness. Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration. Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with concussion, unspecified. Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with state of consciousness unspecified. Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with no loss of consciousness. Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with brief (less than one hour) loss of consciousness. Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with moderate (1–24 hours) loss of consciousness. Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration. Closed fracture of vault of skull with other and unspecified intracranial hemorrhage, with concussion, unspecified. Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with moderate (1–24 hours) loss of consciousness. 80005 ............................................... 80010 80011 80012 80013 80014 ............................................... ............................................... ............................................... ............................................... ............................................... 80015 ............................................... 80016 ............................................... 80019 ............................................... 80020 ............................................... 80021 ............................................... 80022 ............................................... 80023 ............................................... 80024 ............................................... 80025 ............................................... 80026 ............................................... 80029 80030 80031 80032 ............................................... ............................................... ............................................... ............................................... 80033 ............................................... 80034 ............................................... 80035 ............................................... 80036 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 80039 ............................................... 80043 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00318 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24997 TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued Diagnosis code Code title 80044 ............................................... Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Open fracture of vault of skull without mention of intracranial injury, with state of consciousness unspecified. Open fracture of vault of skull without mention of intracranial injury, with no loss of consciousness. Open fracture of vault of skull without mention of intracranial injury, with brief (less than one hour) loss of consciousness. Open fracture of vault of skull without mention of intracranial injury, with moderate (1–24 hours) loss of consciousness. Open fracture of vault of skull without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Open fracture of vault of skull without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Open fracture of vault of skull without mention of intracranial injury, with loss of consciousness of unspecified duration. Open fracture of vault of skull without mention of intracranial injury, with concussion, unspecified. Open fracture of vault of skull with cerebral laceration and contusion, with state of consciousness unspecified. Open fracture of vault of skull with cerebral laceration and contusion, with no loss of consciousness. Open fracture of vault of skull with cerebral laceration and contusion, with brief (less than one hour) loss of consciousness. Open fracture of vault of skull with cerebral laceration and contusion, with moderate (1–24 hours) loss of consciousness. Open fracture of vault of skull with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Open fracture of vault of skull with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Open fracture of vault of skull with cerebral laceration and contusion, with loss of consciousness of unspecified duration. Open fracture of vault of skull with cerebral laceration and contusion, with concussion, unspecified. Open fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with state of consciousness unspecified. Open fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness. Open fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with brief (less than one hour) loss of consciousness. Open fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with moderate (1–24 hours) loss of consciousness. Open fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Open fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Open fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration. Open fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, with concussion, unspecified. Open fracture of vault of skull with other and unspecified intracranial hemorrhage, with state of consciousness unspecified. Open fracture of vault of skull with other and unspecified intracranial hemorrhage, with no loss of consciousness. Open fracture of vault of skull with other and unspecified intracranial hemorrhage, with brief (less than one hour) loss of consciousness. Open fracture of vault of skull with other and unspecified intracranial hemorrhage, with moderate (1–24 hours) loss of consciousness. Open fracture of vault of skull with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours)loss of consciousness and return to pre-existing conscious level. Open fracture of vault of skull with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours)loss of consciousness, without return to pre-existing conscious level. Open fracture of vault of skull with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration. Open fracture of vault of skull with other and unspecified intracranial hemorrhage, with concussion, unspecified. Open fracture of vault of skull with intracranial injury of other and unspecified nature, with state of consciousness unspecified. Open fracture of vault of skull with intracranial injury of other and unspecified nature, with no loss of consciousness. Open fracture of vault of skull with intracranial injury of other and unspecified nature, with brief (less than one hour) loss of consciousness. Open fracture of vault of skull with intracranial injury of other and unspecified nature, with moderate (1–24 hours) loss of consciousness. Open fracture of vault of skull with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. 80045 ............................................... 80050 80051 80052 80053 80054 ............................................... ............................................... ............................................... ............................................... ............................................... 80055 ............................................... 80056 80059 80060 80061 80062 80063 80064 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 80065 ............................................... 80066 ............................................... 80069 ............................................... 80070 ............................................... 80071 ............................................... 80072 ............................................... 80073 ............................................... 80074 ............................................... 80075 ............................................... 80076 ............................................... 80079 80080 80081 80082 ............................................... ............................................... ............................................... ............................................... 80083 ............................................... 80084 ............................................... 80085 ............................................... 80086 ............................................... 80089 80090 80091 80092 ............................................... ............................................... ............................................... ............................................... 80093 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 80094 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00319 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 24998 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued Diagnosis code Code title 80095 ............................................... Open fracture of vault of skull with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Open fracture of vault of skull with intracranial injury of other and unspecified nature, with loss of consciousness of unspecified duration. Open fracture of vault of skull with intracranial injury of other and unspecified nature, with concussion, unspecified. Closed fracture of base of skull without mention of intra cranial injury, with moderate (1–24 hours) loss of consciousness. Closed fracture of base of skull without mention of intra cranial injury, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Closed fracture of base of skull without mention of intra cranial injury, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Closed fracture of base of skull with cerebral laceration and contusion, with state of consciousness unspecified. Closed fracture of base of skull with cerebral laceration and contusion, with no loss of consciousness. Closed fracture of base of skull with cerebral laceration and contusion, with brief (less than one hour) loss of consciousness. Closed fracture of base of skull with cerebral laceration and contusion, with moderate (1–24 hours) loss of consciousness. Closed fracture of base of skull with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Closed fracture of base of skull with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Closed fracture of base of skull with cerebral laceration and contusion, with loss of consciousness of unspecified duration. Closed fracture of base of skull with cerebral laceration and contusion, with concussion, unspecified. Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with state of consciousness unspecified. Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness. Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with brief (less than one hour) loss of consciousness. Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with moderate (1–24 hours) loss of consciousness. Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration. Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with concussion, unspecified. Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with state of consciousness unspecified. Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with no loss of consciousness. Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with brief (less than one hour) loss of consciousness. Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with moderate (1–24 hours) loss of consciousness. Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration. Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with concussion, unspecified. Closed fracture of base of skull with intracranial injury of other and unspecified nature, with moderate (1–24 hours) loss of consciousness. Closed fracture of base of skull with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Closed fracture of base of skull with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Open fracture of base of skull without mention of intracranial injury, with state of consciousness unspecified. Open fracture of base of skull without mention of intracranial injury, with no loss of consciousness. Open fracture of base of skull without mention of intracranial injury, with brief (less than one hour) loss of consciousness. Open fracture of base of skull without mention of intracranial injury, with moderate (1–24 hours) loss of consciousness. Open fracture of base of skull without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. 80096 ............................................... 80099 ............................................... 80103 ............................................... 80104 ............................................... 80105 ............................................... 80110 80111 80112 80113 80114 ............................................... ............................................... ............................................... ............................................... ............................................... 80115 ............................................... 80116 ............................................... 80119 ............................................... 80120 ............................................... 80121 ............................................... 80122 ............................................... 80123 ............................................... 80124 ............................................... 80125 ............................................... 80126 ............................................... 80129 80130 80131 80132 ............................................... ............................................... ............................................... ............................................... 80133 ............................................... 80134 ............................................... 80135 ............................................... 80136 ............................................... 80139 ............................................... 80143 ............................................... 80144 ............................................... 80145 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 80150 80151 80152 80153 80154 ............................................... ............................................... ............................................... ............................................... ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00320 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 24999 TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued Diagnosis code Code title 80155 ............................................... Open fracture of base of skull without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Open fracture of base of skull without mention of intracranial injury, with loss of consciousness of unspecified duration. Open fracture of base of skull without mention of intracranial injury, with concussion, unspecified. Open fracture of base of skull with cerebral laceration and contusion, with state of consciousness unspecified. Open fracture of base of skull with cerebral laceration and contusion, with no loss of consciousness. Open fracture of base of skull with cerebral laceration and contusion, with brief (less than one hour) loss of consciousness. Open fracture of base of skull with cerebral laceration and contusion, with moderate (1–24 hours) loss of consciousness. Open fracture of base of skull with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Open fracture of base of skull with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Open fracture of base of skull with cerebral laceration and contusion, with loss of consciousness of unspecified duration. Open fracture of base of skull with cerebral laceration and contusion, with concussion, unspecified. Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with state of consciousness unspecified. Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness. Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with brief (less than one hour) loss of consciousness. Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with moderate (1–24 hours) loss of consciousness. Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration. Open fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with concussion, unspecified. Open fracture of base of skull with other and unspecified intracranial hemorrhage, with state of consciousness unspecified. Open fracture of base of skull with other and unspecified intracranial hemorrhage, with no loss of consciousness. Open fracture of base of skull with other and unspecified intracranial hemorrhage, with brief (less than one hour) loss of consciousness. Open fracture of base of skull with other and unspecified intracranial hemorrhage, with moderate (1–24 hours) loss of consciousness. Open fracture of base of skull with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Open fracture of base of skull with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Open fracture of base of skull with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration. Open fracture of base of skull with other and unspecified intracranial hemorrhage, with concussion, unspecified. Open fracture of base of skull with intracranial injury of other and unspecified nature, with state of consciousness unspecified. Open fracture of base of skull with intracranial injury of other and unspecified nature, with no loss of consciousness. Open fracture of base of skull with intracranial injury of other and unspecified nature, with brief (less than one hour) loss of consciousness. Open fracture of base of skull with intracranial injury of other and unspecified nature, with moderate (1–24 hours) loss of consciousness. Open fracture of base of skull with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Open fracture of base of skull with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Open fracture of base of skull with intracranial injury of other and unspecified nature, with loss of consciousness of unspecified duration. Open fracture of base of skull with intracranial injury of other and unspecified nature, with concussion, unspecified. Other closed skull fracture without mention of intracranial injury, with moderate (1–24 hours) loss of consciousness. Other closed skull fracture without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Other closed skull fracture without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 80156 80159 80160 80161 80162 80163 80164 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 80165 ............................................... 80166 ............................................... 80169 ............................................... 80170 ............................................... 80171 ............................................... 80172 ............................................... 80173 ............................................... 80174 ............................................... 80175 ............................................... 80176 ............................................... 80179 80180 80181 80182 ............................................... ............................................... ............................................... ............................................... 80183 ............................................... 80184 ............................................... 80185 ............................................... 80186 ............................................... 80189 80190 80191 80192 ............................................... ............................................... ............................................... ............................................... 80193 ............................................... 80194 ............................................... 80195 ............................................... 80196 ............................................... 80199 ............................................... 80303 ............................................... 80304 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 80305 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00321 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25000 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued Diagnosis code 80310 80311 80312 80313 80314 Code title ............................................... ............................................... ............................................... ............................................... ............................................... 80315 ............................................... 80316 80319 80320 80321 80322 ............................................... ............................................... ............................................... ............................................... ............................................... 80323 ............................................... 80324 ............................................... 80325 ............................................... 80326 ............................................... 80329 80330 80331 80332 ............................................... ............................................... ............................................... ............................................... 80333 ............................................... 80334 ............................................... 80335 ............................................... 80336 ............................................... 80339 ............................................... 80343 ............................................... 80344 ............................................... 80345 ............................................... 80350 80351 80352 80353 80354 ............................................... ............................................... ............................................... ............................................... ............................................... 80355 ............................................... 80356 80359 80360 80361 80362 80363 80364 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 80365 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Other closed skull fracture with cerebral laceration and contusion, with state of consciousness unspecified. Other closed skull fracture with cerebral laceration and contusion, with no loss of consciousness. Other closed skull fracture with cerebral laceration and contusion, with brief (less than one hour) loss of consciousness. Other closed skull fracture with cerebral laceration and contusion, with moderate (1–24 hours) loss of consciousness. Other closed skull fracture with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Other closed skull fracture with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Other closed skull fracture with cerebral laceration and contusion, with loss of consciousness of unspecified duration. Other closed skull fracture with cerebral laceration and contusion, with concussion, unspecified. Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with state of consciousness unspecified. Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness. Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with brief (less than one hour) loss of consciousness. Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with moderate (1–24 hours) loss of consciousness. Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration. Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with concussion, unspecified. Other closed skull fracture with other and unspecified intracranial hemorrhage, with state of unconsciousness unspecified. Other closed skull fracture with other and unspecified intracranial hemorrhage, with no loss of consciousness. Other closed skull fracture with other and unspecified intracranial hemorrhage, with brief (less than one hour) loss of consciousness. Other closed skull fracture with other and unspecified intracranial hemorrhage, with moderate (1–24 hours) loss of consciousness. Other closed skull fracture with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Other closed skull fracture with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Other closed skull fracture with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration. Other closed skull fracture with other and unspecified intracranial hemorrhage, with concussion, unspecified. Other closed skull fracture with intracranial injury of other and unspecified nature, with moderate (1–24 hours) loss of consciousness. Other closed skull fracture with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Other site of closed skull fracture with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Other open skull fracture without mention of injury, with state of consciousness unspecified. Other open skull fracture without mention of intracranial injury, with no loss of consciousness. Other open skull fracture without mention of intracranial injury, with brief (less than one hour) loss of consciousness. Other open skull fracture without mention of intracranial injury, with moderate (1–24 hours) loss of consciousness. Other open skull fracture without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Other open skull fracture without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Other open skull fracture without mention of intracranial injury, with loss of consciousness of unspecified duration. Other open skull fracture without mention of intracranial injury, with concussion, unspecified. Other open skull fracture with cerebral laceration and contusion, with state of consciousness unspecified. Other open skull fracture with cerebral laceration and contusion, with no loss of consciousness. Other open skull fracture with cerebral laceration and contusion, with brief (less than one hour) loss of consciousness. Other open skull fracture with cerebral laceration and contusion, with moderate (1–24 hours) loss of consciousness. Other open skull fracture with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Other open skull fracture with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Jkt 223001 PO 00000 Frm 00322 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25001 TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued Diagnosis code 80366 80369 80370 80371 80372 Code title ............................................... ............................................... ............................................... ............................................... ............................................... 80373 ............................................... 80374 ............................................... 80375 ............................................... 80376 ............................................... 80379 80380 80381 80382 ............................................... ............................................... ............................................... ............................................... 80383 ............................................... 80384 ............................................... 80385 ............................................... 80386 ............................................... 80389 80390 80391 80392 ............................................... ............................................... ............................................... ............................................... 80393 ............................................... 80394 ............................................... 80395 ............................................... 80396 ............................................... 80399 ............................................... 80403 ............................................... 80404 ............................................... 80405 ............................................... 80410 ............................................... 80411 ............................................... 80412 ............................................... 80413 ............................................... 80414 ............................................... 80415 ............................................... 80416 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 80419 ............................................... 80420 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Other open skull fracture with cerebral laceration and contusion, with loss of consciousness of unspecified duration. Other open skull fracture with cerebral laceration and contusion, with concussion, unspecified. Other open skull fracture with subarachnoid, subdural, and extradural hemorrhage, with state of consciousness unspecified. Other open skull fracture with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness. Other open skull fracture with subarachnoid, subdural, and extradural hemorrhage, with brief (less than one hour) loss of consciousness. Other open skull fracture with subarachnoid, subdural, and extradural hemorrhage, with moderate (1–24 hours) loss of consciousness. Other open skull fracture with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Other open skull fracture with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Other open skull fracture with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration. Other open skull fracture with subarachnoid, subdural, and extradural hemorrhage, with concussion, unspecified. Other open skull fracture with other and unspecified intracranial hemorrhage, with state of consciousness unspecified. Other open skull fracture with other and unspecified intracranial hemorrhage, with no loss of consciousness. Other open skull fracture with other and unspecified intracranial hemorrhage, with brief (less than one hour) loss of consciousness. Other open skull fracture with other and unspecified intracranial hemorrhage, with moderate (1–24 hours) loss of consciousness. Other open skull fracture with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Other open skull fracture with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Other open skull fracture with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration. Other open skull fracture with other and unspecified intracranial hemorrhage, with concussion, unspecified. Other open skull fracture with intracranial injury of other and unspecified nature, with state of consciousness unspecified. Other open skull fracture with intracranial injury of other and unspecified nature, with no loss of consciousness. Other open skull fracture with intracranial injury of other and unspecified nature, with brief (less than one hour) loss of consciousness. Other open skull fracture with intracranial injury of other and unspecified nature, with moderate (1–24 hours) loss of consciousness. Other open skull fracture with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Other open skull fracture with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Other open skull fracture with intracranial injury of other and unspecified nature, with loss of consciousness of unspecified duration. Other open skull fracture with intracranial injury of other and unspecified nature, with concussion, unspecified. Closed fractures involving skull or face with other bones, without mention of intracranial injury, with moderate (1–24 hours) loss of consciousness. Closed fractures involving skull or face with other bones, without mention or intracranial injury, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Closed fractures involving skull of face with other bones, without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Closed fractures involving skull or face with other bones, with cerebral laceration and contusion, with state of consciousness unspecified. Closed fractures involving skull or face with other bones, with cerebral laceration and contusion, with no loss of consciousness. Closed fractures involving skull or face with other bones, with cerebral laceration and contusion, with brief (less than one hour) loss of consciousness. Closed fractures involving skull or face with other bones, with cerebral laceration and contusion, with moderate (1–24 hours) loss of consciousness. Closed fractures involving skull or face with other bones, with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Closed fractures involving skull or face with other bones, with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Closed fractures involving skull or face with other bones, with cerebral laceration and contusion, with loss of consciousness of unspecified duration. Closed fractures involving skull or face with other bones, with cerebral laceration and contusion, with concussion, unspecified. Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with state of consciousness unspecified. Jkt 223001 PO 00000 Frm 00323 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25002 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued Diagnosis code Code title 80421 ............................................... Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness. Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with brief (less than one hour) loss of consciousness. Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with moderate (1–24 hours) loss of consciousness. Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration. Closed fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with concussion, unspecified. Closed fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with state of consciousness unspecified. Closed fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with no loss of consciousness. Closed fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with brief (less than one hour) loss of consciousness. Closed fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with moderate (1–24 hours) loss of consciousness. Closed fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Closed fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Closed fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration. Closed fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with concussion, unspecified. Closed fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with moderate (1–24 hours) loss of consciousness. Closed fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Closed fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Open fractures involving skull or face with other bones, without mention of intracranial injury, with moderate (1–24 hours) loss of consciousness. Open fractures involving skull or face with other bones, without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Open fractures involving skull or face with other bones, without mention of intracranial injury, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Open fractures involving skull or face with other bones, with cerebral laceration and contusion, with state of consciousness unspecified. Open fractures involving skull or face with other bones, with cerebral laceration and contusion, with no loss of consciousness. Open fractures involving skull or face with other bones, with cerebral laceration and contusion, with brief (less than one hour) loss of consciousness. Open fractures involving skull or face with other bones, with cerebral laceration and contusion, with moderate (1–24 hours) loss of consciousness. Open fractures involving skull or face with other bones, with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Open fractures involving skull or face with other bones, with cerebral laceration and contusion, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Open fractures involving skull or face with other bones, with cerebral laceration and contusion, with loss of consciousness of unspecified duration. Open fractures involving skull or face with other bones, with cerebral laceration and contusion, with concussion, unspecified. Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with state of consciousness unspecified. Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness. Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with brief (less than one hour) loss of consciousness. Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with moderate (1–24 hours) loss of consciousness. Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. 80422 ............................................... 80423 ............................................... 80424 ............................................... 80425 ............................................... 80426 ............................................... 80429 ............................................... 80430 ............................................... 80431 ............................................... 80432 ............................................... 80433 ............................................... 80434 ............................................... 80435 ............................................... 80436 ............................................... 80439 ............................................... 80443 ............................................... 80444 ............................................... 80445 ............................................... 80453 ............................................... 80454 ............................................... 80455 ............................................... 80460 ............................................... 80461 ............................................... 80462 ............................................... 80463 ............................................... 80464 ............................................... 80465 ............................................... 80466 ............................................... 80469 ............................................... 80470 ............................................... 80471 ............................................... 80472 ............................................... 80473 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 80474 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00324 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25003 TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued Diagnosis code Code title 80475 ............................................... Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration. Open fractures involving skull or face with other bones with subarachnoid, subdural, and extradural hemorrhage, with concussion, unspecified. Open fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with state of consciousness unspecified. Open fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with no loss of consciousness. Open fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with brief (less than one hour) loss of consciousness. Open fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with moderate (1– 24 hours) loss of consciousness. Open fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Open fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with prolonged (more than 24 hours) loss consciousness, without return to pre-existing conscious level. Open fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with loss of consciousness of unspecified duration. Open fractures involving skull or face with other bones, with other and unspecified intracranial hemorrhage, with concussion, unspecified. Open fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with moderate (1–24 hours) loss of consciousness. Open fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Open fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with prolonged (more than 24 hours) loss of consciousness without return to pre-existing conscious level. Open fracture of cervical vertebra, unspecified level. Open fracture of first cervical vertebra. Open fracture of second cervical vertebra. Open fracture of third cervical vertebra. Open fracture of fourth cervical vertebra. Open fracture of fifth cervical vertebra. Open fracture of sixth cervical vertebra. Open fracture of seventh cervical vertebra. Open fracture of multiple cervical vertebrae. Open fracture of dorsal (thoracic) vertebra without mention of spinal cord injury. Open fracture of lumbar vertebra without mention of spinal cord injury. Open fracture of sacrum and coccyx without mention of spinal cord injury. Open fracture of unspecified part of vertebral column without mention of spinal cord injury. Closed fracture of C1–C4 level with unspecified spinal cord injury. Closed fracture of C1–C4 level with complete lesion of cord. Closed fracture of C1–C4 level with anterior cord syndrome. Closed fracture of C1–C4 level with central cord syndrome. Closed fracture of C1–C4 level with other specified spinal cord injury. Closed fracture of C5–C7 level with unspecified spinal cord injury. Closed fracture of C5–C7 level with complete lesion of cord. Closed fracture of C5–C7 level with anterior cord syndrome. Closed fracture of C5–C7 level with central cord syndrome. Closed fracture of C5–C7 level with other specified spinal cord injury. Open fracture of C1–C4 level with unspecified spinal cord injury. Open fracture of C1–C4 level with complete lesion of cord. Open fracture of C1–C4 level with anterior cord syndrome. Open fracture of C1–C4 level with central cord syndrome. Open fracture of C1–C4 level with other specified spinal cord injury. Open fracture of C5–C7 level with unspecified spinal cord injury. Open fracture of C5–C7 level with complete lesion of cord. Open fracture of C5–C7 level with anterior cord syndrome. Open fracture of C5–C7 level with central cord syndrome. Open fracture of C5–C7 level with other specified spinal cord injury. Closed fracture of T1–T6 level with unspecified spinal cord injury. Closed fracture of T1–T6 level with complete lesion of cord. Closed fracture of T1–T6 level with anterior cord syndrome. Closed fracture of T1–T6 level with central cord syndrome. Closed fracture of T1–T6 level with other specified spinal cord injury. Closed fracture of T7–T12 level with unspecified spinal cord injury. Closed fracture of T7–T12 level with complete lesion of cord. Closed fracture of T7–T12 level with anterior cord syndrome. Closed fracture of T7–T12 level with central cord syndrome. Closed fracture of T7–T12 level with other specified spinal cord injury. 80476 ............................................... 80479 ............................................... 80480 ............................................... 80481 ............................................... 80482 ............................................... 80483 ............................................... 80484 ............................................... 80485 ............................................... 80486 ............................................... 80489 ............................................... 80493 ............................................... 80494 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 80495 ............................................... 80510 ............................................... 80511 ............................................... 80512 ............................................... 80513 ............................................... 80514 ............................................... 80515 ............................................... 80516 ............................................... 80517 ............................................... 80518 ............................................... 8053 ................................................. 8055 ................................................. 8057 ................................................. 8059 ................................................. 80600 ............................................... 80601 ............................................... 80602 ............................................... 80603 ............................................... 80604 ............................................... 80605 ............................................... 80606 ............................................... 80607 ............................................... 80608 ............................................... 80609 ............................................... 80610 ............................................... 80611 ............................................... 80612 ............................................... 80613 ............................................... 80614 ............................................... 80615 ............................................... 80616 ............................................... 80617 ............................................... 80618 ............................................... 80619 ............................................... 80620 ............................................... 80621 ............................................... 80622 ............................................... 80623 ............................................... 80624 ............................................... 80625 ............................................... 80626 ............................................... 80627 ............................................... 80628 ............................................... 80629 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00325 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25004 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued mmaher on DSK3CLS3C1PROD with $$_JOB Diagnosis code Code title 80630 ............................................... 80631 ............................................... 80632 ............................................... 80633 ............................................... 80634 ............................................... 80635 ............................................... 80636 ............................................... 80637 ............................................... 80638 ............................................... 80639 ............................................... 8064 ................................................. 8065 ................................................. 80660 ............................................... 80661 ............................................... 80662 ............................................... 80669 ............................................... 80670 ............................................... 80671 ............................................... 80672 ............................................... 80679 ............................................... 8068 ................................................. 8069 ................................................. 80710 ............................................... 80711 ............................................... 80712 ............................................... 80713 ............................................... 80714 ............................................... 80715 ............................................... 80716 ............................................... 80717 ............................................... 80718 ............................................... 80719 ............................................... 8073 ................................................. 8074 ................................................. 8075 ................................................. 8076 ................................................. 8080 ................................................. 8081 ................................................. 8083 ................................................. 80851 ............................................... 80852 ............................................... 80853 ............................................... 80859 ............................................... 8089 ................................................. 8091 ................................................. 81210 ............................................... 81211 ............................................... 81212 ............................................... 81213 ............................................... 81219 ............................................... 81230 ............................................... 81231 ............................................... 81250 ............................................... 81251 ............................................... 81252 ............................................... 81253 ............................................... 81254 ............................................... 81259 ............................................... 81310 ............................................... 81311 ............................................... 81312 ............................................... 81313 ............................................... 81314 ............................................... 81315 ............................................... 81316 ............................................... 81317 ............................................... 81318 ............................................... 81330 ............................................... 81331 ............................................... 81332 ............................................... 81333 ............................................... 81350 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Open fracture of T1–T6 level with unspecified spinal cord injury. Open fracture of T1–T6 level with complete lesion of cord. Open fracture of T1–T6 level with anterior cord syndrome. Open fracture of T1–T6 level with central cord syndrome. Open fracture of T1–T6 level with other specified spinal cord injury. Open fracture of T7–T12 level with unspecified spinal cord injury. Open fracture of T7–T12 level with complete lesion of cord. Open fracture of T7–T12 level with anterior cord syndrome. Open fracture of T7–T12 level with central cord syndrome. Open fracture of T7–T–12 level with other specified spinal cord injury. Closed fracture of lumbar spine with spinal cord injury. Open fracture of lumbar spine with spinal cord injury. Closed fracture of sacrum and coccyx with unspecified spinal cord injury. Closed fracture of sacrum and coccyx with complete cauda equina lesion. Closed fracture of sacrum and coccyx with other cauda equina injury. Closed fracture of sacrum and coccyx with other spinal cord injury. Open fracture of sacrum and coccyx with unspecified spinal cord injury. Open fracture of sacrum and coccyx with complete cauda equina lesion. Open fracture of sacrum and coccyx with other cauda equina injury. Open fracture of sacrum and coccyx with other spinal cord injury. Closed fracture of unspecified vertebra with spinal cord injury. Open fracture of unspecified vertebra with spinal cord injury. Open fracture of rib(s), unspecified. Open fracture of one rib. Open fracture of two ribs. Open fracture of three ribs. Open fracture of four ribs. Open fracture of five ribs. Open fracture of six ribs. Open fracture of seven ribs. Open fracture of eight or more ribs. Open fracture of multiple ribs, unspecified. Open fracture of sternum. Flail chest. Closed fracture of larynx and trachea. Open fracture of larynx and trachea. Closed fracture of acetabulum. Open fracture of acetabulum. Open fracture of pubis. Open fracture of ilium. Open fracture of ischium. Multiple open pelvic fractures with disruption of pelvic circle. Open fracture of other specified part of pelvis. Unspecified open fracture of pelvis. Fracture of bones of trunk, open. Fracture of unspecified part of upper end of humerus, open. Fracture of surgical neck of humerus, open. Fracture of anatomical neck of humerus, open. Fracture of greater tuberosity of humerus, open. Other open fracture of upper end of humerus. Fracture of unspecified part of humerus, open. Fracture of shaft of humerus, open. Fracture of unspecified part of lower end of humerus, open. Supracondylar fracture of humerus, open. Fracture of lateral condyle of humerus, open. Fracture of medial condyle of humerus, open. Fracture of unspecified condyle(s) of humerus, open. Other fracture of lower end of humerus, open. Open fracture of upper end of forearm, unspecified. Fracture of olecranon process of ulna, open. Fracture of coronoid process of ulna, open. Monteggia’s fracture, open. Other and unspecified open fractures of proximal end of ulna (alone). Fracture of head of radius, open. Fracture of neck of radius, open. Other and unspecified open fractures of proximal end of radius (alone). Fracture of radius with ulna, upper end (any part), open. Fracture of shaft of radius or ulna, unspecified, open. Fracture of shaft of radius (alone), open. Fracture of shaft of ulna (alone), open. Fracture of shaft of radius with ulna, open. Open fracture of lower end of forearm, unspecified. Jkt 223001 PO 00000 Frm 00326 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25005 TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued Code title 81351 ............................................... 81352 ............................................... 81353 ............................................... 81354 ............................................... 81390 ............................................... 81391 ............................................... 81392 ............................................... 81393 ............................................... 82000 ............................................... 82001 ............................................... 82002 ............................................... 82003 ............................................... 82009 ............................................... 82010 ............................................... 82011 ............................................... 82012 ............................................... 82013 ............................................... 82019 ............................................... 82020 ............................................... 82021 ............................................... 82022 ............................................... 82030 ............................................... 82031 ............................................... 82032 ............................................... 8208 ................................................. 8209 ................................................. 82100 ............................................... 82101 ............................................... 82110 ............................................... 82111 ............................................... 82130 ............................................... 82131 ............................................... 82132 ............................................... 82133 ............................................... 82139 ............................................... 82310 ............................................... 82311 ............................................... 82312 ............................................... 82330 ............................................... 82331 ............................................... 82332 ............................................... 82390 ............................................... 82391 ............................................... 82392 ............................................... 8280 ................................................. 8281 ................................................. 83510 ............................................... 83511 ............................................... 83512 ............................................... 83513 ............................................... 83910 ............................................... 83911 ............................................... 83912 ............................................... 83913 ............................................... 83914 ............................................... 83915 ............................................... 83916 ............................................... 83917 ............................................... 83918 ............................................... 83930 ............................................... 83931 ............................................... 83950 ............................................... 83959 ............................................... 83971 ............................................... 8504 ................................................. 85105 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB Diagnosis code Colles’ fracture, open. Other open fractures of distal end of radius (alone). Fracture of distal end of ulna (alone), open. Fracture of lower end of radius with ulna, open. Fracture of unspecified part of forearm, open. Fracture of unspecified part of radius (alone), open. Fracture of unspecified part of ulna (alone), open. Fracture of unspecified part of radius with ulna, open. Fracture of unspecified intracapsular section of neck of femur, closed. Fracture of epiphysis (separation) (upper) of neck of femur, closed. Fracture of midcervical section of femur, closed. Fracture of base of neck of femur, closed. Other transcervical fracture of femur, closed. Fracture of unspecified intracapsular section of neck of femur, open. Fracture of epiphysis (separation) (upper) of neck of femur, open. Fracture of midcervical section of femur, open. Fracture of base of neck of femur, open. Other transcervical fracture of femur, open. Fracture of unspecified trochanteric section of femur, closed. Fracture of intertrochanteric section of femur, closed. Fracture of subtrochanteric section of femur, closed. Fracture of unspecified trochanteric section of femur, open. Fracture of intertrochanteric section of femur, open. Fracture of subtrochanteric section of femur, open. Fracture of unspecified part of neck of femur, closed. Fracture of unspecified part of neck of femur, open. Fracture of unspecified part of femur, closed. Fracture of shaft of femur, closed. Fracture of unspecified part of femur, open. Fracture of shaft of femur, open. Fracture of lower end of femur, unspecified part, open. Fracture of femoral condyle, open. Fracture of lower epiphysis of femur, open. Supracondylar fracture of femur, open. Other fracture of lower end of femur, open. Open fracture of upper end of tibia. Open fracture of upper end of fibula. Open fracture of upper end of fibula with tibia. Open fracture of shaft of tibia. Open fracture of shaft of fibula. Open fracture of shaft of fibula with tibia. Open fracture of unspecified part of tibia. Open fracture of unspecified part of fibula. Open fracture of unspecified part of fibula with tibia. Multiple fractures involving both lower limbs, lower with upper limb, and lower limb(s) with rib(s) and sternum, closed. Multiple fractures involving both lower limbs, lower with upper limb, and lower limb(s) with rib(s) and sternum, open. Open dislocation of hip, unspecified site. Open posterior dislocation of hip. Open obturator dislocation of hip. Other open anterior dislocation of hip. Open dislocation, cervical vertebra, unspecified. Open dislocation, first cervical vertebra. Open dislocation, second cervical vertebra. Open dislocation, third cervical vertebra. Open dislocation, fourth cervical vertebra. Open dislocation, fifth cervical vertebra. Open dislocation, sixth cervical vertebra. Open dislocation, seventh cervical vertebra. Open dislocation, multiple cervical vertebrae. Open dislocation, lumbar vertebra. Open dislocation, thoracic vertebra. Open dislocation, vertebra, unspecified site. Open dislocation, other vertebra. Open dislocation, sternum. Concussion with prolonged loss of consciousness, without return to pre-existing conscious level. Cortex (cerebral) contusion without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Cortex (cerebral) contusion with open intracranial wound, without mention of specific state of consciousness. Cortex (cerebral) contusion with open intracranial wound, with no loss of consciousness. Cortex (cerebral) contusion with open intracranial wound, with brief (less than one hour) loss of consciousness. 85110 ............................................... 85111 ............................................... 85112 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00327 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25006 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued Diagnosis code Code title 85113 ............................................... 85114 ............................................... Cortex (cerebral) contusion with open intracranial wound, with moderate (1–24 hours) loss of consciousness. Cortex (cerebral) contusion with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Cortex (cerebral) contusion with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Cortex (cerebral) contusion with open intracranial wound, with loss of consciousness of unspecified duration. Cortex (cerebral) contusion with open intracranial wound, with concussion, unspecified. Cortex (cerebral) laceration without mention of open intracranial wound, with state of consciousness unspecified. Cortex (cerebral) laceration without mention of open intracranial wound, with no loss of consciousness. Cortex (cerebral) laceration without mention of open intracranial wound, with brief (less than one hour) loss of consciousness. Cortex (cerebral) laceration without mention of open intracranial wound, with moderate (1–24 hours) loss of consciousness. Cortex (cerebral) laceration without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Cortex (cerebral) laceration without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Cortex (cerebral) laceration without mention of open intracranial wound, with loss of consciousness of unspecified duration. Cortex (cerebral) laceration without mention of open intracranial wound, with concussion, unspecified. Cortex (cerebral) laceration with open intracranial wound, with state of consciousness unspecified. Cortex (cerebral) laceration with open intracranial wound, with no loss of consciousness. Cortex (cerebral) laceration with open intracranial wound, with brief (less than one hour) loss of consciousness. Cortex (cerebral) laceration with open intracranial wound, with moderate (1–24 hours) loss of consciousness. Cortex (cerebral) laceration with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Cortex (cerebral) laceration with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Cortex (cerebral) laceration with open intracranial wound, with loss of consciousness of unspecified duration. Cortex (cerebral) laceration with open intracranial wound, with concussion, unspecified. Cerebellar or brain stem contusion without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Cerebellar or brain stem contusion with open intracranial wound, with state of consciousness unspecified. Cerebellar or brain stem contusion with open intracranial wound, with no loss of consciousness. Cerebellar or brain stem contusion with open intracranial wound, with brief (less than one hour) loss of consciousness. Cerebellar or brain stem contusion with open intracranial wound, with moderate (1–24 hours) loss of consciousness. Cerebellar or brain stem contusion with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Cerebellar or brain stem contusion with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Cerebellar or brain stem contusion with open intracranial wound, with loss of consciousness of unspecified duration. Cerebellar or brain stem contusion with open intracranial wound, with concussion, unspecified. Cerebellar or brain stem laceration without mention of open intracranial wound, with state of consciousness unspecified. Cerebellar or brain stem laceration without mention of open intracranial wound, with no loss of consciousness. Cerebellar or brain stem laceration without mention of open intracranial wound, with brief (less than 1 hour) loss of consciousness. Cerebellar or brain stem laceration without mention of open intracranial wound, with moderate (1–24 hours) loss of consciousness. Cerebellar or brain stem laceration without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Cerebellar or brain stem laceration without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Cerebellar or brain stem laceration without mention of open intracranial wound, with loss of consciousness of unspecified duration. Cerebellar or brain stem laceration without mention of open intracranial wound, with concussion, unspecified. Cerebellar or brain stem laceration with open intracranial wound, with state of consciousness unspecified. Cerebellar or brain stem laceration with open intracranial wound, with no loss of consciousness. Cerebellar or brain stem laceration with open intracranial wound, with brief (less than one hour) loss of consciousness. Cerebellar or brain stem laceration with open intracranial wound, with moderate (1–24 hours) loss of consciousness. Cerebellar or brain stem laceration with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Cerebellar or brain stem laceration with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. 85115 ............................................... 85116 85119 85120 85121 85122 85123 85124 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 85125 ............................................... 85126 85129 85130 85131 85132 85133 85134 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 85135 ............................................... 85136 ............................................... 85139 ............................................... 85145 ............................................... 85150 85151 85152 85153 85154 ............................................... ............................................... ............................................... ............................................... ............................................... 85155 ............................................... 85156 85159 85160 85161 85162 ............................................... ............................................... ............................................... ............................................... ............................................... 85163 ............................................... 85164 ............................................... 85165 ............................................... 85166 ............................................... 85169 85170 85171 85172 85173 85174 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 85175 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00328 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25007 TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued Diagnosis code Code title 85176 ............................................... 85179 ............................................... 85180 ............................................... Cerebellar or brain stem laceration with open intracranial wound, with loss of consciousness of unspecified duration. Cerebellar or brain stem laceration with open intracranial wound, with concussion, unspecified. Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with state of consciousness unspecified. Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with no loss of consciousness. Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with brief (less than one hour) loss of consciousness. Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with moderate (1–24 hours) loss of consciousness. Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with loss of consciousness of unspecified duration. Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, with concussion, unspecified. Other and unspecified cerebral laceration and contusion, with open intracranial wound, with state of consciousness unspecified. Other and unspecified cerebral laceration and contusion, with open intracranial wound, with no loss of consciousness. Other and unspecified cerebral laceration and contusion, with open intracranial wound, with brief (less than one hour) loss of consciousness. Other and unspecified cerebral laceration and contusion, with open intracranial wound, with moderate (1–24 hours) loss of consciousness. Other and unspecified cerebral laceration and contusion, with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Other and unspecified cerebral laceration and contusion, with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Other and unspecified cerebral laceration and contusion, with open intracranial wound, with loss of consciousness of unspecified duration. Other and unspecified cerebral laceration and contusion, with open intracranial wound, with concussion, unspecified. Subarachnoid hemorrhage following injury, without mention of open intracranial wound, with state of consciousness unspecified. Subarachnoid hemorrhage following injury, without mention of open intracranial wound, with no loss of consciousness. Subarachnoid hemorrhage following injury, without mention of open intracranial wound, with brief (less than one hour) loss of consciousness. Subarachnoid hemorrhage following injury, without mention of open intracranial wound, with moderate (1–24 hours) loss of consciousness. Subarachnoid hemorrhage following injury, without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Subarachnoid hemorrhage following injury, without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Subarachnoid hemorrhage following injury, without mention of open intracranial wound, with loss of consciousness of unspecified duration. Subarachnoid hemorrhage following injury, without mention of open intracranial wound, with concussion, unspecified. Subarachnoid hemorrhage following injury, with open intracranial wound, with state of consciousness unspecified. Subarachnoid hemorrhage following injury, with open intracranial wound, with no loss of consciousness. Subarachnoid hemorrhage following injury, with open intracranial wound, with brief (less than one hour) loss of consciousness. Subarachnoid hemorrhage following injury, with open intracranial wound, with moderate (1–24 hours) loss of consciousness. Subarachnoid hemorrhage following injury, with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Subarachnoid hemorrhage following injury, with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Subarachnoid hemorrhage following injury, with open intracranial wound, with loss of consciousness of unspecified duration. Subarachnoid hemorrhage following injury, with open intracranial wound, with concussion, unspecified. Subdural hemorrhage following injury, without mention of open intracranial wound, with state of consciousness unspecified. Subdural hemorrhage following injury, without mention of open intracranial wound, with no loss of consciousness. Subdural hemorrhage following injury, without mention of open intracranial wound, with brief (less than one hour) loss of consciousness. 85181 ............................................... 85182 ............................................... 85183 ............................................... 85184 ............................................... 85185 ............................................... 85186 ............................................... 85189 ............................................... 85190 ............................................... 85191 ............................................... 85192 ............................................... 85193 ............................................... 85194 ............................................... 85195 ............................................... 85196 ............................................... 85199 ............................................... 85200 ............................................... 85201 ............................................... 85202 ............................................... 85203 ............................................... 85204 ............................................... 85205 ............................................... 85206 ............................................... 85209 85210 85211 85212 85213 85214 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 85215 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 85216 85219 85220 85221 85222 ............................................... ............................................... ............................................... ............................................... ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00329 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25008 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued Diagnosis code Code title 85223 ............................................... Subdural hemorrhage following injury, without mention of open intracranial wound, with moderate (1–24 hours) loss of consciousness. Subdural hemorrhage following injury, without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Subdural hemorrhage following injury, without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Subdural hemorrhage following injury, without mention of open intracranial wound, with loss of consciousness of unspecified duration. Subdural hemorrhage following injury, without mention of open intracranial wound, with concussion, unspecified. Subdural hemorrhage following injury, with open intracranial wound, with state of consciousness unspecified. Subdural hemorrhage following injury, with open intracranial wound, with no loss of consciousness. Subdural hemorrhage following injury, with open intracranial wound, with brief (less than one hour) loss of consciousness. Subdural hemorrhage following injury, with open intracranial wound, with moderate (1–24 hours) loss of consciousness. Subdural hemorrhage following injury, with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Subdural hemorrhage following injury, with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Subdural hemorrhage following injury, with open intracranial wound, with loss of consciousness of unspecified duration. Subdural hemorrhage following injury, with open intracranial wound, with concussion, unspecified. Extradural hemorrhage following injury, without mention of open intracranial wound, with state of consciousness unspecified. Extradural hemorrhage following injury, without mention of open intracranial wound, with no loss of consciousness. Extradural hemorrhage following injury, without mention of open intracranial wound, with brief (less than 1 hour) loss of consciousness. Extradural hemorrhage following injury, without mention of open intracranial wound, with moderate (1–24 hours) loss of consciousness. Extradural hemorrhage following injury, without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Extradural hemorrhage following injury, without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Extradural hemorrhage following injury, without mention of open intracranial wound, with loss of consciousness of unspecified duration. Extradural hemorrhage following injury, without mention of open intracranial wound, with concussion, unspecified. Extradural hemorrhage following injury, with open intracranial wound, with state of consciousness unspecified. Extradural hemorrhage following injury, with open intracranial wound, with no loss of consciousness. Extradural hemorrhage following injury, with open intracranial wound, with brief (less than one hour) loss of consciousness. Extradural hemorrhage following injury, with open intracranial wound, with moderate (1–24 hours) loss of consciousness. Extradural hemorrhage following injury, with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Extradural hemorrhage following injury, with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Extradural hemorrhage following injury, with open intracranial wound, with loss of consciousness of unspecified duration. Extradural hemorrhage following injury, with open intracranial wound, with concussion, unspecified. Other and unspecified intracranial hemorrhage following injury, without mention of open intracranial wound, with state of consciousness unspecified. Other and unspecified intracranial hemorrhage following injury, without mention of open intracranial wound, with no loss of consciousness. Other and unspecified intracranial hemorrhage following injury, without mention of open intracranial wound, with brief (less than one hour) loss of consciousness. Other and unspecified intracranial hemorrhage following injury, without mention of open intracranial wound, with moderate (1– 24 hours) loss of consciousness. Other and unspecified intracranial hemorrhage following injury, without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Other and unspecified intracranial hemorrhage following injury. without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Other and unspecified intracranial hemorrhage following injury, without mention of open intracranial wound, with loss of consciousness of unspecified duration. Other and unspecified intracranial hemorrhage following injury, without mention of open intracranial wound, with concussion, unspecified. Other and unspecified intracranial hemorrhage following injury, with open intracranial wound, with state of consciousness unspecified. Other and unspecified intracranial hemorrhage following injury, with open intracranial wound, with no loss of consciousness. 85224 ............................................... 85225 ............................................... 85226 ............................................... 85229 85230 85231 85232 85233 85234 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 85235 ............................................... 85236 85239 85240 85241 85242 ............................................... ............................................... ............................................... ............................................... ............................................... 85243 ............................................... 85244 ............................................... 85245 ............................................... 85246 ............................................... 85249 85250 85251 85252 85253 85254 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 85255 ............................................... 85256 ............................................... 85259 ............................................... 85300 ............................................... 85301 ............................................... 85302 ............................................... 85303 ............................................... 85304 ............................................... 85305 ............................................... 85306 ............................................... 85309 ............................................... 85310 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 85311 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00330 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25009 TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued Diagnosis code Code title 85312 ............................................... Other and unspecified intracranial hemorrhage following injury, with open intracranial wound, with brief (less than one hour) loss of consciousness. Other and unspecified intracranial hemorrhage following injury, with open intracranial wound, with moderate (1–24 hours) loss of consciousness. Other and unspecified intracranial hemorrhage following injury, with open intracranial wound, with prolonged( more than 24 hours) loss of consciousness and return to pre-existing conscious level. Other and unspecified intracranial hemorrhage following injury, with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Other and unspecified intracranial hemorrhage following injury, with open intracranial wound, with loss of consciousness of unspecified duration. Other and unspecified intracranial hemorrhage following injury, with open intracranial wound, with concussion, unspecified. Intracranial injury of other and unspecified nature, without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Intracranial injury of other and unspecified nature, with open intracranial wound, with state of consciousness unspecified. Intracranial injury of other and unspecified nature, with open intracranial wound, with no loss of consciousness. Intracranial injury of other and unspecified nature, with open intracranial wound, with brief (less than one hour) loss of consciousness. Intracranial injury of other and unspecified nature, with open intracranial wound, with moderate (1–24 hours) loss of consciousness. Intracranial injury of other and unspecified nature, with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Intracranial injury of other and unspecified nature, with open intracranial wound, with prolonged (more than 24 hours) loss of consciousness, without return to pre-existing conscious level. Intracranial injury of other and unspecified nature, with open intracranial wound, with loss of consciousness of unspecified duration. Intracranial injury of other and unspecified nature, with open intracranial wound, with concussion, unspecified. Traumatic pneumothorax with open wound into thorax. Traumatic hemothorax without mention of open wound into thorax. Traumatic hemothorax with open wound into thorax. Traumatic pneumohemothorax without mention of open wound into thorax. Traumatic pneumohemothorax with open wound into thorax. Laceration of heart without penetration of heart chambers or open wound into thorax. Laceration of heart with penetration of heart chambers, without mention of open wound into thorax. Unspecified injury of heart with open wound into thorax. Contusion of heart with open wound into thorax. Laceration of heart without penetration of heart chambers, with open wound into thorax. Laceration of heart with penetration of heart chambers and open wound into thorax. Laceration of lung without open wound into thorax. Unspecified injury of lung with open wound into thorax. Contusion of lung with open wound into thorax. Laceration of lung with open wound into thorax. Injury to diaphragm with open wound into cavity. Injury to bronchus without open wound into cavity. Injury to esophagus without mention of open wound into cavity. Injury to bronchus with open wound into cavity. Injury to esophagus with open wound into cavity. Injury to other specified intrathoracic organs with open wound into cavity. Injury to multiple and unspecified intrathoracic organs with open wound into cavity. Injury to stomach with open wound into cavity. Injury to small intestine, unspecified site, with open wound into cavity. Injury to duodenum with open wound into cavity. Other injury to small intestine with open wound into cavity. Injury to colon, unspecified site, with open wound into cavity. Injury to ascending (right) colon with open wound into cavity. Injury to transverse colon with open wound into cavity. Injury to descending (left) colon with open wound into cavity. Injury to sigmoid colon with open wound into cavity. Injury to rectum with open wound into cavity. Injury to multiple sites in colon and rectum with open wound into cavity. Other injury to colon and rectum with open wound into cavity. Injury to gastrointestinal tract, unspecified site, with open wound into cavity. Injury to pancreas head with open wound into cavity. Injury to pancreas body with open wound into cavity. Injury to pancreas tail with open wound into cavity. Injury to pancreas, multiple and unspecified sites, with open wound into cavity. Injury to appendix with open wound into cavity. Injury to other and unspecified gastrointestinal sites with open wound into cavity. Laceration of liver, moderate, without mention of open wound into cavity. Laceration of liver, major, without mention of open wound into cavity. 85313 ............................................... 85314 ............................................... 85315 ............................................... 85316 ............................................... 85319 ............................................... 85405 ............................................... 85410 ............................................... 85411 ............................................... 85412 ............................................... 85413 ............................................... 85414 ............................................... 85415 ............................................... 85416 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 85419 ............................................... 8601 ................................................. 8602 ................................................. 8603 ................................................. 8604 ................................................. 8605 ................................................. 86102 ............................................... 86103 ............................................... 86110 ............................................... 86111 ............................................... 86112 ............................................... 86113 ............................................... 86122 ............................................... 86130 ............................................... 86131 ............................................... 86132 ............................................... 8621 ................................................. 86221 ............................................... 86222 ............................................... 86231 ............................................... 86232 ............................................... 86239 ............................................... 8629 ................................................. 8631 ................................................. 86330 ............................................... 86331 ............................................... 86339 ............................................... 86350 ............................................... 86351 ............................................... 86352 ............................................... 86353 ............................................... 86354 ............................................... 86355 ............................................... 86356 ............................................... 86359 ............................................... 86390 ............................................... 86391 ............................................... 86392 ............................................... 86393 ............................................... 86394 ............................................... 86395 ............................................... 86399 ............................................... 86403 ............................................... 86404 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00331 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25010 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued mmaher on DSK3CLS3C1PROD with $$_JOB Diagnosis code Code title 86410 ............................................... 86411 ............................................... 86412 ............................................... 86413 ............................................... 86414 ............................................... 86415 ............................................... 86419 ............................................... 86503 ............................................... 86504 ............................................... 86510 ............................................... 86511 ............................................... 86512 ............................................... 86513 ............................................... 86514 ............................................... 86519 ............................................... 86603 ............................................... 86610 ............................................... 86611 ............................................... 86612 ............................................... 86613 ............................................... 8671 ................................................. 8673 ................................................. 8675 ................................................. 8677 ................................................. 8679 ................................................. 86810 ............................................... 86811 ............................................... 86812 ............................................... 86813 ............................................... 86814 ............................................... 86819 ............................................... 8691 ................................................. 87400 ............................................... 87401 ............................................... 87402 ............................................... 87410 ............................................... 87411 ............................................... 87412 ............................................... 8876 ................................................. 8877 ................................................. 8962 ................................................. 8963 ................................................. 8976 ................................................. 8977 ................................................. 9010 ................................................. 9011 ................................................. 9012 ................................................. 9013 ................................................. 90140 ............................................... 90141 ............................................... 90142 ............................................... 90183 ............................................... 9020 ................................................. 90210 ............................................... 90211 ............................................... 90219 ............................................... 90220 ............................................... 90221 ............................................... 90222 ............................................... 90223 ............................................... 90224 ............................................... 90225 ............................................... 90226 ............................................... 90227 ............................................... 90229 ............................................... 90231 ............................................... 90232 ............................................... 90233 ............................................... 90234 ............................................... 90239 ............................................... 90240 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Unspecified injury to liver with open wound into cavity. Hematoma and contusion of liver with open wound into cavity. Laceration of liver, minor, with open wound into cavity. Laceration of liver, moderate, with open wound into cavity. Laceration of liver, major, with open wound into cavity. Laceration of liver, unspecified, with open wound into cavity. Other injury to liver with open wound into cavity. Laceration of spleen extending into parenchyma without mention of open wound into cavity. Massive parenchymal disruption of spleen without mention of open wound into cavity. Unspecified injury to spleen with open wound into cavity. Hematoma of spleen, without rupture of capsule, with open wound into cavity. Capsular tears to spleen, without major disruption of parenchyma, with open wound into cavity. Laceration of spleen extending into parenchyma, with open wound into cavity. Massive parenchyma disruption of spleen with open wound into cavity. Other injury to spleen with open wound into cavity. Complete disruption of kidney parenchyma, without mention of open wound into cavity. Unspecified injury to kidney with open wound into cavity. Hematoma of kidney, without rupture of capsule, with open wound into cavity. Laceration of kidney with open wound into cavity. Complete disruption of kidney parenchyma, with open wound into cavity. Injury to bladder and urethra with open wound into cavity. Injury to ureter with open wound into cavity. Injury to uterus with open wound into cavity. Injury to other specified pelvic organs with open wound into cavity. Injury to unspecified pelvic organ with open wound into cavity. Injury to unspecified intra-abdominal organ, with open wound into cavity. Injury to adrenal gland, with open wound into cavity. Injury to bile duct and gallbladder, with open wound into cavity. Injury to peritoneum with open wound into cavity. Injury to retroperitoneum with open wound into cavity. Injury to other and multiple intra-abdominal organs, with open wound into cavity. Internal injury to unspecified or ill-defined organs with open wound into cavity. Open wound of larynx with trachea, uncomplicated. Open wound of larynx, uncomplicated. Open wound of trachea, uncomplicated. Open wound of larynx with trachea, complicated. Open wound of larynx, complicated. Open wound of trachea, complicated. Traumatic amputation of arm and hand (complete) (partial), bilateral (any level), without mention of complication. Traumatic amputation of arm and hand (complete) (partial), bilateral (any level), complicated. Traumatic amputation of foot (complete) (partial), bilateral, without mention of complication. Traumatic amputation of foot (complete) (partial), bilateral, complicated. Traumatic amputation of leg(s) (complete) (partial), bilateral (any level), without mention of complication. Traumatic amputation of leg(s) (complete) (partial), bilateral (any level), complicated. Injury to thoracic aorta. Injury to innominate and subclavian arteries. Injury to superior vena cava. Injury to innominate and subclavian veins. Injury to pulmonary vessel(s), unspecified. Injury to pulmonary artery. Injury to pulmonary vein. Injury to multiple blood vessels of thorax. Injury to abdominal aorta. Injury to inferior vena cava, unspecified. Injury to hepatic veins. Injury to other specified branches of inferior vena cava. Injury to celiac and mesenteric arteries, unspecified. Injury to gastric artery. Injury to hepatic artery. Injury to splenic artery. Injury to other specified branches of celiac axis. Injury to superior mesenteric artery (trunk). Injury to primary branches of superior mesenteric artery. Injury to inferior mesenteric artery. Injury to other celiac and mesenteric arteries. Injury to superior mesenteric vein and primary subdivisions. Injury to inferior mesenteric vein. Injury to portal vein. Injury to splenic vein. Injury to other portal and splenic veins. Injury to renal vessel(s), unspecified. Jkt 223001 PO 00000 Frm 00332 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25011 TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued mmaher on DSK3CLS3C1PROD with $$_JOB Diagnosis code Code title 90241 ............................................... 90242 ............................................... 90249 ............................................... 90250 ............................................... 90251 ............................................... 90252 ............................................... 90253 ............................................... 90254 ............................................... 90259 ............................................... 90287 ............................................... 90300 ............................................... 90301 ............................................... 90302 ............................................... 9040 ................................................. 9041 ................................................. 9042 ................................................. 90440 ............................................... 90441 ............................................... 90442 ............................................... 94821 ............................................... 94822 ............................................... 94831 ............................................... 94832 ............................................... 94833 ............................................... 94841 ............................................... 94842 ............................................... 94843 ............................................... 94844 ............................................... 94851 ............................................... 94852 ............................................... 94853 ............................................... 94854 ............................................... 94855 ............................................... 94861 ............................................... 94862 ............................................... 94863 ............................................... 94864 ............................................... 94865 ............................................... 94866 ............................................... 94871 ............................................... 94872 ............................................... 94873 ............................................... 94874 ............................................... 94875 ............................................... 94876 ............................................... 94877 ............................................... 94881 ............................................... 94882 ............................................... 94883 ............................................... 94884 ............................................... 94885 ............................................... 94886 ............................................... 94887 ............................................... 94888 ............................................... 94891 ............................................... 94892 ............................................... 94893 ............................................... 94894 ............................................... 94895 ............................................... 94896 ............................................... 94897 ............................................... 94898 ............................................... 94899 ............................................... 95200 ............................................... 95201 ............................................... 95202 ............................................... 95203 ............................................... 95204 ............................................... 95205 ............................................... 95206 ............................................... 95207 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Injury to renal artery. Injury to renal vein. Injury to other renal blood vessels. Injury to iliac vessel(s), unspecified. Injury to hypogastric artery. Injury to hypogastric vein. Injury to iliac artery. Injury to iliac vein. Injury to other iliac blood vessels. Injury to multiple blood vessels of abdomen and pelvis. Injury to axillary vessel(s), unspecified. Injury to axillary artery. Injury to axillary vein. Injury to common femoral artery. Injury to superficial femoral artery. Injury to femoral veins. Injury to popliteal vessel(s), unspecified. Injury to popliteal artery. Injury to popliteal vein. Burn (any degree) involving 20–29 percent of body surface with third degree burn of 10–19%. Burn (any degree) involving 20–29 percent of body surface with third degree burn of 20–29%. Burn (any degree) involving 30–39 percent of body surface with third degree burn of 10–19%. Burn (any degree) involving 30–39 percent of body surface with third degree burn of 20–29%. Burn (any degree) involving 30–39 percent of body surface with third degree burn of 30–39%. Burn (any degree) involving 40–49 percent of body surface with third degree burn of 10–19%. Burn (any degree) involving 40–49 percent of body surface with third degree burn of 20–29%. Burn (any degree) involving 40–49 percent of body surface with third degree burn of 30–39%. Burn (any degree) involving 40–49 percent of body surface with third degree burn of 40–49%. Burn (any degree) involving 50–59 percent of body surface with third degree burn of 10–19%. Burn (any degree) involving 50–59 percent of body surface with third degree burn of 20–29%. Burn (any degree) involving 50–59 percent of body surface with third degree burn of 30–39%. Burn (any degree) involving 50–59 percent of body surface with third degree burn of 40–49%. Burn (any degree) involving 50–59 percent of body surface with third degree burn of 50–59%. Burn (any degree) involving 60–69 percent of body surface with third degree burn of 10–19%. Burn (any degree) involving 60–69 percent of body surface with third degree burn of 20–29%. Burn (any degree) involving 60–69 percent of body surface with third degree burn of 30–39%. Burn (any degree) involving 60–69 percent of body surface with third degree burn of 40–49%. Burn (any degree) involving 60–69 percent of body surface with third degree burn of 50–59%. Burn (any degree) involving 60–69 percent of body surface with third degree burn of 60–69%. Burn (any degree) involving 70–79 percent of body surface with third degree burn of 10–19%. Burn (any degree) involving 70–79 percent of body surface with third degree burn of 20–29%. Burn (any degree) involving 70–79 percent of body surface with third degree burn of 30–39%. Burn (any degree) involving 70–79 percent of body surface with third degree burn of 40–49%. Burn (any degree) involving 70–79 percent of body surface with third degree burn of 50–59%. Burn (any degree) involving 70–79 percent of body surface with third degree burn of 60–69%. Burn (any degree) involving 70–79 percent of body surface with third degree burn of 70–79%. Burn (any degree) involving 80–89 percent of body surface with third degree burn of 10–19%. Burn (any degree) involving 80–89 percent of body surface with third degree burn of 20–29%. Burn (any degree) involving 80–89 percent of body surface with third degree burn of 30–39%. Burn (any degree) involving 80–89 percent of body surface with third degree burn of 40–49%. Burn (any degree) involving 80–89 percent of body surface with third degree burn of 50–59%. Burn (any degree) involving 80–89 percent of body surface with third degree burn of 60–69%. Burn (any degree) involving 80–89 percent of body surface with third degree burn of 70–79%. Burn (any degree) involving 80–89 percent of body surface with third degree burn of 80–89%. Burn (any degree) involving 90 percent or more of body surface with third degree burn of 10–19%. Burn (any degree) involving 90 percent or more of body surface with third degree burn of 20–29%. Burn (any degree) involving 90 percent or more of body surface with third degree burn of 30–39%. Burn (any degree) involving 90 percent or more of body surface with third degree burn of 40–49%. Burn (any degree) involving 90 percent or more of body surface with third degree burn of 50–59%. Burn (any degree) involving 90 percent or more of body surface with third degree burn of 60–69%. Burn (any degree) involving 90 percent or more of body surface with third degree burn of 70–79%. Burn (any degree) involving 90 percent or more of body surface with third degree burn of 80–89%. Burn (any degree) involving 90 percent or more of body surface with third degree burn of 90% or more of body surface. C1–C4 level spinal cord injury, unspecified. C1–C4 level with complete lesion of spinal cord. C1–C4 level with anterior cord syndrome. C1–C4 level with central cord syndrome. C1–C4 level with other specified spinal cord injury. C5–C7 level spinal cord injury, unspecified. C5–C7 level with complete lesion of spinal cord. C5–C7 level with anterior cord syndrome. Jkt 223001 PO 00000 Frm 00333 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25012 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6J.—MAJOR COMPLICATION AND COMORBIDITY (MAJOR CC) LIST—Continued Diagnosis code Code title 95208 ............................................... 95209 ............................................... 95210 ............................................... 95211 ............................................... 95212 ............................................... 95213 ............................................... 95214 ............................................... 95215 ............................................... 95216 ............................................... 95217 ............................................... 95218 ............................................... 95219 ............................................... 9522 ................................................. 9523 ................................................. 9524 ................................................. 9528 ................................................. 9580 ................................................. 9581 ................................................. 9584 ................................................. 9585 ................................................. 99591 ............................................... 99592 ............................................... 99594 ............................................... 9991 ................................................. C5–C7 level with central cord syndrome. C5–C7 level with other specified spinal cord injury. T1–T6 level spinal cord injury, unspecified. T1–T6 level with complete lesion of spinal cord. T1–T6 level with anterior cord syndrome. T1–T6 level with central cord syndrome. T1–T6 level with other specified spinal cord injury. T7–T12 level spinal cord injury, unspecified. T7–T12 level with complete lesion of spinal cord. T7–T12 level with anterior cord syndrome. T7–T12 level with central cord syndrome. T7–T12 level with other specified spinal cord injury. Lumbar spinal cord injury without spinal bone injury. Sacral spinal cord injury without spinal bone injury. Cauda equina spinal cord injury without spinal bone injury. Multiple sites of spinal cord injury without spinal bone injury. Air embolism as an early complication of trauma. Fat embolism as an early complication of trauma. Traumatic shock. Traumatic anuria. Sepsis. Severe sepsis. Systemic inflammatory response syndrome due to noninfectious process with acute organ dysfunction. Air embolism as a complication of medical care, not elsewhere classified. TABLE 6K.—COMPLICATION AND COMORBIDITY LIST Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 0010 ................................................. 0011 ................................................. 0019 ................................................. 0020 ................................................. 0021 ................................................. 0022 ................................................. 0023 ................................................. 0029 ................................................. 0030 ................................................. 00323 ............................................... 00324 ............................................... 00329 ............................................... 0038 ................................................. 0039 ................................................. 0040 ................................................. 0050 ................................................. 0051 ................................................. 0052 ................................................. 0053 ................................................. 0054 ................................................. 00581 ............................................... 00589 ............................................... 0060 ................................................. 0061 ................................................. 0062 ................................................. 0068 ................................................. 0071 ................................................. 0072 ................................................. 0074 ................................................. 0075 ................................................. 0078 ................................................. 0079 ................................................. 00800 ............................................... 00801 ............................................... 00802 ............................................... 00803 ............................................... 00804 ............................................... 00809 ............................................... 0081 ................................................. 0082 ................................................. 0083 ................................................. 00841 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Cholera due to vibrio cholerae. Cholera due to vibrio cholerae el tor. Cholera, unspecified. Typhoid fever. Paratyphoid fever A. Paratyphoid fever B. Paratyphoid fever C. Paratyphoid fever, unspecified. Salmonella gastroenteritis. Salmonella arthritis. Salmonella osteomyelitis. Other localized salmonella infections. Other specified salmonella infections. Salmonella infection, unspecified. Shigella dysenteriae. Staphylococcal food poisoning. Botulism food poisoning. Food poisoning due to clostridium perfringens (c. welchii). Food poisoning due to other clostridia. Food poisoning due to vibrio parahaemolyticus. Food poisoning due to vibrio vulnificus. Other bacterial food poisoning. Acute amebic dysentery without mention of abscess. Chronic intestinal amebiasis without mention of abscess. Amebic nondysenteric colitis. Amebic infection of other sites. Giardiasis. Coccidiosis. Cryptosporidiosis. Cyclosporiasis. Other specified protozoal intestinal diseases. Unspecified protozoal intestinal disease. Intestinal infection due to e. coli, unspecified. Intestinal infection due to enteropathogenic e. coli. Intestinal infection due to enterotoxigenic e. coli. Intestinal infection due to enteroinvasive e. coli. Intestinal infection due to enterohemorrhagic e. coli. Intestinal infection due to other intestinal e. coli infections. Intestinal infection due to arizona group of paracolon bacilli. Intestinal infection due to aerobacter aerogenes. Intestinal infection due to proteus (mirabilis) (morganii). Intestinal infection due to staphylococcus. Jkt 223001 PO 00000 Frm 00334 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25013 TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title 00842 ............................................... 