Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2006 Rates, 23306-23673 [05-8507]

Download as PDF 23306 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules Comments will be considered if received at the appropriate address, as provided in the ADDRESSES section, no later than 5 p.m. on June 24, 2005. ADDRESSES: In commenting, please refer to file code CMS–1500–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): DATES: DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 405, 412, 413, 415, 419, 422, and 485 [CMS–1500–P] RIN 0938–AN57 Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2006 Rates Centers for Medicare and Medicaid Services (CMS), HHS. ACTION: Proposed rule. 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. 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 as well as proposed policy changes for hospitals and hospital units excluded from the IPPS that are paid in full or in part on a reasonable cost basis subject to these limits. These proposed changes would be applicable to discharges occurring on or after October 1, 2005, with one exception: The proposed changes relating to submittal of hospital wage data by a campus or campuses of a multicampus hospital system (that is, the proposed changes to § 412.230(d)(2) of the regulations) would be effective upon publication of the final rule. Among the policy changes that we are proposing to make are changes relating to: the classification of cases to the diagnosis-related groups (DRGs); the long-term care (LTC)–DRGs and relative weights; the wage data, including the occupational mix data, used to compute the wage index; rebasing and revision of the hospital market basket; applications for new technologies and medical services add-on payments; policies governing postacute care transfers, payments to hospitals for the direct and indirect costs of graduate medical education, submission of hospital quality data, payment adjustment for low-volume hospitals, changes in the requirements for provider-based facilities; and changes in the requirements for critical access hospitals (CAHs). VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 1. Electronically You may submit electronic comments to https://www.cms.hhs.gov/regulations/ ecomments (attachments should be in Microsoft Word, WordPerfect, or Excel; however, we prefer Microsoft Word). 2. By 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–1500–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 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. 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. After the close of the PO 00000 Frm 00002 Fmt 4701 Sfmt 4702 comment period, CMS posts all electronic comments received before the close of the comment period on its public Web site. Written comments received timely will be available for public inspection as they are received, generally beginning approximately 4 weeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, MD 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. For comments that relate to information collection requirements, mail a copy of comments to the following addresses: Centers for Medicare & Medicaid Services, Office of Strategic Operations and Regulatory Affairs, Security and Standards Group, Office of Regulations Development and Issuances, Room C4–24–02 7500 Security Boulevard, Baltimore, Maryland 21244–1850, Attn: James Wickliffe, CMS–1500–P; and Office of Information and Regulatory Affairs, Office of Management and Budget, Room 3001, New Executive Office Building, Washington, DC 20503, Attn: Christopher Martin, CMS Desk Officer, CMS–1500–P, Christopher_Martin@omb.eop.gov. Fax (202) 395–6974. FOR FURTHER INFORMATION CONTACT: Marc Harstein, (410) 786–4539, Operating Prospective Payment, Diagnosis-Related Groups (DRGs), Wage Index, New Medical Services and Technology Add-On Payments, Hospital Geographic Reclassifications, Postacute Care Transfers, and Disproportionate Share Hospital Issues. Tzvi Hefter, (410) 786–4487, Capital Prospective Payment, Excluded Hospitals, Graduate Medical Education, Critical Access Hospitals, and Long-Term Care (LTC)–DRGs, and Provider-Based Facilities Issues. Steve Heffler, (410) 786–1211, Hospital Market Basket Revision and Rebasing. Siddhartha Mazumdar, (410) 786–6673, Rural Hospital Community Demonstration Project Issues. Mary Collins, (410) 786–3189, Critical Access Hospitals (CAHs) Issues. Dr. Mark Krushat, (410) 786–6809, Quality Data for Annual Payment Update Issues. Martha Kuespert, (410) 786–4605 Specialty Hospitals Definition Issues. SUPPLEMENTARY INFORMATION: Electronic Access This Federal Register document is also available from the Federal Register E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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.access.gpo.gov/nara_docs, 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 AAOS American Association of Orthopedic Surgeons ACGME Accreditation Council on Graduate Medical Education AHIMA American Health Information Management Association AHA American Hospital Association AICD Automatic cardioverter defibrillator AMI Acute myocardial infarction AOA American Osteopathic Association ASC Ambulatory Surgical Center ASP Average sales price AWP Average wholesale price BBA Balanced Budget Act of 1997, Pub. L. 105–33 BES Business Expenses Survey 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 CBSAs Core-Based Statistical Areas CC Complication or comorbidity CIPI Capital Input Price Index CMS Centers for Medicare & Medicaid Services CMSA Consolidated Metropolitan Statistical Area COBRA Consolidated Omnibus Reconciliation Act of 1985, Pub. L. 99–272 CoP Condition of Participation CPI Consumer Price Index CRNA Certified registered nurse anesthetist CRT Cardiac Resynchronization Therapy DRG Diagnosis-related group DSH Disproportionate share hospital ECI Employment Cost Index FDA Food and Drug Administration FIPS Federal Information Processing Standards FQHC Federally qualified health center FTE Full-time equivalent FY Federal fiscal year GAAP Generally accepted accounting principles GAF Geographic adjustment factor HIC Health Insurance Card HIS Health Information System GME Graduate medical education HCRIS Hospital Cost Report Information System HIPC Health Information Policy Council HIPAA Health Insurance Portability and Accountability Act of 1996, Pub. L. 104– 191 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 HHA Home health agency HHS Department of Health and Human Services HPSA Health Professions Shortage Area HQA Hospital Quality Alliance ICD–9–CM International Classification of Diseases, Ninth Revision, Clinical Modification ICD–10–PCS International Classification of Diseases, Tenth Edition, Procedure Coding System ICF/MRs Intermediate care facilities for the mentally retarded ICU Intensive Care Unit IHS Indian Health Service IME Indirect medical education IPPS Acute care hospital inpatient prospective payment system IPF Inpatient psychiatric facility IRF Inpatient rehabilitation facility IRP Initial residency period 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 MCE Medicare Code Editor MCO Managed care organization 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 MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Pub. L. 108–173 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 NCVHS National Committee on Vital and Health Statistics NECMA New England County Metropolitan Areas NICU Neonatal intensive care unit 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) OSHA Occupational Safety and Health Act PRM Provider Reimbursement Manual PPI Producer Price Index PMS Performance Measurement System PMSAs Primary Metropolitan Statistical Areas PPS Prospective payment system PRA Per resident amount ProPAC Prospective Payment Assessment Commission PO 00000 Frm 00003 Fmt 4701 Sfmt 4702 23307 PRRB Provider Reimbursement Review Board PS&R Provider Statistical and Reimbursement System QIA Quality Improvement Organizations RHC Rural health clinic RHQDAPU Reporting Hospital Quality Data for Annual Payment Update RNHCI Religious nonmedical health care institution RRC Rural referral center RUCAs Rural-Urban Commuting Area Codes SCH Sole community hospital SDP Single Drug Pricer SIC Standard Industrial Codes 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 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. IRFs b. LTCH c. IPFs 3. Critical Access Hospitals (CAHs) 4. Payments for Graduate Medical Education (GME) B. Major Contents of this Proposed Rule 1. Proposed Changes to the DRG Reclassifications and Recalibrations of Relative Weights 2. Proposed Changes to the Hospital Wage Index 3. Proposed Revision and Rebasing of the Hospital Market Basket 4. Other Decisions and Proposed Changes to the PPS for Inpatient Operating and GME Costs 5. PPS for Capital-Related Costs 6. Proposed Changes for Hospitals and Hospital Units Excluded from the IPPS 7. Proposed Payment for Blood Clotting Factors for Inpatients with Hemophilia 8. Determining Proposed Prospective Payment Operating and Capital Rates and Rate-of-Increase Limits 9. Impact Analysis 10. Recommendation of Update Factor for Hospital Inpatient Operating Costs 11. Discussion of Medicare Payment Advisory Commission Recommendations II. Proposed Changes to DRG Classifications and Relative Weights A. Background B. DRG Reclassifications 1. General 2. Pre-MDC: Intestinal Transplantation 3. MDC 1 (Diseases and Disorders of the Nervous System) a. Strokes b. Unruptured Cerebral Aneurysms 4. MDC 5 (Diseases and Disorders of the Circulatory System) a. Automatic Implantable Cardioverter/ Defibrillator E:\FR\FM\04MYP2.SGM 04MYP2 23308 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules b. Coronary Artery Stents c. Insertion of Left Atrial Appendage Device d. External Heart Assist System Implant e. Carotid Artery Stent f. Extracorporeal Membrane Oxygenation (ECMO) 5. MDC 6 (Diseases and Disorders of the Digestive System): Artificial Anal Sphincter 6. MDC 8 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue) a. Hip and Knee Replacements b. Kyphoplasty c. Multiple Level Spinal Fusion 7. MDC 18 (Infectious and Parasitic Diseases (Systemic or Unspecified Sites)): Severe Sepsis 8. MDC 20 (Alcohol/Drug Use and Alcohol/Drug Induced Organic Mental Disorders): Drug-Induced Dementia 9. Medicare Code Editor (MCE) Changes a. Newborn Age Edit b. Newborn Diagnoses Edit c. Diagnoses Allowed for ‘‘Males Only’’ Edit d. Tobacco Use Disorder Edit e. Noncovered Procedure Edit 10. Surgical Hierarchies 11. Refinement of Complications and Comorbidities (CC) List a. Background b. Comprehensive Review of the CC List c. CC Exclusion List for FY 2006 12. Review of Procedure Codes in DRGs 468, 476, and 477 a. Moving Procedure Codes from DRG 468 or DRG 477 to MDCs b. Reassignment of Procedures among DRGs 468, 476, and 477 c. Adding Diagnosis or Procedure Codes to MDCs 13. Changes to the ICD–9–CM Coding System 14. Other Issues: Acute Intermittent Porphyria C. Proposed Recalibration of DRG Weights D. Proposed LTC–DRG Reclassifications and Relative Weights for LTCHs for FY 2006 1. Background 2. Proposed Changes in the LTC–DRG Classifications a. Background b. Patient Classifications into DRGs 3. Development of the Proposed FY 2006 LTC–DRG Relative Weights a. General Overview of Development of the LTC–DRG Relative Weights b. Data c. Hospital-Specific Relative Value Methodology d. Proposed Low-Volume LTC–DRGs 4. Steps for Determining the Proposed FY 2006 LTC–DRG Relative Weights E. Proposed Add-On Payments for New Services and Technologies 1. Background 2. FY 2006 Status of Technology Approved for FY 2005 Add-On Payments 3. Reevaluation of FY 2005 Applications That Were Not Approved 4. FY 2006 Applicants for New Technology Add-On Payments III. Proposed Changes to the Hospital Wage Index VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 A. Background B. Core-Based Statistical Areas for the Proposed Hospital Wage Index C. Proposed Occupational Mix Adjustment to FY 2006 Index 1. Development of Data for the Proposed Occupational Mix Adjustment 2. Calculation of the Proposed Occupational Mix Adjustment Factor and the Proposed Occupational Mix Adjusted Wage Index D. Worksheet S–3 Wage Data for the Proposed FY 2006 Wage Index Update E. Verification of Worksheet S–3 Wage Data F. Computation of the Proposed FY 2006 Unadjusted Wage Index G. Computation of the Proposed FY 2006 Blended Wage Index H. Proposed Revisions to the Wage Index Based on Hospital Redesignation 1. General 2. Effects of Reclassification 3. Proposed Application of Hold Harmless Protection for Certain Urban Hospitals Redesignated as Rural 4. FY 2006 MGCRB Reclassifications 5. Proposed FY 2006 Redesignations under Section 1886(d)(8)(B) of the Act 6. Reclassifications under Section 508 of Pub. L. 108–173 I. Proposed FY 2006 Wage Index Adjustment Based on Commuting Patterns of Hospital Employees J. Process for Requests for Wage Index Data Corrections IV. Proposed Rebasing and Revision of the Hospital Market Baskets A. Background B. Rebasing and Revising the Hospital Market Basket 1. Development of Cost Categories and Weights 2. PPS—Selection of Price Proxies 3. Labor-Related Share C. Separate Market Basket for Hospitals and Hospital Units Excluded from the IPPS 1. Hospitals Paid Based on Their Reasonable Costs 2. Excluded Hospitals Paid Under Blend Methodology 3. Development of Cost Categories and Weights for the Proposed 2002-Based Excluded Hospital Market Basket D. Frequency of Updates of Weights in IPPS Hospital Market Basket E. Capital Input Price Index Section V. Other Decisions and Proposed Changes to the IPPS for Operating Costs and GME Costs A. Postacute Care Transfer Payment Policy 1. Background 2. Changes to DRGs Subject to the Postacute Care Transfer Policy B. Reporting of Hospital Quality Data for Annual Hospital Payment Update 1. Background 2. Requirements for Hospital Reporting of Quality Data C. Sole Community Hospitals and Medicare Dependent Hospitals 1. Background 2. Budget Neutrality Adjustment to Hospital Payments Based on HospitalSpecific Rate PO 00000 Frm 00004 Fmt 4701 Sfmt 4702 3. Technical Change D. Rural Referral Centers 1. Case-Mix Index 2. Discharges 3. Technical Change E. Payment Adjustment for Low-Volume Hospitals F. Indirect Medical Education (IME) Adjustment 1. Background 2. IME Adjustment for TEFRA Hospitals Converting to IPPS Hospitals 3. Section 1886(d)(3)(E) Teaching Hospitals That Withdraw Rural Reclassification G. Payment to Disproportionate Share Hospitals (DSHs) 1. Background 2. Implementation of Section 951 of Pub. L. 108–173 H. Geographic Reclassifications 1. Background 2. Multicampus Hospitals 3. Urban Group Hospital Reclassifications 4. Clarification of Goldsmith Modification Criterion for Urban Hospitals Seeking Reclassification as Rural I. Payment for Direct Graduate Medical Education 1. Background 2. Direct GME Initial Residency Period a. Background b. Direct GME Initial Residency Period Limitation: Simultaneous Match 3. New Teaching Hospitals’ Participation in Medicare GME Affiliated Groups 4. GME FTE Cap Adjustments for Rural Hospitals 5. Technical Changes: Cross-References J. Provider-Based Status of Facilities under Medicare 1. Background 2. Limits on Scope of Provider-Based Regulations—Facilities for Which Provider-Based Determinations Will Not Be Made 3. Location Requirement for Off-Campus Facilities: Application to Certain Neonatal Intensive Care Units 4. Technical and Clarifying Changes K. Rural Community Hospital Demonstration Program L. Definition of a Hospital in Connection with Specialty Hospitals VI. PPS for Capital-Related Costs VII. Proposed Changes for Hospitals and Hospital Units Excluded from the IPPS A. Payments to Excluded Hospitals and Hospital Units 1. Payments to Existing Excluded Hospitals and Hospital Units 2. Updated Caps for New Excluded Hospitals and Units 3. Implementation of a PPS for IRFs 4. Implementation of a PPS for LTCHs 5. Implementation of a PPS for IPFs B. Critical Access Hospitals (CAHs) 1. Background 2. Proposed Policy Change Relating to Continued Participation by CAHs in Lugar Counties 3. Proposed Policy Change Relating to Designation of CAHs as Necessary Providers a. Determination of the Relocation Status of a CAH b. Relocation of a CAH Using a Waiver to Meet the CoP for Distance E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules VIII. Payment for Blood Clotting Factor Administered to Hemophilia Inpatients IX. MedPAC Recommendations A. Medicare Payment Policy B. Physician-Owned Specialty Hospitals C. Other MedPAC Recommendations X. Other Required Information A. Requests for Data from the Public B. Collection of Information Requirements C. Public Comments Regulation Text Addendum—Proposed Schedule of Standardized Amounts Effective with Discharges Occurring On or After October 1, 2004 and Update Factors and Rate-of-Increase Percentages Effective With Cost Reporting Periods Beginning On or After October 1, 2004 I. Summary and Background II. Proposed Changes to Prospective Payment Rates for Hospital Inpatient Operating Costs for FY 2006 A. Calculation of the Adjusted Standardized Amount 1. Standardization of Base-Year Costs or Target Amounts 2. Computing the Average Standardized Amount 3. Updating the Average Standardized Amount 4. Other Adjustments to the Average Standardized Amount a. Recalibration of DRG Weights and Updated Wage Index—Budget Neutrality Adjustment b. Reclassified Hospitals—Budget Neutrality Adjustment c. Outliers d. Rural Community Hospital Demonstration Program Adjustment (Section 410A of Pub. L. 108–173) 5. Proposed FY 2006 Standardized Amount B. Adjustments for Area Wage Levels and Cost-of-Living 1. Adjustment for Area Wage Levels 2. Adjustment for Cost-of-Living in Alaska and Hawaii C. DRG Relative Weights D. Calculation of Proposed Prospective Payment Rates for FY 2006 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, and FY 1996 Hospital-Specific Rates for FY 2006 3. General Formula for Calculation of Proposed Prospective Payment Rates for Hospitals Located in Puerto Rico Beginning On or After October 1, 2005 and Before October 1, 2006 a. Puerto Rico Rate b. National Rate III. Proposed Changes to Payment Rates for Acute Care Hospital Inpatient CapitalRelated Costs for FY 2006 A. Determination of Proposed Federal Hospital Inpatient Capital-Related Prospective Payment Rate Update 1. Proposed 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 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 3. Proposed Budget Neutrality Adjustment Factor for Changes in DRG Classifications and Weights and the Geographic Adjustment Factor 4. Proposed Exceptions Payment Adjustment Factor 5. Proposed Capital Standard Federal Rate for FY 2006 6. Proposed Special Capital Rate for Puerto Rico Hospitals B. Calculation of Proposed Inpatient Capital-Related Prospective Payments for FY 2006 C. Capital Input Price Index 1. Background 2. Forecast of the CIPI for FY 2006 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. Updated Caps for New Excluded Hospitals and Units V. Payment for Blood Clotting Factor Administered to Hemophilia Inpatients 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 2004; Hospital Average Hourly Wage for Federal Fiscal Years 2004 (2000 Wage Data), 2005 (2001 Wage Data), and 2006 (2002 Wage Data) Wage Indexes and 3-Year Average of Hospital Average Hourly Wages Table 3A—FY 2006 and 3-Year Average Hourly Wage for Urban Areas Table 3B—FY 2006 and 3-Year Average Hourly Wage for Rural Areas Table 4A—Wage Index and Capital Geographic Adjustment Factor (GAF) for Urban Areas Table 4B—Wage Index and Capital Geographic Adjustment Factor (GAF) for Rural Areas Table 4C—Wage Index and Capital Geographic Adjustment Factor (GAF) for Hospitals That Are Reclassified Table 4F—Puerto Rico Wage Index and Capital Geographic Adjustment Factor (GAF) Table 4J—Out-Migration Adjustment—FY 2006 Table 5—List of Diagnosis-Related Groups (DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay (LOS) Table 6A—New Diagnosis Codes Table 6B—New Procedure Codes Table 6C—Invalid Diagnosis Codes Table 6D—Invalid Procedure Codes PO 00000 Frm 00005 Fmt 4701 Sfmt 4702 23309 Table 6E—Revised Diagnosis Code Titles Table 6F—Revised Procedure Code Titles Table 6G—Additions to the CC Exclusions List Table 6H—Deletions from the CC Exclusions List Table 7A—Medicare Prospective Payment System Selected Percentile Lengths of Stay: FY 2004 MedPAR Update December 2004 GROUPER V22.0 Table 7B—Medicare Prospective Payment System Selected Percentile Lengths of Stay: FY 2004 MedPAR Update December 2004 GROUPER V23.0 Table 8A—Statewide Average Operating Cost-to-Charge Ratios—March 2005 Table 8B—Statewide Average Capital Cost-toCharge Ratios—March 2005 Table 9A—Hospital Reclassifications and Redesignations by Individual Hospital— FY 2006 Table 9B—Hospital Reclassifications and Redesignation by Individual Hospital Under Section 508 of Pub. L. 108–173— FY 2005 Table 9C—Hospitals Redesignated as Rural under Section 1886(d)(8)(E) of the Act— FY 2006 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 Diagnosis-Related Groups (DRGs)— March 2005 Table 11—Proposed FY 2006 LTC–DRGs, Relative Weights, Geometric Average Length of Stay, and 5/6ths of the Geometric Average Length of Stay Appendix A—Regulatory Impact Analysis Appendix B—Recommendation of Update Factors for Operating Cost Rates of Payment for Inpatient Hospital Services 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 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 E:\FR\FM\04MYP2.SGM 04MYP2 23310 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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, or FY 1996) 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 Medicaredependent, 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. (An MDH receives VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 only 50 percent of the difference between the IPPS rate and its hospitalspecific rates 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.) 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 PPS, payments are adjusted by the same DRG for the case as they are under the operating IPPS. Similar adjustments are also made for IME and DSH as under the operating IPPS. In addition, hospitals may receive an outlier payment 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: Psychiatric hospitals and units; rehabilitation hospitals and units; long-term care hospitals (LTCHs); children’s hospitals; and cancer hospitals. 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)), psychiatric hospitals and units (referred to as inpatient psychiatric facilities (IPFs)), and LTCHs, as discussed below. Children’s hospitals and cancer hospitals continue to be paid under reasonable cost-based reimbursement. The existing regulations governing payments to excluded hospitals and hospital units are located in 42 CFR Parts 412 and 413. a. 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 PO 00000 Frm 00006 Fmt 4701 Sfmt 4702 hospital-specific annual limit under section 1886(b) of the Act and the adjusted facility Federal prospective payment rate for cost reporting periods beginning 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 (66 FR 41316, August 7, 2001; 67 FR 49982, August 1, 2002; and 68 FR 45674, August 1, 2003). The existing regulations governing payments under the IRF PPS are located in 42 CFR Part 412, Subpart P. b. 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, LTCHs are being transitioned from being paid for inpatient hospital services based on a blend of reasonable cost-based reimbursement under section 1886(b) of the Act to 100 percent of the Federal rate during a 5-year period, beginning with cost reporting periods that start on or after October 1, 2002. For cost reporting periods beginning on or after October 1, 2006, LTCHs will be paid 100 percent of the Federal rate (May 7, 2004 LTCH PPS final rule (69 FR 25674)). LTCHs may elect to be paid based on 100 percent of the Federal rate instead of a blended payment in any year during the 5-year transition period. The existing regulations governing payment under the LTCH PPS are located in 42 CFR Part 412, Subpart O. c. IPFs Under the authority of sections 124(a) and (c) of Pub. L. 106–113, inpatient psychiatric facilities (IPFs) (formerly psychiatric hospitals and psychiatric units of acute care hospitals) are paid under the new 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 (November 15, 2004 IPF PPS final rule (69 FR 66921)). For cost reporting periods beginning on or after July 1, 2008, 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 part 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 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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. On August 11, 2004, we published a final rule in the Federal Register (69 FR 48916) that implemented changes to the Medicare hospital inpatient prospective payment systems for both operating cost and capital-related costs, as well as changes addressing payments for excluded hospitals and payments for GME costs. Generally these changes were effective for discharges occurring on or after October 1, 2004. On October 7, 2004, we published a document in the Federal Register (69 FR 60242) that corrected technical errors made in the August 11, 2004 final rule. On December 30, 2004, we published another document in the Federal Register (69 FR 78525) that further corrected the August 11, 2004 final rule and the October 7, 2004 correction to that rule, effective January 1, 2005. B. 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 2006. We also are setting forth proposed changes relating to payments for GME costs, payments to certain hospitals and units that continue to be excluded from the IPPS and paid on a reasonable cost basis, payments for DSHs, and requirements and payments for CAHs. The changes being proposed would be effective for discharges occurring on or after October 1, 2005, unless otherwise noted. The following is a summary of the major changes that we are proposing to make: VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 23311 1. Proposed Changes to the DRG Reclassifications and Recalibrations of Relative Weights group (LTC–DRG) classifications and relative weights for use under the LTCH PPS for FY 2006. As required by section 1886(d)(4)(C) of the Act, in section II. of this proposed rule, we are proposing annual adjustments to the DRG classifications and relative weights. Based on analyses of Medicare claims data, we are proposing to establish a number of new DRGs and make changes to the designation of diagnosis and procedure codes under other existing DRGs. The major DRG classification changes we are proposing include: • Reassigning procedure code 35.52 (Repair of atrial septal defect with prosthesis, closed technique) from DRG 108 to DRG 518 (Percutaneous Cardiovascular Procedure Without Coronary Artery Stent or AMI); • Reassigning procedure code 37.26 (Cardiac electrophysiologic stimulation and recording studies) from DRGs 535 and 536 to DRGs 515 (Cardiac Defibrillator Implant Without Cardiac Catheterization); • Splitting DRG 209 into two new DRGs based on the presence or absence of the procedure codes for major joint replacement or reattachment of lower extremity and revision of hip or knee replacement, DRG 545 (Revision of Hip or Knee Replacement) and DRG 544 (Major Joint Replacement or Reattachment of Lower Extremity); • Reassigning procedure code 26.12 (Open biopsy of salivary gland or duct) from DRG 468 to DRG 477 (Nonextensive O.R. Procedure Unrelated To Principal Diagnosis); • Reassigning the principal diagnosis codes for curvature of the spine or malignancy from DRGs 497 and 498 to proposed new DRG 546 (Spinal Fusion Except Cervical with PDX of Curvature of the Spine or Malignancy); • Splitting DRGs 516 and 526 into four new DRGs based on the presence or absence of a CC; • Reassigning procedure code 39.65 (Extracorporeal membrane oxygenation [ECMO]) from DRGs 104 and 105 to DRG 541 (ECMO or Tracheostomy with Mechanical Ventilation 96+ Hours or Principal Diagnosis Except Face, Mouth and Neck Diagnoses With Major Operating Room Procedure). We also are presenting our reevaluation of certain FY 2005 applicants for add-on payments for high-cost new medical services and technologies, and our analysis of FY 2006 applicants (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 2. Proposed Changes to the Hospital Wage Index In section III. of this preamble, we are proposing revisions to the wage index and the annual update of the wage data. Specific issues addressed include the following: • The FY 2006 wage index update, using wage data from cost reporting periods that began during FY 2002. • The proposed occupational mix adjustment to the wage index that we began to apply effective October 1, 2004. • The proposed revisions to the wage index based on hospital redesignations and reclassifications. • The proposed adjustment to the wage index for FY 2006 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 2006 wage index. PO 00000 Frm 00007 Fmt 4701 Sfmt 4702 3. Proposed Revision and Rebasing of the Hospital Market Baskets In section IV. of this proposed rule, we are proposing rebasing and revising the hospital operating and capital market baskets to be used in developing the FY 2006 update factor for the operating prospective payment rates and the excluded hospital market basket to be used in developing the FY 2006 update factor for the excluded hospital rate-of-increase limits. We are also setting forth the data sources used to determine the revised market basket relative weights and choice of price proxies. 4. Other Decisions and Proposed Changes to the PPS for Inpatient Operating and GME Costs In section V. of this proposed rule, we discuss a number of provisions of the regulations in 42 CFR Parts 412 and 413 and set forth proposed changes concerning the following: • Solicitation of public comments on two options for possible expansion of the current postacute care transfer policy. • The reporting of hospital quality data as a condition for receiving the full annual payment update increase. • Proposed changes in the payment adjustment for low-volume hospitals. • Proposed IME adjustment for TEFRA hospitals that are converting to IPPS hospitals, and IME FTE resident caps for urban hospitals that are granted E:\FR\FM\04MYP2.SGM 04MYP2 23312 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules rural reclassification and then withdraw that rural classification. • Proposed changes to implement section 951 of Pub. L. 108–173 relating to the provision of patient stay/SSI days data maintained by CMS to hospitals for the purpose of determining their DSH percentage. • Proposed changes relating to hospitals’ geographic classifications, including multicampus hospitals and urban group hospital reclassifications. • Proposed changes and clarifications relating to GME, including GME initial residency period limitation, new teaching hospitals’ participation in Medicare GME affiliated groups, and the GME FTE cap adjustment for rural hospitals; • Solicitation of public comments on possible changes in requirements for provider-based entities relating to entities the location requirements for certain neonatal intensive care units as off-campus facilities; • Discussion of the second year of implementation of the Rural Community Hospital Demonstration Program; and • Clarification of the definition of a hospital as it relates to ‘‘specialty hospitals’’ participating in the Medicare program. 5. PPS for Capital-Related Costs In section VI. of this proposed rule, we are not proposing any policy changes to the capital-related prospective payment system. For the readers’ benefit, we discuss the payment policy requirements for capital-related costs and capital payments to hospitals. 6. Proposed Changes for Hospitals and Hospital Units Excluded From the IPPS In section VII. of this proposed rule, we discuss the proposed revisions and clarifications concerning excluded hospitals and hospital units, proposed policy changes relating to continued participation by CAHs located in counties redesignated under section 1886(d)(8)(B) of the Act (Lugar counties), and proposed policy changes relating to designation of CAHs as necessary providers. 7. Proposed Changes in Payment for Blood Clotting Factor In section VIII of this proposed rule, we discuss the proposed change in payment for blood clotting factor administered to inpatients with hemophilia for FY 2006. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 8. Determining Prospective Payment Operating and Capital Rates and Rate-ofIncrease Limits In the Addendum to this proposed rule, we set forth proposed changes to the amounts and factors for determining the FY 2006 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 2006 for hospitals and hospital units excluded from the PPS. 9. 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. 10. Recommendation of Update Factor for Hospital Inpatient Operating Costs 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 2006 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. 11. Discussion of Medicare Payment Advisory Commission Recommendations Under section 1805(b) of the Act, the Medicare Payment Advisory Commission (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 2005 recommendation concerning hospital inpatient payment policies addressed only the update factor for inpatient hospital operating costs and capitalrelated 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. MedPAC issued a second Report to Congress: Physician-Owned Specialty Hospitals, March 2005, which addressed other issues relating to Medicare payments to hospitals for inpatient services. The recommendations on these issues from this second report are PO 00000 Frm 00008 Fmt 4701 Sfmt 4702 addressed in section IX. of this preamble. For further information relating specifically to the MedPAC March 2005 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 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 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. The proposed changes to the DRG classification system and the recalibration of the DRG weights for discharges occurring on or after October 1, 2005, are discussed below. B. DRG Reclassifications (If you choose to comment on issues in this section, please include the caption ‘‘DRG Reclassifications’’ at the beginning of your comment.) 1. General Cases are classified into 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 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23313 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 2005, cases are assigned to one of 519 DRGs in 25 MDCs. The table below lists the 25 MDCs. In general, cases are assigned to an MDC based on the patient’s principal diagnosis before assignment to a DRG. However, for FY 2005, there are nine 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, lung, simultaneous pancreas/kidney, and pancreas transplants and for tracheostomies. Cases are assigned to these DRGs before they are classified to an MDC. The table below lists the current nine pre-MDCs. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00009 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.000</GPH> 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 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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. Since 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 (less than 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 a 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, for example, 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 class of patients 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 complication or comorbidity. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 A substantial complication or comorbidity 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 comorbidities or complications would consistently affect the consumption of hospital resources. The actual process of forming the DRGs was, and continues to be, highly iterative, involving a combination of statistical results from test data combined with clinical judgment. In deciding whether to create a separate DRG, we 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 DRG. We evaluate patient care costs using average charges and length of stay as proxies for costs and rely on the judgment of our medical officers to decide whether patients are distinct or clinically similar to other patients in the DRG. In evaluating resource costs, we consider both the absolute and percentage differences in average charges between the cases we are selecting for review and the remainder of cases in the DRG. We also consider variation in charges within these groups; that is, whether observed average differences are consistent across patients or attributable to cases that are extreme in terms of charges or length of stay, or both. Further, we also consider the number of patients who will have a given set of characteristics and generally prefer not to create a new DRG unless it will include a substantial number of PO 00000 Frm 00010 Fmt 4701 Sfmt 4702 cases. As we explain in more detail in section IX. of this preamble, MedPAC has made a number of recommendations regarding the DRG system. As part of our review and analysis of MedPAC’s recommendations, we will consider whether to establish guidelines for making DRG reclassification decisions. A patient’s diagnosis, procedure, discharge status, and demographic information is fed 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 payments 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 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.001</GPH> 23314 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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 July 30, 1999 IPPS final rule (64 FR 41500), we discussed a process for considering non-MedPAR 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 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 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. Many of the changes to the DRG classifications 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 next 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 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 changes we are proposing to the DRG classification system for FY 2006 for the FY 2006 GROUPER, version 23.0 and to the methodology used to recalibrate the DRG weights are set forth below. Unless otherwise noted in this proposed rule, our DRG analysis is based on data from the December 2004 update of the FY 2004 MedPAR file, which contains hospital bills received through December 31, 2004 for discharges in FY 2004. 2. Pre-MDC: Intestinal Transplantation In the FY 2005 IPPS final rule (69 FR 48976), we moved intestinal transplantation cases that were assigned to ICD–9–CM procedure code 46.97 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 (Transplant of intestine) out of DRG 148 (Major Small and Large Bowel Procedures with CC) and DRG 149 (Major Small and Large Bowel Procedures Without CC) and into DRG 480 (Liver Transplant). We also changed the title for DRG 480 to ‘‘Liver Transplant and/or Intestinal Transplant.’’ We moved these cases out of DRGs 148 and 149 because our analysis demonstrated that the average charges for intestinal transplants are significantly higher than the average charges for other cases in these DRGs. We stated at that time that we would continue to monitor these cases. Based on our review of the FY 2004 MedPAR data, we found 959 cases assigned to DRG 480 with overall average charges of approximately $165,622. There were only three cases involving an intestinal transplant alone and one case in which both an intestinal transplant and a liver transplant were performed. The average charges for the intestinal transplant cases ($138,922) were comparable to the average charges for the liver transplant cases ($165,314), while the remaining combination of an intestinal transplant and a liver transplant case had much higher charges ($539,841), and would be paid as an outlier case. Therefore, we are not proposing any DRG modification for intestinal transplantation cases at this time. We note that an institution that performs intestinal transplantation, in correspondence to us written following the publication of the FY 2005 IPPS final rule, agreed with our decision to move cases assigned to code 46.97 to DRG 480. 3. MDC 1 (Diseases and Disorders of the Nervous System) a. Strokes In 1996, the Food and Drug Administration (FDA) approved the use of tissue plasminogen activator (tPA), one type of thrombolytic agent that dissolves blood clots. In 1998, the ICD– 9–CM Coordination and Maintenance Committee created code 99.10 (Injection or infusion of thrombolytic agent) in order to be able to uniquely identify the administration of thrombolytic agents. Studies have shown that tPA can be effective in reducing the amount of damage the brain sustains during an ischemic stroke, which is caused by blood clots that block blood flow to the brain. The use of tPA is approved for PO 00000 Frm 00011 Fmt 4701 Sfmt 4702 23315 patients who have blood clots in the brain, but not for patients who have a bleeding or hemorrhagic stroke. Thrombolytic therapy has been shown to be most effective when used within the first 3 hours after the onset of a stroke, and it is contraindicated in hemorrhagic stroke. The presence or absence of code 99.10 does not currently influence DRG assignment. Since code 99.10 became effective, we have been monitoring the DRGs and cases in which this code can be found, particularly with respect to cardiac and stroke DRGs. Last year, we met with representatives from several hospital stroke centers who recommended modification of the existing stroke DRGs 14 (Intracranial Hemorrhage or Cerebral Infarction) and 15 (Nonspecific CVA and Precerebral Occlusion Without Infarction) by using the administration of tPA as a proxy to identify patients who have severe strokes. The representatives stated that using tPA as a proxy for the more severely ill stroke patient would recognize the higher charges these cases generate because of their higher hospital resource utilization. The stroke representatives made two suggestions concerning DRGs 14 and 15. First, they proposed modifying DRG 14 by renaming it ‘‘Ischemic Stroke Treatment with a Reperfusion Agent,’’ and including only those cases containing code 99.10. The remainder of stroke cases where the patient was not treated with a reperfusion agent would be included in DRG 15, which would be renamed ‘‘Hemorrhagic Stroke or Ischemic Stroke without a Reperfusion Agent.’’ Hemorrhagic stroke cases now found in DRG 14 that are not treated with a reperfusion agent would migrate to DRG 15. The second suggestion was to leave DRGs 14 and 15 as they currently exist, and create a new DRG, with a recommended title ‘‘Ischemic Stroke Treatment with a Reperfusion Agent.’’ This suggested DRG would only include strokes caused by clots, not by hemorrhages, and would include the administration of tPA, identified by procedure code 99.10. We have examined the MedPAR data for the cases in DRGs 14 and 15, and have divided the cases based on the presence of a principal diagnosis of hemorrhage or occlusive ischemia, and the presence of procedure code 99.10. The following table displays the results: E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules The above table shows that the average standardized charges for cases treated with a reperfusion agent are more than $16,000 and $10,000 higher than all other cases in DRGs 14 and 15, respectively. While these data suggest that patients treated with a reperfusion agent are more expensive than all other stroke patients, this conclusion is based on a small number of cases. At this time, we are not proposing a change to the stroke DRGs because of this concern. However, we believe it is possible that more patients are being treated with a reperfusion agent than indicated by our data because the presence of code 99.10 does not affect DRG assignment and may be underreported. We invite public comment on the changes to DRGs 14 and 15 suggested by the hospital representatives. In addition, we are interested in public comment on the number of patients currently being treated with a reperfusion agent as well as the potential costs of these patients relative to others with strokes that are also included in DRGs 14 and 15. b. Unruptured Cerebral Aneurysms In the FY 2004 IPPS final rule (68 FR 45353), we created DRG 528 (Intracranial Vascular Procedures With a Principal Diagnosis of Hemorrhage) in MDC 1. We received a comment at that time that suggested we create another VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 DRG for intracranial vascular procedures for unruptured cerebral aneurysms. For the FY 2004 IPPS final rule (68 FR 45353) and the FY 2005 IPPS final rule (69 FR 48957), we evaluated the data for cases in the MedPAR file involving unruptured cerebral aneurysms assigned to DRG 1 (Craniotomy Age >17 With CC) and DRG 2 (Craniotomy Age >17 Without CC) and concluded that the average charges were consistent with those for other cases found in DRGs 1 and 2. Therefore, we did not propose a change to the DRG assignment for unruptured cerebral aneurysms. We have reviewed the latest data for unruptured cerebral aneurysms cases. In our analysis of the FY 2004 MedPAR data, we found 1,136 unruptured cerebral aneurysm cases assigned to DRG 1 and 964 unruptured cerebral aneurysm cases assigned to DRG 2. Although the average charges for the unruptured cerebral aneurysm cases in DRG 1 ($53,455) and DRG 2 ($34,028) were slightly higher than the average charges for all cases in DRG 1 ($51,466) and DRG 2 ($30,346), we do not believe these differences are significant enough to warrant a change in these two DRGs at this time. Therefore, we are not proposing a change in the structure of these DRGs relating to unruptured cerebral aneurysm cases for FY 2006. PO 00000 Frm 00012 Fmt 4701 Sfmt 4702 4. MDC 5 (Diseases and Disorders of the Circulatory System) a. Automatic Implantable Cardioverter/ Defibrillator As part of our annual review of DRGs, for FY 2006, we performed a review of cases in the FY 2004 MedPAR file involving the implantation of a defibrillator in the following DRGs: DRG 515 (Cardiac Defibrillator Implant Without Cardiac Catheterization). DRG 535 (Cardiac Defibrillator Implant With Cardiac Catheterization With Acute Myocardial Infarction, Heart Failure, or Shock). DRG 536 (Cardiac Defibrillator Implant With Cardiac Catheterization Without Acute Myocardial Infarction, Heart Failure, or Shock). While conducting our review, we noted that there had been considerable comments from hospital coders on code 37.26 (Cardiac electrophysiologic stimulation and recording studies (EPS)), which is included in these DRGs. These comments from hospital coders were directed at both CMS and the American Hospital Association. The procedure codes for these three DRGs describe the procedures that are considered to be a cardiac catheterization. Code 37.26 is classified as a cardiac catheterization within these DRGs. Therefore, the submission of code E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.002</GPH> 23316 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23317 the case is assigned to DRGs 535 or 536, depending on whether or not the patient also had an acute myocardial infarction, heart failure, or shock. The following chart shows the number of cases in each DRG, along with their average length of stay and average charges, found in the data: We have received a number of questions from hospital coders regarding the correct use of code 37.26. There is considerable confusion about whether or not code 37.26 should be reported when the procedure is performed as part of the defibrillator implantation. Currently, the ICD–9–CM instructs the coder not to report code 37.26 when a defibrillator is inserted. There is an inclusion term under the defibrillator code 37.94 (Implantation or replacement of automatic cardioverter/ defibrillator, total system [AICD]) which states that EPS is included in code 37.94. We discussed modifying this instruction at the October 7–8, 2004 meeting of the ICD–9–CM Coordination and Maintenance Committee. We received a number of comments opposing a modification to the use of code 37.26 to also allow it to be reported with an AICD insertion. A report of this meeting can be found on the Web site: https://www.cms.hhs.gov/ paymentsystem/icd9. We performed an analysis of cases within DRGs 535 and 536 with cardiac catheterization and with and without code 37.26 and with code 37.26 only reported without cardiac catheterization and found the following: The data show that when code 37.26 is the only procedure reported from the list of cardiac catheterizations, the average charges and the average length of stay are considerably lower. For example, the average standardized charges for a defibrillator implant with only an EPS are $85,390.88 in DRG 536, while the average standardized charges for DRG 536 with a cardiac catheterization, but not an EPS, are $110,493.86. The average standardized charges for all cases in DRG 536 are $94,453.62. The data show similar findings for DRG 535, with lower lengths of stay and average charges when the only code reported from the cardiac catheterization list is an EPS. When we also consider that there may be some coding problems in the use of code 37.26, we believe it is appropriate to propose a modification to these DRGs. Data reflected in the chart above show that the average standardized charges for DRG 515 were $83,659.76. These average charges are closer to those in DRG 536 with code 37.26 and without any other cardiac catheterization code reported. While the cases in DRG 535 with code 37.26 and without a cardiac catheterization have higher average charges than the average charges for cases in DRG 515, these cases have much lower average charges than the average charges for overall cases in DRG 535. For these reasons, we are proposing to remove code 37.26 from the list of cardiac catheterizations for DRGs 535 and 536. If a defibrillator is implanted and an EPS is performed with no other type of cardiac catheterization, the case would be assigned to DRG 515. CMS issued a National Coverage Determination for implantable cardioverter defibrillators, effective January 27, 2005, that expands coverage and requires, in certain cases, that patient data be reported when the defibrillator is implanted for the clinical indication of primary prevention of sudden cardiac death. The submission of data on patients receiving an implantable cardioverter defibrillator for primary prevention to a data collection system is needed for the determination that the implantable cardioverter VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00013 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.003</GPH> EP04MY05.004</GPH> 37.26 affects the DRG assignment for defibrillator cases and leads to the assignment of DRGs 535 or 536. When a cardiac catheterization is performed, 23318 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules defibrillator is reasonable and necessary and for quality improvement. These data will be made available in some form to providers and practitioners to inform their decisions, monitor performance quality, and benchmark and identify best practices. We made a temporary registry available for use when the policy became effective and used the Quality Net Exchange for data submission because Medicareparticipating hospitals already use the Exchange to report data. We intend to transition from the temporary registry using the Quality Net Exchange to a more sophisticated follow-on registry that will have the ability to collect longitudinal data. Some providers have suggested that CMS increase reimbursement for implantable cardioverter defibrillators to compensate the provider for reporting data. ICD data reporting includes elements of patient demographics, clinical characteristics and indications, medications, provider information, and complications. Since these data elements are commonly found in patient medical records, it is CMS’ expectation that these data are readily available to the individuals abstracting and reporting data. Therefore, we believe that increased reimbursement is not needed at this time. b. Coronary Artery Stents In the FY 2005 IPPS final rule (69 FR 48971 through 48974), we addressed two comments from industry representatives about the DRG assignments for coronary artery stents. These commenters had expressed concern about whether the reimbursement for stents is adequate, especially for insertion of multiple stents. They also expressed concern about whether the current DRG structure represents the most clinically coherent classification of stent cases. The current DRG structure incorporates stent cases into the following two pairs of DRGs, depending on whether bare metal or drug-eluting stents are used and whether acute myocardial infarction (AMI) is present: • DRG 516 (Percutaneous Cardiovascular Procedures with AMI). • DRG 517 (Percutaneous Cardiovascular Procedures with Nondrug-Eluting Stent without AMI). • DRG 526 (Percutaneous Cardiovascular Procedures with DrugEluting Stent with AMI). • DRG 527 (Percutaneous Cardiovascular Procedures with DrugEluting Stent without AMI). The commenters presented two recommendations for refinement and restructuring of the current coronary VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 stent DRGs. One of the recommendations involved restructuring these DRGs to create two additional stent DRGs that are closely patterned after the existing pairs, and would reflect insertion of multiple stents with and without AMI. The commenters recommended incorporating either stenting code 36.06 (Insertion of nondrug-eluting coronary artery stent(s)) or code 36.07 (Insertion of drug-eluting coronary artery stent(s)) when they are reported along with code 36.05 (Multiple vessel percutaneous transluminal coronary angioplasty [PTCA] or coronary atherectomy performed during the same operation, with or without mention of thrombolytic agent). The commenter’s first concern was that hospitals may be steering patients toward coronary artery bypass graft surgery in place of stenting in order to avoid significant financial losses due to what it considered the inadequate reimbursement for inserting multiple stents. In our response to comments in the FY 2005 IPPS final rule, we indicated that it was premature to act on this recommendation because the current coding structure for coronary artery stents cannot distinguish cases in which multiple stents are inserted from those in which only a single stent is inserted. Current codes are able to identify performance of PTCA in more than one vessel by use of code 36.05. However, while this code indicates that PTCA was performed in more than one vessel, its use does not reflect the exact number of procedures performed or the exact number of vessels treated. Similarly, when codes 36.06 and 36.07 are used, they document the insertion of at least one stent. However, these stenting codes do not identify how many stents were inserted in a procedure, nor distinguish insertion of a single stent from insertion of multiple stents. Even the use of one of the stenting codes in conjunction with multiple-PTCA code 36.05 does not distinguish insertion of a single stent from multiple stents. The use of code 36.05 in conjunction with code 36.06 or code 36.07 indicates only performance of PTCA in more than one vessel, along with insertion of at least one stent. The precise numbers of PTCA-treated vessels, the number of vessels into which stents were inserted, and the total number of stents inserted in all treated vessels cannot be determined. Therefore, the capabilities of the current coding structure do not permit the distinction between single and multiple vessel stenting that would be required under the recommended PO 00000 Frm 00014 Fmt 4701 Sfmt 4702 restructuring of the coronary stent DRGs. We agree that the DRG classification of cases involving coronary stents must be clinically coherent and provide for adequate reimbursement, including those cases requiring multiple stents. For this reason, we created four new ICD–9–CM codes identifying multiple stent insertion (codes 00.45, 00.46, 00.47, and 00.48) and four new codes identifying multiple vessel treatment (codes 00.40, 00.41, 00.42, and 00.43) at the October 7, 2004 ICD–9–CM Coordination and Maintenance Committee Meeting. These eight new codes can be found in Table 6B of this proposed rule. We have worked closely with the coronary stent industry and the clinical community to identify the most logical code structure to identify new codes for both multiple vessel and multiple stent use. Effective October 1, 2005, code 36.05 will be deleted and the eight new codes will be used in its place. Coders are encouraged to use as many codes as necessary to describe each case, using one code to describe the angioplasty or atherectomy, and one code each for the number of vessels treated and the number of stents inserted. Coders are encouraged to record codes accurately, as these data will potentially be the basis for future DRG restructuring. While we agree that use of multiple vessel and stent codes will provide useful information in the future on hospital costs associated with percutaneous coronary procedures, we believe it remains premature to proceed with a restructuring of the current coronary stent DRGs on the basis of the number of vessels treated or the number of stents inserted, or both, in the absence of data reflecting use of this new coding structure. The commenter’s second recommendation was that we distinguish ‘‘complex’’ from ‘‘noncomplex’’ cases in the stent DRGs by expanding the higher weighted DRGs (516 and 526) to include conditions other than AMI. The commenter