00843 ............................................... 00844 ............................................... 00845 ............................................... 00846 ............................................... 00847 ............................................... 00849 ............................................... 0085 ................................................. 00861 ............................................... 00862 ............................................... 00863 ............................................... 00864 ............................................... 00865 ............................................... 00866 ............................................... 00867 ............................................... 00869 ............................................... 0090 ................................................. 0091 ................................................. 0092 ................................................. 0093 ................................................. 01000 ............................................... 01001 ............................................... 01002 ............................................... 01003 ............................................... 01004 ............................................... 01005 ............................................... 01006 ............................................... Intestinal infection due to pseudomonas. Intestinal infection due to campylobacter. Intestinal infection due to yersinia enterocolitica. Intestinal infection due to clostridium difficile. Intestinal infection due to other anaerobes. Intestinal infection due to other gram-negative bacteria. Intestinal infection due to other organisms. Bacterial enteritis, unspecified. Enteritis due to rotavirus. Enteritis due to adenovirus. Enteritis due to norwalk virus. Enteritis due to other small round viruses [srv’s]. Enteritis due to calcivirus. Enteritis due to astrovirus. Enteritis due to enterovirus nec. Enteritis due to other viral enteritis. Infectious colitis, enteritis, and gastroenteritis. Colitis, enteritis, and gastroenteritis of presumed infectious origin. Infectious diarrhea. Diarrhea of presumed infectious origin. Primary tuberculous complex, unspecified examination. Primary tuberculous complex, bacteriological or histological examination not done. Primary tuberculous complex, bacteriological or histological examination results unknown (at present). Primary tuberculous complex, tubercle bacilli found (in sputum) by microscopy. Primary tuberculous complex, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Primary tuberculous complex, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Primary tuberculous complex, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculous pleurisy in primary progressive tuberculosis, confirmation unspecified. Tuberculous pleurisy in primary progressive tuberculosis, bacteriological or histological examination not done. Tuberculous pleurisy in primary progressive tuberculosis, bacteriological or histological examination results unknown (at present). Tuberculous pleurisy in primary progressive tuberculosis, tubercle bacilli found (in sputum) by microscopy. Tuberculous pleurisy in primary progressive tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculous pleurisy in primary progressive tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculous pleurisy in primary progressive tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Other primary progressive tuberculosis, confirmation unspecified. Other primary progressive tuberculosis, bacteriological or histological examination not done. Other primary progressive tuberculosis, bacteriological or histological examination results unknown (at present). Other primary progressive tuberculosis, tubercle bacilli found (in sputum) by microscopy. Other primary progressive tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Other primary progressive tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Other primary progressive tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Primary tuberculous infection, unspecified type, confirmation unspecified. Primary tuberculous infection, unspecified type, bacteriological or histological examination not done. Primary tuberculous infection, unspecified type, bacteriological or histological examination results unknown (at present). Primary tuberculous infection, unspecified type, tubercle bacilli found (in sputum) by microscopy. Primary tuberculous infection, unspecified type, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Primary tuberculous infection, unspecified type, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Primary tuberculous infection, unspecified type, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of lung, infiltrative, confirmation unspecified. Tuberculosis of lung, infiltrative, bacteriological or histological examination not done. Tuberculosis of lung, infiltrative, bacteriological or histological examination results unknown (at present). Tuberculosis of lung, infiltrative, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of lung, infiltrative, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of lung, infiltrative, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 01010 ............................................... 01011 ............................................... 01012 ............................................... 01013 ............................................... 01014 ............................................... 01015 ............................................... 01016 ............................................... 01080 01081 01082 01083 01084 01085 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01086 ............................................... 01090 01091 01092 01093 01094 ............................................... ............................................... ............................................... ............................................... ............................................... 01095 ............................................... 01096 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 01100 01101 01102 01103 01104 01105 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00335 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25014 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title 01106 ............................................... Tuberculosis of lung, infiltrative, tubercle bacilli not found bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of lung, nodular, unspecified examination. Tuberculosis of lung, nodular, bacteriological or histological examination not done. Tuberculosis of lung, nodular, bacteriological or histological examination results unknown (at present). Tuberculosis of lung, nodular, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of lung, nodular, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of lung, nodular, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of lung, nodular, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of lung with cavitation, unspecified examination. Tuberculosis of lung with cavitation, bacteriological or histological examination not done. Tuberculosis of lung with cavitation, bacteriological or histological examination results unknown (at present). Tuberculosis of lung with cavitation, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of lung with cavitation, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of lung with cavitation, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of lung with cavitation, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of bronchus, unspecified examination. Tuberculosis of bronchus, bacteriological or histological examination not done. Tuberculosis of bronchus, bacteriological or histological examination results unknown (at present). Tuberculosis of bronchus, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of bronchus, tubercle bacilli not found (in sputum) by microscopy, but found in bacterial culture. Tuberculosis of bronchus, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of bronchus, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculous fibrosis of lung, unspecified examination. Tuberculous fibrosis of lung, bacteriological or histological examination not done. Tuberculous fibrosis of lung, bacteriological or histological examination unknown (at present). Tuberculous fibrosis of lung, tubercle bacilli found (in sputum) by microscopy. Tuberculous fibrosis of lung, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculous fibrosis of lung, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculous fibrosis of lung, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculous bronchiectasis, unspecified examination. Tuberculous bronchiectasis, bacteriological or histological examination not done. Tuberculous bronchiectasis, bacteriological or histological examination results unknown (at present). Tuberculous bronchiectasis, tubercle bacilli found (in sputum) by microscopy. Tuberculous bronchiectasis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculous bronchiectasis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculous bronchiectasis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculous pneumothorax, unspecified examination. Tuberculous pneumothorax, bacteriological or histological examination not done. Tuberculous pneumothorax, bacteriological or histological examination results unknown (at present). Tuberculous pneumothorax, tubercle bacilli found (in sputum) by microscopy. Tuberculous pneumothorax, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculous pneumothorax, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculous pneumothorax, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Other specified pulmonary tuberculosis, unspecified confirmation. Other specified pulmonary tuberculosis, bacteriological or histological examination not done. Other specified pulmonary tuberculosis, bacteriological or histological examination results unknown (at present). Other specified pulmonary tuberculosis, tubercle bacilli found (in sputum) by microscopy. Other specified pulmonary tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Other specified pulmonary tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Other specified pulmonary tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). 01110 01111 01112 01113 01114 01115 01116 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01120 01121 01122 01123 01124 01125 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01126 ............................................... 01130 01131 01132 01133 01134 01135 01136 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01140 01141 01142 01143 01144 01145 01146 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01150 01151 01152 01153 01154 01155 01156 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01170 01171 01172 01173 01174 01175 01176 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01180 01181 01182 01183 01184 01185 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 01186 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00336 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25015 TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code 01190 01191 01192 01193 01194 01195 Code title ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01196 ............................................... 01200 01201 01202 01203 01204 01205 01206 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01210 01211 01212 01213 01214 01215 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01216 ............................................... 01220 01221 01222 01223 01224 01225 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01226 ............................................... 01230 01231 01232 01233 01234 01235 01236 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01280 01281 01282 01283 01284 01285 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01286 ............................................... 01480 01481 01482 01483 01484 ............................................... ............................................... ............................................... ............................................... ............................................... 01485 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 01486 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Unspecified pulmonary tuberculosis, confirmation unspecified. Unspecified pulmonary tuberculosis, bacteriological or histological examination not done. Unspecified pulmonary tuberculosis, bacteriological or histological examination results unknown (at present). Unspecified pulmonary tuberculosis, tubercle bacilli found (in sputum) by microscopy. Unspecified pulmonary tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Unspecified pulmonary tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Unspecified pulmonary tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculous pleurisy, confirmation unspecified. Tuberculous pleurisy, bacteriological or histological examination not done. Tuberculous pleurisy, bacteriological or histological examination results unknown (at present). Tuberculous pleurisy, tubercle bacilli found (in sputum) by microscopy. Tuberculous pleurisy, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculous pleurisy, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculous pleurisy, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of intrathoracic lymph nodes, confirmation unspecified. Tuberculosis of intrathoracic lymph nodes, bacteriological or histological examination not done. Tuberculosis of intrathoracic lymph nodes, bacteriological or histological examination results unknown (at present). Tuberculosis of intrathoracic lymph nodes, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of intrathoracic lymph nodes, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of intrathoracic lymph nodes, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of intrathoracic lymph nodes, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Isolated tracheal or bronchial tuberculosis, unspecified examination. Isolated tracheal or bronchial tuberculosis, bacteriological or histological examination not done. Isolated tracheal or bronchial tuberculosis, bacteriological or histological examination results unknown (at present). Isolated tracheal or bronchial tuberculosis, tubercle bacilli found (in sputum) by microscopy. Isolated tracheal or bronchial tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Isolated tracheal or bronchial tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Isolated tracheal or bronchial tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculous laryngitis, unspecified examination. Tuberculous laryngitis, bacteriological or histological examination not done. Tuberculous laryngitis, bacteriological or histological examination results unknown (at present). Tuberculous laryngitis, tubercle bacilli found (in sputum) by microscopy. Tuberculous laryngitis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculous laryngitis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculous laryngitis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Other specified respiratory tuberculosis, unspecified examination. Other specified respiratory tuberculosis, bacteriological or histological examination not done. Other specified respiratory tuberculosis, bacteriological or histological examination results unknown (at present). Other specified respiratory tuberculosis, tubercle bacilli found (in sputum) by microscopy. Other specified respiratory tuberculosis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Other specified respiratory tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Other specified respiratory tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Other tuberculosis of intestines and mesenteric glands, unspecified examination. Other tuberculosis of intestines and mesenteric glands, bacteriological or histological examination not done. Other tuberculosis of intestines and mesenteric glands, bacteriological or histological examination results unknown (at present). Other tuberculosis of intestines and mesenteric glands, tubercle bacilli found (in sputum) by microscopy. Other tuberculosis of intestines and mesenteric glands, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Other tuberculosis of intestines and mesenteric glands, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Other tuberculosis of intestines and mesenteric glands, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Jkt 223001 PO 00000 Frm 00337 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25016 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code 01500 01501 01502 01503 01504 01505 Code title ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01506 ............................................... 01510 01511 01512 01513 01514 01515 01516 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01520 01521 01522 01523 01524 01525 01526 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01550 01551 01552 01553 01554 01555 01556 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01560 01561 01562 01563 01564 01565 01566 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01570 01571 01572 01573 01574 01575 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01576 ............................................... 01580 01581 01582 01583 01584 01585 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01586 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 01590 01591 01592 01593 ............................................... ............................................... ............................................... ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Tuberculosis of vertebral column, unspecified examination. Tuberculosis of vertebral column, bacteriological or histological examination not done. Tuberculosis of vertebral column, bacteriological or histological examination results unknown (at present). Tuberculosis of vertebral column, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of vertebral column, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of vertebral column, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of vertebral column, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of hip, unspecified examination. Tuberculosis of hip, bacteriological or histological examination not done. Tuberculosis of hip, bacteriological or histological examination results unknown (at present). Tuberculosis of hip, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of hip, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of hip, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of hip, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of knee, unspecified examination. Tuberculosis of knee, bacteriological or histological examination not done. Tuberculosis of knee, bacteriological or histological examination results unknown (at present). Tuberculosis of knee, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of knee, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of knee, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of knee, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of limb bones, unspecified examination. Tuberculosis of limb bones, bacteriological or histological examination not done. Tuberculosis of limb bones, bacteriological or histological examination results unknown (at present). Tuberculosis of limb bones, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of limb bones, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of limb bones, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of limb bones, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of mastoid, unspecified examination. Tuberculosis of mastoid, bacteriological or histological examination not done. Tuberculosis of mastoid, bacteriological or histological examination results unknown (at present). Tuberculosis of mastoid, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of mastoid, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of mastoid, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of mastoid, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of other specified bone, unspecified examination. Tuberculosis of other specified bone, bacteriological or histological examination not done. Tuberculosis of other specified bone, bacteriological or histological examination results unknown (at present). Tuberculosis of other specified bone, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of other specified bone, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of other specified bone, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of other specified bone, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of other specified joint, unspecified examination. Tuberculosis of other specified joint, bacteriological or histological examination not done. Tuberculosis of other specified joint, bacteriological or histological examination results unknown (at present). Tuberculosis of other specified joint, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of other specified joint, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of other specified joint, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of other specified joint, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of unspecified bones and joints, unspecified examination. Tuberculosis of unspecified bones and joints, bacteriological or histological examination not done. Tuberculosis of unspecified bones and joints, bacteriological or histological examination results unknown (at present). Tuberculosis of unspecified bones and joints, tubercle bacilli found (in sputum) by microscopy. Jkt 223001 PO 00000 Frm 00338 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25017 TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title 01594 ............................................... Tuberculosis of unspecified bones and joints, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of unspecified bones and joints, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of unspecified bones and joints, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of kidney, unspecified examination. Tuberculosis of kidney, bacteriological or histological examination not done. Tuberculosis of kidney, bacteriological or histological examination results unknown (at present). Tuberculosis of kidney, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of kidney, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of kidney, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of kidney, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of bladder, unspecified examination. Tuberculosis of bladder, bacteriological or histological examination not done. Tuberculosis of bladder, bacteriological or histological examination results unknown (at present). Tuberculosis of bladder, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of bladder, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of bladder, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of bladder, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of ureter, unspecified examination. Tuberculosis of ureter, bacteriological or histological examination not done. Tuberculosis of ureter, bacteriological or histological examination results unknown (at present). Tuberculosis of ureter, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of ureter, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of ureter, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of ureter, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of other urinary organs, unspecified examination. Tuberculosis of other urinary organs, bacteriological or histological examination not done. Tuberculosis of other urinary organs, bacteriological or histological examination results unknown (at present). Tuberculosis of other urinary organs, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of other urinary organs, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of other urinary organs, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of other urinary organs, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of epididymis, unspecified examination. Tuberculosis of epididymis, bacteriological or histological examination not done. Tuberculosis of epididymis, bacteriological or histological examination results unknown (at present). Tuberculosis of epididymis, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of epididymis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of epididymis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of epididymis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of other male genital organs, unspecified examination. Tuberculosis of other male genital organs, bacteriological or histological examination not done. Tuberculosis of other male genital organs, bacteriological or histological examination results unknown (at present). Tuberculosis of other male genital organs, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of other male genital organs, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of other male genital organs, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of other male genital organs, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculous oophoritis and salpingitis, unspecified examination. Tuberculous oophoritis and salpingitis, bacteriological or histological examination not done. Tuberculous oophoritis and salpingitis, bacteriological or histological examination results unknown (at present). Tuberculous oophoritis and salpingitis, tubercle bacilli found (in sputum) by microscopy. Tuberculous oophoritis and salpingitis, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculous oophoritis and salpingitis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 01595 ............................................... 01596 ............................................... 01600 01601 01602 01603 01604 01605 01606 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01610 01611 01612 01613 01614 01615 01616 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01620 01621 01622 01623 01624 01625 01626 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01630 01631 01632 01633 01634 01635 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01636 ............................................... 01640 01641 01642 01643 01644 01645 01646 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01650 01651 01652 01653 01654 01655 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01656 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 01660 01661 01662 01663 01664 01665 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00339 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25018 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title 01666 ............................................... Tuberculous oophoritis and salpingitis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of other female genital organs, unspecified examination. Tuberculosis of other female genital organs, bacteriological or histological examination not done. Tuberculosis of other female genital organs, bacteriological or histological examination results unknown (at present). Tuberculosis of other female genital organs, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of other female genital organs, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of other female genital organs, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of other female genital organs, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Unspecified genitourinary tuberculosis, unspecified examination. Unspecified genitourinary tuberculosis, bacteriological or histological examination not done. Unspecified genitourinary tuberculosis, bacteriological or histological examination results unknown (at present). Unspecified genitourinary tuberculosis, tubercle bacilli found (in sputum) by microscopy. Unspecified genitourinary tuberculosis, tubercle ba cilli not found (in sputum) by microscopy, but found by bacterial culture. Unspecified genitourinary tuberculosis, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Unspecified genitourinary tuberculosis, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of skin and subcutaneous cellular tissue, unspecified examination. Tuberculosis of skin and subcutaneous cellular tissue, bacteriological or histological examination not done. Tuberculosis of skin and subcutaneous cellular tissue, bacteriological or histological examination results unknown (at present). Tuberculosis of skin and subcutaneous cellular tissue, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of skin and subcutaneous cellular tissue, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of skin and subcutaneous cellular tissue, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of skin and subcutaneous cellular tissue, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of peripheral lymph nodes, unspecified examination. Tuberculosis of peripheral lymph nodes, bacteriological or histological examination not done. Tuberculosis of peripheral lymph nodes, bacteriological or histological examination results unknown (at present). Tuberculosis of peripheral lymph nodes, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of peripheral lymph nodes, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of peripheral lymph nodes, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of peripheral lymph nodes, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of eye, unspecified examination. Tuberculosis of eye, bacteriological or histological examination not done. Tuberculosis of eye, bacteriological or histological examination results unknown (at present). Tuberculosis of eye, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of eye, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of eye, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of eye, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of ear, unspecified examination. Tuberculosis of ear, bacteriological or histological examination not done. Tuberculosis of ear, bacteriological or histological examination results unknown (at present). Tuberculosis of ear, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of ear, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of ear, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of ear, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of thyroid gland, unspecified origin. Tuberculosis of thyroid gland, bacteriological or histological examination not done. Tuberculosis of thyroid gland, bacteriological or histological examination results unknown (at present). Tuberculosis of thyroid gland, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of thyroid gland, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of thyroid gland, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. 01670 01671 01672 01673 01674 01675 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01676 ............................................... 01690 01691 01692 01693 01694 01695 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01696 ............................................... 01700 01701 01702 01703 01704 ............................................... ............................................... ............................................... ............................................... ............................................... 01705 ............................................... 01706 ............................................... 01720 01721 01722 01723 01724 01725 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01726 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01740 01741 01742 01743 01744 01745 01746 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01750 01751 01752 01753 01754 01755 mmaher on DSK3CLS3C1PROD with $$_JOB 01730 01731 01732 01733 01734 01735 01736 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00340 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25019 TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title 01756 ............................................... Tuberculosis of thyroid gland, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of adrenal glands, unspecified examination. Tuberculosis of adrenal glands, bacteriological or histological examination not done. Tuberculosis of adrenal glands, bacteriological or histological examination results unknown (at present). Tuberculosis of adrenal glands, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of adrenal glands, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of adrenal glands, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of adrenal glands, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of spleen, unspecified examination. Tuberculosis of spleen, bacteriological or histological examination not done. Tuberculosis of spleen, bacteriological or histological examination results unknown (at present). Tuberculosis of spleen, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of spleen, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of spleen, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of spleen, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of esophagus, unspecified examination. Tuberculosis of esophagus, bacteriological or histological examination not done. Tuberculosis of esophagus, bacteriological or histological examination results unknown (at present). Tuberculosis of esophagus, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of esophagus, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of esophagus, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of esophagus, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Tuberculosis of other specified organs, unspecified examination. Tuberculosis of other specified organs, bacteriological or histological examination not done. Tuberculosis of other specified organs, bacteriological or histological examination results unknown (at present). Tuberculosis of other specified organs, tubercle bacilli found (in sputum) by microscopy. Tuberculosis of other specified organs, tubercle bacilli not found (in sputum) by microscopy, but found by bacterial culture. Tuberculosis of other specified organs, tubercle bacilli not found by bacteriological examination, but tuberculosis confirmed histologically. Tuberculosis of other specified organs, tubercle bacilli not found by bacteriological or histological examination, but tuberculosis confirmed by other methods (inoculation of animals). Ulceroglandular tularemia. Enteric tularemia. Pulmonary tularemia. Oculoglandular tularemia. Other specified tularemia. Unspecified tularemia. Cutaneous anthrax. Gastrointestinal anthrax. Other specified manifestations of anthrax. Anthrax, unspecified. Other brucellosis. Brucellosis, unspecified. Glanders. Melioidosis. Spirillary fever. Streptobacillary fever. Unspecified rat-bite fever. Listeriosis. Pasteurellosis. Other specified zoonotic bacterial diseases. Unspecified zoonotic bacterial disease. Lepromatous leprosy (type L). Tuberculoid leprosy (type T). Indeterminate leprosy (group I). Borderline leprosy (group B). Other specified leprosy. Leprosy, unspecified. Pulmonary diseases due to other mycobacteria. Cutaneous diseases due to other mycobacteria. Disseminated mycobacterium. 01760 01761 01762 01763 01764 01765 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01766 ............................................... 01770 01771 01772 01773 01774 01775 01776 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01780 01781 01782 01783 01784 01785 01786 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01790 01791 01792 01793 01794 01795 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 01796 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 0210 ................................................. 0211 ................................................. 0212 ................................................. 0213 ................................................. 0218 ................................................. 0219 ................................................. 0220 ................................................. 0222 ................................................. 0228 ................................................. 0229 ................................................. 0238 ................................................. 0239 ................................................. 024 ................................................... 025 ................................................... 0260 ................................................. 0261 ................................................. 0269 ................................................. 0270 ................................................. 0272 ................................................. 0278 ................................................. 0279 ................................................. 0300 ................................................. 0301 ................................................. 0302 ................................................. 0303 ................................................. 0308 ................................................. 0309 ................................................. 0310 ................................................. 0311 ................................................. 0312 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00341 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25020 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 0318 ................................................. 0319 ................................................. 0320 ................................................. 0321 ................................................. 0322 ................................................. 0323 ................................................. 03281 ............................................... 03282 ............................................... 03283 ............................................... 03284 ............................................... 03285 ............................................... 03289 ............................................... 0329 ................................................. 0330 ................................................. 0331 ................................................. 0338 ................................................. 0339 ................................................. 0341 ................................................. 03681 ............................................... 03682 ............................................... 03689 ............................................... 0369 ................................................. 0390 ................................................. 0391 ................................................. 0392 ................................................. 0393 ................................................. 0394 ................................................. 0398 ................................................. 0399 ................................................. 0402 ................................................. 0403 ................................................. 04041 ............................................... 04042 ............................................... 04081 ............................................... 0460 ................................................. 0461 ................................................. 0462 ................................................. 0463 ................................................. 0468 ................................................. 0469 ................................................. 0470 ................................................. 0471 ................................................. 0478 ................................................. 0479 ................................................. 048 ................................................... 0490 ................................................. 0491 ................................................. 0498 ................................................. 0499 ................................................. 0500 ................................................. 0501 ................................................. 0502 ................................................. 0509 ................................................. 0527 ................................................. 0528 ................................................. 0529 ................................................. 05310 ............................................... 05311 ............................................... 05312 ............................................... 05313 ............................................... 05319 ............................................... 05320 ............................................... 05321 ............................................... 05322 ............................................... 05329 ............................................... 05371 ............................................... 05379 ............................................... 0538 ................................................. 0542 ................................................. 05440 ............................................... 05441 ............................................... 05442 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Other specified mycobacterial diseases. Unspecified diseases due to mycobacteria. Faucial diphtheria. Nasopharyngeal diphtheria. Anterior nasal diphtheria. Laryngeal diphtheria. Conjunctival diphtheria. Diphtheritic myocarditis. Diphtheritic peritonitis. Diphtheritic cystitis. Cutaneous diphtheria. Other specified diphtheria. Diphtheria, unspecified. Whooping cough due to bordetella pertussis (b. pertussis). Whooping cough due to bordetella parapertussis (b. parapertussis). Whooping cough due to other specified organism. Whooping cough, unspecified organism. Scarlet fever. Meningococcal optic neuritis. Meningococcal arthropathy. Other specified meningococcal infections. Meningococcal infection, unspecified. Cutaneous actinomycotic infection. Pulmonary actinomycotic infection. Abdominal actinomycotic infection. Cervicofacial actinomycotic infection. Madura foot. Actinomycotic infection of other specified sites. Actinomycotic infection of unspecified site. Whipple’s disease. Necrobacillosis. Infant botulism. Wound botulism. Tropical pyomyositis. Kuru. Jakob-creutzfeldt disease. Subacute sclerosing panencephalitis. Progressive multifocal leukoencephalopathy. Other specified slow virus infection of central nervous system. Unspecified slow virus infection of central nervous system. Meningitis due to coxsackie virus. Meningitis due to echo virus. Other specified viral meningitis. Unspecified viral meningitis. Other enterovirus diseases of central nervous system. Non-arthopod borne lymphocytic choriomeningitis. Non-arthopod borne meningitis due to adenovirus. Other specified non-arthropod-borne viral diseases of central nervous system. Unspecified non-arthropod-borne viral diseases of central nervous system. Variola major. Alastrim. Modified smallpox. Smallpox, unspecified. Chickenpox with other specified complications. Chickenpox with unspecified complication. Varicella without mention of complication. Herpes zoster with unspecified nervous system complication. Geniculate herpes zoster. Postherpetic trigeminal neuralgia. Postherpetic polyneuropathy. Herpes zoster with other nervous system complications. Herpes zoster dermatitis of eyelid. Herpes zoster keratoconjunctivitis. Herpes zoster iridocyclitis. Herpes zoster with other ophthalmic complications. Otitis externa due to herpes zoster. Herpes zoster with other specified complications. Herpes zoster with unspecified complication. Herpetic gingivostomatitis. Herpes simplex with unspecified ophthalmic complication. Herpes simplex dermatitis of eyelid. Dendritic keratitis. Jkt 223001 PO 00000 Frm 00342 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 05443 ............................................... 05444 ............................................... 05449 ............................................... 05471 ............................................... 05479 ............................................... 05571 ............................................... 05579 ............................................... 05600 ............................................... 05609 ............................................... 05671 ............................................... 05679 ............................................... 0570 ................................................. 0600 ................................................. 0601 ................................................. 0609 ................................................. 061 ................................................... 0650 ................................................. 0651 ................................................. 0652 ................................................. 0653 ................................................. 0654 ................................................. 0658 ................................................. 0659 ................................................. 0660 ................................................. 0661 ................................................. 0662 ................................................. 0663 ................................................. 0668 ................................................. 0669 ................................................. 0701 ................................................. 07030 ............................................... 07031 ............................................... 07032 ............................................... 07033 ............................................... 07051 ............................................... 07052 ............................................... 07053 ............................................... 07059 ............................................... 0709 ................................................. 071 ................................................... 0720 ................................................. 0723 ................................................. 07271 ............................................... 07272 ............................................... 07279 ............................................... 0728 ................................................. 0737 ................................................. 0738 ................................................. 0739 ................................................. 07420 ............................................... 07421 ............................................... 07422 ............................................... 07423 ............................................... 0783 ................................................. 0785 ................................................. 0786 ................................................. 0787 ................................................. 07951 ............................................... 07952 ............................................... 07953 ............................................... 07981 ............................................... 07982 ............................................... 07983 ............................................... 080 ................................................... 0810 ................................................. 0811 ................................................. 0812 ................................................. 0819 ................................................. 0820 ................................................. 0821 ................................................. 0822 ................................................. 0823 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Herpes simplex disciform keratitis. Herpes simplex iridocyclitis. Herpes simplex with other ophthalmic complications. Visceral herpes simplex. Herpes simplex with other specified complications. Measles keratoconjunctivitis. Measles with other specified complications. Rubella with unspecified neurological complication. Rubella with other neurological complications. Arthritis due to rubella. Rubella with other specified complications. Erythema infectiosum (fifth disease). Sylvatic yellow fever. Urban yellow fever. Yellow fever, unspecified. Dengue. Crimean hemorrhagic fever (chf congo virus). Omsk hemorrhagic fever. Kyasanur forest disease. Other tick-borne hemorrhagic fever. Mosquito-borne hemorrhagic fever. Other specified arthropod-borne hemorrhagic fever. Arthropod-borne hemorrhagic fever, unspecified. Phlebotomus fever. Tick-borne fever. Venezuelan equine fever. Other mosquito-borne fever. Other specified arthropod-borne viral diseases. Arthropod-borne viral disease, unspecified. Viral hepatitis a without mention of hepatic coma. Viral hepatitis b without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta. Viral hepatitis b without mention of hepatic coma, acute or unspecified, with hepatitis delta. Chronic viral hepatitis b without mention of hepatic coma without mention of hepatitis delta. Chronic viral hepatitis b without mention of hepatic coma with hepatitis delta. Acute hepatitis C without mention of hepatic coma. Hepatitis delta without mention of active hepatitis B disease or hepatic coma. Hepatitis E without mention of hepatic coma. Other specified viral hepatitis without mention of hepatic coma. Unspecified viral hepatitis without mention of hepatic coma. Rabies. Mumps orchitis. Mumps pancreatitis. Mumps hepatitis. Mumps polyneuropathy. Mumps with other specified complications. Mumps with unspecified complication. Ornithosis with other specified complications. Ornithosis with unspecified complication. Ornithosis, unspecified. Coxsackie carditis, unspecified. Coxsackie pericarditis. Coxsackie endocarditis. Coxsackie myocarditis. Cat-scratch disease. Cytomegaloviral disease. Hemorrhagic nephrosonephritis. Arenaviral hemorrhagic fever. Human t-cell lymphotrophic virus, type i [HTLV–I]. Human t-cell lymphotrophic virus, type ii [HTLV–II]. Human immunodeficiency virus, type 2 [HIV–2]. Hantaviris infection. Sars-assoc coronavirus. Parvovirus B19. Louse-borne (epidemic) typhus. Murine (endemic) typhus. Brill’s disease. Scrub typhus. Typhus, unspecified. Spotted fevers. Boutonneuse fever. North asian tick fever. Queensland tick typhus. Jkt 223001 PO 00000 Frm 00343 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25021 25022 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 08240 ............................................... 08241 ............................................... 08249 ............................................... 0828 ................................................. 0829 ................................................. 0830 ................................................. 0831 ................................................. 0832 ................................................. 0838 ................................................. 0839 ................................................. 0841 ................................................. 0842 ................................................. 0843 ................................................. 0844 ................................................. 0845 ................................................. 0846 ................................................. 0847 ................................................. 0848 ................................................. 0849 ................................................. 0850 ................................................. 0851 ................................................. 0852 ................................................. 0853 ................................................. 0854 ................................................. 0855 ................................................. 0859 ................................................. 0860 ................................................. 0861 ................................................. 0862 ................................................. 0863 ................................................. 0864 ................................................. 0865 ................................................. 0869 ................................................. 0870 ................................................. 0871 ................................................. 0879 ................................................. 0880 ................................................. 08881 ............................................... 08882 ............................................... 0900 ................................................. 0902 ................................................. 0903 ................................................. 09040 ............................................... 09049 ............................................... 0905 ................................................. 0913 ................................................. 0914 ................................................. 09150 ............................................... 09151 ............................................... 09152 ............................................... 09161 ............................................... 09162 ............................................... 09169 ............................................... 0917 ................................................. 09182 ............................................... 09189 ............................................... 0919 ................................................. 0930 ................................................. 0931 ................................................. 09320 ............................................... 09321 ............................................... 09322 ............................................... 09323 ............................................... 09324 ............................................... 09381 ............................................... 09382 ............................................... 09389 ............................................... 0939 ................................................. 0940 ................................................. 0941 ................................................. 0943 ................................................. 09482 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Unspecified ehrlichiosis. Ehrlichiosis chafeensis (e chafeensis). Other ehrlichiosis. Other specified tick-borne rickettsioses. Tick-borne rickettsiosis, unspecified. Q fever. Trench fever. Rickettsialpox. Other specified rickettsioses. Rickettsiosis, unspecified. Vivax malaria (benign tertian). Quartan malaria. Ovale malaria. Other malaria. Mixed malaria. Malaria, unspecified. Induced malaria. Blackwater fever. Other pernicious complications of malaria. Leishmaniasis visceral (kala-azar). Cutaneous leishmaniasis, urban. Cutaneous leishmaniasis, asian desert. Cutaneous leishmaniasis, ethiopian. Cutaneous leishmaniasis, american. Mucocutaneous leishmaniasis, (american). Leishmaniasis, unspecified. Chagas’ disease with heart involvement. Chagas’ disease with other organ involvement. Chagas’ disease without mention of organ involvement. Gambian trypanosomiasis. Rhodesian trypanosomiasis. African trypanosomiasis, unspecified. Trypanosomiasis, unspecified. Relapsing fever, louse-borne. Relapsing fever, tick-borne. Relapsing fever, unspecified. Bartonellosis. Lyme disease. Babesiosis. Early congenital syphilis, symptomatic. Early congenital syphilis, unspecified. Syphilitic interstitial keratitis. Juvenile neurosyphilis, unspecified. Other juvenile neurosyphilis. Other late congenital syphilis, symptomatic. Secondary syphilis of skin or mucous membranes. Adenopathy due to secondary syphilis. Syphilitic uveitis, unspecified. Syphilitic chorioretinitis (secondary). Syphilitic iridocyclitis (secondary). Secondary syphilitic periostitis. Secondary syphilitic hepatitis. Secondary syphilis of other viscera. Secondary syphilis, relapse. Syphilitic alopecia. Other forms of secondary syphilis. Unspecified secondary syphilis. Aneurysm of aorta, specified as syphilitic. Syphilitic aortitis. Syphilitic endocarditis of valve, unspecified. Syphilitic endocarditis of mitral valve. Syphilitic endocarditis of aortic valve. Syphilitic endocarditis of tricuspid valve. Syphilitic endocarditis of pulmonary valve. Syphilitic pericarditis. Syphilitic myocarditis. Other specified cardiovascular syphilis. Cardiovascular syphilis, unspecified. Tabes dorsalis. General paresis. Asymptomatic neurosyphilis. Syphilitic parkinsonism. Jkt 223001 PO 00000 Frm 00344 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 09483 ............................................... 09484 ............................................... 09485 ............................................... 09486 ............................................... 09489 ............................................... 0949 ................................................. 0950 ................................................. 0951 ................................................. 0952 ................................................. 0953 ................................................. 0954 ................................................. 0955 ................................................. 0956 ................................................. 0957 ................................................. 0958 ................................................. 0959 ................................................. 0980 ................................................. 09810 ............................................... 09811 ............................................... 09812 ............................................... 09813 ............................................... 09814 ............................................... 09815 ............................................... 09816 ............................................... 09817 ............................................... 09819 ............................................... 09840 ............................................... 09841 ............................................... 09842 ............................................... 09843 ............................................... 09849 ............................................... 09850 ............................................... 09851 ............................................... 09852 ............................................... 09853 ............................................... 09859 ............................................... 09881 ............................................... 09885 ............................................... 09886 ............................................... 09889 ............................................... 09956 ............................................... 1000 ................................................. 10089 ............................................... 1009 ................................................. 101 ................................................... 1120 ................................................. 1122 ................................................. 11282 ............................................... 11284 ............................................... 11285 ............................................... 11289 ............................................... 1140 ................................................. 1141 ................................................. 1143 ................................................. 1144 ................................................. 1145 ................................................. 1149 ................................................. 11502 ............................................... 11509 ............................................... 11512 ............................................... 11519 ............................................... 11592 ............................................... 1160 ................................................. 1161 ................................................. 1173 ................................................. 1174 ................................................. 1175 ................................................. 1176 ................................................. 1178 ................................................. 1179 ................................................. 118 ................................................... 1200 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Syphilitic disseminated retinochoroiditis. Syphilitic optic atrophy. Syphilitic retrobulbar neuritis. Syphilitic acoustic neuritis. Other specified neurosyphilis. Neurosyphilis, unspecified. Syphilitic episcleritis. Syphilis of lung. Syphilitic peritonitis. Syphilis of liver. Syphilis of kidney. Syphilis of bone. Syphilis of muscle. Syphilis of synovium, tendon, and bursa. Other specified forms of late symptomatic syphilis. Late symptomatic syphilis, unspecified. Gonococcal infection (acute) of lower genitourinary tract. Gonococcal infection (acute) of upper genitourinary tract, site unspecified. Gonococcal cystitis (acute). Gonococcal prostatitis (acute). Gonococcal epididymo-orchitis (acute). Gonococcal seminal vesiculitis (acute). Gonococcal cervicitis (acute). Gonococcal endometritis (acute). Gonococcal salpingitis, specified as acute. Other gonococcal infection (acute) of upper genitourinary tract. Gonococcal conjunctivitis (neonatorum). Gonococcal iridocyclitis. Gonococcal endophthalmia. Gonococcal keratitis. Other gonococcal infection of eye. Gonococcal arthritis. Gonococcal synovitis and tenosynovitis. Gonococcal bursitis. Gonococcal spondylitis. Other gonococcal infection of joint. Gonococcal keratosis (blennorrhagica). Other gonococcal heart disease. Gonococcal peritonitis. Gonococcal infection of other specified sites. Other venereal diseases due to chlamydia trachomatis, peritoneum. Leptospirosis icterohemorrhagica. Other specified leptospiral infections. Leptospirosis, unspecified. Vincent’s angina. Candidiasis of mouth. Candidiasis of other urogenital sites. Candidal otitis externa. Candidal esophagitis. Candidal enteritis. Other candidiasis of other specified sites. Primary coccidioidomycosis (pulmonary). Primary extrapulmonary coccidioidomycosis. Other forms of progressive coccidioidomycosis. Chronic pulmonary coccidioidomycosis. Pulmonary coccidioidomycosis, unspecified. Coccidioidomycosis, unspecified. Histoplasma capsulatum retinitis. Infection by histoplasma capsulatum, with mention of other manifestation. Histoplasma duboisii retinitis. Infection by histoplasma duboisii with mention of other manifestation. Histoplasmosis retinitis, unspecified. Blastomycosis. Paracoccidioidomycosis. Aspergillosis. Mycotic mycetomas. Cryptococcosis. Allescheriosis (petriellidosis). Infection by dematiacious fungi, (phaehyphomycosis). Other and unspecified mycoses. Opportunistic mycoses. Schistosomiasis due to schistosoma haematobium. Jkt 223001 PO 00000 Frm 00345 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25023 25024 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 1201 ................................................. 1202 ................................................. 1203 ................................................. 1208 ................................................. 1209 ................................................. 1210 ................................................. 1211 ................................................. 1212 ................................................. 1213 ................................................. 1214 ................................................. 1215 ................................................. 1216 ................................................. 1218 ................................................. 1220 ................................................. 1221 ................................................. 1222 ................................................. 1223 ................................................. 1224 ................................................. 1225 ................................................. 1226 ................................................. 1227 ................................................. 1228 ................................................. 1229 ................................................. 1230 ................................................. 1231 ................................................. 1232 ................................................. 1233 ................................................. 1234 ................................................. 1235 ................................................. 1236 ................................................. 1238 ................................................. 124 ................................................... 1250 ................................................. 1251 ................................................. 1252 ................................................. 1253 ................................................. 1254 ................................................. 1255 ................................................. 1256 ................................................. 1257 ................................................. 1259 ................................................. 1260 ................................................. 1261 ................................................. 1262 ................................................. 1263 ................................................. 1268 ................................................. 1269 ................................................. 1270 ................................................. 1271 ................................................. 1272 ................................................. 1273 ................................................. 1274 ................................................. 1275 ................................................. 1276 ................................................. 1277 ................................................. 1278 ................................................. 1279 ................................................. 1301 ................................................. 1302 ................................................. 1305 ................................................. 1307 ................................................. 1309 ................................................. 1364 ................................................. 1365 ................................................. 1500 ................................................. 1501 ................................................. 1502 ................................................. 1503 ................................................. 1504 ................................................. 1505 ................................................. 1508 ................................................. 1509 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Schistosomiasis due to schistosoma mansoni. Schistosomiasis due to schistosoma japonicum. Cutaneous schistosomiasis. Other specified schistosomiasis. Schistosomiasis, unspecified. Opisthorchiasis. Clonorchiasis. Paragonimiasis. Fascioliasis. Fasciolopsiasis. Metagonimiasis. Heterophyiasis. Other specified trematode infections. Echinococcus granulosus infection of liver. Echinococcus granulosus infection of lung. Echinococcus granulosus infection of thyroid. Echinococcus granulosus infection, other. Echinococcus granulosus infection, unspecified. Echinococcus multilocularis infection of liver. Echinococcus multilocularis infection, other. Echinococcus multilocularis infection, unspecified. Echinococcosis, unspecified, of liver. Echinococcosis, other and unspecified. Taenia solium infection, intestinal form. Cysticercosis. Taenia saginata infection. Taeniasis, unspecified. Diphyllobothriasis, intestinal. Sparganosis (larval diphyllobothriasis). Hymenolepiasis. Other specified cestode infection. Trichinosis. Bancroftian filariasis. Malayan filariasis. Loiasis. Onchocerciasis. Dipetalonemiasis. Mansonella ozzardi infection. Other specified filariasis. Dracontiasis. Unspecified filariasis. Ancylostomiasis due to ancylostoma duodenale. Necatoriasis due to necator americanus. Ancylostomiasis due to ancylostoma braziliense. Ancylostomiasis due to ancylostoma ceylanicum. Other specified ancylostoma. Ancylostomiasis and necatoriasis, unspecified. Ascariasis. Anisakiasis. Strongyloidiasis. Trichuriasis. Enterobiasis. Capillariasis. Trichostrongyliasis. Other specified intestinal helminthiasis. Mixed intestinal helminthiasis. Intestinal helminthiasis, unspecified. Conjunctivitis due to toxoplasmosis. Chorioretinitis due to toxoplasmosis. Hepatitis due to toxoplasmosis. Toxoplasmosis of other specified sites. Toxoplasmosis, unspecified. Psorospermiasis. Sarcosporidiosis. Malignant neoplasm of cervical esophagus. Malignant neoplasm of thoracic esophagus. Malignant neoplasm of abdominal esophagus. Malignant neoplasm of upper third of esophagus. Malignant neoplasm of middle third of esophagus. Malignant neoplasm of lower third of esophagus. Malignant neoplasm of other specified part of esophagus. Malignant neoplasm of esophagus, unspecified site. Jkt 223001 PO 00000 Frm 00346 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code mmaher on DSK3CLS3C1PROD with $$_JOB 1510 1511 1512 1513 1514 1515 1516 1518 1519 1520 1521 1522 1523 1528 1529 1530 1531 1532 1533 1534 1535 1536 1537 1538 1539 1540 1541 1542 1543 1548 1550 1551 1552 1560 1561 1562 1568 1569 1570 1571 1572 1573 1574 1578 1579 1580 1588 1589 1620 1622 1623 1624 1625 1628 1629 1630 1631 1638 1639 1640 1641 1642 1643 1648 1649 1700 1701 1702 1703 1704 1705 1706 Code title ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Malignant Jkt 223001 neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm neoplasm of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of of cardia. pylorus. pyloric antrum. fundus of stomach. body of stomach. lesser curvature of stomach, unspecified. greater curvature of stomach, unspecified. other specified sites of stomach. stomach, unspecified site. duodenum. jejunum. ileum. meckel’s diverticulum. other specified sites of small intestine. small intestine, unspecified site. hepatic flexure. transverse colon. descending colon. sigmoid colon. cecum. appendix vermiformis. ascending colon. splenic flexure. other specified sites of large intestine. colon, unspecified site. rectosigmoid junction. rectum. anal canal. anus, unspecified site. other sites of rectum, rectosigmoid junction, and anus. liver, primary. intrahepatic bile ducts. liver, not specified as primary or secondary. gallbladder. extrahepatic bile ducts. ampulla of vater. other specified sites of gallbladder and extrahepatic bile ducts. biliary tract, part unspecified site. head of pancreas. body of pancreas. tail of pancreas. pancreatic duct. islets of langerhans. other specified sites of pancreas. pancreas, part unspecified. retroperitoneum. specified parts of peritoneum. peritoneum, unspecified. trachea. main bronchus. upper lobe, bronchus or lung. middle lobe, bronchus or lung. lower lobe, bronchus or lung. other parts of bronchus or lung. bronchus and lung, unspecified. parietal pleura. visceral pleura. other specified sites of pleura. pleura, unspecified. thymus. heart. anterior mediastinum. posterior mediastinum. other parts of mediastinum. mediastinum, part unspecified. bones of skull and face, except mandible. mandible. vertebral column, excluding sacrum and coccyx. ribs, sternum, and clavicle. scapula and long bones of upper limb. short bones of upper limb. pelvic bones, sacrum, and coccyx. PO 00000 Frm 00347 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25025 25026 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code mmaher on DSK3CLS3C1PROD with $$_JOB 1707 1708 1709 1710 1712 1713 1714 1715 1716 1717 1718 1719 1760 1761 1762 1763 1764 1765 1768 1769 1830 1890 1891 1892 1893 1894 1898 1899 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1928 1929 1940 1941 1943 1944 1945 1946 1948 1949 1960 1961 1962 1963 1965 1966 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1980 1981 1982 Code title ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Malignant neoplasm of long bones of lower limb. Malignant neoplasm of short bones of lower limb. Malignant neoplasm of bone and articular cartilage, site unspecified. Malignant neoplasm of connective and other soft tissue of head, face, and neck. Malignant neoplasm of connective and other soft tissue of upper limb, including shoulder. Malignant neoplasm of connective and other soft tissue of lower limb, including hip. Malignant neoplasm of connective and other soft tissue of thorax. Malignant neoplasm of connective and other soft tissue of abdomen. Malignant neoplasm of connective and other soft tissue of pelvis. Malignant neoplasm of connective and other soft tissue of trunk, unspecified. Malignant neoplasm of other specified sites of connective and other soft tissue. Malignant neoplasm of connective and other soft tissue, site unspecified. Kaposi’s sarcoma, skin. Kaposi’s sarcoma, soft tissue. Kaposi’s sarcoma, palate. Kaposi’s sarcoma, gastrointestinal sites. Kaposi’s sarcoma, lung. Kaposi’s sarcoma, lymph nodes. Kaposi’s sarcoma, other specified sites. Kaposi’s sarcoma, unspecified site. Malignant neoplasm of ovary. Malignant neoplasm of kidney, except pelvis. Malignant neoplasm of renal pelvis. Malignant neoplasm of ureter. Malignant neoplasm of urethra. Malignant neoplasm of paraurethral glands. Malignant neoplasm of other specified sites of urinary organs. Malignant neoplasm of urinary organ, site unspecified. Malignant neoplasm of cerebrum, except lobes and ventricles. Malignant neoplasm of frontal lobe. Malignant neoplasm of temporal lobe. Malignant neoplasm of parietal lobe. Malignant neoplasm of occipital lobe. Malignant neoplasm of ventricles. Malignant neoplasm of cerebellum nos. Malignant neoplasm of brain stem. Malignant neoplasm of other parts of brain. Malignant neoplasm of brain, unspecified site. Malignant neoplasm of cranial nerves. Malignant neoplasm of cerebral meninges. Malignant neoplasm of spinal cord. Malignant neoplasm of spinal meninges. Malignant neoplasm of other specified sites of nervous system. Malignant neoplasm of nervous system, part unspecified. Malignant neoplasm of adrenal gland. Malignant neoplasm of parathyroid gland. Malignant neoplasm of pituitary gland and craniopharyngeal duct. Malignant neoplasm of pineal gland. Malignant neoplasm of carotid body. Malignant neoplasm of aortic body and other paraganglia. Malignant neoplasm of other endocrine glands and related structures. Malignant neoplasm of endocrine gland, site unspecified. Secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck. Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes. Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes. Secondary and unspecified malignant neoplasm of lymph nodes of axilla and upper limb. Secondary and unspecified malignant neoplasm of lymph nodes of inguinal region and lower limb. Secondary and unspecified malignant neoplasm of intrapelvic lymph nodes. Secondary and unspecified malignant neoplasm of lymph nodes of multiple sites. Secondary and unspecified malignant neoplasm of lymph nodes, site unspecified. Secondary malignant neoplasm of lung. Secondary malignant neoplasm of mediastinum. Secondary malignant neoplasm of pleura. Secondary malignant neoplasm of other respiratory organs. Secondary malignant neoplasm of small intestine including duodenum. Secondary malignant neoplasm of large intestine and rectum. Secondary malignant neoplasm of retroperitoneum and peritoneum. Malignant neoplasm of liver, secondary. Secondary malignant neoplasm of other digestive organs and spleen. Secondary malignant neoplasm of kidney. Secondary malignant neoplasm of other urinary organs. Secondary malignant neoplasm of skin. Jkt 223001 PO 00000 Frm 00348 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 1983 ................................................. 1984 ................................................. 1985 ................................................. 1986 ................................................. 1987 ................................................. 19881 ............................................... 19882 ............................................... 19889 ............................................... 1990 ................................................. 20000 ............................................... 20001 ............................................... 20002 ............................................... 20003 ............................................... 20004 ............................................... 20005 ............................................... 20006 ............................................... 20007 ............................................... 20008 ............................................... 20010 ............................................... 20011 ............................................... 20012 ............................................... 20013 ............................................... 20014 ............................................... 20015 ............................................... 20016 ............................................... 20017 ............................................... 20018 ............................................... 20020 ............................................... 20021 ............................................... 20022 ............................................... 20023 ............................................... 20024 ............................................... 20025 ............................................... 20026 ............................................... 20027 ............................................... 20028 ............................................... 20030 ............................................... 20031 ............................................... 20032 ............................................... 20033 ............................................... 20034 ............................................... 20035 ............................................... 20036 ............................................... 20037 ............................................... 20038 ............................................... 20040 ............................................... 20041 ............................................... 20042 ............................................... 20043 ............................................... 20044 ............................................... 20045 ............................................... 20046 ............................................... 20047 ............................................... 20048 ............................................... 20050 ............................................... 20051 ............................................... 20052 ............................................... 20053 ............................................... 20054 ............................................... 20055 ............................................... 20056 ............................................... 20057 ............................................... 20058 ............................................... 20060 ............................................... 20061 ............................................... 20062 ............................................... 20063 ............................................... 20064 ............................................... 20065 ............................................... 20066 ............................................... 20067 ............................................... 20068 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Secondary malignant neoplasm of brain and spinal cord. Secondary malignant neoplasm of other parts of nervous system. Secondary malignant neoplasm of bone and bone marrow. Secondary malignant neoplasm of ovary. Secondary malignant neoplasm of adrenal gland. Secondary malignant neoplasm of breast. Secondary malignant neoplasm of genital organs. Secondary malignant neoplasm of other specified sites. Disseminated malignant neoplasm. Reticulosarcoma, unspecified site. Reticulosarcoma involving lymph nodes of head, face, and neck. Reticulosarcoma involving intrathoracic lymph nodes. Reticulosarcoma involving intra-abdominal lymph nodes. Reticulosarcoma involving lymph nodes of axilla and upper limb. Reticulosarcoma involving lymph nodes of inguinal region and lower limb. Reticulosarcoma involving intrapelvic lymph nodes. Reticulosarcoma involving spleen. Reticulosarcoma involving lymph nodes of multiple sites. Lymphosarcoma, unspecified site. Lymphosarcoma involving lymph nodes of head, face, and neck. Lymphosarcoma involving intrathoracic lymph nodes. Lymphosarcoma involving intra-abdominal lymph nodes. Lymphosarcoma involving lymph nodes of axilla and upper limb. Lymphosarcoma involving lymph nodes of inguinal region and lower limb. Lymphosarcoma involving intrapelvic lymph nodes. Lymphosarcoma involving spleen. Lymphosarcoma involving lymph nodes of multiple sites. Burkitt’s tumor or lymphoma, unspecified site. Burkitt’s tumor or lymphoma involving lymph nodes of head, face, and neck. Burkitt’s tumor or lymphoma involving intrathoracic lymph nodes. Burkitt’s tumor or lymphoma involving intra-abdominal lymph nodes. Burkitt’s tumor or lymphoma involving lymph nodes of axilla and upper limb. Burkitt’s tumor or lymphoma involving lymph nodes of inguinal region and lower limb. Burkitt’s tumor or lymphoma involving intrapelvic lymph nodes. Burkitt’s tumor or lymphoma involving spleen. Burkitt’s tumor or lymphoma involving lymph nodes of multiple sites. Marginal zone lymphoma, unspecified site, extranodal and solid organ sites. Marginal zone lymphoma, lymph nodes of head, face, and neck. Marginal zone lymphoma, intrathoracic lymph nodes. Marginal zone lymphoma, intraabdominal lymph nodes. Marginal zone lymphoma, lymph nodes of axilla and upper limb. Marginal zone lymphoma, lymph nodes of inguinal region and lower limb. Marginal zone lymphoma, intrapelvic lymph nodes. Marginal zone lymphoma, spleen. Marginal zone lymphoma, lymph nodes of multiple sites. Mantle cell lymphoma, unspecified site, extranodal and solid organ sites. Mantle cell lymphoma, lymph nodes of head, face, and neck. Mantle cell lymphoma, intrathoracic lymph nodes. Mantle cell lymphoma, intra-abdominal lymph nodes. Mantle cell lymphoma, lymph nodes of axilla and upper limb. Mantle cell lymphoma,lymph nodes of inguinal region and lower limb. Mantle cell lymphoma, intrapelvic lymph nodes. Mantle cell lymphoma, spleen. Mantle cell lymphoma, lymph nodes of multiple sites. Primary central nervous system lymphoma, unspecified site, extranodal and solid organ sites. Primary central nervous system lymphoma, lymph nodes of head, face, and neck. Primary central nervous system lymphoma, intrathoracic lymph nodes. Primary central nervous system lymphoma, intra-abdominal lymph nodes. Primary central nervous system lymphoma, lymph nodes of axilla and upper limb. Primary central nervous system lymphoma, lymph nodes of inguinal region and lower limb. Primary central nervous system lymphoma, intrapelvic lymph nodes. Primary central nervous system lymphoma, spleen. Primary central nervous system lymphoma, lymph nodes of multiple sites. Anaplastic large cell lymphoma, unspecified site, extranodal and solid organ sites. Anaplastic large cell lymphoma, lymph nodes of head, face, and neck. Anaplastic large cell lymphoma, intrathoracic lymph nodes. Anaplastic large cell lymphoma, intra-abdominal lymph nodes. Anaplastic large cell lymphoma, lymph nodes of axilla and upper limb. Anaplastic large cell lymphoma, lymph nodes of inguinal region and lower limb. Anaplastic large cell lymphoma, intrapelvic lymph nodes. Anaplastic large cell lymphoma, spleen. Anaplastic large cell lymphoma, lymph nodes of multiple sites. Jkt 223001 PO 00000 Frm 00349 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25027 25028 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code mmaher on DSK3CLS3C1PROD with $$_JOB 20070 20071 20072 20073 20074 20075 20076 20077 20078 20080 20081 20082 20083 20084 20085 20086 20087 20088 20100 20101 20102 20103 20104 20105 20106 20107 20108 20110 20111 20112 20113 20114 20115 20116 20117 20118 20120 20121 20122 20123 20124 20125 20126 20127 20128 20140 20141 20142 20143 20144 20145 20146 20147 20148 20150 20151 20152 20153 20154 20155 20156 20157 20158 20160 20161 20162 20163 20164 20165 20166 Code title ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Large cell lymphoma, unspecified site, extranodal and solid organ sites. Large cell lymphoma, lymph nodes of head, face, and neck. Large cell lymphoma, intrathoracic lymph nodes. Large cell lymphoma, intra-abdominal lymph nodes. Large cell lymphoma, lymph nodes of axilla and upper limb. Large cell lymphoma, lymph nodes of inguinal region and lower limb. Large cell lymphoma, intrapelvic lymph nodes. Large cell lymphoma, spleen. Large cell lymphoma, lymph nodes of multiple sites. Other named variants of lymphosarcoma and reticulosarcoma, unspecified site. Other named variants of lymphosarcoma and reticulosarcoma involving lymph nodes of head, face, and neck. Other named variants of lymphosarcoma and reticulosarcoma involving intrathoracic lymph nodes. Other named variants of lymphosarcoma and reticulosarcoma involving intra-abdominal lymph nodes. Other named variants of lymphosarcoma and reticulosarcoma involving lymph nodes of axilla and upper limb. Other named variants of lymphosarcoma and reticulosarcoma involving lymph nodes of inguinal region and lower limb. Other named variants of lymphosarcoma and reticulosarcoma involving intrapelvic lymph nodes. Other named variants of lymphosarcoma and reticulosarcoma involving spleen. Other named variants of lymphosarcoma and reticulosarcoma involving lymph nodes of multiple sites. Hodgkin’s paragranuloma, unspecified site. Hodgkin’s paragranuloma involving lymph nodes of head, face, and neck. Hodgkin’s paragranuloma involving intrathoracic lymph nodes. Hodgkin’s paragranuloma involving intra-abdominal lymph nodes. Hodgkin’s paragranuloma involving lymph nodes of axilla and upper limb. Hodgkin’s paragranuloma involving lymph nodes of inguinal region and lower limb. Hodgkin’s paragranuloma involving intrapelvic lymph nodes. Hodgkin’s paragranuloma involving spleen. Hodgkin’s paragranuloma involving lymph nodes of multiple sites. Hodgkin’s granuloma, unspecified site. Hodgkin’s granuloma involving lymph nodes of head, face, and neck. Hodgkin’s granuloma involving intrathoracic lymph nodes. Hodgkin’s granuloma involving intra-abdominal lymph nodes. Hodgkin’s granuloma involving lymph nodes of axilla and upper limb. Hodgkin’s granuloma involving lymph nodes of inguinal region and lower limb. Hodgkin’s granuloma involving intrapelvic lymph nodes. Hodgkin’s granuloma involving spleen. Hodgkin’s granuloma involving lymph nodes of multiple sites. Hodgkin’s sarcoma, unspecified site. Hodgkin’s sarcoma involving lymph nodes of head, face, and neck. Hodgkin’s sarcoma involving intrathoracic lymph nodes. Hodgkin’s sarcoma involving intra-abdominal lymph nodes. Hodgkin’s sarcoma involving lymph nodes of axilla and upper limb. Hodgkin’s sarcoma involving lymph nodes of inguinal region and lower limb. Hodgkin’s sarcoma involving intrapelvic lymph nodes. Hodgkin’s sarcoma involving spleen. Hodgkin’s sarcoma involving lymph nodes of multiple sites. Hodgkin’s disease, lymphocytic-histiocytic predominance, unspecified site. Hodgkin’s disease, lymphocytic-histiocytic predominance involving lymph nodes of head, face, and neck. Hodgkin’s disease, lymphocytic-histiocytic predominance involving intrathoracic lymph nodes. Hodgkin’s disease, lymphocytic-histiocytic predominance involving intra-abdominal lymph nodes. Hodgkin’s disease, lymphocytic-histiocytic predominance involving lymph nodes of axilla and upper limb. Hodgkin’s disease, lymphocytic-histiocytic predominance involving lymph nodes of inguinal region and lower limb. Hodgkin’s disease, lymphocytic-histiocytic predominance involving intrapelvic lymph nodes. Hodgkin’s disease, lymphocytic-histiocytic predominance involving spleen. Hodgkin’s disease, lymphocytic-histiocytic predominance involving lymph nodes of multiple sites. Hodgkin’s disease, nodular sclerosis, unspecified site. Hodgkin’s disease, nodular sclerosis, involving lymph nodes of head, face, and neck. Hodgkin’s disease, nodular sclerosis, involving intrathoracic lymph nodes. Hodgkin’s disease, nodular sclerosis, involving intra-abdominal lymph nodes. Hodgkin’s disease, nodular sclerosis, involving lymph nodes of axilla and upper limb. Hodgkin’s disease, nodular sclerosis, involving lymph nodes of inguinal region and lower limb. Hodgkin’s disease, nodular sclerosis, involving intrapelvic lymph nodes. Hodgkin’s disease, nodular sclerosis, involving spleen. Hodgkin’s disease, nodular sclerosis, involving lymph nodes of multiple sites. Hodgkin’s disease, mixed cellularity, unspecified site. Hodgkin’s disease, mixed cellularity, involving lymph nodes of head, face, and neck. Hodgkin’s disease, mixed cellularity, involving intrathoracic lymph nodes. Hodgkin’s disease, mixed cellularity, involving intra-abdominal lymph nodes. Hodgkin’s disease, mixed cellularity, involving lymph nodes of axilla and upper limb. Hodgkin’s disease, mixed cellularity, involving lymph nodes of inguinal region and lower limb. Hodgkin’s disease, mixed cellularity, involving intrapelvic lymph nodes. Jkt 223001 PO 00000 Frm 00350 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code mmaher on DSK3CLS3C1PROD with $$_JOB 20167 20168 20170 20171 20172 20173 20174 20175 20176 20177 20178 20190 20191 20192 20193 20194 20195 20196 20197 20198 20200 20201 20202 20203 20204 20205 20206 20207 20208 20210 20211 20212 20213 20214 20215 20216 20217 20218 20220 20221 20222 20223 20224 20225 20226 20227 20228 20230 20231 20232 20233 20234 20235 20236 20237 20238 20240 20241 20242 20243 20244 20245 20246 20247 20248 20250 20251 20252 20253 20254 20255 20256 Code title ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Hodgkin’s disease, mixed cellularity, involving spleen. Hodgkin’s disease, mixed cellularity, involving lymph nodes of multiple sites. Hodgkin’s disease, lymphocytic depletion, unspecified site. Hodgkin’s disease, lymphocytic depletion, involving lymph nodes of head, face, and neck. Hodgkin’s disease, lymphocytic depletion, involving intrathoracic lymph nodes. Hodgkin’s disease, lymphocytic depletion, involving intra-abdominal lymph nodes. Hodgkin’s disease, lymphocytic depletion, involving lymph nodes of axilla and upper limb. Hodgkin’s disease, lymphocytic depletion, involving lymph nodes of inguinal region and lower limb. Hodgkin’s disease, lymphocytic depletion, involving intrapelvic lymph nodes. Hodgkin’s disease, lymphocytic depletion, involving spleen. Hodgkin’s disease, lymphocytic depletion, involving lymph nodes of multiple sites. Hodgkin’s disease, unspecified type, unspecified site. Hodgkin’s disease, unspecified type, involving lymph nodes of head, face, and neck. Hodgkin’s disease, unspecified type, involving intrathoracic lymph nodes. Hodgkin’s disease, unspecified type, involving intra-abdominal lymph nodes. Hodgkin’s disease, unspecified type, involving lymph nodes of axilla and upper limb. Hodgkin’s disease, unspecified type, involving lymph nodes of inguinal region and lower limb. Hodgkin’s disease, unspecified type, involving intrapelvic lymph nodes. Hodgkin’s disease, unspecified type, involving spleen. Hodgkin’s disease, unspecified type, involving lymph nodes of multiple sites. Nodular lymphoma, unspecified site. Nodular lymphoma involving lymph nodes of head, face, and neck. Nodular lymphoma involving intrathoracic lymph nodes. Nodular lymphoma involving intra-abdominal lymph nodes. Nodular lymphoma involving lymph nodes of axilla and upper limb. Nodular lymphoma involving lymph nodes of inguinal region and lower limb. Nodular lymphoma involving intrapelvic lymph nodes. Nodular lymphoma involving spleen. Nodular lymphoma involving lymph nodes of multiple sites. Mycosis fungoides, unspecified site. Mycosis fungoides involving lymph nodes of head, face, and neck. Mycosis fungoides involving intrathoracic lymph nodes. Mycosis fungoides involving intra-abdominal lymph nodes. Mycosis fungoides involving lymph nodes of axilla and upper limb. Mycosis fungoides involving lymph nodes of inguinal region and lower limb. Mycosis fungoides involving intrapelvic lymph nodes. Mycosis fungoides involving spleen. Mycosis fungoides involving lymph nodes of multiple sites. Sezary’s disease, unspecified site. Sezary’s disease involving lymph nodes of head, face, and neck. Sezary’s disease involving intrathoracic lymph nodes. Sezary’s disease involving intra-abdominal lymph nodes. Sezary’s disease involving lymph nodes of axilla and upper limb. Sezary’s disease involving lymph nodes of inguinal region and lower limb. Sezary’s disease involving intrapelvic lymph nodes. Sezary’s disease involving spleen. Sezary’s disease involving lymph nodes of multiple sites. Malignant histiocytosis, unspecified site. Malignant histiocytosis involving lymph nodes of head, face, and neck. Malignant histiocytosis involving intrathoracic lymph nodes. Malignant histiocytosis involving intra-abdominal lymph nodes. Malignant histiocytosis involving lymph nodes of axilla and upper limb. Malignant histiocytosis involving lymph nodes of inguinal region and lower limb. Malignant histiocytosis involving intrapelvic lymph nodes. Malignant histiocytosis involving spleen. Malignant histiocytosis involving lymph nodes of multiple sites. Leukemic reticuloendotheliosis, unspecified site. Leukemic reticuloendotheliosis involving lymph nodes of head, face, and neck. Leukemic reticuloendotheliosis involving intrathoracic lymph nodes. Leukemic reticuloendotheliosis involving intra-abdominal lymph nodes. Leukemic reticuloendotheliosis involving lymph nodes of axilla and upper arm. Leukemic reticuloendotheliosis involving lymph nodes of inguinal region and lower limb. Leukemic reticuloendotheliosis involving intrapelvic lymph nodes. Leukemic reticuloendotheliosis involving spleen. Leukemic reticuloendotheliosis involving lymph nodes of multipes sites. Letterer-siwe disease, unspecified site. Letterer-siwe disease involving lymph nodes of head, face, and neck. Letterer-siwe disease involving intrathoracic lymph nodes. Letterer-siwe disease involving intra-abdominal lymph nodes. Letterer-siwe disease involving lymph nodes of axilla and upper limb. Letterer-siwe disease involving lymph nodes of inguinal region and lower limb. Letterer-siwe disease involving intrapelvic lymph nodes. Jkt 223001 PO 00000 Frm 00351 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25029 25030 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title 20257 ............................................... 20258 ............................................... 20260 ............................................... 20261 ............................................... 20262 ............................................... 20263 ............................................... 20264 ............................................... 20265 ............................................... 20266 ............................................... 20267 ............................................... 20268 ............................................... 20270 ............................................... 20271 ............................................... 20272 ............................................... 20273 ............................................... 20274 ............................................... 20275 ............................................... 20276 ............................................... 20277 ............................................... 20278 ............................................... 20280 ............................................... 20281 ............................................... 20282 ............................................... 20283 ............................................... 20284 ............................................... 20285 ............................................... 20286 ............................................... 20287 ............................................... 20288 ............................................... 290 ................................................... 20291 ............................................... 20292 ............................................... 20293 ............................................... 20294 ............................................... 20295 ............................................... Letterer-siwe disease involving spleen. Letterer-siwe disease involving lymph nodes of multiple sites. Malignant mast cell tumors, unspecified site. Malignant mast cell tumors involving lymph nodes of head, face, and neck. Malignant mast cell tumors involving intrathoracic lymph nodes. Malignant mast cell tumors involving intra-abdominal lymph nodes. Malignant mast cell tumors involving lymph nodes of axilla and upper limb. Malignant mast cell tumors involving lymph nodes of inguinal region and lower limb. Malignant mast cell tumors involving intrapelvic lymph nodes. Malignant mast cell tumors involving spleen. Malignant mast cell tumors involving lymph nodes of multiple sites. Peripheral T cell lymphoma, unspecified site, extranodal and solid organ sites. Peripheral T cell lymphoma, lymph nodes of head, face, and neck. Peripheral T cell lymphoma, intrathoracic lymph nodes. Peripheral T cell lymphoma, intra-abdominal lymph nodes. Peripheral T cell lymphoma, lymph nodes of axilla and upper limb. Peripheral T cell lymphoma, lymph nodes of inguinal region and lower limb. Peripheral T cell lymphoma, intrapelvic lymph nodes. Peripheral T cell lymphoma, spleen. Peripheral T cell lymphoma, lymph nodes of multiple sites. Other malignant lymphomas, unspecified site. Other malignant lymphomas involving lymph nodes of head, face, and neck. Other malignant lymphomas involving intrathoracic lymph nodes. Other malignant lymphomas involving intra-abdominal lymph nodes. Other malignant lymphomas involving lymph nodes of axilla and upper limb. Other malignant lymphomas involving lymph nodes of inguinal region and lower limb. Other malignant lymphomas involving intrapelvic lymph nodes. Other malignant lymphomas involving spleen. Other malignant lymphomas involving lymph nodes of multiple sites. Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue, unspecified site. Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue involving lymph nodes of head, face, and neck. Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue involving intrathoracic lymph nodes. Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue involving intra-abdominal lymph nodes. Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue involving lymph nodes of axilla and upper limb. Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue involving lymph nodes of inguinal region and lower limb. Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue involving intrapelvic lymph nodes. Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue involving spleen. Other and unspecified malignant neoplasms of lymphoid and histiocytic tissue involving lymph nodes of multiple sites. Multiple myeloma, without mention of remission. Multiple myeloma, in remission. Plasma cell leukemia, without mention of remission. Plasma cell leukemia, in remission. Other immunoproliferative neoplasms, without mention of remission. Other immunoproliferative neoplasms, in remission. Lymphoid leukemia, acute, without mention of remission. Lymphoid leukemia, acute, in remission. Lymphoid leukemia, chronic, without mention of remission. Lymphoid leukemia, chronic, in remission. Lymphoid leukemia, subacute, without mention of remission. Lymphoid leukemia, subacute, in remission. Other lymphoid leukemia, without mention of remission. Other lymphoid leukemia, in remission. Unspecified lymphoid leukemia, without mention of remission. Unspecified lymphoid leukemia, in remission. Myeloid leukemia, acute, without mention of remission. Myeloid leukemia, acute, in remission. Myeloid leukemia, chronic, without mention of remission. Myeloid leukemia, chronic, in remission. Myeloid leukemia, subacute, without mention of remission. Myeloid leukemia, subacute, in remission. Myeloid sarcoma, without mention of remission. Myeloid sarcoma, in remission. Other myeloid leukemia, without mention of remission. Other myeloid leukemia, in remission. Unspecified myeloid leukemia, without mention of remission. mmaher on DSK3CLS3C1PROD with $$_JOB 20296 20297 20298 20300 20301 20310 20311 20380 20381 20400 20401 20410 20411 20420 20421 20480 20481 20490 20491 20500 20501 20510 20511 20520 20521 20530 20531 20580 20581 20590 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00352 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 20591 ............................................... 20600 ............................................... 20601 ............................................... 20610 ............................................... 20611 ............................................... 20620 ............................................... 20621 ............................................... 20680 ............................................... 20681 ............................................... 20690 ............................................... 20691 ............................................... 20700 ............................................... 20701 ............................................... 20710 ............................................... 20711 ............................................... 20720 ............................................... 20721 ............................................... 20780 ............................................... 20781 ............................................... 20800 ............................................... 20801 ............................................... 20810 ............................................... 20811 ............................................... 20820 ............................................... 20821 ............................................... 20880 ............................................... 20881 ............................................... 20890 ............................................... 20891 ............................................... 2385 ................................................. 2386 ................................................. 23873 ............................................... 23874 ............................................... 23876 ............................................... 23879 ............................................... 2450 ................................................. 2463 ................................................. 2510 ................................................. 2513 ................................................. 2531 ................................................. 2532 ................................................. 2535 ................................................. 2536 ................................................. 2541 ................................................. 2550 ................................................. 2553 ................................................. 25541 ............................................... 25542 ............................................... 2555 ................................................. 2556 ................................................. 2592 ................................................. 2632 ................................................. 2638 ................................................. 2639 ................................................. 2650 ................................................. 2651 ................................................. 2660 ................................................. 2680 ................................................. 2700 ................................................. 2701 ................................................. 2702 ................................................. 2703 ................................................. 2704 ................................................. 2705 ................................................. 2706 ................................................. 2707 ................................................. 2708 ................................................. 2709 ................................................. 2710 ................................................. 2711 ................................................. 2718 ................................................. 27411 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Unspecified myeloid leukemia, in remission. Monocytic leukemia, acute, without mention of remission. Monocytic leukemia, acute, in remission. Monocytic leukemia, chronic without mention of remission. Monocytic leukemia, chronic, in remission. Monocytic leukemia, subacute, without mention of remission. Monocytic leukemia, subacute, in remission. Other monocytic leukemia, without mention of remission. Other monocytic leukemia, in remission. Unspecified monocytic leukemia, without mention of remission. Unspecified monocytic leukemia, in remission. Acute erythremia and erythroleukemia, without mention of remission. Acute erythremia and erythroleukemia, in remission. Chronic erythremia, without mention of remission. Chronic erythremia, in remission. Megakaryocytic leukemia, without mention of remission. Megakaryocytic leukemia, in remission. Other specified leukemia, without mention of remission. Other specified leukemia, in remission. Leukemia of unspecified cell type, acute, without mention of remission. Leukemia of unspecified cell type, acute, in remission. Leukemia of unspecified cell type, chronic, without mention of remission. Leukemia of unspecified cell type, chronic, in remission. Leukemia of unspecified cell type, subacute, without mention of remission. Leukemia of unspecified cell type, subacute, in remission. Other leukemia of unspecified cell type, without mention of remission. Other leukemia of unspecified cell type, in remission. Unspecified leukemia, without mention of remission. Unspecified leukemia, in remission. Neoplasm of uncertain behavior of histiocytic and mast cells. Neoplasm of uncertain behavior of plasma cells. High grade myelodysplastic syndrome lesions. Myelodysplastic syndrome with 5q deletion. Myelofibrosis with myeloid metaplasia. Other lymphatic and hematopoietic tissues. Acute thyroiditis. Hemorrhage and infarction of thyroid. Hypoglycemic coma. Postsurgical hypoinsulinemia. Other and unspecified anterior pituitary hyperfunction. Panhypopituitarism. Diabetes insipidus. Other disorders of neurohypophysis. Abscess of thymus. Cushing’s syndrome. Other corticoadrenal overactivity. Glucocorticoid deficiency. Mineralocorticoid deficiency. Other adrenal hypofunction. Medulloadrenal hyperfunction. Carcinoid syndrome. Arrested development following protein-calorie malnutrition. Other protein-calorie malnutrition. Unspecified protein-calorie malnutrition. Beriberi. Other and unspecified manifestations of thiamine deficiency. Ariboflavinosis. Rickets, active. Disturbances of amino-acid transport. Phenylketonuria (PKU). Other disturbances of aromatic amino-acid metabolism. Disturbances of branched-chain amino-acid metabolism. Disturbances of sulphur-bearing amino-acid metabolism. Disturbances of histidine metabolism. Disorders of urea cycle metabolism. Other disturbances of straight-chain amino-acid metabolism. Other specified disorders of amino-acid metabolism. Unspecified disorder of amino-acid metabolism. Glycogenosis. Galactosemia. Other specified disorders of carbohydrate transport and metabolism. Uric acid nephrolithiasis. Jkt 223001 PO 00000 Frm 00353 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25031 25032 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 2760 ................................................. 2761 ................................................. 2762 ................................................. 2763 ................................................. 2764 ................................................. 27700 ............................................... 27703 ............................................... 27709 ............................................... 2771 ................................................. 2772 ................................................. 27730 ............................................... 27731 ............................................... 27739 ............................................... 2775 ................................................. 27785 ............................................... 27786 ............................................... 27787 ............................................... 27789 ............................................... 27900 ............................................... 27901 ............................................... 27902 ............................................... 27903 ............................................... 27904 ............................................... 27905 ............................................... 27906 ............................................... 27909 ............................................... 27910 ............................................... 