recommended recognizing certain comorbid and complicating conditions, including hypertensive renal failure, congestive heart failure, diabetes, arteriosclerotic cardiovascular disease, cerebrovascular disease, and certain procedures such as multiple vessel angioplasty or atherectomy (as evidenced by the presence of procedure code 36.05), as indicators of complex cases for this purpose. Specifically, the commenters recommended replacing the current structure with the following four DRGs: • Recommended restructured DRG 516 (Complex percutaneous E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules cardiovascular procedures with nondrug-eluting stents). • Recommended restructured DRG 517 (Noncomplex percutaneous cardiovascular procedures with nondrug-eluting stents). • Recommended restructured DRG 526 (Complex percutaneous cardiovascular procedures with drugeluting stents). • Recommended restructured DRG 527 (Noncomplex percutaneous cardiovascular procedures with drugeluting stents). The commenter argued that this structure would provide an improvement in both clinical and resource coherence over the current structure that classifies cases according to the type of stent inserted and the presence or absence of AMI alone, without considering other complicating conditions. The commenter also presented an analysis, based on previous MedPAR data, that evaluated charges and lengths of stay for cases with expected high resource use and reclassified cases into its recommended new structure of paired ‘‘complex’’ and ‘‘noncomplex’’ DRGs. The commenter’s analysis showed some evidence of clinical and resource coherence in the recommended DRG structure. However, we did not adopt the proposal in the FY 2005 IPPS final rule. First, the data presented by the commenter still represented preliminary experience under a relatively new DRG structure. Second, the analysis did not reveal significant gains in resource coherence compared to existing DRGs for stenting cases. Therefore, we were reluctant to adopt this approach because of comments and concern about whether the overall level of payment in the coronary stent DRGs was adequate. However, we indicated that this issue deserved further study and consideration, and that we would conduct an analysis of this recommendation and other approaches to restructuring these DRGs with updated data in the FY 2006 proposed rule. This year, we have analyzed the MedPAR data to determine the impact of certain secondary diagnoses or complicating conditions on the four DRGs cited above. Specifically, we examined the data in DRGs 516, 517, 526, and 527, based on the presence of coronary stents (codes 36.06 and 36.07) and the following additional diagnoses: • Congestive heart failure (represented by codes 398.91 (Rheumatic heart failure (congestive)), 402.01 (Hypertensive heart disease, malignant, with heart failure), 402.11, (Hypertensive heart disease, benign, VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 with heart failure), 402.91 (Hypertensive heart disease, unspecified, with heart failure), 404.01 (Hypertensive heart and renal disease, malignant, with heart failure), 404.03 (Hypertensive heart and renal disease, malignant, with heart failure and renal failure), 404.11 (Hypertensive heart and renal disease, benign, with heart failure), 404.13 (Hypertensive heart and renal disease, benign, with heart failure and renal failure), 404.91 (Hypertensive heart and renal disease, unspecified, with heart failure), 404.93 (Hypertensive heart and renal disease, unspecified, with heart failure and renal failure), 428.0 (Congestive heart failure, unspecified), and 428.1 (Left heart failure)). • Arteriosclerotic cardiovascular disease (represented by code 429.2 (Cardiovascular disease, unspecified)). • Cerebrovascular disease (represented by codes 430.0 (Subarachnoid hemorrhage), 431.0 (Intracerebral hemorrhage), 432.0 (Nontraumatic extradural hemorrhage), 432.1, Subdural hemorrhage, 432.9, (Unspecified intracranial hemorrhage), 433.01 (Occlusion and stenosis of basilar artery, with cerebral infarction), 433.11 (Occlusion and stenosis of carotid artery, with cerebral infarction), 433.21 (Occlusion and stenosis of vertebral artery, with cerebral infarction), 433.31 (Occlusion and stenosis of multiple and bilateral precerebral arteries, with cerebral infarction), 433.81 (Occlusion and stenosis of other specified precerebral artery, with cerebral infarction), 434.01 (Cerebral thrombosis with cerebral infarction), 434.11 (Cerebral embolism with cerebral infarction), 434.91 (Cerebral artery occlusion with cerebral infarction, unspecified), 436.0 (Acute, but ill-defined, cerebrovascular disease)). • Secondary diagnosis of acute myocardial infarction (represented by codes 410.01 (Acute myocardial infarction of anterolateral wall, initial episode of care), 410.11 (Acute myocardial infarction of other anterior wall, initial episode of care), 410.21 (Acute myocardial infarction of inferolateral wall, initial episode of care), 410.31 (Acute myocardial infarction of inferoposterior wall, initial episode of care), 410.41 (Acute myocardial infarction of other inferior wall, initial episode of care), 410.51 (Acute myocardial infarction of other lateral wall, initial episode of care), 410.61 (True posterior wall infarction, initial episode of care), 410.71 (Subendocardial infarction, initial episode of care), 410.81 (Acute myocardial infarction of other specified sites, initial episode of care), 410.91 PO 00000 Frm 00015 Fmt 4701 Sfmt 4702 23319 (Acute myocardial infarction of unspecified site, initial episode of care)). • Renal failure (represented by codes 403.01 (Hypertensive renal disease, malignant, with renal failure), 403.11 (Hypertensive renal disease, benign, with renal failure), 403.91 (Hypertensive renal disease, unspecified, with renal failure), 585.0 (Chronic renal failure), V42.0 (Organ or tissue replaced by transplant, kidney), V45.1 (Renal dialysis status), V56.0 (Extracorporeal dialysis), V56.1 (Fitting and adjustment of extracorporeal dialysis catheter), V56.2 (Fitting and adjustment of peritoneal dialysis catheter)). Any renal failure with congestive heart failure will be captured in the 404.xx codes listed above. We reviewed the cases in the four coronary stent DRGs and found that most of the additional or ‘‘complicated’’ cases did, in fact, have higher average charges in most instances. However, these results could potentially be duplicated for many DRGs, or sets of DRGs, within the PPS structure. That is, cases with selected complicating factors will tend to have higher average lengths of stay and average charges than cases without those complicating factors. Since cases with the selected complicating factors necessarily contain sicker patients, longer lengths of stay and higher average charges are to be expected. For example, cases in which patients with a cardiac condition also have renal failure are quite likely to consume higher resources than patients only with a cardiac condition. In addition, selectively recognizing the recommended secondary diagnoses or complicating conditions raises some issues related to the logic and structural integrity of the DRG system. Generally, we have taken into account the higher costs of cases with complications by maintaining a general list of comorbidities and complications (the CC) list), and, where appropriate, distinguishing pairs of DRGs by ‘‘with and without CCs.’’ (This system also specifies exclusions from each pair, to account for cases where a condition on the CC list is an expected and normal constituent of the diagnoses reflected in the paired DRGs.) In order to maintain the basic DRG body-system structure, we have not employed special lists of procedures and diagnoses from one MDC to make determinations about the structure of DRGs in another MDC. The recommended restructuring of the coronary stent DRGs is inconsistent with this principle and may create a new precedent of selecting specific comorbidities and complications to restructure DRGs. For example, the E:\FR\FM\04MYP2.SGM 04MYP2 23320 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules Therefore, restructuring these DRGs on this basis would result in a logical arrangement of cases with regard to both clinical coherence and resource consumption. We have compared the existing CC list with the list of the codes recommended by the commenter as secondary diagnoses. All of the recommended codes already appear on the CC list except for codes 429.2, 432.9, V56.1, and V56.2. Code 429.2 represents a very vague diagnosis (arteriosclerotic cardiovascular disease (ASCVD)). Code 432.9 represents a nonspecific principal diagnosis that is rejected by the MCE when reported as the principal diagnosis. Codes V56.1 and V56.2 describe conditions relating to dialysis for renal failure. Therefore, we believe that our proposal to utilize the existing CC list would encompass most of the cases on the recommended list, as well as other cases with additional CCs requiring additional resources. We have examined the MedPAR data for the cases in the coronary stent DRGs, distinguishing cases that include CCs and those that do not. The following table displays the results: The data show a clear differentiation in average charges between the cases in DRG 516 and 526 ‘‘with CC’’ and those ‘‘without CC.’’ Therefore, the data suggest that a ‘‘with and without CC’’ split in DRG 516 and 526 is warranted. At the same time, the data do not show such a clear differentiation, in either average charges or lengths of stay, among the cases in DRGs 517 and 527. Therefore, we are proposing to delete DRGs 516 and 526, and to substitute four new DRGs in their place. These new DRGs would be patterned after existing DRGs 516 and 526, except that they would be split based on the presence or absence of a secondary diagnosis on the existing CC list. Specifically, we are proposing to create DRG 547 (Percutaneous Cardiovascular Procedure with AMI with CC), DRG 548 (Percutaneous Cardiovascular Procedure with AMI without CC), DRG 549 (Percutaneous Cardiovascular Procedure with Drug-Eluting Stent with AMI with CC), and DRG 550 (Percutaneous Cardiovascular Procedure with DrugEluting Stent with AMI without CC). As we noted above, the MedPAR data do not support restructuring DRGs 517 and 527 based on the presence or absence of a CC. Therefore, we are proposing to retain these two DRGs in their current forms. We believe this revised structure will result in a more inclusive and comprehensive array of cases within MDC 5 without selectively recognizing certain secondary diagnoses as ‘‘complex.’’ While we are proposing some restructuring of the coronary stent DRGs for FY 2006, it is important to note that we will continue to monitor and analyze clinical and resource trends in this area. For example, we have found indications in the current data that treatment may be moving toward use of drug-eluting stents, and away from use of bare metal stents. Specifically, cases in DRGs 516 and 517, which utilize bare metal stents, comprise only 44.4 percent, or less than half, of the cases in the four coronary stent DRGs in the MedPAR data we analyzed. As use of drug-eluting stents becomes the standard of treatment, we may consider over time whether to dispense with the distinction between these stents and the older bare metal stent technology in the structure of the coronary stent DRGs. In addition, we will continue to consider whether the structure of these DRGs ought to reflect differences in the number of vessels treated or the number of stents inserted, or both. As we discussed above, a new coding structure capable of identifying multiple vessel treatment and the insertion of multiple stents will go into effect on October 1, 2005. It remains premature to restructure the coronary stent DRGs on the basis of the number of vessels treated or the number of stents inserted, or both, until data reflecting the use of these new codes become available. However, we will analyze those data when they become available in order to determine whether a restructuring based on multiple vessel treatment or insertion of multiple stents, or both, is warranted. Our proposal to restructure two of the current coronary stent DRGs into paired ‘‘with and without CC’’ DRGs for FY 2006 does not preclude proposals in subsequent years to restructure the coronary stent DRGs in one or both of these ways. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00016 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.005</GPH> presence of code 403.11 (Hypertensive renal disease, malignant, with renal failure) may distinguish cases with higher average charges, but the same argument could be raised for many other procedures across other MDCs. Rather than establishing such a precedent, we are proposing to restructure the coronary stent DRGs on the basis of the standard CC list to differentiate cases that require greater resources. We believe this list to be more inclusive of true comorbid or complicating conditions than selection of specific secondary diagnosis codes. Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23321 c. Insertion of Left Atrial Appendage Device Atrial fibrillation is a common heart rhythm disorder that can lead to a cardiovascular blood clot formation leading to increased risk of stroke. According to product literature, nearly all strokes are from embolic clots arising in the left atrial appendage of the heart: an appendage for which there is no useful function. Standard therapy uses anticoagulation drugs. However, these drugs may be contraindicated in certain patients and may cause complications such as bleeding. The underlying concept behind the left atrial appendage device is to block off the left atrial appendage, so that the blood clots formed therein cannot travel to other sites in the vascular system. The device is implanted using a percutaneous catheter procedure under fluoroscopy through the femoral vein. Implantation is performed in a hospital catheterization laboratory using standard transseptal technique, with the patient generally under local anesthesia. The procedure takes approximately 1 hour, and most patients stay overnight in the hospital. In the FY 2005 IPPS final rule (69 FR 48978, August 11, 2004), we discussed the DRG assignment of new ICD–9–CM procedure code 37.90 (Insertion of left atrial appendage device) for clinical trials, effective for discharges occurring on or after October 1, 2004, to DRG 518 (Percutaneous Cardiovascular Procedure without Coronary Artery Stent or Acute Myocardial Infarction)). In that final rule, we addressed the DRG assignment of procedure code 37.90 in response to a comment from a manufacturer who suggested that placement of the code in DRG 108 (Other Cardiothoracic Procedures) was more representative of the complexity of the procedure than placement in DRG 518. The manufacturer indicated that the suggested placement of procedure code 37.90 in DRG 108 was justified because another percutaneous procedure, described by ICD–9-CM procedure code 35.52 (Repair of atrial septal defect with prosthesis, closed technique), was assigned to DRG 108. As we indicated in the FY 2005 final rule (69 FR 48978), this comment prompted us to examine data in the FY 2003 MedPAR file for cases of code 35.52 assigned to DRG 108 and DRG 518 in comparison to all cases assigned to DRG 108. We found the following: Therefore, we concluded that procedure code 35.52 showed a decided similarity to the cases found in DRG 518, not DRG 108. At that time, we determined that we would analyze the cases for both clinical coherence and charge data as part of the IPPS FY 2006 process of identifying the most appropriate DRG assignment for procedure code 35.52. We have now examined data from the FY 2004 MedPAR file and found results for cases assigned to DRG 108 and DRG 518 that are similar to last year’s findings as indicated in the chart below: From this comparison, we found that when an atrial septal defect is percutaneously repaired, and procedure code 35.52 is the only code reported in DRG 108, there is a significant discrepancy in both the average charges and the average length of stay between the cases with procedure code 35.52 reported in DRG 108 and the total cases in DRG 108. The total cases in DRG 108 have average charges of $51,744 greater than the 872 cases in DRG 108 reporting procedure code 35.52 as the only procedure. The total cases in DRG 108 also have an average length of stay of 7.39 days greater than the average length of stay for cases in DRG 108 with procedure code 35.52 reported. In comparison, the total cases in DRG 518 have average charges of only $1,988 lower than the cases in DRG 108 with only procedure code 35.52 reported. In addition, the length of stay in total cases in DRG 518 is more closely related to cases in DRG 108 with only procedure code 35.52 reported. Based on our analysis of these data, we are proposing to move procedure code 35.52 out of DRG 108 and place it in DRG 518. We believe that this proposal would result in a more coherent group of cases in DRG 518 that reflect all percutaneous procedures. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00017 Fmt 4701 Sfmt 4702 In the August 1, 2002, final rule (67 FR 49989), we attempted to clinically and financially align ventricular assist device (VAD) procedures by creating DRG 525 (Heart Assist System Implant). We also noted that cases in which a heart transplant also occurred during the same hospitalization episode would continue to be assigned to DRG 103 (Heart Transplant). After further data review during the next 2 years, we decided to realign the E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.006</GPH> EP04MY05.007</GPH> VerDate Aug<04>2004 d. External Heart Assist System Implant 23322 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules • 37.54, Replacement or repair of other implantable component of total replacement heart system *. • 37.62, Insertion of non-implantable heart assist system. • 37.63, Repair of heart assist system. • 37.65, Implant of external heart assist system. Since that decision, we have been encouraged by a manufacturer to reevaluate DRG 525 for FY 2006. The manufacturer requested that we again review the data surrounding cases reporting code 37.65 and has suggested moving these cases into DRG 103. The manufacturer pointed out the following: Code 37.65 describes the implantation of an external heart assist system and is currently approved by the FDA as a bridge-to-recovery device. From the standpoint of clinical status, the patients in DRG 103 and receiving an external heart assist system are similar because their native hearts cannot support circulation, and absent a heart transplant, a mechanical pump is needed for patient survival. The surgical procedures for implantation of both an internal VAD and an external VAD are very similar. However, the external heart assist system (code 37.65) is a less expensive device than the implantable heart assist system (code 37.66). The manufacturer suggested that the payment differential between DRGs 103 and 525 is an incentive to choose the higher paying device, and asserted that only a subset of patients receiving an implantable heart assist system are best served by this device. The manufacturer also suggested that the initial use of the least expensive therapeutically appropriate device yields both the best clinical outcomes and the lowest total system costs. We note that, under the DRG system, our intent is to create payments that are reflective of the average resources required to treat a particular case. Our goal is that physicians and hospitals should make treatment decisions based on the clinical needs of the patient and not financial incentives. When we reviewed the FY 2004 MedPAR data, we were able to demonstrate the following comparisons: The above table shows that the 37.8 percent of cases in DRG 525 that reported code 37.65 have average charges that are nearly $33,000 higher than the average charges for all cases in the DRG. However, the average charges for the subset of cases with code 37.65 in DRG 525 ($206,497) are more than $107,086 lower than the average charges for all cases in DRG 103 ($313,583). Furthermore, the average length of stay for the subset of patients in DRG 525 receiving an external heart assist system was 9.26 days compared to 37.5 days for the 633 cases in DRG 103. We note that the analysis above presents the difference in average charges, not costs. Because hospitals’ charges are higher than costs, the difference in hospital costs will be less than the figures shown here. Moving cases containing code 37.65 from DRG 525 to DRG 103 would have two consequences. The cases in DRG 103 reporting code 37.65 would be appreciably overreimbursed, which would be inconsistent with our goal of coherent reimbursement structure within the DRGs. In addition, the relative weight of DRG 103 would decrease by moving the less resourceintensive external heart procedures into the same DRG with the more expensive heart transplant cases. The net effect would be an underpayment for heart transplant cases. Alternatively, we also reconsidered our position on moving the insertion of an implantable heart assist system (code 37.66) back into VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 * These codes represent noncovered services for Medicare beneficiaries. However, it is our longstanding practice to assign every code in the ICD–9–CM classification to a DRG. Therefore, they have been assigned to DRG 525. PO 00000 Frm 00018 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.008</GPH> DRGs containing VAD codes for FY 2005. In the August 11, 2004 final rule (69 FR 48927), we announced changes to DRG 103, DRG 104 (Cardiac Valve and Other Major Cardiothoracic Procedure with Cardiac Catheterization), DRG 105 (Cardiac Valve and Other Major Cardiothoracic Procedures Without Cardiac Catheterization), and DRG 525. In summary, these changes included— • Moving code 37.66 (Insertion of implantable heart assist system) out of DRG 525 and into DRG 103. • Renaming DRG 525 as ‘‘Other Heart Assist System Implant.’’ • Moving code 37.62 (Insertion of non-implantable heart assist system) out of DRGs 104 and 105 and back into DRG 525. DRG 525 currently consists of any principal diagnosis in MDC 5, plus the following surgical procedure codes: • 37.52, Implantation of total replacement heart system *. • 37.53, Replacement or repair of thoracic unit of total replacement heart system *. Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23323 Procedure code 00.61 was assigned to four MDCs and seven DRGs. The most likely scenario is that in which cases are assigned to MDC 1 (Diseases and Disorders of the Nervous System in DRGs 533 (Extracranial Procedures with CC) and 534 (Extracranial Procedures without CC). Cases may also be assigned to MDC 5 (Diseases and Disorders of the Circulatory System), MDC 21 (Injuries, Poisoning, and Toxic Effects of Drugs), and MDC 24 (Multiple Significant Trauma). Other less likely DRG assignments can be found in Table 6B in the Addendum to the FY 2005 IPPS final rule (69 FR 49624). In the FY 2005 final rule, we indicated that we would continue to monitor DRGs 533 and 534 and procedure code 00.61 in combination with procedure code 00.63 in upcoming annual DRG reviews. For this proposed rule, we are using proxy codes to evaluate the costs and DRG assignments for carotid artery stenting because codes 00.61 and 00.63 were only approved for use beginning October 1, 2004, and because MedPAR data for this period are not yet available. We used procedure code 39.50 (Angioplasty or atherectomy of other noncoronary vessel(s)) in combination with procedure code 39.90 (Insertion of nondrug-eluting peripheral vessel stent(s)) in DRGs 533 and 534 as the proxy codes for coronary artery stenting. For this evaluation, we used principal diagnosis code 433.10 (Occlusion and stenosis of carotid artery, without mention of cerebral infarction) because this diagnosis most closely reflects the clinical trial criteria. The following chart shows our findings: The patients receiving a carotid stent (codes 39.50 and 39.90) represented 3.5 percent of all cases in DRG 534. On average, patients receiving a carotid stent had slightly shorter average lengths of stay than other patients in DRGs 533 and 534. While the average charges for patients receiving a carotid artery stent were higher than for other patients in DRG 534, in our view, the small number of cases and the magnitude of the difference in average charges are not sufficient to justify a change in the DRGs. Because we have a paucity of data for the carotid stent device and its insertion, and no data utilizing procedure codes 00.61 and 00.63 in a clinical trial setting, we believe it is premature to revise the DRG structure at this time. We expect to revisit this analysis once data become available on the new codes for carotid artery stents. e. Carotid Artery Stent VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00019 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.009</GPH> Stroke is the third leading cause of death in the United States and the leading cause of serious, long-term disability. Approximately 70 percent of all strokes occur in people age 65 and older. The carotid artery, located in the neck, is the principal artery supplying the head and neck with blood. Accumulation of plaque in the carotid artery can lead to stroke either by decreasing the blood flow to the brain or by having plaque break free and lodge in the brain or in other arteries to the head. The percutaneous transluminal angioplasty (PTA) procedure involves inflating a balloon-like device in the narrowed section of the carotid artery to reopen the vessel. A carotid stent is then deployed in the artery to prevent the vessel from closing or restenosing. A distal filter device (embolic protection device) may also be present, which is intended to prevent pieces of plaque from entering the bloodstream. Effective July 1, 2001, Medicare covers PTA of the carotid artery concurrent with carotid stent placement when furnished in accordance with the FDA-approved protocols governing Category B Investigational Device Exemption (IDE) clinical trials. PTA of the carotid artery, when provided solely for the purpose of carotid artery dilation concurrent with carotid stent placement, is considered to be a reasonable and necessary service only when provided in the context of such clinical trials and, therefore, is considered a covered service for the purposes of these trials. Performance of PTA in the carotid artery when used to treat obstructive lesions outside of approved protocols governing Category B IDE clinical trials remains a noncovered service. At the April 1, 2004 ICD–9–CM Coordination and Maintenance Committee meeting, we discussed creation of a new code or codes to identify carotid artery stenting, along with a concomitant percutaneous angioplasty or atherectomy (PTA) code for delivery of the stent(s). This subject was addressed in response to the need to identify carotid artery stenting for use in clinical trials in the upcoming fiscal year. Public comment confirmed the need for specific codes for this procedure. We established codes for carotid artery stenting procedures effective October 1, 2004, for patients who are enrolled in an FDA-approved clinical trial and are using on-label FDA approved stents and embolic protection devices. New procedure codes 00.61 (Percutaneous angioplasty or atherectomy of precerebral (extracranial vessel(s)) and 00.63 (Percutaneous insertion of carotid artery stent(s)) were published in Table 6B, New Procedure Codes in the FY 2005 IPPS final rule (69 FR 49624). DRG 525. However, as shown in the FY 2005 IPPS final rule (69 FR 48929), the resource costs associated with caring for a patient receiving an implantable heart assist system are far more similar to those cases receiving a heart transplant in DRG 103 than they are to cases in DRG 525. For these reasons, we are not proposing to make any changes to the structure of either DRG 103 or DRG 525 in this proposed rule. Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules f. Extracorporeal Membrane Oxygenation (ECMO) Extracorporeal membrane oxygenation (ECMO) is a procedure to create a closed chest, heart-lung bypass system by insertion of vascular catheters. Patients receiving this procedure require mechanical ventilation. ECMO is performed for a small number of severely ill patients who are at high risk of dying without this procedure. Most often it is done for neonates with persistent pulmonary hypertension and respiratory failure for whom other treatments have failed, certain severely ill neonates receiving major cardiac procedures or diaphragmatic hernia repair, and certain older children and adults, most of whom are receiving major cardiac procedures. We received several letters from institutions that perform ECMO. The commenters stated that, in the CMS GROUPER logic, this procedure has little or no impact on the DRG The average charges for all ECMO cases were approximately $258,821, and the average length of stay was approximately 20.7 days. The average charges for the ECMO cases are closer to the average charges for DRG 541 ($273,656) than to the average charges of DRG 104 ($147,766) and DRG 105 ($131,700). Of the 78 ECMO cases, 14 cases are already assigned to DRG 541. We believe that the data indicate that DRG 541 would be a more appropriate DRG assignment for cases where ECMO is performed. We further note that under the All Payer DRG System used in New York State, cases involving ECMO are assigned to the tracheostomy DRG. Thus, the assignment of ECMO cases to the tracheostomy DRG for Medicare would be similar to how these cases are grouped in another DRG system. For these reasons, we are proposing to reassign ECMO cases reporting code 39.65 to DRG 541. We are also proposing to change the title of DRG 541 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 assignment in the newborn, pediatric, and adult population. According to these letters, patients receiving ECMO are highly resource intensive and should have a unique DRG that reflects the costs of these resources. The commenters recommended the creation of a new DRG for ECMO with a DRG weight equal to or greater than the DRG weight for tracheostomy. ECMO is assigned to procedure code 39.65 (Extracorporeal membrane oxygenation). This code is classified as an O.R. procedure and is assigned to DRG 104 (Cardiac Valve and Other Major Cardiothoracic Procedure With Cardiac Catheterization) and DRG 105 (Cardiac Valve and Other Major Cardiothoracic Procedure Without Cardiac Catheterization). When ECMO is performed with other O.R. procedures, the case is assigned to the higher weighted DRG. For example, when ECMO and a tracheostomy are performed during the same admission, the case would be assigned to DRG 541 (Tracheostomy with Mechanical Ventilation 96+ Hours or Principal Diagnosis Except Face, Mouth, and Neck Diagnoses With Major O.R.). We note that the primary focus of updates to the Medicare DRG classification system is changes relating to the Medicare patient population, not the pediatric patient population. Because ECMO is primarily a pediatric procedure and rarely performed in an adult population, we have few cases in our data to use to evaluate resource costs. We are aware that other insurers sometimes use Medicare’s rates to make payments. We advise private insurers to make appropriate modifications to our payment system when it is being used for children or other patients who are not generally found in the Medicare population. To evaluate the appropriateness of payment under the current DRG assignment, we have reviewed the FY 2004 MedPAR data and found 78 ECMO cases in 13 DRGs. The following table illustrates the results of our findings: to: ‘‘ECMO or Tracheostomy With Mechanical Ventilation 96+ Hours or Principal Diagnosis Except Face, Mouth and Neck Diagnoses With Major O.R.’’ System), DRGs 157 and 158 (Anal and Stomal Procedures With and Without CC, respectively); MDC 9 (Diseases and Disorders of the Skin, Subcutaneous Tissue and Breast), DRG 267 (Perianal and Pilonidal Procedures); MDC 21 (Injuries, Poisonings, and Toxic Effects of Drugs), DRGs 442 and 443 (Other O.R. Procedures for Injuries With and without CC, respectively); and MDC 24 (Multiple Significant Trauma), DRG 486 (Other O.R. Procedures for Multiple Significant Trauma). In the FY 2004 IPPS final rule (68 FR 45372), we discussed the assignment of these codes in response to a request we had received to consider reassignment of these two codes to different MDCs and DRGs. The requester believed that the average charges ($44,000) for these codes warranted reassignment. In the FY 2004 IPPS final rule, we stated that we did not have sufficient MedPAR data available on the reporting of codes 49.75 and 49.76 to make a determination on 5. MDC 6 (Diseases and Disorders of the Digestive System): Artificial Anal Sphincter In the FY 2003 IPPS final rule (67 FR 50242), we created two new codes for procedures involving an artificial anal sphincter, effective for discharges occurring on or after October 1, 2002: code 49.75 (Implantation or revision of artificial anal sphincter) is used to identify cases involving implantation or revision of an artificial anal sphincter and code 49.76 (Removal of artificial anal sphincter) is used to identify cases involving the removal of the device. In Table 6B of that final rule, we assigned both codes to one of four MDCs, based on principal diagnosis, and one of six DRGs within those MDCs: MDC 6 (Diseases and Disorders of the Digestive PO 00000 Frm 00020 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.010</GPH> 23324 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules DRG reassignment of these codes. We agreed that, if warranted, we would give further consideration to the DRG assignments of these codes because it is our customary practice to review DRG assignment(s) for newly created codes to determine clinical coherence and similar resource consumption after we have had the opportunity to collect MedPAR data on utilization, average lengths of stay, average charges, and distribution throughout the system. In the FY 2005 IPPS final rule, we reviewed the FY 2003 MedPAR data for the presence of codes 49.75 and 49.76 and determined that these procedures were not a clinical match with the other procedures in DRGs 157 and 158. Therefore, for FY 2005, we moved procedure codes 49.75 and 49.76 out of DRGs 157 and 158 and into DRGs 146 and 147 (Rectal Resection With and Without CC, respectively). This change had the effect of doubling the payment for the cases with procedure codes 49.75 and 49.76 assigned to DRGs 146 and 147 based on increases in the relative weights. One commenter had suggested that we create a new DRG for ‘‘Complex Anal/Rectal Procedure with Implant.’’ However, we noted that the DRG structure is a system of averages and is based on groups of patients with similar characteristics. At that time, we indicated that we would continue to monitor procedure codes 49.75 and 49.76 and the DRGs to which they are assigned. For this FY 2006 proposed rule, we reviewed the FY 2004 MedPAR data for the presence of codes 49.75 and 49.76. We found that these two procedures are still of low incidence. Among the six possible DRG assignments, we found a total of 18 cases reported with codes 49.75 and 49.76 for the implant, revision, or removal of the artificial anal sphincter. We found 13 of these cases in DRGs 146 and 147 (compared to 12,558 total cases in these DRGs), and the remaining 5 cases in DRGs 442 and 443 (compared to 19,701 total cases in these DRGs). We believe the number of cases with codes 49.75 and 49.76 in these DRGs is too low to provide meaningful data of statistical significance. Therefore, we are not proposing any further changes to the DRGs for these procedures at this time. Neither are we proposing to change the structure of DRGs 146 or 147 at this time. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 6. MDC 8 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue) a. Hip and Knee Replacements Orthopedic surgeons representing the American Association of Orthopaedic Surgeons (AAOS) requested that we subdivide DRG 209 (Major Joint and Limb Reattachment Procedures of Lower Extremity) in MDC 8 by creating a new DRG for revision of lower joint procedures. The AAOS made a presentation at the October 7–8, 2004 meeting of the ICD–9–CM Coordination and Maintenance Committee meeting. A summary report of this meeting can be found at the CMS Web site: https:// www.cms.hhs.gov/paymentsystems/ icd9/. We also received written comments on this request. The AAOS surgeons stated that cases involving patients who require a revision of a prior replacement of a knee or hip require significantly more resources than cases in which patients receive an initial joint replacement. They pointed out that total joint replacement is one of the most commonly performed and successful operations in orthopedic surgery. The surgeons mentioned that, in 2002, over 300,000 hip replacement and 350,000 knee replacement procedures were performed in the United States. They also pointed out that these procedures are a frequent reason for Medicare hospitalization. The surgeons stated that total joint replacements have been shown to be highly cost-effective procedures, resulting in dramatic improvements in quality of life for patients suffering from disabling arthritic conditions involving the hip or knee. In addition, they reported that the medical literature indicates success rates of greater than 90 percent for implant survivorship, reduction in pain, and improvement in function at a 10year to 15-year followup. However, despite these excellent results with primary total joint replacement, factors related to implant longevity and evolving patient demographics have led to an increase in the volume of revision total joint procedures performed in the United States over the past decade. Total hip replacement is an operation that is intended to reduce pain and restore function in the hip joint by replacing the arthritic hip joint with a prosthetic ball and socket joint. The prosthetic hip joint consists of a metal alloy femoral component with a modular femoral head made of either metal or ceramic (the ‘‘ball’’) that articulates with a metal acetabular component with a modular liner made PO 00000 Frm 00021 Fmt 4701 Sfmt 4702 23325 of either metal, ceramic, or high-density polyethylene (the ‘‘socket’’). The AAOS surgeons stated that in a normal knee, four ligaments help hold the bones in place so that the joint works properly. When a knee becomes arthritic, these ligaments can become scarred or damaged. During knee replacement surgery, some of these ligaments, as well as the joint surfaces, are substituted or replaced by the new artificial prostheses. Two types of fixation are used to hold the prostheses in place. Cemented designs use polymethyl methacrylate to hold the prostheses in place. Cementless designs rely on bone growing into the surface of the implant for fixation. The surgeons stated that all hip and knee replacements have an articular bearing surface that is subject to wear (the acetabular bearing surface in the hip and the tibial bearing surface in the knee). Traditionally, these bearing surfaces have been made of metal-onmetal or metal-on-polyethylene, although newer materials (both metals and ceramics) have been used more recently. Earlier hip and knee implant designs had nonmodular bearing surfaces, but later designs included modular articular bearing surfaces to reduce inventory and potentially simplify revision surgery. Wear of the articular bearing surface occurs over time and has been found to be related to many factors, including the age and activity level of the patient. In some cases, wear of the articular bearing surface can produce significant debris particles that can cause peri-prosthetic bone resorption (also known and osteolysis) and mechanical loosening of the prosthesis. Wear of the bearing surface can also lead to instability or prosthetic dislocation, or both, and is a common cause of revision hip or knee replacement surgery. Depending on the cause of failure of the hip replacement, the type of implants used in the previous surgery, the amount and quality of the patient’s remaining bone stock, and factors related to the patient’s overall health and anatomy, revision hip replacement surgery can be relatively straightforward or extremely complex. Revision hip replacement can involve replacing any part or all of the implant, including the femoral or acetabular components, and the bearing surface (the femoral head and acetabular liner), and may involve major reconstruction of the bones and soft tissues around the hip. All of these procedures differ significantly in their clinical indications, outcomes, and resource intensity. The AAOS surgeons provided the following summary of the types of E:\FR\FM\04MYP2.SGM 04MYP2 23326 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules revision knee replacement procedures: Among revision knee replacement procedures, patients who underwent complete revision of all components had longer operative times, higher complication rates, longer lengths of stay, and significantly higher resource utilization, according to studies conducted by the AAOS. Revision of the isolated modular tibial insert component was the next most resourceintensive procedure, and primary total knee replacement was the least resource-intensive of all the procedures studied. • Isolated Modular Tibial Insert Exchange. Isolated removal and exchange of the modular tibial bearing surface involves replacing the modular polyethylene bearing surface without removing the femoral, tibial, or patellar components of the prosthetic joint. Common indications for this procedure include wear of the polyethylene bearing surface or instability (for example, looseness) of the prosthetic knee joint. Patient recovery times are much shorter with this procedure than with removal and exchange of either the tibial, femoral, or patellar components. • Revision of the Tibial Component. Revision of the tibial component involves removal and exchange of the entire tibial component, including both the metal base plate and the modular polyethylene bearing surface. Common indications for tibial component revision are wear of the modular bearing surface, aseptic loosening (often associated with osteolysis), or infection. Depending on the amount of associated bone loss and the integrity of the ligaments around the knee, tibial component revision may require the use of specialized implants with stems that extend into the tibial canal and/or the use of metal augments or bone graft to fill bony defects. • Revision of the Femoral Component. Revision of the femoral component involves removal and exchange of the metal implant that covers the end of the thigh-bone (the distal femur). Common indications for femoral component revision are aseptic loosening with or without associated osteolysis/bone loss, or infection. Similar to tibial revision, femoral component revision that is associated with extensive bone loss often involves the use of specialized implants with stems that extend into the femoral canal and/or the use of metal augments or bone graft to fill bony defects. • Revision of the Patellar Component. Complications related to the patellafemoral joint are one of the most common indications for revision knee replacement surgery. Early patellar VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 implant designs had a metal backing covered by high-density polyethylene; these implants were associated with a high rate of failure due to fracture of the relatively thin polyethylene bearing surface. Other common reasons for isolated patellar component revision include poor tracking of the patella in the femoral groove leading to wear and breakage of the implant, fracture of the patella with or without loosening of the patellar implant, rupture of the quadriceps or patellar tendon, and infection. • Revision of All Components (Tibial, Femoral, and Patellar). The most common type of revision knee replacement procedure is a complete total knee revision. A complete revision of all implants is more common in knee replacements than hip replacements because the components of an artificial knee are not compatible across vendors or types of prostheses. Therefore, even if only one of the implants is loose or broken, a complete revision of all components is often required in order to ensure that the implants are compatible. Complete total knee revision often involves extensive surgical approaches, including osteotomizing (for example, cutting) the tibia bone in order to adequately expose the knee joint and gain access to the implants. These procedures often involve extensive bone loss, requiring reconstruction with specialized implants with long stems and metal augments or bone graft to fill bony defects. Depending on the status of the ligaments in the knee, complete total knee revision at times requires implantation of a highly constrained or ‘‘hinged’’ knee replacement in order to ensure stability of the knee joint. • Reimplantation from previous resection or cement spacer. In cases of deep infection of a prosthetic knee, removal of the implants with implantation of an antibioticimpregnated cement spacer, followed by 6 weeks of intravenous antibiotics is often required in order to clear the infection. Revision knee replacement from an antibiotic impregnated cement spacer often involves complex bony reconstruction due to extensive bone loss that occurs as a result of the infection and removal of the often wellfixed implants. As noted above, the clinical outcomes following revision from a spacer are often poor due to limited functional capacity while the spacer is in place, prolonged periods of protected weight bearing (following reconstruction of extensive bony defects), and the possibility of chronic infection. The surgeons stated that the current ICD–9–CM codes did not adequately PO 00000 Frm 00022 Fmt 4701 Sfmt 4702 capture the complex nature of revisions of hip and knee replacements. Currently, code 81.53 (Revision of hip replacement) captures all ‘‘partial’’ and ‘‘total’’ revision hip replacement procedures. Code 81.55 (Revision of knee replacement) captures all revision knee replacement procedures. These two codes currently capture a wide variety of procedures that differ in their clinical indications, resource intensity, and clinical outcomes. An AAOS representative made a presentation at the October 7–8, 2004 ICD–9–CM Coordination and Maintenance Committee. Based on the comments received at the October 7–8, 2004 meeting and subsequent written comments, new ICD–9–CM procedure codes were developed to better capture the variety of ways that revision of hip and knee replacements can be performed: codes 00.70 through 00.73 and code 81.53 for revisions of hip replacements and codes 00.80 through 00.84 and code 81.55 for revisions of knee replacements. These new and revised procedure codes, which will be effective on October 1, 2005, can be found in Table 6B and Table 6F of this proposed rule. The commenters stated that claims data using these new and specific codes should provide improved data on these procedures for future DRG modifications. However, the commenters requested that CMS consider DRG modifications based on current data using the existing revision codes. The commenters reported on a recently completed study comparing detailed hospital resource utilization and clinical characteristics in over 10,000 primary and revision hip and knee replacement procedures at 3 high volume institutions: The Massachusetts General Hospital, the Mayo Clinic, and the University of California at San Francisco. The purpose of this study was to evaluate differences in clinical outcomes and resource utilization among patients who underwent different types of primary and revision hip or knee replacement procedures. The study found significant differences in operative time, complication rates, hospital length of stay, discharge disposition, and resource utilization among patients who underwent different types of revision hip or knee replacement procedures. Among revision hip replacement procedures, patients who underwent both femoral and acetabular component revision had longer operative times, higher complication rates, longer lengths of stay, significantly higher resource utilization, and were more likely to be discharged to a subacute care facility. Isolated femoral E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23327 In addition, the commenters indicated that the data showed that extensive bone loss around the implants and the presence of a peri-prosthetic fracture were the most significant predictors of higher resource utilization among all revision hip and knee replacement procedures, even when controlling for other significant patient and procedural characteristics. For this proposed rule, we examined data in the FY 2004 MedPAR file on the current hip replacement procedures (codes 81.51, 81.52, 81.53) as well as the replacements and revisions of knee replacement procedures (codes 81.54 and 81.55) in DRG 209. We found that revisions were significantly more resource intensive than the original hip and knee replacements. We found average charges for revisions of hip and knee replacements were approximately $7,000 higher than average charges for the original joint replacements, as shown in the following charts. The average charges for revisions of hip replacements were 21 percent higher than the average charges for initial hip replacements. The average charges for revisions of knee replacements were 25 percent higher than for initial knee replacements. We note that there were no cases in DRG 209 for reattachment of the foot, lower leg, or thigh (codes 84.29, 84.27, and 84.28). To address the higher resource costs associated with hip and knee revisions relative to the initial joint replacement procedure, we are proposing to delete DRG 209, create a proposed new DRG 544 (Major Joint Replacement or Reattachment of Lower Extremity), and create a proposed new DRG 545 (Revision of Hip or Knee Replacement). We are proposing to assign the following codes to the new proposed DRG 544: • 81.51, Total hip replacement. • 81.52, Partial hip replacement. • 81.54, Total knee replacement. • 81.56, Total ankle replacement. • 84.26, Foot reattachment. • 84.27, Lower leg/ankle reattach. • 84.28, Thigh reattachment. We are proposing to assign the following codes to the proposed new DRG 545: • 00.70, Revision of hip replacement, both acetabular and femoral components. • 00.71, Revision of hip replacement, acetabular component. • 00.72, Revision of hip replacement, femoral component. • 00.73, Revision of hip replacement, acetabular liner and/or femoral head only. • 00.80, Revision of knee replacement, total (all components). • 00.81, Revision of knee replacement, tibial component. • 00.82, Revision of knee replacement, femoral component. • 00.83, Revision of knee replacement, patellar component. • 00.84, Revision of knee replacement, tibial insert (liner). • 81.53, Revision of hip replacement, not otherwise specified. • 81.55, Revision of knee replacement, not otherwise specified. We agree with the commenters and the AAOS that the creation of a new DRG for revisions of hip and knee replacements should resolve payment issues for hospitals that perform the more difficult revisions of joint replacements. In addition, as stated earlier, we have worked with the orthopedic community to develop new procedure codes that better capture data on the types of revisions of hip and knee replacements. These new codes will be implemented on October 1, 2005. Once we receive claims data using these new codes, we will review data to determine if additional DRG modifications are needed. This effort may include assigning some of the revision codes, such as 00.83 and 00.84 to a separate DRG. As stated earlier, the AAOS has found that some of the procedures may not be as resource intensive. Therefore, the AAOS has requested that CMS closely examine data from the use of the new codes and consider future revisions. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00023 Fmt 4701 Sfmt 4702 b. Kyphoplasty In the FY 2005 IPPS final rule (69 FR 48938), we discussed the creation of new codes for vertebroplasty (81.65) and kyphoplasty (81.66), which went into effect on October 1, 2004. Prior to October 1, 2004, both of these surgical procedures were assigned to code 78.49 (Other repair or plastic operation on bone). For FY 2005, we assigned these codes to DRGs 233 and 234 (Other Musculoskeletal System and Connective Tissue O.R. Procedure With and Without CC, respectively) in MDC 8 (Table 6B of the FY 2005 final rule). (In the FY 2005 IPPS final rule (69 FR 48938), we indicated that new codes 81.65 and 81.66 were assigned to DRGs 223 and 234. We made a typographical error when indicating that these codes were assigned to DRG 223. Codes 81.65 and 81.66 have been assigned to DRGs E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.011</GPH> component revision was the next most resource-intensive procedure, followed by isolated acetabular revision. Primary hip replacement was the least resource intensive of all the procedures studied. Similarly, among revision knee replacement procedures, patients who underwent complete revision of all components had longer operative times, higher complication rates, longer lengths of stay, and significantly higher resource utilization. Revision of one component was the next most resourceintensive procedure. Primary total knee replacement was the least resource intensive of all the procedures studied. 23328 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules vertebroplasty. The commenters further stated that, while kyphoplasty involves internal fixation of the spinal fracture and restoration of vertebral heights, vertebroplasty involves only fixation. The commenters indicated that hospital costs for kyphoplasty procedures are more similar to resources used in a spinal fusion. We stated in the FY 2005 IPPS final rule that we did not have data in the MedPAR file on kyphoplasty and vertebroplasty. Prior to October 1, 2004, both procedures were assigned in code 78.49, which was assigned to DRGs 233 and 234 in MDC 8. We stated that we would continue to review this area as part of our annual review of MedPAR data. While we do not have separate data for kyphoplasty because code 81.66 was not established until October 1, 2004, for this proposed rule, we did examine data on code 78.49, which includes both kyphoplasty and vertebroplasty procedures reported in DRGs 233 and 234. The following chart illustrates our findings: We do not believe these data findings support moving cases represented by code 78.49 out of DRGs 233 and 234. While we cannot distinguish cases that are kyphoplasty from cases that are vertebroplasty, cases represented by code 78.49 have lower charges than do other cases within DRGs 233 and 234. Therefore, we are not proposing to change the DRG assignment of code 81.66 to DRGs 233 and 234 at this time. However, once specific charge data are available, we will consider whether further changes are warranted. separate DRGs based on the number of vertebrae fused. We also stated that spinal fusion surgery was an area undergoing rapid changes. Effective October 1, 2004, we created a series of codes that describe a new type of spinal surgery, spinal disc replacement. Our medical advisors describe these procedures as a more conservative approach for back pain than the spinal fusion surgical procedure. These codes are as follows: • 84.60, Insertion of spinal disc prosthesis, not otherwise specified. • 84.61, Insertion of partial spinal disc prosthesis, cervical. • 84.62, Insertion of total spinal disc prosthesis, cervical. • 84.63, Insertion of spinal disc prosthesis, thoracic. • 84.64, Insertion of partial spinal disc prosthesis, lumbosacral. • 84.65, Insertion of total spinal disc prosthesis, lumbosacral. • 84.66, Revision or replacement of artificial spinal disc prosthesis, cervical. • 84.67, Revision or replacement of artificial spinal disc prosthesis, thoracic. • 84.68, Revision or replacement of artificial spinal disc prosthesis, lumbosacral. • 84.69, Revision or replacement of artificial spinal disc prosthesis, not otherwise specified. We also created the following two codes effective October 1, 2004, for these new types of spinal surgery that are also a more conservative approach to back pain than is spinal fusion: • 81.65 Vertebroplasty. • 81.66 Kyphoplasty. We do not yet have data in the MedPAR file on these new types of procedures. Therefore, we cannot yet determine what effect these new types of procedures will have on the frequency of spinal fusion procedures. However, we do have data in the MedPAR file on multiple level spinal procedures for analysis for this year’s proposed rule. We examined data in the FY 2004 MedPAR file on spinal fusion cases in the following DRGs: • DRG 496 (Combined Anterior/ Posterior Spinal Fusion). • DRG 497 (Spinal Fusion Except Cervical With CC). • DRG 498 (Spinal Fusion Except Cervical Without CC). • DRG 519 (Cervical Spinal Fusion With CC). • DRG 520 (Cervical Spinal Fusion Without CC). Multiple level spinal fusion is captured by code 81.63 (Fusion or refusion of 4–8 vertebrae) and code 81.64 (Fusion or refusion of 9 or more vertebrae). Code 81.62 includes the fusion of 2–3 vertebrae and is not considered a multiple level spinal fusion. Orthopedic surgeons stated at the October 7–8, 2004 ICD–9–CM Coordination and Maintenance Committee meeting that the most simple and common type of spinal fusion involves fusing either 2 or 3 vertebrae. These surgeons stated that there was not c. Multiple Level Spinal Fusion On October 1, 2003, the following ICD–9–CM codes were created to identify the number of levels of vertebra fused during a spinal fusion procedure: • 81.62, Fusion or refusion of 2–3 vertebrae. • 81.63, Fusion or refusion of 4–8 vertebrae. • 81.64, Fusion or refusion of 9 or more vertebrae. Prior to the creation of these codes, we received a comment recommending the establishment of new DRGs that would be differentiated based on the number of vertebrae fused. In the FY 2005 IPPS final rule (69 FR 48936), we stated that we did not yet have any reported cases utilizing these multiple level spinal fusion codes. We stated that we would wait until sufficient data were available prior to making a final determination on whether to create VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00024 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.012</GPH> 233 and 234.) Last year, we received comments opposing the assignment of code 81.66 to DRGs 233 and 234. The commenters supported the creation of the codes for kyphoplasty and vertebroplasty but recommended that code 81.66 be assigned to DRGs 497 and 498 (Spinal Fusion Except Cervical With and Without CC, respectively). The commenters stated that kyphoplasty requires special inflatable bone tamps and bone cement and is a significantly more resource intensive procedure than Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23329 a significant difference in resource utilization for cases involving the fusion of 2 versus 3 vertebrae. For this reason, the orthopedic surgeons recommended that fusion of 2 and 3 vertebrae be grouped into one ICD–9–CM code. We reviewed the Medicare charge data to determine whether the number of vertebrae fused or specific diagnoses have an effect on average length of stay and resource use for a patient. We found that, while fusing 4 or more levels of the spine results in a small increase in the average length of stay and a somewhat larger increase in average charges for spinal fusion patients, an even greater impact was made by the presence of a principal diagnosis of curvature of the spine or malignancy. The following list of diagnoses describes conditions that have a significant impact on resource use for spinal fusion patients: • 170.2, Malignant neoplasm of vertebral column, excluding sacrum and coccyx. • 198.5, Secondary malignant neoplasm of bone and bone marrow. • 732.0, Juvenile osteochondrosis of spine. • 733.13, Pathologic fracture of vertebrae. • 737.0, Adolescent postural kyphosis. • 737.10, Kyphosis (acquired) (postural). • 737.11, Kyphosis due to radiation. • 737.12, Kyphosis, postlaminectomy. • 737.19, Kyphosis (acquired), other. • 737.20, Lordosis (acquired) (postural). • 737.21, Lordosis, postlaminectomy • 737.22, Other postsurgical lordosis. • 737.29, Lordosis (acquired), other. • 737.30, Scoliosis [and kyphoscoliosis], idiopathic. • 737.31, Resolving infantile idiopathic scoliosis. • 737.32, Progressive infantile idiopathic scoliosis. • 737.33, Scoliosis due to radiation. • 737.34, Thoracogenic scoliosis. • 737.39, Other kyphoscoliosis and scoliosis. • 737.40, Curvature of spine, unspecified. • 737.41, Curvature of spine associated with other conditions, kyphosis. • 737.42, Curvature of spine associated with other conditions, lordosis. • 737.43, Curvature of spine associated with other conditions, scoliosis. • 737.8, Other curvatures of spine. • 737.9, Unspecified curvature of spine. • 754.2, Congenital scoliosis. • 756.51, Osteogenesis imperfecta. The majority of fusion patients with these diagnoses were in DRGs 497 and 498. The chart below reflects our findings. We also include in the chart statistics for cases in DRGs 497 and 498 with spinal fusion of 4 or more vertebrae and cases with a principal diagnosis of curvature of the spine or bone malignancy. Thus, these diagnoses result in a significant increase in resource use. While the fusing of 4 or more vertebrae resulted in average charges of $77,352, the impact of a principal diagnosis of curvature of the spine or bone malignancy was substantially greater with average charges of $95,315. Based on this analysis, we are proposing to create a new DRG for noncervical spinal fusions with a principal diagnosis of curvature of the spine and malignancies. The proposed new DRG would be: proposed new DRG 546 (Spinal Fusions Except Cervical With Principal Diagnosis of Curvature of the Spine or Malignancy). Cases included in this proposed new DRG would include all noncervical spinal fusions previously assigned to DRGs 497 and 498 that have a principal diagnosis of curvature of the spine or malignancy and would include the following codes listed above: 170.2, 198.5, 732.0, 733.13, 737.0, 737.10, 737.11, 737.12, 737.19, 737.20, 737.21, 737.22, 737.29, 737.30, 737.31, 737.32, 737.33, 737.34, 737.39, 737.40, 737.41, 737.42, 737.43, 737.8, 737.9, 754.2, and 756.51. The proposed DRG 546 would not include cases currently assigned to DRGs 496, 519, or 520 that have a principal diagnosis of curvature of the spine or malignancy. The structure of DRGs 496, 519, and 520 would remain the same. As part of our meeting with the AAOS on DRG 209 in February 2005 (discussed under section II.B.6.a. of this preamble), the AAOS offered to work with CMS to analyze clinical issues and make revisions to the spinal fusion DRGs (DRGs 496 through 498 and 519 and 520). At this time, we are limiting our proposed changes to the spinal fusion DRGs for FY 2006 to the creation of the proposed DRG 546 discussed above. However, we look forward to working with the AAOS to obtain its clinical recommendations concerning our proposed changes and potential additional modifications to the spinal fusion DRGs. We are also soliciting comments from the public on our proposed changes and how to incorporate new types of spinal procedures such as kyphoplasty and spinal disc prostheses into the spinal fusion DRGs. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00025 Fmt 4701 Sfmt 4702 As we did for FY 2005, we received a request to consider the creation of a separate DRG for the diagnosis of severe sepsis for FY 2006. Severe sepsis is described by ICD–9–CM code 995.92 (Systemic inflammatory response syndrome due to infection with organ dysfunction). Patients admitted with sepsis currently are assigned to DRG 416 (Septicemia Age > 17) and DRG 417 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.013</GPH> VerDate Aug<04>2004 7. MDC 18 (Infectious and Parasitic Diseases (Systemic or Unspecified Sites)): Severe Sepsis 23330 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules (Septicemia Age 0–17) in MDC 18 (Infectious and Parasitic Diseases, Systemic or Unspecified Sites). The commenter requested that all cases in which severe sepsis is present on admission, as well as those cases in which it develops after admission (which are currently classified elsewhere), be included in this new DRG. We addressed this issue in the FY 2005 IPPS final rule (69 FR 48975). As indicated last year, we do not feel the current clinical definition of severe sepsis is specific enough to identify a meaningful cohort of patients in terms of clinical coherence and resource utilization to warrant a separate DRG. Sepsis is found across hundreds of medical and surgical DRGs, and the term ‘‘organ dysfunction’’ implicates numerous currently existing diagnosis codes. While we recognize that Medicare beneficiaries with severe sepsis are quite ill and require extensive hospital resources, we do not believe that they can be identified adequately to justify removing them from all of the other DRGs in which they appear. We are not proposing a new DRG for severe sepsis at this time. 8. MDC 20 (Alcohol/Drug Use and Alcohol/Drug Induced Organic Mental Disorders): Drug-Induced Dementia In the FY 2005 IPPS final rule (69 FR 48939, August 11, 2004), we discussed a request that CMS modify DRGs 521 through 523 by removing the principal diagnosis code 292.82 (Drug-induced dementia) from these alcohol and drug abuse DRGs. These DRGs are as follows: • DRG 521 (Alcohol/Drug Abuse or Dependence With CC). • DRG 522 (Alcohol/Drug Abuse or Dependence With Rehabilitation Therapy Without CC). • DRG 523 (Alcohol/Drug Abuse or Dependence Without Rehabilitation Therapy Without CC). The commenter indicated that a patient who has a drug-induced dementia should not be classified to an alcohol/drug DRG. However, the commenter did not propose a new DRG assignment for code 292.82. Our medical advisors evaluated the request and determined that the most appropriate DRG classification for a patient with drug-induced dementia was within MDC 20. The medical advisors indicated that because the dementia is drug induced, it is appropriately classified to DRGs 521 through 523 in MDC 20. Therefore, we did not propose a new DRG classification for the principal diagnosis code 292.82. In the FY 2005 IPPS final rule, we addressed a comment from an VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 organization representing hospital coders that disagreed with our decision to keep code 292.82 in DRGs 521 through 523. The commenter stated that DRGs 521 through 523 are described as alcohol/drug abuse and dependence DRGs, and that drug-induced dementia can be caused by an adverse effect of a prescribed medication or a poisoning. The commenter did not believe that assignment to DRGs 521 through 523 was appropriate if the drug-induced dementia is due to one of these events and the patient is not alcohol or drug dependent. The commenter recommended that admissions for druginduced dementia be classified to DRGs 521 through 523 only if there is a secondary diagnosis indicating alcohol/ drug abuse or dependence. The commenter recommended that drug-induced dementia that is due to the adverse effect of a drug or poisoning be classified to the same DRGs as other types of dementia, such as DRG 429 (Organic Disturbances and Mental Retardation). The commenter believed that when drug-induced dementia is caused by a poisoning, either accidental or intentional, the appropriate poisoning code would be sequenced as the principal diagnosis and, therefore, these cases would likely already be assigned to DRGs 449 and 450 (Poisoning and Toxic Effects of Drugs, Age Greater than 17, With and Without CC, respectively) and DRG 451 (Poisoning and Toxic Effects of Drugs, Age 0–17). The commenter stated that these would be the appropriate DRG assignments for drug-induced dementia due to a poisoning. We received a similar comment from a hospital organization. In the FY 2005 IPPS final rule, we acknowledged that the commenters raised additional issues surrounding the DRG assignment for code 292.82 that should be considered. The commenters provided alternatives for DRG assignment based on sequencing of the principal diagnosis and reporting of additional secondary diagnoses. We recognized that patients may develop drug-induced dementia from drugs that are prescribed, as well as from drugs that are not prescribed. However, because dementia develops as a result of use of a drug, we believed the current DRG assignment to DRGs 521 through 523 remained appropriate. Some commenters have agreed with the current DRG assignment of code 292.82 since the dementia was caused by use of a drug. We agree that if either accidental or intentional poisoning caused the drug-induced dementia, the appropriate poisoning code should be sequenced as the principal diagnosis. As PO 00000 Frm 00026 Fmt 4701 Sfmt 4702 one commenter stated, these cases would be assigned to DRGs 449 through 451. We encouraged hospitals to examine the coding for these types of cases to determine if there were any coding or sequencing errors. As suggested by the commenter, if code 292.82 were reported as a secondary diagnosis and not a principal diagnosis in cases of poisoning or adverse drug reactions, the number of cases on DRGs 521 through 523 would decline. In the FY 2005 IPPS final rule, we agreed to analyze this area for FY 2006 and to look at the alternative DRG assignments suggested by the commenters. For this proposed rule, we examined data from the FY 2004 MedPAR file on cases in DRGs 521 through 523 with a principal diagnosis of code 292.82. We found that there were only 134 cases reported with the principal diagnosis code 292.82 in DRGs 521 through 523 without a diagnosis of drug and alcohol abuse. The average standardized charges for cases with a principal diagnosis of code 292.82 that did not have a secondary diagnosis of drug/alcohol abuse or dependence were $12,244.35, compared to the average standardized charges for all cases in DRG 521, which were $10,543.69. There were no cases in DRG 522 with a principal diagnosis of code 292.82. We found only 24 cases in DRG 523 with a principal diagnosis of code 292.82. Given the small number of cases in DRG 522 and 523, and the similarity in average standardized charges between those cases in DRG 521 with a principal diagnosis of code 292.82 and without a secondary diagnosis of drug/alcohol abuse or dependence to the overall average for all cases in the DRG, we do not believe the data suggest that a modification to DRGs 521 through 523 is warranted. Therefore, we are not proposing changes to the current structure of DRGs 521 through 523 for FY 2006. 9. 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. E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules a. Newborn Age Edit In the past, we have discussed and received comments concerning revision of the pediatric portions of the Medicare IPPS DRG classification system, that is, MDC 15 (Newborns and Other Neonates With Conditions Originating in the Perinatal Period). Most recently, we addressed these comments in both the FY 2005 proposed rule (69 FR 28210) and the FY 2005 IPPS final rule (69 FR 48938). In those rules, we indicated that we would be responsive to specific requests for updating MDC 15 on a limited, case-by-case basis. We have recently received a request through the Open Door Forum to revise the MCE ‘‘newborn age edit’’ by removing over 100 codes located in Chapter 15 of ICD–9–CM that are identified as ‘‘newborn’’ codes. This request was made because these codes usually cause an edit or denial to be triggered when they are used on children greater than 1 year of age. However, the underlying issue with these particular edits is that other payers have adopted the CMS Medicare Code Editor in a wholesale manner, instead of adapting it for use in their own patient populations. We acknowledge that Medicare DRGs are sometimes used to classify other patient groups. However, CMS’ primary focus of updates to the Medicare DRG classification system is on changes relating to the Medicare patient population, not the pediatric or neonatal patient populations. There are practical considerations regarding the assumption of a larger role for the Medicare DRG in the pediatric or neonatal areas, given the difference between the Medicare population and that of newborns and children. There are also challenges surrounding the development of DRG classification systems and applications appropriate to children. We do not have the clinical expertise to make decisions about these patients, and must rely on outside clinicians for advice. In addition, because newborns and other children are generally not eligible for Medicare, we must rely on outside data to make decisions. We recognize that there are evolving alternative classification systems for children and encourage payers to use the CMS MCE as a template while making modifications appropriate for pediatric patients. Therefore, we would encourage those non-Medicare systems needing a more comprehensive pediatric system of edits to update their systems by choosing from other existing systems or programs that are currently in use. Because of our reluctance to assume expertise in the VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 pediatric arena, we are not proposing to make the commenter’s suggested changes to the MCE ‘‘newborn age edit’’ for FY 2006. b. Newborn Diagnoses Edit Last year, in our changes to the MCE, we inadvertently added code 796.6 (Abnormal findings on neonatal screening) to both the MCE edit for ‘‘Maternity Diagnoses—age 12 through 55’’, and the MCE edit for ‘‘Diagnoses Allowed for Females Only’’. We are proposing to remove code 796.6 from these two edits and add it to the ‘‘Newborn Diagnoses’’ edit. c. Diagnoses Allowed for ‘‘Males Only’’ Edit We have received a request to remove two codes from the ‘‘Diagnoses Allowed for Males Only’’ edit, related to androgen insensitivity syndrome (AIS). AIS is a new term for testicular feminization. Code 257.8 (Other testicular dysfunction) is used to describe individuals who, despite having XY chromosomes, develop as females with normal female genitalia and mammary glands. Testicles are present in the same general area as the ovaries, but are undescended and are at risk for development of testicular cancer, so are generally surgically removed. These individuals have been raised as females, and would continue to be considered female, despite their XY chromosome makeup. Therefore, as AIS is coded to 257.8, and has posed a problem associated with the gender edit, we are proposing to remove this code from the ‘‘Males Only’’ edit in the MCE. A similar clinical scenario can occur with certain disorders that cause a defective biosynthesis of testicular androgen. This disorder is included in code 257.2 (Other testicular hypofunction). Therefore, we also are proposing to remove code 257.2 from the ‘‘Male Only’’ gender edit in the MCE. d. Tobacco Use Disorder Edit We have become aware of the possible need to add code 305.1 (Tobacco use disorder) to the MCE in order to make admissions for tobacco use disorder a noncovered Medicare service when code 305.1 is reported as the principal diagnosis. On March 22, 2005, CMS published a final decision memorandum and related national coverage determination (NCD) on smoking cessation counseling services on its Web site: (https://www.cms.hhs.gov/ coverage/). Among other things, this NCD provides that: ‘‘Inpatient hospital stays with the principal diagnosis of 305.1, Tobacco Use Disorder, are not reasonable and necessary for the PO 00000 Frm 00027 Fmt 4701 Sfmt 4702 23331 effective delivery of tobacco cessation counseling services. Therefore, we will not cover tobacco cessation services if tobacco cessation is the primary reason for the patient’s hospital stay.’’ Therefore, in order to maintain internal consistency with CMS programs and decisions, we are proposing to add code 305.1 to the MCE edit ‘‘Questionable Admission-Principal Diagnosis Only’’ in order to make tobacco use disorder a noncovered admission. e. Noncovered Procedure Edit Effective October 1, 2004, CMS adopted the use of code 00.61 (Percutaneous angioplasty or atherectomey of precerebral (extracranial) vessel(s) (PTA)) and code 00.63 (Percutaneous insertion of carotid artery stent(s). Both codes are to be recorded to indicate the insertion of a carotid artery stent or stents. At the time of the creation of the codes, the coverage indication for carotid artery stenting was only for patients in a clinical trial setting, and diagnostic code V70.7 (Examination of participation in a clinical trial) was required for payment of these cases. However, effective October 12, 2004, Medicare covers PTA of the carotid artery concurrent with the placement of an FDA-approved carotid stent for an FDA-approved indication when furnished in accordance with FDA-approved protocols governing post-approval studies. Therefore, as the coverage indication has changed, we are proposing to remove codes 00.61, 00.63, and V70.7 from the MCE noncovered procedure edit. 10. Surgical Hierarchies (If you choose to comment on issues in this section, please include the caption ‘‘Surgical Hierarchy’’ 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 E:\FR\FM\04MYP2.SGM 04MYP2 23332 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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 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 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 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. Based on the preliminary recalibration of the DRGs, we are proposing to revise the surgical hierarchy for MDC 5 (Diseases and Disorders of the Circulatory System) and MDC 8 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue) as follows: In MDC 5, we are proposing to reorder— • DRG 116 (Other Permanent Cardiac Pacemaker Implant) above DRG 549 (Percutaneous Cardiovascular Procedure With Drug-Eluting Stent With AMI With CC). • DRG 549 above DRG 550 (Percutaneous Cardiovascular Procedure With Drug-Eluting Stent With AMI Without CC). • DRG 550 above DRG 547 (Percutaneous Cardiovascular Procedure With AMI With CC). • DRG 547 above DRG 548 (Percutaneous Cardiovascular Procedure With AMI Without CC). • DRG 548 above DRG 527 (Percutaneous Cardiovascular Procedure With Drug-Eluting Stent Without AMI). • DRG 527 above DRG 517 (Percutaneous Cardiovascular Procedure With Non-Drug Eluting Stent Without AMI). • DRG 517 above DRG 518 (Percutaneous Cardiovascular Procedure Without Coronary Artery Stent or AMI). • DRG 518 above DRGs 478 and 479 (Other Vascular Procedures With and Without CC, respectively). In MDC 8, we are proposing to reorder— • DRG 496 (Combined Anterior/ Posterior Spinal Fusion) above DRG 546 (Spinal Fusion Except Cervical With Principal Diagnosis of Curvature of the Spine or Malignancy). • DRG 546 above DRGs 497 and 498 (Spinal Fusion Except Cervical With and Without CC, respectively). • DRG 217 (Wound Debridement and Skin Graft Except Hand, For PO 00000 Frm 00028 Fmt 4701 Sfmt 4702 Musculoskeletal and Connective Tissue Disease) above DRG 545 (Revision of Hip or Knee Replacement). • DRG 545 above DRG 544 (Major Joint Replacement or Reattachment). • DRG 544 above DRGs 519 and 520 (Cervical Spinal Fusion With and Without CC, respectively). 11. Refinement of Complications and Comorbidities (CC) List (If you choose to comment on issues in this section, please include the caption ‘‘CC 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. b. Comprehensive Review of the CC List In previous years, we have made changes to the standard list of CCs, either by adding new CCs or deleting CCs already on the list, but we have never conducted a comprehensive review of the list. There are currently 3,285 diagnosis codes on the CC list. There are 121-paired DRGs that are split on the presence or absence of a CC. We have reviewed these paired DRGs and found that the majority of cases that are assigned to DRGs that have a CC split fall into the DRG with CC. While this fact is not new, we have found that a much higher proportion of cases are being grouped to the DRG with a CC than had occurred in the past. In our review of the DRGs included in Table 7b of the September 1, 1987 Federal Register rule (52 FR 33125), we found the following percentages of cases assigned a CC in those DRGs that had a CC split (DRG Definitions Manual, GROUPER Version 5.0 (1986 data)): • Cases with CC: 61.9 percent. • Cases without CC: 38.1 percent. When we compared the above DRG 1986 data to the DRG 2004 data that were included in the DRGs Definitions Manual, GROUPER Version 22.0, we found the following: • Cases with CC: 79.9 percent. E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23333 as currently defined, and we believe that it is possible that the CC distinction has lost much of its ability to differentiate the resource needs of patients. The original definition used to develop the CC list (the presence of a CC would be expected to extend the length of stay of at least 75 percent of the patients who had the CC by at least one day) was used beginning in 1981 and has been part of the IPPS since its inception in 1983. There has been no substantive review of the CC list since its original development. In reviewing this issue, our clinical experts found several diseases that appear to be obvious candidates to be on the CC list, but currently are not: Conversely, our medical experts believe the following conditions are examples of common conditions that are on the CC list, but are not likely to lead to higher treatment costs when present as a secondary diagnosis: We note that the above conditions are examples only of why we believe the CC list needs a comprehensive review. In addition to this review, we note that these conditions may be treated differently under several DRG systems currently in use. For instance, ICD–9– CM code 414.12 (Dissection of coronary artery) is listed as a ‘‘Major CC’’ under the All Patient (AP) DRGs, GROUPER Version 21.0 and an ‘‘Extreme’’ CC under the All Patient Refined (APR) DRGs, GROUPER Version 20.0, but is not listed as a CC at all in GROUPER Version 22.0 of the DRGs Definitions Manual used by Medicare. Similarly, ICD–9–CM code 424.0 (Mitral valve disorder) is a CC under GROUPER Version 22.0 of the DRGs Definitions Manual for Medicare’s DRG system, a minor CC under the GROUPER Version 20.0 of the APR–DRGs, and not a CC at all under GROUPER Version 21.0 of the AP–DRGs. Given the long period of time that has elapsed since the original CC list was developed, the incremental nature of changes to it, and changes in the way inpatient care is delivered, we are planning a comprehensive and systematic review of the CC list for the IPPS rule for FY 2007. As part of this process, we plan to consider revising the standard for determining when a condition is a CC. For instance, we may use an alternative to classifying a condition as a CC based on how it affects the length of stay of a case. Similar to other aspects of the DRG system, we may consider the effect of a specific secondary diagnosis on the charges or costs of a case to evaluate whether to include the condition on the CC list. Using a statistical algorithm, we may classify each diagnosis based on its effect on hospital charges (or costs) relative to other cases when present as a secondary diagnosis to obtain better information on when a particular condition is likely to increase hospital costs. For example, Code 293.84 (Anxiety disorder in conditions classified elsewhere), which is currently listed as a CC, might be removed from the CC list if analysis of the data do not support the fact that it represents a significant increase in resource utilization, and a code such as 359.4 (Toxic myopathy), which is currently not listed as a CC, could be added to the CC list if the data support it. In addition to using hospital charge data as a basis for a review, we would expect to supplement the process with review by our medical experts. Further, we may also consider doing a comparison of the Medicare DRG CC list with other DRG systems such as the AP–DRGs and the APR–DRGs to determine how the same secondary diagnoses are treated under these systems. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00029 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.014</GPH> EP04my05.015</GPH> • Cases without CC: 20.1 percent. (We used DRGs Definitions Manual, GROUPER Version 5.0, for this analysis because prior versions of the DRGs Definitions Manual used age as a surrogate for a CC and the split was ‘‘CC and/or age greater than 69’’.) The vast majority of patients being treated in inpatient settings have a CC 23334 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules By performing a comprehensive review of the CC list, we expect to revise the DRG classification system to better reflect resource utilization and remove conditions from the CC list that only have a marginal impact on a hospital’s costs. We believe that a comprehensive review of the CC list would be consistent with MedPAC’s recommendation that we improve the DRG system to better recognize severity. We will provide more detail about how we expect to undertake this analysis in the future, and any changes to the CC list will only be adopted after a notice and comment rulemaking that fully explains the methodology we plan to use in conducting this review. We encourage comment at this time regarding possible ways that more meaningful indicators of clinical severity and their implications for resource use can be incorporated into our comprehensive review and possible restructuring of the CC list. c. CC Exclusions List for FY 2006 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 this 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. At this time, we are not proposing to delete any of the diagnosis codes on the CC list for FY 2006. 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: • Chronic and acute manifestations of the same condition should not be considered CCs for one another. • Specific and nonspecific (that is, not otherwise specified (NOS)) diagnosis codes for the same condition should not be considered CCs for one another. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 • 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. • Codes for the same condition in anatomically proximal sites should not be considered CCs for one another. • 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.1 We are proposing a limited revision of the CC Exclusions List to take into account the proposed changes that will be made in the ICD–9–CM diagnosis coding system effective October 1, 2004. (See section II.B.13. of this preamble for a discussion of ICD–9–CM changes.) We are proposing these changes in accordance with the principles established when we created the CC Exclusions List in 1987. Tables 6G and 6H in the Addendum to this proposed rule contain the revisions to the CC Exclusions List that would be effective for discharges occurring on or after October 1, 2005. Each table shows the principal diagnoses with changes to the excluded CCs. Each of these principal diagnoses is shown with an asterisk, and the additions or deletions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis. 1 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; and the FY 2005 final rule (69 FR 49848) [August 11, 2004] for the FY 2005 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. PO 00000 Frm 00030 Fmt 4701 Sfmt 4702 CCs that are added to the list are in Table 6G—Additions to the CC Exclusions List. Beginning with discharges on or after October 1, 2005, the indented diagnoses would not be recognized by the GROUPER as valid CCs for the asterisked principal diagnosis. CCs that are deleted from the list are in Table 6H—Deletions from the CC Exclusions List. Beginning with discharges on or after October 1, 2005, the indented diagnoses would be recognized by the GROUPER as valid CCs for the asterisked principal diagnosis. Copies of the original CC Exclusions List applicable to FY 1988 can be obtained from the National Technical Information Service (NTIS) of the Department of Commerce. It is available in hard copy for $152.50 plus shipping and handling. A request for the FY 1988 CC Exclusions List (which should include the identification accession number (PB) 88–133970) should be made to the following address: National Technical Information Service, United States Department of Commerce, 5285 Port Royal Road, Springfield, VA 22161; or by calling (800) 553–6847. Users should be aware of the fact that all revisions to the CC Exclusions List (FYs 1989, 1990, 1991, 1992, 1993, 1994, 1995, 1996, 1997, 1998, 1999, 2001, 2002, 2003, 2004, and 2005) and those in Tables 6G and 6H of this proposed rule for FY 2006 must be incorporated into the list purchased from NTIS in order to obtain the CC Exclusions List applicable for discharges occurring on or after October 1, 2005. (Note: There was no CC Exclusions List in FY 2000 because we did not make changes to the ICD–9–CM codes for FY 2000.) 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 22.0, is available for $225.00, which includes $15.00 for shipping and handling. Version 23.0 of this manual, which will include the final FY 2006 DRG changes, will be available for $225.00. 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. E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 12. Review of Procedure Codes in DRGs 468, 476, and 477 (If you choose to comment on issues in this section, please include the caption ‘‘DRGs 468, 476, and 477’’ at the beginning of your comment.) Each year, we review cases assigned to DRG 468 (Extensive O.R. Procedure Unrelated to Principal Diagnosis), DRG 476 (Prostatic O.R. Procedure Unrelated to Principal Diagnosis), and DRG 477 (Nonextensive O.R. Procedure Unrelated to Principal Diagnosis) to determine whether it would be appropriate to change the procedures assigned among these DRGs. DRGs 468, 476, and 477 are reserved for those cases in which none of the O.R. procedures performed are related to the principal diagnosis. These DRGs are intended to capture atypical cases, that is, those cases not occurring with sufficient frequency to represent a distinct, recognizable clinical group. DRG 476 is assigned to those discharges in which one or more of the following prostatic procedures are performed and are unrelated to the principal diagnosis: • 60.0, Incision of prostate. • 60.12, Open biopsy of prostate. • 60.15, Biopsy of periprostatic tissue. • 60.18, Other diagnostic procedures on prostate and periprostatic tissue. • 60.21, Transurethral prostatectomy. • 60.29, Other transurethral prostatectomy. • 60.61, Local excision of lesion of prostate. • 60.69, Prostatectomy, not elsewhere classified. • 60.81, Incision of periprostatic tissue. • 60.82, Excision of periprostatic tissue. • 60.93, Repair of prostate. • 60.94, Control of (postoperative) hemorrhage of prostate. • 60.95, Transurethral balloon dilation of the prostatic urethra. • 60.96, Transurethral destruction of prostate tissue by microwave thermotherapy. • 60.97, Other transurethral destruction of prostate tissue by other thermotherapy. • 60.99, Other operations on prostate. All remaining O.R. procedures are assigned to DRGs 468 and 477, with DRG 477 assigned to those discharges in which the only procedures performed are nonextensive procedures that are unrelated to the principal diagnosis.2 2 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 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 a. Moving Procedure Codes From DRG 468 or DRG 477 to MDCs We annually conduct a review of procedures producing assignment to DRG 468 or DRG 477 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 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 year’s review, we did not identify any procedures in DRGs 468 or 477 that should be removed to one of the surgical DRGs. Therefore, in this proposed rule, we are not proposing any changes for FY 2006. b. Reassignment of Procedures Among DRGs 468, 476, and 477 We also annually review the list of ICD–9–CM procedures that, when in combination with their principal diagnosis code, result in assignment to DRGs 468, 476, and 477, to ascertain if 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 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 placed 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. PO 00000 Frm 00031 Fmt 4701 Sfmt 4702 23335 have an adequate number of discharges to analyze the data. It has come to our attention that procedure code 26.12 (Open biopsy of salivary gland or duct) is assigned to DRG 468 (Extensive O.R. Procedure Unrelated to Principal Diagnosis). We believe this to be an error, as code 26.31 (Partial sialoadenectomy), which is a more extensive procedure than code 26.12, is assigned to DRG 477. Therefore, we are proposing to correct this error by moving code 26.12 out of DRG 468 and reassigning it to DRG 477. We are not proposing to move any procedure codes from DRG 476 to DRGs 468 or 477, or from DRG 477 to DRGs 468 or 476. 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. 13. Changes to the ICD–9–CM Coding System 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) and CMS, charged with maintaining and updating the ICD–9–CM system. The 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 E:\FR\FM\04MYP2.SGM 04MYP2 23336 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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, medical record administrators, 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 2006 at a public meeting held on October 7–8, 2004, and finalized the coding changes after consideration of comments received at the meetings and in writing by January 12, 2005. Those coding changes are announced in Tables 6A through 6F of the Addendum to this proposed rule. The Committee held its 2005 meeting on March 31-April l, 2005. Proposed new codes for which there was a consensus of public support and for which complete tabular and indexing charges can be made by May 2005 will be included in the October 1, 2005 update to ICD–9–CM. These additional codes will be included in Tables 6A through 6F of the final rule. Copies of the minutes of the procedure codes discussions at the Committee’s October 7–8, 2004 meeting can be obtained from the CMS Web site: https://www.cms.hhs.gov/ paymentsystems/icd9/. The minutes of the diagnoses codes discussions at the October 7–8, 2004 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, VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 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.Brooks1@cms.hhs.gov. The ICD–9–CM code changes that have been approved will become effective October 1, 2005. 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 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, 2005. 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, 2005. 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 2006. 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 April meeting as part of the code revisions effective the following October. As stated previously, ICD–9–CM codes discussed at the March 31-April 1, 2005 Committee meeting that receive consensus and that can be finalized by PO 00000 Frm 00032 Fmt 4701 Sfmt 4702 May 2005 will be included in Tables 6A through 6F of 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 in 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 503(a) states that the addition of new 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 capture the new codes. Hospitals also have to obtain the new code books and encoder updates, and make other system changes in order to capture and report the new codes. The ICD–9–CM Coordination and Maintenance Committee holds its meetings in the Spring and Fall, usually in April and September, 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 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules complete addendum describing details of all changes to ICD–9–CM, both tabular and index, are publicized on CMS and NCHS Web pages 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, 2003 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 503(a) by developing a mechanism for approving, in time for the April update, diagnoses 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, 2005 implementation of an ICD–9–CM code at the October 7–8, 2004 Committee meeting. Therefore, there were no new ICD–9–CM codes implemented on April 1, 2005. We believe that this process captures the intent of section 503(a). 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 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 frequently and most acutely where the new codes will capture 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 page at: https://www.cms.hhs.gov/ paymentsystems/icd9. Summary tables showing new, revised, and deleted code titles are also posted on the following CMS Web page: https:// www.cms.hhs.gov/medlearn/ icd9code.asp. Information on ICD–9– CM diagnosis codes, along with the Official ICD–9–CM Coding Guidelines, can be found on the Wep page 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 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. Currently, code titles are also published in the IPPS proposed and final rules. The code titles are adopted as part of the ICD–9–CM Coordination and Maintenance Committee process. The code titles 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 Pub. L. 108–173. Any midyear coding updates will be available through the websites 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 websites 5 months prior to implementation (that is, early November of the previous year), as is the case for the October 1 updates. Codebook publishers are evaluating how they will PO 00000 Frm 00033 Fmt 4701 Sfmt 4702 23337 provide any code updates to their subscribers. Some publishers may decide to publish mid-year book updates. Others may decide to sell an addendum that lists the changes to the October 1 code book. Coding personnel should contact publishers to determine how they will update their books. CMS and its contractors will also consider developing provider education articles concerning this change to the effective date of certain ICD–9–CM codes. 14. Other Issues: Acute Intermittent Porphyria Acute intermittent porphyria is a rare metabolic disorder. The condition is described by code 277.1 (Disorders of porphyrin metabolism). Code 277.1 is assigned to DRG 299 (Inborn Errors of Metabolism) under MDC 10 (Endocrine, Nutritional, and Metabolic Diseases and Disorders). In the FY 2005 final rule (69 FR 48981), we discussed the DRG assignment of acute intermittent porphyria. This discussion was a result of correspondence that we received during the comment period for the FY 2005 proposed rule in which the commenter suggested that Medicare hospitalization payments do not accurately reflect the cost of treatment. At that time, we indicated that we would take this comment into consideration when we analyzed the MedPAR data for this proposed rule for FY 2006. Our review of the most recent MedPAR data shows a total of 1,370 cases overall in DRG 299, of which 471 had a principal diagnosis coded as 277.1. The average length of stay for all cases in DRG 299 was 5.17 days, while the average length of stay for porphyria cases with code 277.1 was 6.0 days. The average charges for all cases in DRG 299 were $15,891, while the average changes for porphyria cases with code 277.1 were $21,920. Based on our analysis of these data, we do not believe that there is a sufficient difference between the average charges and average length of stay for these cases to justify a change to the DRG assignment for treating this condition. C. Proposed Recalibration of DRG Weights (If you choose to comment on issues in this section, please include the caption ‘‘DRG Weights’’ at the beginning of your comment.) We are proposing to use the same basic methodology for the FY 2006 recalibration as we did for FY 2005 (FY 2005 IPPS final rule (69 FR 48981)). That is, we have recalibrated the DRG weights based on charge data for E:\FR\FM\04MYP2.SGM 04MYP2 23338 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules Medicare discharges using the most current charge information available (the FY 2004 MedPAR file). The MedPAR file is based on fully coded diagnostic and procedure data for all Medicare inpatient hospital bills. The FY 2004 MedPAR data used in this final rule include discharges occurring between October 1, 2003 and September 30, 2004, based on bills received by CMS through December 31, 2004, 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 2004 MedPAR file includes data for approximately 11,910,025 Medicare discharges. Discharges for Medicare beneficiaries enrolled in a Medicare+Choice managed care plan are excluded from this analysis. The data excludes CAHs, including hospitals that subsequently became CAHs after the period from which the data were taken. The proposed methodology used to calculate the DRG relative weights from the FY 2004 MedPAR file is as follows: • To the extent possible, all the claims were regrouped using the DRG classification revisions discussed in section II.B. of this preamble. • The transplant cases that were used to establish the relative weight for heart and heart-lung, liver, and lung transplants (DRGs 103, 480, and 495) were limited to those Medicareapproved transplant centers that have cases in the FY 2004 MedPAR file. (Medicare coverage for heart, heart-lung, liver, and lung transplants is limited to those facilities that have received approval from CMS as transplant centers.) • 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 charge for the DRG and before eliminating statistical outliers. • 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 cost-of-living adjustment. • The average standardized charge per DRG was calculated by summing the standardized charges for all cases in the DRG and dividing that amount by the number of cases classified in the DRG. A transfer case is counted as a fraction VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 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. • Statistical outliers were eliminated by removing all cases that are beyond 3.0 standard deviations from the mean of the log distribution of both the charges per case and the charges per day for each DRG. • The average charge for each DRG was then recomputed (excluding the statistical outliers) and divided by the national average standardized charge per case to determine the relative weight. The proposed new weights are normalized by an adjustment factor of 1.47263 so that the average case weight after recalibration is equal to the average case weight before recalibration. This proposed adjustment is intended to ensure that recalibration by itself neither increases nor decreases total payments under the IPPS. 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 proposed DRG weights for FY 2006. Using the FY 2004 MedPAR data set, there are 41 DRGs that contain fewer than 10 cases. We are proposing to compute the weights for these lowvolume DRGs by adjusting the FY 2005 weights of these DRGs by the percentage change in the average weight of the cases in the other DRGs. Section 1886(d)(4)(C)(iii) of the Act requires that, beginning with FY 1991, reclassification and recalibration changes be made in a manner that assures that the aggregate payments are neither greater than nor less than the aggregate payments that would have been made without the changes. Although normalization is intended to achieve this effect, 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 and as discussed in section II.A.4.a. of the Addendum to this proposed rule, we are making a budget neutrality adjustment to ensure that the requirement of section 1886(d)(4)(C)(iii) of the Act is met. PO 00000 Frm 00034 Fmt 4701 Sfmt 4702 D. Proposed LTC–DRG Reclassifications and Relative Weights for LTCHs for FY 2006 (If you choose to comment on issues in this section, please include the caption ‘‘LTC–DRGs’’ at the beginning of your comment.) 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 is based directly on the DRGs used under the IPPS for acute care hospitals, in that same final rule, we explained that the annual update of the long-term care diagnosisrelated 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. In that same final rule, we specified that we will continue to update the LTC–DRG classifications and relative weights to be effective for discharges occurring on or after October 1 through September 30 each year. Furthermore, we stated that we will publish the annual update of the LTC–DRGs in the proposed and final rules for the IPPS. In the past, the annual update to the IPPS 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 2005 IPPS final rule (69 FR 48954 through 48957) and in the February 3, 2005 LTCH PPS proposed rule (70 FR 5729 through 5733), 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. Specifically, ICD–9–CM diagnosis and procedure codes for new medical technology may be created and added to existing DRGs in the middle of the Federal fiscal year on April 1. This policy change will have no effect, however, on the LTC–DRG relative weights which will continue to be updated only once a year (October 1), nor will there be any impact on Medicare payments under the LTCH PPS. 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. E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules In the health care industry, historically annual changes to the ICD– 9–CM codes were effective for discharges occurring on or after October 1 each year. Thus, the manual and electronic versions of the GROUPER software, which are based on the ICD– 9–CM codes, were also revised annually and effective for discharges occurring on or after October 1 each year. 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 had been updated annually and effective for discharges occurring on or after October 1 through September 30 each year. As mentioned above, the ICD–9–CM coding update process has been revised, as discussed in greater detail in the FY 2005 IPPS final rule (69 FR 48954 through 48957). Specifically, section 503(a) of Pub. L. 108–173 includes a requirement for updating ICD–9–CM codes as often as twice a year instead of the current process of annual updates on October 1 of each year. This requirement is included as part of the amendments to the Act relating to recognition of new medical technology under 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 will improve the recognition of new technologies under the IPPS by accounting for those ICD–9–CM codes in the MedPAR claims data at an earlier date. Despite the fact that aspects of the GROUPER software may be updated to recognize any new technology ICD–9– CM codes, as discussed in the February 3, 2005 LTCH PPS proposed rule (70 FR 5730 through 5733), there will be no impact on either LTC–DRG assignments or payments under the LTCH PPS at that time. That is, changes to the LTC–DRGs (such as the creation or deletion of LTC– DRGs) and the relative weights will continue to be updated in the manner and timing (October 1) as they are now. As noted above and as described in the February 3, 2005 LTCH PPS proposed rule (70 FR 5730), updates to the GROUPER for both the IPPS and the LTCH PPS (with respect to relative weights and the creation or deletion of DRGs) are made in the annual IPPS proposed and final rules and are VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 effective each October 1. We explained in the FY 2005 IPPS final rule (69 FR 48955 and 48956), that since we do not publish a midyear IPPS rule, April 1 code updates discussed above will not be published in a midyear IPPS rule. Rather, we will assign any new diagnostic 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. Any proposed coding updates will be available through the websites indicated in the same rule and provided above in section II.B. of this preamble 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 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, since 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. As we discussed in the FY 2005 IPPS final rule (69 FR 48956), 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. It should be noted 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 has been an open process through the ICD–9–CM C&M Committee since 1995. Requestors will be given the opportunity to present the merits of their proposed new code and 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. In addition, in the FY 2005 IPPS final rule (69 FR 48956), we stated that at the October 2004 ICD–9–CM Coordination and Maintenance Committee meeting, no new codes were proposed for an April 1, 2005 implementation, and the next update to the ICD–9–CM coding system would not occur until October 1, 2005 (FY 2006). Presently, as there were no coding changes suggested for an April 1, 2005 update, the ICD–9–CM coding set implemented on October 1, 2004 will continue through September PO 00000 Frm 00035 Fmt 4701 Sfmt 4702 23339 30, 2005 (FY 2005). The proposed update to the ICD–9–CM coding system for FY 2006 is discussed above in section II.B. of this preamble. In this proposed rule, we are proposing revisions to the LTC–DRG classifications and relative weights and, to the extent that they are finalized, we will publish them in the corresponding IPPS final rule, to be effective October 1, 2005 through September 30, 2006 (FY 2006), using the latest available data. The proposed LTC–DRGs and relative weights for FY 2006 in this proposed rule are based on the proposed IPPS DRGs (GROUPER Version 23.0) discussed in section II. of this proposed rule. 2. Proposed Changes in the LTC–DRG Classifications a. Background Section 123 of Pub. L. 106–113 specifically requires that the PPS for LTCHs be 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 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. The LTC–DRGs used as the patient classification component of the LTCH PPS correspond to the DRGs under the IPPS for acute care hospitals. Thus, in this proposed rule, we are proposing to use the IPPS GROUPER Version 23.0 for FY 2006 to process LTCH PPS claims for LTCH occurring from October 1, 2005 through September 30, 2006. The proposed changes to the CMS DRG classification system used under the IPPS for FY 2006 (GROUPER Version 23.0) are discussed in section II.B. of the preamble to this proposed rule. Under the LTCH PPS, we determine relative weights for each of the CMS DRGs to account for the difference in resource use by patients exhibiting the E:\FR\FM\04MYP2.SGM 04MYP2 23340 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules case complexity and multiple medical problems characteristic of LTCH patients. In a departure from the IPPS, as we discussed in the August 30, 2002 LTCH PPS final rule (67 FR 55985), which implemented the LTCH PPS, and the FY 2004 IPPS final rule (68 FR 45374), we use low-volume quintiles in determining the LTC–DRG weights for LTC–DRGs with less than 25 LTCH cases, because LTCHs do not typically treat the full range of diagnoses as do acute care hospitals. Specifically, we group those low-volume LTC–DRGs (LTC–DRGs with fewer than 25 cases) into 5 quintiles based on average charge per discharge. (A listing of the composition of low-volume quintiles for the FY 2005 LTC–DRGs (based on FY 2003 MedPAR data) appears in section II.D.3. of the FY 2005 IPPS final rule (69 FR 48985 through 48989).) 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.D.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. Similar to case classification for acute care hospitals under the IPPS (see section II.B. of this preamble), cases are classified into 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 codes from the ICD– 9–CM. As discussed in section II.B. of this preamble, the CMS DRGs are organized into 25 major diagnostic categories (MDCs), most of which are based on a particular organ system of the body; the remainder involve 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. Some surgical and medical DRGs are further differentiated based on the presence or absence of CCs. (See section II.B. of this preamble for further discussion of surgical DRGs and medical DRGs.) Because the assignment of a case to a particular LTC–DRG will help determine the amount that is paid for the case, it is important that the coding is accurate. As used under the IPPS, VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 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. We point out again 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. Inappropriate coding of cases can adversely affect the uniformity of cases in each LTC–DRG and produce inappropriate weighting factors at recalibration and result in inappropriate payments under the LTCH PPS. LTCHs are to follow the same coding guidelines used by the acute care hospitals to ensure accuracy and consistency in coding practices. There will be only one LTC–DRG assigned per long-term care hospitalization; it will be assigned at the discharge. Therefore, it is mandatory that the coders continue to report the same principal diagnosis on all claims and include all diagnostic codes that coexist at the time of admission, that are subsequently developed, or that affect the treatment received. Similarly, all procedures performed during that stay are to be reported on each claim. 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 Medicare fiscal intermediary. Medicare fiscal intermediaries enter the clinical and demographic information into their claims processing systems and subject this information to a series of automated screening processes called the Medicare Code Editor (MCE). These screens are designed to identify cases that require further review before assignment into an 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 based on the same GROUPER used under the IPPS. After the LTC– DRG is assigned, the Medicare fiscal intermediary determines the prospective payment by using the Medicare LTCH PO 00000 Frm 00036 Fmt 4701 Sfmt 4702 PPS PRICER program, which accounts for LTCH hospital-specific adjustments. As provided for under the IPPS, we provide an opportunity for the LTCH to review the LTC–DRG assignments made by the fiscal intermediary and to submit additional information within a specified timeframe (§ 412.513(c)). The GROUPER is used both to classify past cases in order to measure relative hospital resource consumption to establish the 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. of this preamble). The LTC–DRG relative weights are based on data for the population of LTCH discharges, reflecting the fact that LTCH patients represent a different patient mix than patients in short-term acute care hospitals. 