27911 ............................................... 27912 ............................................... 27913 ............................................... 27919 ............................................... 2792 ................................................. 2793 ................................................. 2828 ................................................. 2829 ................................................. 2830 ................................................. 28310 ............................................... 28319 ............................................... 2839 ................................................. 28401 ............................................... 28409 ............................................... 2841 ................................................. 2842 ................................................. 2849 ................................................. 2862 ................................................. 2863 ................................................. 2864 ................................................. 2865 ................................................. 2867 ................................................. 2869 ................................................. 2870 ................................................. 28731 ............................................... 28732 ............................................... 28733 ............................................... 2884 ................................................. 2897 ................................................. 28981 ............................................... 28982 ............................................... 28983 ............................................... 29011 ............................................... 29012 ............................................... 29013 ............................................... 29020 ............................................... 29021 ............................................... 2903 ................................................. 29041 ............................................... 29042 ............................................... 29043 ............................................... 2908 ................................................. 2909 ................................................. 2910 ................................................. 2912 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Hyperosmolality and/or hypernatremia. Hyposmolality and/or hyponatremia. Acidosis. Alkalosis. Mixed acid-base balance disorder. Cystic fibrosis without mention of meconium ileus. Cystic fibrosis with gastrointestinal manifestations. Cystic fibrosis with other manifestations. Disorders of porphyrin metabolism. Other disorders of purine and pyrimidine metabolism. Amyloidosis, unspecified. Familial Mediterranean fever. Other amyloidosis. Mucopolysaccharidosis. Disorders of fatty acid oxidation. Peroxisomal disorders. Disorders of mitochondrial metabolism. Other specified disorders of metabolism. Hypogammaglobulinemia, unspecified. Selective iga immunodeficiency. Selective igm immunodeficiency. Other selective immunoglobulin deficiencies. Congenital hypogammaglobulinemia. Immunodeficiency with increased igm. Common variable immunodeficiency. Other deficiency of humoral immunity. Immunodeficiency with predominant T-cell defect, unspecified. Digeorge’s syndrome. Wiskott-aldrich syndrome. Nezelof’s syndrome. Other deficiency of cell-mediated immunity. Combined immunity deficiency. Unspecified immunity deficiency. Other specified hereditary hemolytic anemias. Hereditary hemolytic anemia, unspecified. Autoimmune hemolytic anemias. Non-autoimmune hemolytic anemia, unspecified. Other non-autoimmune hemolytic anemias. Acquired hemolytic anemia, unspecified. Constitutional red blood cell aplasia. Other constitutional aplastic anemia. Pancytopenia. Myelophthisis. Aplastic anemia, unspecified. Congenital factor xi deficiency. Congenital deficiency of other clotting factors. Von willebrand’s disease. Hemorrhagic disorder due to intrinsic circulating anticoagulants. Acquired coagulation factor deficiency. Other and unspecified coagulation defects. Allergic purpura. Immune thrombocytopenic purpura. Evans’ syndrome. Congenital and hereditary thrombocytopenic purpura. Hemophagocytic syndromes. Methemoglobinemia. Primary hypercoagulable state. Secondary hypercoagulable state. Myelofibrosis. Presenile dementia with delirium. Presenile dementia with delusional features. Presenile dementia with depressive features. Senile dementia with delusional features. Senile dementia with depressive features. Senile dementia with delirium. Vascular dementia, with delirium. Vascular dementia, with delusions. Vascular dementia, with depressed mood. Other specified senile psychotic conditions. Unspecified senile psychotic condition. Alcohol withdrawal delirium. Alcohol-induced persisting dementia. Jkt 223001 PO 00000 Frm 00354 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 2913 ................................................. 29181 ............................................... 29189 ............................................... 2919 ................................................. 2920 ................................................. 29211 ............................................... 29212 ............................................... 29281 ............................................... 29282 ............................................... 2930 ................................................. 2931 ................................................. 29381 ............................................... 29382 ............................................... 2939 ................................................. 29411 ............................................... 29500 ............................................... 29501 ............................................... 29502 ............................................... 29503 ............................................... 29504 ............................................... 29510 ............................................... 29511 ............................................... 29512 ............................................... 29513 ............................................... 29514 ............................................... 29520 ............................................... 29521 ............................................... 29522 ............................................... 29523 ............................................... 29524 ............................................... 29530 ............................................... 29531 ............................................... 29532 ............................................... 29533 ............................................... 29534 ............................................... 29540 ............................................... 29541 ............................................... 29542 ............................................... 29543 ............................................... 29544 ............................................... 29553 ............................................... 29554 ............................................... 29560 ............................................... 29561 ............................................... 29562 ............................................... 29563 ............................................... 29564 ............................................... 29571 ............................................... 29572 ............................................... 29573 ............................................... 29574 ............................................... 29580 ............................................... 29581 ............................................... 29582 ............................................... 29583 ............................................... 29584 ............................................... 29591 ............................................... 29592 ............................................... 29593 ............................................... 29594 ............................................... 29600 ............................................... 29601 ............................................... 29602 ............................................... 29603 ............................................... 29604 ............................................... 29610 ............................................... 29611 ............................................... 29612 ............................................... 29613 ............................................... 29614 ............................................... 29620 ............................................... 29621 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Alcohol-induced psychotic disorder with hallucinations. Alcohol withdrawal. Other alcohol-induced mental disorders. Unspecified alcohol-induced mental disorders. Drug withdrawal. Drug-induced psychotic disorder with delusions. Drug-induced psychotic disorder with hallucinations. Drug-induced delirium. Drug-induced persisting dementia. Delirium due to conditions classified elsewhere. Subacute delirium. Psychotic disorder with delusions in conditions classified elsewhere. Psychotic disorder with hallucinations in conditions classified elsewhere. Unspecified transient mental disorder in conditions classified elsewhere. Dementia in conditions classified elsewhere with behavioral disturbance. Simple type schizophrenia, unspecified state. Simple type schizophrenia, subchronic state. Simple type schizophrenia, chronic state. Simple type schizophrenia, subchronic state with acute exacerbation. Simple type schizophrenia, chronic state with acute exacerbation. Disorganized type schizophrenia, unspecified state. Disorganized type schizophrenia, subchronic state. Disorganized type schizophrenia, chronic state. Disorganized type schizophrenia, subchronic state with acute exacerbation. Disorganized type schizophrenia, chronic state with acute exacerbation. Catatonic type schizophrenia, unspecified state. Catatonic type schizophrenia, subchronic state. Catatonic type schizophrenia, chronic state. Catatonic type schizophrenia, subchronic state with acute exacerbation. Catatonic type schizophrenia, chronic state with acute exacerbation. Paranoid type schizophrenia, unspecified state. Paranoid type schizophrenia, subchronic state. Paranoid type schizophrenia, chronic state. Paranoid type schizophrenia, subchronic state with acute exacerbation. Paranoid type schizophrenia, chronic state with acute exacerbation. Schizophreniform disorder, unspecified. Schizophreniform disorder, subchronic. Schizophreniform disorder, chronic. Schizophreniform disorder, subchronic with acute exacerbation. Schizophreniform disorder, chronic with acute exacerbation. Latent schizophrenia, subchronic state with acute exacerbation. Latent schizophrenia, chronic state with acute exacerbation. Schizophrenic disorders, residual type, unspecified. Schizophrenic disorders, residual type, subchronic. Schizophrenic disorders, residual type, chronic. Schizophrenic disorders, residual type, subchronic with acute exacerbation. Schizophrenic disorders, residual type, chronic with acute exacerbation. Schizoaffective disorder, subchronic. Schizoaffective disorder, chronic. Schizoaffective disorder, subchronic with acute exacerbation. Schizoaffective disorder, chronic with acute exacerbation. Other specified types of schizophrenia, unspecified state. Other specified types of schizophrenia, subchronic state. Other specified types of schizophrenia, chronic state. Other specified types of schizophrenia, subchronic state with acute exacerbation. Other specified types of schizophrenia, chronic state with acute exacerbation. Unspecified type schizophrenia, subchronic state. Unspecified type schizophrenia, chronic state. Unspecified type schizophrenia, subchronic state with acute exacerbation. Unspecified type schizophrenia, chronic state with acute exacerbation. Bipolar I disorder, single manic episode, unspecified. Bipolar I disorder, single manic episode, mild. Bipolar I disorder, single manic episode, moderate. Bipolar I disorder, single manic episode, severe, without mention of psychotic behavior. Bipolar I disorder, single manic episode, severe, specified as with psychotic behavior. Manic affective disorder, recurrent episode, unspecified degree. Manic affective disorder, recurrent episode, mild degree. Manic affective disorder, recurrent episode, moderate degree. Manic affective disorder, recurrent episode, severe degree, without mention of psychotic behavior. Manic affective disorder, recurrent episode, severe degree, specified as with psychotic behavior. Major depressive affective disorder, single episode, unspecified degree. Major depressive affective disorder, single episode, mild degree. Jkt 223001 PO 00000 Frm 00355 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25033 25034 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 29622 ............................................... 29623 ............................................... 29624 ............................................... 29630 ............................................... 29631 ............................................... 29632 ............................................... 29633 ............................................... 29634 ............................................... 29640 ............................................... 29641 ............................................... 29642 ............................................... 29643 ............................................... 29644 ............................................... 29650 ............................................... 29651 ............................................... 29652 ............................................... 29653 ............................................... 29654 ............................................... 29660 ............................................... 29661 ............................................... 29662 ............................................... 29663 ............................................... 29664 ............................................... 29689 ............................................... 29699 ............................................... 2980 ................................................. 2981 ................................................. 2983 ................................................. 2984 ................................................. 29900 ............................................... 29901 ............................................... 29910 ............................................... 29911 ............................................... 29980 ............................................... 29981 ............................................... 29990 ............................................... 29991 ............................................... 30151 ............................................... 30401 ............................................... 30411 ............................................... 30421 ............................................... 30441 ............................................... 30451 ............................................... 30461 ............................................... 30471 ............................................... 30481 ............................................... 30491 ............................................... 3071 ................................................. 30751 ............................................... 3181 ................................................. 3182 ................................................. 3222 ................................................. 3300 ................................................. 3301 ................................................. 3302 ................................................. 3303 ................................................. 3308 ................................................. 3309 ................................................. 3313 ................................................. 3314 ................................................. 3315 ................................................. 3321 ................................................. 3330 ................................................. 3334 ................................................. 33371 ............................................... 33372 ............................................... 33379 ............................................... 33390 ............................................... 33391 ............................................... 3340 ................................................. 3341 ................................................. 3342 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Major depressive affective disorder, single episode, moderate degree. Major depressive affective disorder, single episode, severe degree, without mention of psychotic behavior. Major depressive affective disorder, single episode, severe degree, specified as with psychotic behavior. Major depressive affective disorder, recurrent episode, unspecified degree. Major depressive affective disorder, recurrent episode, mild degree. Major depressive affective disorder, recurrent episode, moderate degree. Major depressive affective disorder, recurrent episode, severe degree, without mention of psychotic behavior. Major depressive affective disorder, recurrent episode, severe degree, specified as with psychotic behavior. Bipolar I disorder, most recent episode (or current) manic, unspecified. Bipolar I disorder, most recent episode (or current) manic, mild. Bipolar I disorder, most recent episode (or current) manic, moderate. Bipolar I disorder, most recent episode (or current) manic, severe, without mention of psychotic behavior. Bipolar I disorder, most recent episode (or current) manic, severe, specified as with psychotic behavior. Bipolar I disorder, most recent episode (or current) depressed, unspecified. Bipolar I disorder, most recent episode (or current) depressed, mild. Bipolar I disorder, most recent episode (or current) depressed, moderate. Bipolar I disorder, most recent episode (or current) depressed, severe, without mention of psychotic behavior. Bipolar I disorder, most recent episode (or current) depressed, severe, specified as with psychotic behavior. Bipolar I disorder, most recent episode (or current) mixed, unspecified. Bipolar I disorder, most recent episode (or current) mixed, mild. Bipolar I disorder, most recent episode (or current) mixed, moderate. Bipolar I disorder, most recent episode (or current) mixed, severe, without mention of psychotic behavior. Bipolar I disorder, most recent episode (or current) mixed, severe, specified as with psychotic behavior. Other and unspecified bipolar disorders, other. Other specified episodic mood disorder. Depressive type psychosis. Excitative type psychosis. Acute paranoid reaction. Psychogenic paranoid psychosis. Autistic disorder, current or active state. Autistic disorder, residual state. Childhood disintegrative disorder, current or active state. Childhood disintegrative disorder, residual state. Other specified pervasive developmental disorders, current or active state. Other specified pervasive developmental disorders, residual state. Unspecified pervasive developmental disorder, current or active state. Unspecified pervasive developmental disorder, residual state. Chronic factitious illness with physical symptoms. Opioid type dependence, continuous use. Sedative, hypnotic or anxiolytic dependence, continuous. Cocaine dependence, continuous use. Amphetamine and other psychostimulant dependence, continuous use. Hallucinogen dependence, continuous use. Other specified drug dependence, continuous use. Combinations of opioid type drug with any other drug dependence, continuous use. Combinations of drug dependence excluding opioid type drug, continuous use. Unspecified drug dependence, continuous use. Anorexia nervosa. Bulimia nervosa. Severe mental retardation. Profound mental retardation. Chronic meningitis. Leukodystrophy. Cerebral lipidoses. Cerebral degeneration in generalized lipidoses. Cerebral degeneration of childhood in other diseases classified elsewhere. Other specified cerebral degenerations in childhood. Unspecified cerebral degeneration in childhood. Communicating hydrocephalus. Obstructive hydrocephalus. Idiopathic normal pressure hydrocephalus (INPH). Secondary parkinsonism. Other degenerative diseases of the basal ganglia. Huntington’s chorea. Athetoid cerebral palsy. Acute dystonia due to drugs. Other acquired torsion dystonia. Unspecified extrapyramidal disease and abnormal movement disorder. Stiff-man syndrome. Friedreich’s ataxia. Hereditary spastic paraplegia. Primary cerebellar degeneration. Jkt 223001 PO 00000 Frm 00356 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25035 TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title 3343 ................................................. 3344 ................................................. 3348 ................................................. 3349 ................................................. 3350 ................................................. 33510 ............................................... 33511 ............................................... 33519 ............................................... 33520 ............................................... 33521 ............................................... 33522 ............................................... 33523 ............................................... 33524 ............................................... 33529 ............................................... 3358 ................................................. 3359 ................................................. 3360 ................................................. 3362 ................................................. 3363 ................................................. 3368 ................................................. 3369 ................................................. 3370 ................................................. 3371 ................................................. 33720 ............................................... 33721 ............................................... 33722 ............................................... 33729 ............................................... 3410 ................................................. 3411 ................................................. 34120 ............................................... 34121 ............................................... 34122 ............................................... 3418 ................................................. 3419 ................................................. 34200 ............................................... 34201 ............................................... 34202 ............................................... 34210 ............................................... 34211 ............................................... 34212 ............................................... 34280 ............................................... 34281 ............................................... 34282 ............................................... 34290 ............................................... 34291 ............................................... 34292 ............................................... 3430 ................................................. 3431 ................................................. 3434 ................................................. 3441 ................................................. 3442 ................................................. 34460 ............................................... 34461 ............................................... 34501 ............................................... 34511 ............................................... 3452 ................................................. 34540 ............................................... Other cerebellar ataxia. Cerebellar ataxia in diseases classified elsewhere. Other spinocerebellar diseases. Spinocerebellar disease, unspecified. Werdnig-hoffmann disease. Spinal muscular atrophy, unspecified. Kugelberg-welander disease. Other spinal muscular atrophy. Amyotrophic lateral sclerosis. Progressive muscular atrophy. Progressive bulbar palsy. Pseudobulbar palsy. Primary lateral sclerosis. Other motor neuron diseases. Other anterior horn cell diseases. Anterior horn cell disease, unspecified. Syringomyelia and syringobulbia. Subacute combined degeneration of spinal cord in diseases classified elsewhere. Myelopathy in other diseases classified elsewhere. Other myelopathy. Unspecified disease of spinal cord. Idiopathic peripheral autonomic neuropathy. Peripheral autonomic neuropathy in disorders classified elsewhere. Reflex sympathetic dystrophy, unspecified. Reflex sympathetic dystrophy of the upper limb. Reflex sympathetic dystrophy of the lower limb. Reflex sympathetic dystrophy of other specified site. Neuromyelitis optica. Schilder’s disease. Acute (transverse) myelitis NOS. Acute (transverse) myelitis in conditions classified elsewhere. Idiopathic transverse myelitis. Other demyelinating diseases of central nervous system. Demyelinating disease of central nervous system, unspecified. Flaccid hemiplegia and hemiparesis affecting unspecified side. Flaccid hemiplegia and hemiparesis affecting dominant side. Flaccid hemiplegia and hemiparesis affecting nondominant side. Spastic hemiplegia and hemiparesis affecting unspecified side. Spastic hemiplegia and hemiparesis affecting dominant side. Spastic hemiplegia and hemiparesis affecting nondominant side. Other specified hemiplegia and hemiparesis affecting unspecified side. Other specified hemiplegia and hemiparesis affecting dominant side. Other specified hemiplegia and hemiparesis affecting nondominant side. Unspecified hemiplegia and hemiparesis affecting unspecified side. Unspecified hemiplegia and hemiparesis affecting dominant side. Unspecified hemiplegia and hemiparesis affecting nondominant side. Congenital diplegia. Congenital hemiplegia. Infantile hemiplegia. Paraplegia. Diplegia of upper limbs. Cauda equina syndrome without mention of neurogenic bladder. Cauda equina syndrome with neurogenic bladder. Generalized nonconvulsive epilepsy, with intractable epilepsy. Generalized convulsive epilepsy, with intractable epilepsy. Petit mal status, epileptic. Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, without mention of intractable epilepsy. Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy. Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy. Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy. Infantile spasms, without mention of intractable epilepsy. Infantile spasms, with intractable epilepsy. Epilepsia partialis continua, without mention of intractable epilepsy. Epilepsia partialis continua, with intractable epilepsy. Other forms of epilepsy and recurrent seizures, without mention of intractable epilepsy. Other forms of epilepsy and recurrent seizures, with intractable epilepsy. Epilepsy, unspecified, with intractable epilepsy. Anoxic brain damage. 34541 ............................................... 34550 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 34551 ............................................... 34560 ............................................... 34561 ............................................... 34570 ............................................... 34571 ............................................... 34580 ............................................... 34581 ............................................... 34591 ............................................... 3481 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00357 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25036 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 3491 ................................................. 34981 ............................................... 3563 ................................................. 3570 ................................................. 35781 ............................................... 35782 ............................................... 3581 ................................................. 3590 ................................................. 3591 ................................................. 3594 ................................................. 3596 ................................................. 35981 ............................................... 36000 ............................................... 36001 ............................................... 36002 ............................................... 36004 ............................................... 36011 ............................................... 36012 ............................................... 36013 ............................................... 36019 ............................................... 3612 ................................................. 36181 ............................................... 36189 ............................................... 3619 ................................................. 36230 ............................................... 36231 ............................................... 36232 ............................................... 36233 ............................................... 36234 ............................................... 36235 ............................................... 36240 ............................................... 36242 ............................................... 36243 ............................................... 36284 ............................................... 36310 ............................................... 36311 ............................................... 36312 ............................................... 36313 ............................................... 36314 ............................................... 36315 ............................................... 36320 ............................................... 36363 ............................................... 36370 ............................................... 36371 ............................................... 36372 ............................................... 36400 ............................................... 36401 ............................................... 36402 ............................................... 36403 ............................................... 36422 ............................................... 3643 ................................................. 36522 ............................................... 36811 ............................................... 36812 ............................................... 37601 ............................................... 37602 ............................................... 37603 ............................................... 37700 ............................................... 37701 ............................................... 37730 ............................................... 37731 ............................................... 37732 ............................................... 37739 ............................................... 37751 ............................................... 37752 ............................................... 37753 ............................................... 37754 ............................................... 37761 ............................................... 37762 ............................................... 37763 ............................................... 37771 ............................................... 37772 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Nervous system complications from surgically implanted device. Cerebrospinal fluid rhinorrhea. Refsum’s disease. Acute infective polyneuritis. Chronic inflammatory demyelinating polyneuritis. Critical illness polyneuropathy. Myasthenic syndromes in diseases classified elsewhere. Congenital hereditary muscular dystrophy. Hereditary progressive muscular dystrophy. Toxic myopathy. Symptomatic inflammatory myopathy in diseases classified elsewhere. Critical illness myopathy. Purulent endophthalmitis, unspecified. Acute endophthalmitis. Panophthalmitis. Vitreous abscess. Sympathetic uveitis. Panuveitis. Parasitic endophthalmitis nos. Other endophthalmitis. Serous retinal detachment. Traction detachment of retina. Other forms of retinal detachment. Unspecified retinal detachment. Retinal vascular occlusion, unspecified. Central retinal artery occlusion. Retinal arterial branch occlusion. Partial retinal arterial occlusion. Transient retinal arterial occlusion. Central retinal vein occlusion. Retinal layer separation, unspecified. Serous detachment of retinal pigment epithelium. Hemorrhagic detachment of retinal pigment epithelium. Retinal ischemia. Disseminated chorioretinitis, unspecified. Disseminated choroiditis and chorioretinitis, posterior pole. Disseminated choroiditis and chorioretinitis, peripheral. Disseminated choroiditis and chorioretinitis, generalized. Disseminated retinitis and retinochoroiditis, metastatic. Disseminated retinitis and retinochoroiditis, pigment epitheliopathy. Chorioretinitis, unspecified. Choroidal rupture. Choroidal detachment, unspecified. Serous choroidal detachment. Hemorrhagic choroidal detachment. Acute and subacute iridocyclitis, unspecified. Primary iridocyclitis. Recurrent iridocyclitis. Secondary iridocyclitis, infectious. Glaucomatocyclitic crises. Unspecified iridocyclitis. Acute angle-closure glaucoma. Sudden visual loss. Transient visual loss. Orbital cellulitis. Orbital periostitis. Orbital osteomyelitis. Papilledema, unspecified. Papilledema associated with increased intracranial pressure. Optic neuritis, unspecified. Optic papillitis. Retrobulbar neuritis (acute). Other optic neuritis. Disorders of optic chiasm associated with pituitary neoplasms and disorders. Disorders of optic chiasm associated with other neoplasms. Disorders of optic chiasm associated with vascular disorders. Disorders of optic chiasm associated with inflammatory disorders. Disorders of other visual pathways associated with neoplasms. Disorders of other visual pathways associated with vascular disorders. Disorders of other visual pathways associated with inflammatory disorders. Disorders of visual cortex associated with neoplasms. Disorders of visual cortex associated with vascular disorders. Jkt 223001 PO 00000 Frm 00358 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25037 TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title 37773 ............................................... 38014 ............................................... 38300 ............................................... 38301 ............................................... 38302 ............................................... 38861 ............................................... 3910 ................................................. 3911 ................................................. 3912 ................................................. 3918 ................................................. 3919 ................................................. 3920 ................................................. 3929 ................................................. 393 ................................................... 3980 ................................................. 39891 ............................................... 4010 ................................................. 40200 ............................................... 40201 ............................................... 40211 ............................................... 40291 ............................................... 40300 ............................................... 40301 ............................................... 40311 ............................................... 40400 ............................................... Disorders of visual cortex associated with inflammatory disorders. Malignant otitis externa. Acute mastoiditis without complications. Subperiosteal abscess of mastoid. Acute mastoiditis with other complications. Cerebrospinal fluid otorrhea. Acute rheumatic pericarditis. Acute rheumatic endocarditis. Acute rheumatic myocarditis. Other acute rheumatic heart disease. Acute rheumatic heart disease, unspecified. Rheumatic chorea with heart involvement. Rheumatic chorea without mention of heart involvement. Chronic rheumatic pericarditis. Rheumatic myocarditis. Rheumatic heart failure (congestive). Malignant essential hypertension. Malignant hypertensive heart disease without congestive heart failure. Malignant hypertensive heart disease with congestive heart failure. Benign hypertensive heart disease with congestive heart failure. Unspecified hypertensive heart disease with congestive heart failure. Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage I through stage IV, or unspecified. Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease. Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end stage renal disease. Hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kidney disease stage I through stage IV, or unspecified. Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified. Hypertensive heart and chronic kidney disease, malignant, without heart failure and with chronic kidney disease stage V or end stage renal disease. Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease. Hypertensive heart and chronic kidney disease, benign, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified. Hypertensive heart and chronic kidney disease, benign, without heart failure and with chronic kidney disease stage V or end stage renal disease. Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end stage renal disease. Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified. Hypertensive heart and chronic kidney disease, unspecified, without heart failure and with chronic kidney disease stage V or end stage renal disease. Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease. Malignant renovascular hypertension. Other malignant secondary hypertension. Postmyocardial infarction syndrome. Intermediate coronary syndrome. Other acute and subacute forms of ischemic heart disease, acute ischemic heart disease without myocardial infarction. Other acute and subacute forms of ischemic heart disease, other. Angina decubitus. Prinzmetal angina. Coronary atherosclerosis of autologous vein bypass graft. Coronary atherosclerosis of nonautologous biological bypass graft. Coronary atherosclerosis of artery bypass graft. Coronary atherosclerosis of native coronary artery of transplanted heart. Coronary atherosclerosis, of bypass graft (artery) (vein) of transplanted heart. Aneurysm of heart (wall). Other aneurysm of heart. Primary pulmonary hypertension. Kyphoscoliotic heart disease. Arteriovenous fistula of pulmonary vessels. Aneurysm of pulmonary artery. Acute pericarditis in diseases classified elsewhere. Acute pericarditis, unspecified. Acute idiopathic pericarditis. Other acute pericarditis. Hemopericardium. Adhesive pericarditis. 40401 ............................................... 40402 ............................................... 40403 ............................................... 40411 ............................................... 40412 ............................................... 40413 ............................................... 40491 ............................................... 40492 ............................................... 40493 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 40501 ............................................... 40509 ............................................... 4110 ................................................. 4111 ................................................. 41181 ............................................... 41189 ............................................... 4130 ................................................. 4131 ................................................. 41402 ............................................... 41403 ............................................... 41404 ............................................... 41406 ............................................... 41407 ............................................... 41410 ............................................... 41419 ............................................... 4160 ................................................. 4161 ................................................. 4170 ................................................. 4171 ................................................. 4200 ................................................. 42090 ............................................... 42091 ............................................... 42099 ............................................... 4230 ................................................. 4231 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00359 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25038 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 4232 ................................................. 4233 ................................................. 4238 ................................................. 4239 ................................................. 42490 ............................................... 42491 ............................................... 42499 ............................................... 4250 ................................................. 4251 ................................................. 4252 ................................................. 4253 ................................................. 4254 ................................................. 4255 ................................................. 4257 ................................................. 4258 ................................................. 4259 ................................................. 4260 ................................................. 42612 ............................................... 42689 ............................................... 4270 ................................................. 4271 ................................................. 42732 ............................................... 4281 ................................................. 42820 ............................................... 42822 ............................................... 42830 ............................................... 42832 ............................................... 42840 ............................................... 42842 ............................................... 42971 ............................................... 42979 ............................................... 42981 ............................................... 42982 ............................................... 42983 ............................................... 4329 ................................................. 4350 ................................................. 4351 ................................................. 4352 ................................................. 4353 ................................................. 4358 ................................................. 4359 ................................................. 436 ................................................... 4371 ................................................. 4372 ................................................. 4374 ................................................. 4375 ................................................. 4376 ................................................. 43820 ............................................... 43821 ............................................... 43822 ............................................... 44024 ............................................... 4440 ................................................. 4441 ................................................. 44421 ............................................... 44422 ............................................... 44481 ............................................... 44489 ............................................... 4449 ................................................. 44501 ............................................... 44502 ............................................... 44581 ............................................... 44589 ............................................... 4460 ................................................. 4461 ................................................. 44620 ............................................... 44621 ............................................... 44629 ............................................... 4463 ................................................. 4464 ................................................. 4467 ................................................. 4472 ................................................. 4474 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Constrictive pericarditis. Cardiac tamponade. Other specified diseases of pericardium. Unspecified disease of pericardium. Endocarditis, valve unspecified, unspecified cause. Endocarditis in diseases classified elsewhere. Other endocarditis, valve unspecified. Endomyocardial fibrosis. Hypertrophic obstructive cardiomyopathy. Obscure cardiomyopathy of africa. Endocardial fibroelastosis. Other primary cardiomyopathies. Alcoholic cardiomyopathy. Nutritional and metabolic cardiomyopathy. Cardiomyopathy in other diseases classified elsewhere. Secondary cardiomyopathy, unspecified. Atrioventricular block, complete. Mobitz (type) ii atrioventricular block. Other specified conduction disorders. Paroxysmal supraventricular tachycardia. Paroxysmal ventricular tachycardia. Atrial flutter. Left heart failure. Unspecified systolic heart failure. Chronic systolic heart failure. Unspecified diastolic heart failure. Chronic diastolic heart failure. Unspecified combined systolic and diastolic heart failure. Chronic combined systolic and diastolic heart failure. Certain sequelae of myocardial infarction, not elsewhere classified, acquired cardiac septal defect. Certain sequelae of myocardial infarction, not elsewhere classified, other. Other disorders of papillary muscle. Hyperkinetic heart disease. Takotsubo syndrome. Unspecified intracranial hemorrhage. Basilar artery syndrome. Vertebral artery syndrome. Subclavian steal syndrome. Vertebrobasilar artery syndrome. Other specified transient cerebral ischemias. Unspecified transient cerebral ischemia. Acute, but ill-defined, cerebrovascular disease. Other generalized ischemic cerebrovascular disease. Hypertensive encephalopathy. Cerebral arteritis. Moyamoya disease. Nonpyogenic thrombosis of intracranial venous sinus. Hemiplegia affecting unspecified side. Hemiplegia affecting dominant side. Hemiplegia affecting nondominant side. Atherosclerosis of native arteries of the extremities with gangrene. Embolism and thrombosis of abdominal aorta. Embolism and thrombosis of thoracic aorta. Arterial embolism and thrombosis of upper extremity. Arterial embolism and thrombosis of lower extremity. Embolism and thrombosis of iliac artery. Embolism and thrombosis of other artery. Embolism and thrombosis of unspecified artery. Atheroembolism, upper extremity. Atheroembolism, lower extremity. Atheroembolism, kidney. Atheroembolism, other site. Polyarteritis nodosa. Acute febrile mucocutaneous lymph node syndrome (mcls). Hypersensitivity angiitis, unspecified. Goodpasture’s syndrome. Other specified hypersensitivity angiitis. Lethal midline granuloma. Wegener’s granulomatosis. Takayasu’s disease. Rupture of artery. Celiac artery compression syndrome. Jkt 223001 PO 00000 Frm 00360 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 4475 ................................................. 449 ................................................... 45119 ............................................... 45181 ............................................... 45183 ............................................... 45189 ............................................... 4531 ................................................. 4533 ................................................. 45340 ............................................... 45341 ............................................... 45342 ............................................... 4538 ................................................. 4539 ................................................. 4542 ................................................. 4561 ................................................. 45621 ............................................... 45911 ............................................... 45913 ............................................... 4592 ................................................. 45931 ............................................... 45933 ............................................... 46430 ............................................... 46611 ............................................... 46619 ............................................... 475 ................................................... 47821 ............................................... 47822 ............................................... 47824 ............................................... 47834 ............................................... 47871 ............................................... 49121 ............................................... 49122 ............................................... 49301 ............................................... 49302 ............................................... 49311 ............................................... 49312 ............................................... 49321 ............................................... 49322 ............................................... 49391 ............................................... 49392 ............................................... 4941 ................................................. 4957 ................................................. 4958 ................................................. 4959 ................................................. 5060 ................................................. 5080 ................................................. 5081 ................................................. 5119 ................................................. 5121 ................................................. 5128 ................................................. 514 ................................................... 5160 ................................................. 5161 ................................................. 5162 ................................................. 5163 ................................................. 5168 ................................................. 5169 ................................................. 5171 ................................................. 5172 ................................................. 5173 ................................................. 5180 ................................................. 5183 ................................................. 5186 ................................................. 5187 ................................................. 51882 ............................................... 51883 ............................................... 51900 ............................................... 51901 ............................................... 51902 ............................................... 51909 ............................................... 5220 ................................................. 5224 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Necrosis of artery. Septic arterial embolism. Phlebitis and thrombophlebitis of other. Phlebitis and thrombophlebitis of iliac vein. Phlebitis and thrombophlebitis of deep veins of upper extremities. Phlebitis and thrombophlebitis of other sites. Thrombophlebitis migrans. Embolism and thrombosis of renal vein. Venous embolism and thrombosis of unspecified deep vessels of lower extremity. Venous embolism and thrombosis of deep vessels of proximal lower extremity. Venous embolism and thrombosis of deep vessels of distal lower extremity. Embolism and thrombosis of other specified veins. Embolism and thrombosis of unspecified site. Varicose veins of lower extremities with ulcer and inflammation. Esophageal varices without mention of bleeding. Esophageal varices in diseases classified elsewhere, without mention of bleeding. Postphlebetic syndrome with ulcer. Postphlebetic syndrome with ulcer and inflammation. Compression of vein. Chronic venous hypertension with ulcer. Chronic venous hypertension with ulcer and inflammation. Acute epiglottitis without mention of obstruction. Acute bronchiolitis due to respiratory syncytial virus (RSV). Acute bronciolitis due to other infectious organisms. Peritonsillar abscess. Cellulitis of pharynx or nasopharynx. Parapharyngeal abscess. Retropharyngeal abscess. Complete bilateral paralysis of vocal cords. Cellulitis and perichondritis of larynx. Obstructive chronic bronchitis, with (acute) exacerbation. Obstructive chronic bronchitis with acute bronchitis. Extrinsic asthma with status asthmaticus. Extrinsic asthma, with (acute) exacerbation. Intrinsic asthma with status asthmaticus. Intrinsic asthma, with (acute) exacerbation. Chronic obstructive asthma with status asthmaticus. Chronic obstructive asthma, with (acute) exacerbation. Asthma, unspecified type, with status asthmaticus. Asthma, unspecified type, with (acute) exacerbation. Bronchiectasis with acute exacerbation. ’Ventilation’ pneumonitis. Other specified allergic alveolitis and pneumonitis. Unspecified allergic alveolitis and pneumonitis. Bronchitis and pneumonitis due to fumes and vapors. Acute pulmonary manifestations due to radiation. Chronic and other pulmonary manifestations due to radiation. Unspecified pleural effusion. Iatrogenic pneumothorax. Other spontaneous pneumothorax. Pulmonary congestion and hypostasis. Pulmonary alveolar proteinosis. Idiopathic pulmonary hemosiderosis. Pulmonary alveolar microlithiasis. Idiopathic fibrosing alveolitis. Other specified alveolar and parietoalveolar pneumonopathies. Unspecified alveolar and parietoalveolar pneumonopathy. Rheumatic pneumonia. Lung involvement in systemic sclerosis. Acute chest syndrome. Pulmonary collapse. Pulmonary eosinophilia. Allergic bronchopulmonary aspergilliosis. Transfusion related acute lung injury (TRALI). Other pulmonary insufficiency, not elsewhere classified. Chronic respiratory failure. Tracheostomy complication, unspecified. Infection of tracheostomy. Mechanical complication of tracheostomy. Other tracheostomy complications. Pulpitis. Acute apical periodontitis of pulpal origin. Jkt 223001 PO 00000 Frm 00361 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25039 25040 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 5273 ................................................. 5274 ................................................. 5283 ................................................. 53012 ............................................... 53020 ............................................... 53086 ............................................... 53087 ............................................... 53130 ............................................... 53230 ............................................... 53330 ............................................... 53430 ............................................... 5361 ................................................. 53641 ............................................... 53642 ............................................... 5370 ................................................. 5373 ................................................. 5374 ................................................. 538 ................................................... 5409 ................................................. 55010 ............................................... 55011 ............................................... 55012 ............................................... 55013 ............................................... 55200 ............................................... 55201 ............................................... 55202 ............................................... 55203 ............................................... 5521 ................................................. 55220 ............................................... 55221 ............................................... 55229 ............................................... 5523 ................................................. 5528 ................................................. 5529 ................................................. 5550 ................................................. 5551 ................................................. 5552 ................................................. 5559 ................................................. 5560 ................................................. 5561 ................................................. 5562 ................................................. 5563 ................................................. 5564 ................................................. 5565 ................................................. 5566 ................................................. 5568 ................................................. 5569 ................................................. 5571 ................................................. 5579 ................................................. 5581 ................................................. 5582 ................................................. 5600 ................................................. 5601 ................................................. 56030 ............................................... 56031 ............................................... 56039 ............................................... 56081 ............................................... 56089 ............................................... 5609 ................................................. 56201 ............................................... 56211 ............................................... 5647 ................................................. 56481 ............................................... 566 ................................................... 56782 ............................................... 56882 ............................................... 5693 ................................................. 56941 ............................................... 5695 ................................................. 56961 ............................................... 56962 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Abscess of salivary gland. Fistula of salivary gland. Cellulitis and abscess of oral soft tissues. Acute esophagitis. Ulcer of esophagus without bleeding. Infection of esophagostomy. Mechanical complication of esophagostomy. Acute gastric ulcer without mention of hemorrhage or perforation, without mention of obstruction. Acute duodenal ulcer without mention of hemorrhage or perforation, without mention of obstruction. Acute peptic ulcer of unspecified site without mention of hemorrhage and perforation, without mention of obstruction. Acute gastrojejunal ulcer without mention of hemorrhage or perforation, without mention of obstruction. Acute dilatation of stomach. Infection of gastrostomy. Mechanical complication of gastrostomy. Acquired hypertrophic pyloric stenosis. Other obstruction of duodenum. Fistula of stomach or duodenum. Gastrointestinal mucositis (ulcerative). Acute appendicitis without mention of peritonitis. Unilateral or unspecified inguinal hernia, with obstruction, without mention of gangrene. Recurrent unilateral or unspecified inguinal hernia with obstruction, without mention of gangrene. Bilateral inguinal hernia, with obstruction, without mention of gangrene. Recurrent bilateral inguinal hernia, with obstruction, without mention of gangrene. Unilateral or unspecified femoral hernia with obstruction. Recurrent unilateral or unspecified femoral hernia with obstruction. Bilateral femoral hernia with obstruction. Recurrent bilateral femoral hernia with obstruction. Umbilical hernia with obstruction. Unspecified ventral hernia with obstruction. Incisional hernia with obstruction. Other ventral hernia with obstruction. Diaphragmatic hernia with obstruction. Hernia of other specified sites, with obstruction. Hernia of unspecified site, with obstruction. Regional enteritis of small intestine. Regional enteritis of large intestine. Regional enteritis of small intestine with large intestine. Regional enteritis of unspecified site. Ulcerative (chronic) enterocolitis. Ulcerative (chronic) ileocolitis. Ulcerative (chronic) proctitis. Ulcerative (chronic) proctosigmoiditis. Pseudopolyposis of colon. Left-sided ulcerative (chronic) colitis. Universal ulcerative (chronic) colitis. Other ulcerative colitis. Ulcerative colitis, unspecified. Chronic vascular insufficiency of intestine. Unspecified vascular insufficiency of intestine. Gastroenteritis and colitis due to radiation. Toxic gastroenteritis and colitis. Intussusception. Paralytic ileus. Impaction of intestine, unspecified. Gallstone ileus. Other impaction of intestine. Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection). Other specified intestinal obstruction. Unspecified intestinal obstruction. Diverticulitis of small intestine (without mention of hemorrhage). Diverticulitis of colon (without mention of hemorrhage). Megacolon, other than hirschsprung’s. Neurogenic bowel. Abscess of anal and rectal regions. Sclerosing mesenteritis. Peritoneal effusion (chronic). Hemorrhage of rectum and anus. Ulcer of anus and rectum. Abscess of intestine. Infection of colostomy or enterostomy. Mechanical complication of colostomy and enterostomy. Jkt 223001 PO 00000 Frm 00362 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 56969 ............................................... 56981 ............................................... 56982 ............................................... 5723 ................................................. 5731 ................................................. 5732 ................................................. 57400 ............................................... 57401 ............................................... 57410 ............................................... 57411 ............................................... 57421 ............................................... 57430 ............................................... 57431 ............................................... 57440 ............................................... 57441 ............................................... 57451 ............................................... 57460 ............................................... 57461 ............................................... 57470 ............................................... 57471 ............................................... 57480 ............................................... 57491 ............................................... 5750 ................................................. 57512 ............................................... 5752 ................................................. 5753 ................................................. 5755 ................................................. 5761 ................................................. 5764 ................................................. 5771 ................................................. 5772 ................................................. 5780 ................................................. 5781 ................................................. 5789 ................................................. 5791 ................................................. 5792 ................................................. 5793 ................................................. 5794 ................................................. 5798 ................................................. 5799 ................................................. 5810 ................................................. 5811 ................................................. 5812 ................................................. 5813 ................................................. 58181 ............................................... 58189 ............................................... 5819 ................................................. 5820 ................................................. 5821 ................................................. 5822 ................................................. 5824 ................................................. 58281 ............................................... 58289 ............................................... 5829 ................................................. 5830 ................................................. 5831 ................................................. 5832 ................................................. 5837 ................................................. 5854 ................................................. 5855 ................................................. 5881 ................................................. 58881 ............................................... 59001 ............................................... 59010 ............................................... 5903 ................................................. 59080 ............................................... 59081 ............................................... 591 ................................................... 5921 ................................................. 5934 ................................................. 5935 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Other colostomy and enterostomy complication. Fistula of intestine, excluding rectum and anus. Ulceration of intestine. Portal hypertension. Hepatitis in viral diseases classified elsewhere. Hepatitis in other infectious diseases classified elsewhere. Calculus of gallbladder with acute cholecystitis, without mention of obstruction. Calculus of gallbladder with acute cholecystitis, with obstruction. Calculus of gallbladder with other cholecystitis, without mention of obstruction. Calculus of gallbladder with other cholecystitis, with obstruction. Calculus of gallbladder without mention of cholecystitis, with obstruction. Calculus of bile duct with acute cholecystitis without mention of obstruction. Calculus of bile duct with acute cholecystitis, with obstruction. Calculus of bile duct with other cholecystitis, without mention of obstruction. Calculus of bile duct with other cholecystitis, with obstruction. Calculus of bile duct without mention of cholecystitis, with obstruction. Calculus of gallbladder and bile duct with acute cholecystitis, without mention of obstruction. Calculus of gallbladder and bile duct with acute cholecystitis, with obstruction. Calculus of gallbladder and bile duct with other cholecystitis, without mention of obstruction. Calculus of gallbladder and bile duct with other cholecystitis, with obstruction. Calculus of gallbladder and bile duct with acute and chronic cholecystitis, without mention of obstruction. Calculus of gallbladder and bile duct without cholecystitis, with obstruction. Acute cholecystitis. Acute and chronic cholecystitis. Obstruction of gallbladder. Hydrops of gallbladder. Fistula of gallbladder. Cholangitis. Fistula of bile duct. Chronic pancreatitis. Cyst and pseudocyst of pancreas. Hematemesis. Blood in stool. Hemorrhage of gastrointestinal tract, unspecified. Tropical sprue. Blind loop syndrome. Other and unspecified postsurgical nonabsorption. Pancreatic steatorrhea. Other specified intestinal malabsorption. Unspecified intestinal malabsorption. Nephrotic syndrome with lesion of proliferative glomerulonephritis. Nephrotic syndrome with lesion of membranous glomerulonephritis. Nephrotic syndrome with lesion of membranoproliferative glomerulonephritis. Nephrotic syndrome with lesion of minimal change glomerulonephritis. Nephrotic syndrome in diseases classified elsewhere. Other nephrotic syndrome with specified pathological lesion in kidney. Nephrotic syndrome with unspecified pathological lesion in kidney. Chronic glomerulonephritis with lesion of proliferative glomerulonephritis. Chronic glomerulonephritis with lesion of membranous glomerulonephritis. Chronic glomerulonephritis with lesion of membranoproliferative glomerulonephritis. Chronic glomerulonephritis with lesion of rapidly progressive glomerulonephritis. Chronic glomerulonephritis in diseases classified elsewhere. Other chronic glomerulonephritis with specified pathological lesion in kidney. Chronic glomerulonephritis with unspecified pathological lesion in kidney. Nephritis and nephropathy, not specified as acute or chronic, with lesion of proliferative glomerulonephritis. Nephritis and nephropathy, not specified as acute or chronic, with lesion of membranous glomerulonephritis. Nephritis and nephropathy, not specified as acute or chronic, with lesion of membranoproliferative glomerulonephritis. Nephritis and nephropathy, not specified as acute or chronic, with lesion of renal medullary necrosis. Chronic kidney disease, Stage IV (severe). Chronic kidney disease, Stage V. Nephrogenic diabetes insipidus. Secondary hyperparathyroidism (of renal origin). Chronic pyelonephritis with lesion of renal medullary necrosis. Acute pyelonephritis without lesion of renal medullary necrosis. Pyeloureteritis cystica. Pyelonephritis, unspecified. Pyelitis or pyelonephritis in diseases classified elsewhere. Hydronephrosis. Calculus of ureter. Other ureteric obstruction. Hydroureter. Jkt 223001 PO 00000 Frm 00363 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25041 25042 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 59381 ............................................... 59382 ............................................... 5950 ................................................. 59582 ............................................... 5961 ................................................. 5962 ................................................. 5967 ................................................. 5970 ................................................. 5990 ................................................. 5991 ................................................. 6010 ................................................. 6012 ................................................. 6031 ................................................. 6040 ................................................. 6073 ................................................. 60782 ............................................... 60820 ............................................... 60821 ............................................... 60822 ............................................... 60823 ............................................... 60824 ............................................... 6140 ................................................. 6143 ................................................. 6147 ................................................. 6150 ................................................. 6163 ................................................. 6164 ................................................. 61681 ............................................... 6190 ................................................. 6191 ................................................. 6192 ................................................. 6198 ................................................. 6199 ................................................. 6205 ................................................. 63300 ............................................... 63301 ............................................... 63310 ............................................... 63311 ............................................... 63320 ............................................... 63321 ............................................... 63380 ............................................... 63381 ............................................... 63390 ............................................... 63391 ............................................... 63400 ............................................... 63401 ............................................... 63402 ............................................... 63420 ............................................... 63421 ............................................... 63422 ............................................... 63440 ............................................... 63441 ............................................... 63442 ............................................... 63460 ............................................... 63470 ............................................... 63471 ............................................... 63472 ............................................... 63480 ............................................... 63481 ............................................... 63482 ............................................... 63500 ............................................... 63501 ............................................... 63502 ............................................... 63520 ............................................... 63521 ............................................... 63522 ............................................... 63540 ............................................... 63541 ............................................... 63542 ............................................... 63570 ............................................... 63571 ............................................... 63572 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Vascular disorders of kidney. Ureteral fistula. Acute cystitis. Irradiation cystitis. Intestinovesical fistula. Vesical fistula, not elsewhere classified. Hemorrhage into bladder wall. Urethral abscess. Urinary tract infection, site not specified. Urethral fistula. Acute prostatitis. Abscess of prostate. Infected hydrocele. Orchitis, epididymitis, and epididymo-orchitis, with abscess. Priapism. Vascular disorders of penis. Torsion of testis, unspecified. Extravaginal torsion of spermatic cord. Intravaginal torsion of spermatic cord. Torsion of appendix testis. Torsion of appendix epididymis. Acute salpingitis and oophoritis. Acute parametritis and pelvic cellulitis. Other chronic pelvic peritonitis, female. Acute inflammatory diseases of uterus, except cervix. Abscess of bartholin’s gland. Other abscess of vulva. Mucositis (ulcerative) of cervix, vagina, and vulva. Urinary-genital tract fistula, female. Digestive-genital tract fistula, female. Genital tract-skin fistula, female. Other specified fistulas involving female genital tract. Unspecified fistula involving female genital tract. Torsion of ovary, ovarian pedicle, or fallopian tube. Abdominal pregnancy without intrauterine pregnancy. Abdominal pregnancy with intrauterine pregnancy. Tubal pregnancy without intrauterine pregnancy. Tubal pregnancy with intrauterine pregnancy. Ovarian pregnancy without intrauterine pregnancy. Ovarian pregnancy with intrauterine pregnancy. Other ectopic pregnancy without intrauterine pregnancy. Other ectopic pregnancy with intrauterine pregnancy. Unspecified ectopic pregnancy without intrauterine pregnancy. Unspecified ectopic pregnancy with intrauterine pregnancy. Spontaneous abortion, unspecified, complicated by genital tract and pelvic infection. Spontaneous abortion, incomplete, complicated by genital tract and pelvic infection. Spontaneous abortion, complete, complicated by genital tract and pelvic infection. Spontaneous abortion, unspecified, complicated by damage to pelvic organs or tissues. Spontaneous abortion, incomplete, complicated by damage to pelvic organs or tissues. Spontaneous abortion, complete, complicated by damage to pelvic organs or tissues. Spontaneous abortion, unspecified, complicated by metabolic disorder. Spontaneous abortion, incomplete, complicated by metabolic disorder. Spontaneous abortion, complete, complicated by metabolic disorder. Spontaneous abortion, unspecified, complicated by embolism. Spontaneous abortion, unspecified, with other specified complications. Spontaneous abortion, incomplete, with other specified complications. Spontaneous abortion, complete, with other specified complications. Spontaneous abortion, unspecified, with unspecified complication. Spontaneous abortion, incomplete, with unspecified complication. Spontaneous abortion, complete, with unspecified complication. Legally induced abortion, unspecified, complicated by genital tract and pelvic infection. Legally induced abortion, incomplete, complicated by genital tract and pelvic infection. Legally induced abortion, complete, complicated by genital tract and pelvic infection. Legally induced abortion, unspecified, complicated by damage to pelvic organs or tissues. Legally induced abortion, incomplete, complicated by damage to pelvic organs or tissues. Legally induced abortion, complete, complicated by damage to pelvic organs or tissues. Legally induced abortion, unspecified, complicated by metabolic disorder. Legally induced abortion, incomplete, complicated by metabolic disorder. Legally induced abortion, complete, complicated by metabolic disorder. Legally induced abortion, unspecified, with other specified complications. Legally induced abortion, incomplete, with other specified complications. Legally induced abortion, complete, with other specified complications. Jkt 223001 PO 00000 Frm 00364 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 63580 ............................................... 63581 ............................................... 63582 ............................................... 63600 ............................................... 63601 ............................................... 63602 ............................................... 63620 ............................................... 63621 ............................................... 63622 ............................................... 63640 ............................................... 63641 ............................................... 63642 ............................................... 63670 ............................................... 63671 ............................................... 63672 ............................................... 63680 ............................................... 63681 ............................................... 63682 ............................................... 63700 ............................................... 63701 ............................................... 63702 ............................................... 63720 ............................................... 63721 ............................................... 63722 ............................................... 63740 ............................................... 63741 ............................................... 63742 ............................................... 63770 ............................................... 63771 ............................................... 63772 ............................................... 63780 ............................................... 63781 ............................................... 63782 ............................................... 6380 ................................................. 6381 ................................................. 6382 ................................................. 6384 ................................................. 6387 ................................................. 6388 ................................................. 6390 ................................................. 6391 ................................................. 6392 ................................................. 6394 ................................................. 6398 ................................................. 6399 ................................................. 64001 ............................................... 64003 ............................................... 64093 ............................................... 64101 ............................................... 64103 ............................................... 64123 ............................................... 64201 ............................................... 64202 ............................................... 64203 ............................................... 64213 ............................................... 64214 ............................................... 64231 ............................................... 64232 ............................................... 64241 ............................................... 64243 ............................................... 64244 ............................................... 64291 ............................................... 64292 ............................................... 64293 ............................................... 64294 ............................................... 64413 ............................................... 64420 ............................................... 64621 ............................................... 64622 ............................................... 64623 ............................................... 64624 ............................................... 64631 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Legally induced abortion, unspecified, with unspecified complication. Legally induced abortion, incomplete, with unspecified complication. Legally induced abortion, complete, with unspecified complication. Illegal abortion, unspecified, complicated by genital tract and pelvic infection. Illegal abortion, incomplete, complicated by genital tract and pelvic infection. Illegal abortion, complete, complicated by genital tract and pelvic infection. Illegal abortion, unspecified, complicated by damage to pelvic organs or tissues. Illegal abortion, incomplete, complicated by damage to pelvic organs or tissues. Illegal abortion, complete, complicated by damage to pelvic organs or tissues. Illegal abortion, unspecified, complicated by metabolic disorder. Illegal abortion, incomplete, complicated by metabolic disorder. Illegal abortion, complete, complicated by metabolic disorder. Illegal abortion, unspecified, with other specified complications. Illegal abortion, incomplete, with other specified complications. Illegal abortion, complete, with other specified complications. Illegal abortion, unspecified, with unspecified complication. Illegal abortion, incomplete, with unspecified complication. Illegal abortion, complete, with unspecified complication. Unspecified type of abortion, unspecified, complicated by genital tract and pelvic infection. Unspecified abortion, incomplete, complicated by genital tract and pelvic infection. Unspecified abortion, complete, complicated by genital tract and pelvic infection. Legally unspecified type of abortion, unspecified, complicated by damage to pelvic organs or tissues. Legally unspecified abortion, incomplete, complicated by damage to pelvic organs or tissues. Legally unspecified abortion, complete, complicated by damage to pelvic organs or tissues. Legally unspecified type of abortion, unspecified, complicated by metabolic disorder. Legally unspecified abortion, incomplete, complicated by metabolic disorder. Legally unspecified abortion, complete, complicated by metabolic disorder. Legally unspecified type of abortion, unspecified, with other specified complications. Legally unspecified abortion, incomplete, with other specified complications. Legally unspecified abortion, complete, with other specified complications. Legally unspecified type of abortion, unspecified, with unspecified complication. Legally unspecified abortion, incomplete, with unspecified complication. Legally unspecified abortion, complete, with unspecified complication. Failed attempted abortion complicated by genital tract and pelvic infection. Failed attempted abortion complicated by delayed or excessive hemorrhage. Failed attempted abortion complicated by damage to pelvic organs or tissues. Failed attempted abortion complicated by metabolic disorder. Failed attempted abortion with other specified complications. Failed attempted abortion with unspecified complication. Genital tract and pelvic infection following abortion or ectopic and molar pregnancies. Delayed or excessive hemorrhage following abortion or ectopic and molar pregnancies. Damage to pelvic organs and tissues following abortion or ectopic and molar pregnancies. Metabolic disorders following abortion or ectopic and molar pregnancies. Other specified complications following abortion or ectopic and molar pregnancies. Unspecified complication following abortion or ectopic and molar pregnancies. Threatened abortion, delivered. Threatened abortion, antepartum. Unspecified hemorrhage in early pregnancy, antepartum. Placenta previa without hemorrhage, with delivery. Placenta previa without hemorrhage, antepartum. Premature separation of placenta, antepartum. Benign essential hypertension with delivery. Benign essential hypertension, with delivery, with mention of postpartum complication. Antepartum benign essential hypertension. Hypertension secondary to renal disease, antepartum. Hypertension secondary to renal disease, postpartum. Transient hypertension of pregnancy, with delivery. Transient hypertension of pregnancy, with delivery, with mention of postpartum complication. Mild or unspecified pre-eclampsia, with delivery. Mild or unspecified pre-eclampsia, antepartum. Mild or unspecified pre-eclampsia, postpartum. Unspecified hypertension, with delivery. Unspecified hypertension, with delivery, with mention of postpartum complication. Unspecified antepartum hypertension. Unspecified postpartum hypertension. Other threatened labor, antepartum. Early onset of delivery, unspecified as to episode of care. Unspecified renal disease in pregnancy, with delivery. Unspecified renal disease in pregnancy, with delivery, with mention of postpartum complication. Unspecified antepartum renal disease. Unspecified postpartum renal disease. Habitual aborter, delivered, with or without mention of antepartum condition. Jkt 223001 PO 00000 Frm 00365 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25043 25044 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code 64661 64662 64663 64664 64671 64673 64701 64702 64703 64704 64711 64712 64713 64714 64721 64722 64723 64724 64731 64732 64733 64734 64741 64742 64743 64744 64751 64752 64753 64754 64761 64762 64763 64764 64781 64782 64783 64784 64791 64792 64793 64794 64800 64803 64804 64831 64832 64833 64834 64851 64852 64853 64854 64861 64862 64863 64864 64871 64872 64873 64874 64930 64931 Code title ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 64932 ............................................... 64933 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Infections of genitourinary tract in pregnancy, with delivery. Infections of genitourinary tract in pregnancy, with delivery, with mention of postpartum complication. Antepartum infections of genitourinary tract. Postpartum infections of genitourinary tract. Liver disorders in pregnancy, with delivery. Antepartum liver disorders. Syphilis of mother, complicating pregnancy, with delivery. Syphilis of mother, complicating pregnancy, with delivery, with mention of postpartum complication. Antepartum syphilis. Postpartum syphilis. Gonorrhea of mother, with delivery. Gonorrhea of mother, with delivery, with mention of postpartum complication. Antepartum gonorrhea. Postpartum gonorrhea. Other venereal diseases of mother, with delivery. Other venereal diseases of mother, with delivery, with mention of postpartum complication. Other antepartum venereal diseases. Other postpartum venereal diseases. Tuberculosis of mother, with delivery. Tuberculosis of mother, with delivery, with mention of postpartum complication. Antepartum tuberculosis. Postpartum tuberculosis. Malaria of mother, with delivery. Malaria of mother, with delivery, with mention of postpartum complication. Antepartum malaria. Postpartum malaria. Rubella of mother, with delivery. Rubella of mother, with delivery, with mention of postpartum complication. Antepartum rubella. Postpartum rubella. Other viral diseases of mother, with delivery. Other viral diseases of mother, with delivery, with mention of postpartum complication. Other antepartum viral diseases. Other postpartum viral diseases. Other specified infectious and parasitic diseases of mother, with delivery. Other specified infectious and parasitic diseases of mother, with delivery, with mention of postpartum complication. Other specified infectious and parasitic diseases of mother, antepartum. Other specified infectious and parasitic diseases of mother, postpartum. Unspecified infection or infestation of mother, with delivery. Unspecified infection or infestation of mother, with delivery, with mention of postpartum complication. Unspecified infection or infestation of mother, antepartum. Unspecified infection or infestation of mother, postpartum. Diabetes mellitus of mother, complicating pregnancy, childbirth, or the puerperium, unspecified as to episode of care. Antepartum diabetes mellitus. Postpartum diabetes mellitus. Drug dependence of mother, with delivery. Drug dependence of mother, with delivery, with mention of postpartum complication. Antepartum drug dependence. Postpartum drug dependence. Congenital cardiovascular disorders of mother, with delivery. Congenital cardiovascular disorders of mother, with delivery, with mention of postpartum complication. Congenital cardiovascular disorders of mother, antepartum. Congenital cardiovascular disorders of mother, postpartum. Other cardiovascular diseases of mother, with delivery. Other cardiovascular diseases of mother, with delivery, with mention of postpartum complication. Other cardiovascular diseases of mother, antepartum. Other cardiovascular diseases of mother, postpartum. Bone and joint disorders of back, pelvis, and lower limbs of mother, with delivery. Bone and joint disorders of back, pelvis, and lower limbs of mother, with delivery, with mention of postpartum complication. Bone and joint disorders of back, pelvis, and lower limbs of mother, antepartum. Bone and joint disorders of back, pelvis, and lower limbs of mother, postpartum. Coagulation defects complicating pregnancy, childbirth, or the puerperium, unspecified as to episode of care or not applicable. Coagulation defects complicating pregnancy, childbirth, or the puerperium, delivered, with or without mention of antepartum condition. Coagulation defects complicating pregnancy, childbirth, or the puerperium, delivered, with mention of postpartum complication. Coagulation defects complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication. Jkt 223001 PO 00000 Frm 00366 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25045 TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code 64934 64941 64942 64943 64944 65101 65111 65113 65121 65123 65141 Code title ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 65143 ............................................... 65151 ............................................... 65153 65181 65183 65613 65631 65641 65643 65651 65701 65801 65803 65881 65921 66003 66211 66421 66431 66461 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 66464 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 66522 66531 66541 66551 66561 66571 66572 66602 66604 66612 66614 66622 66624 66632 66924 67120 67121 67122 67123 67124 67130 67140 67150 67151 67152 67153 67154 67180 67181 67182 67183 67184 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Coagulation defects complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication. Epilepsy complicating pregnancy, childbirth, or the puerperium, delivered, with or without mention of antepartum condition. Epilepsy complicating pregnancy, childbirth, or the puerperium, delivered, with mention of postpartum complication. Epilepsy complicating pregnancy, childbirth, or the puerperium, antepartum condition or complication. Epilepsy complicating pregnancy, childbirth, or the puerperium, postpartum condition or complication. Twin pregnancy, delivered. Triplet pregnancy, delivered. Triplet pregnancy, antepartum condition or complication. Quadruplet pregnancy, delivered. Quadruplet pregnancy, antepartum condition or complication. Triplet pregnancy with fetal loss and retention of one or more fetus(es), delivered, with or without mention of antepartum condition. Triplet pregnancy with fetal loss and retention of one or more fetus(es), antepartum condition or complication. Quadruplet pregnancy with fetal loss and retention of one or more fetus(es), delivered, with or without mention of antepartum condition. Quadruplet pregnancy with fetal loss and retention of one or more fetus(es), antepartum condition or complication. Other specified multiple gestation, delivered. Other specified multiple gestation, antepartum condition or complication. Rhesus isoimmunization, affecting management of mother, antepartum condition. Fetal distress, affecting management of mother, delivered. Intrauterine death, affecting management of mother, delivered. Intrauterine death, affecting management of mother, antepartum. Poor fetal growth, affecting management of mother, delivered. Polyhydramnios, with delivery. Oligohydramnios, delivered. Oligohydramnios, antepartum. Other problems associated with amniotic cavity and membranes, delivered. Unspecified type maternal pyrexia during labor, delivered. Obstruction caused by malposition of fetus at onset of labor, antepartum. Unspecified type prolonged labor, delivered. Third-degree perineal laceration, with delivery. Fourth-degree perineal laceration, with delivery. Anal sphincter tear complicating delivery, not associated with third-degree perineal laceration,delivered, with or without mention of antepartum condition. Anal sphincter tear complicating delivery, not associated with third-degree perineal laceration,postpartum condition or complication. Inversion of uterus, delivered with postpartum complication. Laceration of cervix, with delivery. High vaginal laceration, with delivery. Other injury to pelvic organs, with delivery. Damage to pelvic joints and ligaments, with delivery. Pelvic hematoma, with delivery. Pelvic hematoma, delivered with postpartum complication. Third-stage postpartum hemorrhage, with delivery. Third-stage postpartum hemorrhage. Other immediate postpartum hemorrhage, with delivery. Other immediate postpartum hemorrhage. Delayed and secondary postpartum hemorrhage, with delivery. Delayed and secondary postpartum hemorrhage. Postpartum coagulation defects, with delivery. Maternal hypotension syndrome, postpartum. Superficial thrombophlebitis complicating pregnancy and the puerperium, unspecified as to episode of care. Superficial thrombophlebitis with delivery, with or without mention of antepartum condition. Superficial thrombophlebitis with delivery, with mention of postpartum complication. Antepartum superficial thrombophlebitis. Postpartum superficial thrombophlebitis. Deep phlebothrombosis, antepartum, unspecified as to episode of care. Deep phlebothrombosis, postpartum, unspecified as to episode of care. Other phlebitis and thrombosis complicating pregnancy and the puerperium, unspecified as to episode of care. Other phlebitis and thrombosis with delivery, with or without mention of antepartum condition. Other phlebitis and thrombosis with delivery, with mention of postpartum complication. Other antepartum phlebitis and thrombosis. Other postpartum phlebitis and thrombosis. Other venous complications of pregnancy and the puerperium, unspecified as to episode of care. Other venous complications, with delivery, with or without mention of antepartum condition. Other venous complications, with delivery, with mention of postpartum complication. Other antepartum venous complications. Other postpartum venous complications. Jkt 223001 PO 00000 Frm 00367 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25046 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 67190 ............................................... 67191 ............................................... 67192 ............................................... 67202 ............................................... 67204 ............................................... 67330 ............................................... 67402 ............................................... 67403 ............................................... 67404 ............................................... 67511 ............................................... 67512 ............................................... 6820 ................................................. 6821 ................................................. 6822 ................................................. 6823 ................................................. 6824 ................................................. 6825 ................................................. 6826 ................................................. 6827 ................................................. 6828 ................................................. 6829 ................................................. 6850 ................................................. 68601 ............................................... 6944 ................................................. 6945 ................................................. 6950 ................................................. 6951 ................................................. 70700 ............................................... 70701 ............................................... 70709 ............................................... 70710 ............................................... 70711 ............................................... 70712 ............................................... 70713 ............................................... 70714 ............................................... 70719 ............................................... 7103 ................................................. 7104 ................................................. 7105 ................................................. 7108 ................................................. 71100 ............................................... 71101 ............................................... 71102 ............................................... 71103 ............................................... 71104 ............................................... 71105 ............................................... 71106 ............................................... 71107 ............................................... 71108 ............................................... 71109 ............................................... 71110 ............................................... 71111 ............................................... 71112 ............................................... 71113 ............................................... 71114 ............................................... 71115 ............................................... 71116 ............................................... 71117 ............................................... 71118 ............................................... 71119 ............................................... 71120 ............................................... 71121 ............................................... 71122 ............................................... 71123 ............................................... 71124 ............................................... 71125 ............................................... 71126 ............................................... 71127 ............................................... 71128 ............................................... 71129 ............................................... 71130 ............................................... 71131 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Unspecified venous complication of pregnancy and the puerperium, unspecified as to episode of care. Unspecified venous complication, with delivery, with or without mention of antepartum condition. Unspecified venous complication, with delivery, with mention of postpartum complication. Puerperal pyrexia of unknown origin, delivered, with mention of postpartum complication. Puerperal pyrexia of unknown origin, postpartum. Obstetrical pyemic and septic embolism, unspecified as to episode of care. Cerebrovascular disorders, with delivery, with mention of postpartum complication. Antepartum cerebrovascular disorders. Postpartum cerebrovascular disorders. Abscess of breast associated with childbirth, delivered, with or without mention of antepartum condition. Abscess of breast associated with childbirth, delivered, with mention of postpartum complication. Cellulitis and abscess of face. Cellulitis and abscess of neck. Cellulitis and abscess of trunk. Cellulitis and abscess of upper arm and forearm. Cellulitis and abscess of hand, except fingers and thumb. Cellulitis and abscess of buttock. Cellulitis and abscess of leg, except foot. Cellulitis and abscess of foot, except toes. Cellulitis and abscess of other specified sites. Cellulitis and abscess of unspecified sites. Pilonidal cyst with abscess. Pyoderma gangrenosum. Pemphigus. Pemphigoid. Toxic erythema. Erythema multiforme. Decubitus ulcer, unspecified site. Decubitus ulcer, elbow. Decubitus ulcer, other site. Unspecified ulcer of lower limb. Ulcer of thigh. Ulcer of calf. Ulcer of ankle. Ulcer of heel and midfoot. Ulcer of other part of lower limb. Dermatomyositis. Polymyositis. Eosinophilia myalgia syndrome. Other specified diffuse diseases of connective tissue. Pyogenic arthritis, site unspecified. Pyogenic arthritis involving shoulder region. Pyogenic arthritis involving upper arm. Pyogenic arthritis involving forearm. Pyogenic arthritis involving hand. Pyogenic arthritis involving pelvic region and thigh. Pyogenic arthritis involving lower leg. Pyogenic arthritis involving ankle and foot. Pyogenic arthritis involving other specified sites. Pyogenic arthritis involving multiple sites. Arthropathy, site unspecified, associated with reiter’s disease and nonspecific urethritis. Arthropathy involving shoulder region associated with reiter’s disease and nonspecific urethritis. Arthropathy involving upper arm associated with reiter’s disease and nonspecific urethritis. Arthropathy involving forearm associated with reiter’s disease and nonspecific urethritis. Arthropathy involving hand associated with reiter’s disease and nonspecific urethritis. Arthropathy involving pelvic region and thigh associated with reiter’s disease and nonspecific urethritis. Arthropathy involving lower leg associated with reiter’s disease and nonspecific urethritis. Arthropathy involving ankle and foot associated with reiter’s disease and nonspecific urethritis. Arthropathy involving other specified sites associated with reiter’s disease and nonspecific urethritis. Arthropathy involving multiple sites associated with reiter’s disease and nonspecific urethritis. Arthropathy in behcet’s syndrome, site unspecified. Arthropathy in behcet’s syndrome involving shoulder region. Arthropathy in behcet’s syndrome involving upper arm. Arthropathy in behcet’s syndrome involving forearm. Arthropathy in behcet’s syndrome involving hand. Arthropathy in behcet’s syndrome involving pelvic region and thigh. Arthropathy in behcet’s syndrome involving lower leg. Arthropathy in behcet’s syndrome involving ankle and foot. Arthropathy in behcet’s syndrome involving other specified sites. Arthropathy in behcet’s syndrome involving multiple sites. Postdysenteric arthropathy, site unspecified. Postdysenteric arthropathy involving shoulder region. Jkt 223001 PO 00000 Frm 00368 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code mmaher on DSK3CLS3C1PROD with $$_JOB 71132 71133 71134 71135 71136 71137 71138 71139 71140 71141 71142 71143 71144 71145 71146 71147 71148 71149 71150 71151 71152 71153 71154 71155 71156 71157 71158 71159 71160 71161 71162 71163 71164 71165 71166 71167 71168 71169 71170 71171 71172 71173 71174 71175 71176 71177 71178 71179 71180 71181 71182 71183 71184 71185 71186 71187 71188 71189 71190 71191 71192 71193 71194 71195 71196 71197 71198 71199 71431 71910 71911 71912 Code title ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Postdysenteric arthropathy involving upper arm. Postdysenteric arthropathy involving forearm. Postdysenteric arthropathy involving hand. Postdysenteric arthropathy involving pelvic region and thigh. Postdysenteric arthropathy involving lower leg. Postdysenteric arthropathy involving ankle and foot. Postdysenteric arthropathy involving other specified sites. Postdysenteric arthropathy involving multiple sites. Arthropathy, site unspecified, associated with other bacterial diseases. Arthropathy involving shoulder region associated with other bacterial diseases. Arthropathy involving upper arm associated with other bacterial diseases. Arthropathy involving forearm associated with other bacterial diseases. Arthropathy involving hand associated with other bacterial diseases. Arthropathy involving pelvic region and thigh associated with other bacterial diseases. Arthropathy involving lower leg associated with other bacterial diseases. Arthropathy involving ankle and foot associated with other bacterial disease. Arthropathy involving other specified sites associated with other bacterial diseases. Arthropathy involving multiple sites associated with other bacterial diseases. Arthropathy, site unspecified, associated with other viral diseases. Arthropathy involving shoulder region associated with other viral diseases. Arthropathy involving upper arm associated with other viral diseases. Arthropathy involving forearm associated with other viral diseases. Arthropathy involving hand associated with other viral diseases. Arthropathy involving pelvic region and thigh associated with other viral diseases. Arthropathy involving lower leg associated with other viral diseases. Arthropathy involving ankle and foot associated with other viral diseases. Arthropathy involving other specified sites associated with other viral diseases. Arthropathy involving multiple sites associated with other viral diseases. Arthropathy, site unspecified, associated with mycoses. Arthropathy involving shoulder region associated with mycoses. Arthropathy involving upper arm associated with mycoses. Arthropathy involving forearm associated with mycoses. Arthropathy involving hand associated with mycoses. Arthropathy involving pelvic region and thigh associated with mycoses. Arthropathy involving lower leg associated with mycoses. Arthropathy involving ankle and foot associated with mycoses. Arthropathy involving other specified sites associated with mycoses. Arthropathy involving multiple sites associated with mycoses. Arthropathy, site unspecified, associated with helminthiasis. Arthropathy involving shoulder region associated with helminthiasis. Arthropathy involving upper arm associated with helminthiasis. Arthropathy involving forearm associated with helminthiasis. Arthropathy involving hand associated with helminthiasis. Arthropathy involving pelvic region and thigh associated with helminthiasis. Arthropathy involving lower leg associated with helminthiasis. Arthropathy involving ankle and foot associated with helminthiasis. Arthropathy involving other specified sites associated with helminthiasis. Arthropathy involving multiple sites associated with helminthiasis. Arthropathy, site unspecified, associated with other infectious and parasitic diseases. Arthropathy involving shoulder region associated with other infectious and parasitic diseases. Arthropathy involving upper arm associated with other infectious and parasitic diseases. Arthropathy involving forearm associated with other infectious and parasitic diseases. Arthropathy involving hand associated with other infectious and parasitic diseases. Arthropathy involving pelvic region and thigh associated with other infectious and parasitic diseases. Arthropathy involving lower leg associated with other infectious and parasitic diseases. Arthropathy involving ankle and foot associated with other infectious and parasitic diseases. Arthropathy involving other specified sites associated with other infectious and parasitic diseases. Arthropathy involving multiple sites associated with other infectious and parasitic diseases. Unspecified infective arthritis, site unspecified. Unspecified infective arthritis involving shoulder region. Unspecified infective arthritis involving upper arm. Unspecified infective arthritis involving forearm. Unspecified infective arthritis involving hand. Unspecified infective arthritis involving pelvic region and thigh. Unspecified infective arthritis involving lower leg. Unspecified infective arthritis involving ankle and foot. Unspecified infective arthritis involving other specified sites. Unspecified infective arthritis involving multiple sites. Acute polyarticular juvenile rheumatoid arthritis. Hemarthrosis, site unspecified. Herarthrosis involving shoulder region. Hemarthorsis involving upper arm. Jkt 223001 PO 00000 Frm 00369 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25047 25048 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 71913 ............................................... 71914 ............................................... 71915 ............................................... 71916 ............................................... 71917 ............................................... 71918 ............................................... 71919 ............................................... 7211 ................................................. 72141 ............................................... 