3. Development of the Proposed FY 2006 LTC–DRG Relative Weights a. General Overview of Development of the 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 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 adjust the LTCH PPS standard Federal prospective payment system rate by the applicable LTC–DRG relative weight in determining payment to LTCHs for each case. Under the LTCH PPS, relative weights for each 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 LTC–DRG have access to an appropriate level of services and to encourage efficiency, we calculate a relative weight for each LTC–DRG that represents the resources needed by an average inpatient LTCH case in that LTC–DRG. For example, cases in an LTC–DRG with a relative weight of 2 will, on average, cost twice as much as cases in an LTC– DRG with a weight of 1. E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules b. Data To calculate the proposed LTC–DRG relative weights for FY 2006 in this proposed rule, we obtained total Medicare allowable charges from FY 2004 Medicare hospital bill data from the December 2004 update of the MedPAR file, and we used the proposed Version 23.0 of the CMS GROUPER for IPPS (as discussed in section II.B. of this preamble) to classify cases. Consistent with the methodology under the IPPS, we are proposing to recalculate the FY 2006 LTC–DRG relative weights based on the best available data for this proposed rule. As we discussed in the FY 2005 IPPS final rule (69 FR 48984), we have excluded the data from LTCHs that are all-inclusive rate providers and LTCHs that are reimbursed in accordance with demonstration projects authorized under section 402(a) of Pub. L. 90–248 (42 U.S.C. 1395b–1) or section 222(a) of Pub. L. 92–603 (42 U.S.C. 1395b–1). Therefore, in the development of the proposed FY 2006 LTC–DRG relative weights, 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 2003 MedPAR file. In the FY 2005 IPPS final rule (6 FR 48984), we discussed coding inaccuracies that were found in the claims data for a large chain of LTCHs in the FY 2002 MedPAR file, which were used to determine the LTC–DRG relative weights for FY 2004. As we discussed in the same final rule, after notifying the large chain of LTCHs whose claims contained the coding inaccuracies to request that they resubmit those claims with the correct diagnosis, from an analysis of LTCH claims data from the December 2003 update of the FY 2003 MedPAR file, it appeared that such claims data no longer contain coding errors. Therefore, it was not necessary to correct the FY 2003 MedPAR data for the development of the FY 2005 LTC–DRGs and relative weights established in the same final rule. As stated above, in this proposed rule, we are proposing to use the December 2004 update of the FY 2004 MedPAR file for the determination of the proposed FY 2006 LTC–DRG relative weights as these are the best available data. Based on an analysis of LTCH claims data from the December 2004 update of the FY 2004 MedPAR file, it appears that such claims data do not contain coding inaccuracies found previously in LTCH claims data. Therefore, it was not necessary to correct the FY 2004 MedPAR data for VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 the development of the proposed FY 2006 LTC–DRGs and relative weights presented in this proposed rule. 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 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 method to calculate the LTC–DRG relative weights instead of the methodology used to determine the DRG relative weights under the IPPS described above in section II.C. of this preamble. 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 hospital-specific relative value 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, averages 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). In accordance with the methodology established under § 412.523, we 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.D.4. (step 3) of this preamble) 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 LTC–DRG. The PO 00000 Frm 00037 Fmt 4701 Sfmt 4702 23341 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 in 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 in 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 in 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 Low-Volume LTC–DRGs In order to account for LTC–DRGs with low-volume (that is, with fewer than 25 LTCH cases), in accordance with the methodology established in the August 30, 2002 LTCH PPS final rule (67 FR 55984), we group those lowvolume LTC–DRGs into one of five categories (quintiles) based on average charges, for the purposes of determining relative weights. For this proposed rule, using LTCH cases from the December 2004 update of the FY 2004 MedPAR file, we identified 172 LTC–DRGs that contained between 1 and 24 cases. This list of proposed LTC–DRGs was then divided into one of the 5 low-volume quintiles, each containing a minimum of 34 LTC–DRGs (172/5 = 34 with 2 LTC– DRGs as the remainder). For FY 2006, we are proposing to make an assignment to a specific low-volume quintile by sorting the low-volume proposed LTC– DRGs in ascending order by average charge. For this proposed rule, this results in an assignment to a specific low volume quintile of the sorted 172 low-volume proposed LTC–DRGs by ascending order by average charge. Because the number of LTC–DRGs with less than 25 LTCH cases is not evenly divisible by five, the average charge of the low-volume proposed LTC–DRG was used to determine which low- E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules volume quintile received the additional proposed LTC–DRG. After sorting the 172 low-volume LTC–DRGs in ascending order, we are proposing that the first fifth of low-volume LTC–DRGs with the lowest average charge would be grouped into Quintile 1. The highest average charge cases would be grouped into Quintile 5. Since the average charge of the proposed 35th LTC–DRG in the sorted list is closer to the proposed 34th LTC–DRG’s average charge (assigned to Quintile 1) than to the average charge of the proposed 36th LTC–DRG in the sorted list (to be assigned to Quintile 2), we are proposing to place it into Quintile 1. This process was repeated through the remaining low-volume proposed LTC–DRGs so that 2 proposed VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 low-volume quintiles contain 35 proposed LTC–DRGs and 3 proposed low-volume quintiles contain 34 proposed LTC–DRGs. In order to determine the proposed relative weights for the proposed LTC– DRGs with low volume for FY 2006, in accordance with the methodology established in the August 30, 2002 LTCH PPS final rule (67 FR 55984), we are proposing to use the proposed five low-volume quintiles described above. The composition of each of the proposed five low-volume quintiles shown in the chart below would be used in determining the proposed LTC–DRG relative weights for FY 2006. We would determine a proposed relative weight and (geometric) average length of stay PO 00000 Frm 00038 Fmt 4701 Sfmt 4725 for each of the proposed five lowvolume quintiles using the formula that we apply to the regular proposed LTC– DRGs (25 or more cases), as described below in section II.D.4. of this preamble. We are proposing to assign the same relative weight and average length of stay to each of the proposed LTC–DRGs that make up that proposed low-volume quintile. We note that, as this system is dynamic, it is possible that the number and specific type of 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 LTC–DRGs and to calculate the relative weights based on our methodology. E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.016</GPH> 23342 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00039 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 23343 EP04MY05.017</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules VerDate Aug<04>2004 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00040 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.018</GPH> 23344 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00041 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 23345 EP04MY05.019</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 4. Steps for Determining the Proposed FY 2006 LTC–DRG Relative Weights As we noted previously, the proposed FY 2006 LTC–DRG relative weights are determined in accordance with the methodology established in the August 1, 2003 IPPS final rule (68 FR 45367). In summary, LTCH cases must be grouped in the appropriate LTC–DRG, while taking into account the lowvolume proposed LTC–DRGs as described above, before the proposed FY 2006 LTC–DRG relative weights can be determined. After grouping the cases in the appropriate proposed LTC–DRG, we are proposing to calculate the proposed relative weights for FY 2006 in this proposed rule 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 LTC–DRG for the effect of short-stay 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 LTC–DRG using the hospital-specific relative value method described above. Below we discuss in detail the steps for calculating the proposed FY 2006 LTC–DRG relative weights. Step 1—Remove statistical outliers. The first step in the calculation of the proposed FY 2006 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 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 distribution of both charges per case and the charges per day for each LTC–DRG. These statistical outliers are removed prior to calculating the proposed relative weights. 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 proposed relative weight that does not truly reflect relative resource use among the proposed LTC–DRGs. Step 2—Remove cases with a length of stay of 7 days or less. The proposed FY 2006 LTC–DRG relative weights reflect the average of resources used on representative cases of a specific type. Generally, cases with a length of stay 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. If we were to include stays of 7 days or less in the computation of the proposed FY 2006 LTC–DRG relative weights, the value of many proposed 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, in order to include data from these very short-stays. Thus, in determining the proposed FY 2006 LTC–DRG relative weights, we remove PO 00000 Frm 00042 Fmt 4701 Sfmt 4702 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 2006 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). (However, 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 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 LTC– DRG for nonshort-stay outlier cases. This has the effect of proportionately reducing the impact of the lower charges for the short-stay outlier cases in calculating the average charge for the proposed 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 LTC– DRG. As we explained in the FY 2005 IPPS final rule (69 FR 48991), counting short- E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.020</GPH> 23346 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules stay outlier cases as full discharges with no adjustment in determining the proposed LTC–DRG relative weights would lower the proposed LTC–DRG relative weight for affected proposed 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 LTC– DRG. This would result in an ‘‘underpayment’’ to nonshort-stay outlier cases and an ‘‘overpayment’’ to short-stay outlier cases. Therefore, in this proposed rule, we adjust for shortstay 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 2006 LTC–DRG relative weights on an iterative basis. The process of calculating the proposed LTC–DRG relative weights using the hospital specific relative value methodology is iterative. First, for each LTCH case, we calculate a hospitalspecific 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 hospitalspecific relative charge value for the case. An initial case-mix index value of 1.0 is used for each LTCH. For each proposed LTC–DRG, the proposed FY 2006 LTC–DRG relative weight is calculated by dividing the average of the adjusted hospital-specific relative charge values (from above) for the proposed LTC–DRG by the overall average hospital-specific relative charge value across all cases for all LTCHs. Using these recalculated proposed LTC– DRG relative weights, each proposed LTCH’s average relative weight for all of its cases (case-mix) is calculated by dividing the sum of all the proposed LTCH’s 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 adjusted relative charge values are then used to calculate a new set of proposed 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. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Step 5–Adjust the proposed FY 2006 LTC–DRG relative weights to account for nonmonotonically increasing relative weights. As explained in section II.B. of this preamble, the proposed FY 2006 CMS DRGs, which the proposed FY 2006 LTC–DRGs are based, contain ‘‘pairs’’ that are differentiated based on the presence or absence of CCs. The proposed LTC–DRGs with CCs are defined by certain secondary diagnoses not related to or inherently a part of the disease process identified by the principal diagnosis, but the presence of additional diagnoses does not automatically generate a CC. As we discussed in the FY 2005 IPPS final rule (69 FR 48991), the value of monotonically increasing relative weights rises as the resource use increases (for example, from uncomplicated to more complicated). The presence of CCs in a proposed LTC– DRG means that cases classified into a ‘‘without CC’’ proposed LTC–DRG are expected to have lower resource use (and lower costs). In other words, resource use (and costs) are expected to decrease across ‘‘with CC’’/‘‘without CC’’ pairs of proposed LTC–DRGs. For a case to be assigned to a proposed LTC–DRG with CCs, more coded information is called for (that is, at least one relevant secondary diagnosis), than for a case to be assigned to a proposed LTC–DRG ‘‘without CCs’’ (which is based on only one principal diagnosis and no relevant secondary diagnoses). Currently, the LTCH claims data include both accurately coded cases without complications and cases that have complications (and cost more), but were not coded completely. Both types of cases are grouped to a proposed LTC–DRG ‘‘without CCs’’ because only one principal diagnosis was coded. Since the LTCH PPS was only implemented for cost reporting periods beginning on or after October 1, 2002 (FY 2003) and LTCHs were previously paid under cost-based reimbursement, which is not based on patient diagnoses, coding by LTCHs for these cases may not have been as detailed as possible. Thus, in developing the FY 2003 LTC–DRG relative weights for the LTCH PPS based on FY 2001 claims data, as we discussed in the August 30, 2002 LTCH PPS final rule (67 FR 55990), we found on occasion that the data suggested that cases classified to the LTC–DRG ‘‘with CCs’’ of a ‘‘with CC’’/ ‘‘without CC’’ pair had a lower average charge than the corresponding LTC– DRG ‘‘without CCs.’’ Similarly, as discussed in the FY 2005 IPPS final rule (69 FR 48991 through 48992), based on FY 2003 claims data, we also found on PO 00000 Frm 00043 Fmt 4701 Sfmt 4702 23347 occasion that the data suggested that cases classified to the LTC–DRG ‘‘with CCs’’ of a ‘‘with CC’’/‘‘without CC’’ pair have a lower average charge than the corresponding LTC–DRG ‘‘without CCs’’ for the FY 2005 LTC–DRG relative weights. We believe this anomaly may be due to coding that may not have fully reflected all comorbidities that were present. Specifically, LTCHs may have failed to code relevant secondary diagnoses, which resulted in cases that actually had CCs being classified into a ‘‘without CC’’ LTC–DRG. It would not be appropriate to pay a lower amount for the ‘‘with CC’’ LTC–DRG because, in general, cases classified into a ‘‘with CC’’ LTC–DRG are expected to have higher resource use (and higher cost) as discussed above. Therefore, previously when we determined the LTC–DRG relative weights in accordance with the methodology established in the August 30, 2002 LTCH PPS final rule (67 FR 55990), we grouped both the cases ‘‘with CCs’’ and ‘‘without CCs’’ together for the purpose of calculating the LTC–DRG relative weights for FYs 2003 through 2005. As we stated in that same final rule, we will continue to employ this methodology to account for nonmonotonically increasing relative weights until we have adequate data to calculate appropriate separate weights for these anomalous LTC–DRG pairs. We expect that, as was the case when we first implemented the IPPS, this problem will be self-correcting, as LTCHs submit more completely coded data in the future. There are three types of ‘‘with CC’’ and ‘‘without CC’’ pairs that could be nonmonotonic; that is, where the ‘‘without CC’’ proposed LTC–DRG would have a higher average charge than the ‘‘with CC’’ proposed LTC–DRG. For this proposed rule, using the LTCH cases in the December 2004 update of the FY 2004 MedPAR file (the best available data at this time), we identified one of the three types of nonmonotonic LTC–DRG pairs. The first category of nonmonotonically increasing proposed relative weights for FY 2006 proposed LTC–DRG pairs ‘‘with and without CCs’’ contains zero pairs of proposed LTC– DRGs in which both the proposed LTC– DRG ‘‘with CCs’’ and the proposed LTC– DRG ‘‘without CCs’’ had 25 or more LTCH cases and, therefore, did not fall into one of the 5 low-volume quintiles. For those nonmonotonic proposed LTC– DRG pairs, we would combine the LTCH cases and compute a new proposed relative weight based on the case-weighted average of the combined LTCH cases of the proposed LTC–DRGs. E:\FR\FM\04MYP2.SGM 04MYP2 23348 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules The case-weighted average charge is determined by dividing the total charges for all LTCH cases by the total number of LTCH cases for the combined proposed LTC–DRG. This new proposed relative weight would then be assigned to both of the proposed LTC–DRGs in the pair. In this proposed rule, for FY 2006, there are no proposed LTC–DRGs that fall into this category. The second category of nonmonotonically increasing relative weights for proposed LTC–DRG pairs ‘‘with and without CCs’’ consists of one pair of proposed LTC–DRGs that has fewer than 25 cases, and each proposed LTC–DRG would be grouped to different proposed low-volume quintiles in which the ‘‘without CC’’ proposed LTC– DRG is in a higher-weighted proposed low-volume quintile than the ‘‘with CC’’ proposed LTC–DRG. For those pairs, we would combine the LTCH cases and determine the case-weighted average charge for all LTCH cases. The caseweighted average charge is determined by dividing the total charges for all LTCH cases by the total number of LTCH cases for the combined proposed LTC–DRG. Based on the case-weighted average LTCH charge, we determine within which low-volume quintile the ‘‘combined LTC–DRG’’ is grouped. Both proposed LTC–DRGs in the pair are then grouped into the same proposed lowvolume quintile, and thus have the same proposed relative weight. In this proposed rule, for FY 2006, proposed LTC–DRGs 531 and 532 fall into this category. The third category of nonmonotonically increasing relative weights for proposed LTC–DRG pairs ‘‘with and without CCs’’ consists of zero pairs of proposed LTC–DRGs where one of the proposed LTC–DRGs has fewer than 25 LTCH cases and is grouped to a proposed low-volume quintile and the other proposed LTC–DRG has 25 or more LTCH cases and has its own proposed LTC–DRG relative weight, and the proposed LTC–DRG ‘‘without CCs’’ VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 has the higher proposed relative weight. We remove the proposed low-volume LTC–DRG from the proposed lowvolume quintile and combine it with the other proposed LTC–DRG for the computation of a new proposed relative weight for each of these proposed LTC– DRGs. This new proposed relative weight is assigned to both proposed LTC–DRGs, so they each have the same proposed relative weight. In this proposed rule, for FY 2006, there are no proposed LTC–DRGs that fall into this category. Step 6–Determine a proposed FY 2006 LTC–DRG relative weight for proposed LTC–DRGs with no LTCH cases. As we stated above, we determine the proposed relative weight for each proposed LTC–DRG using charges reported in the December 2004 update of the FY 2004 MedPAR file. Of the 526 proposed LTC–DRGs for FY 2006, we identified 194 proposed LTC–DRGs for which there were no LTCH cases in the database. That is, based on data from the FY 2004 MedPAR file used in this proposed rule, no patients who would have been classified to those LTC–DRGs were treated in LTCHs during FY 2004 and, therefore, no charge data were reported for those proposed LTC–DRGs. Thus, in the process of determining the proposed LTC–DRG relative weights, we are unable to determine weights for these 194 proposed LTC–DRGs using the methodology described in steps 1 through 5 above. However, because patients with a number of the diagnoses under these proposed LTC–DRGs may be treated at LTCHs beginning in FY 2006, we assign proposed relative weights to each of the 194 ‘‘no volume’’ proposed LTC–DRGs based on clinical similarity and relative costliness to one of the remaining 332 (156—194 = 332) proposed LTC–DRGs for which we are able to determine proposed relative weights, based on FY 2004 claims data. As there are currently no LTCH cases in these ‘‘no volume’’ proposed LTC– DRGs, we determine proposed relative PO 00000 Frm 00044 Fmt 4701 Sfmt 4702 weights for the 194 proposed LTC–DRGs with no LTCH cases in the FY 2004 MedPAR file used in this proposed rule by grouping them to the appropriate proposed low-volume quintile. This methodology is consistent with our methodology used in determining proposed relative weights to account for the proposed low-volume LTC–DRGs described above. Our methodology for determining proposed relative weights for the proposed ‘‘no volume’’ LTC–DRGs is as follows: We crosswalk the proposed no volume LTC–DRGs by matching them to other similar proposed LTC–DRGs for which there were LTCH cases in the FY 2004 MedPAR file based on clinical similarity and 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, post-operative care, and length of stay. We assign the proposed relative weight for the applicable proposed low-volume quintile to the proposed no volume LTC–DRG if the proposed LTC–DRG to which it is crosswalked is grouped to one of the proposed low-volume quintiles. If the proposed LTC–DRG to which the proposed no volume LTC–DRG is crosswalked is not one of the proposed LTC–DRGs to be grouped to one of the proposed low-volume quintiles, we compare the proposed relative weight of the proposed LTC–DRG to which the proposed no volume LTC–DRG is crosswalked to the proposed relative weights of each of the five quintiles and we assign the proposed no volume LTC– DRG the proposed relative weight of the proposed low-volume quintile with the closest weight. For this proposed rule, a list of the proposed no volume FY 2006 LTC–DRGs and the proposed FY 2006 LTC–DRG to which it is crosswalked in order to determine the appropriate proposed low-volume quintile for the assignment of a relative weight for FY 2006 is shown in the chart below. E:\FR\FM\04MYP2.SGM 04MYP2 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00045 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 23349 EP04my05.021</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules VerDate Aug<04>2004 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00046 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 EP04my05.022</GPH> 23350 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00047 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 23351 EP04my05.023</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules VerDate Aug<04>2004 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00048 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 EP04my05.024</GPH> 23352 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 25 cases in proposed LTC–DRG 90. Therefore, it would not be assigned to a low-volume quintile for the purpose of determining the proposed LTC–DRG relative weights. However, under our established methodology, proposed LTC–DRG 91, with no LTCH cases, would need to be grouped to a proposed low-volume quintile. We determined that the proposed low-volume quintile with the closest weight to proposed LTC–DRG 90 (0.5004) (refer to Table 11 in the Addendum to this proposed rule) would be proposed low-volume Quintile 1 (0. 4502) (refer to Table 11 in the Addendum to this proposed rule). Therefore, we assign proposed LTC– DRG 91 a proposed relative weight of 0.4502 for FY 2006. Furthermore, we are proposing LTC– DRG relative weights of 0.0000 for heart, kidney, liver, lung, pancreas, and simultaneous pancreas/kidney transplants (LTC–DRGs 103, 302, 480, 495, 512, and 513, respectively) for FY 2006 because Medicare will 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 would 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 PO 00000 Frm 00049 Fmt 4701 Sfmt 4702 an interest in becoming a transplant center. However, if in the future a LTCH applies for certification as a Medicareapproved transplant center, we believe that the application and approval procedure would allow sufficient time for us to determine appropriate weights for the LTC–DRGs affected. At the present time, we would only include these six transplant LTC–DRGs in the GROUPER program for administrative purposes. Because we use the same GROUPER program for LTCHs as is used under the IPPS, removing these LTC– DRGs would be administratively burdensome. Again, we note that as this system is dynamic, it is entirely possible that the number of proposed LTC–DRGs with a zero volume of LTCH cases based on the system will vary in the future. We used the best most recent available claims data in the MedPAR file to identify zero volume LTC–DRGs and to determine the proposed relative weights in this proposed rule. Table 11 in the Addendum to this proposed rule lists the proposed 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 2006. E. 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 Applications’’ at the beginning of your comment.) E:\FR\FM\04MYP2.SGM 04MYP2 EP04my05.025</GPH> To illustrate this methodology for determining the proposed relative weights for the 194 proposed LTC–DRGs with no LTCH cases, we are providing the following examples, which refer to the proposed no volume LTC–DRGs crosswalk information for FY 2006 provided in the chart above. Example 1: There were no cases in the FY 2004 MedPAR file used for this proposed rule for proposed LTC–DRG 163 (Hernia Procedures Age 0–17). Since the procedure is similar in resource use and the length and complexity of the procedures and the length of stay are similar, we determined that proposed LTC–DRG 178 (Uncomplicated Peptic Ulcer Without CC), which is assigned to proposed low-volume Quintile 3 for the purpose of determining the proposed FY 2006 relative weights, would display similar clinical and resource use. Therefore, we assign the same proposed relative weight of proposed LTC–DRG 178 of 0.7586 (proposed Quintile 3) for FY 2006 (Table 11 in the Addendum to this proposed rule) to proposed LTC– DRG 163. Example 2: There were no LTCH cases in the FY 2004 MedPAR file used in this proposed rule for proposed LTC–DRG 91 (Simple Pneumonia and Pleurisy Age 0–17). Since the severity of illness in patients with bronchitis and asthma is similar in patients regardless of age, we determined that proposed LTC–DRG 90 (Simple Pneumonia and Pleurisy Age >17 Without CC) would display similar clinical and resource use characteristics and have a similar length of stay to proposed LTC–DRG 91. There were over 23353 23354 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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 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 techniques to receive an additional payment. First, § 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 2004 are used to calculate the proposed FY 2006 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 technology or medical service 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 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 production or drug production had 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 technology ceases (§ 412.87(b)(2)). For example, an approved new technology that received FDA approval in October 2004 and entered the market at that time may be eligible to receive add-on payments as a new technology until FY 2007 (discharges occurring before October 1, 2006), when data reflecting the costs of the technology would be used to recalibrate the DRG weights. Because the FY 2007 DRG weights will be calculated using FY 2005 MedPAR data, the costs of such a new technology would likely be reflected in the FY 2007 DRG weights. Section 412.87(b)(3) further provides that, to receive special payment treatment, new medical services or technologies must be inadequately paid otherwise under the DRG system. 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). Table 10 in the Addendum to the FY 2004 IPPS final rule (68 FR 45648) listed the qualifying threshold by DRG, based on the discharge data that we used to calculate the FY 2004 DRG weights. 