72142 ............................................... 7217 ................................................. 72191 ............................................... 72271 ............................................... 72272 ............................................... 72273 ............................................... 7280 ................................................. 72888 ............................................... 72971 ............................................... 72972 ............................................... 72973 ............................................... 72979 ............................................... 73000 ............................................... 73001 ............................................... 73002 ............................................... 73003 ............................................... 73004 ............................................... 73005 ............................................... 73006 ............................................... 73007 ............................................... 73008 ............................................... 73009 ............................................... 73010 ............................................... 73011 ............................................... 73012 ............................................... 73013 ............................................... 73014 ............................................... 73015 ............................................... 73016 ............................................... 73017 ............................................... 73018 ............................................... 73019 ............................................... 73020 ............................................... 73021 ............................................... 73022 ............................................... 73023 ............................................... 73024 ............................................... 73025 ............................................... 73026 ............................................... 73027 ............................................... 73028 ............................................... 73029 ............................................... 73080 ............................................... 73081 ............................................... 73082 ............................................... 73083 ............................................... 73084 ............................................... 73085 ............................................... 73086 ............................................... 73087 ............................................... 73088 ............................................... 73089 ............................................... 73090 ............................................... 73091 ............................................... 73092 ............................................... 73093 ............................................... 73094 ............................................... 73095 ............................................... 73096 ............................................... 73097 ............................................... 73098 ............................................... 73099 ............................................... 73310 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Hemarthrosis involving forearm. Hemarthrosis involving hand. Hemarthrosis involving pelvic region and thigh. Hemarthrosis involving lower leg. Hemarthrosis involving ankle and foot. Hemarthrosis involving other specified sites. Hemarthrosis involving multiple sites. Cervical spondylosis with myelopathy. Spondylosis with myelopathy, thoracic region. Spondylosis with myelopathy, lumbar region. Traumatic spondylopathy. Spondylosis of unspecified site with myelopathy. Intervertebral disc disorder with myelopathy, cervical region. Intervertebral disc disorder with myelopathy, thoracic region. Intervertebral disc disorder with myelopathy, lumbar region. Infective myositis. Rhabdomyolysis. Nontraumatic compartment syndrome of upper extremity. Nontraumatic compartment syndrome of lower extremity. Nontraumatic compartment syndrome of abdomen. Nontraumatic compartment syndrome of other sites. Acute osteomyelitis, site unspecified. Acute osteomyelitis involving shoulder region. Acute osteomyelitis involving upper arm. Acute osteomyelitis involving forearm. Acute osteomyelitis involving hand. Acute osteomyelitis involving pelvic region and thigh. Acute osteomyelitis involving lower leg. Acute osteomyelitis involving ankle and foot. Acute osteomyelitis involving other specified sites. Acute osteomyelitis involving multiple sites. Chronic osteomyelitis, site unspecified. Chronic osteomyelitis involving shoulder region. Chronic osteomyelitis involving upper arm. Chronic osteomyelitis involving forearm. Chronic osteomyelitis involving hand. Chronic osteomyelitis involving pelvic region and thigh. Chronic osteomyelitis involving lower leg. Chronic osteomyelitis involving ankle and foot. Chronic osteomyelitis involving other specified sites. Chronic osteomyelitis involving multiple sites. Unspecified osteomyelitis, site unspecified. Unspecified osteomyelitis involving shoulder region. Unspecified osteomyelitis involving upper arm. Unspecified osteomyelitis involving forearm. Unspecified osteomyelitis involving hand. Unspecified osteomyelitis involving pelvic region and thigh. Unspecified osteomyelitis involving lower leg. Unspecified osteomyelitis involving ankle and foot. Unspecified osteomyelitis involving other specified sites. Unspecified osteomyelitis involving multiple sites. Other infections involving bone in diseases classified elsewhere, site unspecified. Other infections involving bone of shoulder region in diseases classified elsewhere. Other infections involving upper arm bone in diseases classified elsewhere. Other infections involving forearm bone in diseases classified elsewhere. Other infections involving hand bone in diseases classified elsewhere. Other infections involving bone of pelvic region and thigh in diseases classified elsewhere. Other infections involving lower leg bone in diseases classified elsewhere. Other infections involving ankle and foot bone in diseases classified elsewhere. Other infections involving bone, of other specified sites, in diseases classified elsewhere. Other infections involving bone, of multiple sites, in diseases classified elsewhere. Unspecified infection of bone, site unspecified. Unspecified infection of bone of shoulder region. Unspecified infection of upper arm bone. Unspecified infection of forearm bone. Unspecified infection of hand bone. Unspecified infection of bone of pelvic region and thigh. Unspecified infection of lower leg bone. Unspecified infection of ankle and foot bone. Unspecified infection of bone of other specified sites. Unspecified infection of bone in multiple sites. Pathologic fracture, unspecified site. Jkt 223001 PO 00000 Frm 00370 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 73311 ............................................... 73312 ............................................... 73313 ............................................... 73314 ............................................... 73315 ............................................... 73316 ............................................... 73319 ............................................... 73340 ............................................... 73341 ............................................... 73342 ............................................... 73343 ............................................... 73344 ............................................... 73345 ............................................... 73349 ............................................... 73381 ............................................... 73382 ............................................... 74100 ............................................... 74101 ............................................... 74102 ............................................... 74103 ............................................... 7420 ................................................. 7424 ................................................. 74512 ............................................... 7454 ................................................. 7455 ................................................. 74560 ............................................... 74561 ............................................... 74569 ............................................... 74600 ............................................... 74602 ............................................... 74609 ............................................... 7463 ................................................. 7464 ................................................. 7465 ................................................. 7466 ................................................. 74683 ............................................... 74685 ............................................... 74687 ............................................... 7470 ................................................. 74710 ............................................... 74720 ............................................... 74721 ............................................... 74722 ............................................... 74729 ............................................... 74740 ............................................... 74741 ............................................... 74742 ............................................... 74749 ............................................... 74782 ............................................... 74789 ............................................... 7479 ................................................. 7483 ................................................. 7484 ................................................. 74861 ............................................... 7504 ................................................. 7511 ................................................. 7512 ................................................. 7513 ................................................. 7514 ................................................. 7515 ................................................. 75160 ............................................... 75162 ............................................... 75169 ............................................... 7517 ................................................. 7530 ................................................. 75310 ............................................... 75311 ............................................... 75312 ............................................... 75313 ............................................... 75314 ............................................... 75315 ............................................... 75316 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Pathologic fracture of humerus. Pathologic fracture of distal radius and ulna. Pathologic fracture of vertebrae. Pathologic fracture of neck of femur. Pathologic fracture of other specified part of femur. Pathologic fracture of tibia or fibula. Pathologic fracture of other specified site. Aseptic necrosis of bone, site unspecified. Aseptic necrosis of head of humerus. Aseptic necrosis of head and neck of femur. Aseptic necrosis of medial femoral condyle. Aseptic necrosis of talus. Aseptic necrosis of bone, jaw. Aseptic necrosis of other bone sites. Malunion of fracture. Nonunion of fracture. Spina bifida, unspecified region, with hydrocephalus. Spina bifida, cervical region, with hydrocephalus. Spina bifida, dorsal (thoracic) region, with hydrocephalus. Spina bifida, lumbar region, with hydrocephalus. Encephalocele. Other specified congenital anomalies of brain. Corrected transposition of great vessels. Ventricular septal defect. Ostium secundum type atrial septal defect. Endocardial cushion defect, unspecified type. Ostium primum defect. Other endocardial cushion defects. Congenital pulmonary valve anomaly, unspecified. Stenosis of pulmonary valve, congenital. Other congenital anomalies of pulmonary valve. Congenital stenosis of aortic valve. Congenital insufficiency of aortic valve. Congenital mitral stenosis. Congenital mitral insufficiency. Infundibular pulmonic stenosis, congenital. Coronary artery anomaly, congenital. Malposition of heart and cardiac apex. Patent ductus arteriosus. Coarctation of aorta (preductal) (postductal). Congenital anomaly of aorta, unspecified. Congenital anomalies of aortic arch. Congenital atresia and stenosis of aorta. Other congenital anomalies of aorta. Congenital anomaly of great veins, unspecified. Total anomalous pulmonary venous connection. Partial anomalous pulmonary venous connection. Other anomalies of great veins. Spinal vessel anolmaly. Other specified congenital anomalies of circulatory system. Unspecified congenital anomaly of circulatory system. Other congenital anomalies of larynx, trachea, and bronchus. Congenital cystic lung. Congenital bronchiectasis. Other specified congenital anomalies of esophagus. Congenital atresia and stenosis of small intestine. Congenital atresia and stenosis of large intestine, rectum, and anal canal. Hirschsprung’s disease and other congenital functional disorders of colon. Congenital anomalies of intestinal fixation. Other congenital anomalies of intestine. Unspecified congenital anomaly of gallbladder, bile ducts, and liver. Congenital cystic disease of liver. Other congenital anomalies of gallbladder, bile ducts, and liver. Congenital anomalies of pancreas. Renal agenesis and dysgenesis. Cystic kidney disease, unspecified. Congenital single renal cyst. Polycystic kidney, unspecified type. Polycystic kidney, autosomal dominant. Polycystic kidney, autosomal recessive. Renal dysplasia. Medullary cystic kidney. Jkt 223001 PO 00000 Frm 00371 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25049 25050 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 75317 ............................................... 75319 ............................................... 75320 ............................................... 75321 ............................................... 75322 ............................................... 75323 ............................................... 75329 ............................................... 7535 ................................................. 7536 ................................................. 7542 ................................................. 75489 ............................................... 75613 ............................................... 7563 ................................................. 75651 ............................................... 75652 ............................................... 75683 ............................................... 7581 ................................................. 7582 ................................................. 75831 ............................................... 75833 ............................................... 75839 ............................................... 7590 ................................................. 7593 ................................................. 7595 ................................................. 7596 ................................................. 7597 ................................................. 75981 ............................................... 75982 ............................................... 75989 ............................................... 76711 ............................................... 7704 ................................................. 7705 ................................................. 77081 ............................................... 77082 ............................................... 77083 ............................................... 7710 ................................................. 7714 ................................................. 7715 ................................................. 77182 ............................................... 77183 ............................................... 77189 ............................................... 77210 ............................................... 77211 ............................................... 77212 ............................................... 7725 ................................................. 7751 ................................................. 7752 ................................................. 7753 ................................................. 7754 ................................................. 77581 ............................................... 77589 ............................................... 7760 ................................................. 7763 ................................................. 7765 ................................................. 7766 ................................................. 7774 ................................................. 7781 ................................................. 7785 ................................................. 7794 ................................................. 7795 ................................................. 78001 ............................................... 78003 ............................................... 7801 ................................................. 78031 ............................................... 78032 ............................................... 7814 ................................................. 7816 ................................................. 7817 ................................................. 7818 ................................................. 7824 ................................................. 7843 ................................................. 7854 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Medullary sponge kidney. Other specified cystic kidney disease. Unspecified obstructive defect of renal pelvis and ureter. Congenital obstruction of ureteropelvic junction. Congenital obstruction of ureterovesical junction. Congenital ureterocele. Other obstructive defect of renal pelvis and ureter. Exstrophy of urinary bladder. Congenital atresia and stenosis of urethra and bladder neck. Congenital musculoskeletal deformities of spine. Other specified nonteratogenic anomalies. Absence of vertebra, congenital. Other congenital anomalies of ribs and sternum. Osteogenesis imperfecta. Osteopetrosis. Ehlers-danlos syndrome. Patau’s syndrome. Edwards’ syndrome. Cri-du-chat syndrome. Other microdeletions. Other autosomal deletions. Anomalies of spleen, congenital. Situs inversus. Tuberous sclerosis. Other congenital hamartoses, not elsewhere classified. Multiple congenital anomalies, so described. Prader-willi syndrome. Marfan syndrome. Other specified congenital anomalies. Epicranial subaponeurotic hemorrhage (massive). Primary atelectasis of newborn. Other and unspecified atelectasis of newborn. Primary apnea of newborn. Other apnea of newborn. Cyanotic attacks of newborn. Congenital rubella. Omphalitis of the newborn. Neonatal infective mastitis. Urinary tract infection of newborn. Bacteremia of newborn. Other infections specific to the perinatal period. Intraventricular hemorrhage unspecified grade. Intraventricular hemorrhage grade i. Intraventricular hemorrhage grade ii. Adrenal hemorrhage of fetus or newborn. Neonatal diabetes mellitus. Neonatal myasthenia gravis. Neonatal thyrotoxicosis. Hypocalcemia and hypomagnesemia of newborn. Other acidosis of newborn. Other neonatal endocrine and metabolic disturbances. Hemorrhagic disease of newborn. Other transient neonatal disorders of coagulation. Congenital anemia. Anemia of prematurity. Transitory ileus of newborn. Sclerema neonatorum. Other and unspecified edema of newborn. Drug reactions and intoxications specific to newborn. Drug withdrawal syndrome in newborn. Coma. Persistent vegetative state. Hallucinations. Febrile convulsions (simple), unspecified. Complex febrile convulsions. Transient paralysis of limb. Meningismus. Tetany. Neurological neglect syndrome. Jaundice, unspecified, not of newborn. Aphasia. Gangrene. Jkt 223001 PO 00000 Frm 00372 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25051 TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title 78550 ............................................... 78604 ............................................... 7863 ................................................. 7888 ................................................. 78951 ............................................... 78959 ............................................... 79001 ............................................... 7907 ................................................. 7911 ................................................. 7913 ................................................. 79901 ............................................... 7994 ................................................. 80000 ............................................... 80001 ............................................... 80002 ............................................... 80006 ............................................... 80009 ............................................... 80040 ............................................... 80041 ............................................... 80042 ............................................... Shock, unspecified. Cheyne-stokes respiration. Hemoptysis. Extravasation of urine. Malignant ascites. Other ascites. Precipitous drop in hematocrit. Bacteremia. Chyluria. Myoglobinuria. Asphyxia. Cachexia. Closed fracture of vault of skull without mention of intracranial injury, with state of consciousness unspecified. Closed fracture of vault of skull without mention of intracranial injury, with no loss of consciousness. Closed fracture of vault of skull without mention of intracranial injury, with brief (less than one hour) loss of consciousness. Closed fracture of vault of skull without mention of intra cranial injury, with loss of consciousness of unspecified duration. Closed fracture of vault of skull without mention of intracranial injury, with concussion, unspecified. Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with state of consciousness unspecified. Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with no loss of consciousness. Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with brief (less than one hour) loss of consciousness. Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with loss of consciousness of unspecified duration. Closed fracture of vault of skull with intracranial injury of other and unspecified nature, with concussion, unspecified. Closed fracture of base of skull without mention of intra cranial injury, with state of consciousness unspecified. Closed fracture of base of skull without mention of intra cranial injury, with no loss of consciousness. Closed fracture of base of skull without mention of intra cranial injury, with brief (less than one hour) loss of consciousness. Closed fracture of base of skull without mention of intra cranial injury, with loss of consciousness of unspecified duration. Closed fracture of base of skull without mention of intra cranial injury, with concussion, unspecified. Closed fracture of base of skull with intracranial injury of other and unspecified nature, with state of consciousness unspecified. Closed fracture of base of skull with intracranial injury of other and unspecified nature, with no loss of consciousness. Closed fracture of base of skull with intracranial injury of other and unspecified nature, with brief (less than one hour) loss of consciousness. Closed fracture of base of skull with intracranial injury of other and unspecified nature, with loss of consciousness of unspecified duration. Closed fracture of base of skull with intracranial injury of other and unspecified nature, with concussion, unspecified. Open fracture of nasal bones. Closed fracture of unspecified site of mandible. Closed fracture of condylar process of mandible. Closed fracture of subcondylar process of mandible. Closed fracture of coronoid process of mandible. Closed fracture of unspecified part of ramus of mandible. Closed fracture of angle of jaw. Closed fracture of symphysis of body of mandible. Closed fracture of alveolar border of body of mandible. Closed fracture of other and unspecified part of body of mandible. Closed fracture of multiple sites of mandible. Open fracture of unspecified site of mandible. Open fracture of condylar process of mandible. Open fracture of subcondylar process of mandible. Open fracture of coronoid process of mandible. Open fracture of unspecified part of ramus of mandible. Open fracture of angle of jaw. Open fracture of symphysis of body of mandible. Open fracture of alveolar border of body of mandible. Open fracture of body of mandible, other and unspecified. Open fracture of multiple sites of mandible. Closed fracture of malar and maxillary bones. Open fracture of malar and maxillary bones. Closed fracture of orbital floor (blow-out). Open fracture of orbital floor (blow-out). Closed fracture of other facial bones. 80046 ............................................... 80049 80100 80101 80102 80106 80109 80140 80141 80142 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 80146 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 80149 ............................................... 8021 ................................................. 80220 ............................................... 80221 ............................................... 80222 ............................................... 80223 ............................................... 80224 ............................................... 80225 ............................................... 80226 ............................................... 80227 ............................................... 80228 ............................................... 80229 ............................................... 80230 ............................................... 80231 ............................................... 80232 ............................................... 80233 ............................................... 80234 ............................................... 80235 ............................................... 80236 ............................................... 80237 ............................................... 80238 ............................................... 80239 ............................................... 8024 ................................................. 8025 ................................................. 8026 ................................................. 8027 ................................................. 8028 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00373 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25052 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title 8029 ................................................. 80300 ............................................... 80301 ............................................... 80302 ............................................... 80306 ............................................... 80309 ............................................... 80340 ............................................... 80341 ............................................... 80342 ............................................... Open fracture of other facial bones. Other closed skull fracture without mention of intracranial injury, with state of consciousness unspecified. Other closed skull fracture without mention of intracranial injury, with no loss of consciousness. Other closed skull fracture without mention of intracranial injury, with brief (less than one hour) loss of consciousness. Other closed skull fracture without mention of intracranial injury, with loss of consciousness of unspecified duration. Other closed skull fracture without mention of intracranial injury, with concussion, unspecified. Other closed skull fracture with intracranial injury of other and unspecified nature, with state of consciousness unspecified. Other closed skull fracture with intracranial injury of other and unspecified nature, with no loss of consciousness. Other closed skull fracture with intracranial injury of other and unspecified nature, with brief (less than one hour) loss of consciousness. Other site of closed skull fracture with intracranial injury of other and unspecified nature, with loss of consciousness of unspecified duration. Other site of closed skull fracture with intracranial injury of other and unspecified nature, with concussion, unspecified. Closed fractures involving skull or face with other bones, without mention of intracranial injury, with state of consciousness unspecified. Closed fractures involving skull or face with other bones, without mention of intracranial injury, with no loss of consciousness. Closed fractures involving skull or face with other bones, without mention of intracranial injury, with brief (less than one hour) loss of consciousness. Closed fractures involving skull of face with other bones, without mention of intracranial injury, with loss of consciousness of unspecified duration. Closed fractures involving skull of face with other bones, without mention of intracranial injury, with concussion, unspecified. Closed fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with state of consciousness unspecified. Closed fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with no loss of consciousness. Closed fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with brief (less than one hour) loss of consciousness. Closed fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with loss of consciousness of unspecified duration. Closed fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with concussion, unspecified. Open fractures involving skull or face with other bones, without mention of intracranial injury, with state of consciousness unspecified. Open fractures involving skull or face with other bones, without mention of intracranial injury, with no loss of consciousness. Open fractures involving skull or face with other bones, without mention of intracranial injury, with brief (less than one hour) loss of consciousness. Open fractures involving skull or face with other bones, without mention of intracranial injury, with loss of consciousness of unspecified duration. Open fractures involving skull or face with other bones, without mention of intracranial injury, with concussion, unspecified. Open fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with state of consciousness unspecified. Open fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with no loss of consciousness. Open fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with brief (less than one hour) loss of consciousness. Open fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with loss of consciousness of unspecified duration. Open fractures involving skull or face with other bones, with intracranial injury of other and unspecified nature, with concussion, unspecified. Closed fracture of cervical vertebra, unspecified level. Closed fracture of first cervical vertebra. Closed fracture of second cervical vertebra. Closed fracture of third cervical vertebra. Closed fracture of fourth cervical vertebra. Closed fracture of fifth cervical vertebra. Closed fracture of sixth cervical vertebra. Closed fracture of seventh cervical vertebra. Closed fracture of multiple cervical vertebrae. Closed fracture of dorsal (thoracic) vertebra without mention of spinal cord injury. Closed fracture of lumbar vertebra without mention of spinal cord injury. Closed fracture of sacrum and coccyx without mention of spinal cord injury. Closed fracture of unspecified part of vertebral column without mention of spinal cord injury. Closed fracture of rib(s), unspecified. 80346 ............................................... 80349 ............................................... 80400 ............................................... 80401 ............................................... 80402 ............................................... 80406 ............................................... 80409 ............................................... 80440 ............................................... 80441 ............................................... 80442 ............................................... 80446 ............................................... 80449 ............................................... 80450 ............................................... 80451 ............................................... 80452 ............................................... 80456 ............................................... 80459 ............................................... 80490 ............................................... 80491 ............................................... 80492 ............................................... 80496 ............................................... 80499 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 80500 ............................................... 80501 ............................................... 80502 ............................................... 80503 ............................................... 80504 ............................................... 80505 ............................................... 80506 ............................................... 80507 ............................................... 80508 ............................................... 8052 ................................................. 8054 ................................................. 8056 ................................................. 8058 ................................................. 80700 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00374 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 80701 ............................................... 80702 ............................................... 80703 ............................................... 80704 ............................................... 80705 ............................................... 80706 ............................................... 80707 ............................................... 80708 ............................................... 80709 ............................................... 8072 ................................................. 8082 ................................................. 80841 ............................................... 80842 ............................................... 80843 ............................................... 80849 ............................................... 8088 ................................................. 8090 ................................................. 81010 ............................................... 81011 ............................................... 81012 ............................................... 81013 ............................................... 81110 ............................................... 81111 ............................................... 81112 ............................................... 81113 ............................................... 81119 ............................................... 81200 ............................................... 81201 ............................................... 81202 ............................................... 81203 ............................................... 81209 ............................................... 81220 ............................................... 81221 ............................................... 81240 ............................................... 81241 ............................................... 81242 ............................................... 81243 ............................................... 81244 ............................................... 81249 ............................................... 81320 ............................................... 81321 ............................................... 81322 ............................................... 81323 ............................................... 81340 ............................................... 81341 ............................................... 81342 ............................................... 81343 ............................................... 81344 ............................................... 81345 ............................................... 81380 ............................................... 81382 ............................................... 81383 ............................................... 81410 ............................................... 81411 ............................................... 81412 ............................................... 81413 ............................................... 81414 ............................................... 81415 ............................................... 81416 ............................................... 81417 ............................................... 81418 ............................................... 81419 ............................................... 81510 ............................................... 81511 ............................................... 81512 ............................................... 81513 ............................................... 81514 ............................................... 81519 ............................................... 81610 ............................................... 81611 ............................................... 81612 ............................................... 81613 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Closed fracture of one rib. Closed fracture of two ribs. Closed fracture of three ribs. Closed fracture of four ribs. Closed fracture of five ribs. Closed fracture of six ribs. Closed fracture of seven ribs. Closed fracture of eight or more ribs. Closed fracture of multiple ribs, unspecified. Closed fracture of sternum. Closed fracture of pubis. Closed fracture of ilium. Closed fracture of ischium. Multiple closed pelvic fractures with disruption of pelvic circle. Closed fracture of other specified part of pelvis. Unspecified closed fracture of pelvis. Fracture of bones of trunk, closed. Open fracture of clavicle, unspecified part. Open fracture of sternal end of clavicle. Open fracture of shaft of clavicle. Open fracture of acromial end of clavicle. Open fracture of scapula, unspecified part. Open fracture of acromial process of scapula. Open fracture of coracoid process. Open fracture of glenoid cavity and neck of scapula. Open fracture of other part of scapula. Fracture of unspecified part of upper end of humerus, closed. Fracture of surgical neck of humerus, closed. Fracture of anatomical neck of humerus, closed. Fracture of greater tuberosity of humerus, closed. Other closed fractures of upper end of humerus. Fracture of unspecified part of humerus, closed. Fracture of shaft of humerus, closed. Fracture of unspecified part of lower end of humerus, closed. Supracondylar fracture of humerus, closed. Fracture of lateral condyle of humerus, closed. Fracture of medial condyle of humerus, closed. Fracture of unspecified condyle(s) of humerus, closed. Other closed fractures of lower end of humerus. Fracture of shaft of radius or ulna, unspecified, closed. Fracture of shaft of radius (alone), closed. Fracture of shaft of ulna (alone), closed. Fracture of shaft of radius with ulna, closed. Closed fracture of lower end of forearm, unspecified. Colles’ fracture, closed. Other closed fractures of distal end of radius (alone). Fracture of distal end of ulna (alone), closed. Fracture of lower end of radius with ulna, closed. Torus fracture of radius. Closed fracture of unspecified part of forearm. Fracture of unspecified part of ulna (alone), closed. Fracture of unspecified part of radius with ulna, closed. Open fracture of carpal bone, unspecified. Open fracture of navicular (scaphoid) bone of wrist. Open fracture of lunate (semilunar) bone of wrist. Open fracture of triquetral (cuneiform) bone of wrist. Open fracture of pisiform bone of wrist. Open fracture of trapezium bone (larger multangular) of wrist. Open fracture of trapezoid bone (smaller multangular) of wrist. Open fracture of capitate bone (os magnum) of wrist. Open fracture of hamate (unciform) bone of wrist. Open fracture of other bone of wrist. Open fracture of metacarpal bone(s), site unspecified. Open fracture of base of thumb (first) metacarpal. Open fracture of base of other metacarpal bone(s). Open fracture of shaft of metacarpal bone(s). Open fracture of neck of metacarpal bone(s). Open fracture of multiple sites of metacarpus. Open fracture of phalanx or phalanges of hand, unspecified. Open fracture of middle or proximal phalanx or phalanges of hand. Open fracture of distal phalanx or phalanges of hand. Open fracture of multiple sites of phalanx or phalanges of hand. Jkt 223001 PO 00000 Frm 00375 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25053 25054 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 8171 ................................................. 8181 ................................................. 8190 ................................................. 8191 ................................................. 82120 ............................................... 82121 ............................................... 82122 ............................................... 82123 ............................................... 82129 ............................................... 8220 ................................................. 8221 ................................................. 82300 ............................................... 82302 ............................................... 82320 ............................................... 82322 ............................................... 82340 ............................................... 82342 ............................................... 82380 ............................................... 82382 ............................................... 8241 ................................................. 8243 ................................................. 8245 ................................................. 8247 ................................................. 8249 ................................................. 8251 ................................................. 82530 ............................................... 82531 ............................................... 82532 ............................................... 82533 ............................................... 82534 ............................................... 82535 ............................................... 82539 ............................................... 8271 ................................................. 8301 ................................................. 83110 ............................................... 83111 ............................................... 83112 ............................................... 83113 ............................................... 83114 ............................................... 83119 ............................................... 83210 ............................................... 83211 ............................................... 83212 ............................................... 83213 ............................................... 83214 ............................................... 83219 ............................................... 83310 ............................................... 83311 ............................................... 83312 ............................................... 83313 ............................................... 83314 ............................................... 83315 ............................................... 83319 ............................................... 83500 ............................................... 83501 ............................................... 83502 ............................................... 83503 ............................................... 8364 ................................................. 83660 ............................................... 83661 ............................................... 83662 ............................................... 83663 ............................................... 83664 ............................................... 83669 ............................................... 8371 ................................................. 83900 ............................................... 83901 ............................................... 83902 ............................................... 83903 ............................................... 83904 ............................................... 83905 ............................................... 83906 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Multiple open fractures of hand bones. Ill-defined open fractures of upper limb. Multiple closed fractures involving both upper limbs, and upper limb with rib(s) and sternum. Multiple open fractures involving both upper limbs, and upper limb with rib(s) and sternum. Fracture of lower end of femur, unspecified part, closed. Fracture of femoral condyle, closed. Fracture of lower epiphysis of femur, closed. Supracondylar fracture of femur, closed. Other fracture of lower end of femur, closed. Closed fracture of patella. Open fracture of patella. Closed fracture of upper end of tibia. Closed fracture of upper end of fibula with tibia. Closed fracture of shaft of tibia. Closed fracture of shaft of fibula with tibia. Torus fracture, tibia alone. Torus fracture, fibula with tibia. Closed fracture of unspecified part of tibia. Closed fracture of unspecified part of fibula with tibia. Fracture of medial malleolus, open. Fracture of lateral malleolus, open. Bimalleolar fracture, open. Trimalleolar fracture, open. Unspecified fracture of ankle, open. Fracture of calcaneus, open. Fracture of unspecified bone(s) of foot (except toes), open. Fracture of astragalus, open. Fracture of navicular (scaphoid) bone of foot, open. Fracture of cuboid bone, open. Fracture of cuneiform bone of foot, open. Fracture of metatarsal bone(s), open. Other fractures of tarsal and metatarsal bones, open. Other, multiple and ill-defined fractures of lower limb, open. Open dislocation of jaw. Open dislocation of shoulder, unspecified. Open anterior dislocation of humerus. Open posterior dislocation of humerus. Open inferior dislocation of humerus. Open dislocation of acromioclavicular (joint). Open dislocation of other site of shoulder. Open dislocation of elbow, unspecified site. Open anterior dislocation of elbow. Open posterior dislocation of elbow. Open medial dislocation of elbow. Open lateral dislocation of elbow. Open dislocation of other site of elbow. Open dislocation of wrist, unspecified part. Open dislocation of radioulnar (joint), distal. Open dislocation of radiocarpal (joint). Open dislocation of midcarpal (joint). Open dislocation of carpometacarpal (joint). Open dislocation of metacarpal (bone), proximal end. Open dislocation of other part of wrist. Closed dislocation of hip, unspecified site. Closed posterior dislocation of hip. Closed obturator dislocation of hip. Other closed anterior dislocation of hip. Dislocation of patella, open. Dislocation of knee, unspecified part, open. Anterior dislocation of tibia, proximal end, open. Posterior dislocation of tibia, proximal end, open. Medial dislocation of tibia, proximal end, open. Lateral dislocation of tibia, proximal end, open. Other dislocation of knee, open. Open dislocation of ankle. Closed dislocation, cervical vertebra, unspecified. Closed dislocation, first cervical vertebra. Closed dislocation, second cervical vertebra. Closed dislocation, third cervical vertebra. Closed dislocation, fourth cervical vertebra. Closed dislocation, fifth cervical vertebra. Closed dislocation, sixth cervical vertebra. Jkt 223001 PO 00000 Frm 00376 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25055 TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title 83907 ............................................... 83908 ............................................... 83951 ............................................... 83952 ............................................... 83961 ............................................... 83979 ............................................... 8399 ................................................. 85011 ............................................... 85012 ............................................... 8502 ................................................. 8503 ................................................. 8505 ................................................. 85102 ............................................... 85103 ............................................... 85104 ............................................... Closed dislocation, seventh cervical vertebra. Closed dislocation, multiple cervical vertebrae. Open dislocation, coccyx. Open dislocation, sacrum. Closed dislocation, sternum. Open dislocation, other location. Open dislocation, multiple and ill-defined sites. Concussion, with loss of consciousness of 30 minutes or less. Concussion, with loss of consciousness from 31 to 59 minutes. Concussion with moderate loss of consciousness. Concussion with prolonged loss of consciousness and return to pre-existing conscious level. Concussion with loss of consciousness of unspecified duration. Cortex (cerebral) contusion without mention of open intracranial wound, with brief (less than one hour) loss of consciousness. Cortex (cerebral) contusion without mention of open intracranial wound, with moderate (1-24 hours) loss of consciousness. Cortex (cerebral) contusion without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-exisiting conscious level. Cortex (cerebral) contusion without mention of open intracranial wound, with loss of consciousness of unspecified duration. Cerebellar or brain stem contusion without mention of open intracranial wound, with brief (less than one hour) loss of consciousness. Cerebellar or brain stem contusion without mention of open intracranial wound, with moderate (1-24 hours) loss of consciousness. Cerebellar or brain stem contusion without mention of open intracranial wound, with prolonged (more than 24 hours) loss consciousness and return to pre-existing conscious level. Cerebellar or brain stem contusion without mention of open intracranial wound, with loss of consciousness of unspecified duration. Intracranial injury of other and unspecified nature, without mention of open intracranial wound, with brief (less than one hour) loss of consciousness. Intracranial injury of other and unspecified nature, without mention of open intracranial wound, with moderate (1-24 hours) loss of consciousness. Intracranial injury of other and unspecified nature, without mention of open intracranial wound, with prolonged (more than 24 hours) loss of consciousness and return to pre-existing conscious level. Intracranial injury of other and unspecified nature, without mention of open intracranial wound, with loss of consciousness of unspecified duration. Traumatic pneumothorax without mention of open wound into thorax. Unspecified injury of heart without mention of open wound into thorax. Contusion of heart without mention of open wound into thorax. Unspecified injury of lung without open wound into thorax. Contusion of lung without open wound into thorax. Injury to diaphragm without mention of open wound into cavity. Injury to other specified intrathoracic organs without mention of open wound into cavity. Injury to multiple and unspecified intrathoracic organs without mention of open wound into cavity. Injury to stomach without mention of open wound into cavity. Injury to small intestine, unspecified site, without open wound into cavity. Injury to duodenum without open wound into cavity. Other injury to small intestine without open wound into cavity. Injury to colon, unspecified site, without mention of open wound into cavity. Injury to ascending (right) colon without open wound into cavity. Injury to transverse colon without open wound into cavity. Injury to descending (left) colon without open wound into cavity. Injury to sigmoid colon without open wound into cavity. Injury to rectum without open wound into cavity. Injury to multiple sites in colon and rectum without open wound into cavity. Other injury to colon and rectum, without open wound into cavity. Injury to gastrointestinal tract, unspecified site, without open wound into cavity. Injury to pancreas head without mention of open wound into cavity. Injury to pancreas body without mention of open wound into cavity. Injury to pancreas tail without mention of open wound into cavity. Injury to pancreas, multiple and unspecified sites, without open wound into cavity. Injury to appendix without open wound into cavity. Injury to other and unspecified gastrointestinal sites without open wound into cavity. Unspecified injury to liver without mention of open wound into cavity. Hematoma and contusion of liver without mention of open wound into cavity. Laceration of liver, minor, without mention of open wound into cavity. Laceration of liver, unspecified, without mention of open wound into cavity. Other injury to liver without mention of open wound into cavity. Unspecified injury to spleen without mention of open wound into cavity. Hematoma of spleen, without rupture of capsule, without mention of open wound into cavity. Capsular tears to spleen, without major disruption of parenchyma, without mention of open wound into cavity. Other injury into spleen without mention of open wound into cavity. 85106 ............................................... 85142 ............................................... 85143 ............................................... 85144 ............................................... 85146 ............................................... 85402 ............................................... 85403 ............................................... 85404 ............................................... 85406 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 8600 ................................................. 86100 ............................................... 86101 ............................................... 86120 ............................................... 86121 ............................................... 8620 ................................................. 86229 ............................................... 8628 ................................................. 8630 ................................................. 86320 ............................................... 86321 ............................................... 86329 ............................................... 86340 ............................................... 86341 ............................................... 86342 ............................................... 86343 ............................................... 86344 ............................................... 86345 ............................................... 86346 ............................................... 86349 ............................................... 86380 ............................................... 86381 ............................................... 86382 ............................................... 86383 ............................................... 86384 ............................................... 86385 ............................................... 86389 ............................................... 86400 ............................................... 86401 ............................................... 86402 ............................................... 86405 ............................................... 86409 ............................................... 86500 ............................................... 86501 ............................................... 86502 ............................................... 86509 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00377 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25056 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 86600 ............................................... 86601 ............................................... 86602 ............................................... 8670 ................................................. 8672 ................................................. 8674 ................................................. 8676 ................................................. 8678 ................................................. 86800 ............................................... 86801 ............................................... 86802 ............................................... 86803 ............................................... 86804 ............................................... 86809 ............................................... 8690 ................................................. 8702 ................................................. 8703 ................................................. 8704 ................................................. 8708 ................................................. 8709 ................................................. 8710 ................................................. 8711 ................................................. 8712 ................................................. 8713 ................................................. 8715 ................................................. 8716 ................................................. 8719 ................................................. 87212 ............................................... 87261 ............................................... 87262 ............................................... 87263 ............................................... 87264 ............................................... 87269 ............................................... 87271 ............................................... 87272 ............................................... 87273 ............................................... 87274 ............................................... 87279 ............................................... 87323 ............................................... 87333 ............................................... 8742 ................................................. 8743 ................................................. 8744 ................................................. 8745 ................................................. 8750 ................................................. 8751 ................................................. 88020 ............................................... 88021 ............................................... 88022 ............................................... 88023 ............................................... 88029 ............................................... 88120 ............................................... 88121 ............................................... 88122 ............................................... 8822 ................................................. 8832 ................................................. 8842 ................................................. 8870 ................................................. 8871 ................................................. 8872 ................................................. 8873 ................................................. 8874 ................................................. 8875 ................................................. 8902 ................................................. 8912 ................................................. 8922 ................................................. 8932 ................................................. 8942 ................................................. 8960 ................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Unspecified injury to kidney without mention of open wound into cavity. Hematoma of kidney, without rupture of capsule, without mention of open wound into cavity. Laceration of kidney without mention of open wound into cavity. Injury to bladder and urethra without mention of open wound into cavity. Injury to ureter without mention of open wound into cavity. Injury to uterus without mention of open wound into cavity. Injury to other specified pelvic organs without mention of open wound into cavity. Injury to unspecified pelvic organ without mention of open wound into cavity. Injury to unspecified intra-abdominal organ without mention of open wound into cavity. Injury to adrenal gland without mention of open wound into cavity. Injury to bile duct and gallbladder without mention of open wound into cavity. Injury to peritoneum without mention of open wound into cavity. Injury to retroperitoneum without mention of open wound into cavity. Injury to other and multiple intra-abdominal organs without mention of open wound into cavity. Internal injury to unspecified or ill-defined organs without mention of open wound into cavity. Laceration of eyelid involving lacrimal passages. Penetrating wound of orbit, without mention of foreign body. Penetrating wound of orbit with foreign body. Other specified open wounds of ocular adnexa. Unspecified open wound of ocular adnexa. Ocular laceration without prolapse of intraocular tissue. Ocular laceration with prolapse or exposure of intraocular tissue. Rupture of eye with partial loss of intraocular tissue. Avulsion of eye. Penetration of eyeball with magnetic foreign body. Penetration of eyeball with (nonmagnetic) foreign body. Unspecified open wound of eyeball. Open wound of auditory canal, complicated. Open wound of ear drum, uncomplicated. Open wound of ossicles, uncomplicated. Open wound of eustachian tube, uncomplicated. Open wound of cochlea, uncomplicated. Open wound of other and multiple sites, uncomplicated. Open wound of ear drum, complicated. Open wound of ossicles, complicated. Open wound of eustachian tube, complicated. Open wound of cochlea, complicated. Open wound of other and multiple sites, complicated. Open wound of nasal sinus, uncomplicated. Open wound of nasal sinus, complicated. Open wound of thyroid gland, without mention of complication. Open wound of thyroid gland, complicated. Open wound of pharynx, without mention of complication. Open wound of pharynx, complicated. Open wound of chest (wall), without mention of complication. Open wound of chest (wall), complicated. Open wound of shoulder region, with tendon involvement. Open wound of scapular region, with tendon involvement. Open wound of axillary region, with tendon involvement. Open wound of upper arm, with tendon involvement. Open wound of multiple sites of shoulder and upper arm, with tendon involvement. Open wound of forearm, with tendon involvement. Open wound of elbow, with tendon involvement. Open wound of wrist, with tendon involvement. Open wound of hand except fingers alone, with tendon involvement. Open wound of fingers, with tendon involvement. Multiple and unspecified open wound of upper limb, with tendon involvement. Traumatic amputation of arm and hand (complete) (partial), unilateral, below elbow, without mention of complication. Traumatic amputation of arm and hand (complete) (partial), unilateral, below elbow, complicated. Traumatic amputation of arm and hand (complete) (partial), unilateral, at or above elbow, without mention of complication. Traumatic amputation of arm and hand (complete) (partial), unilateral, at or above elbow, complicated. Traumatic amputation of arm and hand (complete) (partial), unilateral, level not specified, without mention of complication. Traumatic amputation of arm and hand (complete) (partial), unilateral, level not specified, complicated. Open wound of hip and thigh, with tendon involvement. Open wound of knee, leg (except thigh), and ankle, with tendon involvement. Open wound of foot except toe(s) alone, with tendon involvement. Open wound of toe(s), with tendon involvement. Multiple and unspecified open wound of lower limb, with tendon involvement. Traumatic amputation of foot (complete) (partial), unilateral, without mention of complication. Jkt 223001 PO 00000 Frm 00378 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25057 TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title 8961 ................................................. 8970 ................................................. 8971 ................................................. 8972 ................................................. 8973 ................................................. 8974 ................................................. 8975 ................................................. 90000 ............................................... 90001 ............................................... 90002 ............................................... 90003 ............................................... 9001 ................................................. 90081 ............................................... 90082 ............................................... 90089 ............................................... 9009 ................................................. 90181 ............................................... 90182 ............................................... 90189 ............................................... 9019 ................................................. 90255 ............................................... 90256 ............................................... 90281 ............................................... 90282 ............................................... 90289 ............................................... 9029 ................................................. 9031 ................................................. 9032 ................................................. 9033 ................................................. 9034 ................................................. 9035 ................................................. 9038 ................................................. 9039 ................................................. 9043 ................................................. 90450 ............................................... 90451 ............................................... 90452 ............................................... 90453 ............................................... 90454 ............................................... 9046 ................................................. 9047 ................................................. 9048 ................................................. 9049 ................................................. 9251 ................................................. 9252 ................................................. 92800 ............................................... 92801 ............................................... 9340 ................................................. 9341 ................................................. 9348 ................................................. 9405 ................................................. 94130 ............................................... 94131 ............................................... 94132 ............................................... 94133 ............................................... 94134 ............................................... 94135 ............................................... 94136 ............................................... 94137 ............................................... 94138 ............................................... 94139 ............................................... 94140 ............................................... Traumatic amputation of foot (complete) (partial), unilateral, complicated. Traumatic amputation of leg(s) (complete) (partial), unilateral, below knee, without mention of complication. Traumatic amputation of leg(s) (complete) (partial), unilateral, below knee, complicated. Traumatic amputation of leg(s) (complete) (partial), unilateral, at or above knee, without mention of complication. Traumatic amputation of leg(s) (complete) (partial), unilateral, at or above knee, complicated. Traumatic amputation of leg(s) (complete) (partial), unilateral, level not specified, without mention of complication. Traumatic amputation of leg(s) (complete) (partial), unilateral, level not specified, complicated. Injury to carotid artery, unspecified. Injury to common carotid artery. Injury to external carotid artery. Injury to internal carotid artery. Injury to internal jugular vein. Injury to external jugular vein. Injury to multiple blood vessels of head and neck. Injury to other specified blood vessels of head and neck. Injury to unspecified blood vessel of head and neck. Injury to intercostal artery or vein. Injury to internal mammary artery or vein. Injury to other specified blood vessels of thorax. Injury to unspecified blood vessel of thorax. Injury to uterine artery. Injury to uterine vein. Injury to ovarian artery. Injury to ovarian vein. Injury to other specified blood vessels of abdomen and pelvis. Injury to unspecified blood vessel of abdomen and pelvis. Injury to brachial blood vessels. Injury to radial blood vessels. Injury to ulnar blood vessels. Injury to palmar artery. Injury to digital blood vessels. Injury to other specified blood vessels of upper extremity. Injury to unspecified blood vessel of upper extremity. Injury to saphenous veins. Injury to tibial vessel(s), unspecified. Injury to anterior tibial artery. Injury to anterior tibial vein. Injury to posterior tibial artery. Injury to posterior tibial vein. Injury to deep plantar blood vessels. Injury to other specified blood vessels of lower extremity. Injury to unspecified blood vessel of lower extremity. Injury to blood vessels of unspecified site. Crushing injury of face and scalp. Crushing injury of neck. Crushing injury of thigh. Crushing injury of hip. Foreign body in trachea. Foreign body in main bronchus. Foreign body in other specified parts bronchus and lung. Burn with resulting rupture and destruction of eyeball. Full-thickness skin loss due to burn (third degree nos) of unspecified site of face and head. Full-thickness skin loss due to burn (third degree nos) of ear (any part). Full-thickness skin loss due to burn (third degree nos) of of eye (with other parts of face, head, and neck). Full-thickness skin loss due to burn (third degree nos) of lip(s). Full-thickness skin loss due to burn (third degree nos) of chin. Full-thickness skin loss due to burn (third degree nos) of nose (septum). Full-thickness skin loss due to burn (third degree nos) of scalp (any part). Full-thickness skin loss due to burn (third degree nos) of forehead and cheek. Full-thickness skin loss due to burn (third degree nos) of neck. Full-thickness skin loss due to burn (third degree nos) of multiple sites (except with eye) of face, head, and neck. Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of face and head, without mention of loss of body part. Deep necrosis of underlying tissues due to burn (deep third degree) of ear (any part), without mention of loss of ear. Deep necrosis of underlying tissues due to burn (deep third degree) of eye (with other parts of face, head, and neck), without mention of loss of body part. Deep necrosis of underlying tissues due to burn (deep third degree) of lip(s), without mention of loss of lip(s). Deep necrosis of underlying tissues due to burn (deep third degree) of chin, without mention of loss of chin. 94141 ............................................... 94142 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 94143 ............................................... 94144 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00379 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25058 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title 94145 ............................................... 94146 ............................................... 94147 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of nose (septum), without mention of loss of nose. Deep necrosis of underlying tissues due to burn (deep third degree) of scalp (any part), without mention of loss of scalp. Deep necrosis of underlying tissues due to burn (deep third degree) of forehead and cheek, without mention of loss of forehead and cheek. Deep necrosis of underlying tissues due to burn (deep third degree) of neck, without mention of loss of neck. Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites (except with eye) of face, head, and neck, without mention of loss of a body part. Deep necrosis of underlying tissues due to burn (deep third degree) of face and head, unspecified site, with loss of body part. Deep necrosis of underlying tissues due to burn (deep third degree) of ear (any part), with loss of ear. Deep necrosis of underlying tissues due to burn (deep third degree) of eye (with other parts of face, head, and neck), with loss of a body part. Deep necrosis of underlying tissues due to burn (deep third degree) of lip(s), with loss of lip(s). Deep necrosis of underlying tissues due to burn (deep third degree) of chin, with loss of chin. Deep necrosis of underlying tissues due to burn (deep third degree) of nose (septum), with loss of nose. Deep necrosis of underlying tissues due to burn (deep third degree) of scalp (any part), with loss of scalp. Deep necrosis of underlying tissues due to burn (deep third degree) of forehead and cheek, with loss of forehead and cheek. Deep necrosis of underlying tissues due to burn (deep third degree) of neck, with loss of neck. Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites (except eye) of face, head, and neck, with loss of a body part. Full-thickness skin loss due to burn (third degree nos) of unspecified site of trunk. Full-thickness skin loss due to burn (third degree nos) of breast. Full-thickness skin loss due to burn (third degree nos) of chest wall, excluding breast and nipple. Full-thickness skin loss due to burn (third degree nos) of abdominal wall. Full-thickness skin loss due to burn (third degree nos) of back (any part). Full-thickness skin loss due to burn (third degree nos) of genitalia. Full-thickness skin loss due to burn (third degree nos) of other and multiple sites of trunk. Deep necrosis of underlying tissues due to burn (deep third degree) of trunk, unspecified site, without mention of loss of body part. Deep necrosis of underlying tissues due to burn (deep third degree) of breast, without mention of loss of breast. Deep necrosis of underlying tissues due to burn (deep third degree) of chest wall, excluding breast and nipple, without mention of loss of chest wall. Deep necrosis of underlying tissues due to burn (deep third degree) of abdominal wall, without mention of loss of abdominal wall. Deep necrosis of underlying tissues due to burn (deep third degree) of back (any part), without mention of loss of back. Deep necrosis of underlying tissues due to burn (deep third degree) of genitalia, without mention of loss of genitalia. Deep necrosis of underlying tissues due to burn (deep third degree) of other and multiple sites of trunk, without mention of loss of body part. Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of trunk, with loss of body part. Deep necrosis of underlying tissues due to burn (deep third degree) of breast, with loss of breast. Deep necrosis of underlying tissues due to burn (deep third degree) of chest wall, excluding breast and nipple, with loss of chest wall. Deep necrosis of underlying tissues due to burn (deep third degree) of abdominal wall with loss of abdominal wall. Deep necrosis of underlying tissues due to burn (deep third degree) of back (any part), with loss of back. Deep necrosis of underlying tissues due to burn (deep third degree) of genitalia, with loss of genitalia. Deep necrosis of underlying tissues due to burn (deep third degree) of other and multiple sites of trunk, with loss of a body part. Full-thickness skin loss due to burn (third degree nos) of unspecified site of upper limb. Full-thickness skin loss due to burn (third degree nos) of forearm. Full-thickness skin loss due to burn (third degree nos) of elbow. Full-thickness skin loss due to burn (third degree nos) of upper arm. Full-thickness skin loss due to burn (third degree nos) of axilla. Full-thickness skin loss due to burn (third degree nos) of shoulder. Full-thickness skin loss due to burn (third degree nos) of scapular region. Full-thickness skin loss due to burn (third degree nos) of multiple sites of upper limb, except wrist and hand. Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of upper limb, without mention of loss of a body part. Deep necrosis of underlying tissues due to burn (deep third degree) of forearm, without mention of loss of forearm. Deep necrosis of underlying tissues due to burn (deep third degree) of elbow, without mention of loss of elbow. Deep necrosis of underlying tissues due to burn (deep third degree) of upper arm, without mention of loss of upper arm. Deep necrosis of underlying tissues due to burn of axilla, without mention of loss of axilla. 94148 ............................................... 94149 ............................................... 94150 ............................................... 94151 ............................................... 94152 ............................................... 94153 94154 94155 94156 94157 94158 94159 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 94230 94231 94232 94233 94234 94235 94239 94240 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 94241 ............................................... 94242 ............................................... 94243 ............................................... 94244 ............................................... 94245 ............................................... 94249 ............................................... 94250 ............................................... 94251 ............................................... 94252 ............................................... ............................................... ............................................... ............................................... ............................................... 94330 94331 94332 94333 94334 94335 94336 94339 94340 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 94341 94342 94343 94344 mmaher on DSK3CLS3C1PROD with $$_JOB 94253 94254 94255 94259 ............................................... ............................................... ............................................... ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00380 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25059 TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title 94345 ............................................... 94346 ............................................... 94349 ............................................... Deep necrosis of underlying tissues due to burn (deep third degree) of shoulder, without mention of loss of shoulder. Deep necrosis of underlying tissues due to burn (deep third degree) of scapular region, without mention of loss of scapula. Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites of upper limb, except wrist and hand, without mention of loss of upper limb. Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of upper limb, with loss of a body part. Deep necrosis of underlying tissues due to burn (deep third degree) of forearm, with loss of forearm. Deep necrosis of underlying tissues due to burn (deep third degree) of elbow, with loss of elbow. Deep necrosis of underlying tissues due to burn (deep third degree) of upper arm, with loss of upper arm. Deep necrosis of underlying tissues due to burn (deep third degree) of axilla, with loss of axilla. Deep necrosis of underlying tissues due to burn (deep third degree) of shoulder, with loss of shoulder. Deep necrosis of underlying tissues due to burn (deep third degree) of scapular region, with loss of scapula. Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites of upper limb, except wrist and hand, with loss of upper limb. Full-thickness skin loss due to burn (third degree nos) of unspecified site of hand. Full-thickness skin loss due to burn (third degree nos) of single digit (finger (nail)) other than thumb. Full-thickness skin loss due to burn (third degree nos) of thumb (nail). Full-thickness skin loss due to burn (third degree nos) of two or more digits of hand, not including thumb. Full-thickness skin loss due to burn (third degree nos) of two or more digits of hand including thumb. Full-thickness skin loss due to burn (third degree nos) of palm of hand. Full-thickness skin loss due to burn (third degree nos) of back of hand. Full-thickness skin loss due to burn (third degree nos) of wrist. Full-thickness skin loss due to burn (third degree nos) of multiple sites of wrist(s) and hand(s). Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of hand, without mention of loss of hand. Deep necrosis of underlying tissues due to burn (deep third degree) of single digit (finger (nail)) other than thumb, without mention of loss of finger. Deep necrosis of underlying tissues due to burn (deep third degree) of thumb (nail), without mention of loss of thumb. Deep necrosis of underlying tissues due to burn (deep third degree) of two or more digits of hand, not including thumb, without mention of fingers. Deep necrosis of underlying tissues due to burn (deep third degree) of two or more digits of hand including thumb, without mention of loss of fingers. Deep necrosis of underlying tissues due to burn (deep third degree) of palm of hand, without mention of loss of palm. Deep necrosis of underlying tissues due to burn (deep third degree) of back of hand, without mention of loss of back of hand. Deep necrosis of underlying tissues due to burn (deep third degree) of wrist, without mention of loss of wrist. Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites of wrist(s) and hand(s), without mention of loss of a body part. Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of hand, with loss of hand. Deep necrosis of underlying tissues due to burn (deep third degree) of single digit (finger (nail)) other than thumb, with loss of finger. Deep necrosis of underlying tissues due to burn (deep third degree) of thumb (nail), with loss of thumb. Deep necrosis of underlying tissues due to burn (deep third degree) of two or more digits of hand, not including thumb, with loss of fingers. Deep necrosis of underlying tissues due to burn (deep third degree) of two or more digits of hand including thumb, with loss of fingers. Deep necrosis of underlying tissues due to burn (deep third degree) of palm of hand, with loss of palm of hand. Deep necrosis of underlying tissues due to burn (deep third degree) of back of hand, with loss of back of hand. Deep necrosis of underlying tissues due to burn (deep third degree) of wrist, with loss of wrist. Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites of wrist(s) and hand(s), with loss of a body part. Full-thickness skin loss due to burn (third degree nos) of unspecified site of lower limb. Full-thickness skin loss due to burn (third degree nos) of toe(s) (nail). Full-thickness skin loss due to burn (third degree nos) of foot. Full-thickness skin loss due to burn (third degree nos) of ankle. Full-thickness skin loss due to burn (third degree nos) of lower leg. Full-thickness skin loss due to burn (third degree nos) of knee. Full-thickness skin loss due to burn (third degree nos) of thigh (any part). Full-thickness skin loss due to burn (third degree nos) of multiple sites of lower limb(s). Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of lower limb (leg), without mention of loss of a body part. Deep necrosis of underlying tissues due to burn (deep third degree) of toe(s) (nail), without mention of loss of toe(s). Deep necrosis of underlying tissues due to burn (deep third degree) of foot, without mention of loss of foot. Deep necrosis of underlying tissues due to burn (deep third degree) of ankle, without mention of loss of ankle. 94350 94351 94352 94353 94354 94355 94356 94359 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 94430 94431 94432 94433 94434 94435 94436 94437 94438 94440 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... 94441 ............................................... 94442 ............................................... 94443 ............................................... 94444 ............................................... 94445 94446 94447 94448 ............................................... ............................................... ............................................... ............................................... 94450 ............................................... 94451 ............................................... 94452 ............................................... 94453 ............................................... 94454 ............................................... 94455 94456 94457 94458 ............................................... ............................................... ............................................... ............................................... 94530 94531 94532 94533 94534 94535 94536 94539 94540 ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 94541 ............................................... 94542 ............................................... 94543 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00381 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25060 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code 94544 94545 94546 94549 Code title ............................................... ............................................... ............................................... ............................................... 94550 ............................................... 94551 ............................................... 94552 ............................................... 94553 ............................................... 94554 ............................................... 94555 ............................................... 94556 ............................................... 94559 ............................................... 9463 ................................................. 9464 ................................................. 9465 ................................................. 9471 ................................................. 9472 ................................................. 9473 ................................................. 9474 ................................................. 94810 ............................................... 94811 ............................................... 94820 ............................................... 94830 ............................................... 94840 ............................................... 94850 ............................................... 94860 ............................................... 94870 ............................................... 94880 ............................................... 94890 ............................................... mmaher on DSK3CLS3C1PROD with $$_JOB 9493 ................................................. 9494 ................................................. 9495 ................................................. 9500 ................................................. 9501 ................................................. 9502 ................................................. 9503 ................................................. 9509 ................................................. 9510 ................................................. 9511 ................................................. 9512 ................................................. 9513 ................................................. 9514 ................................................. 9515 ................................................. 9516 ................................................. 9517 ................................................. 9518 ................................................. 9519 ................................................. 9582 ................................................. 9583 ................................................. 9587 ................................................. 95890 ............................................... 95891 ............................................... 95892 ............................................... 95893 ............................................... 95899 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Deep necrosis of underlying tissues due to burn (deep third degree) of lower leg, without mention of loss of lower leg. Deep necrosis of underlying tissues due to burn (deep third degree) of knee, without mention of loss of knee. Deep necrosis of underlying tissues due to burn (deep third degree) of thigh (any part), without mention of loss of thigh. Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites of lower limb(s), without mention of loss of a body part. Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site lower limb (leg), with loss of a body part. Deep necrosis of underlying tissues due to burn (deep third degree) of toe(s) (nail), with loss of toe(s). Deep necrosis of underlying tissues due to burn (deep third degree) of foot, with loss of foot. Deep necrosis of underlying tissues due to burn (deep third degree) of ankle, with loss of ankle. Deep necrosis of underlying tissues due to burn (deep third degree) of lower leg, with loss of lower leg. Deep necrosis of underlying tissues due to burn (deep third degree) of knee, with loss of knee. Deep necrosis of underlying tissues due to burn (deep third degree) of thigh (any part), with loss of thigh. Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites of lower limb(s), with loss of a body part. Full-thickness skin loss due to burn (third degree nos) of multiple specified sites. Deep necrosis of underlying tissues due to burn (deep third degree) of multiple specified sites, without mention of loss of a body part. Deep necrosis of underlying tissues due to burn (deep third degree) of multiple specified sites, with loss of a body part. Burn of larynx, trachea, and lung. Burn of esophagus. Burn of gastrointestinal tract. Burn of vagina and uterus. Burn (any degree) involving 10-19 percent of body surface with third degree burn of less than 10 percent or unspecified amount. Burn (any degree) involving 10-19 percent of body surface with third degree burn of 10-19%. Burn (any degree) involving 20-29 percent of body surface with third degree burn of less than 10 percent or unspecified amount. Burn (any degree) involving 30-39 percent of body surface with third degree burn of less than 10 percent or unspecified amount. Burn (any degree) involving 40-49 percent of body surface with third degree burn of less than 10 percent or unspecified amount. Burn (any degree) involving 50-59 percent of body surface with third degree burn of less than 10 percent or unspecified amount. Burn (any degree) involving 60-69 percent of body surface with third degree burn of less than 10 percent or unspecified amount. Burn (any degree) involving 70-79 percent of body surface with third degree burn of less than 10 percent or unspecified amount. Burn (any degree) involving 80-89 percent of body surface with third degree burn of less than 10 percent or unspecified amount. Burn (any degree) involving 90 percent or more of body surface with third degree burn of less than 10 percent or unspecified amount. Full-thickness skin loss due to burn (third degree nos), unspecified site. Deep necrosis of underlying tissue due to burn (deep third degree), unspecified site without mention of loss of a body part. Deep necrosis of underlying tissues due to burn (deep third degree, unspecified site with loss of a body part. Optic nerve injury. Injury to optic chiasm. Injury to optic pathways. Injury to visual cortex. Injury to unspecified optic nerve and pathways. Injury to oculomotor nerve. Injury to trochlear nerve. Injury to trigeminal nerve. Injury to abducens nerve. Injury to facial nerve. Injury to acoustic nerve. Injury to accessory nerve. Injury to hypoglossal nerve. Injury to other specified cranial nerves. Injury to unspecified cranial nerve. Secondary and recurrent hemorrhage as an early complication of trauma. Posttraumatic wound infection not elsewhere classified. Traumatic subcutaneous emphysema. Compartment syndrome, unspecified. Traumatic compartment syndrome of upper extremity. Traumatic compartment syndrome of lower extremity. Traumatic compartment syndrome of abdomen. Traumatic compartment syndrome of other sites. Jkt 223001 PO 00000 Frm 00382 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 9910 ................................................. 9911 ................................................. 9912 ................................................. 9913 ................................................. 9914 ................................................. 9920 ................................................. 9933 ................................................. 9941 ................................................. 9947 ................................................. 9950 ................................................. 9954 ................................................. 99550 ............................................... 99551 ............................................... 99552 ............................................... 99553 ............................................... 99554 ............................................... 99555 ............................................... 99559 ............................................... 99560 ............................................... 99561 ............................................... 99562 ............................................... 99563 ............................................... 99564 ............................................... 99565 ............................................... 99566 ............................................... 99567 ............................................... 99568 ............................................... 99569 ............................................... 99580 ............................................... 99581 ............................................... 99583 ............................................... 99584 ............................................... 99585 ............................................... 99586 ............................................... 99590 ............................................... 99593 ............................................... 99600 ............................................... 99601 ............................................... 99602 ............................................... 99603 ............................................... 99604 ............................................... 99609 ............................................... 9961 ................................................. 9962 ................................................. 99630 ............................................... 99639 ............................................... 99640 ............................................... 99641 ............................................... 99642 ............................................... 99643 ............................................... 99644 ............................................... 99645 ............................................... 99646 ............................................... 99647 ............................................... 99649 ............................................... 99651 ............................................... 99652 ............................................... 99653 ............................................... 99654 ............................................... 99655 ............................................... 99656 ............................................... 99657 ............................................... 99659 ............................................... 99660 ............................................... 99661 ............................................... 99662 ............................................... 99663 ............................................... 99664 ............................................... 99665 ............................................... 99666 ............................................... 99667 ............................................... 99668 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Frostbite of face. Frostbite of hand. Frostbite of foot. Frostbite of other and unspecified sites. Immersion foot. Heat stroke and sunstroke. Caisson disease. Drowning and nonfatal submersion. Asphyxiation and strangulation. Other anaphylactic shock, not elsewhere classified. Shock due to anesthesia, not elsewhere classified. Unspecified child abuse. Child emotional/psychological abuse. Child neglect (nutritional). Child sexual abuse. Child physical abuse. Shaken baby syndrome. Other child abuse and neglect. Anaphylactic shock due to unspecified food. Anaphylactic shock due to peanuts. Anaphylactic shock due to crustaceans. Anaphylactic shock due to fruits and vegetables. Anaphylactic shock due to tree nuts and seeds. Anaphylactic shock due to fish. Anaphylactic shock due to food additives. Anaphylactic shock due to milk products. Anaphylactic shock due to eggs. Anaphylactic shock due to other specified food. Unspecified adult maltreatment. Adult physical abuse. Adult sexual abuse. Adult neglect (nutritional). Other adult abuse and neglect. Malignant hyperthermia. Systemic inflammatory response syndrome, unspecified. Systemic inflammatory response syndrome due to noninfectious process without acute organ dysfunction. Mechanical complications of unspecified cardiac device, implant, and graft. Mechanical complication due to cardiac pacemaker (electrode). Mechanical complication due to heart valve prosthesis. Mechanical complication due to coronary bypass graft. Mechanical complication of automatic implantable cardiac defibrillator. Other mechanical complication of cardiac device, implant, and graft. Mechanical complication of other vascular device, implant, and graft. Mechanical complication of nervous system device, implant, and graft. Mechanical complication of unspecified genitourinary device, implant, and graft. Other mechanical complication of genitourinary device, implant, and graft. Unspecified mechanical complication of internal orthopedic device, implant, and graft. Mechanical loosening of prosthetic joint. Dislocation of prosthetic joint. Prosthetic joint implant failure. Peri-prosthetic fracture around prosthetic joint. Peri-prosthetic osteolysis. Articular bearing surface wear of prosthetic joint. Other mechanical complication of prosthetic joint implant. Other mechanical complication of other internal orthopedic device, implant, and graft. Mechanical complication of prosthetic corneal graft. Mechanical complication of prosthetic graft of other tissue, not elsewhere classified. Mechanical complication of prosthetic ocular lens prosthesis. Mechanical complication of breast prosthesis. Mechanical complication due to artificial skin graft and decellularized allodermis. Mechanical complication due to peritoneal dialysis catheter. COMPLICATION, DUE TO INSULIN PUMP. Mechanical complication of other implant and internal device, not elsewhere classfied. Infection and inflammatory reaction due to unspecified device, implant, and graft. Infection and inflammatory reaction due to cardiac device, implant, and graft. Infection and inflammatory reaction due to other vascular device, implant, and graft. Infection and inflammatory reaction due to nervous system device, implant, and graft. Infection and inflammatory reaction due to indwelling urinary catheter. Infection and inflammatory reaction due to other genitourinary device, implant, and graft. Infection and inflammatory reaction due to internal joint prosthesis. Infection and inflammatory reaction due to other internal orthopedic device, implant, and graft. Infection and inflammatory reaction due to peritoneal dialysis catheter. Jkt 223001 PO 00000 Frm 00383 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25061 25062 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title mmaher on DSK3CLS3C1PROD with $$_JOB 99669 ............................................... 99671 ............................................... 99672 ............................................... 99673 ............................................... 99674 ............................................... 99675 ............................................... 99676 ............................................... 99677 ............................................... 99678 ............................................... 99679 ............................................... 99680 ............................................... 99681 ............................................... 99682 ............................................... 99683 ............................................... 99684 ............................................... 99685 ............................................... 99686 ............................................... 99687 ............................................... 99689 ............................................... 99690 ............................................... 99691 ............................................... 99692 ............................................... 99693 ............................................... 99694 ............................................... 99695 ............................................... 99696 ............................................... 99699 ............................................... 99701 ............................................... 99702 ............................................... 99709 ............................................... 9971 ................................................. 9972 ................................................. 9973 ................................................. 9974 ................................................. 99762 ............................................... 99771 ............................................... 99772 ............................................... 99779 ............................................... 99799 ............................................... 9980 ................................................. 99811 ............................................... 99812 ............................................... 99813 ............................................... 9982 ................................................. 99831 ............................................... 99832 ............................................... 9984 ................................................. 99851 ............................................... 99859 ............................................... 9986 ................................................. 9987 ................................................. 99883 ............................................... 9990 ................................................. 9992 ................................................. 9993 ................................................. 9994 ................................................. 9995 ................................................. 9996 ................................................. 9997 ................................................. 9998 ................................................. V420 ................................................. V421 ................................................. V426 ................................................. V427 ................................................. V4281 ............................................... V4282 ............................................... V4283 ............................................... V4284 ............................................... V4321 ............................................... V4322 ............................................... V4611 ............................................... V4612 ............................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Infection and inflammatory reaction due to other internal prosthetic device, implant, and graft. Other complications due to heart valve prosthesis. Other complications due to other cardiac device, implant, and graft. Other complications due to renal dialysis device, implant, and graft. Other complications due to other vascular device, implant, and graft. Other complications due to nervous system device, implant, and graft. Other complications due to genitourinary device, implant, and graft. Other complications due to internal joint prosthesis. Other complications due to other internal orthopedic device, implant, and graft. Other complications due to other internal prosthetic device, implant, and graft. Complications of unspecified transplanted organ. Complications of transplanted kidney. Complications of transplanted liver. Complications of transplanted heart. Complications of transplanted lung. Complications of transplanted bone marrow. Complications of transplanted pancreas. Complications of transplanted organ, intestine. Complications of other specified transplanted organ. Complications of unspecified reattached extremity. Complications of reattached forearm. Complications of reattached hand. Complications of reattached finger(s). Complications of reattached upper extremity, other and unspecified. Complication of reattached foot and toe(s). Complication of reattached lower extremity, other and unspecified. Complication of other specified reattached body part. Central nervous system complication. Iatrogenic cerebrovascular infarction or hemorrhage. Other nervous system complications. Cardiac complications, not elsewhere classified. Peripheral vascular complications, not elsewhere classified. Respiratory complications, not elsewhere classified. Digestive system complications, not elsewhere classified. Infection (chronic) of amputation stump. Vascular complications of mesenteric artery. Vascular complications of renal artery. Vascular complications of other vessels. Complications affecting other specified body systems, not elsewhere classified. Postoperative shock, not elsewhere classified. Hemorrhage complicating a procedure. Hematoma complicating a procedure. Seroma complicating a procedure. Accidental puncture or laceration during a procedure, not elsewhere classified. Disruption of internal operation wound. Disruption of external operation wound. Foreign body accidentally left during a procedure, not elsewhere classified. Infected postoperative seroma. Other postoperative infection. Persistent postoperative fistula, not elsewhere classified. Acute reaction to foreign substance accidentally left during a procedure, not elsewhere classified. Non-healing surgical wound. Generalized vaccinia as a complication of medical care, not elsewhere classified. Other vascular complications of medical care, not elsewhere classified. Other infection due to medical care, not elsewhere classified. Anaphylactic shock due to serum, not elsewhere classified. Other serum reaction, not elsewhere classified. Abo incompatibility reaction, not elsewhere classified. Rh incompatibility reaction, not elsewhere classified. Other transfusion reaction, not elsewhere classified. Kidney replaced by transplant. Heart replaced by transplant. Lung replaced by transplant. Liver replaced by transplant. Bone marrow replaced by transplant. Peripheral stem cells replaced by transplant. Pancreas replaced by transplant. Organ or tissue replaced by transplant, intestines. Organ or tissue replaced by other means, heart assist device. Organ or tissue replaced by other means, fully implantable artificial heart. Dependence on respirator, status. Encounter for respirator dependence during power failure. Jkt 223001 PO 00000 Frm 00384 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 03MYP2 25063 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 6K.—COMPLICATION AND COMORBIDITY LIST—Continued Diagnosis code Code title V4613 ............................................... V4614 ............................................... V551 ................................................. V6284 ............................................... V850 ................................................. V854 ................................................. Encounter for weaning from respirator [ventilator]. Mechanical complication of respirator [ventilator]. Attention to gastrostomy. Suicidal ideation. Body Mass Index less than 19, adult. Body Mass Index 40 and over, adult. TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V24.0 CMS DRGS Number of discharges DRG mmaher on DSK3CLS3C1PROD with $$_JOB 1 .................................................................... 2 .................................................................... 3 .................................................................... 6 .................................................................... 7 .................................................................... 8 .................................................................... 9 .................................................................... 10 .................................................................. 11 .................................................................. 12 .................................................................. 13 .................................................................. 14 .................................................................. 15 .................................................................. 16 .................................................................. 17 .................................................................. 18 .................................................................. 19 .................................................................. 21 .................................................................. 22 .................................................................. 23 .................................................................. 26 .................................................................. 27 .................................................................. 28 .................................................................. 29 .................................................................. 31 .................................................................. 32 .................................................................. 34 .................................................................. 35 .................................................................. 36 .................................................................. 37 .................................................................. 38 .................................................................. 39 .................................................................. 40 .................................................................. 42 .................................................................. 43 .................................................................. 44 .................................................................. 45 .................................................................. 46 .................................................................. 47 .................................................................. 49 .................................................................. 50 .................................................................. 51 .................................................................. 52 .................................................................. 53 .................................................................. 55 .................................................................. 56 .................................................................. 57 .................................................................. 58 .................................................................. 59 .................................................................. 60 .................................................................. 61 .................................................................. 62 .................................................................. 63 .................................................................. 64 .................................................................. 65 .................................................................. 66 .................................................................. 67 .................................................................. 68 .................................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Arithmetic mean LOS 24,941 9,519 3 254 14,373 3,072 1,749 18,799 2,768 56,172 7,636 262,424 13,780 20,050 3,109 33,745 7,451 2,071 3,366 10,269 32 6,179 21,197 6,674 4,986 1,691 29,326 7,738 270 1,171 52 274 1,098 1,470 127 1,261 2,846 4,002 1,258 2,449 1,973 177 181 1,896 1,234 369 732 1 111 5 212 1 2,551 3,044 39,254 7,743 348 14,437 PO 00000 Frm 00385 10th percentile 9.4334 4.2485 31.6667 2.9409 9.0353 2.7119 5.7616 5.7674 3.6120 5.3189 4.8707 5.2666 3.8482 6.2493 3.2078 5.1228 3.3182 6.1772 5.1242 3.7083 2.8750 4.6716 5.4894 3.0853 3.7706 2.2389 4.6962 2.9340 1.9370 4.1076 2.3846 2.2336 4.4791 2.5966 3.0236 4.8882 2.9301 3.9725 2.9754 4.2450 1.7988 2.7910 1.5304 3.8745 2.7626 2.5799 3.4549 1.0000 2.4414 3.4000 5.8821 4.0000 4.5468 6.0798 2.7302 3.2033 3.6063 3.7100 Fmt 4742 25th percentile 2 1 2 1 2 1 1 2 1 2 2 2 1 2 1 2 1 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 4 1 1 1 1 1 1 Sfmt 4742 50th percentile 4 2 2 1 4 1 2 3 2 3 3 3 2 3 1 3 2 3 2 2 1 1 2 1 2 1 2 1 1 1 1 1 2 1 1 3 2 2 1 2 1 1 1 1 1 1 1 1 1 1 1 4 2 2 1 1 2 2 E:\FEDREG\03MYP2.LOC 7 3 42 2 7 2 4 4 3 4 4 4 3 5 2 4 3 5 4 3 2 3 4 3 3 2 4 2 1 3 2 1 4 1 2 4 2 3 2 3 1 1 1 2 1 2 2 1 1 1 4 4 3 4 2 2 3 3 03MYP2 75th percentile 12 6 51 4 11 3 7 7 5 6 6 6 5 8 4 6 4 8 6 5 4 6 7 4 5 3 6 4 2 5 3 2 5 3 4 6 4 5 4 5 2 3 2 5 3 3 4 1 3 6 7 4 6 8 3 4 4 5 90th percentile 19 8 51 6 18 6 11 11 7 10 8 10 7 12 6 10 6 12 10 7 7 10 11 6 7 4 9 5 4 9 4 5 9 6 5 9 5 8 6 8 3 6 2 9 6 5 7 1 4 8 13 4 10 13 5 6 7 7 25064 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V24.0 CMS DRGS—Continued Number of discharges DRG mmaher on DSK3CLS3C1PROD with $$_JOB 69 .................................................................. 70 .................................................................. 71 .................................................................. 72 .................................................................. 73 .................................................................. 75 .................................................................. 76 .................................................................. 77 .................................................................. 78 .................................................................. 79 .................................................................. 80 .................................................................. 81 .................................................................. 82 .................................................................. 83 .................................................................. 84 .................................................................. 85 .................................................................. 86 .................................................................. 87 .................................................................. 88 .................................................................. 89 .................................................................. 90 .................................................................. 91 .................................................................. 92 .................................................................. 93 .................................................................. 94 .................................................................. 95 .................................................................. 96 .................................................................. 97 .................................................................. 98 .................................................................. 99 .................................................................. 100 ................................................................ 101 ................................................................ 102 ................................................................ 103 ................................................................ 104 ................................................................ 105 ................................................................ 106 ................................................................ 108 ................................................................ 110 ................................................................ 111 ................................................................ 113 ................................................................ 114 ................................................................ 117 ................................................................ 118 ................................................................ 119 ................................................................ 120 ................................................................ 121 ................................................................ 122 ................................................................ 123 ................................................................ 124 ................................................................ 125 ................................................................ 126 ................................................................ 127 ................................................................ 128 ................................................................ 129 ................................................................ 130 ................................................................ 131 ................................................................ 132 ................................................................ 133 ................................................................ 134 ................................................................ 135 ................................................................ 136 ................................................................ 138 ................................................................ 139 ................................................................ 140 ................................................................ 141 ................................................................ 142 ................................................................ 143 ................................................................ 144 ................................................................ 145 ................................................................ VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Arithmetic mean LOS 3,512 22 64 1,377 9,817 46,052 45,066 1,766 52,142 149,996 5,865 8 60,815 7,094 1,294 22,232 1,423 104,584 375,666 468,634 33,813 42 15,894 1,094 13,571 1,396 52,187 20,991 11 20,681 5,367 24,043 4,155 957 19,277 31,935 3,273 9,206 56,354 10,370 30,526 7,216 7,054 7,940 788 30,139 131,942 47,504 24,024 110,702 85,159 5,156 627,657 3,363 3,233 83,923 20,275 84,452 4,929 37,743 6,937 893 206,453 67,628 24,872 125,207 44,070 220,824 105,937 4,992 PO 00000 Frm 00386 10th percentile 2.7958 2.4545 3.8125 3.3834 4.3653 9.3570 10.1322 4.4077 5.9448 7.8785 5.2055 3.1250 6.5333 5.0369 3.0077 6.1018 3.3710 6.2374 4.7615 5.3910 3.5880 5.1667 5.8223 3.5932 5.8596 3.4362 4.1808 3.2644 4.6364 3.0888 2.0781 4.1874 2.4363 36.6813 14.5529 9.9262 10.9050 10.4328 7.8017 2.7754 12.4437 8.1332 4.0186 3.0072 5.5063 9.0112 5.9604 3.2315 4.6391 4.4070 2.6783 10.7455 5.0473 4.9854 2.6087 5.2374 3.6403 2.7444 2.0801 3.0024 4.2093 2.4894 3.8403 2.3918 2.3395 3.3954 2.4524 2.1144 5.8550 2.5032 Fmt 4742 25th percentile 1 1 1 1 1 3 3 1 2 3 2 1 2 2 1 2 1 2 2 2 1 1 2 1 2 1 1 1 1 1 1 1 1 8 6 4 5 4 1 1 4 2 1 1 1 1 2 1 1 1 1 3 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Sfmt 4742 50th percentile 2 1 2 2 2 4 5 2 4 4 3 2 3 3 2 3 2 3 3 3 2 2 3 2 3 2 2 2 2 1 1 2 1 13 8 6 7 6 3 1 6 4 1 1 1 3 3 1 1 2 1 6 3 3 1 3 2 1 1 1 2 1 2 1 1 2 1 1 2 1 E:\FEDREG\03MYP2.LOC 2 2 3 3 3 7 8 4 5 6 4 3 5 4 3 5 3 5 4 4 3 3 5 3 5 3 3 3 4 2 2 3 2 25 12 8 9 8 6 2 10 7 2 2 4 6 5 3 3 3 2 8 4 4 1 4 3 2 2 2 3 2 3 2 2 3 2 2 4 2 03MYP2 75th percentile 4 3 5 4 6 12 13 6 7 10 6 3 8 6 4 8 4 8 6 7 4 6 7 5 8 4 5 4 6 4 3 5 3 46 18 11 13 13 10 4 15 10 5 4 8 12 8 4 6 6 3 13 6 6 3 7 5 3 3 4 5 3 5 3 3 4 3 3 7 3 90th percentile 5 4 7 6 8 19 19 9 10 15 10 4 13 9 5 12 7 12 9 10 6 8 11 7 11 7 8 6 7 6 4 8 5 80 26 18 19 19 16 6 24 16 9 7 12 19 11 6 11 9 5 20 9 8 6 10 6 5 4 6 8 5 7 4 4 6 4 4 12 5 25065 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V24.0 CMS DRGS—Continued Number of discharges DRG mmaher on DSK3CLS3C1PROD with $$_JOB 146 147 149 150 151 152 153 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 210 211 212 213 216 217 218 219 220 ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Arithmetic mean LOS 9,704 2,408 18,456 23,405 5,118 4,885 1,840 5,761 3 8,102 3,241 18,979 10,791 9,709 4,384 7 5,991 2,312 5,472 4,821 1,635 846 17,758 1,371 32,071 1,902 239,405 24,762 13,258 7,710 2,265 14,563 89,516 23,153 281,768 72,273 78 5,963 4 635 84,689 11,667 8 10,210 1,287 3,705 425 2,428 498 15,180 3,553 1,320 884 2,591 26,311 30,311 66,617 31,699 1,725 37,546 8,523 126,659 23,197 6 8,062 19,672 14,549 30,810 19,731 4 PO 00000 Frm 00387 10th percentile 9.6600 5.3218 5.4416 10.4474 4.9334 7.8047 4.7315 3.7808 19.0000 5.5242 2.6245 5.0830 2.5814 4.5090 2.0739 4.7143 7.6306 3.8824 4.2149 2.0797 4.5976 2.1572 10.3417 3.9081 6.7286 3.4332 4.6424 2.8116 5.0499 4.4132 3.1007 5.7533 5.2296 3.2759 4.0590 2.8170 3.6026 4.4223 4.7500 3.9984 5.2986 2.9734 5.2500 12.1666 5.2883 12.0302 6.6165 10.2105 5.5542 8.9159 4.2651 8.7841 10.3801 13.0475 6.0668 6.3680 5.3058 5.7534 3.8458 5.1840 2.8941 6.5368 4.5195 4.6667 9.2446 5.4472 11.8718 5.4129 3.1027 6.5000 Fmt 4742 25th percentile 4 2 3 3 1 3 2 1 2 1 1 1 1 1 1 2 3 1 1 1 1 1 2 1 2 1 2 1 2 2 1 2 2 1 1 1 1 1 3 1 1 1 1 3 1 4 3 4 2 3 2 2 2 3 2 2 2 2 1 2 1 3 3 1 2 1 3 2 1 1 Sfmt 4742 50th percentile 6 4 4 6 2 4 3 2 2 2 1 2 1 2 1 3 4 2 2 1 2 1 5 2 3 1 3 2 3 2 2 3 3 2 2 1 2 2 3 2 2 1 2 6 3 6 4 6 3 5 3 3 4 6 3 3 3 3 2 2 1 4 3 1 4 1 5 3 2 1 E:\FEDREG\03MYP2.LOC 8 5 5 9 4 6 4 3 16 4 2 4 2 3 2 4 6 4 3 2 3 2 8 3 5 3 4 2 4 4 3 4 4 3 3 2 2 3 3 3 4 2 3 9 5 10 6 9 5 7 4 6 7 10 5 5 4 4 3 4 2 5 4 2 7 3 8 4 3 2 03MYP2 75th percentile 11 7 7 13 7 9 6 5 39 7 3 6 3 6 3 5 9 5 5 3 6 3 13 5 8 4 6 4 6 5 4 7 6 4 5 4 4 6 6 5 7 4 5 15 7 15 8 13 7 11 5 11 13 17 8 8 6 7 5 6 4 7 5 8 12 8 15 7 4 4 90th percentile 17 8 8 19 9 14 7 8 39 11 5 10 5 9 4 7 14 7 8 4 9 4 21 8 13 7 8 5 9 8 5 11 10 6 8 5 7 9 7 8 10 6 9 25 9 22 11 18 9 16 7 19 21 26 12 13 10 11 7 10 5 11 7 8 18 12 24 10 5 19 25066 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V24.0 CMS DRGS—Continued Number of discharges DRG mmaher on DSK3CLS3C1PROD with $$_JOB 223 224 225 226 227 228 229 230 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 283 284 285 286 287 288 289 290 291 292 293 294 295 ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Arithmetic mean LOS 11,839 8,611 6,109 7,188 4,669 2,587 951 2,423 465 22,278 10,535 4,464 41,174 1,818 9,430 37,225 12,432 2,370 2,575 97,388 16,696 5,092 1,268 21,168 17,364 13,232 4,411 1,877 25,596 9,175 1 7,625 12,191 10,164 2,447 1,978 1,466 562 20,802 3,458 3,941 2,095 213 993 11,402 2,537 19,773 5,748 1,091 2,206 176 1,437 121,125 31,136 9 19,413 5,892 6,796 1,736 8,300 3,003 4,991 9,102 5,813 12,096 50 7,589 322 93,724 4,525 PO 00000 Frm 00388 10th percentile 3.3929 1.9527 5.1627 6.3445 2.5740 4.2041 2.3060 5.7693 2.9441 5.9501 2.4870 4.5459 4.3733 3.7041 7.9829 5.9285 6.4345 3.5924 6.3763 4.4757 4.3404 3.0330 3.5804 3.3470 4.7551 3.9306 3.8601 2.7475 4.5348 3.0765 3.0000 5.0515 2.5461 1.6868 2.9918 1.3519 2.1296 4.8986 10.1605 5.9974 6.3144 3.0897 4.9437 3.3625 8.0560 3.7040 6.7454 5.6475 3.7993 6.1215 2.8750 4.4628 5.3596 3.8929 2.5556 3.9496 2.8130 4.3792 2.9891 9.7928 5.2148 9.5642 3.3196 2.5230 2.0051 1.5200 10.0137 4.6863 4.1793 3.6320 Fmt 4742 25th percentile 1 1 1 1 1 1 1 1 1 1 1 1 2 1 3 2 2 1 2 1 1 1 1 1 2 1 1 1 2 1 3 1 1 1 1 1 1 1 3 2 1 1 1 1 2 1 2 2 1 2 1 1 2 2 1 1 1 1 1 3 1 3 1 1 1 1 2 1 1 1 Sfmt 4742 50th percentile 1 1 2 3 1 1 1 2 1 2 1 2 3 2 4 3 3 2 3 2 2 1 2 2 3 1 2 1 3 2 3 2 1 1 1 1 1 2 5 3 2 1 2 1 4 1 3 3 2 3 1 2 3 2 1 2 1 2 1 5 2 5 2 1 1 1 4 2 2 2 E:\FEDREG\03MYP2.LOC 75th percentile 3 1 4 4 2 3 2 4 2 5 1 4 4 3 6 5 5 3 5 4 4 3 3 3 4 3 3 3 4 3 3 4 2 1 1 1 1 4 7 5 4 2 3 2 6 3 5 4 3 5 2 4 4 3 3 3 3 3 2 8 4 7 2 1 1 1 8 3 3 3 03MYP2 4 2 7 8 3 6 3 7 3 8 3 6 5 5 9 7 8 4 8 6 5 4 4 4 6 5 5 3 5 4 3 6 3 2 3 1 2 6 12 7 8 4 5 4 10 5 8 7 5 8 4 6 7 5 4 5 4 5 4 13 6 11 4 2 2 2 12 6 5 4 90th percentile 7 4 11 13 5 9 5 12 7 12 6 8 8 7 15 11 13 6 12 8 8 6 7 6 8 8 7 5 8 5 3 10 5 3 7 2 4 10 20 11 14 6 9 7 16 7 12 10 7 12 6 8 10 7 4 7 5 8 6 18 10 18 6 5 3 2 19 9 8 7 25067 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V24.0 CMS DRGS—Continued Number of discharges DRG mmaher on DSK3CLS3C1PROD with $$_JOB 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 344 345 346 347 348 349 350 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Arithmetic mean LOS 207,831 35,935 81 1,546 21,703 3,570 10,439 19,565 13,755 2,882 5,206 1,648 5,035 2,761 24,646 5,023 1,369 480 34,790 231,484 2,498 5,778 324 225,977 29,439 79 19,180 3,829 9,248 2,288 5 525 49 1 55,533 3,151 301 9,233 12,674 25,171 19,038 614 1,126 1 2,792 458 2,027 1,253 3,369 207 4,244 491 7,160 1,127 2,799 7,293 4,614 21,201 5,224 19,606 26,471 13,718 267 2 1,787 1,636 1,522 4,653 414 4,106 PO 00000 Frm 00389 10th percentile 4.4830 2.9945 3.3827 5.2523 5.7447 3.3908 7.9171 6.0558 7.8484 2.9139 5.8832 1.9205 5.4111 1.6092 4.5628 1.8176 4.8254 2.1250 6.7300 5.9894 3.5020 5.7885 2.7593 4.9150 3.4932 3.2658 3.0764 1.9128 3.6718 2.5013 2.6000 3.4400 1.6531 1.0000 5.4057 3.0378 5.5681 3.9509 2.2587 3.1752 1.7807 5.5684 5.6536 1.0000 3.1866 3.3952 2.9842 5.1875 5.7133 2.9517 4.0224 2.5682 4.4365 4.2316 5.7153 5.4880 2.9272 1.8026 7.8335 3.7991 2.2429 2.3371 3.0749 1.5000 4.1365 3.8863 7.8160 6.2102 2.9928 6.5933 Fmt 4742 25th percentile 1 1 1 1 2 1 4 2 2 1 1 1 1 1 1 1 1 1 1 2 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 2 1 2 2 2 1 3 1 1 1 1 1 1 1 2 1 1 2 Sfmt 4742 50th percentile 2 2 2 2 3 2 5 3 3 2 2 1 2 1 2 1 1 1 1 3 1 3 1 3 2 2 1 1 2 1 1 1 1 1 2 1 2 2 1 1 1 2 1 1 1 1 1 2 3 1 2 1 2 2 3 3 2 1 4 2 2 1 1 1 2 1 3 3 1 3 E:\FEDREG\03MYP2.LOC 75th percentile 3 3 2 4 5 3 6 5 6 2 3 2 3 1 3 1 3 2 4 5 2 4 2 4 3 3 2 1 3 2 2 2 1 1 4 2 4 3 2 2 2 4 3 1 1 2 1 3 4 1 3 2 4 3 4 4 3 1 6 3 2 2 2 2 3 3 5 4 2 5 03MYP2 6 4 4 6 7 4 9 7 10 4 8 2 7 2 6 2 6 3 9 7 4 7 4 6 4 4 4 2 5 3 2 4 2 1 7 4 7 5 3 3 2 8 7 1 3 4 3 6 7 4 5 3 5 5 6 6 3 2 9 4 3 3 3 2 4 5 10 8 4 8 90th percentile 8 5 7 10 11 6 14 11 16 5 14 3 12 3 10 3 10 4 16 12 7 12 5 9 6 6 6 3 7 4 6 6 2 1 10 6 13 7 4 7 3 12 12 1 7 7 7 12 11 6 8 5 8 9 11 10 4 3 15 7 3 4 6 2 9 8 18 13 6 13 25068 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V24.0 CMS DRGS—Continued Number of discharges DRG mmaher on DSK3CLS3C1PROD with $$_JOB 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 386 389 390 392 394 395 396 397 398 399 401 402 403 404 406 407 408 409 410 411 412 413 414 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 439 440 441 442 443 444 445 446 447 449 450 451 452 453 ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Arithmetic mean LOS 3,621 2,353 2,785 1,443 5,236 119 10 492 86 178 489 107 181 47 3,004 125 1 1 7 1,925 2,690 101,460 15 15,074 6,358 975 6,310 1,179 30,542 3,385 2,200 552 1,906 1,500 27,864 3 8 4,888 445 34 29,239 17,140 2,658 11,406 54 8,780 968 10,497 4,577 1,656 786 21,621 77,784 376 424 4,480 1,739 4,793 745 18,713 3,247 5,714 2,057 1 6,286 42,005 7,022 2 29,335 5,041 PO 00000 Frm 00390 10th percentile 3.1188 5.2660 3.4032 3.2467 2.3067 2.8824 5.8000 3.5691 5.7326 2.0674 2.7607 2.6449 2.7017 2.7021 3.8129 2.7920 65.0000 7.0000 1.2857 9.1771 6.9978 4.0582 3.0667 5.1932 5.2378 3.1241 11.0125 3.9763 7.8445 4.0148 9.6227 3.4094 8.5661 5.9887 3.7178 5.0000 3.0000 6.6970 3.6584 6.3235 5.9953 4.2593 3.0865 4.0990 3.4815 8.1794 11.1746 3.2223 4.1534 4.4771 7.4288 5.3979 7.5960 5.8963 4.5825 2.9406 8.8902 8.1083 3.2725 8.6001 3.3760 4.0441 2.6719 1.0000 2.5021 3.6920 1.9939 4.0000 4.8062 2.8252 Fmt 4742 25th percentile 1 2 2 2 1 1 2 1 1 1 1 1 1 1 1 1 65 7 1 2 1 1 1 1 1 1 2 1 2 1 2 1 1 1 1 1 1 2 1 1 2 1 1 1 1 2 1 1 1 1 1 2 2 1 1 1 1 2 1 2 1 1 1 1 1 1 1 2 1 1 Sfmt 4742 50th percentile 1 3 3 2 2 2 3 2 2 1 1 1 1 1 1 1 65 7 1 4 2 2 2 2 2 2 5 1 3 2 4 2 2 3 2 1 1 3 2 2 3 2 2 2 2 3 4 1 2 2 2 3 3 2 2 1 3 3 1 3 1 2 1 1 1 1 1 2 2 1 E:\FEDREG\03MYP2.LOC 2 4 3 3 2 2 4 2 3 2 2 1 1 1 3 1 65 7 1 6 5 3 2 4 4 2 9 3 6 3 7 3 5 4 3 2 2 5 3 4 5 3 3 3 3 6 8 2 3 3 4 4 6 4 3 2 5 5 2 6 3 3 2 1 2 3 1 6 3 2 03MYP2 75th percentile 4 5 4 3 3 3 8 4 7 3 3 2 2 1 4 2 65 7 1 11 9 5 3 7 7 4 14 5 10 5 12 4 11 6 4 12 5 8 4 7 7 5 4 5 4 10 14 4 5 5 8 6 9 6 5 3 9 9 4 10 4 5 3 1 3 4 2 6 6 3 90th percentile 6 8 5 4 3 5 9 7 12 3 5 4 6 2 7 5 65 7 2 20 15 8 6 11 10 6 22 8 16 8 20 7 20 13 6 12 5 14 7 14 11 8 6 8 7 17 24 6 8 8 16 10 15 11 8 6 17 17 7 18 7 8 5 1 5 7 4 6 10 5 25069 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V24.0 CMS DRGS—Continued Number of discharges DRG mmaher on DSK3CLS3C1PROD with $$_JOB 454 455 461 462 463 464 465 466 467 468 471 473 476 477 479 480 481 482 484 485 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 515 518 519 520 521 522 523 524 525 528 529 530 531 532 533 534 535 536 537 538 539 540 ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Arithmetic mean LOS 4,454 763 2,190 8,257 33,398 7,481 189 1,029 990 51,687 15,315 8,258 2,607 26,467 28,424 914 1,237 4,697 446 3,720 2,710 4,989 830 13,468 4,959 23,713 3,909 60,142 22,403 363 4,220 32,341 21,707 34,248 44,035 3,031 688 5,421 182 155 980 274 557 137 1,681 498 560 177 57,719 24,896 13,824 17,200 30,284 3,408 13,997 103,803 150 1,710 5,094 3,221 5,251 2,973 40,452 34,384 8,642 7,797 9,423 5,014 4,747 1,406 PO 00000 Frm 00391 10th percentile 4.0624 2.4862 5.6918 9.4810 3.8312 2.9051 3.1746 4.0049 3.7434 12.1152 4.5714 11.7129 9.4941 8.6280 2.2886 19.3184 21.5618 11.1901 12.2825 9.4664 12.6207 6.7019 17.0000 8.2464 5.2503 3.0033 13.6723 5.9490 2.7073 17.3251 8.4123 5.5152 3.5698 4.0122 2.1007 9.3817 5.4230 3.8493 28.9670 5.9097 14.7245 7.3869 7.3878 4.5766 6.0684 3.8313 11.8982 10.2486 3.5718 2.4103 4.5428 1.8812 5.3526 10.4745 3.7162 3.0689 11.9600 16.5509 6.8828 2.8712 9.2400 3.6266 3.5306 1.6709 8.7836 7.1789 6.5040 2.8957 10.5886 3.3940 Fmt 4742 25th percentile 1 1 1 4 1 1 1 1 1 3 3 2 2 1 1 6 12 4 2 4 2 1 4 2 1 1 3 2 1 8 3 3 2 1 1 4 2 1 9 1 3 1 2 1 1 1 6 6 1 1 1 1 2 3 1 1 1 5 1 1 2 1 1 1 2 2 1 1 2 1 Sfmt 4742 50th percentile 2 1 2 6 2 1 1 1 1 6 3 3 4 3 1 9 16 6 6 5 6 3 7 3 2 2 5 3 1 10 4 3 3 2 1 5 3 2 15 1 7 3 3 2 2 1 7 7 1 1 1 1 3 5 2 2 2 9 2 1 3 1 1 1 4 3 3 1 3 1 E:\FEDREG\03MYP2.LOC 3 2 4 8 3 2 2 2 2 10 4 6 8 7 1 13 20 8 10 7 10 5 13 6 4 2 6 5 2 14 6 4 3 3 2 7 5 3 25 2 12 6 5 3 4 3 9 9 1 1 2 1 4 8 3 3 6 15 4 2 7 3 2 1 7 6 5 2 7 2 03MYP2 75th percentile 5 3 7 11 5 4 4 4 3 15 5 15 13 11 3 23 24 13 16 11 16 8 21 10 6 3 23 8 4 20 10 6 4 5 3 11 7 5 40 6 19 11 9 5 7 5 13 12 4 3 6 2 6 14 4 4 15 22 9 3 12 5 4 2 11 9 8 4 14 4 90th percentile 8 5 13 16 7 5 6 8 6 24 7 31 19 18 5 42 32 21 23 18 25 13 35 17 10 5 32 11 5 29 17 9 6 8 4 17 9 7 54 14 29 15 14 10 13 8 20 16 9 5 11 4 10 21 6 6 34 29 16 5 19 7 8 3 17 14 13 6 23 7 25070 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V24.0 CMS DRGS—Continued Number of discharges DRG 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 560 561 562 563 564 565 566 567 568 569 570 571 572 573 574 575 576 577 578 579 ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ Arithmetic mean LOS 24,001 21,753 5,669 440,451 43,688 3,558 29,673 26,417 12,901 29,627 51,141 78,452 44,355 77,753 37,647 17,813 128,804 184,255 4,814 3,365 2,944 52,768 19,974 16,370 46,197 79,447 9,976 16,065 58,700 68,714 10,974 54,656 6,467 27,588 13,709 295,836 11,072 38,795 19,756 11,663,472 10th percentile 40.4864 29.2444 11.3277 4.3239 5.0764 7.8111 12.1403 8.6920 10.1190 6.6683 6.0806 3.3411 8.8636 5.1191 4.6506 1.9014 3.9579 1.7491 6.8467 9.9964 9.4440 4.7011 3.1487 3.3764 14.9311 7.2748 15.6049 11.0504 14.1940 9.8921 4.8136 6.9428 10.8919 5.7540 15.2387 7.0992 2.3475 15.6194 10.6732 25th percentile 16 11 2 3 3 3 6 5 5 4 1 1 1 1 1 1 1 1 2 3 3 1 1 1 6 1 6 2 5 4 2 2 4 2 6 2 1 5 3 50th percentile 23 17 4 3 3 4 8 6 6 5 2 1 3 2 2 1 2 1 4 5 5 2 2 2 9 3 8 5 8 6 2 4 6 3 8 3 1 8 5 34 24 9 4 4 6 10 8 8 6 5 2 7 3 3 1 3 1 5 8 8 4 3 3 13 6 12 9 12 8 4 5 8 4 13 6 1 12 8 75th percentile 49 36 16 5 6 9 14 10 12 8 8 4 12 7 6 2 5 2 8 13 12 6 4 4 18 10 19 14 18 12 6 8 12 7 19 9 2 19 13 90th percentile 72 51 23 7 8 15 20 13 18 10 12 7 19 11 10 4 8 3 13 19 18 9 6 6 26 14 29 22 26 18 9 13 20 11 27 14 5 29 22 TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS Number of discharges DRG mmaher on DSK3CLS3C1PROD with $$_JOB 1 .................................................................... 2 .................................................................... 3 .................................................................... 4 .................................................................... 5 .................................................................... 6 .................................................................... 7 .................................................................... 8 .................................................................... 9 .................................................................... 10 .................................................................. 11 .................................................................. 12 .................................................................. 13 .................................................................. 20 .................................................................. 21 .................................................................. 22 .................................................................. 23 .................................................................. 24 .................................................................. 25 .................................................................. 26 .................................................................. 27 .................................................................. 28 .................................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Arithmetic mean LOS 628 329 24,007 21,748 842 495 413 560 1,359 177 1,290 1,923 1,484 901 558 251 3,113 2,576 8,419 11,628 14,459 1,611 PO 00000 Frm 00392 10th percentile 43.9968 22.7173 40.4921 29.2363 22.5713 9.9717 17.3123 11.8982 21.7454 10.2486 16.1558 10.9111 7.2352 19.1088 15.5430 9.6096 13.5888 8.5901 13.3480 8.2665 4.6581 14.6629 Fmt 4742 25th percentile 10 8 16 11 7 5 8 6 10 6 6 4 3 6 7 3 3 1 4 3 1 4 Sfmt 4742 50th percentile 17 10 23 17 10 7 10 7 15 7 8 6 4 11 10 5 6 3 7 4 2 7 E:\FEDREG\03MYP2.LOC 32 15 34 24 16 9 14 9 20 9 13 9 7 18 14 9 11 7 11 7 4 11 03MYP2 75th percentile 56 27 49 36 28 11 20 13 24 12 19 13 9 25 20 13 19 12 17 11 6 18 90th percentile 92 46 72 51 50 16 29 20 33 16 28 19 12 34 26 17 27 18 25 15 9 28 25071 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued Number of discharges DRG mmaher on DSK3CLS3C1PROD with $$_JOB 29 .................................................................. 30 .................................................................. 31 .................................................................. 32 .................................................................. 33 .................................................................. 34 .................................................................. 35 .................................................................. 36 .................................................................. 37 .................................................................. 38 .................................................................. 39 .................................................................. 40 .................................................................. 41 .................................................................. 42 .................................................................. 52 .................................................................. 53 .................................................................. 54 .................................................................. 55 .................................................................. 56 .................................................................. 57 .................................................................. 58 .................................................................. 59 .................................................................. 60 .................................................................. 61 .................................................................. 62 .................................................................. 63 .................................................................. 64 .................................................................. 65 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Arithmetic mean LOS 2,862 3,751 1,058 2,989 4,270 814 2,510 7,748 4,777 14,603 55,391 4,549 7,720 5,430 1,156 593 4,665 16,902 7,719 48,453 789 2,640 4,205 1,340 2,289 1,185 55,567 112,235 94,622 1,383 12,397 103,803 7,093 10,005 6,061 8,660 32,536 1,197 874 1,101 1,307 958 2,077 8,192 1,646 1,941 2,592 5,330 10,385 12,156 717 2,641 3,319 6,678 14,897 15,489 1,521 1,089 755 1,253 1,048 643 15,840 56,927 1,352 15,025 568 603 1,098 665 PO 00000 Frm 00393 10th percentile 7.6530 3.6726 13.1361 5.7969 3.0745 7.2715 3.0351 1.6075 8.6847 3.8074 1.8575 13.5997 7.4211 3.6440 6.6678 3.9949 7.2223 5.0128 7.8009 4.9236 8.0279 5.2098 4.0587 9.7060 6.3451 4.5823 7.6787 5.3134 3.7946 6.2133 3.5843 3.0689 7.9026 5.6338 3.7703 6.4130 4.3661 7.6115 4.2128 7.1599 4.5792 3.5282 4.8681 3.4143 6.3991 5.2849 3.1154 7.9328 5.1475 3.3901 6.1046 3.7830 2.4760 6.5861 4.4665 3.2219 12.4938 9.1726 6.1536 11.8164 8.5334 6.3048 6.2835 3.7154 5.0473 3.2255 5.6039 2.6982 4.4791 3.4602 Fmt 4742 25th percentile 2 1 3 1 1 1 1 1 2 1 1 4 2 1 2 1 2 1 2 2 2 2 2 3 3 2 2 2 1 2 1 1 2 2 1 2 1 3 2 2 2 1 1 1 1 1 1 2 1 1 1 1 1 2 1 1 4 3 2 4 3 2 2 1 1 1 1 1 1 1 Sfmt 4742 50th percentile 4 1 5 2 1 2 1 1 3 1 1 6 4 1 3 2 3 2 4 3 4 3 2 5 4 3 4 3 2 3 2 2 4 3 2 3 2 4 2 3 2 2 2 2 1 2 1 3 3 2 3 2 1 3 2 2 7 5 3 6 5 3 3 2 2 2 2 1 2 1 E:\FEDREG\03MYP2.LOC 6 3 10 4 2 5 2 1 7 2 1 10 6 2 5 3 5 4 6 4 6 4 4 8 5 4 6 4 3 5 3 3 6 5 3 5 4 6 3 6 4 3 4 3 4 4 2 6 4 3 4 3 2 5 4 3 11 8 5 10 7 6 5 3 4 3 4 2 4 2 03MYP2 75th percentile 10 5 18 7 4 10 4 2 11 5 2 17 9 5 8 5 9 6 9 6 9 6 5 12 8 6 10 7 5 8 5 4 10 7 5 8 5 10 5 9 6 4 6 4 9 7 4 10 7 4 7 5 3 8 6 4 16 12 8 16 11 8 8 5 6 4 7 3 5 4 90th percentile 15 7 26 13 6 15 7 3 18 9 3 26 14 8 13 8 14 10 15 9 16 9 7 19 11 8 15 10 7 12 7 6 15 10 7 13 8 14 8 14 8 6 9 6 15 10 6 16 10 6 12 7 5 13 8 6 23 16 11 22 15 11 13 7 10 6 12 6 9 8 25072 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued Number of discharges DRG mmaher on DSK3CLS3C1PROD with $$_JOB 117 121 122 123 124 125 129 130 131 132 133 134 135 136 137 138 139 146 147 148 149 150 151 152 153 154 155 156 157 158 159 163 164 165 166 167 168 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Arithmetic mean LOS 1,401 587 674 2,846 679 4,708 1,374 1,075 655 728 1,352 2,662 781 1,115 1,109 1,372 2,150 687 1,422 935 39,254 939 6,804 2,352 16,031 1,843 4,208 5,143 1,145 3,039 2,418 13,433 18,051 14,557 20,293 20,775 5,758 11,958 40,184 57,194 71,205 27,468 22,478 32,170 6,167 1,654 4,141 2,593 8,534 9,970 5,151 104,581 57,046 121,674 196,930 88,072 266,642 147,775 5,143 6,895 4,944 3,258 8,186 3,523 31,594 41,595 26,048 5,777 22,421 46,195 PO 00000 Frm 00394 10th percentile 1.9807 5.8245 4.0727 2.9301 5.2901 3.4904 5.0786 3.1795 5.6260 2.5742 6.3750 2.3020 6.0948 2.3193 5.4238 2.4249 1.8805 10.2227 5.7771 3.4963 2.7302 5.4494 2.8933 4.6947 3.3617 6.4704 4.5696 3.1808 6.9092 4.4659 3.0790 14.9768 8.3639 5.3898 13.0059 8.1439 5.4139 7.4075 5.5095 9.1881 7.4692 5.6397 7.9687 5.9642 4.2701 7.1826 4.6450 3.2815 7.5378 5.4881 4.1561 6.2368 6.4788 5.1201 4.0420 6.8766 5.3586 4.1514 7.3502 5.4181 4.2945 8.4936 5.1467 4.1198 4.5021 3.4745 2.8805 5.6382 3.4891 14.9298 Fmt 4742 25th percentile 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 2 1 1 2 1 1 5 3 2 4 3 1 3 2 3 3 2 2 2 1 2 2 1 2 2 1 2 2 2 2 2 2 2 2 2 1 3 1 1 2 1 1 1 1 6 Sfmt 4742 50th percentile 1 3 2 2 2 2 2 1 2 1 2 1 2 1 2 1 1 4 2 1 1 2 1 2 2 3 2 2 3 2 1 8 5 3 7 4 2 4 4 5 4 3 4 3 2 4 3 2 4 3 2 3 3 3 2 4 3 2 4 3 2 4 2 2 2 2 1 3 2 9 E:\FEDREG\03MYP2.LOC 1 5 3 2 4 3 4 2 4 2 4 1 4 1 4 2 1 7 4 2 2 4 2 4 3 5 4 3 5 3 2 13 7 5 10 7 5 6 5 8 6 5 7 5 3 6 4 3 6 4 3 5 5 4 3 6 5 4 6 5 4 7 4 3 4 3 2 4 3 13 03MYP2 75th percentile 2 7 5 4 7 4 6 4 7 3 8 3 8 3 7 3 2 13 7 5 3 7 4 6 4 8 6 4 9 6 4 19 10 7 16 10 7 9 7 12 9 7 10 8 6 9 6 4 10 7 5 8 8 6 5 9 7 5 9 7 5 11 7 5 6 4 4 7 4 18 90th percentile 4 11 8 5 11 7 10 6 11 5 14 5 13 5 11 5 3 20 12 7 5 11 5 9 6 12 9 6 14 9 6 27 15 9 24 15 10 13 9 17 14 10 15 12 8 14 8 6 14 11 8 12 12 9 7 13 9 7 14 10 8 16 10 8 8 6 6 11 7 26 25073 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued Number of discharges DRG mmaher on DSK3CLS3C1PROD with $$_JOB 208 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Arithmetic mean LOS 79,446 150 8,411 7,610 3,256 10,063 13,483 8,389 2,869 5,773 1,920 5,877 7,049 50,670 3,087 4,130 1,989 1,478 1,795 16,914 39,176 9,630 32,898 21,792 44,932 13,821 13,355 3,350 17,182 37,874 68,296 6,241 32,667 280,392 5,013 29,674 5,740 39,929 44,611 46,868 59,053 2,609 3,833 774 598 7,342 867 2,804 3,383 788 30,138 60,743 57,742 60,961 15,856 4,912 3,256 23,286 172,575 3,248 1,423 485 183,811 217,099 226,747 1,705 1,658 1,732 945 556 PO 00000 Frm 00395 10th percentile 7.2748 11.9600 18.6918 12.3029 9.1198 14.4558 8.6970 6.4682 13.2426 6.5676 11.5104 5.7638 9.3723 2.7649 14.6317 9.1191 6.6435 13.2104 9.0067 14.2938 8.8853 11.4974 6.6079 11.4604 4.8672 15.5449 10.5939 7.0236 8.9305 5.1880 2.9635 3.3249 6.3103 2.2324 6.5163 2.5339 7.5240 2.9531 8.7554 6.2739 2.9056 9.9279 7.5458 4.9922 7.5769 2.6350 10.1753 3.9675 2.4830 5.5063 9.0102 7.4498 4.9623 3.2953 5.4845 3.4770 2.2752 7.0619 3.1957 12.2155 8.7850 6.6536 6.6240 5.0937 3.7248 5.5666 4.3878 3.3256 1.9725 1.4568 Fmt 4742 25th percentile 1 1 8 6 5 6 5 4 5 1 4 2 1 1 6 4 3 5 5 7 5 5 4 2 1 5 4 3 3 1 1 1 1 1 1 1 1 1 1 1 1 2 2 1 2 1 2 1 1 1 1 2 2 1 1 1 1 2 1 4 3 2 2 2 1 2 2 1 1 1 Sfmt 4742 50th percentile 3 2 11 8 6 8 6 5 7 3 6 3 3 1 8 6 4 7 6 9 6 7 5 5 2 8 6 4 4 2 1 1 2 1 3 1 3 1 3 2 1 4 4 2 3 1 4 1 1 1 3 4 3 2 1 1 1 3 1 7 5 4 3 3 2 3 3 1 1 1 E:\FEDREG\03MYP2.LOC 6 6 16 11 8 11 7 6 11 6 9 5 8 1 12 8 6 11 8 12 8 9 6 9 4 12 8 6 7 4 2 2 5 1 5 2 6 2 6 5 2 8 6 4 6 2 8 3 2 4 6 6 4 3 3 2 1 6 2 10 7 6 5 4 3 5 4 1 1 1 03MYP2 75th percentile 10 15 23 15 11 18 10 7 17 9 14 7 13 3 18 11 8 16 11 17 11 14 8 15 7 19 13 9 11 7 4 4 8 3 9 3 10 4 12 8 4 13 10 7 10 3 13 5 3 8 12 9 6 4 7 4 3 9 4 15 11 8 8 6 5 7 6 4 2 1 90th percentile 14 34 32 20 14 27 14 10 24 13 22 11 19 7 26 15 11 24 14 24 13 21 10 23 10 29 20 13 17 10 6 8 13 5 13 5 15 6 19 13 6 19 14 10 15 6 20 8 5 12 19 14 9 6 13 8 5 14 6 23 15 12 13 9 7 9 7 8 4 2 25074 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued Number of discharges DRG mmaher on DSK3CLS3C1PROD with $$_JOB 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Arithmetic mean LOS 17,445 46,825 39,928 7,876 81,505 2,087 35,655 1,379 6,451 33,533 79,767 160,781 24,872 169,277 220,824 60,079 30,738 20,111 11,568 10,903 9,334 48,146 66,316 31,408 1,891 6,198 4,023 7,164 12,520 8,839 1,500 3,195 3,608 874 2,537 6,882 899 2,917 2,909 1,568 3,986 5,789 1,669 3,998 8,429 3,184 9,129 17,461 8,367 8,046 2,716 3,052 4,006 3,916 16,846 22,911 14,899 9,417 19,736 4,820 50,521 84,839 128,807 2,917 4,895 5,446 1,303 8,672 2,107 7,223 PO 00000 Frm 00396 10th percentile 6.8633 5.1739 3.7906 4.3526 2.5488 5.2386 2.8710 6.4141 3.4999 5.7559 3.9679 2.7683 2.3395 3.1499 2.1144 7.1189 4.6782 3.0454 17.2235 10.3403 4.6128 15.8920 9.8949 6.1136 14.7361 8.9923 5.7062 14.3626 9.3056 5.6987 10.8567 7.1894 4.2783 7.2563 4.3532 2.2819 12.0445 7.3318 5.0248 8.3412 5.5738 3.1036 8.0617 4.6791 2.4582 8.7148 5.0778 2.8775 13.2579 8.1130 4.7128 6.6432 4.7791 3.4229 8.7684 6.8602 5.0055 8.8178 6.0537 4.1102 6.4758 4.7121 3.5255 7.2129 5.3263 3.6430 5.8496 3.8546 9.0128 5.7597 Fmt 4742 25th percentile 2 2 1 1 1 1 1 2 1 1 1 1 1 1 1 2 1 1 6 3 1 6 4 3 6 4 2 6 3 2 4 3 2 2 1 1 4 3 2 2 1 1 2 1 1 2 1 1 3 2 1 2 2 1 3 3 2 2 2 1 2 2 1 2 2 1 2 1 3 2 Sfmt 4742 50th percentile 3 3 2 2 1 2 1 3 2 3 2 1 1 2 1 3 2 1 9 6 2 9 6 4 8 6 4 8 5 3 6 4 2 3 2 1 6 4 3 4 2 1 4 2 1 4 3 1 6 4 2 3 3 2 4 4 3 4 3 2 3 3 2 4 3 2 3 2 4 3 E:\FEDREG\03MYP2.LOC 6 4 3 3 2 4 2 5 3 4 3 2 2 3 2 5 4 2 14 9 3 13 8 5 12 8 5 12 8 5 9 6 4 5 3 2 9 6 5 7 4 2 7 4 2 7 4 2 10 7 4 5 4 3 7 6 4 7 5 3 5 4 3 5 4 3 5 3 7 5 03MYP2 75th percentile 9 7 5 5 3 7 4 8 4 7 5 4 3 4 3 9 6 4 22 13 6 20 12 7 18 11 7 18 12 8 14 9 6 10 6 3 15 9 6 11 7 4 11 6 3 11 7 4 17 10 6 8 6 4 11 8 6 11 8 5 8 6 4 9 7 5 7 5 11 7 90th percentile 13 9 7 9 5 10 5 12 7 11 7 5 4 6 4 14 9 6 32 19 9 29 17 10 26 15 9 25 16 11 19 12 7 15 8 4 23 13 8 16 11 6 16 9 5 17 9 5 26 16 9 13 9 6 17 13 9 17 12 8 12 8 6 14 10 6 11 7 18 11 25075 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued Number of discharges DRG mmaher on DSK3CLS3C1PROD with $$_JOB 387 388 389 390 391 392 393 394 395 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 453 454 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 477 ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Arithmetic mean LOS 5,233 18,272 46,336 48,061 47,516 306,603 23,924 45,966 26,474 3,903 5,246 2,310 1,645 1,713 722 978 1,063 882 5,599 6,852 6,228 16,677 27,572 38,296 714 1,091 364 1,501 912 157 16,264 9,022 946 11,915 13,991 4,359 14,432 24,824 27,361 13,922 12,759 6,703 12,453 16,759 16,857 846 1,497 1,877 765 1,764 1,535 3,183 50,358 1,062 14,253 5,285 6,322 2,942 4,153 10,821 28,714 29,744 410,707 2,229 6,221 22,573 2,831 3,533 1,698 2,257 PO 00000 Frm 00397 10th percentile 4.4323 7.4310 5.0762 3.5994 5.4690 3.5476 6.9569 4.9372 3.4027 17.3051 9.5141 5.6078 14.8182 9.9440 6.8172 13.0276 8.8579 6.0907 11.8391 7.7478 4.9045 8.4020 5.6679 3.1868 14.0126 7.8570 4.4615 15.3911 10.2664 5.8790 6.8549 4.8422 3.5888 7.6726 5.8723 4.3595 7.7379 5.4652 3.8783 6.9813 5.1323 3.8532 6.6271 4.8121 3.3299 15.8995 8.6306 4.8636 15.6693 8.2874 4.7466 9.6183 4.3516 8.3606 4.2891 16.7069 10.3945 6.3606 9.5538 6.0700 4.0543 8.4430 4.0256 10.0983 4.3728 2.0132 12.4822 8.6575 5.0683 12.5109 Fmt 4742 25th percentile 2 2 2 1 2 1 2 1 1 5 2 1 5 4 3 5 4 2 5 3 2 3 2 1 3 2 1 4 3 2 2 1 1 2 2 1 2 2 1 2 2 1 2 2 1 6 3 2 5 3 2 4 2 4 3 5 3 2 4 3 2 4 3 2 1 1 4 3 1 4 Sfmt 4742 50th percentile 2 3 3 2 2 2 3 2 2 8 5 3 8 6 4 7 5 4 7 5 3 4 3 1 6 3 2 7 5 3 3 2 2 3 3 2 3 3 2 3 3 2 3 2 2 8 5 3 7 5 3 5 3 5 3 7 5 3 5 4 3 5 3 4 1 1 6 4 2 6 E:\FEDREG\03MYP2.LOC 4 6 4 3 4 3 5 4 3 13 8 5 12 8 6 11 8 5 10 7 4 7 5 3 11 6 4 12 8 5 5 4 3 6 5 3 6 4 3 5 4 3 5 4 3 13 7 4 12 7 4 7 4 7 4 12 8 5 7 5 4 7 4 8 3 1 10 7 4 10 03MYP2 75th percentile 6 9 6 5 7 4 9 6 4 22 12 7 19 12 8 16 11 8 15 10 6 10 7 4 18 10 6 19 13 8 8 6 5 10 8 6 10 7 5 9 6 5 8 6 4 20 11 6 19 10 6 11 5 10 5 21 13 8 11 7 5 10 4 13 6 2 16 11 7 15 90th percentile 8 15 9 6 11 7 14 9 6 34 18 10 27 18 11 23 15 11 21 13 8 16 10 6 27 16 8 29 20 11 14 9 7 15 11 9 16 10 7 14 10 7 13 9 6 28 16 8 30 15 7 18 7 15 7 33 20 12 18 10 6 15 6 20 10 4 24 16 10 23 25076 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued Number of discharges DRG mmaher on DSK3CLS3C1PROD with $$_JOB 478 479 480 481 482 483 484 485 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 514 515 516 517 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 557 558 559 560 561 562 ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Arithmetic mean LOS 7,144 10,271 25,882 59,159 64,819 5,732 17,981 968 1,536 1,215 1,552 3,869 19,809 58,474 4,704 15,253 30,588 1,867 5,049 7,520 1,177 1,246 1,349 3,679 6,829 736 2,155 3,218 909 779 2,723 465 957 4,009 11,982 1,288 1,341 3,577 10,964 18,272 829 3,635 6,844 34,330 654 1,164 3,382 4,190 1,858 6,162 18,418 12,645 4,019 5,885 4,888 592 1,078 905 9,504 87,884 2,793 20,263 1,995 19,173 3,184 14,180 1,635 3,979 7,618 5,000 PO 00000 Frm 00398 10th percentile 6.9120 2.8762 9.4645 6.2065 4.9470 4.5700 2.5039 12.6715 8.3665 5.8025 5.6746 3.1171 4.8572 2.2865 8.7245 5.3926 3.4237 11.0664 6.0594 3.2645 8.4274 3.2584 11.1979 6.0294 2.9776 8.8628 6.5225 3.4058 3.2288 5.3286 2.0525 2.9441 6.6029 3.8735 2.1194 5.1250 2.6346 10.8784 6.0369 2.9365 6.9035 4.0083 6.3819 3.9729 4.7156 3.1357 10.1730 7.2535 5.6416 8.6883 5.9972 4.4837 9.0109 5.5694 3.9544 9.3125 6.3163 4.5271 7.2317 4.1777 6.0859 3.7237 4.9133 3.1840 6.9416 4.2641 7.2765 4.8030 2.7569 6.5032 Fmt 4742 25th percentile 1 1 4 3 3 2 1 5 3 3 2 1 1 1 3 2 1 3 1 1 2 1 3 2 1 3 2 1 1 1 1 1 2 1 1 1 1 3 1 1 2 1 2 1 2 1 3 3 2 3 2 2 2 2 1 3 2 1 2 1 2 1 1 1 2 2 2 1 1 2 Sfmt 4742 50th percentile 3 1 6 4 4 2 2 7 5 4 3 2 2 1 5 3 2 5 3 1 3 1 5 3 1 4 3 2 1 2 1 1 3 2 1 2 1 5 3 1 3 2 3 3 3 2 5 4 3 4 3 3 4 3 2 4 3 3 3 2 3 2 2 2 4 3 3 2 1 3 E:\FEDREG\03MYP2.LOC 6 1 8 5 5 3 2 10 7 5 4 3 3 2 7 4 3 9 5 2 6 3 8 5 2 7 5 3 2 4 2 2 5 3 2 4 2 9 5 2 5 3 5 3 4 3 8 6 5 7 5 4 7 4 3 7 5 4 6 3 5 3 4 3 6 4 5 4 2 5 03MYP2 75th percentile 9 4 11 7 6 6 3 15 10 7 7 4 6 3 11 7 4 14 8 4 11 4 14 8 4 11 8 4 4 7 2 3 8 5 3 7 3 14 8 4 9 5 8 5 6 4 12 9 7 11 7 6 11 7 5 11 8 6 9 5 8 5 6 4 8 5 9 6 3 8 90th percentile 14 7 17 10 7 9 4 23 15 10 11 6 10 4 16 9 6 21 12 7 16 6 22 12 6 17 12 7 7 11 4 7 12 7 4 10 5 20 12 7 13 7 12 7 9 5 19 13 10 17 11 8 18 10 7 17 12 8 14 8 11 7 10 6 13 7 14 9 5 12 25077 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued Number of discharges DRG mmaher on DSK3CLS3C1PROD with $$_JOB 563 564 565 566 573 574 575 576 577 578 579 580 581 582 583 584 585 592 593 594 595 596 597 598 599 600 601 602 603 604 605 606 607 614 615 616 617 618 619 620 621 622 623 624 625 626 627 628 629 630 637 638 639 640 641 642 643 644 645 652 653 654 655 656 657 658 659 660 661 662 ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Arithmetic mean LOS 36,060 1,607 3,238 2,780 5,688 12,103 6,469 558 2,179 3,299 3,088 6,767 5,290 8,978 15,578 1,431 2,821 3,984 12,834 2,955 1,083 5,756 549 1,483 350 572 865 21,315 130,955 2,627 22,678 1,363 7,169 1,377 1,626 1,133 6,824 343 663 1,878 6,561 1,234 3,269 488 1,099 2,523 14,337 3,267 3,958 684 16,290 40,817 41,142 55,697 188,150 1,544 5,019 11,848 8,406 10,439 1,585 3,231 1,651 3,721 7,360 8,484 4,442 7,446 4,749 988 PO 00000 Frm 00399 10th percentile 3.7152 7.1413 5.1115 3.7737 13.7773 9.4910 6.0077 12.1505 6.0069 3.4826 11.4058 7.2707 4.0115 2.7738 1.7536 4.5206 1.9018 8.8542 6.5156 4.9005 8.1782 4.8211 8.0729 5.6109 3.5914 5.4143 3.8335 7.0332 4.7383 5.4328 3.4824 5.8782 3.7576 7.3682 3.3911 15.5119 9.0098 6.4781 9.2926 4.2572 2.4476 13.1118 8.7641 5.9529 7.5332 3.3096 1.5601 11.7410 8.9277 5.4883 6.1765 4.4088 3.1006 5.6186 3.8620 5.2448 7.7675 5.4716 3.9222 7.9171 16.7584 10.1619 6.6887 10.7788 6.1595 3.8944 11.3197 6.6108 3.5475 10.4686 Fmt 4742 25th percentile 1 2 2 1 4 3 2 2 1 1 3 2 1 1 1 1 1 3 2 2 2 2 2 2 1 2 1 2 2 1 1 1 1 2 1 6 3 2 3 2 1 4 3 2 2 1 1 2 3 1 2 1 1 1 1 1 2 2 1 4 7 5 3 4 3 2 3 2 1 2 Sfmt 4742 50th percentile 2 3 3 2 6 5 3 4 2 1 5 3 2 1 1 1 1 4 4 3 4 2 3 3 1 3 2 4 3 3 2 2 2 3 2 8 5 3 4 2 1 6 5 3 3 1 1 4 5 2 3 2 2 2 2 2 4 3 2 5 9 7 4 5 4 3 5 3 2 4 E:\FEDREG\03MYP2.LOC 3 6 4 3 10 7 5 8 4 2 9 6 3 2 1 2 1 7 5 4 6 4 6 4 3 4 3 6 4 4 3 4 3 5 3 13 8 6 6 3 2 9 7 5 5 2 1 8 7 4 5 4 3 4 3 4 6 4 3 6 13 9 7 8 5 4 8 5 3 8 03MYP2 75th percentile 4 9 7 5 16 11 7 15 8 4 14 9 5 3 2 6 2 11 8 6 10 6 10 7 5 7 5 9 6 7 4 7 5 9 4 19 12 8 10 5 3 16 10 7 9 4 2 15 11 7 7 6 4 7 5 6 10 7 5 9 20 12 8 13 7 5 14 8 4 14 90th percentile 6 14 9 7 28 18 11 26 13 7 22 14 8 5 3 11 4 17 12 9 16 9 16 11 8 10 7 13 8 11 6 12 7 15 6 27 16 12 21 7 4 27 16 11 17 7 2 24 16 11 12 8 6 11 7 10 15 10 7 14 31 17 10 21 10 6 23 13 7 21 25078 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued Number of discharges DRG mmaher on DSK3CLS3C1PROD with $$_JOB 663 664 665 666 667 668 669 670 671 672 673 674 675 682 683 684 685 686 687 688 689 690 691 692 693 694 695 696 697 698 699 700 707 708 709 710 711 712 713 714 715 716 717 718 722 723 724 725 726 727 728 729 730 734 735 736 737 738 739 740 741 742 743 744 745 746 747 748 749 750 ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Arithmetic mean LOS 2,131 4,677 690 2,213 3,951 3,757 12,494 13,418 884 965 12,578 10,504 11,707 75,855 112,156 43,471 2,498 1,582 3,322 1,198 55,402 200,093 898 655 2,235 19,221 975 10,566 575 21,065 22,826 15,094 4,875 17,032 755 2,037 922 819 11,760 32,760 638 1,389 635 633 871 2,038 666 802 3,941 1,098 6,177 578 552 1,470 1,329 840 3,429 955 975 4,370 6,562 10,709 35,368 1,498 2,194 2,487 11,231 21,201 1,038 484 PO 00000 Frm 00400 10th percentile 5.2407 2.1760 12.1942 6.3448 2.8697 8.6191 4.3597 2.5885 5.7896 2.5990 10.1248 7.2773 2.5849 7.2988 5.8525 4.0578 3.5020 8.0493 5.3058 3.3222 6.3745 4.3011 4.1648 2.2580 5.2098 2.5735 5.7323 3.2277 3.2835 6.7737 5.0096 3.6045 4.8568 2.4324 6.6715 1.8949 7.9469 3.0024 4.1367 2.0154 6.1661 1.5227 7.6567 2.7994 7.4409 5.4328 3.3498 5.6160 3.5202 6.5556 4.0570 5.1488 3.2591 7.7129 3.5056 13.8619 7.4278 3.9874 10.2318 5.2190 3.1617 4.7158 2.3568 5.9012 2.6135 4.2059 1.9232 1.8026 9.9075 3.3306 Fmt 4742 25th percentile 1 1 3 1 1 2 1 1 1 1 1 1 1 2 2 1 1 2 1 1 2 2 1 1 1 1 2 1 1 2 1 1 2 1 1 1 1 1 1 1 1 1 1 1 2 2 1 2 1 2 1 1 1 3 1 5 3 2 4 2 2 2 1 1 1 1 1 1 2 1 Sfmt 4742 50th percentile 2 1 6 2 1 4 2 1 2 1 3 2 1 3 3 2 1 4 3 1 3 2 2 1 2 1 3 2 1 3 2 2 2 1 2 1 3 1 2 1 2 1 3 1 3 3 1 3 2 3 2 2 1 4 2 8 4 3 5 3 2 2 2 2 1 2 1 1 4 2 E:\FEDREG\03MYP2.LOC 4 1 10 4 2 7 3 2 4 2 7 5 1 6 5 3 2 6 4 3 5 4 3 2 4 2 4 3 2 5 4 3 4 2 4 1 6 2 3 2 4 1 5 2 6 4 3 4 3 5 3 4 2 5 3 12 6 4 7 4 3 3 2 4 2 3 2 1 7 3 03MYP2 75th percentile 7 2 15 9 3 11 6 3 8 3 13 10 3 9 7 5 4 10 7 4 8 5 5 3 7 3 7 4 4 8 6 5 6 3 8 2 10 4 5 2 8 1 10 4 9 7 4 7 4 8 5 7 4 9 4 18 9 5 13 6 4 5 3 7 3 5 2 2 13 4 90th percentile 11 4 22 14 6 17 9 6 12 5 22 16 6 15 11 7 7 15 10 6 12 8 9 4 10 5 12 6 6 13 10 7 9 4 15 3 16 7 9 3 14 2 16 5 14 10 7 11 7 12 7 10 6 15 6 25 13 6 20 9 5 9 4 12 5 8 3 3 21 6 25079 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued Number of discharges DRG mmaher on DSK3CLS3C1PROD with $$_JOB 754 755 756 757 758 759 760 761 765 766 767 768 769 770 774 775 776 777 778 779 780 781 782 790 793 794 799 800 801 802 803 804 808 809 810 811 812 813 814 815 816 820 821 822 823 824 825 826 827 828 829 830 834 835 836 837 838 839 840 841 842 843 844 845 846 847 848 849 853 854 ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Arithmetic mean LOS 1,083 3,152 832 1,323 1,597 1,186 1,703 1,918 2,501 2,637 119 10 86 181 1,443 5,236 492 178 489 107 47 3,004 125 1 1 7 623 700 602 692 1,004 996 8,316 15,532 3,819 18,353 83,122 15,074 1,631 3,340 2,359 1,481 2,530 2,142 2,437 3,039 2,010 562 1,318 872 1,375 531 5,260 1,469 1,526 1,624 900 1,385 15,155 11,017 7,682 1,477 2,856 1,008 2,481 23,676 1,701 1,500 31,446 6,882 PO 00000 Frm 00401 10th percentile 8.8144 5.6551 3.3221 8.9131 6.1327 4.6256 3.8227 2.4937 5.3215 3.2461 2.8824 5.8000 5.7326 2.7017 3.2467 2.3067 3.5691 2.0674 2.7607 2.6449 2.7021 3.8129 2.7920 65.0000 7.0000 1.2857 14.2472 8.3700 4.8688 12.9538 6.5787 3.3203 7.9752 5.0147 3.9296 5.5474 3.7292 5.1932 7.1594 4.9177 3.4349 18.3849 7.8375 3.7250 15.3943 8.8427 4.7866 17.3488 7.6115 3.7500 10.4611 3.6591 14.6249 8.2178 5.0125 22.6558 9.2122 6.0368 9.5956 6.6239 4.2890 8.7204 6.0007 4.3065 8.4869 3.2722 2.9259 5.9887 16.7084 11.1935 Fmt 4742 25th percentile 2 1 1 3 2 2 1 1 2 2 1 2 1 1 2 1 1 1 1 1 1 1 1 65 7 1 4 3 2 3 1 1 2 2 1 1 1 1 2 2 1 5 1 1 5 2 1 5 2 1 2 1 2 1 1 5 3 3 2 2 1 2 2 1 2 1 1 1 5 4 Sfmt 4742 50th percentile 4 3 1 4 3 2 2 1 3 2 2 3 2 1 2 2 2 1 1 1 1 1 1 65 7 1 7 4 2 6 3 1 4 2 2 2 2 2 3 2 2 8 3 1 8 4 2 8 4 2 4 1 4 3 2 9 4 4 4 3 2 4 3 2 3 2 1 3 8 6 E:\FEDREG\03MYP2.LOC 7 4 3 7 5 4 3 2 4 3 2 4 3 1 3 2 2 2 2 1 1 3 1 65 7 1 11 6 4 10 5 2 6 4 3 4 3 4 5 4 3 14 6 3 13 7 3 13 6 3 7 2 9 5 3 23 5 5 7 5 3 7 5 3 5 3 2 4 13 9 03MYP2 75th percentile 11 7 4 11 8 6 5 3 5 4 3 8 7 2 3 3 4 3 3 2 1 4 2 65 7 1 19 11 6 16 8 4 10 6 5 7 5 7 9 6 4 24 10 5 20 12 7 21 9 5 14 4 23 9 6 30 7 6 12 8 6 11 8 6 10 4 4 6 21 14 90th percentile 19 11 7 17 11 8 7 5 8 4 5 9 12 6 4 3 7 3 5 4 2 7 5 65 7 2 28 17 9 26 13 7 15 9 7 11 7 11 15 9 7 37 16 8 28 17 10 34 15 7 23 8 35 20 10 39 25 8 20 13 8 17 12 9 19 6 5 13 31 20 25080 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued Number of discharges DRG mmaher on DSK3CLS3C1PROD with $$_JOB 855 856 857 858 862 863 864 865 866 867 868 869 870 871 872 876 880 881 882 883 884 885 886 887 894 895 896 897 901 902 903 904 905 906 907 908 909 913 914 915 916 917 918 919 920 921 922 923 927 928 929 933 934 935 939 940 941 945 946 947 948 949 950 951 955 956 957 958 959 963 ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Arithmetic mean LOS 467 6,188 10,066 3,502 7,426 21,813 19,829 2,019 9,410 5,307 2,371 1,101 13,711 203,725 92,141 968 10,497 4,577 1,656 786 21,621 77,784 376 424 4,480 6,477 5,372 35,839 917 2,136 1,740 941 798 745 8,101 7,885 5,974 813 6,959 915 5,370 14,156 34,873 10,570 12,143 11,663 1,005 4,212 182 795 459 155 694 2,179 423 690 1,077 5,058 3,199 6,546 34,333 742 476 990 446 3,720 1,157 737 816 1,395 PO 00000 Frm 00402 10th percentile 7.5096 16.1577 8.8965 6.0888 8.2665 5.2222 4.0996 6.8366 3.5129 9.9354 6.0017 4.3697 15.2393 7.6898 5.7923 11.1746 3.2223 4.1534 4.4771 7.4288 5.3979 7.5960 5.8963 4.5825 2.9406 10.4868 6.6035 4.0848 14.4275 8.0108 4.8977 12.3528 4.8070 3.2725 11.6595 7.0411 3.6696 6.0873 3.3993 4.6120 2.1391 5.2280 2.7266 6.2364 4.4851 2.9882 6.0836 3.2946 28.9670 16.1975 7.7930 5.9097 6.8329 5.5571 10.9622 6.4580 3.1309 10.5042 7.8634 4.9904 3.4084 4.1631 3.4286 3.7434 12.2825 9.4664 16.7398 11.5875 7.7132 9.4803 Fmt 4742 25th percentile 2 5 3 2 2 2 1 2 1 3 2 2 6 2 2 1 1 1 1 1 2 2 1 1 1 3 2 1 3 2 1 2 1 1 3 2 1 2 1 1 1 1 1 1 1 1 1 1 9 4 2 1 1 1 2 1 1 4 4 1 1 1 1 1 2 4 3 3 1 1 Sfmt 4742 50th percentile 4 7 4 3 4 3 2 3 2 4 3 2 8 4 3 4 1 2 2 2 3 3 2 2 1 5 3 2 5 3 2 4 2 1 5 3 2 3 2 2 1 2 1 3 2 1 2 1 15 8 3 1 3 2 4 3 1 6 5 2 2 1 1 1 6 5 8 6 4 4 E:\FEDREG\03MYP2.LOC 6 12 7 5 6 4 3 5 3 7 5 4 13 6 5 8 2 3 3 4 4 6 4 3 2 8 5 3 9 6 4 7 4 2 8 5 3 5 3 3 2 4 2 4 3 2 4 2 25 14 6 2 5 4 8 5 2 9 7 4 3 2 2 2 10 7 14 10 6 8 03MYP2 75th percentile 10 20 11 7 10 7 5 8 4 13 7 5 19 10 7 14 4 5 5 8 6 9 6 5 3 14 8 5 17 10 6 14 6 4 14 9 5 8 4 6 3 6 3 8 6 4 8 4 40 20 11 6 8 7 14 8 4 13 9 6 4 5 4 3 16 11 21 14 10 13 90th percentile 14 32 17 11 16 9 8 15 6 20 11 8 27 15 10 24 6 8 8 16 10 15 11 8 6 21 13 7 30 16 10 22 9 7 24 14 7 12 6 10 4 11 5 13 9 6 14 6 54 31 16 14 14 12 22 14 6 19 12 10 6 8 6 6 23 18 31 21 15 19 25081 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY FY 2006 MEDPAR UPDATE—DECEMBER 2006 GROUPER V25.0 MS–DRGS—Continued Number of discharges DRG 964 965 969 970 974 975 976 977 981 982 983 984 985 986 987 988 989 ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ ................................................................ 1,578 2,016 598 231 7,276 3,463 2,729 4,874 26,287 18,597 6,767 669 1,048 890 8,037 11,880 6,538 11,663,472 TABLE 8A.—PROPOSED STATEWIDE AVERAGE OPERATING COST-TOCHARGE RATIOS—MARCH 2007 mmaher on DSK3CLS3C1PROD with $$_JOB State Urban Alabama .............................. Alaska .................................. Arizona ................................ Arkansas ............................. California ............................. Colorado .............................. Connecticut ......................... Delaware ............................. District of Columbia ............. Florida ................................. Georgia ................................ Hawaii .................................. Idaho ................................... Illinois .................................. Indiana ................................. Iowa ..................................... Kansas ................................ Kentucky .............................. Louisiana ............................. Maine ................................... Maryland .............................. Massachusetts .................... Michigan .............................. Minnesota ............................ Mississippi ........................... Missouri ............................... Montana .............................. Nebraska ............................. Nevada ................................ New Hampshire ................... New Jersey ......................... New Mexico ......................... New York ............................. North Carolina ..................... North Dakota ....................... Ohio ..................................... Oklahoma ............................ Oregon ................................ Pennsylvania ....................... Puerto Rico ......................... Rhode Island ....................... South Carolina .................... South Dakota ...................... Tennessee ........................... Texas ................................... Utah ..................................... Vermont ............................... Virginia ................................ Washington ......................... VerDate Mar 15 2010 02:00 Aug 26, 2011 0.26 0.42 0.28 0.332 0.23 0.302 0.417 0.496 0.351 0.246 0.341 0.37 0.47 0.319 0.411 0.374 0.296 0.379 0.307 0.495 0.732 0.48 0.371 0.385 0.317 0.329 0.431 0.363 0.224 0.456 0.183 0.379 0.358 0.434 0.443 0.361 0.308 0.467 0.275 0.452 0.394 0.284 0.352 0.316 0.271 0.418 0.54 0.363 0.401 Arithmetic mean LOS Jkt 223001 6.8054 4.6984 19.0033 11.7965 9.3487 8.0323 5.5790 5.2154 15.2524 10.0533 5.5626 14.6114 9.8559 5.2213 13.1528 7.9806 4.2389 25th percentile 2 1 5 2 2 2 2 1 5 3 1 5 2 1 4 2 1 State Urban West Virginia ....................... Wisconsin ............................ Wyoming ............................. 0.484 0.425 0.431 0.474 0.476 0.53 Ratio Alabama .................................................. Alaska ...................................................... Arizona .................................................... Arkansas ................................................. California ................................................. Colorado .................................................. Connecticut ............................................. Delaware ................................................. District of Columbia ................................. Florida ..................................................... Georgia .................................................... Hawaii ...................................................... Idaho ....................................................... Illinois ...................................................... Indiana ..................................................... Iowa ......................................................... Kansas .................................................... Kentucky .................................................. Louisiana ................................................. Maine ....................................................... Maryland .................................................. Massachusetts ........................................ Michigan .................................................. Minnesota ................................................ Mississippi ............................................... Missouri ................................................... Montana .................................................. Nebraska ................................................. Nevada .................................................... New Hampshire ....................................... New Jersey ............................................. New Mexico ............................................. New York ................................................. North Carolina ......................................... North Dakota ........................................... PO 00000 Frm 00403 Fmt 4742 Sfmt 4742 0.025 0.039 0.024 0.025 0.016 0.029 0.028 0.036 0.025 0.023 0.029 0.032 0.04 0.026 0.037 0.028 0.03 0.029 0.03 0.033 0.055 0.032 0.03 0.028 0.028 0.027 0.036 0.038 0.023 0.034 0.013 0.032 0.029 0.036 0.04 75th percentile 6 4 14 8 7 6 4 4 12 8 5 13 9 4 11 7 3 90th percentile 9 6 24 15 12 10 7 6 19 13 7 18 13 8 17 10 6 12 9 38 25 20 16 11 10 28 19 11 27 18 11 25 15 9 TABLE 8B.—PROPOSED STATEWIDE AVERAGE CAPITAL COST-TOCHARGE RATIOS—MARCH 2007— Continued Rural TABLE 8B.—PROPOSED STATEWIDE AVERAGE CAPITAL COST-TOCHARGE RATIOS—MARCH 2007 State 50th percentile 4 3 8 5 4 3 3 2 8 5 2 8 5 2 6 4 1 TABLE 8A.—PROPOSED STATEWIDE AVERAGE OPERATING COST-TOCHARGE RATIOS—MARCH 2007— Continued Rural 0.34 0.714 0.43 0.353 0.33 0.446 0.502 0.462 ................ 0.288 0.392 0.444 0.565 0.403 0.447 0.455 0.441 0.375 0.355 0.466 0.799 ................ 0.467 0.526 0.369 0.372 0.49 0.457 0.483 0.443 ................ 0.386 0.523 0.414 0.467 0.534 0.394 0.42 0.436 ................ ................ 0.317 0.442 0.379 0.348 0.571 0.637 0.37 0.447 10th percentile State Ratio Ohio ......................................................... Oklahoma ................................................ Oregon .................................................... Pennsylvania ........................................... Puerto Rico ............................................. Rhode Island ........................................... South Carolina ........................................ South Dakota .......................................... Tennessee ............................................... Texas ....................................................... Utah ......................................................... Vermont ................................................... Virginia .................................................... Washington ............................................. West Virginia ........................................... Wisconsin ................................................ Wyoming ................................................. 0.029 0.029 0.032 0.023 0.035 0.021 0.025 0.033 0.031 0.027 0.037 0.042 0.037 0.031 0.033 0.039 0.044 TABLE 8C.—PROPOSED STATEWIDE AVERAGE TOTAL COST-TO-CHARGE RATIOS FOR LTCHS—MARCH 2007 State Alabama .............................. Alaska .................................. Arizona ................................ Arkansas ............................. California ............................. Colorado .............................. Connecticut ......................... Delaware ............................. E:\FEDREG\03MYP2.LOC 03MYP2 Urban 0.283 0.453 0.305 0.355 0.244 0.329 0.445 0.532 Rural 0.372 0.776 0.465 0.383 0.351 0.491 0.543 0.504 25082 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 8C.—PROPOSED STATEWIDE AVERAGE TOTAL COST-TO-CHARGE RATIOS FOR LTCHS—MARCH 2007—Continued State Urban District of Columbia * .......... Florida ................................. Georgia ................................ Hawaii .................................. Idaho ................................... Illinois .................................. Indiana ................................. Iowa ..................................... Kansas ................................ Kentucky .............................. Louisiana ............................. Maine ................................... Maryland ** .......................... Massachusetts * .................. Michigan .............................. Minnesota ............................ Mississippi ........................... Missouri ............................... Montana .............................. 0.376 0.269 0.369 0.4 0.509 0.344 0.448 0.398 0.323 0.408 0.337 0.53 0.445 0.512 0.4 0.412 0.344 0.354 0.463 TABLE 8C.—PROPOSED STATEWIDE AVERAGE TOTAL COST-TO-CHARGE RATIOS FOR LTCHS—MARCH 2007—Continued Rural State Urban ................ 0.32 0.427 0.482 0.609 0.436 0.493 0.496 0.482 0.405 0.385 0.495 0.351 ................ 0.503 0.564 0.398 0.406 0.533 Nebraska ............................. Nevada ................................ New Hampshire ................... New Jersey * ....................... New Mexico ......................... New York ............................. North Carolina ..................... North Dakota ....................... Ohio ..................................... Oklahoma ............................ Oregon ................................ Pennsylvania ....................... Puerto Rico * ....................... Rhode Island * .................... South Carolina .................... South Dakota ...................... Tennessee ........................... Texas ................................... Utah ..................................... 0.398 0.246 0.491 0.196 0.412 0.387 0.47 0.48 0.388 0.336 0.5 0.295 0.487 0.415 0.309 0.381 0.346 0.297 0.454 TABLE 8C.—PROPOSED STATEWIDE AVERAGE TOTAL COST-TO-CHARGE RATIOS FOR LTCHS—MARCH 2007—Continued Rural State 0.504 0.549 0.475 ................ 0.417 0.56 0.449 0.515 0.575 0.425 0.451 0.469 ................ ................ 0.344 0.481 0.413 0.379 0.627 Vermont ............................... Virginia ................................ Washington ......................... West Virginia ....................... Wisconsin ............................ Wyoming ............................. Urban Rural 0.584 0.4 0.432 0.517 0.464 0.466 0.676 0.408 0.48 0.507 0.516 0.583 * All counties in the State or Territory are classified as urban, with the exception of Massachusetts, which has areas designated as rural. However, no short-term acute care IPPS hospitals or LTCHs are located in those areas as of March 2007. **National average IPPS total cost-to-charge ratios, as discussed in section VI.E. of this proposed rule. TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008 Geographic CBSA Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 010005 010009 010010 010012 010022 010025 010029 010035 010044 010045 010054 010059 010065 010072 010083 010085 010090 010100 010101 010118 010126 010143 010150 010158 010164 020008 030007 030033 030055 030101 040014 040017 040019 040020 040027 040039 040041 040069 040071 040076 040078 040080 040085 040088 040091 .............................................................................................................................................................. .............................................................................................................................................................. .............................................................................................................................................................. 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00404 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 01 19460 01 01 01 01 12220 01 01 01 19460 19460 01 01 01 19460 33660 01 01 01 01 01 01 01 01 02 39140 03 29420 29420 04 04 04 27860 04 04 04 04 38220 04 26300 04 04 04 04 03MYP2 Reclassified CBSA 26620 26620 13820 40660 12060 17980 17980 13820 13820 13820 26620 26620 13820 11500 33660 26620 37700 37860 13820 46220 33860 13820 33860 19460 11500 11260 22380 22380 39140 29820 30780 22220 32820 32820 44180 26 30780 32820 30780 30780 30780 27860 32820 33740 45500 LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25083 TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued Geographic CBSA Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 040100 040119 050006 050009 050013 050014 050022 050042 050046 050054 050065 050069 050071 050073 050076 050082 050089 050090 050099 050101 050102 050118 050129 050133 050136 050140 050150 050159 050168 050173 050174 050193 050194 050197 050224 050226 050230 050236 050242 050243 050245 050272 050279 050291 050292 050298 050300 050301 050327 050329 050348 050367 050385 050390 050394 050423 050426 050476 050494 050510 050517 050526 050534 050535 050541 050543 050547 050548 050549 050550 050551 .............................................................................................................................................................. .............................................................................................................................................................. .............................................................................................................................................................. .............................................................................................................................................................. 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00405 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 04 04 05 34900 34900 05 40140 05 37100 40140 42044 42044 41940 46700 41884 37100 40140 42220 40140 46700 40140 44700 40140 49700 42220 40140 05 37100 42044 42044 42220 42044 42100 41884 42044 42044 42044 37100 42100 40140 40140 40140 40140 42220 40140 40140 40140 05 40140 40140 42044 46700 42220 40140 37100 40140 42044 05 05 41884 40140 42044 40140 42044 41884 42044 42220 42044 37100 42044 42044 03MYP2 Reclassified CBSA 30780 30780 39820 46700 46700 40900 42044 39820 31084 42044 31084 31084 36084 36084 36084 31084 31084 41884 31084 36084 42044 33700 31084 40900 41884 31084 0900 31084 31084 31084 41884 31084 41940 36084 31084 31084 31084 31084 41940 42044 31084 31084 31084 41884 42044 31084 31084 42220 31084 42044 31084 36084 41884 42044 31084 42044 31084 42220 40900 36084 31084 31084 42044 31084 36084 31084 41884 31084 31084 31084 31084 LUGAR 25084 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued Geographic CBSA Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 050567 050570 050573 050580 050584 050585 050586 050589 050592 050594 050603 050609 050616 050667 050678 050680 050684 050686 050690 050693 050694 050701 050709 050714 050718 050720 050749 060001 060003 060023 060027 060049 060075 060096 060103 060116 070001 070003 070005 070006 070010 070015 070016 070017 070018 070019 070022 070028 070031 070033 070034 070036 070038 070039 080001 080003 080004 080006 080007 090011 100002 100014 100017 100022 100023 100024 100045 100047 100049 100068 100072 .............................................................................................................................................................. 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00406 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 42044 42044 40140 42044 40140 42044 40140 42044 42044 42044 42044 42044 37100 34900 42044 46700 40140 40140 42220 42044 40140 40140 40140 42100 40140 42044 37100 24540 14500 24300 14500 06 06 06 14500 14500 35300 07 35300 14860 14860 25540 35300 35300 14860 35300 35300 14860 35300 14860 14860 25540 35300 35300 48864 48864 20100 08 08 47894 48424 19660 19660 33124 10 10 19660 39460 10 19660 19660 03MYP2 Reclassified CBSA 31084 31084 42044 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 46700 31084 36084 42044 42044 41884 31084 42044 42044 31084 41940 42044 31084 31084 19740 19740 19740 19740 22660 24300 19740 19740 19740 35004 25540 35004 35644 35644 35644 35004 35004 35644 35004 35004 35644 35004 35644 35644 35300 35004 35004 37964 37964 48864 20100 36140 13644 22744 36740 36740 22744 36740 33124 36740 42260 29460 36740 36740 LUGAR LUGAR 25085 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued Geographic CBSA Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 100077 100080 100081 100105 100109 100118 100130 100139 100150 100156 100157 100168 100176 100217 100232 100234 100236 100239 100249 100252 100253 100258 100268 100269 100275 100287 100288 100292 110002 110016 110023 110029 110038 110040 110041 110052 110054 110069 110075 110088 110095 110117 110121 110122 110125 110128 110146 110150 110153 110168 110187 110189 120028 130002 130003 130018 130049 130067 140010 140012 140015 140032 140033 140034 140040 140043 140046 140058 140064 140084 140100 .............................................................................................................................................................. 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00407 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 39460 48424 10 42680 10 37380 48424 10 10 10 29460 48424 48424 42680 10 48424 39460 45300 10 10 48424 48424 48424 48424 48424 48424 48424 10 11 11 11 23580 11 11 11 11 40660 47580 11 11 11 11 11 46660 11 11 11 11 47580 40660 11 11 12 13 30300 26820 17660 13 16974 14 14 14 29404 14 14 14 14 14 14 29404 29404 03MYP2 Reclassified CBSA 42260 22744 23020 38940 36740 27260 22744 23540 33124 23540 45300 22744 22744 38940 23540 22744 42260 42260 45300 42680 22744 22744 22744 22744 22744 22744 22744 23020 12060 17980 12060 12060 45220 12060 12060 16860 12060 31420 42340 12060 10500 12060 45220 45220 31420 42340 27260 12060 31420 12060 12060 12060 26180 29 28420 38540 44060 26820 16974 16974 41180 41180 16974 41180 37900 19340 41180 41180 37900 16974 16974 LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR 25086 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued Geographic CBSA Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 140110 140130 140143 140155 140160 140161 140164 140186 140202 140233 140236 140291 150002 150004 150006 150008 150011 150018 150026 150030 150034 150042 150045 150048 150051 150065 150069 150076 150088 150090 150091 150102 150112 150113 150115 150122 150125 150126 150133 150146 150147 160001 160016 160057 160064 160080 160089 160147 170006 170012 170013 170020 170023 170033 170058 170068 170120 170142 170175 170190 170193 180002 180005 180011 180012 180013 180017 180019 180024 180027 180029 .............................................................................................................................................................. .............................................................................................................................................................. 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00408 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 14 29404 14 28100 14 14 14 28100 29404 40420 14 29404 23844 23844 33140 23844 15 21140 21140 15 23844 15 15 15 14020 15 15 15 11300 23844 15 15 18020 11300 15 15 23844 23844 15 15 23844 16 16 16 16 16 16 16 17 17 17 17 17 17 17 17 17 17 17 17 17 18 18 18 21060 14540 18 18 18 18 18 03MYP2 Reclassified CBSA 16974 16974 16974 16974 40420 16974 41180 16974 16974 16974 28100 16974 16974 16974 43780 16974 26900 43780 43780 26900 16974 14020 23060 17140 26900 26900 17140 43780 26900 16974 23060 23844 26900 26900 21780 26900 16974 16974 23060 23060 16974 11180 11180 26980 47940 19340 26980 11180 27900 48620 48620 48620 48620 48620 28140 11100 27900 45820 48620 45820 48620 49 26580 30460 31140 34980 21060 17140 31140 17300 30460 LUGAR LUGAR LUGAR LUGAR 25087 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued Geographic CBSA Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 180044 180048 180049 180050 180066 180069 180075 180078 180080 180093 180102 180104 180116 180124 180127 180132 190003 190015 190086 190088 190099 190106 190144 190155 190164 190167 190184 190191 190208 190218 190223 200020 200024 200034 200039 200050 200063 220001 220002 220008 220010 220011 220019 220020 220025 220028 220029 220033 220035 220049 220058 220062 220063 220070 220073 220077 220080 220082 220084 220090 220095 220098 220101 220105 220133 220163 220171 220174 230002 230003 230013 .............................................................................................................................................................. .............................................................................................................................................................. 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00409 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 18 18 18 18 18 18 18 18 18 18 18 18 18 14540 18 18 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 38860 30340 30340 20 20 20 49340 15764 39300 37764 15764 49340 39300 49340 49340 37764 37764 37764 15764 49340 49340 15764 15764 39300 44140 37764 15764 15764 49340 49340 15764 15764 15764 15764 49340 15764 37764 19804 26100 47644 03MYP2 Reclassified CBSA 26580 31140 30460 28700 34980 26580 14540 26580 28940 21780 17300 17300 17300 34980 31140 30460 29180 35380 33740 43340 12940 10780 43340 12940 45 29180 33740 29180 04 43340 12940 40484 38860 38860 38860 12620 38860 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 25540 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 11460 34740 22420 LUGAR LUGAR LUGAR LUGAR 25088 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued Geographic CBSA Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 230019 230020 230021 230022 230024 230029 230030 230035 230036 230037 230038 230047 230053 230054 230059 230065 230069 230071 230072 230077 230080 230089 230092 230096 230097 230099 230104 230105 230106 230119 230121 230130 230134 230135 230142 230146 230151 230165 230174 230176 230195 230204 230207 230208 230217 230222 230223 230227 230236 230244 230254 230257 230264 230269 230270 230273 230277 230279 230293 230295 240030 240036 240064 240069 240071 240075 240088 240093 240105 240150 240187 .............................................................................................................................................................. .............................................................................................................................................................. 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00410 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 47644 19804 35660 23 19804 47644 23 23 23 23 24340 47644 19804 23 24340 19804 47644 47644 26100 40980 23 19804 27100 23 23 33780 19804 23 24340 19804 23 47644 23 19804 19804 19804 47644 19804 26100 19804 47644 47644 47644 23 12980 23 47644 47644 24340 19804 47644 47644 47644 47644 19804 19804 47644 47644 19804 23 24 41060 24 24 24 24 24 24 24 24 24 03MYP2 Reclassified CBSA 22420 11460 28020 29620 11460 22420 40980 24340 13020 11460 34740 19804 11460 24580 34740 11460 11460 22420 34740 22420 13020 11460 11460 28020 24340 11460 11460 13020 34740 11460 29620 22420 26100 11460 11460 11460 22420 11460 34740 11460 19804 19804 22420 24340 29620 13020 22420 19804 34740 11460 22420 19804 19804 22420 11460 11460 22420 11460 11460 26100 41060 33460 20260 40340 40340 41060 41060 33460 40340 40340 33460 LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR 25089 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued Geographic CBSA Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 250002 250004 250006 250009 250023 250031 250034 250040 250042 250044 250069 250078 250079 250081 250082 250094 250097 250099 250100 250104 250117 260009 260015 260017 260022 260025 260049 260050 260064 260074 260094 260110 260113 260119 260175 260183 260186 270003 270017 280009 280023 280032 280061 280065 280125 290002 290006 290008 290019 300011 300012 300014 300018 300019 300020 300034 310002 310009 310013 310014 310015 310017 310018 310021 310031 310032 310038 310039 310048 310050 310054 .............................................................................................................................................................. .............................................................................................................................................................. 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00411 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 25 25 25 25 25 25 25 37700 25 25 25 25620 25 25 25 25620 25 25 25 25 25 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 26 27 27 28 28 28 28 28 28 29 29 29 16180 31700 31700 40484 40484 30 31700 31700 35084 35084 35084 15804 35084 35084 35084 45940 15804 47220 20764 20764 20764 35084 35084 03MYP2 Reclassified CBSA 22520 32820 32820 27180 25060 27140 32820 25060 32820 22520 46220 25060 27140 46220 38220 25060 12940 27140 46220 46220 25060 28140 27860 27620 16 41180 44180 41140 17860 17860 44180 41180 14 27860 28140 41180 27620 24500 33540 30700 30700 30700 53 24540 43580 16180 39900 41620 39900 15764 15764 31700 31700 15764 15764 15764 35644 35644 35644 37964 35644 35644 35644 35084 20764 48864 35644 35644 35084 35644 35644 LUGAR LUGAR LUGAR LUGAR LUGAR 25090 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued Geographic CBSA Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 310070 310076 310081 310083 310093 310096 310108 310119 320003 320005 320006 320013 320014 320033 320063 320065 330004 330008 330023 330027 330038 330049 330067 330073 330079 330085 330094 330103 330106 330126 330136 330157 330167 330181 330182 330191 330198 330224 330225 330229 330235 330239 330250 330259 330277 330331 330332 330372 330386 340004 340008 340010 340013 340015 340021 340023 340027 340039 340050 340051 340068 340069 340070 340071 340073 340091 340109 340114 340115 340124 340126 .............................................................................................................................................................. .............................................................................................................................................................. 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00412 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 20764 35084 15804 35084 35084 35084 20764 35084 32 22140 32 32 32 32 32 32 28740 33 39100 35004 33 39100 39100 33 33 33 33 33 35004 39100 33 33 35004 35004 35004 24020 35004 28740 35004 33 33 33 33 35004 33 35004 35004 35004 33 24660 34 24140 34 34 34 11700 34 34 34 34 34 39580 15500 34 39580 24660 34 39580 34 34 34 03MYP2 Reclassified CBSA 35644 35644 37964 35644 35644 35644 35644 35644 42140 10740 10740 42140 29740 42140 36220 36220 39100 15380 14860 35644 40380 14860 14860 40380 47 45060 28740 39 35644 35644 45060 45060 35644 35644 35644 10580 35644 39100 35644 21500 45060 21500 15540 35644 27060 35644 35644 35644 35084 49180 16740 39580 16740 16740 16740 24860 24780 16740 22180 25860 48900 20500 24660 39580 20500 49180 47260 20500 20500 39580 39580 LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR 25091 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued Geographic CBSA Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 340127 340129 340131 340136 340138 340144 340145 340147 340173 350003 350006 350009 360008 360010 360011 360013 360014 360019 360020 360025 360027 360036 360039 360054 360065 360078 360079 360084 360086 360095 360096 360107 360121 360150 360159 360175 360185 360187 360197 360211 360238 360241 360245 360253 370004 370006 370014 370015 370016 370018 370022 370025 370026 370047 370049 370113 370149 380001 380022 380027 380050 380090 390006 390013 390016 390030 390031 390044 390046 390048 390065 .............................................................................................................................................................. .............................................................................................................................................................. .............................................................................................................................................................. .............................................................................................................................................................. .............................................................................................................................................................. .............................................................................................................................................................. .............................................................................................................................................................. .............................................................................................................................................................. 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00413 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 34 34 34 34 39580 34 34 40580 39580 35 35 35 36 36 36 36 36 10420 10420 41780 10420 36 36 36 36 10420 19380 15940 44220 36 36 36 36 10420 36 36 36 44220 36 48260 36 10420 36 19380 37 37 37 37 37 37 37 37 37 37 37 37 37 38 38 38 38 38 39 39 39 39 39 39740 49620 39 39 03MYP2 Reclassified CBSA 20500 16740 24780 20500 20500 16740 16740 39580 20500 13900 13900 22020 26580 15940 18140 30620 18140 17460 17460 45780 17460 17460 18140 26580 45780 17460 17140 10420 19380 45780 49660 45780 45780 17460 18140 18140 49660 19380 18140 38300 49660 17460 17460 17140 27900 46140 43300 46140 36420 46140 30020 46140 36420 36420 36420 22220 36420 38900 18700 21660 32780 21660 25420 25420 36 10900 39740 37964 29540 25420 12580 LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR 25092 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued Geographic CBSA Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 390066 390071 390079 390081 390086 390091 390093 390096 390110 390113 390133 390138 390150 390151 390156 390162 390180 390222 390246 390313 400048 410001 410004 410005 410007 410010 410011 410012 410013 420007 420009 420020 420027 420028 420030 420036 420039 420062 420067 420068 420069 420071 420080 420083 420085 420098 430012 430013 430014 440002 440008 440020 440024 440025 440035 440056 440060 440067 440068 440072 440073 440148 440151 440175 440185 440192 450007 450032 450039 450059 450064 .............................................................................................................................................................. .............................................................................................................................................................. 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00414 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 30140 39 39 37964 39 39 39 39740 27780 39 10900 39 39 39 37964 10900 37964 37964 39 39 25020 39300 39300 39300 39300 39300 39300 39300 39300 43900 42 42 11340 42 42 42 42 42 42 42 42 42 42 43900 34820 42 43 43 43 27180 44 44 17420 44 17300 34100 44 34100 44 44 44 44 44 44 17420 44 45 45 23104 41700 23104 03MYP2 Reclassified CBSA 25420 48700 13780 48864 27780 49660 38300 37964 38300 49660 37964 25420 38300 13644 48864 35084 48864 48864 48700 39740 41980 14484 14484 14484 14484 14484 14484 14484 35980 24860 24860 16770 24860 44940 16700 16740 43900 16740 42340 16700 44940 24860 42340 24860 48900 34820 43620 43620 22020 32820 27180 26620 16860 34 34980 28940 27180 28700 16860 32820 34980 34980 34980 34980 16860 34980 41700 43340 19124 12420 19124 LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR 25093 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued Geographic CBSA Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 450080 450087 450099 450121 450135 450137 450148 450178 450187 450196 450211 450214 450224 450283 450286 450324 450347 450351 450389 450393 450395 450419 450438 450447 450465 450469 450484 450508 450563 450596 450639 450656 450672 450675 450677 450747 450770 450779 450813 450830 450839 450858 450872 450880 460004 460005 460007 460011 460021 460026 460039 460041 460042 470001 470012 490004 490005 490013 490018 490019 490042 490048 490079 490092 490097 490105 490106 490109 500002 500003 500007 .............................................................................................................................................................. .............................................................................................................................................................. 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VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00415 Fmt 4742 Sfmt 4742 E:\FEDREG\03MYP2.LOC 45 23104 45 23104 23104 23104 23104 45 45 45 45 45 45 45 45 43300 45 45 45 43300 45 23104 45 45 45 43300 45 45 23104 45 23104 45 23104 23104 23104 45 45 23104 45 45 45 23104 23104 23104 36260 36260 46 46 41100 46 46 36260 36260 47 47 25500 49020 49 49 49 13980 40220 49 49 49 49 49 47260 50 34580 34580 03MYP2 Reclassified CBSA 30980 19124 11100 19124 19124 19124 19124 36220 26420 19124 30980 26420 46340 19124 17780 19124 26420 23104 19124 19124 26420 19124 26420 19124 26420 19124 30980 30980 19124 23104 19124 30980 19124 19124 19124 46340 12420 19124 41700 36220 43340 19124 19124 19124 41620 41620 41100 39340 29820 39340 30860 41620 41620 30 38340 16820 47894 31340 16820 47894 40220 31340 49180 40060 40060 28700 16820 40060 28420 42644 42644 LUGAR LUGAR LUGAR LUGAR LUGAR 25094 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 9A.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS—FY 2008—Continued Geographic CBSA Provider No. 500016 500021 500024 500031 500039 500041 500072 500079 500108 500129 500139 500143 510001 510002 510006 510018 510024 510030 510046 510047 510062 510070 510071 510077 520002 520021 520028 520037 520059 520071 520076 520095 520102 520107 520113 520116 520189 530015 .............................................................................................................................................................. .............................................................................................................................................................. .............................................................................................................................................................. .............................................................................................................................................................. 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Reclassified CBSA 48300 45104 36500 50 14740 31020 50 45104 45104 45104 36500 36500 34060 51 51 51 34060 51 51 51 51 51 51 51 52 29404 52 52 39540 52 52 52 52 52 52 52 29404 53 42644 42644 45104 36500 42644 38900 14740 42644 42644 42644 45104 45104 38300 40220 34060 16620 38300 34060 13980 38300 16620 16620 13980 26580 48140 16974 31540 48140 29404 33340 31540 31540 33340 22540 24580 33340 16974 26820 LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR TABLE 9C.—HOSPITALS REDESIGNATED AS RURAL UNDER SECTION 1886(d)(8)(E) OF THE ACT—FY TABLE 9C.—HOSPITALS REDESIGNATED AS RURAL UNDER SECTION 1886(d)(8)(E) OF THE ACT—FY TABLE 9C.—HOSPITALS REDESIGNATED AS RURAL UNDER SECTION 1886(d)(8)(E) OF THE ACT—FY 2008 2008—Continued 2008—Continued Provider No. mmaher on DSK3CLS3C1PROD with $$_JOB 050192 ................ VerDate Mar 15 2010 Geographic CBSA Redesignated rural area 23420 02:00 Aug 26, 2011 05 Jkt 223001 Provider No. Geographic CBSA 050528 ................ PO 00000 Frm 00416 Fmt 4742 32900 Sfmt 4742 Redesignated rural area 05 Provider No. 050618 070004 100048 100134 140167 170137 220051 230078 250126 260006 260047 260195 330044 330245 330268 360125 370054 380040 390181 390183 390201 440135 440144 450052 E:\FEDREG\03MYP2.LOC ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ 03MYP2 Geographic CBSA 40140 25540 37860 27260 14 29940 38340 35660 32820 41140 27620 44180 46540 46540 10580 36 36420 13460 39 39 39 34980 44 45 Redesignated rural area 05 07 10 10 14 17 22 23 25 26 26 26 33 33 33 36 37 38 39 39 39 44 44 45 25095 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 9C.—HOSPITALS REDESIGNATED AS RURAL UNDER SECTION 1886(d)(8)(E) OF THE ACT—FY TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY PROPOSED MEDICARE SEVERITY DIAGNOSISRELATED GROUP (MS– DRG) APRIL 2007 1—Continued 2008—Continued Provider No. 450078 450243 450348 500148 520060 Redesignated rural area Geographic CBSA ................ ................ ................ ................ ................ 10180 10180 45 48300 52 45 45 45 50 52 TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY PROPOSED MEDICARE SEVERITY DIAGNOSISRELATED GROUP (MS– DRG) APRIL 2007 1 Number of cases Threshold 1 .................................. 2 .................................. 3 .................................. 4 .................................. 5 .................................. 6 .................................. 7 .................................. 8 .................................. 9 .................................. 10 ................................ 11 ................................ 12 ................................ 13 ................................ 20 ................................ 21 ................................ 22 ................................ 23 ................................ 24 ................................ 25 ................................ 26 ................................ 27 ................................ 28 ................................ 29 ................................ 30 ................................ 31 ................................ 32 ................................ 33 ................................ 34 ................................ 35 ................................ 36 ................................ 37 ................................ 38 ................................ 39 ................................ 40 ................................ 41 ................................ mmaher on DSK3CLS3C1PROD with $$_JOB Proposed MS–DRG 629 328 23,999 21,742 842 495 413 560 1,358 177 1,289 1,923 1,484 901 558 251 3,112 2,576 8,417 11,626 14,454 1,609 2,862 3,751 1,057 2,987 4,263 813 2,506 7,710 4,777 14,602 55,357 4,549 7,720 $368,015 $193,497 $290,254 $177,964 $174,380 $99,214 $141,623 $101,160 $104,436 $78,629 $77,495 $55,136 $39,385 $151,503 $117,026 $80,993 $88,345 $65,146 $85,623 $56,519 $43,781 $79,474 $48,075 $32,131 $64,226 $37,367 $30,935 $61,467 $44,314 $38,140 $54,615 $34,542 $25,687 $62,715 $41,782 VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Proposed MS–DRG Number of cases Threshold 42 ................................ 52 ................................ 53 ................................ 54 ................................ 55 ................................ 56 ................................ 57 ................................ 58 ................................ 59 ................................ 60 ................................ 61 ................................ 62 ................................ 63 ................................ 64 ................................ 65 ................................ 66 ................................ 67 ................................ 68 ................................ 69 ................................ 70 ................................ 71 ................................ 72 ................................ 73 ................................ 74 ................................ 75 ................................ 76 ................................ 77 ................................ 78 ................................ 79 ................................ 80 ................................ 81 ................................ 82 ................................ 83 ................................ 84 ................................ 85 ................................ 86 ................................ 87 ................................ 88 ................................ 89 ................................ 90 ................................ 91 ................................ 92 ................................ 93 ................................ 94 ................................ 95 ................................ 96 ................................ 97 ................................ 98 ................................ 99 ................................ 100 .............................. 101 .............................. 102 .............................. 103 .............................. 113 .............................. 5,430 1,156 593 4,664 16,896 7,716 48,432 789 2,639 4,201 1,340 2,288 1,185 55,552 112,189 94,547 1,383 12,393 103,747 7,092 10,001 6,056 8,655 32,523 1,197 874 1,101 1,307 957 2,077 8,190 1,646 1,940 2,591 5,328 10,382 12,152 717 2,641 3,319 6,676 14,890 15,484 1,521 1,088 755 1,252 1,048 642 15,837 56,905 1,352 15,023 568 $36,036 $31,042 $23,808 $32,133 $25,987 $30,536 $19,657 $29,810 $23,219 $17,679 $56,598 $44,319 $38,047 $36,315 $28,253 $21,586 $32,331 $23,593 $18,936 $35,876 $27,570 $20,628 $28,280 $21,427 $35,846 $24,623 $34,912 $25,663 $20,523 $25,444 $17,502 $36,204 $30,062 $23,356 $37,792 $27,625 $20,144 $31,775 $24,257 $17,874 $31,194 $22,313 $17,172 $60,743 $45,389 $38,576 $54,573 $37,845 $31,587 $30,385 $19,341 $25,466 $17,133 $33,509 PO 00000 Frm 00417 Fmt 4742 Sfmt 4742 TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY PROPOSED MEDICARE SEVERITY DIAGNOSISRELATED GROUP (MS– DRG) APRIL 2007 1—Continued Proposed MS–DRG 114 115 116 117 121 122 123 124 125 129 130 131 132 133 134 135 136 137 138 139 146 147 148 149 150 151 152 153 154 155 156 157 158 159 163 164 165 166 167 168 175 176 177 178 179 180 181 182 183 184 185 186 .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. E:\FEDREG\03MYP2.LOC 03MYP2 Number of cases Threshold 601 1,098 665 1,400 587 674 2,843 679 4,705 1,374 1,072 655 728 1,352 2,661 781 1,113 1,108 1,370 2,145 687 1,422 935 39,248 939 6,801 2,352 16,028 1,843 4,207 5,140 1,145 3,039 2,418 13,431 18,047 14,553 20,290 20,772 5,758 11,954 40,173 57,179 71,192 27,454 22,474 32,156 6,163 1,654 4,141 2,593 8,533 $21,640 $26,668 $24,976 $16,827 $23,703 $13,518 $19,108 $25,406 $16,568 $39,926 $30,097 $38,488 $28,470 $32,869 $20,306 $37,347 $24,451 $29,974 $20,587 $22,300 $37,368 $26,407 $18,944 $15,883 $26,227 $13,607 $23,720 $15,145 $29,263 $22,020 $16,103 $29,722 $21,662 $15,345 $84,838 $50,487 $39,842 $62,666 $42,250 $31,795 $35,088 $26,922 $38,623 $31,821 $25,264 $34,645 $27,982 $23,372 $31,015 $22,561 $15,740 $33,538 25096 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY PROPOSED MEDICARE SEVERITY DIAGNOSISRELATED GROUP (MS– DRG) APRIL 2007 1—Continued Proposed MS–DRG mmaher on DSK3CLS3C1PROD with $$_JOB 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. VerDate Mar 15 2010 Number of cases Threshold 9,968 5,148 104,531 57,041 121,659 196,903 88,053 266,599 147,744 5,143 6,894 4,943 3,257 8,185 3,523 31,587 41,587 26,039 5,775 22,415 46,165 79,432 150 8,411 7,609 3,256 10,062 13,481 8,383 2,865 5,770 1,919 5,871 7,048 50,536 3,084 4,128 1,989 1,478 1,795 16,911 39,167 9,628 32,871 21,789 44,929 13,814 13,349 3,350 17,179 37,856 68,201 6,241 32,661 279,972 5,013 29,657 5,739 39,905 $26,845 $20,974 $30,042 $29,138 $24,641 $18,419 $31,201 $25,213 $18,274 $32,537 $26,836 $21,129 $34,933 $24,946 $17,676 $20,635 $15,003 $17,394 $27,595 $18,854 $89,753 $43,969 $161,680 $176,029 $124,842 $104,178 $140,684 $99,812 $85,690 $159,922 $123,934 $147,237 $115,628 $120,197 $93,738 $135,095 $94,076 $77,297 $147,555 $114,348 $128,139 $91,908 $103,136 $71,913 $90,628 $56,647 $69,191 $45,896 $33,094 $68,158 $52,815 $44,155 $57,244 $68,691 $49,206 $61,557 $43,877 $56,715 $40,116 02:00 Aug 26, 2011 Jkt 223001 TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY PROPOSED MEDICARE SEVERITY DIAGNOSISRELATED GROUP (MS– DRG) APRIL 2007 1—Continued Proposed MS–DRG 252 253 254 255 256 257 258 259 260 261 262 263 264 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 326 327 328 329 330 331 332 333 334 PO 00000 .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. Frm 00418 Fmt 4742 Number of cases Threshold 44,602 46,864 59,029 2,609 3,833 774 598 7,328 867 2,804 3,378 788 30,137 60,735 57,734 60,951 15,852 4,911 3,254 23,282 172,488 3,245 1,423 484 183,774 217,052 226,688 1,704 1,658 1,730 943 554 17,443 46,820 39,910 7,873 81,458 2,084 35,646 1,379 6,447 33,528 79,751 160,738 24,867 169,247 220,769 60,053 30,730 20,101 11,567 10,901 9,333 48,135 66,303 31,391 1,890 6,196 4,023 $51,463 $45,888 $36,249 $42,857 $32,015 $23,818 $53,008 $36,819 $50,387 $29,564 $23,301 $30,589 $42,489 $38,714 $29,876 $23,031 $32,521 $24,328 $17,351 $42,720 $29,775 $53,565 $38,265 $29,384 $30,658 $24,625 $17,810 $21,989 $13,805 $28,035 $20,306 $12,889 $29,542 $21,997 $15,712 $24,885 $15,192 $25,286 $15,139 $29,019 $18,857 $28,534 $20,827 $14,816 $13,364 $18,273 $14,894 $32,586 $24,616 $16,823 $94,842 $52,780 $33,659 $85,323 $49,556 $36,640 $78,691 $48,432 $35,774 Sfmt 4742 TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY PROPOSED MEDICARE SEVERITY DIAGNOSISRELATED GROUP (MS– DRG) APRIL 2007 1—Continued Proposed MS–DRG 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 405 406 407 408 409 410 411 .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. E:\FEDREG\03MYP2.LOC 03MYP2 Number of cases Threshold 7,161 12,516 8,835 1,499 3,192 3,607 874 2,536 6,875 898 2,915 2,909 1,568 3,985 5,787 1,669 3,997 8,419 3,182 9,118 17,451 8,366 8,046 2,714 3,052 4,005 3,914 16,843 22,903 14,897 9,414 19,730 4,816 50,503 84,806 128,748 2,917 4,894 5,445 1,303 8,664 2,107 7,221 5,230 18,267 46,328 48,052 47,511 306,515 23,917 45,952 26,460 3,903 5,241 2,310 1,644 1,713 722 978 $72,588 $45,452 $34,087 $61,541 $41,786 $31,931 $45,417 $33,389 $24,258 $54,574 $35,196 $27,779 $38,823 $29,136 $19,265 $43,250 $29,564 $19,894 $46,944 $32,066 $23,281 $62,960 $42,318 $32,613 $33,308 $26,885 $20,084 $34,017 $27,955 $20,598 $36,691 $27,763 $22,720 $32,599 $25,682 $19,140 $34,352 $28,117 $20,581 $29,683 $21,556 $35,137 $26,066 $20,543 $31,162 $23,425 $16,336 $25,915 $17,829 $30,478 $24,292 $17,594 $90,226 $52,384 $38,743 $71,983 $49,309 $37,665 $69,625 25097 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY PROPOSED MEDICARE SEVERITY DIAGNOSISRELATED GROUP (MS– DRG) APRIL 2007 1—Continued Proposed MS–DRG mmaher on DSK3CLS3C1PROD with $$_JOB 412 413 414 415 416 417 418 419 420 421 422 423 424 425 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 453 454 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 477 478 479 480 481 482 .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. VerDate Mar 15 2010 Number of cases Threshold 1,063 881 5,596 6,847 6,222 16,671 27,563 38,264 714 1,091 364 1,500 912 157 16,259 9,022 945 11,908 13,987 4,357 14,426 24,816 27,346 13,912 12,756 6,698 12,447 16,757 16,849 846 1,496 1,875 764 1,763 1,534 3,180 50,317 1,062 14,234 5,283 6,322 2,942 4,152 10,818 28,701 29,730 410,173 2,227 6,218 22,546 2,829 3,530 1,698 2,257 7,144 10,267 25,866 59,136 64,739 $50,630 $39,302 $63,496 $42,806 $31,773 $49,010 $38,299 $29,285 $65,599 $38,623 $30,085 $68,219 $46,919 $38,094 $32,310 $23,457 $17,210 $34,335 $27,538 $24,539 $33,536 $26,419 $18,913 $30,900 $24,488 $18,374 $32,912 $26,999 $20,274 $174,685 $117,216 $90,966 $142,125 $100,035 $82,734 $98,971 $64,868 $82,101 $61,454 $68,787 $44,864 $32,894 $74,863 $55,556 $46,551 $60,216 $43,290 $76,468 $50,893 $41,804 $54,927 $37,782 $26,665 $60,431 $43,558 $34,775 $53,540 $40,012 $34,370 02:00 Aug 26, 2011 Jkt 223001 TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY PROPOSED MEDICARE SEVERITY DIAGNOSISRELATED GROUP (MS– DRG) APRIL 2007 1—Continued Proposed MS–DRG 483 484 485 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 514 515 516 517 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 556 PO 00000 .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. Frm 00419 Fmt 4742 Number of cases Threshold 5,729 17,949 967 1,535 1,214 1,551 3,866 19,803 58,396 4,700 15,248 30,563 1,867 5,049 7,519 1,177 1,245 1,349 3,679 6,825 736 2,155 3,214 909 779 2,722 465 957 4,008 11,961 1,287 1,339 3,577 10,963 18,263 828 3,634 6,844 34,321 654 1,164 3,379 4,187 1,858 6,158 18,413 12,644 4,016 5,881 4,880 591 1,077 904 9,502 87,859 2,790 20,253 1,995 19,168 $46,686 $39,280 $59,138 $43,053 $34,867 $34,851 $26,609 $35,660 $24,028 $51,225 $38,100 $29,460 $54,818 $36,082 $28,326 $38,828 $22,858 $50,966 $32,218 $23,032 $40,314 $32,350 $24,352 $25,086 $34,570 $26,249 $25,608 $40,566 $31,428 $23,087 $31,071 $20,718 $54,297 $39,039 $31,703 $28,832 $15,819 $28,150 $15,408 $20,405 $12,954 $36,833 $28,818 $22,002 $34,845 $26,086 $18,008 $36,462 $25,135 $18,469 $34,989 $26,366 $18,381 $31,033 $18,492 $25,374 $14,944 $23,282 $14,428 Sfmt 4742 TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY PROPOSED MEDICARE SEVERITY DIAGNOSISRELATED GROUP (MS– DRG) APRIL 2007 1—Continued Proposed MS–DRG 557 558 559 560 561 562 563 564 565 566 573 574 575 576 577 578 579 580 581 582 583 584 585 592 593 594 595 596 597 598 599 600 601 602 603 604 605 606 607 614 615 616 617 618 619 620 621 622 623 624 625 626 627 628 629 630 637 638 639 .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. E:\FEDREG\03MYP2.LOC 03MYP2 Number of cases Threshold 3,184 14,178 1,635 3,979 7,617 4,996 36,056 1,606 3,237 2,779 5,687 12,100 6,468 558 2,179 3,299 3,088 6,766 5,288 8,972 15,549 1,431 2,818 3,982 12,832 2,955 1,082 5,755 548 1,483 350 572 865 21,307 130,923 2,627 22,672 1,363 7,169 1,376 1,626 1,132 6,822 343 663 1,877 6,556 1,234 3,268 487 1,098 2,522 14,305 3,267 3,958 684 16,283 40,811 41,135 $30,733 $19,372 $30,332 $20,901 $13,636 $28,213 $15,451 $28,809 $21,478 $15,695 $50,477 $35,412 $26,698 $47,915 $32,787 $23,686 $48,029 $33,258 $23,944 $24,930 $19,001 $29,247 $20,786 $32,110 $24,303 $16,562 $31,299 $19,571 $31,103 $24,558 $15,943 $22,870 $15,125 $28,307 $18,145 $26,277 $16,152 $24,074 $14,791 $47,229 $34,519 $65,696 $39,614 $29,975 $64,216 $43,862 $37,409 $49,435 $35,278 $26,158 $42,919 $28,885 $19,134 $55,480 $43,435 $33,106 $28,425 $20,070 $14,010 25098 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY PROPOSED MEDICARE SEVERITY DIAGNOSISRELATED GROUP (MS– DRG) APRIL 2007 1—Continued Proposed MS–DRG mmaher on DSK3CLS3C1PROD with $$_JOB 640 641 642 643 644 645 652 653 654 655 656 657 658 659 660 661 662 663 664 665 666 667 668 669 670 671 672 673 674 675 682 683 684 685 686 687 688 689 690 691 692 693 694 695 696 697 698 699 700 707 708 709 710 711 712 713 714 715 716 .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. VerDate Mar 15 2010 Number of cases Threshold 55,690 188,104 1,542 5,014 11,845 8,402 10,437 1,585 3,231 1,650 3,721 7,359 8,479 4,442 7,444 4,745 988 2,131 4,676 690 2,213 3,948 3,757 12,491 13,411 884 965 12,577 10,503 11,704 75,827 112,129 43,451 2,493 1,581 3,322 1,198 55,398 200,059 898 654 2,235 19,213 974 10,565 575 21,061 22,820 15,089 4,874 17,015 755 2,037 921 819 11,755 32,745 638 1,382 $25,143 $16,575 $24,193 $32,744 $25,227 $18,520 $62,402 $91,794 $57,305 $42,998 $59,955 $40,718 $33,723 $54,626 $38,339 $31,241 $44,122 $30,611 $23,754 $49,701 $31,959 $19,910 $41,676 $29,038 $19,410 $30,142 $19,128 $46,104 $42,636 $32,785 $31,972 $26,767 $19,020 $20,233 $32,841 $25,246 $18,441 $27,175 $18,352 $33,393 $25,534 $29,001 $17,667 $25,020 $14,808 $17,475 $29,461 $24,300 $17,723 $37,314 $29,414 $36,305 $29,222 $36,269 $20,449 $26,239 $15,644 $36,067 $28,098 02:00 Aug 26, 2011 Jkt 223001 TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY PROPOSED MEDICARE SEVERITY DIAGNOSISRELATED GROUP (MS– DRG) APRIL 2007 1—Continued Proposed MS–DRG 717 718 722 723 724 725 726 727 728 729 730 734 735 736 737 738 739 740 741 742 743 744 745 746 747 748 749 750 754 755 756 757 758 759 760 761 765 766 767 768 769 770 774 775 776 777 778 779 780 781 782 794 799 800 801 802 803 804 808 PO 00000 .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. Frm 00420 Fmt 4742 Number of cases Threshold 634 633 871 2,037 666 802 3,940 1,098 6,176 578 552 1,470 1,328 840 3,429 954 975 4,366 6,554 10,705 35,310 1,498 2,189 2,486 11,218 21,171 1,037 484 1,083 3,152 831 1,322 1,597 1,186 1,703 1,918 2,497 2,634 119 10 86 181 1,442 5,224 491 177 489 107 47 3,004 125 7 623 699 602 691 1,003 996 8,315 $33,174 $19,455 $30,591 $24,888 $15,999 $24,549 $16,420 $27,652 $16,848 $23,477 $14,387 $42,020 $26,263 $73,881 $41,554 $29,484 $51,269 $33,218 $24,119 $31,515 $21,122 $30,509 $20,066 $29,036 $20,664 $19,841 $45,581 $24,671 $33,538 $25,336 $16,790 $32,841 $25,832 $19,161 $19,848 $13,557 $22,146 $14,889 $15,750 $29,739 $31,941 $18,191 $12,637 $9,066 $15,413 $19,480 $8,798 $14,082 $5,638 $13,343 $8,369 $2,880 $80,879 $48,145 $37,100 $55,325 $35,487 $25,527 $35,924 Sfmt 4742 TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY PROPOSED MEDICARE SEVERITY DIAGNOSISRELATED GROUP (MS– DRG) APRIL 2007 1—Continued Proposed MS–DRG 809 810 811 812 813 814 815 816 820 821 822 823 824 825 826 827 828 829 830 834 835 836 837 838 839 840 841 842 843 844 845 846 847 848 849 853 854 855 856 857 858 862 863 864 865 866 867 868 869 870 871 872 876 880 881 882 883 884 885 .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. E:\FEDREG\03MYP2.LOC 03MYP2 Number of cases Threshold 15,527 3,818 18,344 83,082 15,031 1,631 3,337 2,355 1,481 2,529 2,139 2,436 3,039 2,009 562 1,318 872 1,374 531 5,257 1,469 1,526 1,623 900 1,385 15,152 11,012 7,678 1,477 2,854 1,008 2,480 23,667 1,699 1,498 31,444 6,881 467 6,187 10,059 3,500 7,425 21,807 19,826 2,019 9,406 5,306 2,369 1,100 13,710 203,702 92,118 968 10,494 4,576 1,656 786 21,619 77,763 $25,920 $21,504 $25,759 $18,156 $26,262 $31,374 $24,871 $18,234 $89,134 $42,943 $30,127 $68,790 $42,669 $31,129 $82,779 $42,427 $30,710 $47,009 $26,963 $54,533 $32,379 $24,423 $91,611 $44,011 $28,304 $40,430 $30,388 $23,796 $34,387 $26,126 $21,865 $39,831 $26,464 $20,748 $28,295 $83,950 $53,045 $37,927 $74,156 $39,007 $30,128 $34,703 $21,882 $20,564 $29,189 $16,786 $40,813 $25,734 $20,520 $99,453 $35,587 $26,548 $43,100 $15,328 $11,727 $12,481 $17,701 $19,048 $16,598 25099 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY PROPOSED MEDICARE SEVERITY DIAGNOSISRELATED GROUP (MS– DRG) APRIL 2007 1—Continued Proposed MS–DRG 886 887 894 895 896 897 901 902 903 904 905 906 907 908 909 913 914 915 916 917 918 919 920 921 .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. Number of cases Threshold 376 423 4,480 6,474 5,369 35,835 917 2,135 1,739 941 798 745 8,098 7,884 5,971 813 6,958 915 5,369 14,155 34,847 10,569 12,135 11,659 $14,393 $18,850 $8,389 $16,201 $26,659 $13,689 $51,824 $33,272 $24,889 $42,415 $26,522 $24,393 $57,686 $37,304 $27,385 $27,433 $16,346 $25,250 $10,725 $30,038 $14,539 $29,326 $22,791 $15,316 TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY PROPOSED MEDICARE SEVERITY DIAGNOSISRELATED GROUP (MS– DRG) APRIL 2007 1—Continued Proposed MS–DRG 922 923 927 928 929 933 934 935 939 940 941 945 946 947 948 949 950 951 955 956 957 958 959 963 .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. Number of cases Threshold 1,005 4,211 182 794 459 155 694 2,179 423 690 1,077 5,053 3,199 6,544 34,325 742 476 990 446 3,718 1,157 737 816 1,395 $28,199 $16,053 $206,517 $66,194 $35,403 $33,800 $25,296 $22,619 $45,897 $34,557 $27,512 $21,694 $17,198 $24,507 $15,485 $18,955 $12,079 $14,489 $89,598 $58,558 $112,575 $76,928 $58,670 $49,648 TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES BY PROPOSED MEDICARE SEVERITY DIAGNOSISRELATED GROUP (MS– DRG) APRIL 2007 1—Continued Proposed MS–DRG 964 965 969 970 974 975 976 977 981 982 983 984 985 986 987 988 989 999 .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. .............................. Number of cases Threshold 1,578 2,016 598 231 7,276 3,463 2,728 4,871 26,280 18,594 6,766 669 1,048 890 8,036 11,880 6,537 18 $34,426 $29,169 $83,524 $52,404 $37,920 $32,068 $25,665 $24,657 $82,945 $56,659 $40,536 $59,799 $41,065 $29,062 $58,165 $38,036 $27,418 $16,006 1 Cases taken from the FY 2006 MedPAR file; proposed MSDRGs are from GROUPER Version 25.0. TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY Proposed MS–LTC–DRG description 1 .................. 2 .................. 3 .................. 4 .................. 5 .................. 6 .................. 7 .................. 8 .................. 9 .................. 10 ................ 11 ................ 12 ................ 13 ................ 20 ................ 21 ................ mmaher on DSK3CLS3C1PROD with $$_JOB Proposed MS–LTC– DRG Heart transplant or implant of heart assist system w MCC 7 .......................... Heart transplant or implant of heart assist system w/o MCC 7 ....................... ECMO or trach w MV 96+ hrs or PDX exc face, mouth & neck w maj O.R .. Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R ............... Liver transplant w MCC or intestinal transplant 7 ............................................ Liver transplant w/o MCC 7 .............................................................................. Lung transplant 7 .............................................................................................. Simultaneous pancreas/kidney transplant 7 .................................................... Bone marrow transplant 8 ................................................................................ Pancreas transplant 7 ...................................................................................... Tracheostomy for face, mouth & neck diagnoses w MCC 9 ........................... Tracheostomy for face, mouth & neck diagnoses w CC 5 .............................. Tracheostomy for face, mouth & neck diagnoses w/o CC/MCC 9 .................. Intracranial vascular procedures w PDX hemorrhage w MCC 8 ..................... Intracranial vascular procedures w PDX hemorrhage w CC 8 ........................ VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00421 Fmt 4742 Base MS– LTC–DRG Sfmt 4742 1 1 3 4 5 5 7 8 9 10 11 11 11 20 20 FY 2006 LTCH cases 0 0 270 1,069 0 0 0 0 0 0 0 1 0 0 0 E:\FEDREG\03MYP2.LOC Proposed relative weight Proposed geometric average length of stay Proposed 5/6ths of the Geometric average length of stay 0.0000 0.0000 4.2008 2.9804 0.0000 0.0000 0.0000 0.0000 1.0950 0.0000 1.6489 1.6489 1.6489 1.6489 0.4800 0.0 0.0 64.5 46.7 0.0 0.0 0.0 0.0 30.3 0.0 36.5 36.5 36.5 36.5 19.9 0.0 0.0 53.8 38.9 0.0 0.0 0.0 0.0 25.3 0.0 30.4 30.4 30.4 30.4 16.6 03MYP2 25100 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued Proposed MS–LTC– DRG mmaher on DSK3CLS3C1PROD with $$_JOB 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ ................ VerDate Mar 15 2010 Base MS– LTC–DRG Proposed MS–LTC–DRG description Intracranial vascular procedures w PDX hemorrhage w/o CC/MCC 8 ............ Craniotomy w major device implant or acute complex CNS PDX w MCC 8 .. Craniotomy w major device implant or acute complex CNS PDX w/o MCC 8 Craniotomy & endovascular intracranial procedures w MCC 9 ....................... Craniotomy & endovascular intracranial procedures w CC 5 .......................... Craniotomy & endovascular intracranial procedures w/o CC/MCC 9 .............. Spinal procedures w MCC 4 ............................................................................ Spinal procedures w CC 4 ............................................................................... Spinal procedures w/o CC/MCC 1 ................................................................... Ventricular shunt procedures w MCC 5 ........................................................... Ventricular shunt procedures w CC 1 .............................................................. Ventricular shunt procedures w/o CC/MCC 1 .................................................. Carotid artery stent procedure w MCC 8 ......................................................... Carotid artery stent procedure w CC 8 ............................................................ Carotid artery stent procedure w/o CC/MCC 8 ................................................ Extracranial procedures w MCC 5 ................................................................... Extracranial procedures w CC 4 ...................................................................... Extracranial procedures w/o CC/MCC 4 .......................................................... Periph & cranial nerve & other nerv syst proc w MCC ................................... Periph & cranial nerve & other nerv syst proc w CC ...................................... Periph & cranial nerve & other nerv syst proc w/o CC/MCC 3 ....................... Spinal disorders & injuries w CC/MCC ............................................................ Spinal disorders & injuries w/o CC/MCC 3 ...................................................... Nervous system neoplasms w MCC ................................................................ Nervous system neoplasms w/o MCC ............................................................. Degenerative nervous system disorders w MCC ............................................ Degenerative nervous system disorders w/o MCC ......................................... Multiple sclerosis & cerebellar ataxia w MCC 6 .............................................. Multiple sclerosis & cerebellar ataxia w CC .................................................... Multiple sclerosis & cerebellar ataxia w/o CC/MCC 6 ..................................... Acute ischemic stroke w use of thrombolytic agent w MCC 8 ........................ Acute ischemic stroke w use of thrombolytic agent w CC 8 ........................... Acute ischemic stroke w use of thrombolytic agent w/o CC/MCC 8 ............... Intracranial hemorrhage or cerebral infarction w MCC ................................... Intracranial hemorrhage or cerebral infarction w CC ...................................... Intracranial hemorrhage or cerebral infarction w/o CC/MCC 1 ....................... Nonspecific cva & precerebral occlusion w/o infarct w MCC 1 ....................... Nonspecific cva & precerebral occlusion w/o infarct w/o MCC 1 .................... Transient ischemia 1 ........................................................................................ Nonspecific cerebrovascular disorders w MCC ............................................... Nonspecific cerebrovascular disorders w CC .................................................. Nonspecific cerebrovascular disorders w/o CC/MCC 1 ................................... Cranial & peripheral nerve disorders w MCC .................................................. Cranial & peripheral nerve disorders w/o MCC ............................................... Viral meningitis w CC/MCC 2 ........................................................................... Viral meningitis w/o CC/MCC 1 ........................................................................ Hypertensive encephalopathy w MCC 2 .......................................................... Hypertensive encephalopathy w CC 2, 6 .......................................................... Hypertensive encephalopathy w/o CC/MCC 1 ................................................. Nontraumatic stupor & coma w MCC .............................................................. Nontraumatic stupor & coma w/o MCC ........................................................... Traumatic stupor & coma, coma ≤1 hr w MCC ............................................... Traumatic stupor & coma, coma ≤1 hr w CC2 ................................................ 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00422 Fmt 4742 Sfmt 4742 20 23 23 25 25 25 28 28 28 31 31 31 34 34 34 37 37 37 40 40 40 52 52 54 54 56 56 58 58 58 61 61 61 64 64 64 67 67 69 70 70 70 73 73 75 75 77 77 77 80 80 82 82 FY 2006 LTCH cases 0 0 0 0 2 0 6 4 2 2 1 1 0 0 0 12 7 1 156 99 10 78 19 50 67 1,320 2,623 23 44 22 0 0 0 126 116 24 5 8 17 103 86 9 83 173 20 1 4 9 1 40 71 27 12 E:\FEDREG\03MYP2.LOC Proposed relative weight Proposed geometric average length of stay Proposed 5/6ths of the Geometric average length of stay 0.4800 1.6489 0.4800 1.6489 1.6489 1.6489 1.0950 1.0950 0.4800 1.6489 0.4800 0.4800 1.6489 1.0950 1.0950 1.6489 1.0950 1.0950 1.3371 0.9653 0.8072 1.0786 0.8072 0.7245 0.6543 0.7993 0.5844 0.5405 0.5405 0.5405 0.8131 0.4800 0.4800 0.8199 0.6159 0.4800 0.4800 0.4800 0.4800 0.8131 0.5751 0.4800 0.8630 0.5645 0.6513 0.4800 0.6513 0.6513 0.4800 0.6767 0.5395 0.8821 0.6513 19.9 36.5 19.9 36.5 36.5 36.5 30.3 30.3 19.9 36.5 19.9 19.9 36.5 30.3 30.3 36.5 30.3 30.3 36.3 34.3 24.6 32.8 24.6 23.6 22.0 26.4 24.4 22.2 22.2 22.2 24.0 19.9 19.9 25.1 23.5 19.9 19.9 19.9 19.9 24.0 22.7 19.9 24.9 23.3 22.7 19.9 22.7 22.7 19.9 24.6 23.1 29.5 22.7 16.6 30.4 16.6 30.4 30.4 30.4 25.3 25.3 16.6 30.4 16.6 16.6 30.4 25.3 25.3 30.4 25.3 25.3 30.3 28.6 20.5 27.3 20.5 19.7 18.3 22.0 20.3 18.5 18.5 18.5 20.0 16.6 16.6 20.9 19.6 16.6 16.6 16.6 16.6 20.0 18.9 16.6 20.8 19.4 18.9 16.6 18.9 18.9 16.6 20.5 19.3 24.6 18.9 03MYP2 25101 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued Proposed MS–LTC–DRG description 84 ................ 85 ................ 86 ................ 87 ................ 88 ................ 89 ................ 90 ................ 91 ................ 92 ................ 93 ................ 94 ................ 95 ................ 96 ................ 97 ................ 98 ................ 99 ................ 100 .............. 101 .............. 102 .............. 103 .............. 113 .............. 114 .............. 115 .............. 116 .............. 117 .............. 121 .............. 122 .............. 123 .............. 124 .............. 125 .............. 129 .............. 130 .............. 131 .............. 132 .............. 133 .............. 134 .............. 135 .............. 136 .............. 137 .............. 138 .............. 139 .............. 146 .............. 147 .............. 148 .............. 149 .............. 150 .............. 151 .............. 152 .............. 153 .............. 154 .............. 155 .............. 156 .............. 157 .............. 158 .............. 159 .............. 163 .............. 164 .............. mmaher on DSK3CLS3C1PROD with $$_JOB Proposed MS–LTC– DRG Traumatic stupor & coma, coma ≤1 hr w/o CC/MCC 2 ................................... Traumatic stupor & coma, coma <1 hr w MCC ............................................... Traumatic stupor & coma, coma <1 hr w CC .................................................. Traumatic stupor & coma, coma <1 hr w/o CC/MCC ...................................... Concussion w MCC 4, 6 .................................................................................... Concussion w CC 4 .......................................................................................... Concussion w/o CC/MCC 9 ............................................................................. Other disorders of nervous system w MCC .................................................... Other disorders of nervous system w CC ....................................................... Other disorders of nervous system w/o CC/MCC ........................................... Bacterial & tuberculous infections of nervous system w MCC ........................ Bacterial & tuberculous infections of nervous system w CC ........................... Bacterial & tuberculous infections of nervous system w/o CC/MCC .............. Non-bacterial infect of nervous sys exc viral meningitis w MCC .................... Non-bacterial infect of nervous sys exc viral meningitis w CC ....................... Non-bacterial infect of nervoussys exc viral meningitis w/o CC/MCC 2 .......... Seizures w MCC .............................................................................................. Seizures w/o MCC ........................................................................................... Headaches w MCC 3, 6 .................................................................................... Headaches w/o MCC 3 .................................................................................... Orbital procedures w CC/MCC 2 ..................................................................... Orbital procedures w/o CC/MCC 9 .................................................................. Extraocular procedures exceptorbit 8 .............................................................. Intraocular procedures w CC/MCC 8 ............................................................... Intraocular procedures w/o CC/MCC 8 ............................................................ Acute major eye infections w CC/MCC 2 ........................................................ Acute major eye infections w/o CC/MCC 1 ..................................................... Neurological eye disorders 1 ............................................................................ Other disorders of the eye w MCC 4 ............................................................... Other disorders of the eye w/o MCC 2 ............................................................ Major head & neck procedures w CC/MCC or major device 8 ....................... Major head & neck procedures w/o CC/MCC 8 .............................................. Cranial/facial procedures w CC/MCC 5 ........................................................... Cranial/facial procedures w/o CC/MCC 9 ........................................................ Other ear, nose, mouth & throat O.R. procedures w CC/MCC 3, 6 ................. Other ear, nose, mouth & throat O.R. procedures w/o CC/MCC 3, 6 .............. Sinus & mastoid procedures w CC/MCC 8 ...................................................... Sinus & mastoid procedures w/o CC/MCC 8 ................................................... Mouth procedures w CC/MCC 5 ...................................................................... Mouth procedures w/o CC/MCC 9 ................................................................... Salivary gland procedures 5 ............................................................................. Ear, nose, mouth & throat malignancy w MCC ............................................... Ear, nose, mouth & throat malignancy w CC .................................................. Ear, nose, mouth & throat malignancy w/o CC/MCC 2 ................................... Dysequilibrium 1 ............................................................................................... Epistaxis w MCC 8 ........................................................................................... Epistaxis w/o MCC 8 ........................................................................................ Otitis media & URI w MCC 2 ........................................................................... Otitis media & URI w/o MCC 1 ........................................................................ Nasal trauma & deformity w MCC ................................................................... Nasal trauma & deformity w CC ...................................................................... Nasal trauma & deformity w/o CC/MCC 2 ....................................................... Dental & Oral Diseases w MCC 3, 6 ................................................................ Dental & Oral Diseases w CC 3, 6 ................................................................... Dental & Oral Diseases w/o CC/MCC 3, 6 ....................................................... Major chest procedures w MCC ...................................................................... Major chest procedures w CC 5 ...................................................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00423 Fmt 4742 Base MS– LTC–DRG Sfmt 4742 82 85 85 85 88 88 88 91 91 91 94 94 94 97 97 97 100 100 102 102 113 113 115 116 116 121 121 123 124 124 129 129 131 131 133 133 135 135 137 137 139 146 146 146 149 150 150 152 152 154 154 154 157 157 157 163 163 FY 2006 LTCH cases 4 102 86 30 1 2 0 243 189 54 211 105 26 57 33 10 40 37 6 11 1 0 0 0 0 8 2 3 2 10 0 0 2 0 3 1 0 0 1 0 1 44 37 4 9 0 0 10 23 55 44 11 9 18 2 27 10 E:\FEDREG\03MYP2.LOC Proposed relative weight Proposed geometric average length of stay Proposed 5/6ths of the Geometric average length of stay 0.6513 0.9666 0.6711 0.5363 1.0950 1.0950 1.0950 0.8500 0.5981 0.4835 1.0574 0.8454 0.8454 0.9189 0.8242 0.6513 0.8295 0.5564 0.8072 0.8072 0.6513 0.6513 0.6513 0.6513 0.6513 0.6513 0.4800 0.4800 1.0950 0.6513 1.0950 0.6513 1.6489 1.6489 0.8072 0.8072 0.8072 0.8072 1.6489 1.6489 1.6489 1.2620 0.9530 0.6513 0.4800 0.6513 0.4800 0.6513 0.4800 0.7560 0.7320 0.6513 0.8072 0.8072 0.8072 2.2983 1.6489 22.7 28.3 25.2 20.1 30.3 30.3 30.3 25.7 21.9 20.0 28.0 26.8 26.8 26.2 22.7 22.7 26.5 21.4 24.6 24.6 22.7 22.7 22.7 22.7 22.7 22.7 19.9 19.9 30.3 22.7 30.3 22.7 36.5 36.5 24.6 24.6 24.6 24.6 36.5 36.5 36.5 26.4 24.9 22.7 19.9 22.7 19.9 22.7 19.9 21.2 20.4 22.7 24.6 24.6 24.6 39.7 36.5 18.9 23.6 21.0 16.8 25.3 25.3 25.3 21.4 18.3 16.7 23.3 22.3 22.3 21.8 18.9 18.9 22.1 17.8 20.5 20.5 18.9 18.9 18.9 18.9 18.9 18.9 16.6 16.6 25.3 18.9 25.3 18.9 30.4 30.4 20.5 20.5 20.5 20.5 30.4 30.4 30.4 22.0 20.8 18.9 16.6 18.9 16.6 18.9 16.6 17.7 17.0 18.9 20.5 20.5 20.5 33.1 30.4 03MYP2 25102 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued Proposed MS–LTC– DRG mmaher on DSK3CLS3C1PROD with $$_JOB 165 166 167 168 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. VerDate Mar 15 2010 Base MS– LTC–DRG Proposed MS–LTC–DRG description Major chest procedures w/o CC/MCC 9 .......................................................... Other resp system O.R. procedures w MCC ................................................... Other resp system O.R. procedures w CC ...................................................... Other resp system O.R. procedures w/o CC/MCC 4 ....................................... Pulmonary embolism w MCC .......................................................................... Pulmonary embolism w/o MCC ....................................................................... Respiratory infections & inflammations w MCC .............................................. Respiratory infections & inflammations w CC ................................................. Respiratory infections & inflammations w/o CC/MCC ..................................... Respiratory neoplasms w MCC ....................................................................... Respiratory neoplasms w CC .......................................................................... Respiratory neoplasms w/o CC/MCC 1 ........................................................... Major chest trauma w MCC 1 .......................................................................... Major chest trauma w CC 1, 6 .......................................................................... Major chest trauma w/o CC/MCC 9 ................................................................. Pleural effusion w MCC ................................................................................... Pleural effusion w CC ...................................................................................... Pleural effusion w/o CC/MCC 6 ....................................................................... Pulmonary edema & respiratory failure ........................................................... Chronic obstructive pulmonary disease w MCC .............................................. Chronic obstructive pulmonary disease w CC ................................................. Chronic obstructive pulmonary disease w/o CC/MCC .................................... Simple pneumonia & pleurisy w MCC ............................................................. Simple pneumonia & pleurisy w CC ................................................................ Simple pneumonia & pleurisy w/o CC/MCC .................................................... Interstitial lung disease w MCC ....................................................................... Interstitial lung disease w CC .......................................................................... Interstitial lung disease w/o CC/MCC .............................................................. Pneumothorax w MCC ..................................................................................... Pneumothorax w CC2 ...................................................................................... Pneumothorax w/o CC/MCC 1 ......................................................................... Bronchitis & asthma w CC/MCC ...................................................................... Bronchitis & asthma w/o CC/MCC ................................................................... Respiratory signs & symptoms ........................................................................ Other respiratory system diagnoses w MCC ................................................... Other respiratory system diagnoses w/o MCC ................................................ Respiratory system diagnosis w ventilator support 96+ hours ........................ Respiratory system diagnosis w ventilator support 96 hours .......................... Other heart assist system implant 8 ................................................................ Cardiac valve & oth maj cardiothoracic proc w card cath w MCC 8 ............... Cardiac valve & oth maj cardiothoracic proc w card cath w CC 8 .................. Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC 8 ...... Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC 8 ............ Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC 8 ............... Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC 8 ... Cardiac defib implant w cardiaccath w AMI/HF/shock w MCC 8 .................... Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC 8 ................ Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC 8 ................ Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o MCC 8 ............. Cardiac defibrillator implant w/o cardiac cath w MCC 5 .................................. Cardiac defibrillator implant w/o cardiac cath w/o MCC 5 ............................... Other cardiothoracic procedures w MCC 8 ...................................................... Other cardiothoracic procedures w CC 8 ......................................................... Other cardiothoracic procedures w/o CC/MCC 8 ............................................ 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00424 Fmt 4742 Sfmt 4742 163 166 166 166 175 175 177 177 177 180 180 180 183 183 183 186 186 186 189 190 190 190 193 193 193 196 196 196 199 199 199 202 202 204 205 205 207 208 215 216 216 216 219 219 219 222 222 224 224 226 226 228 228 228 FY 2006 LTCH cases 0 1,568 233 10 103 139 2,943 2,247 390 162 110 19 1 1 0 136 64 14 5,686 1,657 1,542 894 1,689 2,090 475 114 94 45 25 16 11 92 38 313 260 169 12,390 1,879 0 0 0 0 0 0 0 0 0 0 0 11 4 0 0 0 E:\FEDREG\03MYP2.LOC Proposed relative weight Proposed geometric average length of stay Proposed 5/6ths of the Geometric average length of stay 1.6489 2.4517 1.8802 1.0950 0.7766 0.5350 0.8638 0.7254 0.5896 0.8433 0.6481 0.4800 0.4800 0.4800 0.4800 0.8571 0.6165 0.6165 0.9560 0.7195 0.6024 0.5192 0.7400 0.6108 0.5321 0.6613 0.5863 0.5717 0.7596 0.6513 0.4800 0.6915 0.4994 0.8025 0.8221 0.7446 1.9944 1.5234 0.8072 1.6489 0.8072 0.8072 1.6489 0.8072 0.8072 1.6489 1.6489 1.6489 1.6489 1.6489 1.6489 1.6489 1.0950 1.0950 36.5 42.4 37.6 30.3 22.9 20.2 23.6 22.2 19.2 20.1 19.3 19.9 19.9 19.9 19.9 23.6 21.1 21.1 23.9 20.9 19.6 17.2 21.6 19.8 18.1 20.0 19.6 19.7 22.4 22.7 19.9 21.4 16.6 22.0 22.5 21.7 34.2 27.8 24.6 36.5 24.6 24.6 36.5 24.6 24.6 36.5 36.5 36.5 36.5 36.5 36.5 36.5 30.3 30.3 30.4 35.3 31.3 25.3 19.1 16.8 19.7 18.5 16.0 16.8 16.1 16.6 16.6 16.6 16.6 19.7 17.6 17.6 19.9 17.4 16.3 14.3 18.0 16.5 15.1 16.7 16.3 16.4 18.7 18.9 16.6 17.8 13.8 18.3 18.8 18.1 28.5 23.2 20.5 30.4 20.5 20.5 30.4 20.5 20.5 30.4 30.4 30.4 30.4 30.4 30.4 30.4 25.3 25.3 03MYP2 25103 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued Proposed MS–LTC– DRG mmaher on DSK3CLS3C1PROD with $$_JOB 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. VerDate Mar 15 2010 Base MS– LTC–DRG Proposed MS–LTC–DRG description Coronary bypass w PTCA w MCC 8 ............................................................... Coronary bypass w PTCA w/o MCC 8 ............................................................ Coronary bypass w cardiac cath w MCC 8 ..................................................... Coronary bypass w cardiac cath w/o MCC 8 .................................................. Coronary bypass w/o cardiac cath w MCC 8 .................................................. Coronary bypass w/o cardiac cath w/o MCC 8 ............................................... Major cardiovascular procedures w MCC 5 ..................................................... Major cardiovascular procedures w/o MCC 3 .................................................. Amputation for circ sys disorders exc upper limb & toe w MCC .................... Amputation for circ sys disorders exc upper limb & toe w CC ....................... Amputation for circ sys disorders exc upper limb & toe w/o CC/MCC 4 ......... Permanent cardiac pacemaker implant w MCC 5, 6 ........................................ Permanent cardiac pacemaker implant w CC 5 .............................................. Permanent cardiac pacemaker implant w/o CC/MCC 4 .................................. AICD lead & generator procedures 2 ............................................................... Percutaneous cardiovascular proc w drug-eluting stent w MCC 3 .................. Percutaneous cardiovascular proc w drug-eluting stent w/o MCC 9 ............... Percutaneous cardiovasc proc w non-drug-eluting stent w MCC 5 ................ Percutaneous cardiovasc proc w non-drug-eluting stent w/o MCC 9 ............. Perc cardiovasc proc w/o coronary artery stent or AMI w MCC 3 .................. Perc cardiovasc proc w/o coronary artery stent or AMI w/o MCC 9 ............... Other vascular procedures w MCC ................................................................. Other vascular procedures w CC .................................................................... Other vascular procedures w/o CC/MCC 4 ..................................................... Upper limb & toe amputation for circ system disorders w MCC ..................... Upper limb & toe amputation for circ system disorders w CC ........................ Upper limb & toe amputation for circ system disorders w/o CC/MCC 6 ......... Cardiac pacemaker device replacement w MCC 5 ......................................... Cardiac pacemaker device replacement w/o MCC 9 ...................................... Cardiac pacemaker revision except device replacement w MCC 5 ................ Cardiac pacemaker revision except device replacement w CC 1 ................... Cardiac pacemaker revision except device replacement w/o CC/MCC 1 ....... Vein ligation & stripping 3 ................................................................................ Other circulatory system O.R. procedures ...................................................... Circulatory disorders w AMI, discharged alive w MCC ................................... Circulatory disorders w AMI, discharged alive w CC ...................................... Circulatory disorders w AMI, discharged alive w/o CC/MCC 2 ....................... Circulatory disorders w AMI, expired w MCC .................................................. Circulatory disorders w AMI, expired w CC 6 .................................................. Circulatory disorders w AMI, expired w/o CC/MCC 6 ...................................... Circulatory disorders except AMI, w card cath w MCC 4 ................................ Circulatory disorders except AMI, w card cath w/o MCC 3 ............................. Acute & subacute endocarditis w MCC ........................................................... Acute & subacute endocarditis w CC .............................................................. Acute & subacute endocarditis w/o CC/MCC .................................................. Heart failure & shock w MCC .......................................................................... Heart failure & shock w CC ............................................................................. Heart failure & shock w/o CC/MCC ................................................................. Deep vein thrombophlebitis w CC/MCC 3 ....................................................... Deep vein thrombophlebitis w/o CC/MCC 9 .................................................... 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00425 Fmt 4742 Sfmt 4742 231 231 233 233 235 235 237 237 239 239 239 242 242 242 245 246 246 248 248 250 250 252 252 252 255 255 255 258 258 260 260 260 263 264 280 280 280 283 283 283 286 286 288 288 288 291 291 291 294 294 FY 2006 LTCH cases 0 0 0 0 0 0 3 3 171 92 6 14 9 3 2 1 0 1 0 1 0 107 54 6 45 37 1 1 0 1 1 1 1 596 107 60 9 26 5 1 15 7 450 216 61 1,603 1,115 461 7 0 E:\FEDREG\03MYP2.LOC Proposed relative weight Proposed geometric average length of stay Proposed 5/6ths of the Geometric average length of stay 1.6489 0.8072 1.6489 0.8072 1.6489 0.8072 1.6489 0.8072 1.3954 1.2100 1.0950 1.6489 1.6489 1.0950 0.6513 0.8072 0.8072 1.6489 1.6489 0.8072 0.8072 1.5938 1.0987 1.0950 1.2596 0.8278 0.8278 1.6489 1.6489 1.6489 0.4800 0.4800 0.8072 1.0516 0.7177 0.6709 0.6513 0.6486 0.6486 0.6486 1.0950 0.8072 0.9199 0.8385 0.6409 0.7271 0.5887 0.5015 0.8072 0.8072 36.5 24.6 36.5 24.6 36.5 24.6 36.5 24.6 37.4 36.1 30.3 36.5 36.5 30.3 22.7 24.6 24.6 36.5 36.5 24.6 24.6 34.9 30.8 30.3 33.7 29.4 29.4 36.5 36.5 36.5 19.9 19.9 24.6 31.6 21.4 23.3 22.7 17.0 17.0 17.0 30.3 24.6 26.4 26.7 25.1 21.4 20.5 18.6 24.6 24.6 30.4 20.5 30.4 20.5 30.4 20.5 30.4 20.5 31.2 30.1 25.3 30.4 30.4 25.3 18.9 20.5 20.5 30.4 30.4 20.5 20.5 29.1 25.7 25.3 28.1 24.5 24.5 30.4 30.4 30.4 16.6 16.6 20.5 26.3 17.8 19.4 18.9 14.2 14.2 14.2 25.3 20.5 22.0 22.3 20.9 17.8 17.1 15.5 20.5 20.5 03MYP2 25104 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued Proposed MS–LTC– DRG mmaher on DSK3CLS3C1PROD with $$_JOB 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 368 369 370 371 372 373 .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. VerDate Mar 15 2010 Base MS– LTC–DRG Proposed MS–LTC–DRG description Cardiac arrest, unexplained w MCC 8 ............................................................. Cardiac arrest, unexplained w CC 8 ................................................................ Cardiac arrest, unexplained w/o CC/MCC 8 .................................................... Peripheral vascular disorders w MCC ............................................................. Peripheral vascular disorders w CC ................................................................ Peripheral vascular disorders w/o CC/MCC .................................................... Atherosclerosis w MCC .................................................................................... Atherosclerosis w/o MCC ................................................................................. Hypertension w MCC 2 .................................................................................... Hypertension w/o MCC .................................................................................... Cardiac congenital & valvular disorders w MCC ............................................. Cardiac congenital & valvular disorders w/o MCC .......................................... Cardiac arrhythmia & conduction disorders w MCC ....................................... Cardiac arrhythmia & conduction disorders w CC .......................................... Cardiac arrhythmia & conduction disorders w/o CC/MCC .............................. Angina pectoris 2 .............................................................................................. Syncope & collapse ......................................................................................... Chest pain 1 ..................................................................................................... Other circulatory system diagnoses w MCC ................................................... Other circulatory system diagnoses w CC ...................................................... Other circulatory system diagnoses w/o CC/MCC .......................................... Stomach, esophageal & duodenal proc w MCC ............................................. Stomach, esophageal & duodenal proc w CC 5 .............................................. Stomach, esophageal & duodenal proc w/o CC/MCC 1 ................................. Major small & large bowel procedures w MCC 5 ............................................ Major small & large bowel procedures w CC 5 ............................................... Major small & large bowel procedures w/o CC/MCC 1 ................................... Rectal resection w MCC 8 ............................................................................... Rectal resection w CC 8 .................................................................................. Rectal resection w/o CC/MCC 8 ...................................................................... Peritoneal adhesiolysis w MCC 5 .................................................................... Peritoneal adhesiolysis w CC2 ........................................................................ Peritoneal adhesiolysis w/o CC/MCC 9 ........................................................... Appendectomy w complicated principal diag w MCC 8 ................................... Appendectomy w complicated principal diag w CC 8 ...................................... Appendectomy w complicated principal diag w/o CC/MCC 8 ......................... Appendectomy w/o complicated principal diag w MCC 8 ................................ Appendectomy w/o complicated principal diag w CC 8 ................................... Appendectomy w/o complicated principal diag w/o CC/MCC 8 ...................... Minor small & large bowel procedures w MCC 8 ............................................ Minor small & large bowel procedures w CC 8 ............................................... Minor small & large bowel procedures w/o CC/MCC 8 ................................... Anal & stomal procedures w MCC 3 ................................................................ Anal & stomal procedures w CC 3 ................................................................... Anal & stomal procedures w/o CC/MCC 1 ...................................................... Inguinal & femoral hernia procedures w MCC 5 .............................................. Inguinal & femoral hernia procedures w CC 4 ................................................. Inguinal & femoral hernia procedures w/o CC/MCC 3 .................................... Hernia procedures except inguinal & femoral w MCC 9 ................................. Hernia procedures except inguinal & femoral w CC 3 .................................... Hernia procedures except inguinal & femoral w/o CC/MCC 9 ........................ Other digestive system O.R. procedures w MCC ........................................... Other digestive system O.R. procedures w CC .............................................. Other digestive system O.R. procedures w/o CC/MCC 3 ............................... Major esophageal disorders w MCC 4 ............................................................. Major esophageal disorders w CC 4 ................................................................ Major esophageal disorders w/o CC/MCC 4, 6 ................................................ Major gastrointestinal disorders & peritoneal infections w MCC ..................... Major gastrointestinal disorders & peritoneal infections w CC ........................ Major gastrointestinal disorders & peritoneal infections w/o CC/MCC ............ 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00426 Fmt 4742 Sfmt 4742 296 296 296 299 299 299 302 302 304 304 306 306 308 308 308 311 312 313 314 314 314 326 326 326 329 329 329 332 332 332 335 335 335 338 338 338 341 341 341 344 344 344 347 347 347 350 350 350 353 353 353 356 356 356 368 368 368 371 371 371 FY 2006 LTCH cases 0 0 0 551 790 103 68 94 12 42 54 39 87 79 39 4 44 5 1,393 426 122 33 9 1 24 20 1 0 0 0 4 2 0 0 0 0 0 0 0 0 0 0 5 3 1 1 1 1 0 1 0 107 45 3 22 8 1 667 422 55 E:\FEDREG\03MYP2.LOC Proposed relative weight Proposed geometric average length of stay Proposed 5/6ths of the Geometric average length of stay 0.6513 0.6513 0.6513 0.7657 0.5711 0.4906 0.6324 0.5383 0.6513 0.5464 0.9077 0.7090 0.8126 0.5311 0.4341 0.6513 0.5159 0.4800 0.8267 0.6380 0.5126 2.0279 1.6489 0.4800 1.6489 1.6489 0.4800 1.6489 1.0950 0.8072 1.6489 0.6513 0.6513 0.8072 0.6513 0.4800 0.8072 0.6513 0.4800 0.8072 0.6513 0.4800 0.8072 0.8072 0.4800 1.6489 1.0950 0.8072 0.8072 0.8072 0.8072 1.4828 1.1816 0.8072 1.0950 1.0950 1.0950 0.9214 0.6969 0.5312 22.7 22.7 22.7 24.7 22.2 19.4 22.3 20.3 22.7 22.2 24.2 23.1 24.7 20.6 16.5 22.7 19.7 19.9 23.0 21.6 19.4 36.0 36.5 19.9 36.5 36.5 19.9 36.5 30.3 24.6 36.5 22.7 22.7 24.6 22.7 19.9 24.6 22.7 19.9 24.6 22.7 19.9 24.6 24.6 19.9 36.5 30.3 24.6 24.6 24.6 24.6 36.0 30.8 24.6 30.3 30.3 30.3 24.0 22.2 19.8 18.9 18.9 18.9 20.6 18.5 16.2 18.6 16.9 18.9 18.5 20.2 19.3 20.6 17.2 13.8 18.9 16.4 16.6 19.2 18.0 16.2 30.0 30.4 16.6 30.4 30.4 16.6 30.4 25.3 20.5 30.4 18.9 18.9 20.5 18.9 16.6 20.5 18.9 16.6 20.5 18.9 16.6 20.5 20.5 16.6 30.4 25.3 20.5 20.5 20.5 20.5 30.0 25.7 20.5 25.3 25.3 25.3 20.0 18.5 16.5 03MYP2 25105 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued Proposed MS–LTC– DRG mmaher on DSK3CLS3C1PROD with $$_JOB 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 432 433 434 435 436 437 438 439 440 441 442 443 444 .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. VerDate Mar 15 2010 Base MS– LTC–DRG Proposed MS–LTC–DRG description Digestive malignancy w MCC .......................................................................... Digestive malignancy w CC ............................................................................. Digestive malignancy w/o CC/MCC 1 .............................................................. G.I. hemorrhage w MCC .................................................................................. G.I. hemorrhage w CC ..................................................................................... G.I. hemorrhage w/o CC/MCC ......................................................................... Complicated peptic ulcer w MCC 3 .................................................................. Complicated peptic ulcer w CC 3 ..................................................................... Complicated peptic ulcer w/o CC/MCC 2 ........................................................ Uncomplicated peptic ulcer w MCC 3 .............................................................. Uncomplicated peptic ulcer w/o MCC 2 ........................................................... Inflammatory bowel disease w MCC ............................................................... Inflammatory bowel disease w CC .................................................................. Inflammatory bowel disease w/o CC/MCC 6 ................................................... G.I. obstruction w MCC .................................................................................... G.I. obstruction w CC ....................................................................................... G.I. obstruction w/o CC/MCC 2 ........................................................................ Esophagitis, gastroent & misc digest disorders w MCC ................................. Esophagitis, gastroent & misc digest disorders w/o MCC .............................. Other digestive system diagnoses w MCC ...................................................... Other digestive system diagnoses w CC ......................................................... Other digestive system diagnoses w/o CC/MCC ............................................ Pancreas, liver & shunt procedures w MCC 5 ................................................. Pancreas, liver & shunt procedures w CC 5 .................................................... Pancreas, liver & shunt procedures w/o CC/MCC 4 ....................................... Biliary tract proc except only cholecyst w or w/o c.d.e. w MCC 5, 6 ............... Biliary tract proc except only cholecyst w or w/o c.d.e. w CC 5 ...................... Biliary tract proc except only cholecyst w or w/o c.d.e. w/o CC/MCC 9 ......... Cholecystectomy w c.d.e. w MCC 9 ................................................................ Cholecystectomy w c.d.e. w CC 4 ................................................................... Cholecystectomy w c.d.e. w/o CC/MCC 9 ....................................................... Cholecystectomy except by laparoscope w/o c.d.e. w MCC 4 ........................ Cholecystectomy except by laparoscope w/o c.d.e. w CC 4 ........................... Cholecystectomy except by laparoscope w/o c.d.e. w/o CC/MCC 9 .............. Laparoscopic cholecystectomy w/o c.d.e. w MCC 5 ....................................... Laparoscopic cholecystectomy w/o c.d.e. w CC 4 .......................................... Laparoscopic cholecystectomy w/o c.d.e. w/o CC/MCC 9 .............................. Hepatobiliary diagnostic procedures w MCC 3 ................................................ Hepatobiliary diagnostic procedures w CC 3 ................................................... Hepatobiliary diagnostic procedures w/o CC/MCC 9 ....................................... Other hepatobiliary or pancreas O.R. procedures w MCC 4 ........................... Other hepatobiliary or pancreas O.R. procedures w CC 3 .............................. Other hepatobiliary or pancreas O.R. procedures w/o CC/MCC 3 ................. Cirrhosis & alcoholic hepatitis w MCC ............................................................. Cirrhosis & alcoholic hepatitis w CC 6 ............................................................. Cirrhosis & alcoholic hepatitis w/o CC/MCC 6 ................................................. Malignancy of hepatobiliary system or pancreas w MCC ............................... Malignancy of hepatobiliary system or pancreas w CC .................................. Malignancy of hepatobiliary system or pancreas w/o CC/MCC 2 ................... Disorders of pancreas except malignancy w MCC ......................................... Disorders of pancreas except malignancy w CC ............................................ Disorders of pancreas except malignancy w/o CC/MCC ................................ Disorders of liver except malig, cirr, alc hepa w MCC .................................... Disorders of liver except malig, cirr, alc hepa w CC ....................................... Disorders of liver except malig, cirr, alc hepa w/o CC/MCC 2 ........................ Disorders of the biliary tract w MCC ................................................................ 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00427 Fmt 4742 Sfmt 4742 374 374 374 377 377 377 380 380 380 383 383 385 385 385 388 388 388 391 391 393 393 393 405 405 405 408 408 408 411 411 411 414 414 414 417 417 417 420 420 420 423 423 423 432 432 432 435 435 435 438 438 438 441 441 441 444 FY 2006 LTCH cases 122 83 9 94 54 26 14 17 6 6 6 32 26 5 189 89 14 246 270 680 385 33 9 2 1 1 1 0 0 1 0 2 3 0 7 5 0 2 1 0 23 4 1 98 21 1 48 35 4 251 167 29 117 66 13 71 E:\FEDREG\03MYP2.LOC Proposed relative weight Proposed geometric average length of stay Proposed 5/6ths of the Geometric average length of stay 0.8609 0.7077 0.4800 0.7327 0.6107 0.4401 0.8072 0.8072 0.6513 0.8072 0.6513 0.9337 0.6932 0.6932 0.9293 0.7306 0.6513 0.9179 0.6195 1.0363 0.7624 0.5956 1.6489 1.6489 1.0950 1.6489 1.6489 1.6489 1.0950 1.0950 1.0950 1.0950 1.0950 1.0950 1.6489 1.0950 1.0950 0.8072 0.8072 0.8072 1.0950 0.8072 0.8072 0.6000 0.6000 0.6000 0.7447 0.7039 0.6513 1.0728 0.7538 0.5185 0.7825 0.6893 0.6513 0.8602 22.9 19.7 19.9 22.5 21.7 19.0 24.6 24.6 22.7 24.6 22.7 24.6 22.9 22.9 22.7 22.2 22.7 24.3 20.4 25.6 22.1 19.8 36.5 36.5 30.3 36.5 36.5 36.5 30.3 30.3 30.3 30.3 30.3 30.3 36.5 30.3 30.3 24.6 24.6 24.6 30.3 24.6 24.6 18.7 18.7 18.7 20.2 20.5 22.7 24.3 21.9 19.0 21.8 22.1 22.7 24.0 19.1 16.4 16.6 18.8 18.1 15.8 20.5 20.5 18.9 20.5 18.9 20.5 19.1 19.1 18.9 18.5 18.9 20.3 17.0 21.3 18.4 16.5 30.4 30.4 25.3 30.4 30.4 30.4 25.3 25.3 25.3 25.3 25.3 25.3 30.4 25.3 25.3 20.5 20.5 20.5 25.3 20.5 20.5 15.6 15.6 15.6 16.8 17.1 18.9 20.3 18.3 15.8 18.2 18.4 18.9 20.0 03MYP2 25106 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued Proposed MS–LTC– DRG mmaher on DSK3CLS3C1PROD with $$_JOB 445 446 453 454 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 477 478 479 480 481 482 483 484 485 486 487 488 489 490 491 492 493 .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. VerDate Mar 15 2010 Base MS– LTC–DRG Proposed MS–LTC–DRG description Disorders of the biliary tract w CC ................................................................... Disorders of the biliary tract w/o CC/MCC 1 .................................................... Combined anterior/posterior spinal fusion w MCC 9 ....................................... Combined anterior/posterior spinal fusion w CC 5 .......................................... Combined anterior/posterior spinal fusion w/o CC/MCC 9 .............................. Spinal fusion exc cerv w spinal curv, malig or 9+ fusions w MCC 5 .............. Spinal fusion exc cerv w spinal curv, malig or 9+ fusions w CC 8 ................. Spinal fusion exc cerv w spinal curv, malig or 9+ fusions w/o CC/MCC 9 ..... Spinal fusion except cervical w MCC 5 ........................................................... Spinal fusion except cervical w/o MCC 5 ........................................................ Bilateral or multiple major joint procs of lower extremity w MCC 8 ................. Bilateral or multiple major joint procs of lower extremity w/o MCC 8 .............. Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w MCC .............. Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w CC ................. Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w/o CC/MCC ..... Revision of hip or knee replacement w MCC 5 ............................................... Revision of hip or knee replacement w CC 5 .................................................. Revision of hip or knee replacement w/o CC/MCC 9 ...................................... Major joint replacement or reattachment of lower extremity w MCC 5 ........... Major joint replacement or reattachment of lower extremity w/o MCC 5 ........ Cervical spinal fusion w MCC 5 ....................................................................... Cervical spinal fusion w CC 4 .......................................................................... Cervical spinal fusion w/o CC/MCC 9 .............................................................. Amputation for musculoskeletal sys & conn tissue dis w MCC ...................... Amputation for musculoskeletal sys & conn tissue dis w CC ......................... Amputation for musculoskeletal sys & conn tissue dis w/o CC/MCC 6 .......... Biopsies of musculoskeletal system & connective tissue w MCC 5 ................ Biopsies of musculoskeletal system & connective tissue w CC 4 ................... Biopsies of musculoskeletal system & connective tissue w/o CC/MCC 4 ....... Hip & femur procedures except major joint w MCC 5 ..................................... Hip & femur procedures except major joint w CC 5 ........................................ Hip & femur procedures except major joint w/o CC/MCC 4 ............................ Major joint & limb reattachment proc of upper extremity w CC/MCC 8 .......... Major joint & limb reattachment proc of upper extremity w/o CC/MCC 8 ....... Knee procedures w pdx of infection w MCC 5 ................................................ Knee procedures w pdx of infection w CC 4 ................................................... Knee procedures w pdx of infection w/o CC/MCC 4 ....................................... Knee procedures w/o pdx of infection w CC/MCC 5 ....................................... Knee procedures w/o pdx of infection w/o CC/MCC 9 .................................... Back & neck procedures except spinal fusion w CC/MCC or disc devices 4 Back & neck procedures except spinal fusion w/o CC/MCC 9 ....................... Lower extrem & humer proc except hip, foot, femur w MCC 5 ....................... Lower extrem & humer proc except hip, foot, femur w CC 4 .......................... 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00428 Fmt 4742 Sfmt 4742 444 444 453 453 453 456 456 456 459 459 461 461 463 463 463 466 466 466 469 469 471 471 471 474 474 474 477 477 477 480 480 480 483 483 485 485 485 488 488 490 490 492 492 FY 2006 LTCH cases 39 9 0 1 0 1 0 0 2 3 0 0 506 310 60 3 4 0 2 2 5 2 0 91 52 10 13 14 5 10 19 1 0 0 10 9 1 2 0 7 0 5 18 E:\FEDREG\03MYP2.LOC Proposed relative weight Proposed geometric average length of stay Proposed 5/6ths of the Geometric average length of stay 0.6390 0.4800 1.6489 1.6489 1.6489 1.6489 1.6489 1.6489 1.6489 1.6489 1.6489 1.0950 1.4061 1.0963 0.8588 1.6489 1.6489 1.6489 1.6489 1.6489 1.6489 1.0950 1.0950 1.3850 0.9993 0.9993 1.6489 1.0950 1.0950 1.6489 1.6489 1.0950 1.6489 1.0950 1.6489 1.0950 1.0950 1.6489 1.6489 1.0950 1.0950 1.6489 1.0950 22.2 19.9 36.5 36.5 36.5 36.5 36.5 36.5 36.5 36.5 36.5 30.3 38.7 36.5 28.5 36.5 36.5 36.5 36.5 36.5 36.5 30.3 30.3 36.6 32.7 32.7 36.5 30.3 30.3 36.5 36.5 30.3 36.5 30.3 36.5 30.3 30.3 36.5 36.5 30.3 30.3 36.5 30.3 18.5 16.6 30.4 30.4 30.4 30.4 30.4 30.4 30.4 30.4 30.4 25.3 32.3 30.4 23.8 30.4 30.4 30.4 30.4 30.4 30.4 25.3 25.3 30.5 27.3 27.3 30.4 25.3 25.3 30.4 30.4 25.3 30.4 25.3 30.4 25.3 25.3 30.4 30.4 25.3 25.3 30.4 25.3 03MYP2 25107 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued Proposed MS–LTC– DRG mmaher on DSK3CLS3C1PROD with $$_JOB 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 514 515 516 517 533 534 535 536 537 538 539 540 541 542 543 544 545 546 547 548 549 550 551 552 553 554 555 .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. VerDate Mar 15 2010 Base MS– LTC–DRG Proposed MS–LTC–DRG description Lower extrem & humer proc except hip, foot, femur w/o CC/MCC 3 .............. Local excision & removal int fix devices exc hip & femur w MCC .................. Local excision & removal int fix devices exc hip & femur w CC ..................... Local excision & removal int fix devices exc hip & femur w/o CC/MCC 4 ...... Local excision & removal int fix devices of hip & femur w CC/MCC 5 ............ Local excision & removal int fix devices of hip & femur w/o CC/MCC 2 ......... Soft tissue procedures w MCC ........................................................................ Soft tissue procedures w CC ........................................................................... Soft tissue procedures w/o CC/MCC 3 ............................................................ Foot procedures w MCC 4 ............................................................................... Foot procedures w CC 3 .................................................................................. Foot procedures w/o CC/MCC 1 ...................................................................... Major thumb or joint procedures 8 ................................................................... Major shoulder or elbow joint procedures w CC/MCC 3 ................................. Major shoulder or elbow joint procedures w/o CC/MCC 9 .............................. Arthroscopy 8 ................................................................................................... Shoulder,elbow or forearm proc, exc major joint proc w MCC 9 ..................... Shoulder,elbow or forearm proc, exc major joint proc w CC 4 ........................ Shoulder,elbow or forearm proc, exc major joint proc w/o CC/MCC 1 ........... Hand or wrist proc, except major thumb or joint proc w CC/MCC 5 ............... Hand or wrist proc, except major thumb or joint proc w/o CC/MCC 2 ............ Other musculoskelet sys & conn tiss O.R. proc w MCC ................................. Other musculoskelet sys & conn tiss O.R. proc w CC 4 ................................. Other musculoskelet sys & conn tiss O.R. proc w/o CC/MCC 3 ..................... Fractures of femur w MCC 3 ............................................................................ Fractures of femur w/o MCC 2 ......................................................................... Fractures of hip & pelvis w MCC 2 .................................................................. Fractures of hip & pelvis w/o MCC .................................................................. Sprains, strains, & dislocations of hip, pelvis & thigh w CC/MCC 8 ................ Sprains, strains, & dislocations of hip, pelvis & thigh w/o CC/MCC 8 ............. Osteomyelitis w MCC ....................................................................................... Osteomyelitis w CC .......................................................................................... Osteomyelitis w/o CC/MCC ............................................................................. Pathological fractures & musculoskelet & conn tiss malig w MCC ................. Pathological fractures & musculoskelet & conn tiss malig w CC .................... Pathological fractures & musculoskelet & conn tiss malig w/o CC/MCC 1 ..... Connective tissue disorders w MCC ................................................................ Connective tissue disorders w CC ................................................................... Connective tissue disorders w/o CC/MCC 1 .................................................... Septic arthritis w MCC ..................................................................................... Septic arthritis w CC ........................................................................................ Septic arthritis w/o CC/MCC ............................................................................ Medical back problems w MCC ....................................................................... Medical back problems w/o MCC .................................................................... Bone diseases & arthropathies w MCC 2 ........................................................ Bone diseases & arthropathies w/o MCC ........................................................ Signs & symptoms of musculoskeletal system & conn tissue w MCC 2 ......... 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00429 Fmt 4742 Sfmt 4742 492 495 495 495 498 498 500 500 500 503 503 503 506 507 507 509 510 510 510 513 513 515 515 515 533 533 535 535 537 537 539 539 539 542 542 542 545 545 545 548 548 548 551 551 553 553 555 FY 2006 LTCH cases 2 32 26 3 8 2 46 27 4 18 13 1 0 3 0 0 0 4 1 4 4 48 21 6 3 7 18 34 0 0 932 745 273 56 61 18 58 39 13 166 187 72 109 248 24 66 13 E:\FEDREG\03MYP2.LOC Proposed relative weight Proposed geometric average length of stay Proposed 5/6ths of the Geometric average length of stay 0.8072 1.4142 1.1010 1.0950 1.6489 0.6513 1.3054 1.2940 0.8072 1.0950 0.8072 0.4800 0.6513 0.8072 0.8072 0.4800 1.0950 1.0950 0.4800 1.6489 0.6513 1.3557 1.0950 0.8072 0.8072 0.6513 0.6513 0.5447 0.4800 0.4800 0.9369 0.7697 0.6853 0.7914 0.5904 0.4800 0.9349 0.5510 0.4800 0.9257 0.6862 0.5780 0.8081 0.5575 0.6513 0.4534 0.6513 24.6 38.1 38.3 30.3 36.5 22.7 35.2 30.9 24.6 30.3 24.6 19.9 22.7 24.6 24.6 19.9 30.3 30.3 19.9 36.5 22.7 34.7 30.3 24.6 24.6 22.7 22.7 23.7 19.9 19.9 29.7 28.9 26.4 21.7 21.3 19.9 24.0 20.7 19.9 28.1 26.4 23.6 26.6 22.8 22.7 20.5 22.7 20.5 31.8 31.9 25.3 30.4 18.9 29.3 25.8 20.5 25.3 20.5 16.6 18.9 20.5 20.5 16.6 25.3 25.3 16.6 30.4 18.9 28.9 25.3 20.5 20.5 18.9 18.9 19.8 16.6 16.6 24.8 24.1 22.0 18.1 17.8 16.6 20.0 17.3 16.6 23.4 22.0 19.7 22.2 19.0 18.9 17.1 18.9 03MYP2 25108 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued Proposed MS–LTC– DRG mmaher on DSK3CLS3C1PROD with $$_JOB 556 557 558 559 560 561 562 563 564 565 566 573 574 575 576 577 578 579 580 581 582 583 584 585 592 593 594 595 596 597 598 599 600 601 602 603 604 605 606 607 614 615 616 617 618 619 620 621 .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. VerDate Mar 15 2010 Base MS– LTC–DRG Proposed MS–LTC–DRG description Signs & symptoms of musculoskeletal system & conn tissue w/o MCC 2 ...... Tendonitis, myositis & bursitis w MCC ............................................................ Tendonitis, myositis & bursitis w/o MCC ......................................................... Aftercare, musculoskeletal system & connective tissue w MCC ..................... Aftercare, musculoskeletal system & connective tissue w CC ........................ Aftercare, musculoskeletal system & connective tissue w/o CC/MCC ........... Fx, sprn, strn & disl except femur, hip, pelvis & thigh w MCC 4 ..................... Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o MCC 1 .................. Other musculoskeletal sys & connective tissue diagnoses w MCC ................ Other musculoskeletal sys & connective tissue diagnoses w CC ................... Other musculoskeletal sys & connective tissue diagnoses w/o CC/MCC ...... Skin graft &/or debrid for skn ulcer or cellulitis w MCC .................................. Skin graft &/or debrid for skn ulcer or cellulitis w CC ..................................... Skin graft &/or debrid for skn ulcer or cellulitis w/o CC/MCC ......................... Skin graft &/or debrid exc for skin ulcer or cellulitis w MCC 4 ........................ Skin graft &/or debrid exc for skin ulcer or cellulitis w CC 4 ........................... Skin graft &/or debrid exc for skin ulcer or cellulitis w/o CC/MCC 2 ............... Other skin, subcut tiss & breast proc w MCC ................................................. Other skin, subcut tiss & breast proc w CC .................................................... Other skin, subcut tiss & breast proc w/o CC/MCC ........................................ Mastectomy for malignancy w CC/MCC 5 ....................................................... Mastectomy for malignancy w/o CC/MCC 9 .................................................... Breast biopsy, local excision & other breast procedures w CC/MCC 4 .......... Breast biopsy, local excision & other breast procedures w/o CC/MCC 9 ....... Skin ulcers w MCC .......................................................................................... Skin ulcers w CC ............................................................................................. Skin ulcers w/o CC/MCC ................................................................................. Major skin disorders w MCC ............................................................................ Major skin disorders w/o MCC ......................................................................... Malignant breast disorders w MCC 3 ............................................................... Malignant breast disorders w CC 2, 6 ............................................................... Malignant breast disorders w/o CC/MCC 2, 6 .................................................. Non-malignant breast disorders w CC/MCC 2 ................................................. Non-malignant breast disorders w/o CC/MCC 2 .............................................. Cellulitis w MCC ............................................................................................... Cellulitis w/o MCC ............................................................................................ Trauma to the skin, subcut tiss & breast w MCC 3 ......................................... Trauma to the skin, subcut tiss & breast w/o MCC ......................................... Minor skin disorders w MCC ............................................................................ Minor skin disorders w/o MCC ......................................................................... Adrenal & pituitary proceduresw CC/MCC 8 ................................................... Adrenal & pituitary procedures w/o CC/MCC 8 ............................................... Amputat of lower limb for endocrine,nutrit,& metabol dis w MCC .................. Amputat of lower limb for endocrine,nutrit,& metabol dis w CC ..................... Amputat of lower limb for endocrine,nutrit,& metabol dis w/o CC/MCC 3 ....... O.R. procedures for obesity w MCC 3 ............................................................. O.R. procedures for obesity w CC 3, 6 ............................................................. O.R. procedures for obesity w/o CC/MCC 9 .................................................... 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00430 Fmt 4742 Sfmt 4742 555 557 557 559 559 559 562 562 564 564 564 573 573 573 576 576 576 579 579 579 582 582 584 584 592 592 592 595 595 597 597 597 600 600 602 602 604 604 606 606 614 614 616 616 616 619 619 619 FY 2006 LTCH cases 15 86 113 1,366 1,995 1,074 6 23 240 225 75 1,862 1,898 215 22 24 5 489 414 35 3 0 2 0 2,984 3,110 437 30 54 13 17 4 12 9 757 1,492 23 60 60 84 0 0 62 116 2 2 3 0 E:\FEDREG\03MYP2.LOC Proposed relative weight Proposed geometric average length of stay Proposed 5/6ths of the Geometric average length of stay 0.6513 0.8676 0.6167 0.7654 0.6174 0.5146 1.0950 0.4800 0.8462 0.6991 0.6073 1.3619 1.0731 0.8813 1.0950 1.0950 0.6513 1.3275 1.0027 0.7370 1.6489 1.6489 1.0950 1.0950 0.9267 0.7339 0.6369 0.8062 0.5954 0.8072 0.6513 0.6513 0.6513 0.6513 0.7127 0.5136 0.8072 0.5413 0.8986 0.6120 1.0950 0.4800 1.5681 1.1395 0.8072 0.8072 0.8072 0.8072 22.7 25.9 21.4 26.2 24.7 21.6 30.3 19.9 24.9 25.1 21.6 38.0 37.1 31.6 30.3 30.3 22.7 36.7 34.9 29.7 36.5 36.5 30.3 30.3 27.0 26.8 24.2 24.5 23.9 24.6 22.7 22.7 22.7 22.7 22.4 19.4 24.6 21.5 23.2 22.6 30.3 19.9 41.0 32.9 24.6 24.6 24.6 24.6 18.9 21.6 17.8 21.8 20.6 18.0 25.3 16.6 20.8 20.9 18.0 31.7 30.9 26.3 25.3 25.3 18.9 30.6 29.1 24.8 30.4 30.4 25.3 25.3 22.5 22.3 20.2 20.4 19.9 20.5 18.9 18.9 18.9 18.9 18.7 16.2 20.5 17.9 19.3 18.8 25.3 16.6 34.2 27.4 20.5 20.5 20.5 20.5 03MYP2 25109 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued Proposed MS–LTC– DRG mmaher on DSK3CLS3C1PROD with $$_JOB 622 623 624 625 626 627 628 629 630 637 638 639 640 641 642 643 644 645 652 653 654 655 656 657 658 659 660 661 662 663 664 665 666 667 668 669 670 671 672 673 674 675 682 683 684 685 686 687 688 689 690 691 692 693 694 695 696 697 698 699 700 .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. VerDate Mar 15 2010 Base MS– LTC–DRG Proposed MS–LTC–DRG description Skin grafts & wound debrid for endoc, nutrit & metab dis w MCC ................. Skin grafts & wound debrid for endoc, nutrit & metab dis w CC .................... Skin grafts & wound debrid for endoc, nutrit & metab dis w/o CC/MCC 3 ..... Thyroid, parathyroid & thyroglossal procedures w MCC 8 .............................. Thyroid, parathyroid & thyroglossal procedures w CC 8 ................................. Thyroid, parathyroid & thyroglossal procedures w/o CC/MCC 8 ..................... Other endocrine, nutrit & metab O.R. proc w MCC ........................................ Other endocrine, nutrit & metab O.R. proc w CC ........................................... Other endocrine, nutrit & metab O.R. proc w/o CC/MCC 1 ............................ Diabetes w MCC .............................................................................................. Diabetes w CC ................................................................................................. Diabetes w/o CC/MCC ..................................................................................... Nutritional & misc metabolic disorders w MCC ............................................... Nutritional & misc metabolic disorders w/o MCC ............................................ Inborn errors of metabolism 2 .......................................................................... Endocrine disorders w MCC ............................................................................ Endocrine disorders w CC 3 ............................................................................ Endocrine disorders w/o CC/MCC 1 ................................................................ Kidney transplant 7 ........................................................................................... Major bladder procedures w MCC 8 ................................................................ Major bladder procedures w CC 8 ................................................................... Major bladder procedures w/o CC/MCC 8 ....................................................... Kidney & ureter procedures for neoplasm w MCC 9 ....................................... Kidney & ureter procedures forneoplasm w CC 3 ........................................... Kidney & ureter procedures for neoplasm w/o CC/MCC 9 .............................. Kidney & ureter procedures for non-neoplasm w MCC 4 ................................ Kidney & ureter procedures for non-neoplasm w CC2 ................................... Kidney & ureter procedures for non-neoplasm w/o CC/MCC 1 ...................... Minor bladder procedures w MCC 3 ................................................................ Minor bladder procedures w CC9 .................................................................... Minor bladder procedures w/o CC/MCC 5 ....................................................... Prostatectomy w MCC 3 .................................................................................. Prostatectomy w CC 8 ..................................................................................... Prostatectomy w/o CC/MCC 3 ......................................................................... Transurethral procedures w MCC 5 ................................................................. Transurethral procedures w CC 5 .................................................................... Transurethral procedures w/o CC/MCC 5 ........................................................ Urethral procedures w CC/MCC 8 ................................................................... Urethral procedures w/o CC/MCC 8 ................................................................ Other kidney & urinary tract procedures w MCC ............................................ Other kidney & urinary tract procedures w CC ............................................... Other kidney & urinary tract procedures w/o CC/MCC 4 ................................ Renal failure w MCC ........................................................................................ Renal failure w CC ........................................................................................... Renal failure w/o CC/MCC ............................................................................... Admit for renal dialysis ..................................................................................... Kidney & urinary tract neoplasms w MCC ....................................................... Kidney & urinary tract neoplasms w CC2 ........................................................ Kidney & urinary tract neoplasms w/o CC/MCC 1 ........................................... Kidney & urinary tract infections w MCC ......................................................... Kidney & urinary tract infections w/o MCC ...................................................... Urinary stones w esw lithotripsy w CC/MCC 5 ................................................ Urinary stones w esw lithotripsy w/o CC/MCC 9 ............................................. Urinary stones w/o esw lithotripsy w MCC 2 ................................................... Urinary stones w/ot esw lithotripsy w/o MCC 2, 6 ............................................ Kidney & urinary tract signs & symptoms w MCC 3 ........................................ Kidney & urinary tract signs & symptoms w/o MCC 1 ..................................... Urethral stricture 8 ............................................................................................ Other kidney & urinary tract diagnoses w MCC .............................................. Other kidney & urinary tract diagnoses w CC ................................................. Other kidney & urinary tract diagnoses w CC ................................................. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00431 Fmt 4742 Sfmt 4742 622 622 622 625 625 625 628 628 628 637 637 637 640 640 642 643 643 643 652 653 653 653 656 656 656 659 659 659 662 662 662 665 665 665 668 668 668 671 671 673 673 673 682 682 682 685 686 686 686 689 689 691 691 693 693 695 695 697 698 698 698 FY 2006 LTCH cases 165 338 15 0 0 0 52 88 5 363 1,041 114 606 620 4 27 18 6 0 0 0 0 0 1 0 9 4 1 2 0 1 2 0 1 8 5 1 0 0 226 87 13 1,334 726 184 50 31 17 3 760 727 4 0 16 12 4 1 0 270 155 52 E:\FEDREG\03MYP2.LOC Proposed relative weight Proposed geometric average length of stay Proposed 5/6ths of the Geometric average length of stay 1.2199 0.9703 0.8072 1.6489 1.0950 0.4800 1.4033 1.1143 0.4800 0.8347 0.6491 0.5241 0.8190 0.6364 0.6513 0.8880 0.8072 0.4800 0.0000 1.0950 0.6513 0.4800 0.8072 0.8072 0.8072 1.0950 0.6513 0.4800 0.8072 0.8072 1.6489 0.8072 0.8072 0.8072 1.6489 1.6489 1.6489 0.6513 0.4800 1.3376 1.1684 1.0950 0.8784 0.7271 0.5951 0.7543 0.9234 0.6513 0.4800 0.6796 0.5158 1.6489 1.6489 0.6513 0.6513 0.8072 0.4800 0.4800 0.8112 0.7032 0.5387 35.6 32.2 24.6 36.5 30.3 19.9 35.9 33.3 19.9 25.8 24.1 20.1 23.2 22.0 22.7 27.3 24.6 19.9 0.0 30.3 22.7 19.9 24.6 24.6 24.6 30.3 22.7 19.9 24.6 24.6 36.5 24.6 24.6 24.6 36.5 36.5 36.5 22.7 19.9 33.5 30.6 30.3 23.6 21.9 20.1 25.9 23.6 22.7 19.9 22.8 20.2 36.5 36.5 22.7 22.7 24.6 19.9 19.9 22.7 22.2 20.2 29.7 26.8 20.5 30.4 25.3 16.6 29.9 27.8 16.6 21.5 20.1 16.8 19.3 18.3 18.9 22.8 20.5 16.6 0.0 25.3 18.9 16.6 20.5 20.5 20.5 25.3 18.9 16.6 20.5 20.5 30.4 20.5 20.5 20.5 30.4 30.4 30.4 18.9 16.6 27.9 25.5 25.3 19.7 18.3 16.8 21.6 19.7 18.9 16.6 19.0 16.8 30.4 30.4 18.9 18.9 20.5 16.6 16.6 18.9 18.5 16.8 03MYP2 25110 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued Proposed MS–LTC– DRG mmaher on DSK3CLS3C1PROD with $$_JOB 707 708 709 710 711 712 713 714 715 716 717 718 722 723 724 725 726 727 728 729 730 734 735 736 737 738 739 740 741 742 743 744 745 746 747 748 749 750 754 755 756 757 758 759 760 761 765 .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. VerDate Mar 15 2010 Base MS– LTC–DRG Proposed MS–LTC–DRG description Major male pelvic procedures w CC/MCC 8 .................................................... Major male pelvic procedures w/o CC/MCC 8 ................................................. Penis procedures w CC/MCC 4 ....................................................................... Penis procedures w/o CC/MCC 9 .................................................................... Testes procedures w CC/MCC 4, 6 .................................................................. Testes procedures w/o CC/MCC 4, 6 ............................................................... Transurethral prostatectomy w CC/MCC 5 ...................................................... Transurethral prostatectomy w/o CC/MCC 1 ................................................... Other male reproductive system O.R. proc for malignancy w CC/MCC 5 ...... Other male reproductive system O.R. proc for malignancy w/o CC/MCC 9 ... Other male reproductive system O.R. proc exc malignancy w CC/MCC 4 ..... Other male reproductive system O.R. proc exc malignancy w/o CC/MCC 1 .. Malignancy, male reproductive system w MCC 3 ............................................ Malignancy, male reproductive system w CC2 ............................................... Malignancy, male reproductive system w/o CC/MCC 1 .................................. Benign prostatic hypertrophy w MCC 4 ........................................................... Benign prostatic hypertrophy w/o MCC 1 ........................................................ Inflammation of the male reproductive system w MCC ................................... Inflammation of the male reproductive system w/o MCC ................................ Other male reproductive system diagnoses w CC/MCC ................................. Other male reproductive system diagnoses w/o CC/MCC 2 ........................... Pelvic evisceration, rad hysterectomy & rad vulvectomy w CC/MCC 8 .......... Pelvic evisceration, rad hysterectomy & rad vulvectomy w/o CC/MCC 8 ....... Uterine & adnexa proc for ovarian or adnexal malignancy w MCC 8 ............. Uterine & adnexa proc for ovarian or adnexal malignancy w CC 8 ................ Uterine & adnexa proc for ovarian or adnexal malignancy w/o CC/MCC 8 .... Uterine, adnexa proc for non-ovarian/adnexal malig w MCC 8 ....................... Uterine, adnexa proc for non-ovarian/adnexal malig w CC 8 .......................... Uterine, adnexa proc for non-ovarian/adnexal malig w/o CC/MCC 8 ............. Uterine & adnexa proc for non-malignancy w CC/MCC 8 ............................... Uterine & adnexa proc for non-malignancy w/o CC/MCC 8 ............................ D&C, conization, laparascopy & tubal interruption w CC/MCC 2 .................... D&C, conization, laparascopy & tubal interruption w/o CC/MCC 9 ................. Vagina, cervix & vulva procedures w CC/MCC 3 ............................................ Vagina, cervix & vulva procedures w/o CC/MCC 9 ......................................... Female reproductive system reconstructive procedures 8 .............................. Other female reproductive system O.R. procedures w CC/MCC 3 ................. Other female reproductive system O.R. procedures w/o CC/MCC 9 .............. Malignancy, female reproductive system w MCC 4 ......................................... Malignancy, female reproductive system w CC 3 ............................................ Malignancy, female reproductive system w/o CC/MCC 1 ............................... Infections, female reproductive system w MCC .............................................. Infections, female reproductive system w CC ................................................. Infections, female reproductive system w/o CC/MCC 1 .................................. Menstrual & other female reproductive system disorders w CC/MCC 4 ......... Menstrual & other female reproductive system disorders w/o CC/MCC 1 ...... Cesarean section w CC/MCC 8 ....................................................................... 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00432 Fmt 4742 Sfmt 4742 707 707 709 709 711 711 713 713 715 715 717 717 722 722 722 725 725 727 727 729 729 734 734 736 736 736 739 739 739 742 742 744 744 746 746 748 749 749 754 754 754 757 757 757 760 760 765 FY 2006 LTCH cases 0 0 6 0 7 1 1 1 1 0 17 2 12 7 2 2 3 37 57 34 2 0 0 0 0 0 0 0 0 0 0 1 0 3 0 0 3 0 14 15 1 29 25 5 3 1 0 E:\FEDREG\03MYP2.LOC Proposed relative weight Proposed geometric average length of stay Proposed 5/6ths of the Geometric average length of stay 0.6513 0.4800 1.0950 1.0950 1.0950 1.0950 1.6489 0.4800 1.6489 1.6489 1.0950 0.4800 0.8072 0.6513 0.4800 1.0950 0.4800 0.8768 0.5605 1.0242 0.6513 1.0950 0.4800 1.0950 0.8072 0.4800 1.0950 0.8072 0.4800 0.8072 0.4800 0.6513 0.6513 0.8072 0.8072 0.8072 0.8072 0.8072 1.0950 0.8072 0.4800 0.8441 0.8274 0.4800 1.0950 0.4800 0.6513 22.7 19.9 30.3 30.3 30.3 30.3 36.5 19.9 36.5 36.5 30.3 19.9 24.6 22.7 19.9 30.3 19.9 25.9 20.9 26.6 22.7 30.3 19.9 30.3 24.6 19.9 30.3 24.6 19.9 24.6 19.9 22.7 22.7 24.6 24.6 24.6 24.6 24.6 30.3 24.6 19.9 22.6 27.2 19.9 30.3 19.9 22.7 18.9 16.6 25.3 25.3 25.3 25.3 30.4 16.6 30.4 30.4 25.3 16.6 20.5 18.9 16.6 25.3 16.6 21.6 17.4 22.2 18.9 25.3 16.6 25.3 20.5 16.6 25.3 20.5 16.6 20.5 16.6 18.9 18.9 20.5 20.5 20.5 20.5 20.5 25.3 20.5 16.6 18.8 22.7 16.6 25.3 16.6 18.9 03MYP2 25111 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued Proposed MS–LTC– DRG mmaher on DSK3CLS3C1PROD with $$_JOB 766 767 768 769 770 774 775 776 777 778 779 780 781 782 789 790 791 792 793 794 795 799 800 801 802 803 804 808 809 810 811 812 813 814 815 816 820 821 822 823 824 825 826 827 828 829 830 .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. VerDate Mar 15 2010 Base MS– LTC–DRG Proposed MS–LTC–DRG description Cesarean section w/o CC/MCC 8 .................................................................... Vaginal delivery w sterilization &/or D&C8 ...................................................... Vaginal delivery w O.R. proc except steril &/or D&C8 .................................... Postpartum & post abortion diagnoses w O.R. procedure 2 ........................... Abortion w D&C, aspiration curettage or hysterotomy 8 ................................. Vaginal delivery w complicating diagnoses 8 .................................................. Vaginal delivery w/o complicating diagnoses 8 ............................................... Postpartum & post abortion diagnoses w/o O.R. procedure 4 ........................ Ectopic pregnancy 8 ......................................................................................... Threatened abortion 8 ...................................................................................... Abortion w/o D&C 8 .......................................................................................... False labor 8 ..................................................................................................... Other antepartum diagnoses w medical complications 4 ................................ Other antepartum diagnoses w/o medical complications 8 ............................. Neonates, died or transferred to another acute care facility 8 ........................ Extreme immaturity or respiratory distress syndrome, neonate 8 ................... Prematurity w major problems 8 ...................................................................... Prematurity w/o major problems 8 ................................................................... Full term neonate w major problems 8 ............................................................ Neonate w other significant problems 8 ........................................................... Normal newborn 8 ............................................................................................ Splenectomy w MCC 8 ..................................................................................... Splenectomy w CC 8 ........................................................................................ Splenectomy w/o CC/MCC 8 ........................................................................... Other O.R. proc of the blood & blood forming organs w MCC 5 .................... Other O.R. proc of the blood & blood forming organs w CC2 ........................ Other O.R. proc of the blood & blood forming organs w/o CC/MCC 9 ........... Major hematol/immun diag exc sickle cell crisis & coagul w MCC ................. Major hematol/immun diag exc sickle cell crisis & coagul w CC 3 ................. Major hematol/immun diag exc sickle cell crisis & coagul w/o CC/MCC 3 ..... Red blood cell disorders w MCC ..................................................................... Red blood cell disorders w/o MCC .................................................................. Coagulation disorders ...................................................................................... Reticuloendothelial & immunity disorders w MCC ........................................... Reticuloendothelial & immunity disorders w CC2 ............................................ Reticuloendothelial & immunity disorders w/o CC/MCC 2, 6 ............................ Lymphoma & leukemia w major O.R. procedure w MCC 9 ............................ Lymphoma & leukemia w major O.R. procedure w CC 3 ............................... Lymphoma & leukemia w major O.R. procedure w/o CC/MCC 9 ................... Lymphoma & non-acute leukemia w other O.R. proc w MCC 4 ..................... Lymphoma & non-acute leukemia w other O.R. proc w CC 4 ........................ Lymphoma & non-acute leukemia w other O.R. proc w/o CC/MCC 1 ............ Myeloprolif disord or poorly diff neopl w maj O.R. proc w MCC 3 .................. Myeloprolif disord or poorly diff neopl w maj O.R. proc w CC 8 ..................... Myeloprolif disord or poorly diff neopl w maj O.R. proc w/o CC/MCC ? ......... Myeloprolif disord or poorly diff neopl w other O.R. proc w CC/MCC 5 .......... Myeloprolif disord or poorly diff neopl w other O.R. proc w/o CC/MCC 9 ....... 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00433 Fmt 4742 Sfmt 4742 765 767 768 769 770 774 775 776 777 778 779 780 781 782 789 790 791 792 793 794 795 799 799 799 802 802 802 808 808 808 811 811 813 814 814 814 820 820 820 823 823 823 826 826 826 829 829 FY 2006 LTCH cases 0 0 0 1 0 0 0 3 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 7 3 0 26 24 3 35 48 49 40 17 6 0 2 0 12 3 1 1 0 0 9 0 E:\FEDREG\03MYP2.LOC Proposed relative weight Proposed geometric average length of stay Proposed 5/6ths of the Geometric average length of stay 0.6513 0.6513 0.6513 0.6513 0.6513 0.6513 0.6513 1.0950 0.6513 0.4800 0.4800 0.4800 1.0950 0.4800 0.4800 0.4800 1.0950 0.4800 1.0950 1.0950 0.4800 1.0950 0.8072 0.8072 1.6489 0.6513 0.6513 0.8185 0.8072 0.8072 0.6773 0.5210 0.7876 0.7805 0.6513 0.6513 0.8072 0.8072 0.8072 1.0950 1.0950 0.4800 0.8072 0.8072 0.8072 1.6489 1.6489 22.7 22.7 22.7 22.7 22.7 22.7 22.7 30.3 22.7 19.9 19.9 19.9 30.3 19.9 19.9 19.9 30.3 19.9 30.3 30.3 19.9 30.3 24.6 24.6 36.5 22.7 22.7 22.7 24.6 24.6 22.8 19.5 21.5 22.6 22.7 22.7 24.6 24.6 24.6 30.3 30.3 19.9 24.6 24.6 24.6 36.5 36.5 18.9 18.9 18.9 18.9 18.9 18.9 18.9 25.3 18.9 16.6 16.6 16.6 25.3 16.6 16.6 16.6 25.3 16.6 25.3 25.3 16.6 25.3 20.5 20.5 30.4 18.9 18.9 18.9 20.5 20.5 19.0 16.3 17.9 18.8 18.9 18.9 20.5 20.5 20.5 25.3 25.3 16.6 20.5 20.5 20.5 30.4 30.4 03MYP2 25112 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued Proposed MS–LTC– DRG .............. .............. .............. .............. .............. .............. 840 841 842 843 844 845 846 847 848 849 853 854 855 856 857 858 862 863 864 865 866 867 868 869 870 871 872 876 880 881 882 883 884 885 886 887 894 895 896 897 901 902 903 904 905 mmaher on DSK3CLS3C1PROD with $$_JOB 834 835 836 837 838 839 .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. VerDate Mar 15 2010 Base MS– LTC–DRG Proposed MS–LTC–DRG description Acute leukemia w/o major O.R. procedure w MCC 3 ...................................... Acute leukemia w/o major O.R. procedure w CC 3 ......................................... Acute leukemia w/o major O.R. procedure w/o CC/MCC 1 ............................ Chemo w acute leukemia as sdxor w high dose chemo agent w MCC 5 ....... Chemo w acute leukemia as sdx or w high dose chemo agent w CC 3 ........ Chemo w acute leukemia as sdx or w high dose chemo agent w/o CC/MCC 9. Lymphoma & non-acute leukemia w MCC ENT≤840 ...................................... Lymphoma & non-acute leukemia w CC ......................................................... Lymphoma & non-acute leukemia w/o CC/MCC 2 .......................................... Other myeloprolif dis or poorly diff neopl diag w MCC 4, 6 .............................. Other myeloprolif dis or poorly diff neopl diag w CC 4, 6 ................................. Other myeloprolif dis or poorly diff neopl diag w/o CC/MCC 4, 6 .................... Chemotherapy w/o acute leukemia as secondary diagnosis w MCC ............. Chemotherapy w/o acute leukemia as secondary diagnosis w CC ................ Chemotherapy w/o acute leukemia as secondary diagnosis w/o CC/MCC 2 Radiotherapy .................................................................................................... Infectious & parasitic diseases w O.R. procedure w MCC ............................. Infectious & parasitic diseases w O.R. procedure w CC ................................ Infectious & parasitic diseases w O.R. procedure w/o CC/MCC 3 ................. Postoperative or post-traumatic infections w O.R. proc w MCC ..................... Postoperative or post-traumatic infections w O.R. proc w CC ........................ Postoperative or post-traumatic infections w O.R. proc w/o CC/MCC ............ Postoperative & post-traumatic infections w MCC .......................................... Postoperative & post-traumatic infections w/o MCC ....................................... Fever of unknown origin 2 ................................................................................ Viral illness w MCC .......................................................................................... Viral illness w/o MCC ....................................................................................... Other infectious & parasitic diseases diagnoses w MCC ................................ Other infectious & parasitic diseases diagnoses w CC ................................... Other infectious & parasitic diseases diagnoses w/o CC/MCC 1 .................... Septicemia w MV 96+ hours ............................................................................ Septicemia w/o MV 96+ hours w MCC ............................................................ Septicemia w/o MV 96+ hours w/o MCC ......................................................... O.R. procedure w principal diagnoses of mental illness 1 .............................. Acute adjustment reaction & psychosocial dysfunction 4 ................................ Depressive neuroses 1 ..................................................................................... Neuroses except depressive 1 ......................................................................... Disorders of personality & impulse control 1 ................................................... Organic disturbances & mental retardation ..................................................... Psychoses ........................................................................................................ Behavioral & developmental disorders 1 ......................................................... Other mental disorder diagnoses 8 .................................................................. Alcohol/drug abuse or dependence, left ama 1 ............................................... Alcohol/drug abuse or dependence w rehabilitation therapy 1 ........................ Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC 3 ....... Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC 2 .... Wound debridements for injuries w MCC ........................................................ Wound debridements for injuries w CC ........................................................... Wound debridements for injuries w/o CC/MCC 2 ............................................ Skin grafts for injuries w CC/MCC ................................................................... Skin grafts for injuries w/o CC/MCC 2 ............................................................. 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00434 Fmt 4742 Sfmt 4742 FY 2006 LTCH cases Proposed relative weight Proposed geometric average length of stay Proposed 5/6ths of the Geometric average length of stay 834 834 834 837 837 837 20 3 1 1 2 0 0.8072 0.8072 0.4800 1.6489 0.8072 0.8072 24.6 24.6 19.9 36.5 24.6 24.6 20.5 20.5 16.6 30.4 20.5 20.5 174 840 840 843 843 843 846 846 846 849 853 853 853 856 856 856 862 862 864 865 865 867 867 867 870 871 871 876 880 881 882 883 884 885 886 887 894 895 896 896 901 901 901 904 904 0.8758 65 11 19 13 3 31 61 1 141 698 94 3 338 230 30 1,172 1,298 16 56 33 293 80 11 585 3,871 1,532 5 21 15 16 15 201 1,386 18 0 1 1 10 24 222 159 23 87 8 20.8 0.7405 0.6513 1.0950 1.0950 1.0950 1.8155 1.3078 0.6513 0.8756 1.7901 1.1472 0.8072 1.5473 1.0438 0.8873 0.9120 0.6802 0.6513 0.8213 0.5498 1.1329 0.7220 0.4800 1.9084 0.8437 0.6551 0.4800 1.0950 0.4800 0.4800 0.4800 0.4785 0.4066 0.4800 0.4800 0.4800 0.4800 0.8072 0.6513 1.4003 1.0434 0.6513 1.3377 0.6513 17.3 20.1 22.7 30.3 30.3 30.3 37.9 27.6 22.7 23.5 38.1 31.0 24.6 36.2 31.6 27.9 25.1 23.4 22.7 21.8 21.2 23.6 22.0 19.9 30.4 23.5 21.8 19.9 30.3 19.9 19.9 19.9 23.2 23.7 19.9 19.9 19.9 19.9 24.6 22.7 35.2 33.4 22.7 40.7 22.7 16.8 18.9 25.3 25.3 25.3 31.6 23.0 18.9 19.6 31.8 25.8 20.5 30.2 26.3 23.3 20.9 19.5 18.9 18.2 17.7 19.7 18.3 16.6 25.3 19.6 18.2 16.6 25.3 16.6 16.6 16.6 19.3 19.8 16.6 16.6 16.6 16.6 20.5 18.9 29.3 27.8 18.9 33.9 18.9 E:\FEDREG\03MYP2.LOC 03MYP2 25113 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued Proposed MS–LTC– DRG mmaher on DSK3CLS3C1PROD with $$_JOB 906 907 908 909 913 914 915 916 917 918 919 920 921 922 923 927 928 929 933 934 935 939 940 941 945 946 947 948 949 950 951 955 956 957 958 959 963 964 965 969 970 974 975 976 977 981 982 983 984 985 986 .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. .............. VerDate Mar 15 2010 Base MS– LTC–DRG Proposed MS–LTC–DRG description Hand procedures for injuries 1 ......................................................................... Other O.R. procedures for injuries w MCC ..................................................... Other O.R. procedures for injuries w CC ........................................................ Other O.R. procedures for injuries w/o CC/MCC 4 ......................................... Traumatic injury w MCC .................................................................................. Traumatic injury w/o MCC ............................................................................... Allergic reactions w MCC 9 .............................................................................. Allergic reactions w/o MCC 1 ........................................................................... Poisoning & toxic effects of drugs w MCC 2 ................................................... Poisoning & toxic effects of drugs w/o MCC 2 ................................................ Complications of treatment w MCC ................................................................. Complications of treatment w CC .................................................................... Complications of treatment w/o CC/MCC ........................................................ Other injury, poisoning & toxic effect diag w MCC 1 ....................................... Other injury, poisoning & toxic effect diag w/o MCC 1 .................................... Extensive burns or full thickness burns w MV 96+ hrs w skin graft 8 ............. Full thickness burn w skin graft or inhal inj w CC/MCC 4 ............................... Full thickness burn w skin graft or inhal inj w/o CC/MCC 2 ............................ Extensive burns or full thickness burns w MV 96+ hrs w/o skin graft 4 .......... Full thickness burn w/o skin grft or inhal inj .................................................... Non-extensive burns ........................................................................................ O.R. proc w diagnoses of other contact w health services w MCC ................ O.R. proc w diagnoses of other contact w health services w CC ................... O.R. proc w diagnoses of other contact w health services w/o CC/MCC ...... Rehabilitation w CC/MCC ................................................................................ Rehabilitation w/o CC/MCC ............................................................................. Signs & symptoms w MCC .............................................................................. Signs & symptoms w/o MCC ........................................................................... Aftercare w CC/MCC ....................................................................................... Aftercare w/o CC/MCC .................................................................................... Other factors influencing health status ............................................................ Craniotomy for multiple significant trauma 8 .................................................... Limb reattachment, hip & femur proc for multiple significant trauma 2 ........... Other O.R. procedures for multiple significant trauma w MCC 5 .................... Other O.R. procedures for multiple significant trauma w CC 4 ....................... Other O.R. procedures for multiple significant trauma w/o CC/MCC 9 ........... Other multiple significant trauma w MCC 3 ..................................................... Other multiple significant trauma w CC 2 ........................................................ Other multiple significant trauma w/o CC/MCC 2 ............................................ HIV w extensive O.R. procedure w MCC 5 ..................................................... HIV w extensive O.R. procedure w/o MCC 5 .................................................. HIV w major related condition w MCC ............................................................ HIV w major related condition w CC ............................................................... HIV w major related condition w/o CC/MCC ................................................... HIV w or w/o other related condition 2 ............................................................ Extensive O.R. procedure unrelated to principal diagnosis w MCC ............... Extensive O.R. procedure unrelated to principal diagnosis w CC .................. Extensive O.R. procedure unrelated to principal diagnosis w/o CC/MCC 4 ... Prostatic O.R. procedure unrelated to principal diagnosis w MCC 5 .............. Prostatic O.R. procedure unrelated to principal diagnosis w CC 4 ................. Prostatic O.R. procedure unrelated to principal diagnosis w/o CC/MCC 4 ..... 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00435 Fmt 4742 Sfmt 4742 906 907 907 907 913 913 915 915 917 917 919 919 919 922 922 927 928 928 933 934 935 939 939 939 945 945 947 947 949 949 951 955 956 957 957 957 963 963 963 969 969 974 974 974 977 981 981 981 984 984 984 FY 2006 LTCH cases 1 85 44 7 50 70 0 1 7 6 1,066 811 113 5 9 0 10 1 7 48 40 378 210 38 2,173 527 88 168 4,486 839 38 0 1 3 1 0 12 9 3 7 3 160 70 43 21 1,065 279 24 14 13 1 E:\FEDREG\03MYP2.LOC Proposed relative weight Proposed geometric average length of stay Proposed 5/6ths of the Geometric average length of stay 0.4800 1.7294 1.1963 1.0950 0.9333 0.5330 0.4800 0.4800 0.6513 0.6513 1.0291 0.7703 0.6374 0.4800 0.4800 1.0950 1.0950 0.6513 1.0950 0.6866 0.7294 1.2925 1.0280 0.7470 0.5928 0.4271 0.6459 0.5300 0.6728 0.4847 1.2107 1.6489 0.6513 1.6489 1.0950 1.0950 0.8072 0.6513 0.6513 1.6489 1.6489 0.9279 0.6707 0.6703 0.6513 2.2695 1.4994 1.0950 1.6489 1.0950 1.0950 19.9 36.8 34.2 30.3 26.8 21.3 19.9 19.9 22.7 22.7 26.2 24.6 22.6 19.9 19.9 30.3 30.3 22.7 30.3 24.2 24.9 33.8 33.9 28.9 22.3 18.9 22.8 23.5 22.1 18.5 24.0 36.5 22.7 36.5 30.3 30.3 24.6 22.7 22.7 36.5 36.5 21.8 20.7 19.2 22.7 41.8 37.8 30.3 36.5 30.3 30.3 16.6 30.7 28.5 25.3 22.3 17.8 16.6 16.6 18.9 18.9 21.8 20.5 18.8 16.6 16.6 25.3 25.3 18.9 25.3 20.2 20.8 28.2 28.3 24.1 18.6 15.8 19.0 19.6 18.4 15.4 20.0 30.4 18.9 30.4 25.3 25.3 20.5 18.9 18.9 30.4 30.4 18.2 17.3 16.0 18.9 34.8 31.5 25.3 30.4 25.3 25.3 03MYP2 25114 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE 11.—PROPOSED FY 2008 MS–LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/ 6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued Proposed MS–LTC– DRG 987 988 989 998 999 .............. .............. .............. .............. .............. Base MS– LTC–DRG Proposed MS–LTC–DRG description Non-extensive O.R. proc unrelated to principal diagnosis w MCC ................. Non-extensive O.R. proc unrelated to principal diagnosis w CC .................... Non-extensive O.R. proc unrelated to principal diagnosis w/o CC/MCC 3 ..... Ungroupable 7 .................................................................................................. Principal diagnosis invalid as discharge diagnosis 7 ....................................... 987 987 987 998 999 FY 2006 LTCH cases 391 182 21 0 0 Proposed relative weight Proposed geometric average length of stay Proposed 5/6ths of the Geometric average length of stay 1.8112 1.0902 0.8072 0.0000 0.0000 37.9 33.0 24.6 0.0 0.0 31.6 27.5 20.5 0.0 0.0 1 Proposed relative weights for these proposed MS-LTC-DRGs were determined by assigning these cases to proposed low-volume quintile 1. Proposed relative weights for these proposed MS–LTC–DRGs were determined by assigning these cases to proposed low-volume quintile 2. Proposed relative weights for these proposed MS–LTC–DRGs were determined by assigning these cases to proposed low-volume quintile 3. Proposed relative weights for these proposed MS–LTC–DRGs were determined by assigning these cases to proposed low-volume quintile 4. 5 Proposed relative weights for these proposed MS–LTC–DRGs were determined by assigning these cases to proposed low-volume quintile 5. 6 Proposed relative weights for these proposed MS–LTC–DRGs were determined after adjusting to account for nonmonotonicity (see step 4 in section II.I.4. of the Addendum of this proposed rule). 7 Proposed relative weights for these proposed MS–LTC–DRGs were assigned a proposed relative weight of 0.0000. 8 Proposed relative weights for these proposed MS–LTC–DRGs were determined by cross-walking these cases to the appropriate proposed MS–LTC–DRG and then assigning them to the appropriate proposed low volume quintile because they had no LTCH cases in the FY 2006 MedPAR file (see step 5 in section II.I.4 of the Addendum of this proposed rule). 9 Proposed relative weights for these proposed MS–LTC–DRGs were determined by combining with its base MS–LTC–DRG because they had no LTCH cases in the FY 2006 MedPAR file (see step 5 in section II.I.4 of the Addendum of this proposed rule). 2 3 4 mmaher on DSK3CLS3C1PROD with $$_JOB Appendix A—Regulatory Impact Analysis I. Overall Impact We have examined the impacts of this proposed rule as required by Executive Order 12866 (September 1993, Regulatory Planning and Review) and the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96– 354), section 1102(b) of the Social Security Act, the Unfunded Mandates Reform Act of 1995 (Pub. L. 104–4), and Executive Order 13132. Executive Order 12866 (as amended by Executive Order 13258, which merely reassigns responsibility of duties) directs agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year). We have determined that this rule is a major rule as defined in 5 U.S.C. 804(2). We estimate that the proposed changes for FY 2008 operating and capital payments will redistribute in excess of $100 million among different types of inpatient cases. The market basket update to the IPPS rates required by the statute, in conjunction with other proposed payment changes in this proposed rule, would result in an approximate $3.3 billion increase in FY 2008 operating and capital payments. This amount does not reflect changes in hospital admissions or case-mix intensity in operating PPS payments, which would also affect overall payment changes. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 The RFA requires agencies to analyze options for regulatory relief of small businesses. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and government agencies. Most hospitals and most other providers and suppliers are considered to be small entities, either by nonprofit status or by having revenues of $31 million in any 1 year. (For details on the latest standards for health care providers, we refer readers to the Small Business Administration Web site at: https:// sba.gov/idc/ groups/pubic/documents/sba— homepage/serv—sstd—tablepdf.pdf.) For purposes of the RFA, all hospitals and other providers and suppliers are considered to be small entities. Individuals and States are not included in the definition of a small entity. We believe that this proposed rule will have a significant impact on small entities as explained in this Appendix. Because we acknowledge that many of the affected entities are small entities, the analysis discussed throughout the preamble of this proposed rule constitutes our initial regulatory flexibility analysis. Therefore, we are soliciting comments on our estimates and analysis of the impact of the proposed rule on those small entities. In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis for any proposed rule that may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 603 of the RFA. With the exception of hospitals located in certain New England counties, for purposes of section 1102(b) of the Act, we previously defined a small rural hospital as a hospital with fewer than 100 beds that is located outside of a Metropolitan Statistical Area (MSA) or New England County Metropolitan Area (NECMA). However, under the current labor market PO 00000 Frm 00436 Fmt 4742 Sfmt 4702 definitions, we no longer employ NECMAs to define urban areas in New England. Therefore, we now define a small rural hospital as a hospital that is located outside of an MSA and has fewer than 100 beds. Section 601(g) of the Social Security Amendments of 1983 (Pub. L. 98–21) designated hospitals in certain New England counties as belonging to the adjacent NECMA. Thus, for purposes of the IPPS, we continue to classify these hospitals as urban hospitals. Section 202 of the Unfunded Mandates Reform Act of 1995 (Pub. L. 104–4) also requires that agencies assess anticipated costs and benefits before issuing any rule whose mandates require spending in any 1 year of $100 million in 1995 dollars, updated annually for inflation. That threshold level is currently approximately $120 million. This proposed rule will not mandate any requirements for State, local, or tribal governments, nor will it affect private sector costs. Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on State and local governments, preempts State law, or otherwise has Federalism implications. As stated above, this proposed rule would not have a substantial effect on State and local governments. The following analysis, in conjunction with the remainder of this document, demonstrates that this rule is consistent with the regulatory philosophy and principles identified in Executive Order 12866, the RFA, and section 1102(b) of the Act. The rule will affect payments to a substantial number of small rural hospitals, as well as other classes of hospitals, and the effects on some hospitals may be significant. E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules II. Objectives The primary objective of the IPPS is to create incentives for hospitals to operate efficiently and minimize unnecessary costs while at the same time ensuring that payments are sufficient to adequately compensate hospitals for their legitimate costs. In addition, we share national goals of preserving the Medicare Hospital Insurance Trust Fund. We believe the proposed changes in this proposed rule would further each of these goals while maintaining the financial viability of the hospital industry and ensuring access to high quality health care for Medicare beneficiaries. We expect that these proposed changes would ensure that the outcomes of this payment system are reasonable and equitable while avoiding or minimizing unintended adverse consequences. mmaher on DSK3CLS3C1PROD with $$_JOB III. Limitations of Our Analysis The following quantitative analysis presents the projected effects of our proposed policy changes, as well as statutory changes effective for FY 2008, on various hospital groups. We estimate the effects of individual proposed policy changes by estimating payments per case while holding all other payment policies constant. We use the best data available, but, generally, we do not attempt to predict behavioral responses to our proposed policy changes, and we do not make adjustments for future changes in such variables as admissions, lengths of stay, or case-mix. However, we believe that adoption of the MS–DRGs proposed in this proposed rule would create a risk of increased aggregate levels of payment as a result of more comprehensive documentation and coding. As explained earlier in this proposed rule, the Secretary has broad discretion under section 1886(d)(3)(A)(vi) of the Act to adjust the standardized amount so as to eliminate the effect of changes in coding or classification of discharges that do not reflect real changes in case-mix. Using this authority, the Medicare Actuary estimates that an adjustment of 4.8 percent over 2 years will be necessary to maintain budget neutrality for the transition to the MS–DRGs. We are proposing to reduce the IPPS standardized amounts by -2.4 percent each year for FY 2008 and FY 2009. The payment impacts shown below illustrate the impact of changes in hospital payment, including the proposed -2.4 percent adjustment to the IPPS standardized amounts both prior to and following the assumed growth in case-mix. As we have done in the previous rules, we are soliciting comments and information about the anticipated effects of these proposed changes on hospitals and our methodology for estimating them. IV. Hospitals Included In and Excluded From the IPPS The prospective payment systems for hospital inpatient operating and capitalrelated costs encompass nearly all general short-term, acute care hospitals that participate in the Medicare program. There were 35 Indian Health Service hospitals in our database, which we excluded from the analysis due to the special characteristics of VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 the prospective payment methodology for these hospitals. Among other short-term, acute care hospitals, only the 45 such hospitals in Maryland remain excluded from the IPPS under the waiver at section 1814(b)(3) of the Act. As of March 2007, there are 3,535 IPPS hospitals to be included in our analysis. This represents about 59 percent of all Medicareparticipating hospitals. The majority of this impact analysis focuses on this set of hospitals. There are also approximately 1,283 CAHs. These small, limited service hospitals are paid on the basis of reasonable costs rather than under the IPPS. There are also 1,186 specialty hospitals and 2,315 specialty units that are excluded from the IPPS. These specialty hospitals include IPFs, IRFs, LTCHs, RNHCIs, children’s hospitals, and cancer hospitals. Proposed changes in payments for IPFs and IRFs are made through other separate rulemaking. Payment impacts for these specialty hospitals and units, other than the reasonable cost updates for IPFs paid under a blend, are not included in this proposed rule. There is also a separate rule to update and propose changes to the LTCHs for its July 1 to June 30 rate year. However, we have traditionally used the IPPS rule to update the LTCH relative weights because the LTCH PPS uses the same DRGs as the IPPS, resulting in the LTCH relative weights being recalibrated according to the same schedule as the IPPS (that is, for each Federal fiscal year). The impacts of our proposed policy changes on LTCHs, where applicable, are discussed below. V. Effects on Excluded Hospitals and Hospital Units As of March 2007, there were 1,197 hospitals excluded from the IPPS. Of these 1,187 hospitals, 483 IPFs, 6 LTCHs, 81 children’s hospitals, 11 cancer hospitals, and 16 RNHCIs are either being paid, on a reasonable cost basis or have a portion of the PPS payment based on a reasonable cost subject to the rate-of-increase ceiling under § 413.40. The remaining providers, 216 IRFs and 371 LTCHs, are paid 100 percent of the Federal prospective rate under the IRF PPS and the LTCH PPS, respectively. As stated above, IRFs and IPFS are not affected by this proposed rule. The impacts of the changes to LTCHs are discussed separately below. In addition, there are 1,283 IPFs co-located in hospitals otherwise subject to IPPS, paid on a blend of the IPF PPS per diem payment and the reasonable cost-based payment and 996 IRFs (paid under the IRF PPS) co-located in hospitals otherwise subject to the IPPS. Under § 413.40(a)(2)(i)(A), the rate-ofincrease ceiling is not applicable to the 93 IPPS excluded hospitals and units in Maryland that are paid in accordance with the waiver at section 1814(b)(3) of the Act. In the past, hospitals and units excluded from the IPPS have been paid based on their reasonable costs subject to limits as established by the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). Hospitals that continue to be paid fully on a reasonable cost basis are subject to TEFRA limits for FY 2008. For these hospitals (cancer and children’s hospitals), consistent with section 1886(b)(3)(B)(ii) of the Act, the PO 00000 Frm 00437 Fmt 4742 Sfmt 4702 25115 proposed update will be the percentage increase in the FY 2008 IPPS operating market basket, currently estimated to be 3.3 percent. In addition, in accordance with § 403.752(a) of the regulations, RNHCIs are paid under § 413.40, which also uses section 1886(b)(3)(B)(ii) of the Act to update the percentage increase in the rate-of-increase limits. For RNHCIs, the update will be the percentage increase in the FY 2008 IPPS operating market basket increase, currently estimated to be 3.3 percent. Effective for cost reporting periods beginning on or after October 1, 2002, LTCHs that elected to be paid based on 100 percent of the LTCH PPS rule are paid, based on a Federal prospective payment amount that is updated annually. Existing LTCHs would receive a PPS blended payment that consisted of the Federal prospective payment rate and a reasonable cost-based payment rate over a 5-year transition period, unless the LTCH elected to be paid at 100 percent of the Federal prospective rate at the beginning of any of its cost reporting periods during the 5-year transition period. In accordance with § 412.533, for cost reporting periods beginning on or after October 1, 2006, the LTCH PPS transition blend percentages are 100 percent of the Federal prospective payment amount and zero percent of the PPS amount calculated under reasonable cost principles. FY 2007 was the fifth year of the 5-year transition period established under § 412.533. Because the reasonable cost principles amount is zero percent for cost reporting periods beginning during FY 2008, LTCHs no longer receive a portion of their payment that is based in part on a reasonable cost subject to the rate-of-increase ceiling. Thus, there is no longer a need for an update factor for LTCHs’ TEFRA target amount for FY 2008. The final rule implementing the IPF PPS (69 FR 66922) established a 3-year transition to the IPF PPS during which some providers will receive a blend of the IPF PPS per diem payment and the TEFRA reasonable costbased payment. For purposes of determining what the TEFRA payment to the IPF will be, we updated the IPF’s TEFRA target amount by the excluded hospital market basket percentage increase of 3.4 percent. The impact on excluded hospitals and hospital units of the proposed update in the rate-of-increase limit depends on the cumulative cost increases experienced by each excluded hospital or unit since its applicable base period. For excluded hospitals and units that have maintained their cost increases at a level below the rateof-increase limits since their base period, the major effect is on the level of incentive payments these hospitals and hospital units receive. Conversely, for excluded hospitals and hospital units with per-case cost increases above the cumulative update in their rate-of-increase limits, the major effect is the amount of excess costs that will not be reimbursed. We note that, under § 413.40(d)(3), an excluded hospital or unit whose costs exceed 110 percent of its rate-of-increase limit receives its rate-of-increase limit plus 50 percent of the difference between its reasonable costs and 110 percent of the limit, E:\FEDREG\03MYP2.LOC 03MYP2 25116 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules not to exceed 110 percent of its limit. In addition, under the various provisions set forth in § 413.40, certain excluded hospitals and hospital units can obtain payment adjustments for justifiable increases in operating costs that exceed the limit. mmaher on DSK3CLS3C1PROD with $$_JOB VI. Quantitative Effects of the Proposed Policy Changes Under the IPPS for Operating Costs A. Basis and Methodology of Estimates In this proposed rule, we are announcing proposed policy changes and proposed payment rate updates for the IPPS for operating costs. Proposed changes to the capital payments are discussed in section VIII. of this Appendix. Based on the overall percentage change in payments per case estimated using our payment simulation model, we estimate that proposed total FY 2008 operating payments would increase 3.3 percent compared to FY 2007 largely due to the statutorily mandated update to the IPPS rates. This amount reflects an adjustment of -2.4 percent to the IPPS standardized amounts to offset an anticipated increase in payments resulting from improved documentation and coding that does not represent real increases in underlying resource demands and patient acuity due to the proposed adoption of MS– DRGs. The impacts do not illustrate changes in hospital admissions or real case-mix intensity, which would also affect overall payment changes. We have prepared separate impact analyses of the proposed changes to each system. This section deals with proposed changes to the operating prospective payment system. Our payment simulation model relies on the most recent available data to enable us to estimate the impacts on payments per case of certain changes in this proposed rule. However, there are other proposed changes for which we do not have data available that would allow us to estimate the payment impacts using this model. For those proposed changes, we have attempted to predict the payment impacts based upon our experience and other more limited data. The data used in developing the quantitative analyses of proposed changes in payments per case presented below are taken from the FY 2006 MedPAR file and the most current Provider-Specific File that is used for payment purposes. Although the analyses of the changes to the operating PPS do not incorporate cost data, data from the most recently available hospital cost report were used to categorize hospitals. Our analysis has several qualifications. First, in this analysis, we do not make adjustments for future changes in such variables as admissions, lengths of stay, or underlying growth in real case-mix. Second, due to the interdependent nature of the IPPS payment components, it is very difficult to precisely quantify the impact associated with each proposed change. Third, we use various sources for the data used to categorize hospitals in the tables. In some cases, particularly the number of beds, there is a fair degree of variation in the data from different sources. We have attempted to construct these variables with the best available source overall. However, for individual hospitals, some miscategorizations are possible. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Using cases from the FY 2006 MedPAR file, we simulated payments under the operating IPPS given various combinations of payment parameters. Any short-term, acute care hospitals not paid under the IPPS (Indian Health Service hospitals and hospitals in Maryland) were excluded from the simulations. The impact of payments under the capital IPPS, or the impact of payments for costs other than inpatient operating costs, are not analyzed in this section. Estimated payment impacts of proposed FY 2008 changes to the capital IPPS are discussed in section VIII of this Appendix. The proposed changes discussed separately below are the following: <bullet≤ The effects of the proposed annual reclassification of diagnoses and procedures and the proposed recalibration of the DRG relative weights required by section 1886(d)(4)(C) of the Act. <bullet≤ The effects of the proposed changes in hospitals’ wage index values reflecting wage data from hospitals’ cost reporting periods beginning during FY 2004, compared to the FY 2003 wage data. <bullet≤ The effects of the proposed wage and recalibration budget neutrality factors. <bullet≤ The effects of the expiration of the labor market area transition for those hospitals that were urban under the old labor market area designations and are now considered rural hospitals. <bullet≤ The effects of the expiration of the 3-year provision for applying an imputed rural floor to States that have no rural areas and to States that have rural areas but no IPPS hospitals are located in those areas (69 FR 49109). <bullet≤ The effects of geographic reclassifications by the MGCRB that will be effective in FY 2008. <bullet≤ The effects of the proposed adjustment to the application of the rural floor budget neutrality provision on the wage index instead of on the standardized amount. <bullet≤ The effects of the September 30, 2007 expiration of section 508 of Pub. L. 108–173, which allowed qualifying hospitals to appeal the wage index classification otherwise and apply for reclassification to another area of the State in which the hospital is located (or, at the discretion of the Secretary, to an area within a contiguous State). <bullet≤ The effects of section 505 of Pub. L. 108–173, which provides for an increase in a hospital’s wage index if the hospital qualifies by meeting a threshold percentage of residents of the county where the hospital is located who commute to work at hospitals in counties with higher wage indexes. <bullet≤ The effect of the budget neutrality adjustment being made for the adoption of the proposed MS-DRGs under section 1886(d)(3)(A)(iv) of the Act for the change in aggregate payments that is a result of changes in the coding or classification of discharges that do not reflect real changes in case-mix. <bullet≤ The total estimated change in payments based on proposed FY 2008 policies relative to payments based on FY 2007 policies. To illustrate the impacts of the proposed FY 2008 changes, our analysis begins with a FY 2007 baseline simulation model using: PO 00000 Frm 00438 Fmt 4742 Sfmt 4702 the proposed FY 2008 update of 3.3 percent; the FY 2007 DRG GROUPER (Version 24.0); the most current CBSA designations for hospitals based on OMB’s MSA definitions; the FY 2007 wage index; and no MGCRB reclassifications. Outlier payments are set at 5.1 percent of total operating DRG and outlier payments. Section 1886(b)(3)(B)(viii) of the Act, as added by section 5001(a) of Pub. L. 109–171, provides that for FY 2007 and subsequent years, the update factor will be reduced by 2.0 percentage points for any hospital that does not submit quality data in a form and manner and at a time specified by the Secretary. At the time this impact was prepared, 147 providers did not receive the full market basket rate-of-increase for FY 2007 because they failed the quality data submission process. For purposes of the simulations shown below, we modeled the proposed payment changes for FY 2008 using a reduced update for these 147 hospitals. However, we do not have enough information to determine which hospitals will not receive the full market basket rateof-increase for FY 2008 at this time. Each proposed and statutory policy change is then added incrementally to this baseline, finally arriving at an FY 2008 model incorporating all of the proposed changes. This simulation allows us to isolate the effects of each proposed change. Our final comparison illustrates the proposed percent change in payments per case from FY 2007 to FY 2008. Three factors not discussed separately have significant impacts here. The first is the update to the standardized amount. In accordance with section 1886(b)(3)(B)(i) of the Act, we are updating the standardized amounts for FY 2008 using the most recently forecasted hospital market basket increase for FY 2008 of 3.3 percent. (Hospitals that fail to comply with the quality data submission requirement to receive the full update will receive an update reduced by 2.0 percentage points to 1.3 percent.) Under section 1886(b)(3)(B)(iv) of the Act, the updates to the hospitalspecific amounts for SCHs and for MDHs are also equal to the market basket increase, or 3.3 percent. A second significant factor that affects the proposed changes in hospitals’ payments per case from FY 2007 to FY 2008 is the change in a hospital’s geographic reclassification status from one year to the next. That is, payments may be reduced for hospitals reclassified in FY 2007 that are no longer reclassified in FY 2008. Conversely, payments may increase for hospitals not reclassified in FY 2007 that are reclassified in FY 2008. Particularly with the expiration of section 508 of Pub. L. 108–173, the reclassification provision, these impacts can be quite substantial, so if a relatively small number of hospitals in a particular category lose their reclassification status, the percentage change in payments for the category may be below the national mean. A third significant factor is that we currently estimate that actual outlier payments during FY 2007 will be 4.9 percent of total DRG payments. When the FY 2007 final rule was published, we projected FY 2007 outlier payments would be 5.1 percent E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules of total DRG plus outlier payments; the average standardized amounts were offset correspondingly. The effects of the lower than expected outlier payments during FY 2008 (as discussed in the Addendum to this proposed rule) are reflected in the analyses below comparing our current estimates of FY 2007 payments per case to estimated FY 2008 payments per case (with outlier payments projected to equal 5.1 percent of total DRG payments). B. Analysis of Table I mmaher on DSK3CLS3C1PROD with $$_JOB Table I displays the results of our analysis of the proposed changes for FY 2008. The table categorizes hospitals by various geographic and special payment consideration groups to illustrate the varying impacts on different types of hospitals. The top row of the table shows the overall impact on the 3,535 hospitals included in the analysis. The next four rows of Table I contain hospitals categorized according to their geographic location: All urban, which is further divided into large urban and other urban; and rural. There are 2,540 hospitals located in urban areas included in our analysis. Among these, there are 1,409 hospitals located in large urban areas (populations over 1 million), and 1,131 VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 hospitals in other urban areas (populations of 1 million or fewer). In addition, there are 995 hospitals in rural areas. The next two groupings are by bed-size categories, shown separately for urban and rural hospitals. The final groupings by geographic location are by census divisions, also shown separately for urban and rural hospitals. The second part of Table I shows hospital groups based on hospitals’ FY 2008 payment classifications, including any reclassifications under section 1886(d)(10) of the Act. For example, the rows labeled urban, large urban, other urban, and rural show that the number of hospitals paid based on these categorizations after consideration of geographic reclassifications (including reclassifications under section 1886(d)(8)(B) and section 1886(d)(8)(E) of the Act that have implications for capital payments) are 2,619, 1,436, 1,183 and 916, respectively. The next three groupings examine the impacts of the proposed changes on hospitals grouped by whether or not they have GME residency programs (teaching hospitals that receive an IME adjustment) or receive DSH payments, or some combination of these two adjustments. There are 2,479 nonteaching hospitals in our analysis, 816 teaching hospitals with fewer than 100 residents, and PO 00000 Frm 00439 Fmt 4742 Sfmt 4702 25117 240 teaching hospitals with 100 or more residents. In the DSH categories, hospitals are grouped according to their DSH payment status, and whether they are considered urban or rural for DSH purposes. The next category groups together hospitals considered urban after geographic reclassification, in terms of whether they receive the IME adjustment, the DSH adjustment, both, or neither. The next five rows examine the impacts of the proposed changes on rural hospitals by special payment groups (SCHs, RRCs, and MDHs), as well as rural hospitals not receiving a special payment designation. There were 59 RRCs, 45 SCHs, 21 MDHs, 17 hospitals that are both SCHs and RRCs, and 1 hospital that is both MDH and RRC. The next series of groupings concern the geographic reclassification status of hospitals. The first grouping displays all urban hospitals that were reclassified by the MGCRB for FY 2008. The second grouping shows the MGCRB rural reclassifications. The final two groupings are based on the type of ownership and the hospital’s Medicare utilization expressed as a percent of total patient days. These data were taken from the FY 2004 Medicare cost reports. BILLING CODE 4120–01–P E:\FEDREG\03MYP2.LOC 03MYP2 VerDate Mar 15 2010 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00440 Fmt 4742 Sfmt 4725 E:\FEDREG\03MYP2.LOC 03MYP2 EP03MY07.009 mmaher on DSK3CLS3C1PROD with $$_JOB 25118 VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00441 Fmt 4742 Sfmt 4725 E:\FEDREG\03MYP2.LOC 03MYP2 25119 EP03MY07.010 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules VerDate Mar 15 2010 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00442 Fmt 4742 Sfmt 4725 E:\FEDREG\03MYP2.LOC 03MYP2 EP03MY07.011 mmaher on DSK3CLS3C1PROD with $$_JOB 25120 VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00443 Fmt 4742 Sfmt 4725 E:\FEDREG\03MYP2.LOC 03MYP2 25121 EP03MY07.012 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules VerDate Mar 15 2010 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00444 Fmt 4742 Sfmt 4725 E:\FEDREG\03MYP2.LOC 03MYP2 EP03MY07.013 mmaher on DSK3CLS3C1PROD with $$_JOB 25122 VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00445 Fmt 4742 Sfmt 4725 E:\FEDREG\03MYP2.LOC 03MYP2 25123 EP03MY07.014 mmaher on DSK3CLS3C1PROD with $$_JOB Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules 25124 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules BILLING CODE 4120–01–C C. Effects of the Proposed Changes to the DRG Reclassifications and Relative CostBased Weights (Column 2) In Column 2 of Table I, we present the combined effects of the proposed DRG reclassifications and recalibration, as discussed in section II. of the preamble to this proposed rule. Section 1886(d)(4)(C)(i) of the Act requires us annually to make appropriate classification changes in order to reflect changes in treatment patterns, technology, and any other factors that may change the relative use of hospital resources. As discussed in the preamble of this proposed rule, we are proposing to continue the 3-year transition from charge-based to cost-based relative weights. The proposed relative weights for FY 2008 will be 2⁄3 costbased and 1⁄3 charge-based. Further, we are proposing to adopt MS–DRGs that would increase the number of DRGs from 538 to 745. In column 2, we compare aggregate payments using the proposed FY 2008 MS– DRGS (GROUPER Version 25.0) and blended relative weights to the FY 2007 CMS DRG blended relative weights (GROUPER Version 24.0). The proposed methods of calculating the relative weights and the reclassification changes to the GROUPER are described in more detail in section II.H. of the preamble to this proposed rule. We note that, consistent with section 1886(d)(4)(C)(iii) of the Act, we are proposing to apply a budget neutrality factor to ensure that the overall payment impact of the proposed DRG changes (combined with the proposed wage index changes) is budget neutral. This proposed budget neutrality factor of 0.999317 is applied to payments in Column 4 and not Column 2 because it is a combined DRG reclassification and recalibration and wage index budget neutrality factor. We estimate that proposed changes to the relative weights and DRGs will increase payments to hospitals located in large urban areas (populations over 1 million) by approximately 0.9 percent. These changes generally increase payments to hospitals in all urban areas (0.4 percent) and large teaching hospitals (0.7 percent). Rural hospitals will generally experience a decrease in payments from these changes (- 1.8 percent). However, it is important to evaluate these changes together with the cost weights that we adopted in the FY 2007 IPPS final rule. We are adopting cost weights over a transition period from FY 2007 to FY 2009. The cost weights generally increased payments to rural hospitals. Column 2 shows the changes for the proposed rule only and therefore reflects the full payment impact of the MS–DRGs while showing only the FY 2008 portion of the transition to cost weights finalized in last year’s rule. In FY 2007, we are paying hospitals using a blend of 1⁄3 cost and 2⁄3 charge relative weights. In FY 2008, we will pay hospitals using a blend of 2⁄3 cost and 1⁄3 charge relative weights. In FY 2009, we will pay hospitals using 100 percent cost relative weights. Therefore, there will likely be some additional increases in payments to rural hospitals from the final year of the transition to fully implemented cost weights that are not illustrated in the above table. Cardiac specialty hospitals would experience the greatest decline in payments (4.0 percent) from the proposed changes to adopt MS– DRGs and the blended relative cost weights. D. Effects of Proposed Wage Index Changes (Column 3) Section 1886(d)(3)(E) of the Act requires that, beginning October 1, 1993, we annually update the wage data used to calculate the wage index. In accordance with this requirement, the proposed wage index for FY 2008 is based on data submitted for hospital cost reporting periods beginning on or after October 1, 2003 and before October 1, 2004. The estimated impact of the proposed wage data on hospital payments is isolated in Column 3 by holding the other payment parameters constant in this simulation. That is, Column 3 shows the percentage changes in payments when going from a model using the FY 2007 wage index, based on FY 2003 wage data and having a 100-percent occupational mix adjustment applied, to a model using the FY 2008 pre-reclassification wage index, adjusted for occupational mix, based on FY 2004 wage data. The wage data collected on the FY 2004 cost report include overhead costs for contract labor that were not collected on FY 2003 and earlier cost reports. The impacts below incorporate the effects of the FY 2004 wage data collected on hospital cost reports, including additional overhead costs for contract labor compared to the wage data from FY 2003 cost reports that were used to calculate the FY 2007 wage index. Column 3 shows the impacts of updating the wage data using FY 2004 cost reports. Overall, the new wage data will lead to a -0.1 percent change for all hospitals. This decrease could be attributed to fluctuations in the wage data. Among the regions, the largest increase is in the rural Pacific region, which experiences a 0.5 percent increase. The largest decline from updating the wage data is seen in the Puerto Rico region (a 0.5 percent decrease). In looking at the wage data itself, the national average hourly wage increased 4.3 percent compared to FY 2007. Therefore, the only manner in which to maintain or exceed the previous year’s wage index was to match or exceed the national 4.3 percent increase in average hourly wage. Of the 3,486 hospitals with wage data for both FYs 2007 and 2008, 1,709, or 49.0 percent, experienced an average hourly wage increase of 4.3 percent or more. The following chart compares the shifts in wage index values for hospitals for FY 2008 relative to FY 2007. Among urban hospitals, 52 will experience an increase of more than 5 percent and less than 10 percent and 6 will experience an increase of more than 10 percent. Among rural hospitals, 21 will experience an increase of more than 5 percent and less than 10 percent, and 4 will experience an increase of more than 10 percent. However, 965 rural hospitals will experience increases or decreases of less than 5 percent, while 2,384 urban hospitals will experience increases or decreases of less than 5 percent. Thirty-three urban hospitals will experience decreases in their wage index values of more than 5 percent and less than 10 percent. Twenty-one urban hospitals will experience decreases in their wage index values of greater than 10 percent. No rural hospitals will experience decreases of more than 5 percent. The following chart shows the projected impact for urban and rural hospitals. Number of hospitals Percentage change in area wage index values Urban mmaher on DSK3CLS3C1PROD with $$_JOB Increase more than 10 percent ............................................................................................................................................... Increase more than 5 percent and less than 10 percent ........................................................................................................ Increase or decrease less than 5 percent ............................................................................................................................... Decrease more than 5 percent and less than 10 percent ...................................................................................................... Decrease more than 10 percent .............................................................................................................................................. E. Combined Effects of Proposed DRG and Wage Index Changes (Column 4) Section 1886(d)(4)(C)(iii) of the Act requires that changes to DRG reclassifications and the relative weights cannot increase or decrease aggregate payments. In addition, section 1886(d)(3)(E) of the Act specifies that any updates or adjustments to the wage index are to be budget neutral. As noted in the Addendum to this proposed rule, in VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 determining the budget neutrality factor, we equated simulated aggregate payments for FY 2007 and FY 2008 using the FY 2006 Medicare utilization data after applying the proposed changes to the DRG relative weights and the wage index. We computed a wage and DRG recalibration budget neutrality factor of 0.999317. The 0.0 percent impact for all hospitals demonstrates that these proposed PO 00000 Frm 00446 Fmt 4742 Sfmt 4702 6 52 2,384 33 21 Rural 4 21 965 0 0 changes, in combination with the proposed budget neutrality factor, are budget neutral. In Table I, the combined overall impacts of the effects of both the proposed DRG reclassifications and the updated wage index are shown in Column 4. The estimated changes shown in this column reflect the combined effects of the proposed changes in Columns 2 and 3 and the budget neutrality factor for the revised FY 2008 wage index. E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules Due to the proposed changes to the application of the rural floor budget neutrality, this column does not include the wage index floor for urban areas as required by section 4410 of Pub. L. 105–33. The effects of that provision are included in Column 7. There also may be some variation of plus or minus 0.1 percentage point due to rounding. mmaher on DSK3CLS3C1PROD with $$_JOB F. Effects of the Expiration of the 3-Year Provision Allowing Urban Hospitals That Were Converted to Rural as a Result of the FY 2005 Labor Market Area Changes To Maintain the Wage Index of the Urban Labor Market Area in Which They Were Formerly Located (Column 5) The policy adopted in FY 2005 for urban hospitals that became rural under the new labor market area definitions is to expire in FY 2008. In FY 2005, we adopted a policy that allowed urban hospitals that became rural under the new labor market area regions to maintain the wage index assignment of the MSA where they were located for the 3-year period FY 2005, FY 2006, and FY 2007. Beginning in FY 2008, these hospitals will receive their statewide rural wage index or their FY 2008 MGCRB reclassified wage index. Column 5 shows the impact of the expiration of the labor market area transition for those hospitals that were urban under the old labor market area designations and are now considered rural hospitals. Currently, the rural hospital row shows a 0.2 percent decrease from the end of the provision as these hold harmless hospitals are now considered geographically rural and are now receiving the wage index of the MSA where they are currently located. G. Effects of MGCRB Reclassifications (Column 6) Our impact analysis to this point has assumed hospitals are paid on the basis of their actual geographic location (with the exception of ongoing policies that provide that certain hospitals receive payments on other bases than where they are geographically located). The proposed changes in Column 6 reflect the per case payment impact of moving from this baseline to a simulation incorporating the MGCRB decisions for FY 2008 which affect hospitals’ wage index area assignments. By February 28 of each year, the MGCRB makes reclassification determinations that will be effective for the next fiscal year, which begins on October 1. The MGCRB may approve a hospital’s reclassification request for the purpose of using another area’s wage index value. The proposed FY 2008 wage index values incorporate all of the MGCRB’s reclassification decisions for FY 2008. The wage index values also reflect any decisions made by the CMS Administrator through the appeals and review process through February 28, 2007. The overall effect of geographic reclassification is required by section 1886(d)(8)(D) of the Act to be budget neutral. Therefore, we are proposing to apply an adjustment of 0.991938 to ensure that the effects of the section 1886(d)(10) reclassifications are budget neutral. (See section II.A. of the Addendum to this proposed rule.) Geographic reclassification VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 generally benefits hospitals in rural areas. We estimate that geographic reclassification will increase payments to rural hospitals by an average of 1.7 percent. H. Effects of the Adjustment to the Application of the Rural Floor (Column 7) As discussed in section III.G. of the preamble of this proposed rule, section 4410 of Pub. L. 105–33 established the rural floor by requiring that the wage index for a hospital in any urban area cannot be less than the area wage index determined for the state’s rural area. Since FY 1998, we have implemented this provision by adjusting the standardized amounts. In this proposed rule, we are proposing to change how we apply budget neutrality to the rural floor beginning in FY 2008. Rather than applying a budget neutrality adjustment to the standardized amount, a uniform budget neutrality adjustment would be applied to the wage index. Therefore, we are proposing to apply an adjustment to the wage index of 0.997084 (-0.29 percent) to ensure that the rural floor adjustments are budget neutral as indicated by the zero effect on payments to hospitals overall. Column 7 shows the projected impact of change in the application of the rural floor. The column compares the postreclassification FY 2008 wage index of providers before the rural floor adjustment and the post-reclassification FY 2008 wage index of providers with the rural floor adjustment. Only urban hospitals can benefit from the rural floor provision. Because the provision is budget neutral, all other hospitals (that is, all rural hospitals and those urban hospitals to which the adjustment is not made) will experience a decrease in payments due to the budget neutrality adjustment. We project rural hospitals will experience a 0.1 percent decrease in payments. We project hospitals located in other urban areas (populations of 1 million or fewer) will experience a 0.1 percent increase in payments. The rural floor will benefit 77 percent of the hospitals in New Hampshire (10) and 45 percent of the hospitals in Connecticut (15), explaining the average increase of 1 percent shown in the table for hospitals located in New England. The average increase among hospitals in the Pacific region is estimated at 0.4 percent and is explained by application of the rural floor to 34 percent of the hospitals in California (114) and 18 percent of the hospitals in Washington (9). I. Effects of the Expiration of the Imputed Rural Floor (Column 8) The FY 2005 IPPS final rule (69 FR 49109) established a temporary imputed rural floor for all urban States from FY 2005 to FY 2007. The rural floor requires that an urban wage index cannot be lower than the wage index for any rural hospital in that State. Therefore, an imputed rural floor was established for States that do not have rural areas or rural IPPS hospitals. The provision will expire at the end of FY 2007 unless we were to adopt a change to the regulation to continue it for FY 2008. Column 8 shows the effects of the expiration of the imputed rural floor. Only PO 00000 Frm 00447 Fmt 4742 Sfmt 4702 25125 hospitals located in Massachusetts and New Jersey were affected by the provision. However, as explained in section III.G. of the preamble of this proposed rule, the imputed rural floor will no longer apply in Massachusetts even if it were to be continued because one hospital acquired rural status under § 412.103 of the regulations. Urban providers in New England (MA) and the MidAtlantic region (NJ) will experience a decrease by 0.1 percent and by 0.2 percent respectively from the imputed rural floor no longer being applied in those States. J. Effects of the Expiration of Section 508 of Pub. L. 108–173 (Column 9) Section 508 of Pub. L. 108–173 will expire on September 30, 2007. As stated in the FY 2007 IPPS final rule (71 FR 48333), we established procedural rules under section 1886(d)(10)(D)(v) of the Act to address specific circumstances where individual and group reclassifications involve a section 508 hospital. In the final rule, the rules were designed to recognize the special circumstances of section 508 hospital reclassifications ending mid-year during FY 2007 and were intended to allow previously approved reclassifications to continue through March 31, 2007, and new section 1886(d)(10) reclassifications to begin April 1, 2007, upon the conclusion of the section 508 reclassifications. Under these procedural rules, some section 1886(d)(10) hospital reclassifications are only in effect for the second half of the fiscal year. However, Division B, Title I, section 106(a) of the MIEA-TRHCA (Pub. L. 109–432) extended any geographic reclassifications of hospitals that would expire on March 31, 2007, by 6 months until September 30, 2007. For FY 2008, the providers that had been reclassified under section 508 in FY 2007 will receive payment using the wage index for the area where they are currently located. The impact of the expiration of the policy is modeled in Column 9 of Table I. Section 508 of Pub. L. 108–173 was not a budget neutral provision of statute. Its enactment increased total payments for Medicare inpatient hospital services. Therefore, relative to FY 2007, the expiration of section 508 of Pub. L. 108–173 will reduce Medicare inpatient hospital payments by an estimated 0.1 percent. K. Effects of the Proposed Wage Index Adjustment for Out-Migration (Column 10) Section 1886(d)(13) of the Act, as added by section 505 of Pub. L. 108–173, provides for an increase in the wage index for hospitals located in certain counties that have a relatively high percentage of hospital employees who reside in the county, but work in a different area with a higher wage index. Hospitals located in counties that qualify for the payment adjustment are to receive an increase in the wage index that is equal to a weighted average of the difference between the wage index of the resident county, post-reclassification and the higher wage index work area(s), weighted by the overall percentage of workers who are employed in an area with a higher wage index. With the out-migration adjustment, rural providers will experience a 0.1 percent increase in payments in FY 2008 relative to E:\FEDREG\03MYP2.LOC 03MYP2 25126 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules no adjustment at all. We included these additional payments to providers in the impact table shown above, and we estimate the impact of these providers receiving the out-migration increase to be approximately $15 million. L. Effects of All Proposed Changes With CMI Adjustment Prior to Assumed Growth (Column 11) Column 11 compares our estimate of payments per case between FY 2007 and FY 2008 with all proposed changes reflected in this proposed rule for FY 2008 including a 0.976 adjustment to the payment rates to account for anticipated improvements in documentation and coding that is expected to increase case-mix. We generally apply an adjustment to the DRGs to ensure budget neutrality assuming constant utilization. However, with the proposed adoption of the MS-DRGs, the number of DRGs will expand from 538 to 745. Therefore, we expect an increase in the CMI due to improved coding and have applied an additional adjustment to achieve budget neutrality. However, because we modeled the impact, including the adjustment for anticipated case-mix increase but not the actual case-mix increase itself in column 11, this column illustrates a total payment changes that is less than what is anticipated to occur. M. Effects of All Proposed Changes With CMI Adjustment and Assumed Growth (Column 12) Column 12 compares our estimate of payments per case between FY 2007 and FY 2008, incorporating all proposed changes reflected in this proposed rule for FY 2008 (including statutory changes). This column includes all of the proposed policy changes and assumes the 2.4 percent increase in casemix from improved documentation and coding will occur equally across all hospitals. Column 12 reflects the impact of all proposed FY 2008 changes relative to FY 2007, including those shown in Columns 2 through 10. The average increase for all hospitals is approximately 3.3 percent. This increase includes the effects of the proposed 3.3 percent market basket update. It also reflects the 0.2 percentage point difference between the projected outlier payments in FY experience an estimated decrease in payments by 0.7 percent. The Pacific and South Atlantic regions would benefit the most, with 2.0 and 1.8 percent estimated increases, respectively. Among special categories of rural hospitals in Column 12, the one MDH/RRC provider would experience an estimated decrease in payments of 0.8 percent and MDH providers would receive an estimated increase of 0.3 percent. RRCs would experience an estimated increase in payments by 2.5 percent. Urban hospitals reclassified for FY 2008 are anticipated to receive an increase of 3.3 percent, while urban hospitals that not reclassified for FY 2008 are expected to receive an increase of 3.6 percent. Rural hospitals reclassifying for FY 2008 are anticipated to receive a 1.5 percent payment increase. 2008 (5.1 percent of total DRG payments) and the current estimate of the percentage of actual outlier payments in FY 2007 (4.9 percent), as described in the introduction to this Appendix and the Addendum to this proposed rule. As a result, payments are projected to be 0.2 percentage points lower in FY 2007 than originally estimated, resulting in a 0.2 percentage point greater increase for FY 2008 than would otherwise occur. In addition, the impact of expiration of section 508 of Pub. L. 108–173 reclassification accounts for a 0.1 percent decrease in estimated payments. As stated earlier, section 1886(d)(13) of the Act provides for an increase in the wage index for hospitals located in certain counties that have a relatively high percentage of hospital employees who reside in the county, but work in a different area with a higher wage index. This provision of the statute is not budget neutral. Although the out-migration adjustment will increase payments to some hospitals in FY 2008 relative to not having an adjustment at all, the total number of hospitals receiving the adjustment will be less in FY 2008 than FY 2007, resulting in a 0.1 percent reduction in total IPPS payments. There might also be interactive effects among the various factors comprising the payment system that we are not able to isolate. For these reasons, the values in Column 10 may not equal the product of the percentage changes described above. The proposed overall change in payments per case for hospitals in FY 2008 is estimated to increase by 3.3 percent. Hospitals in urban areas would experience an estimated 3.6 percent increase in payments per case compared to FY 2007. Hospitals in large urban areas would experience an estimated 4.2 percent increase and hospitals in other urban areas would experience an estimated 2.8 percent increase in payments per case in FY 2008. Hospitals’ payments per case in rural areas are estimated to increase 0.9 percent. Among urban census divisions, the largest estimated payment increases would be 4.7 percent in the Pacific region and 4.2 percent in the South Atlantic region. The smallest urban increase is estimated at 2.6 percent in the New England region. Among rural regions in Column 12, the providers in the West South Central region N. Effects of Proposed Policy on Payment Adjustments for Low-Volume Hospitals For FY 2008, we are proposing to continue to apply the volume adjustment criteria we specified in the FY 2005 IPPS final rule (69 FR 49099). We expect that three providers would receive the low-volume adjustment for FY 2008. We included these additional payments to providers in the impact table shown above and we estimate the impact of these providers receiving the additional 25percent payment increase to be approximately $50,000. O. Impact Analysis of Table II Table II presents the projected impact of the proposed changes for FY 2008 for urban and rural hospitals and for the different categories of hospitals shown in Table I. It compares the estimated payments per case for FY 2007 with the proposed average estimated per case payments for FY 2008, as calculated under our models. Thus, this table presents, in terms of the average dollar amounts paid per discharge, the combined effects of the proposed changes presented in Table I. The proposed percentage changes shown in the last column of Table II equal the percentage changes in average payments from Column 12 of Table I. TABLE II.—IMPACT ANALYSIS OF PROPOSED CHANGES FOR FY 2008 OPERATING PROSPECTIVE PAYMENT SYSTEM [Payments per case] mmaher on DSK3CLS3C1PROD with $$_JOB Number of hospitals (1) All hospitals ....................................................................................................................................... By Geographic Location: Urban hospitals .......................................................................................................................... Large urban areas (populations over 1 million) ......................................................................... Other urban areas (populations of 1 million or fewer) .............................................................. Rural hospitals ........................................................................................................................... Bed Size (Urban): 0–99 beds .................................................................................................................................. 100–199 beds ............................................................................................................................ 200–299 beds ............................................................................................................................ 300–499 beds ............................................................................................................................ 500 or more beds ...................................................................................................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00448 Fmt 4742 Sfmt 4702 Average FY 2007 payment per case 1 (2) Average proposed FY 2008 payment per case 1 (3) All proposed FY 2008 changes (4) 3535 9004 9299 3.3 2540 1409 1131 995 9343 9750 8854 7060 9678 10156 9103 7123 3.6 4.2 2.8 0.9 632 849 480 412 167 7236 7904 8815 9749 11762 7263 8170 9120 10136 12234 0.4 3.4 3.5 4.0 4.0 E:\FEDREG\03MYP2.LOC 03MYP2 25127 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE II.—IMPACT ANALYSIS OF PROPOSED CHANGES FOR FY 2008 OPERATING PROSPECTIVE PAYMENT SYSTEM— Continued [Payments per case] Average FY 2007 payment per case 1 (2) Average proposed FY 2008 payment per case 1 (3) All proposed FY 2008 changes (4) 342 369 172 67 45 6161 6558 6867 7626 8759 6065 6588 6960 7735 8938 -1.6 0.5 1.3 1.4 2.0 126 350 388 395 166 156 358 153 395 53 9748 10243 8801 8890 8512 9064 8819 9507 11136 4368 10001 10529 9175 9197 8784 9321 9174 9826 11657 4525 2.6 2.8 4.2 3.4 3.2 2.8 4.0 3.3 4.7 3.6 19 72 173 124 177 115 194 80 41 9675 7466 6579 7521 6400 7743 6381 7766 8725 9714 7525 6700 7574 6479 7792 6339 7834 8896 0.4 0.8 1.8 0.7 1.2 0.6 -0.7 0.9 2.0 2619 1436 1183 916 9298 9725 8789 7175 9629 10127 9034 7242 3.6 4.1 2.8 0.9 2479 816 240 7648 9067 13006 7851 9384 13533 2.7 3.5 4.1 879 1527 359 8146 9792 6574 8307 10182 6697 2.0 4.0 1.9 391 189 36 154 6992 7686 5902 5333 7013 7818 6028 5353 0.3 1.7 2.1 0.4 805 192 1081 541 10750 8861 7990 7664 11185 9078 8283 7812 4.0 2.5 3.7 1.9 59 45 21 17 1 8155 9225 6321 9968 9755 8358 9301 6339 10239 9674 2.5 0.8 0.3 2.7 -0.8 2069 823 598 9136 8173 9270 9424 8478 9593 3.2 3.7 3.5 230 1292 1453 441 12731 10160 7913 7240 13443 10570 8116 7331 5.6 4.0 2.6 1.2 Number of hospitals (1) mmaher on DSK3CLS3C1PROD with $$_JOB Bed Size (Rural): 0–49 beds .................................................................................................................................. 50–99 beds ................................................................................................................................ 100–149 beds ............................................................................................................................ 150–199 beds ............................................................................................................................ 200 or more beds ...................................................................................................................... Urban by Region: New England .............................................................................................................................. Middle Atlantic ............................................................................................................................ South Atlantic ............................................................................................................................. East North Central ..................................................................................................................... East South Central ..................................................................................................................... West North Central .................................................................................................................... West South Central .................................................................................................................... Mountain .................................................................................................................................... Pacific ......................................................................................................................................... Puerto Rico ................................................................................................................................ Rural by Region: New England .............................................................................................................................. Middle Atlantic ............................................................................................................................ South Atlantic ............................................................................................................................. East North Central ..................................................................................................................... East South Central ..................................................................................................................... West North Central .................................................................................................................... West South Central .................................................................................................................... Mountain .................................................................................................................................... Pacific ......................................................................................................................................... By Payment Classification: Urban hospitals .......................................................................................................................... Large urban areas (populations over 1 million) ......................................................................... Other urban areas (populations of 1 million or fewer) .............................................................. Rural areas ................................................................................................................................ Teaching Status: Non-teaching .............................................................................................................................. Fewer than 100 Residents ......................................................................................................... 100 or more Residents .............................................................................................................. Urban DSH: Non-DSH .................................................................................................................................... 100 or more beds ...................................................................................................................... Less than 100 beds ................................................................................................................... Rural DSH: SCH ............................................................................................................................................ RRC ........................................................................................................................................... 100 or more beds ...................................................................................................................... Less than 100 beds ................................................................................................................... Urban teaching and DSH: Both teaching and DSH ............................................................................................................. Teaching and no DSH ............................................................................................................... No teaching and DSH ................................................................................................................ No teaching and no DSH ........................................................................................................... Rural Hospital Types: RRC ........................................................................................................................................... SCH ............................................................................................................................................ MDH ........................................................................................................................................... SCH and RRC ........................................................................................................................... MDH and RRC ........................................................................................................................... Type of Ownership: Voluntary .................................................................................................................................... Proprietary .................................................................................................................................. Government ............................................................................................................................... Medicare Utilization as a Percent of Inpatient Days: 0–25 ........................................................................................................................................... 25–50 ......................................................................................................................................... 50–65 ......................................................................................................................................... Over 65 ...................................................................................................................................... VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00449 Fmt 4742 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 25128 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE II.—IMPACT ANALYSIS OF PROPOSED CHANGES FOR FY 2008 OPERATING PROSPECTIVE PAYMENT SYSTEM— Continued [Payments per case] Average FY 2007 payment per case 1 (2) Average proposed FY 2008 payment per case 1 (3) All proposed FY 2008 changes (4) 801 2734 434 2105 367 568 31 61 107 8695 9106 9273 9359 7555 6411 8647 6635 9766 8938 9417 9581 9701 7669 6392 8799 6729 9814 2.8 3.4 3.3 3.6 1.5 -0.3 1.8 1.4 0.5 22 10736 10676 -0.6 Number of hospitals (1) Hospitals Reclassified by the Medicare Geographic Classification Review Board: FY 2008 Reclassifications: All Reclassified Hospitals FY 2008 ............................................................................................ All Non-Reclassified Hospitals FY 2008 .................................................................................... Urban Reclassified Hospitals FY 2008 ...................................................................................... Urban Non-reclassified Hospitals FY 2008 ............................................................................... Rural Reclassified Hospitals FY 2008 ....................................................................................... Rural Nonreclassified Hospitals FY 2008 .................................................................................. All Section 401 Reclassified Hospitals ...................................................................................... Other Reclassified Hospitals (Section 1886(d)(8)(B)) ............................................................... Former Section 508 Hospitals ................................................................................................... Specialty Hospitals: Cardiac Specialty Hospitals ....................................................................................................... 1 These payment amounts per case do not reflect any estimates of annual case-mix increase. VII. Effects of Other Proposed Policy Changes In addition to those proposed policy changes discussed above that we are able to model using our IPPS payment simulation model, we are proposing to make various other changes in this proposed rule. Generally, we have limited or no specific data available with which to estimate the impacts of these proposed changes. Our estimates of the likely impacts associated with these other proposed changes are discussed below. mmaher on DSK3CLS3C1PROD with $$_JOB A. Effects of Proposed Policy on HospitalAcquired Conditions, Including Infections In section II.F. of the preamble of this proposed rule, we discuss our proposal to implement section 5001(c) of Pub. L. 109– 171, which requires the Secretary to identify, by October 1, 2007, at least two conditions that are (a) high cost or high volume or both, (2) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through application of evidence-based guidelines. For discharges occurring on or after October 1, 2008, hospitals will not receive additional payment for cases in which one of the selected conditions was not present on admission. That is, the case will be paid as though the secondary diagnosis was not present. However, the statute also requires the Secretary to continue counting the condition as a secondary diagnosis that results in a higher IPPS payment when doing the budget neutrality calculations for DRG reclassifications and recalibration. Therefore, we do our budget neutrality calculations as though the payment provision did not apply but Medicare will make a lower payment to the hospital for the specific case that includes the secondary diagnosis. Thus, the provision will result in cost savings to the Medicare program. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 Although we believe there will be modest savings to the Medicare program from implementation of this provision, we cannot estimate them at this time. To estimate savings associated with this provision, we would need to know the frequency that the selected conditions are not present on admission in the Medicare population. Medicare will not begin collecting this information from hospitals until October 1, 2007. Therefore, there is currently no data upon which to estimate the savings of this provision. The provision does not go into effect until October 1, 2008. For this reason, there will be no savings for FY 2008. Any savings associated with this provision will not be realized until FY 2009. Based on the data available to us for next year’s IPPS rule, we will estimate the savings associated with the conditions we selected under this provision for FY 2009 and subsequent years. We further note that the provision will only apply when the selected conditions are the only secondary diagnosis present on the claim that will lead to higher payment. Therefore, if a nonselected secondary diagnosis that leads to the same higher payment is on the claim, the case will continue to be assigned to the higher paying DRG and there will be no savings to Medicare from the case. Our analysis of the Medicare claims suggests that patients will generally have multiple secondary diagnoses during a hospital stay. Patients having one MCC or CC will frequently have additional conditions that also lead to higher payment. In only a small percentage of the cases did we find that a patient had only one secondary diagnosis that would lead to higher payment, and in these cases, we have no information to suggest whether the condition was acquired after admission. Therefore, we believe the savings associated with this provision are likely to be very modest. Again, once we have data on the frequency of occurrence of the selected conditions after admission, we will refine our analysis. PO 00000 Frm 00450 Fmt 4742 Sfmt 4702 B. Effects of Proposed MS–LTC–DRG Reclassifications and Relative Weights for LTCHs In section II.I. of the preamble to this final rule, we discuss the proposed changes to adopt MS–LTC–DRG relative weights for FY 2008, which are based on the Version 25.0 of the CMS GROUPER (including the changes in the classifications, relative weights, and geometric mean length of stay for each proposed MS–LTC–DRG). We noted in the same section that, in the FY 2008 LTCH PPS proposed rule (72 FR 4784 through 4786), we proposed that, beginning with the MS–LTC– DRG update for FY 2008, the annual update to the proposed MS–LTC–DRG classifications and relative weights would be done in a budget neutral manner, such that estimated aggregate LTCH PPS payments would be unaffected; that is, they would be neither greater than nor less than the estimated aggregate LTCH PPS payments that would have been made without the proposed MS– LTC–DRG classification and relative weight changes. However, if the budget neutrality policy had not been proposed, we are estimating that, under the current payment policies (RY 2007), using the most recent available claims data (FY 2006 MedPAR files) for the 376 LTCHs in our database, the proposed changes to the MS–LTC–DRG classifications and relative weights for FY 2008 would have resulted in an aggregate decrease in LTCH PPS payments of approximately 1.6 percent. In applying the budget neutrality adjustment described above, we assumed constant utilization. However, with the proposed adoption of the MS–LTC–DRGs, we expect an increase in coding or classification of discharges that do not reflect real change in case-mix due to the adoption of the new patient classification system. Therefore, we have applied an additional adjustment of 0.976 to the proposed MS–LTC–DRG relative weights for the anticipated increase in case-mix due to improved documentation and coding. E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB C. Effects of Proposed New Technology AddOn Payments In section II.I. of the preamble to this proposed rule, we discuss proposed add-on payments for new medical services and technologies. As explained in that section, we are not required to ensure that any addon payments for new technology under section 1886(d)(5)(K) of the Act are budget neutral. As discussed earlier in this proposed rule, we have yet to determine whether Wingspan[supreg] meets the criteria for new technology add-on payments for FY 2008. Therefore, it is premature to estimate the potential payment impact in FY 2008 of any potential decision to make new technology add-on payments for Wingspan[supreg]. In addition, for FY 2008, we have proposed to discontinue new technology add-on payments for GORE TAG, Restore[supreg], and X STOP. In the FY 2007 IPPS final rule (71 FR 48344), we estimated that FY 2007 IPPS new technology add-on payments would be $16.61 million, $6.01 million, and $9.35 million, respectively, for these technologies. We have no additional information to further refine these estimates. Therefore, we estimate that Medicare’s new technology add-on payments will decline by approximately $32 million (the sum of our estimates for FY 2007) in FY 2008 compared to FY 2007. D. Effects of Requirements for Hospital Reporting of Quality Data for Annual Hospital Payment Update In section IV.A. of the preamble of this proposed rule, we discuss the requirements for hospitals to report quality data in order for hospitals to receive the full annual hospital payment update for FY 2008 and FY 2009. We also note that, for the FY 2008 payment update, hospitals must pass our validation requirement of a minimum of 80 percent reliability, based upon our chartaudit validation process, for the first three quarters of data from CY 2006. These data were due to the QIO Clinical Warehouse by August 15, 2006 (first quarter CY 2006 discharges), November 15, 2006 (second quarter CY 2006 discharges), and February 15, 2007 (third quarter CY 2006 discharges). We have continued our efforts to ensure that QIOs provide assistance to all hospitals that wish to submit data. In the preamble of this proposed rule, we are providing additional validation criteria to ensure that the quality data being sent to CMS are accurate. The requirement of 5 charts per hospital will result in approximately 21,500 charts per quarter total submitted to the agency. We reimburse hospitals for the cost of sending charts to the Clinical Data Abstraction Center (CDAC) at the rate of 12 cents per page for copying and approximately $4.00 per chart for postage. Our experience shows that the average chart received at the CDAC is approximately 150 pages. Thus, the agency will have expenditures of approximately $473,200 per quarter to collect the charts. Given that we reimburse for the data collection effort, we believe that a requirement for five charts per hospital per quarter represents a minimal burden to the participating hospital. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 E. Effects of Proposed Policy on Cancellation of Classification of Acquired Rural Status and Rural Referral Centers In section IV.C.2. of the preamble of this proposed rule, we are proposing to revise our regulations to change the effective date of cancellation of acquired rural status for rural referral centers from ‘‘the hospital’s next full cost reporting period following the date of its request for cancellation’’ to the next cost reporting period for hospitals paid on the basis of reasonable costs (such as CAHs) and for hospitals under the IPPS, after at least one 12-month cost reporting period as rural and not until the beginning of the Federal fiscal year following the date of its request for cancellation. Currently, there are about 100 IPPS hospitals that have acquired rural status. During this fiscal year (FY 2007), we have only received requests for cancellations from five hospitals. However, this number may increase if the current policy is not changed. We anticipate that the proposed policy change would, at a minimum, affect these five hospitals. However, we estimate that the proposed policy change would not have a significant impact on IPPS hospitals. F. Effects of Proposed Policy on Payment for IME and Direct GME In section IV.D.3. of the preamble of this proposed rule, we discuss our proposed changes related to whether vacation and sick leave as well as orientation should be included in the FTE count for IME and direct GME payment purposes. We are proposing, for cost reporting periods beginning on or after October, 1, 2007, for direct GME and IME, that time spent by residents on vacation or sick leave be removed from the total time considered to constitute an FTE resident. In addition, we are proposing to continue our existing policy to count time spent by residents in orientation activities for both IME and direct GME payment purposes. Because we are proposing to remove vacation and sick leave from the total time considered to constitute an FTE resident, we believe the impact of this change would be negligible. In addition, there is no impact from the clarification of the policy for orientation time since it is not a change in policy. G. Effects of Proposed Policy Changes Relating to Emergency Services Under EMTALA During an Emergency Period In section IV.F. of the preamble of this proposed rule, we are proposing to amend the EMTALA regulations regarding EMTALA implementation in emergency areas during an emergency period. Section 1135 of the Act authorizes the Secretary to temporarily waive or modify the application of several requirements and their implementing regulations as they relate to actions taken in an emergency area during an emergency period. The EMTALA regulations (§ 489.24(a)(2)) now specify that sanctions for inappropriate transfer during a national emergency do not apply to a hospital with a dedicated emergency department located in an emergency area. To make our regulations better reflect the scope of the authority under section 1135 of the Act, we are proposing to revise them to clarify that such waivers also may apply to PO 00000 Frm 00451 Fmt 4742 Sfmt 4702 25129 sanctions for the redirection or relocation of an individual to an alternate location to receive a medical screening examination where that direction or relocation occurs pursuant to a State emergency preparedness plan. We also are proposing to revise the regulations to incorporate changes made by the Pandemic and All-Hazards Preparedness Act. That legislation amended section 1135 of the Act to state that, in the case of a public health emergency that involves a pandemic infectious disease, sanctions for the direction or relocation of an individual to an alternative location for screening may be waived based on either a State emergency preparedness plan or a State pandemic preparedness plan, whichever applies in the State. In addition, section 1135 of the Act was amended to create an exception to the otherwise applicable 72-hour limitation on the duration of waivers or modifications of sanctions for EMTALA violations in cases where a public health emergency involves a pandemic infectious disease (such as pandemic influenza). As described more fully earlier in this preamble, these changes are not discretionary and do not impose any substantive new requirements. On the contrary, they merely update our regulations to make them consistent with current statutory requirements. Because of this, we are estimating no impact on Medicare expenditures and no significant impact on hospitals with emergency departments. H. Effects of Proposed Policy on Disclosure of Physician Ownership in Hospitals and Patient Safety Measures In section IV.G. of the preamble of this proposed rule, we discuss our proposals to adopt a requirement relating to disclosure of physician ownership in hospitals and to increase patient safety measures. In the strategic and implementing plan included in our ‘‘Final Report to the Congress and Strategic and Implementing Plan’’ required under section 5006 of the Deficit Reduction Act of 2005, we stated that we would adopt a disclosure requirement that would require hospitals to disclose to patients whether they are physician-owned and, if so, the names of the physician-owners. In addition, we recognize that patients should be made aware of whether or not a physician is present in the hospital at all times, and the hospital’s plans to address patients’ emergency medical conditions when a physician is not present. We believe this proposed rule would impose minimal additional costs on hospitals. We believe the cost of implementing these provisions borne by hospitals would be limited to a one-time cost associated with completing minor revisions to portions of the medical staff bylaws and policies and procedures related to patient admission and registration, as well as providing written notification to patients and affected staff. In addition, the proposed changes concerning disclosure of physician ownership in hospitals are consistent with current practices of members of the physician-owned specialty hospital associations. Therefore, we do not believe that these proposed changes will have any significant economic impact on hospitals. E:\FEDREG\03MYP2.LOC 03MYP2 25130 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules I. Effects of Implementation of Rural Community Hospital Demonstration Program In section IV.H. of the preamble to this proposed rule, we discuss our implementation of section 410A of Pub. L. 108–173 that required the Secretary to establish a demonstration that will modify reimbursement for inpatient services for up to 15 small rural hospitals. Section 410A(c)(2) requires that ‘‘in conducting the demonstration program under this section, the Secretary shall ensure that the aggregate payments made by the Secretary do not exceed the amount which the Secretary would have paid if the demonstration program under this section was not implemented.’’ As discussed in section IV.H. of the preamble to this proposed rule, we are satisfying this requirement by adjusting national IPPS rates by a factor that is sufficient to account for the added costs of this demonstration. We estimate that the average additional annual payment for FY 2008 that would be made to each participating hospital under the demonstration would be approximately $1,075,765. We based this estimate on the recent historical experience of the difference between inpatient cost and payment for hospitals that are participating in the demonstration. For the 9 participating hospitals, the total annual impact of the demonstration program is estimated to be $9,681,893. The proposed adjustment factor to the Federal rate used in calculating Medicare inpatient prospective payments as a result of the demonstration is 0.999899. J. Effects of Proposed Policy on Services Furnished to Beneficiaries in Custody of Penal Authorities In section VII. of the preamble of this proposed rule, we discuss our proposal to revise our regulations relating to the special conditions under which Medicare payment may be made for services furnished to individuals in custody of penal authorities. We are proposing to indicate that, for purposes of Medicare payment, individuals who are in custody include, but are not limited to, individuals who are under arrest, incarcerated, imprisoned, escaped from confinement, under supervised release, required to reside in mental health facilities, required to reside in halfway houses, required to live under home detention, or confined completely or partially in any way under a penal statute or rule. This proposed definition is in accordance with how custody has been defined by Federal courts for purposes of the habeas corpus protections of the Constitution and is consistent with current CMS policy. We anticipate that this proposed change would have no measurable impact on Medicare expenditures. mmaher on DSK3CLS3C1PROD with $$_JOB VIII. Impact of Proposed Changes in the Capital IPPS A. General Considerations Fiscal year (FY) 2001 was the last year of the 10-year transition period established to phase in the PPS for hospital capital-related costs. During the transition period, hospitals were paid under one of two payment methodologies: fully prospective or hold harmless. Under the fully prospective VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 methodology, hospitals were paid a blend of the capital Federal rate and their hospitalspecific rate (see § 412.340). Under the holdharmless methodology, unless a hospital elected payment based on 100 percent of the capital Federal rate, hospitals were paid 85 percent of reasonable costs for old capital costs (100 percent for SCHs) plus an amount for new capital costs based on a proportion of the capital Federal rate (see § 412.344). As we state in section V. of the preamble of this proposed rule, with the 10-year transition period ending with hospital cost reporting periods beginning on or after October 1, 2001 (FY 2002), beginning in FY 2002 capital prospective payment system payments for most hospitals are based solely on the capital Federal rate. Therefore, we no longer include information on obligated capital costs or projections of old capital costs and new capital costs, which were factors needed to calculate payments during the transition period, for our impact analysis. In accordance with § 412.312, the basic methodology for determining a capital PPS payment includes a large urban add-on adjustment. However, as discussed above and in section V. of the preamble of this proposed rule, we are proposing to eliminate the large urban add-on adjustment to capital IPPS payments in FY 2008. The proposed basic methodology for calculating capital IPPS payments in FY 2008 would be: (Standard Federal Rate) x (DRG weight) x (GAF) x (COLA for hospitals located in Alaska and Hawaii) x (1 + Disproportionate Share Adjustment Factor + IME Adjustment Factor, if applicable). In addition, hospitals may also receive outlier payments for those cases that qualify under the threshold established for each fiscal year. The data used in developing the impact analysis presented below are taken from the December 2006 update of the FY 2006 MedPAR file and the December 2006 update of the Provider-Specific File that is used for payment purposes. Although the analyses of the proposed changes to the capital prospective payment system do not incorporate cost data, we used the December 2006 update of the most recently available hospital cost report data (FYs 2004 and 2005) to categorize hospitals. Our analysis has several qualifications. In general, we do not make adjustments for behavioral changes that hospitals may adopt in response to proposed policy changes. However, as discussed in section III. of the Addendum to this proposed rule, we proposed that the capital rates would be adjusted to account for upcoding under the proposed MS–DRGs. Furthermore, due to the interdependent nature of the IPPS, it is very difficult to precisely quantify the impact associated with each proposed change. In addition, we draw upon various sources for the data used to categorize hospitals in the tables. In some cases (for instance, the number of beds), there is a fair degree of variation in the data from different sources. We have attempted to construct these variables with the best available sources overall. However, for individual hospitals, some miscategorizations are possible. Using cases from the December 2006 update of the FY 2006 MedPAR file, we PO 00000 Frm 00452 Fmt 4742 Sfmt 4702 simulated payments under the capital PPS for FY 2007 and FY 2008 for a comparison of total payments per case. Any short-term, acute care hospitals not paid under the general IPPS (Indian Health Service hospitals and hospitals in Maryland) are excluded from the simulations. As we explain in section III.A. of the Addendum to this proposed rule, payments are no longer made under the regular exceptions provision under § § 412.348(b) through (e). Therefore, we no longer use the actuarial capital cost model (described in Appendix B of the August 1, 2001 proposed rule (66 FR 40099)). We modeled payments for each hospital by multiplying the capital Federal rate by the GAF and the hospital’s case-mix. We then added estimated payments for indirect medical education, disproportionate share, large urban add-on, and outliers, if applicable. (We note that, consistent with our proposal to eliminate the large urban add-on beginning in FY 2008, such estimated payments under this policy are only reflected in the payments we modeled for FY 2007 and were not included in the payments we modeled for FY 2008.) For purposes of this impact analysis, the model includes the following assumptions: <bullet≤ We estimate that the Medicare case-mix index will increase by 1.0 percent in both FYs 2007 and 2008. (We note that this does not reflect the proposed adjustment to the capital rates to account for assumed growth in case mix due to improvement in documentation and coding (upcoding) under the proposed MS–DRGs, as discussed in section III. of the Addendum of this proposed rule.) <bullet≤ We estimate that the Medicare discharges will be 12.925 million in FY 2007 and 12.995 million in FY 2008 for an estimated 0.54 percent increase from FY 2007 to FY 2008. <bullet≤ The capital Federal rate was updated beginning in FY 1996 by an analytical framework that considers changes in the prices associated with capital-related costs and adjustments to account for forecast error, changes in the case-mix index, allowable changes in intensity, and other factors. As discussed in section V. of the preamble and section III.A. of the Addendum to this proposed rule, the proposed FY 2008 update for rural hospitals is 0.8 percent. We are proposing a 0.0 percent update for urban hospitals in FY 2008. <bullet≤ In addition to the proposed FY 2008 update factors, the proposed FY 2008 capital Federal rate for both urban and rural hospitals was calculated based on a proposed GAF/DRG budget neutrality factor of 1.0018, a proposed outlier adjustment factor of 0.9484, and a proposed exceptions adjustment factor of 0.9997. <bullet≤ For FY 2008, as discussed in section V. of the preamble and section III.A. of the Addendum to this proposed rule, the proposed FY 2008 capital rates for all hospitals was further adjusted by a factor of 0.976 (or -2.4 percent) to maintain budget neutrality if the proposed MS–DRGs are implemented by eliminating the effect of changes in coding or classification of discharges that do not reflect real case mix changes. E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules B. Results mmaher on DSK3CLS3C1PROD with $$_JOB We used the actuarial model described above to estimate the potential impact of our proposed changes for FY 2008 on total capital payments per case, using a universe of 3,535 hospitals. As described above, the individual hospital payment parameters are taken from the best available data, including the December 2006 update of the FY 2006 MedPAR file, the December 2006 update to the Provider-Specific File, and the most recent cost report data from the December 2006 update of HCRIS. In Table III, we present a comparison of total payments per case for FY 2007 compared to proposed FY 2008 based on the proposed FY 2008 payment policies. Column 2 shows estimates of payments per case under our model for FY 2007. Column 3 shows estimates of payments per case under our model for FY 2008. Column 4 shows the total percentage change in payments from FY 2007 to FY 2008. The change represented in Column 4 includes the proposed 0.8 percent update to the capital Federal rate for rural hospitals and a 0.0 percent update for urban hospitals, a 1.0 percent increase in case-mix, changes in the adjustments to the capital Federal rate (for example, the effect of the hospital wage index on the GAF), reclassifications by the MGCRB, and the proposed additional 2.4 percent reduction to all of the rates to account for upcoding or changes in coding that do not reflect real changes in case-mix if the proposed MS–DRGs are implemented. The comparisons are provided by: (1) geographic location; (2) region; and (3) payment classification. The simulation results show that, on average, capital payments per case can be expected to decrease 0.7 percent in FY 2008. In addition to the proposed 0.0 percent update for urban hospitals, this projected decrease in capital payments per case can be attributed to the proposed -2.4 percent adjustment to all hospitals to account for assumed growth in case mix due to improvements in documentation and coding prior to the assumed growth occurring if the proposed MS–DRGs are implemented. Although the proposed GAF/DRG factor is expected to increase payments slightly (0.18 percent) in FY 2008 as compared to FY 2007, the proposed outlier factor is expected to contribute to the estimated decrease in capital payments from FY 2007 to FY 2008 by 0.88 percent. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 The results of our comparisons by geographic location and by region are consistent with the results we expected after proposing to eliminate the large urban addon adjustment, and the proposed 0.0 percent update for urban hospitals. The geographic comparison shows that urban hospitals are expected to experience a 0.6 percent decrease in IPPS capital payments per case, while rural hospitals are expected to experience a 0.9 percent decrease in capital payments per case. This difference is mostly due to the proposed MS–DRGs. Specifically, based on existing hospital claims data, under the proposed MS–DRGs, the better recognition of severity of illness is expected to increase payments to urban hospitals that treat a more acutely ill mix of patients and improvement in the DRG system will increase their payments. Similarly, however, the improved recognition of severity of illness will decrease payments to rural hospitals because they are treating less severely ill patients. Therefore we project a lower increase in estimated payments for rural hospitals due to the proposed DRG changes as compared to urban hospitals. In addition to the effect of the proposed DRG changes, the capital impact is also somewhat affected by the proposed wage-index changes because the GAF values are derived from the proposed wage index. Another factor contributing to the decrease in payments for rural hospitals is the expiration of the 3-year hold harmless provision for urban hospitals that were converted to rural under the new CBSAs in FY 2005. The policy allowed urban hospitals under the old labor market area designations that became rural under the CBSAs to receive payment using the wage index of the MSA where they were previously classified as urban for 3 years: FY 2005 through FY 2007. Beginning in FY 2008, these rural hospitals will receive the wage index for the area that they are currently located in. As a result, rural hospitals will experience a decrease in payments because of the addition of these formerly urban hospitals. More than half of all regions are estimated to experience a decrease in total capital payments per case from FY 2007 to FY 2008. These decreases vary by region and range from a -2.3 percent in the Middle Atlantic urban region to a -0.7 in the East South Central urban region. For most of the regions projected to experience a larger than average decrease in capital payments, the difference is mostly due to changes in the proposed PO 00000 Frm 00453 Fmt 4742 Sfmt 4702 25131 GAF and the elimination of the large urban add-on adjustment. In the regions experiencing an increase in total capital payments per case, the range is from 0.7 in the Pacific rural region to a 0.1 percent increase in the South Atlantic rural region. For most of the regions projected to experience an increase in capital payments, it is mostly due to changes to adopt the proposed MS–DRGs. The change in payments per case for all hospitals is -0.7 percent. By type of ownership, voluntary hospitals are estimated to experience a decrease of -1.0 percent in capital payments per case, while proprietary and government hospitals are estimated to experience 0.1 percent and 0.2 percent increases in payments, respectively. Government hospitals and proprietary hospitals are projected to have slight increases in capital payments mostly due to a smaller than average estimated decrease in payments due to proposed changes in the GAF and a slightly larger than average estimated increase in payments due to proposed changes to adopt MS–DRGs. Section 1886(d)(10) of the Act established the MGCRB. Before FY 2005, hospitals could apply to the MGCRB for reclassification for purposes of the standardized amount, wage index, or both. Section 401(c) of Pub. L. 108– 173 equalized the standardized amounts under the operating IPPS. Therefore, beginning in FY 2005, there is no longer reclassification for the purposes of the standardized amounts; however, hospitals still may apply for reclassification for purposes of the wage index for FY 2008. Reclassification for wage index purposes also affects the GAF because that factor is constructed from the hospital wage index. To present the effects of the hospitals being reclassified for FY 2008, we show the average payments per case for reclassified hospitals for FY 2007. Rural nonreclassified hospitals are expected to have the largest decrease in payments (-2.0 percent), as compared to the -0.3 percent for rural reclassified hospitals for FY 2008. This difference is mostly due to proposed changes in the GAF and proposed changes to adopt MS–DRGs. Urban hospitals are expected to experience a decrease in payments of 0.9 percent and 0.6 percent, respectively, for reclassified and nonreclassified hospitals. This difference is mostly due to the proposed elimination of the large urban add-on. E:\FEDREG\03MYP2.LOC 03MYP2 25132 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE III.—COMPARISON OF TOTAL PAYMENTS PER CASE [FY 2007 payments compared to FY 2008 payments] Average FY 2007 payments/case Average FY 2008 payments/case 3,535 1,409 1,131 995 2,540 632 849 480 412 167 995 342 369 172 67 45 758 842 747 524 799 628 683 754 828 1,002 524 430 480 523 576 657 753 833 747 519 794 618 677 748 824 999 519 418 473 521 573 656 -0.7 -1.1 0.0 -0.9 -0.6 -1.7 -0.8 -0.8 -0.5 -0.3 -0.9 -2.8 -1.5 -0.3 -0.5 -0.1 2,540 126 350 388 395 166 156 358 153 395 53 995 19 72 173 124 177 115 194 80 41 799 847 875 756 783 723 780 749 797 914 348 524 694 536 508 557 487 556 478 522 634 794 830 855 759 777 718 772 750 799 918 344 519 683 531 508 548 481 550 469 524 639 -0.6 -2.1 -2.3 0.3 -0.8 -0.7 -1.0 0.2 0.2 0.5 -1.2 -0.9 -1.5 -0.8 0.1 -1.6 -1.2 -1.1 -2.0 0.4 0.7 3,535 1,436 1,183 916 758 840 742 527 753 831 742 522 -0.7 -1.1 0.1 -1.0 2,479 816 240 640 770 1,096 636 764 1,090 -0.6 -0.8 -0.5 1,527 359 823 551 820 542 -0.2 -1.7 391 189 469 584 463 583 -1.3 -0.2 36 154 479 433 478 425 -0.2 -1.8 805 192 1,081 541 902 807 672 704 899 788 672 694 -0.4 -2.3 -0.1 -1.4 2,477 59 45 21 17 801 693 633 450 741 796 692 623 433 740 -0.6 -0.2 -1.5 -3.7 0.0 434 2,105 367 568 61 793 800 570 459 511 786 796 568 450 501 -0.9 -0.6 -0.3 -2.0 -2.1 2,069 823 776 689 768 690 -1.0 0.1 mmaher on DSK3CLS3C1PROD with $$_JOB Number of hospitals By Geographic Location: All hospitals ................................................................................................................................ Large urban areas (populations over 1 million) ......................................................................... Other urban areas (populations of 1 million or fewer) .............................................................. Rural areas ................................................................................................................................ Urban hospitals .......................................................................................................................... 0–99 beds .................................................................................................................................. 100–199 beds ............................................................................................................................ 200–299 beds ............................................................................................................................ 300–499 beds ............................................................................................................................ 500 or more beds ...................................................................................................................... Rural hospitals ........................................................................................................................... 0–49 beds .................................................................................................................................. 50–99 beds ................................................................................................................................ 100–149 beds ............................................................................................................................ 150–199 beds ............................................................................................................................ 200 or more beds ...................................................................................................................... By Region: Urban by Region ........................................................................................................................ New England .............................................................................................................................. Middle Atlantic ............................................................................................................................ South Atlantic ............................................................................................................................. East North Central ..................................................................................................................... East South Central ..................................................................................................................... West North Central .................................................................................................................... West South Central .................................................................................................................... Mountain .................................................................................................................................... Pacific ......................................................................................................................................... Puerto Rico ................................................................................................................................ Rural by Region ......................................................................................................................... New England .............................................................................................................................. Middle Atlantic ............................................................................................................................ South Atlantic ............................................................................................................................. East North Central ..................................................................................................................... East South Central ..................................................................................................................... West North Central .................................................................................................................... West South Central .................................................................................................................... Mountain .................................................................................................................................... Pacific ......................................................................................................................................... By Payment Classification: All hospitals ................................................................................................................................ Large urban areas (populations over 1 million) ......................................................................... Other urban areas (populations of 1 million or fewer) .............................................................. Rural areas ................................................................................................................................ Teaching Status: Non-teaching .............................................................................................................................. Fewer than 100 Residents ......................................................................................................... 100 or more Residents .............................................................................................................. Urban DSH: 100 or more beds ...................................................................................................................... Less than 100 beds ................................................................................................................... Rural DSH: Sole Community (SCH/EACH) .................................................................................................. Referral Center (RRC/EACH) .................................................................................................... Other Rural: 100 or more beds ...................................................................................................................... Less than 100 beds ................................................................................................................... Urban teaching and DSH: Both teaching and DSH ............................................................................................................. Teaching and no DSH ............................................................................................................... No teaching and DSH ................................................................................................................ No teaching and no DSH ........................................................................................................... Rural Hospital Types: Non special status hospitals ...................................................................................................... RRC/EACH ................................................................................................................................ SCH/EACH ................................................................................................................................. Medicare-dependent hospitals (MDH) ....................................................................................... SCH, RRC and EACH ............................................................................................................... Hospitals Reclassified by the Medicare Geographic Classification Review Board: FY2008 Reclassifications: All Urban Reclassified ................................................................................................................ All Urban Non-Reclassified ........................................................................................................ All Rural Reclassified ................................................................................................................. All Rural Non-Reclassified ......................................................................................................... Other Reclassified Hospitals (Section 1886(d)(8)(B)) ............................................................... Type of Ownership: Voluntary .................................................................................................................................... Proprietary .................................................................................................................................. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 PO 00000 Frm 00454 Fmt 4742 Sfmt 4702 E:\FEDREG\03MYP2.LOC 03MYP2 Change 25133 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules TABLE III.—COMPARISON OF TOTAL PAYMENTS PER CASE—Continued [FY 2007 payments compared to FY 2008 payments] Average FY 2007 payments/case Number of hospitals Government ............................................................................................................................... Medicare Utilization as a Percent of Inpatient Days: 0–25 ........................................................................................................................................... 25–50 ......................................................................................................................................... 50–65 ......................................................................................................................................... Over 65 ...................................................................................................................................... IX. Alternatives Considered This proposed rule contains a range of proposed policies. The preamble of this proposed rule provides descriptions of the statutory provisions that are addressed, identifies those proposed policies when discretion has been exercised, presents rationale for our decisions and, where relevant, alternatives that were considered. X. Overall Conclusion The changes we are proposing in this proposed rule would affect all classes of hospitals. Some hospitals are expected to experience significant gains and others less significant gains, but overall hospitals are projected to experience positive updates in IPPS payments in FY 2008. Table I of section VI of this Appendix demonstrates the estimated distributional impact of the IPPS budget neutrality requirements for proposed DRG and wage index changes, and for the wage index reclassifications under the MGCRB. Table I also shows an overall increase of 3.3 percent in operating payments, an estimated increase of $3.28 billion, which includes hospital reporting of quality data program costs ($1.89 million) and all operating payment policies as described in section VI. of this Appendix. Capital payments are estimated to decrease by 0.7 percent per case, as shown in Table III of section VIII. of this Appendix. Therefore, we project that capital payments will decline by $13 million in FY 2008 compared to FY 2007. The operating and capital payments should result in a net increase of $3.269 billion to IPPS providers. The discussions presented in the previous pages, in combination with the rest of this proposed rule, constitute a regulatory impact analysis. mmaher on DSK3CLS3C1PROD with $$_JOB XI. Accounting Statement As required by OMB Circular A–4 (available at https://www.whitehousegov/ omb/circulars/a004/a-4.pdf), in Table IV below, we have prepared an accounting statement showing the classification of the expenditures associated with the provisions of this proposed rule. This table provides our best estimate of the increase in Medicare payments on providers as a result of the proposed changes to the IPPS presented in this rule. All expenditures are classified as transfers to Medicare providers. VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 598 745 746 0.2 1,001 857 672 605 1,006 854 666 594 0.5 -0.4 -1.0 -1.8 Transfers Annualized Monetized Transfers. From Whom to Whom $3.269 Billion. Total ................... $3.269 Billion. Federal Government to IPPS Medicare Providers. XII. Executive Order 12866 In accordance with the provisions of Executive Order 12866, the Office of Management and Budget reviewed this proposed rule. of Update Factors for Operating Cost Rates of Payment for Inpatient Hospital Services (If you choose to comment on issues in this section, please include the caption ‘‘Update Factors’’ at the beginning of your comment.) I. Background Section 1886(e)(4)(A) of the Act requires that the Secretary, taking into consideration the recommendations of the MedPAC, recommend update factors for inpatient hospital services for each fiscal year that take into account the amounts necessary for the efficient and effective delivery of medically appropriate and necessary care of high quality. Under section 1886(e)(5)(B) of the Act, we are required to publish the proposed and final update factors recommended by the Secretary in the proposed and final IPPS rules, respectively. Accordingly, this Appendix provides the recommendations of appropriate update factors for the IPPS standardized amount, the hospital-specific rates for SCHs and MDHs, and the rate-ofincrease limits for hospitals and hospital units excluded from the IPPS, as well as IPFs and IRFs. We also discuss our response to MedPAC’s recommended update factors for inpatient hospital services. II. Inpatient Hospital Update for FY 2008 Section 1886(b)(3)(B)(i)(XX) of the Act, as amended by section 5001(a) of Pub. L. 109– 171, sets the FY 2008 percentage increase in the operating cost standardized amount equal to the rate-of-increase in the hospital market basket for IPPS hospitals in all areas, subject PO 00000 Frm 00455 Fmt 4742 Sfmt 4702 Change 230 1,292 1,453 441 TABLE IV.—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES FROM FY 2007 TO FY 2008 Category Average FY 2008 payments/case to the hospital submitting quality information under rules established by the Secretary in accordance with 1886(b)(3)(B)(viii) of the Act. For hospitals that do not provide these data, the update is equal to the market basket percentage increase less 2.0 percentage points. Consistent with current law, based on the Office of the Actuary’s first quarter 2007 forecast of the FY 2008 market basket increase, we are estimating that the FY 2008 update to the standardized amount will be 3.3 percent (that is, the current estimate of the market basket rate-of-increase) for hospitals in all areas, provided the hospital submits quality data in accordance with our rules. For hospitals that do not submit quality data, we are estimating that the update to the standardized amount will be 1.3 percent (that is, the current estimate of the market basket rate-of-increase minus 2.0 percentage points). Section 1886(b)(3)(B)(iv) of the Act sets the FY 2008 percentage increase in the hospitalspecific rates applicable to SCHs and MDHs equal to the rate set forth in section 1886(b)(3)(B)(i) of the Act (that is, the same update factor as for all other hospitals subject to the IPPS, or the rate-of-increase in the market basket). Therefore, the update to the hospital-specific rates applicable to SCHs and MDHs is also estimated to be 3.3 percent. Section 1886(b)(3)(B)(ii) of the Act is used for purposes of determining the percentage increase in the rate-of-increase limits for children’s and cancer hospitals. Section 1886(b)(3)(B)(ii) of the Act sets the percentage increase in the rate-of-increase limits equal to the market basket percentage increase. In accordance with § 403.752(a) of the regulations, RNHCIs are paid under § 413.40, which also uses section 1886(b)(3)(B)(ii) of the Act to update the percentage increase in the rate-of-increase limits. Section 1886(j)(3)(C) of the Act addresses the increase factor for the Federal prospective payment rate of IRFs. Section 123 of Pub. L. 106–113, as amended by section 307(b) of Pub. L. 106–554, provides the statutory authority for updating payment rates under the LTCH PPS. As discussed below, for cost reporting periods beginning on or after October 1, 2006, LTCHs that are not defined as new under § 412.23(e)(4), and that had not elected to be paid under 100 percent of the Federal rate are paid 100 percent of the adjusted Federal PPS rate. Therefore, because no portion of LTCHs’ prospective payments will be based on E:\FEDREG\03MYP2.LOC 03MYP2 mmaher on DSK3CLS3C1PROD with $$_JOB 25134 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules reasonable cost concepts for cost reporting periods beginning on or after October 1, 2006, we are not proposing a rate-of-increase percentage for FY 2008 for LTCHs to be used under § 413.40. In addition, section 124 of Pub. L. 106–113 provides the statutory authority for updating all aspects of the payment rates for IPFs. Under this broad authority, IPFs that are not defined as new under § 412.426(c) will be paid under a blend methodology for cost reporting periods beginning on or after January 1, 2005, and before January 1, 2008. The methodology blends the estimated Federal per diem payment amount and a facility-specific payment amount. The portion of the IPF PPS payment that is based on reasonable cost principles is updated in accordance with 42 CFR Part 413, which uses section 1886(b)(3)(B)(ii) of the Act to determine the percentage increase in the rate-of-increase limits. For the reasonable cost-based portion of an IPF’s PPS blended payments, we are proposing our current estimate of the excluded hospital market basket increase (3.4 percent) to update the target amounts. New IPFs are paid based on 100 percent of the Federal per diem payment amount. Currently, children’s hospitals, cancer hospitals, and RNHCIs are the remaining three types of hospitals still reimbursed under the reasonable cost methodology. We are providing our current estimate of the FY 2008 IPPS operating market basket percentage increase (3.3 percent) to update the target limits for children’s hospitals, cancer hospitals, and RNHCIs. Effective for cost reporting periods beginning on or after October 1, 2002, LTCHs have been paid under the LTCH PPS, which was implemented with a 5-year transition period for LTCHs not defined as new under § 412.23(e)(4) (hereafter referred to as ‘‘existing’’). (See 67 FR 55954.) An existing LTCH could have elected to be paid at 100 percent of the adjusted Federal prospective rate at the start of any of its cost reporting periods during the transition period. During this transition period, if an existing LTCH did not elect to be paid at 100 percent of the adjusted Federal prospective payment rate, it received a PPS payment that consisted of a blend of its reasonable cost-based payment and the Federal prospective payment rate. For cost reporting periods beginning on or after October 1, 2006, no portion of a LTCH’s PPS payments can be based on reasonable cost concepts. Consequently, there is no need to propose to update the target limit under § 413.40 effective October 1, 2007 for LTCHs. In the RY 2008 LTCH PPS proposed rule (72 FR 4791 through 4792), we recommended an update of 0.71 percent (that is, the latest estimate of the market basket rate-of-increase of 3.2 percent minus an adjustment factor of 2.49 percentage points for case-mix growth due to improved coding) to the LTCH PPS Federal rate for RY 2008. Effective for cost reporting periods beginning on or after January 1, 2005, IPFs are paid under the IPF PPS. IPF PPS payments are based on a Federal per diem rate that is derived from the sum of the average routine operating, ancillary, and capital costs for each patient day of psychiatric care in an IPF, adjusted for VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 budget neutrality. For cost reporting periods beginning on or after January 1, 2005, and before January 1, 2008, existing IPFs (those not defined as ‘‘new’’ under § 412.426(c)) are paid based on a blend of the reasonable costbased PPS payments and the Federal per diem base rate. For cost reporting periods beginning on or after January 1, 2008, existing IPFs will be paid based on 100 percent of the Federal per diem rate. For purposes of the update factor for FY 2008, the portion of the IPF PPS transitional blend payment based on reasonable costs would be determined by updating the IPF’s TEFRA limit by the current estimate of the excluded hospital market basket, which is estimated to be 3.4 percent. The update factor of 4.3 percent to the Federal per diem rate for July 1, 2006 through June 30, 2007 was provided in the rate year (RY) 2007 IPF PPS final rule (71 FR 27046). The Federal per diem rate for RY 2008 will be updated in the RY 2008 update notice that is scheduled for publication in May 2007. IRFs are paid under the IRF PPS for cost reporting periods beginning on or after January 1, 2002. For cost reporting periods beginning on or after October 1, 2002 (FY 2003), and thereafter, the Federal prospective payments to IRFs are based on 100 percent of the adjusted Federal IRF prospective payment amount, updated annually. (See 69 FR 45721). Under section 1886(j)(3)(C) of the Act, the FY 2008 IRF PPS update will equal 3.3 percent based on the Global Insight, Inc.’s first quarter 2007 forecast with historical data through the fourth quarter of 2006. We expect that the market basket will be updated with more recent data to the extent the data are available. III. Secretary’s Recommendation MedPAC is recommending an inpatient hospital update equal to the market basket rate of increase for FY 2008. MedPAC’s rationale for this update recommendation is described in more detail below. Using the 2007 first quarter forecast from the Office of the Actuary of the FY 2008 market basket increase and an adjustment factor based on the FY 2008 President’s Budget, we are recommending an update to the standardized amount of 2.65 percent (that is, the market basket rate-of-increase of 3.3 percent minus an adjustment factor of 0.65 percentage points). We are recommending that this same update factor apply to SCHs and MDHs. Our rationale for this recommended update is described below. In addition to making a recommendation for IPPS hospitals, in accordance with section 1886(e)(4)(A) of the Act, we are also recommending update factors for all other types of hospitals. Consistent with the President’s budget, we are recommending an update based on the market basket increase for children’s hospitals, cancer hospitals, and RNHCIs of 3.3 percent. For IPFs that are currently paid on a PPS blended payment basis, a portion of which is based on reasonable cost-principles and Federal prospective payment amounts, we are recommending an update factor of 3.4 percent for the portion of the payment that is based on reasonable costs. Consistent with the President’s Budget, based on Global PO 00000 Frm 00456 Fmt 4742 Sfmt 4702 Insight Inc.’s 1st quarter 2007 forecast of the RPL market basket increase, we are recommending an update equal to the market basket increase of 3.2 percent for the Federal per diem payment amount. In the RY 2008 LTCH PPS proposed rule (72 FR 4791 through 4792), we recommended an update of 0.71 percent (that is, the most recent estimate of the market basket rate-ofincrease of 3.2 percent minus an adjustment factor of 2.49 percentage points for case-mix growth due to improved coding) to the Federal rate for RY 2008. We will provide the final update in the LTCH final rule. Finally, consistent with the President’s FY 2008 Budget, we are recommending that the Federal rate to the IRF PPS remain unchanged for FY 2008. For fiscal years prior to FY 2008, section 1886(e)(3) of the Act directed the Secretary to report to the Congress an initial estimate of his recommendation of an appropriate payment inflation update for inpatient hospital services for the upcoming fiscal year not later than March 1. Section 1886(d)(4)(C) of the Act further required the Secretary to include recommendations with respect to adjustments to the DRG weighting factors in the March 1 Report to Congress. In addition, sections 1886(e)(4)(A) and (e)(5)(B) of the Act require that the Secretary recommend update factors in each of the IPPS proposed and final rules, taking into account MedPAC’s recommendation. Thus, the statute required the Secretary to make update recommendations in both a March 1 Report to Congress, and later in the IPPS proposed and final rules. Historically, the only difference between the recommendation we provided in the March 1 Report to Congress and the IPPS proposed rule was the use of a later estimate of the market basket increase for the proposed rule. Section 106(c) of Pub. L. 109–432 eliminated the requirement to make the Report to Congress recommending an update and adjustments to DRG weighting factors by March 1. In accordance with section 106(c) of Pub. L. 109–432, we are making the Secretary’s only recommendation for an update factor in the IPPS rules. IV. MedPAC Recommendation for Assessing Payment Adequacy and Updating Payments in Traditional Medicare In its March 2007 Report to Congress, MedPAC assessed the adequacy of current payments and costs, and the relationship between payments and an appropriate cost base, utilizing an established methodology used by MedPAC in the past several years. MedPAC recommended an update to the hospital inpatient rates equal to the increase in the hospital market basket in FY 2008, concurrent with implementation of a quality incentive payment program. MedPAC also recommended that CMS put pressure on hospitals to control their costs rather than accommodate the current rate of cost growth. MedPAC noted that, notwithstanding negative overall Medicare margins, most of the indicators of Medicare payment adequacy to hospitals are positive, including beneficiaries’ access to care, increased access to capital, and service volume increases. MedPAC also noted that this recommendation ‘‘should have no impact on E:\FEDREG\03MYP2.LOC 03MYP2 Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed Rules mmaher on DSK3CLS3C1PROD with $$_JOB beneficiary access to care and is not expected to affect providers’ willingness and ability to provide care to Medicare beneficiaries.’’ Response: We agree with MedPAC that hospitals should control costs rather than accommodate the current rate of growth. An update equal to less than the market basket will pressure hospitals to control their costs, consistent with MedPAC’s recommendation. As MedPAC noted, rising hospital costs are resulting in margins for some hospitals that are below zero. As discussed in section II. of VerDate Mar 15 2010 02:00 Aug 26, 2011 Jkt 223001 the preamble of this proposed rule, CMS is refining the DRGs to better account for severity illness and is basing the DRG weights on cost rather than charges. We believe that these refinements will better match Medicare payments to the cost of care and provide incentives for hospitals to be more efficient in controlling costs. For these reasons, we are recommending an inpatient hospital update equal to the market basket increase minus an adjustment factor of 0.65 PO 00000 Frm 00457 Fmt 4742 Sfmt 4702 25135 percentage points for hospitals paid under the IPPS for FY 2008. We note that, because the operating and capital prospective payment systems remain separate, we are proposing to continue to use separate updates for operating and capital payments. The proposed update to the capital payment rate is discussed in section III. of the Addendum to this proposed rule. [FR Doc. 07–1920 Filed 4–13–07; 4:15 pm] BILLING CODE 4120–01–P E:\FEDREG\03MYP2.LOC 03MYP2

Agencies

[Federal Register Volume 72, Number 85 (Thursday, May 3, 2007)]
[Proposed Rules]
[Pages 24680-25135]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 07-1920]

[[Page 24679]]

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Part II

Department of Health and Human Services

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Centers for Medicare & Medicaid Services

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42 CFR Parts 411, 412, 413, and 489

Medicare Program; Proposed Changes to the Hospital Inpatient
Prospective Payment Systems and Fiscal Year 2008 Rates; Proposed Rule

Federal Register / Vol. 72, No. 85 / Thursday, May 3, 2007 / Proposed
Rules

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 411, 412, 413, and 489

[CMS-1533-P]
RIN 0938-AO70

Medicare Program; Proposed Changes to the Hospital Inpatient
Prospective Payment Systems and Fiscal Year 2008 Rates

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

ACTION: Proposed rule.

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SUMMARY: We are proposing to revise 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 certain provisions made by the Deficit
Reduction Act of 2005 (Pub. L. 109-171), the Medicare Improvements and
Extension Act under Division B, Title I of the Tax Relief and Health
Care Act of 2006 (Pub. L. 109-432), and the Pandemic and All-Hazards
Preparedness Act (Pub. L. 109-417). In addition, in the Addendum to
this proposed rule, we describe the proposed 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 proposed rate-of-increase limits for certain 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 or that have a
portion of a prospective payment system payment based on reasonable
cost principles. These proposed changes would be applicable to
discharges occurring on or after October 1, 2007.
In this proposed rule, we discuss our proposals to further refine
the diagnosis-related group (DRG) system under the IPPS to better
recognize severity of illness among patients--for FY 2008, we are
proposing to adopt a Medicare Severity DRG (MS-DRG) classification
system for the IPPS. We are also proposing to use the structure of the
proposed MS-DRG system for the LTCH prospective payment system
(referred to as MS-LTC-DRGs) for FY 2008.
Among the other policy changes that we are proposing to make are
changes related to: Limited revisions of the reclassification of cases
to proposed MS-DRGs, the proposed relative weights for the proposed MS-
LTC-DRGs; 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 indirect costs
of graduate medical education; submission of hospital quality data;
provisions governing application of sanctions relating to the Emergency
Medical Treatment and Labor Act of 1986 (EMTALA); provisions governing
disclosure of physician ownership in hospitals and patient safety
measures; and provisions relating to services furnished to
beneficiaries in custody of penal authorities.

DATES: To be assured consideration, comments must be received at one of
the addresses provided below, no later than 5 p.m. on June 12, 2007.

ADDRESSES: In commenting, please refer to file code CMS-1533-P. Because
of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
You may submit comments in one of three ways (no duplicates,
please):
1. Electronically. You may submit electronic comments on specific
issues in this regulation to https://www.cms.hhs.gov/eRulemaking. Click
on the link ``Submit electronic comments on CMS regulations with an
open comment period''. (Attachments should be in Microsoft Word,
WordPerfect, or Excel; however, we prefer Microsoft Word.)
2. By regular mail. You may mail written comments (one original and
two copies) to the following address ONLY: Centers for Medicare &
Medicaid Services, Department of Health and Human Services, Attention:
CMS-1533-P, P.O. Box 8011, Baltimore, MD 21244-1850.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments (one
original and two copies) to the following address ONLY: Centers for
Medicare & Medicaid Services, Department of Health and Human Services,
Attention: CMS-1533-P, Mail Stop C4-26-05, 7500 Security Boulevard,
Baltimore, MD 21244-1850.
4. By hand or courier. If you prefer, you may deliver (by hand or
courier) your written comments (one original and two copies) before the
close of the comment period to one of the following addresses. If you
intend to deliver your comments to the Baltimore address, please call
telephone number (410) 786-7195 in advance to schedule your arrival
with one of our staff members. Room 445-G, Hubert H. Humphrey Building,
200 Independence Avenue, SW., Washington, DC 20201, or 7500 Security
Boulevard, Baltimore, MD 21244-1850.
(Because access to the interior of the Hubert H. Humphrey Building
is not readily available to persons without Federal Government
identification, commenters are encouraged to leave their comments in
the CMS drop slots located in the main lobby of the building. A stamp-
in clock is available for persons wishing to retain proof of filing by
stamping in and retaining an extra copy of the comments being filed.)
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and received after the comment
period.
Submission of comments on paperwork requirements. You may submit
comments on this document's paperwork requirements by mailing your
comments to the addresses provided at the end of the ``Collection of
Information Requirements'' section in this document.
For information on viewing public comments, see the beginning of
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT:
Marc Hartstein, (410) 786-4548, Operating Prospective Payment,
Diagnosis-Related Groups (DRGs), Wage Index, New Medical Services and
Technology Add-On Payments, and Hospital Geographic Reclassifications
Issues
Tzvi Hefter, (410) 786-4487, Capital Prospective Payment, Excluded
Hospitals, Graduate Medical Education, Critical Access Hospitals, and
Long-Term Care (LTC)-DRG 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
Jacqueline Proctor, (410) 786-8852, Disclosure of Physician Ownership
in Hospitals and Patient Safety Measures Issues
Fred Grabau, (410) 786-0206, Services to Beneficiaries in Custody of
Penal Authorities Issues

SUPPLEMENTARY INFORMATION:
Submitting Comments: We welcome comments from the public on all
issues set forth in this rule to assist us in fully considering issues
and developing policies. You can assist us by referencing the file code
CMS-1533-P

[[Page 24681]]

and the specific ``issue identifier'' that precedes the section on
which you choose to comment.
Inspection of Public Comments: All comments received before the
close of the comment period are available for viewing by the public,
including any personally identifiable or confidential business
information that is included in a comment. We post all comments
received before the close of the comment period on the following Web
site as soon as possible after they have been received: https://www.cms.hhs.gov/eRulemaking. Click on the link ``Electronic Comments on
CMS Regulations'' on that Web site to view public comments.
Comments received timely will also be available for public
inspection as they are received, generally beginning approximately 3
weeks after publication of a document, at the headquarters of the
Centers for Medicare & Medicaid Services, 7500 Security Boulevard,
Baltimore, Maryland 21244, Monday through Friday of each week from 8:30
a.m. to 4 p.m. To schedule an appointment to view public comments,
phone 1-800-743-3951.

Electronic Access

This Federal Register document is also available from the Federal
Register online database through GPO Access, a service of the U.S.
Government Printing Office. Free public access is available on a Wide
Area Information Server (WAIS) through the Internet and via
asynchronous dial-in. Internet users can access the database by using
the World Wide Web; the Superintendent of Documents' home page address
is https://www.gpoaccess.gov/, by using local WAIS client software, or
by telnet to swais.access.gpo.gov, then login as guest (no password
required). Dial-in users should use communications software and modem
to call (202) 512-1661; type swais, then login as guest (no password
required).

Acronyms

AHA American Hospital Association
AHIMA American Health Information Management Association
AHRQ Agency for Health Care Research and Quality
AMI Acute myocardial infarction
AOA American Osteopathic Association
APR DRG All Patient Refined Diagnosis Related Group System
ASC Ambulatory surgical center
ASP Average sales price
AWP Average wholesale price
BBA Balanced Budget Act of 1997, Pub. L. 105-33
BBRA Medicare, Medicaid, and SCHIP [State Children's Health
Insurance Program] Balanced Budget Refinement Act of 1999, Pub. L.
106-113
BIPA Medicare, Medicaid, and SCHIP [State Children's Health
Insurance Program] Benefits Improvement and Protection Act of 2000,
Pub. L. 106-554
BLS Bureau of Labor Statistics
CAH Critical access hospital
CART CMS Abstraction & Reporting Tool
CBSAs Core-based statistical areas
CC Complication or comorbidity
CCR Cost-to-charge ratio
CDAC Clinical Data Abstraction Center
CIPI Capital input price index
CPI Consumer price index
CMI Case-mix index
CMS Centers for Medicare & Medicaid Services
CMSA Consolidated Metropolitan Statistical Area
COBRA Consolidated Omnibus Reconciliation Act of 1985, Pub. L. 99-
272
CPI Consumer price index
CY Calendar year
DRA Deficit Reduction Act of 2005, Pub. L. 109-171
DRG Diagnosis-related group
DSH Disproportionate share hospital
ECI Employment cost index
EMR Electronic medical record
EMTALA Emergency Medical Treatment and Labor Act of 1986, Pub. L.
99-272
FDA Food and Drug Administration
FFY Federal fiscal year
FIPS Federal information processing standards
FQHC Federally qualified health center
FTE Full-time equivalent
FY Fiscal year
GAAP Generally Accepted Accounting Principles
GAF Geographic Adjustment Factor
GME Graduate medical education
HCAHPS Hospital Consumer Assessment of Healthcare Providers and
Systems
HCFA Health Care Financing Administration
HCRIS Hospital Cost Report Information System
HHA Home health agency
HHS Department of Health and Human Services
HIC Health insurance card
HIPAA Health Insurance Portability and Accountability Act of 1996,
Pub. L. 104-191
HIPC Health Information Policy Council
HIS Health information system
HIT Health information technology
HMO Health maintenance organization
HSA Health savings account
HSCRC Maryland Health Services Cost Review Commission
HSRV Hospital-specific relative value
HSRVcc Hospital-specific relative value cost center
HQA Hospital Quality Alliance
HQI Hospital Quality Initiative
ICD-9-CM International Classification of Diseases, Ninth Revision,
Clinical Modification
ICD-10-PCS International Classification of Diseases, Tenth Edition,
Procedure Coding System
IHS Indian Health Service
IME Indirect medical education
IOM Institute of Medicine
IPF Inpatient psychiatric facility
IPPS Acute care hospital inpatient prospective payment system
IRF Inpatient rehabilitation facility
JCAHO Joint Commission on Accreditation of Healthcare Organizations
LAMCs Large area metropolitan counties
LTC-DRG Long-term care diagnosis-related group
LTCH Long-term care hospital
MAC Medicare Administrative Contractor
MCC Major complication or comorbidity
MCE Medicare Code Editor
MCO Managed care organization
MCV Major cardiovascular condition
MDC Major diagnostic category
MDH Medicare-dependent, small rural hospital
MedPAC Medicare Payment Advisory Commission
MedPAR Medicare Provider Analysis and Review File
MEI Medicare Economic Index
MGCRB Medicare Geographic Classification Review Board
MIEA-TRHCA Medicare Improvements and Extension Act, Division B of
the Tax Relief and Health Care Act of 2006, Pub. L. 109-432
MMA Medicare Prescription Drug, Improvement, and Modernization Act
of 2003, Pub. L. 108-173
MPN Medicare provider number
MRHFP Medicare Rural Hospital Flexibility Program
MSA Metropolitan Statistical Area
NAICS North American Industrial Classification System
NCD National coverage determination
NCHS National Center for Health Statistics
NCQA National Committee for Quality Assurance
NCVHS National Committee on Vital and Health Statistics
NECMA New England County Metropolitan Areas
NQF National Quality Forum
NTIS National Technical Information Service
NVHRI National Voluntary Hospital Reporting Initiative
OES Occupational employment statistics
OIG Office of the Inspector General
OMB Executive Office of Management and Budget
O.R. Operating room
OSCAR Online Survey Certification and Reporting (System)
PRM Provider Reimbursement Manual
PPI Producer price index
PMSAs Primary metropolitan statistical areas
PPS Prospective payment system
PRA Per resident amount
ProPAC Prospective Payment Assessment Commission
PRRB Provider Reimbursement Review Board
PS&R Provider Statistical and Reimbursement (System)
QIG Quality Improvement Group, CMS
QIO Quality Improvement Organization
RHC Rural health clinic
RHQDAPU Reporting hospital quality data for annual payment update
RNHCI Religious nonmedical health care institution

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RRC Rural referral center
RUCAs Rural-urban commuting area codes
RY Rate year
SAF Standard Analytic File
SCH Sole community hospital
SFY State fiscal year
SIC Standard Industrial Classification
SNF Skilled nursing facility
SOCs Standard occupational classifications
SOM State Operations Manual
SSA Social Security Administration
SSI Supplemental Security Income
TEFRA Tax Equity and Fiscal Responsibility Act of 1982, Pub. L. 97-
248
UHDDS Uniform hospital discharge data set
VBP Value-based purchasing

Table of Contents

I. Background
A. Summary
1. Acute Care Hospital Inpatient Prospective Payment System
(IPPS)
2. Hospitals and Hospital Units Excluded From the IPPS
a. Inpatient Rehabilitation Facilities (IRFs)
b. Long-Term Care Hospitals (LTCHs)
c. Inpatient Psychiatric Facilities (IPFs)
3. Critical Access Hospitals (CAHs)
4. Payments for Graduate Medical Education (GME)
B. Provisions of the Deficit Reduction Act of 2005 (DRA)
C. Provisions of the Medicare Improvements and Extension Act
Under Division B of the Tax Relief and Health Care Act of 2006
D. Provisions of the Pandemic and All-Hazards Preparedness Act
E. Major Contents of this Proposed Rule
1. Proposed DRG Reclassifications and Recalibrations of Relative
Weights
2. Proposed Changes to the Hospital Wage Index
3. Other Decisions and Proposed Changes to the IPPS for
Operating Costs and GME Costs
4. Proposed Changes to the IPPS for Capital-Related Costs
5. Proposed Changes to the Payment Rate for Excluded Hospitals
and Hospital Units: Rate-of-Increase Percentages
6. Services Furnished to Beneficiaries in Custody of Penal
Authorities
7. Determining Proposed Prospective Payment Operating and
Capital Rates and Rate-of-Increase Limits
8. Impact Analysis
9. Recommendation of Update Factors for Operating Cost Rates of
Payment for Inpatient Hospital Services
10. Discussion of Medicare Payment Advisory Commission
Recommendations
II. Proposed Changes to DRG Classifications and Relative Weights
A. Background
B. DRG Reclassifications
1. General
2. Yearly Review for Making DRG Changes
C. MedPAC Recommendations for Revisions to the IPPS DRG System
D. Refinement of DRGs Based on Severity of Illness
1. Evaluation of Alternative Severity-Adjusted DRG Systems
a. Overview of Alternative DRG Classification Systems
b. Comparative Performance in Explaining Variation in Resource
Use
c. Payment Accuracy and Case-Mix Impact
d. Issues for Future Consideration
2. Development of Proposed Medicare Severity DRGs (MS-DRGs)
a. Comprehensive Review of the CC List
b. Chronic Diagnosis Codes
c. Acute Diagnosis Codes
d. Prior Research on Subdivisions of CCs Into Multiple
Categories
e. Proposed Medicare Severity DRGs (MS-DRGs)
3. Dividing Proposed MS-DRGs on the Basis of the CCs and MCCs
4. Conclusion
5. Impact of the Proposed MS-DRGs
6. Changes to Case-Mix Index (CMI) from the Proposed MS-DRGs
7. Effect of the Proposed MS-DRGs on the Outlier Threshold
8. Effect of the Proposed MS-DRGs on the Postacute Care Transfer
Policy
E. Refinement of the Relative Weight Calculation
1. Summary of RTI's Report on Charge Compression
2. RTI Recommendations
a. Short-Term Recommendations
b. Medium-Term Recommendations
c. Long-Term Recommendations
F. Hospital-Acquired Conditions, Including Infections
1. General
2. Legislative Requirements
3. Public Input
4. Collaborative Effort
5. Criteria for Selection of the Hospital-Acquired Conditions
6. Proposed Selection of Hospital-Acquired Conditions
7. Other Issues
G. Proposed Changes to the Specific DRG Classifications
1. Pre-MDC: Intestinal Transplantations
2. MDC 1 (Diseases and Disorders of the Nervous System)
a. Implantable Neurostimulators
b. Intracranial Stents
3. MDC 3 (Diseases and Disorders of the Ear, Nose, Mouth, and
Throat)--Cochler Implants
4. MDC 8 (Diseases and Disorders of the Musculoskeletal System
and Connective Tissue)
a. Hip and Knee Replacements
b. Spinal Fusions
c. Spinal Disc Devices
d. Other Spinal DRGs
5. MDC 17 (Myeloproliferative Diseases and Disorders, Poorly
Differentiated Neoplasm): Endoscopic Procedures
6. Medicare Code Editor (MCE) Changes
a. Non-Covered Procedure Edit: Code 00.62 (Percutaneous
Angioplasty or Atherectomy of Intracranial Vessel(s))
b. Non-Specific Principal Diagnosis Edit 7 and Non-Specific O.R.
Procedures Edit 10
c. Limited Coverage Edit 17
7. Surgical Hierarchies
8. CC Exclusion List Proposed for FY 2008
a. Background
b. Proposed CC Exclusions List for FY 2008
9. Review of Procedure Codes in CMS DRGs 468, 476, and 477
a. Moving Procedure Codes From CMS DRG 468 (Proposed MS-DRGs 981
Through 983) or CMS DRG 477 (Proposed MS-DRGs 987 Through 989) to
MDCs
b. Reassignment of Procedures Among CMS DRGs 468, 476, and 477
(Proposed MS-DRG 981 Through 983, 984 Through 986, and 987 Through
989)
c. Adding Diagnosis or Procedure Codes to MDCs
10. Changes to the ICD-9-CM Coding System
11. Other Issues
a. Seizures and Headaches
b. Devices That Are Replaced Without Cost or Where Credit for a
Replaced Device Is Furnished to the Hospital
H. Recalibration of DRG Weights
I. Proposed MS-LTC-DRG Reclassifications and Relative Weights
for LTCHs for FY 2008
1. Background
2. Proposed Changes in the LTC-DRG Classifications
a. Background
b. Patient Classifications Into DRGs
3. Development of the Proposed FY 2008 MS-LTC-DRG Relative
Weights
a. General Overview of Development of the Proposed MS-LTC-DRG
Relative Weights
b. Data
c. Hospital-Specific Relative Value Methodology
d. Proposed Treatment of Severity Levels in Developing Relative
Weights
e. Proposed Low-Volume MS-LTC-DRGs
4. Steps for Determining the Proposed FY 2008 MS-LTC-DRG
Relative Weights
J. Proposed Add-On Payments for New Services and Technologies
1. Background
2. Public Input Before Publication of a Notice of Proposed
Rulemaking on Add-On Payments
3. FY 2008 Status of Technologies Approved for FY 2007 Add-On
Payments
a. Endovascular Graft Repair of the Thoracic Aorta
b. Restore^[reg] Rechargeable Implantable
Neurostimulators
c. X STOP Interspinous Process Decompression System
4. FY 2008 Application for New Technology Add-On Payments
5. Technical Correction
III. Proposed Changes to the Hospital Wage Index
A. Background
B. Core-Based Statistical Areas for the Hospital Wage Index
C. Proposed Occupational Mix Adjustment to the Proposed FY 2008
Wage Index
1. Development of Data for the Proposed FY 2008 Occupational Mix
Adjustment
2. Timeline for the Collection, Review, and Correction of the
Occupational Mix Data
3. Calculation of the Proposed Occupational Mix Adjustment for
FY 2008
4. Proposed 2007-2008 Occupational Mix Survey for the FY 2010
Wage Index
D. Worksheet S-3 Wage Data for the Proposed FY 2008 Wage Index
1. Included Categories of Costs

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2. Contract Labor for Indirect Patient Care Services
3. Excluded Categories of Costs
4. Use of Wage Index Data by Providers Other Than Acute Care
Hospitals Under the IPPS
E. Verification of Worksheet S-3 Wage Data
F. Wage Index for Multicampus Hospitals
G. Computation of the Proposed FY 2008 Unadjusted Wage Index
1. Method for Computing the Proposed FY 2008 Unadjusted Wage
Index
2. Expiration of the Imputed Floor
3. CAHs Reverting Back to IPPS Hospitals and Raising the Rural
Floor
4. Application of Rural Floor Budget Neutrality
H. Analysis and Implementation of the Proposed Occupational Mix
Adjustment and the Proposed FY 2008 Occupational Mix Adjusted Wage
Index
I. Revisions to the Proposed Wage Index Based on Hospital
Redesignations
1. General
2. Effects of Reclassification/Redesignation
3. FY 2008 MGCRB Reclassifications
4. Hospitals That Applied for Reclassification Effective in FY
2008 and Reinstating Reclassifications in FY 2008
5. Clarification of Policy on Reinstating Reclassifications
6. ``Fallback'' Reclassifications
7. Geographic Reclassification Issues for Multicampus Hospitals
8. Redesignations of Hospitals under Section 1886(d)(8)(B) of
the Act
9. Reclassifications Under Section 1886(d)(8)(B) of the Act
10. New England Deemed Counties
11. Reclassifications under Section 508 of Pub. L. 108-173
12. Other Issues
J. Proposed FY 2008 Wage Index Adjustment Based on Commuting
Patterns of Hospital Employees
K. Process for Requests for Wage Index Data Corrections
L. Labor-Related Share for the Proposed Wage Index for FY 2008
M. Wage Index Study Required Under Pub. L. 109-432
N. Proxy for the Hospital Market Basket
IV. Other Decisions and Proposed Changes to the IPPS for Operating
Costs and GME Costs
A. Reporting of Hospital Quality Data for Annual Hospital
Payment Update
1. Background
2. FY 2008 Quality Measures
3. New Quality Measures and Data Submission Requirements for FY
2009 and Subsequent Years
a. Proposed New Quality Measures for FY 2009 and Subsequent
Years
b. Data Submission
4. Retiring or Modifying RHQDAPU Program Quality Measures
5. Procedures for the RHQDAPU Program for FY 2008 and FY 2009
a. Procedures for Participating in the RHQDAPU Program
b. Chart Validation Requirements
c. Data Validation and Attestation
d. Public Display
e. Reconsideration and Appeal Procedures
f. RHQDAPU Program Withdrawal Requirements
6. Electronic Medical Records
7. New Hospitals
B. Development of the Medicare Hospital Value-Based Purchasing
Plan
C. Rural Referral Centers (RRCs)
1. Proposed Annual Update of RRC Status Criteria
a. Case-Mix Index
b. Discharges
2. Acquired Rural Status of RRCs
D. Indirect Medical Education (IME) Adjustment
1. Background
2. IME Adjustment Factor for FY 2008
3. Time Spent by Residents on Vacation or Sick Leave and in
Orientation
a. Background
b. Vacation and Sick Leave Time
c. Orientation Activities
d. Proposed Regulation Changes
E. Hospital Emergency Services Under EMTALA
1. Background
2. Recent Legislation Affecting EMTALA Implementation
a. Secretary's Authority to Waive Requirements During National
Emergencies
b. Provisions of the Pandemic and All-Hazards Preparedness Act
c. Proposed Revisions to the EMTALA Regulations
F. Disclosure of Physician Ownership in Hospitals and Patient
Safety Measures
1. Disclosure of Physician Ownership in Hospitals
2. Patient Safety Measures
G. Rural Community Hospital Demonstration Program
V. Proposed Changes to the IPPS for Capital-Related Costs
A. Background
B. Proposed Policy Change
VI. Proposed Changes for Hospitals and Hospital Units Excluded From
the IPPS
A. Payments to Existing and New Excluded Hospitals and Hospital
Units
B. Separate PPS for IRFs
C. Separate PPS for LTCHs
D. Separate PPS for IPFs
E. Determining Proposed LTCH Cost-to-Charge Ratios (CCRs) Under
the LTCH PPS
VII. Services Furnished to Beneficiaries in Custody of Penal
Authorities
VIII. MedPAC Recommendations
IX. Other Required Information
A. Requests for Data From the Public
B. Collection of Information Requirements
C. Response to Public Comments

Regulation Text

Addendum--Proposed Schedule of Standardized Amounts, Update Factors,
and Rate-of-Increase Percentages Effective With Cost Reporting Periods
Beginning On or After October 1, 2007

I. Summary and Background
II. Proposed Changes to the Prospective Payment Rates for Hospital
Inpatient Operating Costs for FY 2008
A. Calculation of the Proposed Adjusted Standardized Amount
1. Standardization of Base-Year Costs or Target Amounts
2. Computing the Proposed Average Standardized Amount
3. Updating the Proposed Average Standardized Amount
4. Other Adjustments to the Average Standardized Amount
a. Proposed Recalibration of DRG Weights and Updated Wage
Index--Budget Neutrality Adjustment
b. Reclassified Hospitals--Budget Neutrality Adjustment
c. Case-Mix Budget Neutrality Adjustment
d. Outliers
e. Proposed Rural Community Hospital Demonstration Program
Adjustment (Section 410A of Pub. L. 108-173)
5. Proposed FY 2008 Standardized Amount
B. Proposed Adjustments for Area Wage Levels and Cost-of-Living
1. Proposed Adjustment for Area Wage Levels
2. Proposed Adjustment for Cost-of-Living in Alaska and Hawaii
C. Proposed DRG Relative Weights
D. Calculation of the Proposed Prospective Payment Rates for FY
2008
1. Federal Rate
2. Hospital-Specific Rate (Applicable Only to SCHs and MDHs)
a. Calculation of Hospital-Specific Rate
b. Updating the FY 1982, FY 1987, FY 1996, and FY 2002 Hospital-
Specific Rates for FY 2008
3. General Formula for Calculation of Proposed Prospective
Payment Rates for Hospitals Located in Puerto Rico Beginning On or
After October 1, 2007 and Before October 1, 2008
a. Puerto Rico Rate
b. National Rate
III. Proposed Changes to Payment Rates for Acute Care Hospital
Inpatient Capital-Related Costs for FY 2008
A. Determination of Proposed Federal Hospital Inpatient Capital-
Related Prospective Payment Rate Update
1. Projected Capital Standard Federal Rate Update
a. Description of the Update Framework
b. Comparison of CMS and MedPAC Update Recommendation
2. Proposed Outlier Payment Adjustment Factor
3. Proposed Budget Neutrality Adjustment Factor for Changes in
DRG Classifications and Weights and the GAF
4. Proposed Exceptions Payment Adjustment Factor
5. Proposed Capital Standard Federal Rate for FY 2008
6. Proposed Special Capital Rate for Puerto Rico Hospitals
B. Calculation of the Proposed Inpatient Capital-Related
Prospective Payments for FY 2008
C. Capital Input Price Index
1. Background
2. Forecast of the CIPI for FY 2008
IV. Proposed Changes to Payment Rates for Excluded Hospitals and
Hospital Units: Rate-of-Increase Percentages
A. Payments to Existing Excluded Hospitals and Units
B. New Excluded Hospitals and Units

[[Page 24684]]

V. Tables
Table 1A--National Adjusted Operating Standardized Amounts,
Labor/Nonlabor (69.7 Percent Labor Share/30.3 Percent Nonlabor Share
If Wage Index Is Greater Than 1)
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)
Table 1C--Adjusted Operating Standardized Amounts for Puerto
Rico, Labor/Nonlabor
Table 1D--Capital Standard Federal Payment Rate
Table 2--Hospital Case-Mix Indexes for Discharges Occurring in
Federal Fiscal Year 2006; Hospital Wage Indexes for Federal Fiscal
Year 2008; Hospital Average Hourly Wages for Federal Fiscal Years
2006 (2002 Wage Data), 2007 (2003 Wage Data), and 2008 (2004 Wage
Data); and 3-Year Average of Hospital Average Hourly Wages
Table 3A--FY 2008 and 3-Year Average Hourly Wage for Urban Areas
by CBSA
Table 3B--FY 2008 and 3-Year Average Hourly Wage for Rural Areas
by CBSA
Table 4A--Wage Index and Capital Geographic Adjustment Factor
(GAF) for Urban Areas by CBSA--FY 2008
Table 4B--Wage Index and Capital Geographic Adjustment Factor
(GAF) for Rural Areas by CBSA--FY 2008
Table 4C--Wage Index and Capital Geographic Adjustment Factor
(GAF) for Hospitals That Are Reclassified by CBSA--FY 2008
Table 4F--Puerto Rico Wage Index and Capital Geographic
Adjustment Factor (GAF) by CBSA--FY 2008
Table 4J--Out-Migration Wage Adjustment--FY 2008
Table 5--List of Proposed Medicare Severity Diagnosis-Related
Groups (MS-DRGs), Relative Weighting Factors, and Geometric and
Arithmetic Mean Length of Stay
Table 6A--New Diagnosis Codes
Table 6B--New Procedure Codes
Table 6C--Invalid Diagnosis Codes
Table 6D--Invalid Procedure Codes
Table 6E--Revised Diagnosis Code Titles
Table 6F--Revised Procedure Code Titles
Table 6G--Additions to the CC Exclusion List (Available only
through the Internet on the CMS Web site at: https://www.cms.hhs.gov/AcuteInpatientPPS/)
Table 6H--Deletions from the CC Exclusion List (Available only
through the Internet on the CMS Web site at: https://www.cms.hhs.gov/AcuteInpatientPPS/)
Table 6I--Complete List of Complication and Comorbidity (CC)
Exclusions (Available only through the Internet on the CMS Web site
at: https://www.cms.hhs.gov/AcuteInpatientPPS/)
Table 6J--Major Complication and Comorbidity (MCC) List
Table 6K--Complications and Comorbidity (CC) List
Table 7A--Medicare Prospective Payment System Selected
Percentile Lengths of Stay: FY 2006 MedPAR Update--December 2006
GROUPER V24.0 CMS-DRGs
Table 7B--Medicare Prospective Payment System Selected
Percentile Lengths of Stay: FY 2006 MedPAR Update--December 2006
GROUPER V25.0 CMS DRGs
Table 8A--Proposed Statewide Average Operating Cost-to-Charge
Ratios--March 2007
Table 8B--Proposed Statewide Average Capital Cost-to-Charge
Ratios--March 2007
Table 8C--Proposed Statewide Average Total Cost-to-Charge Ratios
for LTCHs--March 2007
Table 9A--Hospital Reclassifications and Redesignations--FY 2008
Table 9C--Hospitals Redesignated as Rural under Section
1886(d)(8)(E) of the Act--FY 2008
Table 10--Geometric Mean Plus the Lesser of .75 of the National
Adjusted Operating Standardized Payment Amount (Increased to Reflect
the Difference Between Costs and Charges) or .75 of One Standard
Deviation of Mean Charges by Proposed Medicare Severity Diagnosis-
Related Groups (MS-DRGs)--March 2007
Table 11--Proposed FY 2008 MS-LTC-DRGs, Relative Weights,
Geometric Average Length of Stay, and 5/6ths of the Geometric
Average Length of Stay

Appendix A--Regulatory Impact Analysis

I. Overall Impact
II. Objectives
III. Limitations on Our Analysis
IV. Hospitals Included In and Excluded From the IPPS
V. Effects on Excluded Hospitals and Hospital Units
VI. Quantitative Effects of the Proposed Policy Changes Under the
IPPS for Operating Costs
A. Basis and Methodology of Estimates
B. Analysis of Table I
C. Effects of the Proposed Changes to the DRG Reclassifications
and Relative Cost-Based Weights (Column 2)
D. Effects of Proposed Wage Index Changes (Column 3)
E. Combined Effects of Proposed DRG and Wage Index Changes
(Column 4)
F. Effects of the Expiration of the 3-Year Provision Allowing
Urban Hospitals That Were Converted to Rural as a Result of the FY
2005 Labor Market Area Changes to Maintain the Wage Index of the
Urban Labor Market Area in Which They Were Formerly Located (Column
5)
G. Effects of MGCRB Reclassifications (Column 6)
H. Effects of the Adjustment to the Application of the Rural
Floor (Column 7)
I. Effects of Expiration of the Imputed Rural Floor (Column 8)
J. Effects of the Expiration of Section 508 of Pub. L. 108-173
(Column 9)
K. Effects of the Proposed Wage Index Adjustment for Out-
Migration (Column 10)
L. Effects of All Proposed Changes With CMI Adjustment Prior to
Assumed Growth (Column 11)
M. Effects of All Proposed Changes With CMI Adjustment and
Assumed Growth (Column 12)
N. Effects of Proposed Policy on Payment Adjustment for Low-
Volume Hospitals
O. Impact Analysis of Table II
VII. Effects of Other Proposed Policy Changes
A. Effects of Proposed Policy on Hospital-Acquired Conditions,
Including Infections
B. Effects of Proposed MS-LTC-DRG Reclassifications and Relative
Weights for LTCHs
C. Effects of Proposed New Technology Add-On Payments
D. Effects of Requirements for Hospital Reporting of Quality
Data for Annual Hospital Payment Update
E. Effects of Proposed Policy on Cancellation of Classification
of Acquired Rural Status and Rural Referral Centers
F. Effects of Proposed Policy Change on Payment for Indirect
Graduate Medical Education
G. Effects of Proposed Policy Changes Relating to Emergency
Services Under EMTALA
H. Effects of Proposed Policy on Disclosure of Physician
Ownership in Hospitals and Patient Safety Measures
I. Effects of Implementation of Rural Community Hospital
Demonstration Program
J. Effects of Proposed Policy Changes on Services Furnished to
Beneficiaries in Custody of Penal Authorities
VIII. Effects of Proposed Changes in the Capital IPPS
A. General Considerations
B. Results
IX. Alternatives Considered
X. Overall Conclusion
XI. Accounting Statement
XII. Executive Order 12866

Appendix B--Recommendation of Update Factors for Operating Cost Rates
of Payment for Inpatient Hospital Services

I. Background
II. Inpatient Hospital Update for FY 2008
III. Secretary's Recommendation
IV. MedPAC Recommendation for Assessing Payment Adequacy and
Updating Payments in Traditional Medicare

I. Background

A. Summary

1. Acute Care Hospital Inpatient Prospective Payment System (IPPS)
Section 1886(d) of the Social Security Act (the Act) sets forth a
system of payment for the operating costs of acute care hospital
inpatient stays under Medicare Part A (Hospital Insurance) based on
prospectively set rates. Section 1886(g) of the Act requires the
Secretary to pay for the capital-related costs of hospital inpatient
stays under a prospective payment system (PPS). Under these PPSs,
Medicare payment for hospital inpatient operating and capital-related
costs is made at

[[Page 24685]]

predetermined, specific rates for each hospital discharge. Discharges
are classified according to a list of diagnosis-related groups (DRGs).
The base payment rate is comprised of a standardized amount that is
divided into a labor-related share and a nonlabor-related share. The
labor-related share is adjusted by the wage index applicable to the
area where the hospital is located; and if the hospital is located in
Alaska or Hawaii, the nonlabor-related share is adjusted by a cost-of-
living adjustment factor. This base payment rate is multiplied by the
DRG relative weight.
If the hospital treats a high percentage of low-income patients, it
receives a percentage add-on payment applied to the DRG-adjusted base
payment rate. This add-on payment, known as the disproportionate share
hospital (DSH) adjustment, provides for a percentage increase in
Medicare payments to hospitals that qualify under either of two
statutory formulas designed to identify hospitals that serve a
disproportionate share of low-income patients. For qualifying
hospitals, the amount of this adjustment may vary based on the outcome
of the statutory calculations.
If the hospital is an approved teaching hospital, it receives a
percentage add-on payment for each case paid under the IPPS, known as
the indirect medical education (IME) adjustment. This percentage
varies, depending on the ratio of residents to beds.
Additional payments may be made for cases that involve new
technologies or medical services that have been approved for special
add-on payments. To qualify, a new technology or medical service must
demonstrate that it is a substantial clinical improvement over
technologies or services otherwise available, and that, absent an add-
on payment, it would be inadequately paid under the regular DRG
payment.
The costs incurred by the hospital for a case are evaluated to
determine whether the hospital is eligible for an additional payment as
an outlier case. This additional payment is designed to protect the
hospital from large financial losses due to unusually expensive cases.
Any outlier payment due is added to the DRG-adjusted base payment rate,
plus any DSH, IME, and new technology or medical service add-on
adjustments.
Although payments to most hospitals under the IPPS are made on the
basis of the standardized amounts, some categories of hospitals are
paid the higher of a hospital-specific rate based on their costs in a
base year (the higher of FY 1982, FY 1987, FY 1996, or FY 2002) or the
IPPS rate based on the standardized amount. For example, sole community
hospitals (SCHs) are the sole source of care in their areas, and
Medicare-dependent, small rural hospitals (MDHs) are a major source of
care for Medicare beneficiaries in their areas. Both of these
categories of hospitals are afforded this special payment protection in
order to maintain access to services for beneficiaries. (Until FY 2007,
an MDH has received the IPPS rate plus 50 percent of the difference
between the IPPS rate and its hospital-specific rate if the hospital-
specific rate is higher than the IPPS rate. In addition, an MDH does
not have the option of using FY 1996 as the base year for its hospital-
specific rate. As discussed below, for discharges occurring on or after
October 1, 2007, but before October 1, 2011, an MDH will receive the
IPPS rate plus 75 percent of the difference between the IPPS rate and
its hospital-specific rate, if the hospital-specific rate is higher
than the IPPS rate.)
Section 1886(g) of the Act requires the Secretary to pay for the
capital-related costs of inpatient hospital services ``in accordance
with a prospective payment system established by the Secretary.'' The
basic methodology for determining capital prospective payments is set
forth in our regulations at 42 CFR 412.308 and 412.312. Under the
capital IPPS, payments are adjusted by the same DRG for the case as
they are under the operating IPPS. Capital IPPS payments are also
adjusted for IME and DSH, similar to the adjustments made under the
operating IPPS. In addition, hospitals may receive outlier payments for
those cases that have unusually high costs.
The existing regulations governing payments to hospitals under the
IPPS are located in 42 CFR part 412, subparts A through M.

2. Hospitals and Hospital Units Excluded From the IPPS

Under section 1886(d)(1)(B) of the Act, as amended, certain
specialty hospitals and hospital units are excluded from the IPPS.
These hospitals and units are: rehabilitation hospitals and units;
long-term care hospitals (LTCHs); psychiatric hospitals and units;
children's hospitals; and cancer hospitals. Religious nonmedical health
care institutions (RNHCIs) are also excluded from the IPPS. Various
sections of the Balanced Budget Act of 1997 (Pub. L. 105-33), the
Medicare, Medicaid and SCHIP [State Children's Health Insurance
Program] Balanced Budget Refinement Act of 1999 (Pub. L. 106-113), and
the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection
Act of 2000 (Pub. L. 106-554) provide for the implementation of PPSs
for rehabilitation hospitals and units (referred to as inpatient
rehabilitation facilities (IRFs)), LTCHs, and psychiatric hospitals and
units (referred to as inpatient psychiatric facilities (IPFs)), as
discussed below. Children's hospitals, cancer hospitals, and RNHCIs
continue to be paid solely under a reasonable cost-based system.
The existing regulations governing payments to excluded hospitals
and hospital units are located in 42 CFR parts 412 and 413.
a. Inpatient Rehabilitation Facilities (IRFs)
Under section 1886(j) of the Act, as amended, rehabilitation
hospitals and units (IRFs) have been transitioned from payment based on
a blend of reasonable cost reimbursement subject to a hospital-specific
annual limit under section 1886(b) of the Act and the adjusted facility
Federal prospective payment rate for cost reporting periods beginning
on or after January 1, 2002 through September 30, 2002, to payment at
100 percent of the Federal rate effective for cost reporting periods
beginning on or after October 1, 2002. IRFs subject to the blend were
also permitted to elect payment based on 100 percent of the Federal
rate. The existing regulations governing payments under the IRF PPS are
located in 42 CFR part 412, subpart P.
b. Long-Term Care Hospitals (LTCHs)
Under the authority of sections 123(a) and (c) of Pub. L. 106-113
and section 307(b)(1) of Pub. L. 106-554, the LTCH PPS was effective
for a LTCH's first cost reporting period beginning on or after October
1, 2002. LTCHs that do not meet the definition of ``new'' under Sec.
412.23(e)(4) are paid, during a 5-year transition period, a LTCH
prospective payment that is comprised of an increasing proportion of
the LTCH Federal rate and a decreasing proportion based on reasonable
cost principles. Those LTCHs that did not meet the definition of
``new'' could elect to be paid based on 100 percent of the Federal
prospective payment rate instead of a blended payment in any year
during the 5-year transition. For cost reporting periods beginning on
or after October 1, 2006, all LTCHs are paid 100 percent of the Federal
rate. The existing regulations governing payment under the LTCH PPS are
located in 42 CFR part 412, subpart O.
c. Inpatient Psychiatric Facilities (IPFs)
Under the authority of sections 124(a) and (c) of Pub. L. 106-113,
inpatient

[[Page 24686]]

psychiatric facilities (IPFs) (formerly psychiatric hospitals and
psychiatric units of acute care hospitals) are paid under the IPF PPS.
Under the IPF PPS, some IPFs are transitioning from being paid for
inpatient hospital services based on a blend of reasonable cost-based
payment and a Federal per diem payment rate, effective for cost
reporting periods beginning on or after January 1, 2005. For cost
reporting periods beginning on or after January 1, 2008, all IPFs will
be paid 100 percent of the Federal per diem payment amount. The
existing regulations governing payment under the IPF PPS are located in
42 CFR 412, subpart N.
3. Critical Access Hospitals (CAHs)
Under sections 1814, 1820, and 1834(g) of the Act, payments are
made to critical access hospitals (CAHs) (that is, rural hospitals or
facilities that meet certain statutory requirements) for inpatient and
outpatient services based on 101 percent of reasonable cost. Reasonable
cost is determined under the provisions of section 1861(v)(1)(A) of the
Act and existing regulations under 42 CFR parts 413 and 415.
4. Payments for Graduate Medical Education (GME)
Under section 1886(a)(4) of the Act, costs of approved educational
activities are excluded from the operating costs of inpatient hospital
services. Hospitals with approved graduate medical education (GME)
programs are paid for the direct costs of GME in accordance with
section 1886(h) of the Act; the amount of payment for direct GME costs
for a cost reporting period is based on the hospital's number of
residents in that period and the hospital's costs per resident in a
base year. The existing regulations governing payments to the various
types of hospitals are located in 42 CFR part 413.

B. Provisions of the Deficit Reduction Act of 2005 (DRA)

The Deficit Reduction Act of 2005 (DRA), Pub. L. 109-171, made a
number of changes to the Act relating to prospective payments to
hospitals and other providers for inpatient services. This proposed
rule would implement amendments made by (1) section 5001(a), which,
effective for FY 2007 and subsequent years, expands the requirements
for hospital quality data reporting; and (2) section 5001(c), which
requires the Secretary to select, by October 1, 2007, at least two
hospital-acquired conditions that meet certain specified criteria that
will be subject to a quality adjustment in DRG payments during FY 2008.
In this proposed rule, we also discuss our development of a plan to
implement, beginning with FY 2009, a value-based purchasing plan for
section 1886(d) hospitals, in accordance with the requirements of
section 5001(b) of Pub. L. 109-171.

C. Provisions of the Medicare Improvements and Extension Act Under
Division B of the Tax Relief and Health Care Act of 2006

In this proposed rule, we discuss the provisions of section
106(b)(1) of the Medicare Improvements and Extensions Act under
Division B, Title I of the Tax Relief and Health Care Act of 2006
(MIEA-TRHCA), Pub. L. 109-432, which requires MedPAC to submit to
Congress, not later than June 30, 2007, a report on the Medicare wage
index classification system applied under the Medicare Prospective
Payment System. Section 106(b) of the MIEA-TRHCA requires the report to
include any alternatives that MedPAC recommends to the method to
compute the wage index under section 1886(d)(3)(E) of the Act.
In addition, we discuss the provisions of section 106(b)(2) of the
MIEA-TRHCA, which instructs the Secretary of Health and Human Services,
taking into account MedPAC's recommendations on the Medicare wage index
classification system, to include in the FY 2009 IPPS proposed rule one
or more proposals to revise the wage index adjustment applied under
section 1886(d)(3)(E) of the Act for purposes of the IPPS.
We note that we published a notice in the Federal Register on March
23, 2007 (72 FR 13799) that addressed the provisions of section 106(a)
of the MIEA-TRHCA relating to the extension of geographic
reclassifications of hospitals under section 508 of Pub. L. 108-173
(that expired on March 31, 2007) through September 30, 2007.

D. Provisions of the Pandemic and All-Hazards Preparedness Act

On December 19, 2006, Congress enacted the Pandemic and All-Hazards
Preparedness Act, Pub. L. 109-417. Section 302(b) of Pub. L. 109-417
makes two specific changes that affect EMTALA implementation in
emergency areas during an emergency period. Specifically section
302(b)(1)(A) of Pub. L. 109-417 amended section 1135(b)(3)(B) of the
Act to state that sanctions may be waived for the direction or
relocation of an individual for screening where, in the case of a
public health emergency that involves a pandemic infections disease,
that direction or relocation occurs pursuant to a State pandemic
preparedness plan. In addition, sections 302(b)(1)(B) and (b)(1)(C) of
Pub. L. 109-417 amended section 1135(b)(3)(B) of the Act to state that,
if a public health emergency involves a pandemic infectious disease
(such as pandemic influenza), the duration of a waiver or modification
under section 1135(b)(3) of the Act (relating to EMTALA) shall be
determined in accordance with section 1135(e) of the Act as that
subsection applies to public health emergencies.
In this proposed rule, we are proposing to make changes to the
EMTALA regulations to conform them to the sanction waiver provisions of
section 302(b) of Pub. L. 109-417.

E. Major Contents of This Proposed Rule

In this proposed rule, we are setting forth proposed changes to the
Medicare IPPS for operating costs and for capital-related costs in FY
2008. We also are setting forth proposed changes relating to payments
for IME costs and payments to certain hospitals and units that continue
to be excluded from the IPPS and paid on a reasonable cost basis. The
changes being proposed would be effective for discharges occurring on
or after October 1, 2007, unless otherwise noted.
The following is a summary of the major changes that we are
proposing to make:
1. Proposed DRG Reclassifications and Recalibrations of Relative
Weights
We are proposing to adopt a Medicare Severity DRG (MS-DRG)
classification system for the IPPS to better recognize severity of
illness. We present the methodology we used to establish the proposed
MS-DRGs and discuss our efforts to further analyze alternative
severity-adjusted DRG systems and to refine the relative weight
calculations for DRGs.
We present a proposed listing and discussion of hospital-acquired
conditions, including infections, which we have evaluated and are
considering for selection to be subject to the statutorily required
quality adjustment in DRG payments for FY 2008.
We are proposing limited annual revisions to the DRG classification
system in the following areas: intestinal transplants,
neurostimulators, intracranial stents, cochlear implants, knee and hip
replacements, spinal fusions and spinal disc devices, and endoscopic
procedures.
We are presenting our reevaluation of certain FY 2007 applicants
for add-on payments for high-cost new medical services and
technologies, and our analysis of the FY 2008 applicant

[[Page 24687]]

(including public input, as directed by Pub. L. 108-173, obtained in a
town hall meeting).
We are proposing the annual update of the long-term care diagnosis-
related group (LTC-DRG) classifications and relative weights for use
under the LTCH PPS for FY 2008. We are proposing that the LTC-DRGs
would be revised to mirror the proposed MS-DRGs for the IPPS.
2. Proposed Changes to the Hospital Wage Index
In section III. of the preamble to this proposed rule, we are
proposing revisions to the wage index and the annual update of the wage
data. Specific issues addressed include the following:
The FY 2008 wage index update, using wage data from cost
reporting periods that began during FY 2004.
Analysis and implementation of the proposed FY 2008
occupational mix adjustment to the wage index.
Proposed changes relating to expiration of the imputed
floor for the wage index and application of budget neutrality for the
rural floor.
Proposed changes in determining the wage index for
multicampus hospitals.
The proposed revisions to the wage index based on hospital
redesignations and reclassifications, including reclassifications for
multicampus hospitals.
The proposed adjustment to the wage index for FY 2008
based on commuting patterns of hospital employees who reside in a
county and work in a different area with a higher wage index.
The timetable for reviewing and verifying the wage data
that will be in effect for the proposed FY 2008 wage index.
The labor-related share for the FY 2008 wage index,
including the labor-related share for Puerto Rico.
3. Other Decisions and Proposed Changes to the IPPS for Operating Costs
and GME Costs
In section IV. of the preamble to this proposed rule, we discuss a
number of provisions of the regulations in 42 CFR Parts 412, 413, and
489, including the following:
The reporting of hospital quality data as a condition for
receiving the full annual payment update increase.
Development of the Medicare value-based purchasing plan
and scheduled ``listening sessions.''
The proposed updated national and regional case-mix values
and discharges for purposes of determining RRC status and a proposed
policy change relating to the acquired rural status of RRCs.
The statutorily-required IME adjustment factor for FY 2008
and a proposed policy change relating to determining counts of
residents on vacation or sick leave and in orientation for IME and
direct GME purposes.
Proposed changes relating to waiver of sanctions for
requirements for emergency services for hospitals under EMTALA during
national emergency.
Proposed policy changes relating to disclosure to patients
of physician ownership of hospitals and patient safety measures.
Discussion of the fourth year of implementation of the
Rural Community Hospital Demonstration Program.
4. Proposed Changes to the IPPS for Capital-Related Costs
In section V. of the preamble to this proposed rule, we discuss the
payment policy requirements for capital-related costs and capital
payments to hospitals and propose changes relating to adjustments to
the Federal capital rate to address continuous large positive margins.
5. Proposed Changes to the Payment Rates for Excluded Hospitals and
Hospital Units: Rate-of-Increase Percentages
In section VI. of the preamble to this proposed rule, we discuss
payments to excluded hospitals and hospital units, and proposed changes
for determining LTCH CCRs under the LTCH PPS.
6. Services Furnished to Beneficiaries in Custody of Penal Authorities
In section VII. of the preamble to this proposed rule, we clarify
when individuals are considered to be in ``custody'' for purposes of
Medicare payment for services furnished to beneficiaries who are under
penal authorities.
7. Determining Proposed Prospective Payment Operating and Capital Rates
and Rate-of-Increase Limits
In the Addendum to this proposed rule, we set forth proposed
changes to the amounts and factors for determining the FY 2008
prospective payment rates for operating costs and capital-related
costs. We also establish the proposed threshold amounts for outlier
cases. In addition, we address the proposed update factors for
determining the rate-of-increase limits for cost reporting periods
beginning in FY 2008 for hospitals and hospital units excluded from the
PPS.
8. Impact Analysis
In Appendix A of this proposed rule, we set forth an analysis of
the impact that the proposed changes would have on affected hospitals.
9. Recommendation of Update Factors for Operating Cost Rates of Payment
for Inpatient Hospital Services
In Appendix B of this proposed rule, as required by sections
1886(e)(4) and (e)(5) of the Act, we provided our recommendations of
the appropriate percentage changes for FY 2008 for the following:
A single average standardized amount for all areas for
hospital inpatient services paid under the IPPS for operating costs
(and hospital-specific rates applicable to SCHs and MDHs).
Target rate-of-increase limits to the allowable operating
costs of hospital inpatient services furnished by hospitals and
hospital units excluded from the IPPS.
10. Discussion of Medicare Payment Advisory Commission Recommendations
Under section 1805(b) of the Act, MedPAC is required to submit a
report to Congress, no later than March 1 of each year, in which MedPAC
reviews and makes recommendations on Medicare payment policies.
MedPAC's March 2007 recommendation concerning hospital inpatient
payment policies addressed the update factor for inpatient hospital
operating costs and capital-related costs under the IPPS and for
hospitals and distinct part hospital units excluded from the IPPS. This
recommendation is addressed in Appendix B of this proposed rule. For
further information relating specifically to the MedPAC March 2007
reports or to obtain a copy of the reports, contact MedPAC at (202)
220-3700 or visit MedPAC's Web site at: https://www.medpac.gov.

II. Proposed Changes to DRG Classifications and Relative Weights

(If you choose to comment on issues in this section, please include
the caption ``DRG Reclassifications'' at the beginning of your
comment.)

A. Background

Section 1886(d) of the Act specifies that the Secretary shall
establish a classification system (referred to as DRGs) for inpatient
discharges and adjust payments under the IPPS based on appropriate
weighting factors assigned to each DRG. Therefore, under the IPPS, we
pay for inpatient hospital services on a rate per discharge basis that
varies according to the DRG to

[[Page 24688]]

which a beneficiary's stay is assigned. The formula used to calculate
payment for a specific case multiplies an individual hospital's payment
rate per case by the weight of the DRG to which the case is assigned.
Each DRG weight represents the average resources required to care for
cases in that particular DRG, relative to the average resources used to
treat cases in all DRGs.
Congress recognized that it would be necessary to recalculate the
DRG relative weights periodically to account for changes in resource
consumption. Accordingly, section 1886(d)(4)(C) of the Act requires
that the Secretary adjust the DRG classifications and relative weights
at least annually. These adjustments are made to reflect changes in
treatment patterns, technology, and any other factors that may change
the relative use of hospital resources.

B. DRG Reclassifications

1. General
As discussed in the preamble to the FY 2007 IPPS final rule (71 FR
47881 through 47971), we are focusing our efforts in FY 2008 on making
significant reforms to the IPPS consistent with the recommendations
made by MedPAC in its ``Report to the Congress, Physician-Owned
Specialty Hospitals'' in March 2005. MedPAC recommended that the
Secretary refine the entire DRG system by taking into account severity
of illness and applying hospital-specific relative value (HSRV) weights
to DRGs.\1\ We began this reform process by adopting cost-based weights
over a 3-year transition period beginning in FY 2007 and making interim
changes to the DRG system for FY 2007 by creating 20 new CMS DRGs and
modifying 32 others across 13 different clinical areas involving nearly
1.7 million cases. As described below in more detail, these refinements
are intermediate steps towards comprehensive reform of both the
relative weights and the DRG system that is occurring as we undertake
further study.
---------------------------------------------------------------------------

\1\ Medicare Payment Advisory Commission: Report to the
Congress, Physician-Owned Specialty Hospitals, March 2005, page
viii.
---------------------------------------------------------------------------

Currently, cases are classified into CMS DRGs for payment under the
IPPS based on the principal diagnosis, up to eight additional
diagnoses, and up to six procedures performed during the stay. In a
small number of DRGs, classification is also based on the age, sex, and
discharge status of the patient. The diagnosis and procedure
information is reported by the hospital using codes from the
International Classification of Diseases, Ninth Revision, Clinical
Modification (ICD-9-CM).
The process of forming the DRGs was begun by dividing all possible
principal diagnoses into mutually exclusive principal diagnosis areas,
referred to as Major Diagnostic Categories (MDCs). The MDCs were formed
by physician panels as the first step toward ensuring that the DRGs
would be clinically coherent. The diagnoses in each MDC correspond to a
single organ system or etiology and, in general, are associated with a
particular medical specialty. Thus, in order to maintain the
requirement of clinical coherence, no final DRG could contain patients
in different MDCs. Most MDCs are based on a particular organ system of
the body. For example, MDC 6 is Diseases and Disorders of the Digestive
System. This approach is used because clinical care is generally
organized in accordance with the organ system affected. However, some
MDCs are not constructed on this basis because they involve multiple
organ systems (for example, MDC 22 (Burns)). For FY 2007, cases are
assigned to one of 538 DRGs in 25 MDCs. The table below lists the 25
MDCs.

Major Diagnostic Categories (MDCs)
------------------------------------------------------------------------

------------------------------------------------------------------------
1................. Diseases and Disorders of the Nervous System.
2................. Diseases and Disorders of the Eye.
3................. Diseases and Disorders of the Ear, Nose, Mouth, and
Throat.
4................. Diseases and Disorders of the Respiratory System.
5................. Diseases and Disorders of the Circulatory System.
6................. Diseases and Disorders of the Digestive System.
7................. Diseases and Disorders of the Hepatobiliary System
and Pancreas.
8................. Diseases and Disorders of the Musculoskeletal System
and Connective Tissue.
9................. Diseases and Disorders of the Skin, Subcutaneous
Tissue and Breast.
10................ Endocrine, Nutritional and Metabolic Diseases and
Disorders.
11................ Diseases and Disorders of the Kidney and Urinary
Tract.
12................ Diseases and Disorders of the Male Reproductive
System.
13................ Diseases and Disorders of the Female Reproductive
System.
14................ Pregnancy, Childbirth, and the Puerperium.
15................ Newborns and Other Neonates with Conditions
Originating in the Perinatal Period.
16................ Diseases and Disorders of the Blood and Blood
Forming Organs and Immunological Disorders.
17................ Myeloproliferative Diseases and Disorders and Poorly
Differentiated Neoplasms.
18................ Infectious and Parasitic Diseases (Systemic or
Unspecified Sites).
19................ Mental Diseases and Disorders.
20................ Alcohol/Drug Use and Alcohol/Drug Induced Organic
Mental Disorders.
21................ Injuries, Poisonings, and Toxic Effects of Drugs.
22................ Burns.
23................ Factors Influencing Health Status and Other Contacts
with Health Services.
24................ Multiple Significant Trauma.
25................ Human Immunodeficiency Virus Infections.
------------------------------------------------------------------------

In general, cases are assigned to an MDC based on the patient's
principal diagnosis before assignment to a DRG. However, for FY 2007,
there are 9 DRGs to which cases are directly assigned on the basis of
ICD-9-CM procedure codes. These DRGs are for heart transplant or
implant of heart assist systems, liver and/or intestinal transplants,
bone marrow transplants, lung transplants, simultaneous pancreas/kidney
transplants, pancreas transplants, and

[[Page 24689]]

for tracheostomies. Cases are assigned to these DRGs before they are
classified to an MDC. The table below lists the nine current pre-MDCs.

Pre-Major Diagnostic Categories (Pre-MDCs)
------------------------------------------------------------------------

------------------------------------------------------------------------
DRG 103.............. Heart Transplant o

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