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. We updated Table 10 from the October 6, 2003 Federal Register correction document, which contains the thresholds that we used to evaluate applications for new service or PO 00000 Frm 00050 Fmt 4701 Sfmt 4702 technology add-on payments for FY 2005, using the section 503(b)(1) measures stated above, and posted these new thresholds on our Web site at: https://www.cms.hhs.gov/providers/ hipps/newtech.asp. In the FY 2005 IPPS final rule (in Table 10 of the Addendum), we included the final thresholds that are being used to evaluate applicants for new technology add-on payments for FY 2006. (Refer to section IV.D. of the preamble to the FY 2005 IPPS final rule (69 FR 49084) for a discussion of a revision of the regulations to incorporate the change made by section 503(b)(1) of Pub. L. 108–173.) 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 in medical technology 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. (See 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 payment is limited to the DRG payment plus 50 percent of the estimated costs of the new technology. The report language accompanying section 533 of Pub. L. 106–554 indicated Congressional intent that the Secretary 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 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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 503(d)(2) of Pub. L. 108–173 amended section 1886(d)(5)(K)(ii)(III) of the Act to provide 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 will not be budget neutral. Applicants for add-on payments for new medical services or technologies for FY 2007 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, no later than October 15, 2005. Applicants must submit a complete database no later than December 30, 2005. Complete application information, along with final deadlines for submitting a full application, will be available after publication of the FY 2006 final rule at our Web site: https://www.cms.hhs.gov/ providers/hipps/default.asp. To allow interested parties to identify the new medical services or technologies under review before the publication of the proposed rule for FY 2007, the website will also list the tracking forms completed by each applicant. 2. Public Input Before Publication of This Notice of Proposed Rulemaking on Add-On Payments Section 503(b)(2) of Pub. L. 108–173 amended section 1886(d)(5)(K) of the Act by adding a clause (viii) to provide for a mechanism for public input before publication of a notice of proposed rulemaking regarding whether a medical service or technology represents a substantial improvement or advancement. The revised process for evaluating new medical service and technology applications requires the Secretary to— • Provide, before publication of a proposed rule, for public input VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 regarding whether a new service or technology represents an advance in medical technology that substantially improves the diagnosis or treatment of Medicare beneficiaries. • Make public and periodically update a list of the services and technologies for which an application for add-on payments is pending. • Accept comments, recommendations, and data from the public regarding whether a service or technology represents a substantial improvement. • 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 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 2006 before publication of this proposed rule, we published a notice in the Federal Register on December 30, 2004 (69 FR 78466) and held a town hall meeting at the CMS Headquarters Office in Baltimore, MD, on February 23, 2005. 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 discussions of the substantial clinical improvement criteria for each of the FY 2006 new medical service and technology add-on payment applications before the publication of this FY 2006 IPPS proposed rule. Approximately 45 participants registered and attended in person, while additional participants listened over an open telephone line. The participants focused on presenting data on the substantial clinical improvement aspect of their products, as well as the need for additional payments to ensure access to Medicare beneficiaries. In addition, we received written comments regarding the substantial clinical improvement criterion for the applicants. We have considered these comments in our evaluation of each new application for FY 2006 in this proposed rule. We have summarized these comments or, if applicable, indicated that no comments were received, at the end of the discussion of the individual applications. Section 503(c) of Pub. L. 108–173 amended section 1886(d)(5)(K) of the Act by adding a new clause (ix) requiring that, before establishing any PO 00000 Frm 00051 Fmt 4701 Sfmt 4702 23355 add-on payment for a new medical service or technology, the Secretary shall seek to identify one or more DRGs associated with the new technology, based on similar clinical or anatomical characteristics and the costs of the technology and assign the new technology into a DRG where the average costs of care most closely approximate the costs of care using the new technology. No add-on payment shall be made with respect to such a new technology. At the time an application for new technology add-on payments is submitted, the DRGs associated with the new technology are identified. We only determine that a new technology add-on payment is appropriate when the reimbursement under these DRGs is not adequate for this new technology. The criterion for this determination is the cost threshold, which we discuss below. We discuss the assignments of several new technologies within the DRG payment system in section II.B. of this proposed rule. In this proposed rule, we evaluate whether new technology add-on payments will continue in FY 2006 for the three technologies that currently receive such payments. In addition, we present our evaluations of eight applications for add-on payments in FY 2006. The eight applications for FY 2006 include two applications for products that were denied new technology add-on payments for FY 2005. 3. FY 2006 Status of Technology Approved for FY 2005 Add-On Payments a. INFUSE TM (Bone Morphogenetic Proteins (BMPs) for Spinal Fusions) INFUSE TM was approved by FDA for use on July 2, 2002, and became available on the market immediately thereafter. In the FY 2004 IPPS final rule (68 FR 45388), we approved INFUSE TM for add-on payments under § 412.88, effective for FY 2004. This approval was on the basis of using INFUSE TM for single-level, lumbar spinal fusion, consistent with the FDA’s approval and the data presented to us by the applicant. Therefore, we limited the add-on payment to cases using this technology for anterior lumbar fusions in DRGs 497 (Spinal Fusion Except Cervical With CC) and 498 (Spinal Fusion Except Cervical Without CC). Cases involving INFUSE TM that are eligible for the new technology add-on payment are identified by assignment to DRGs 497 and 498 as a lumbar spinal fusion, with the combination of ICD–9– CM procedure codes 84.51 (Insertion of E:\FR\FM\04MYP2.SGM 04MYP2 23356 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules interbody spinal fusion device) and 84.52 (Insertion of recombinant bone morphogenetic protein). The FDA approved INFUSE TM for use on July 2, 2002. For FY 2005, INFUSE TM was still within the 2-year to 3-year period during which a technology can be considered new under the regulations. Therefore, in the FY 2005 IPPS final rule (69 FR 49007 through 49009), we continued add-on payments for FY 2005 for cases receiving INFUSE TM for spinal fusions in DRGs 497 (Spinal Fusion Except Cervical With CC) and 498 (Spinal Fusion Except Cervical Without CC). As we discussed in the September 7, 2001 final rule (66 FR 46915), an approval of a new technology for special payment should extend to all technologies that are substantially similar. Otherwise, our payment policy would bestow an advantage to the first applicant to receive approval for a particular new technology. In last year’s final rule (69 FR 49008), we discussed another product, called OP–1 Putty, manufactured by Stryker Biotech, that promotes natural bone growth by using a closely related bone morphogenetic protein called rhBMP–7. (INFUSE TM is rhBMP–2.) We also stated in last year’s final rule that we had determined that the costs associated with the OP–1 Putty are similar to those associated with INFUSE TM. Because the OP–1 Putty became available on the market in May 2004 (when it received FDA approval for spinal fusions) for similar spinal fusion procedures and because this product also eliminates the need for the autograft bone surgery, we extended new technology add-on payments to this technology as well for FY 2005. As noted above, the period for which technologies are eligible to receive new technology add-on payments is 2 to 3 years after the product becomes available on the market and data reflecting the cost of the technology are reflected in the DRG weights. The FDA approved INFUSE TM bone graft on July 2, 2002. Therefore, data reflecting the cost of the technology are now reflected in the DRG weights. In addition, by the end of FY 2005, the add-on payment will have been made for 2 years. Therefore, we are proposing to discontinue new technology add-on payment for INFUSE TM for FY 2006. Because we apply the same policies in making new technology payment for OP–1 Putty as we do for INFUSE TM, we are proposing to discontinue new technology add-on payment for OP–1 Putty as well for FY 2006. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 b. InSync Defibrillator System (Cardiac Resynchronization Therapy With Defibrillation (CRT–D)) Cardiac Resynchronization Therapy (CRT), also known as bi-ventricular pacing, is a therapy for chronic heart failure. A CRT implantable system provides electrical stimulation to the right atrium, right ventricle, and left ventricle to coordinate or resynchronize ventricular contractions and improve cardiac output. In the FY 2005 IPPS final rule (69 FR 49016), we determined that cardiac resynchronization therapy with defibrillator (CRT–D) was eligible for add-on payments in FY 2005. Cases involving CRT–D that are eligible for new technology add-on payments are identified by either one of the following two ICD–9–CM procedure codes: 00.51 (Implantation of Cardiac Resynchronization Defibrillator, Total System (CRT–D)) or 00.54 (Implantation or Replacement of Pulse Generator Device Only (CRT–D)). InSync Defibrillation System received FDA approval on June 26, 2002. However, another manufacturer, Guidant, received FDA approval for its CRT–D device on May 2, 2002. As we discussed in the September 7, 2001 final rule (66 FR 46915), an approval of a new technology for special payment should extend to all technologies that are substantially similar. Otherwise, our payment policy would bestow an advantage to the first applicant to receive approval for a particular new technology. We also noted that we would extend new technology add-on payments for the entire FY 2005 even though the 2–3 year period of newness ended in May 2005 for CRT–D since predictability is an important aspect of the prospective payment methodology and, therefore, we believe it is appropriate to apply a consistent payment methodology for new technologies throughout the fiscal year (69 FR 49016). As noted in the FY 2005 IPPS final rule (69 FR 49014), because CRT–Ds were available upon the initial FDA approval in May 2002, we considered the technology to be new from this date. As a result, for FY 2006, the CRT–D will be beyond the 2–3 year period during which a technology can be considered new. Therefore, we are proposing to discontinue add-on payments for the CRT–D for FY 2006. c. Kinetra Implantable Neurostimulator for Deep Brain Stimulation Medtronic, Inc. submitted an application for approval of the Kinetra implantable neurostimulator device for new technology add-on payments for FY PO 00000 Frm 00052 Fmt 4701 Sfmt 4702 2005. The Kinetra device was approved by the FDA on December 16, 2003. The Kinetra implantable neurostimulator is designed to deliver electrical stimulation to the subthalamic nucleus (STN) or internal globus pallidus (GPi) in order to ameliorate symptoms caused by abnormal neurotransmitter levels that lead to abnormal cell-to-cell electrical impulses in Parkinson’s Disease and essential tremor. Before the development of Kinetra, treating bilateral symptoms of patients with these disorders required the implantation of two neurostimulators (in the form of a product called SoletraTM, also manufactured by Medtronic): one for the right side of the brain (to control symptoms on the left side of the body), the other for the left side of the brain (to control symptoms on the right side of the body). Additional procedures were required to create pockets in the chest cavity to place the two generators required to run the individual leads. The Kinetra neurostimulator generator, implanted in the pectoral area, is designed to eliminate the need for two devices by accommodating two leads that are placed in both the left and right sides of the brain to deliver the necessary impulses. The manufacturer argued that the development of a single neurostimulator that treats bilateral symptoms provides a less invasive treatment option for patients, and simpler implantation, follow up, and programming procedures for physicians. In December 2003, the FDA approved the device. Therefore, for FY 2006, Kinetra qualifies under the newness criterion because FDA approval was within the statutory timeframe of 2 to 3 years and its costs are not yet reflected in the DRG weights. Because there were no data available to evaluate costs associated with Kinetra, in the FY 2005 IPPS final rule, we conducted the cost analysis using SoletraTM, the predecessor technology used to treat this condition, as a proxy for Kinetra. The preexisting technology provided the closest means to track cases that have actually used similar technology and served to identify the need and use of the new device. The manufacturer informed us that the cost of the Kinetra device is twice the price of a single SoletraTM device. Because most patients would receive two SoletraTM devices if the Kinetra device is not implanted, we believed data regarding the cost of SoletraTM would give a good measure of the actual costs that would be incurred. Medtronic submitted data for 104 cases that involved the SoletraTM device (26 cases in DRG 1 (Craniotomy Age > 17 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules With CC), and 78 cases in DRG 2 (Craniotomy Age > 17 Without CC)). These cases were identified from the FY 2002 MedPAR file using procedure codes 02.93 (Implantation, intracranial neurostimulator) and 86.09 (Other incision of skin and subcutaneous tissue). In the analysis presented by the applicant, the mean standardized charges for cases involving SoletraTM in DRGs 1 and 2 were $69,018 and $44,779, respectively. The mean standardized charge for these SoletraTM cases according to Medtronic’s data was $50,839. Last year, we used the same procedure codes to identify 187 cases involving the SoletraTM device in DRGs 1 and 2 in the FY 2003 MedPAR file. Similar to the Medtronic data, 53 of the cases were found in DRG 1, and 134 cases were found in DRG 2. The average standardized charges for these cases in DRGs 1 and 2 were $51,163 and $44,874, respectively. Therefore, the case-weighted average standardized charge for cases that included implantation of the SoletraTM device was $46,656. The new cost thresholds established under the revised criteria in Pub. L. 108–173 for DRGs 1 and 2 are $43,245 and $30,129, respectively. Accordingly, the case-weighted threshold to qualify for new technology add-on payment using the data we identified was determined to be $33,846. Under this analysis, Kinetra met the cost threshold. We note that an ICD–9–CM code was approved for dual array pulse generator devices, effective October 1, 2004, for IPPS tracking purposes. The new ICD– 9–CM code that will be assigned to this device is 86.95 (Insertion or replacement of dual array neurostimulator pulse generator), which includes dual array and dual channel generators for intracranial, spinal, and peripheral neurostimulators. The code will not separately identify cases with the Kinetra device and will only be used to distinguish single versus dual channel-pulse generator devices. Because the code only became effective on October 1, 2004, we do not have any specific data regarding the costs of cases involving dual array pulse generator devices. The manufacturer claimed that Kinetra provides a range of substantial improvements beyond previously available technology. These include a reduced rate of device-related complications and hospitalizations or physician visits and less surgical trauma because only one generator implantation procedure is required. Kinetra has a reed switch disabling function that physicians can use to prevent VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 inadvertent shutoff of the device, as occurs when accidentally tripped by electromagnetic inference (caused by common products such as metal detectors and garage door openers). Kinetra also provides significant patient control, allowing patients to monitor whether the device is on or off, to monitor battery life, and to fine-tune the stimulation therapy within clinician-programmed parameters. While Kinetra provides the ability for patients to better control their symptoms and reduce the complications associated with the existing technology, it does not eliminate the necessity for two surgeries. Because the patients who receive the device are often frail, the implantation generally occurs in two phases: the brain leads are implanted in one surgery, and the generator is implanted in another surgery, typically on another day. However, implanting Kinetra does reduce the number of potential surgeries compared to its predecessor (which requires two surgeries to implant the two single-lead arrays to the brain and an additional surgery for implantation of the second generator). Therefore, the Kinetra device reduces the number of surgeries from 3 to 2. Last year, we solicited comments on (1) the issue of whether the device is sufficiently different from the previously used technology to qualify as a substantially improved treatment for the same patient symptoms; (2) the cost of the device; and (3) the approval of the device for add-on payment, given the uncertainty over the frequency with which the patients receiving the device have the generator implanted in a second hospital stay, and the frequency with which this implantation occurs in an outpatient setting. In the response, we received sufficient evidence to demonstrate that Kinetra does represent a substantial clinical improvement over the previous Soletra TM device. Specifically, the increased patient control, reduced surgery, fewer complications, and elimination of environmental interference significantly improve patient outcomes. Therefore, we approved Kinetra for new technology add-on payments for FY 2005. Cases receiving Kinetra for Parkinson’s disease or essential tremor on or after October 1, 2004, are eligible to receive an add-on payment of up to $8,285, or half the cost of the device, which is approximately $16,570. These cases are identified by the presence of procedure codes 02.93 (Implantation or replacement of intracranial neurostimulator leads) and 86.95 (Insertion or replacement of dual array PO 00000 Frm 00053 Fmt 4701 Sfmt 4702 23357 neurostimulator pulse generator). If a claim has only the procedure code identifying the implantation of the intracranial leads, or if the claim identifies only insertion of the generator, no add-on payment will be made. This technology received FDA approval on December 16, 2003, and remains within the 2 to 3 year period during which it can be considered new. Therefore, we are proposing to continue add-on payments for Kinetra Inplantable Neurostimulator for deep brain stimulation for FY 2006. 4. FY 2006 Applications for New Technology Add-On a. INFUSE TM Bone Graft (Bone Morphogenetic Proteins (BMPs) for Tibia Fractures) Bone Morphogenetic Proteins (BMPs) have been shown to have the capacity to induce new bone formation and, therefore, to enhance the healing of fractures. Using recombinant techniques, some BMPs (also referred to as rhBMPs) can be produced in large quantities. This innovation has cleared the way for the potential use of BMPs in a variety of clinical applications such as in delayed union and nonunion of fractured bones and spinal fusions. One such product, rhBMP–2, is developed as an alternative to bone graft with spinal fusions. Medtronic Sofamor Danek (Medtronic) resubmitted an application (previously submitted for consideration for FY 2005) for a new technology addon payment in FY 2006 for the use of INFUSE TM Bone Graft in open tibia fractures. In cases of open tibia fractures, INFUSE TM is applied using an absorbable collagen sponge, which is then applied to the fractured bone to promote new bone formation and improved healing. The manufacturer contends that patient access to this technology is restricted due to the increased costs of treating these cases with INFUSE TM. The FDA approved use of INFUSE TM for open tibia fractures on April 30, 2004. Medtronic’s first application for a new technology add-on payment for INFUSE TM Bone Graft in open tibia fractures was denied. As we discussed in the FY 2005 IPPS final rule (69 FR 49010), the FY 2005 application for INFUSE TM for open tibia fractures was denied because a similar product, OP– 1, was approved in 2001 for the treatment of nonunion of tibia fractures. Comment: In comments presented at the February 2005 new technology town hall meeting, Medtronic contended that there was no opportunity for public E:\FR\FM\04MYP2.SGM 04MYP2 23358 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules comment on our decision regarding OP– 1 Putty: ‘‘the public had no opportunity to comment on whether the follow-on products were ‘substantially similar’ to the primary technologies under consideration. The absence of such provisions led to unpredictability and confusion about the new-technology add-on program.’’ Response: In the FY 2005 IPPS final rule, we noted that a commenter brought the existence of the Stryker Biotech OP–1 product to our attention during the comment period on the IPPS proposed rule for FY 2005. The commenter noted OP–1’s clinical similarity to INFUSE TM and contended that the products should be treated the same with respect to new technology payments when the product is used for tibia fractures. At that time, we determined that, despite the differences in indications under the respective FDA approvals, the two products were in use for many of the same kinds of cases. Specifically, clinical studies on the safety of OP–1 included patients with complicated fractures of the tibia, and those cases were similar to the cases described in the clinical trials for INFUSE TM for open tibia fractures. In addition, cases involving the use of OP– 1 for long bone union and open tibia fractures are assigned to the same DRGs (DRGs 218 and 219 (Lower Extremity Procedures With and Without CC, respectively)) as cases involving INFUSE TM. Therefore, we denied new technology add-on payments for INFUSE TM for open tibia fractures for FY 2005 on the grounds that the technology involving the use of bone morphogenetic proteins to treat severe long bone fractures (including open tibia fractures) and recalcitrant long bone fractures had been in use for more than 3 years. We note that Medtronic had ample opportunity, prior to the issuance of the FY 2005 IPPS final rule, to bring to our attention the fact that there was a similar product on the market that was being used in long bone fractures. We based our decision for FY 2005 on the record that was placed at our disposal by the applicant and by commenters during the comment period. Nevertheless, we have considered the issues raised by these two products again in the course of evaluating Medtronic’s new application for approval of INFUSE TM for new technology add-on payments in FY 2006. As part of its FY 2006 application, Medtronic advanced several arguments designed to demonstrate that OP–1 and INFUSE TM are substantially different. The application cites data from several VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 studies as evidence of the clinical superiority of INFUSE TM over OP–1. Medtronic presented studies at the February 2005 new technology town hall meeting to provide evidence that INFUSE TM is superior to OP–1 in the time it takes for critical-sized defects to heal and in radiographic assessment, mechanical testing of the repaired bone, and histology of the union for trial subjects receiving INFUSE TM compared with OP–1. (Study subjects were canines whose ulnas had 2.5 cm each of bone removed and then equal amounts of OP–1 and INFUSE TM were put into the front legs in a head to head trial.) Medtronic has also argued that these studies demonstrate that OP–1 has been shown to be less effective than using the patient’s own bone or the current standard of care (nail fixation with soft tissue medical management). Medtronic argued that the INFUSE TM product is not only superior to OP–1 for patients with open tibia fractures, but also that it is superior to any other treatment for these serious injuries. Medtronic also pointed out that the FDA approved OP–1 for Humanitarian Device Exemption (HDE) status, whereas INFUSE TM received a PreMarket Approval (PMA). To receive HDE approval, a product only needs to meet a safety standard, while standards of both safety and efficacy have to be met for a PMA approval. Medtronic argued that, because the only point the manufacturer of OP–1 was able to prove was that it did not harm those individuals that received it, the efficacy of OP–1 not only has not been demonstrated for the general population, but also more specifically, it has not been proven in the Medicare population. Medtronic presented arguments that INFUSE TM is a superior product to OP–1 because the INFUSE TM product has demonstrated safety and efficacy, while the OP–1 product has merely demonstrated that it is safe to use in humans. Medtronic pointed to the labeled indications and package inserts provided with the two products, stating that only INFUSE TM provides a substantial clinical improvement to patients receiving a BMP product. We do not believe that the different types of FDA approvals for the two products are relevant to distinguish between the two products in determining whether either product should be considered for new technology add-on payments under the IPPS. Manufacturers seek different types of FDA approval for many different reasons, including timing, the availability of adequate studies, the availability of resources to pursue research studies, and the size of the PO 00000 Frm 00054 Fmt 4701 Sfmt 4702 patient population that may be affected. The FDA has stated that the HDE approval process was established to address cases involving devices used in the treatment or diagnosis of diseases affecting fewer than 4,000 individuals in the United States per year: ‘‘A device manufacturer’s research and development costs could exceed its market returns for diseases or conditions affecting small patient populations. FDA, therefore, developed and published [the regulation establishing the HDE process] to provide an incentive for the development of devices for use in the treatment or diagnosis of diseases affecting these populations.’’ (https:// www.accessdata.fda.gov/scripts/cdrh/ cfdocs/cfHDE/HDEInformation.cfm). The fact that two products received different types of approval does not demonstrate either that they are substantially different for purposes of new technology add-on payments, or that one is new and the other is not. Nor do the different types of FDA approval imply that one product could meet our substantial clinical improvement criterion and the other could not. Neither type of FDA approval requires that products establish substantial clinical improvement, as is required for approval of new technology add-on payments. Theoretically, a product that receives an FDA HDE approval could subsequently meet our substantial clinical improvement criterion, while a product that receives an FDA PMA approval could fail to do so. We base our substantial clinical improvement determinations on the evidence presented in the course of the application process, and not on the type of FDA approval. For purposes of determining whether the use of rhBMPs for open tibia fracture represents a new technology, the crucial consideration is whether the costs of this technology are represented in the weights of the relevant DRGs. Cases that involve treatment of non-healed and acute tibia fractures fall into the same DRGs. We have identified 10,047 cases involving the use of rhBMPs in the FY 2004 MedPAR data file. This use includes the approved indications for INFUSE TM in spinal fusions (6,712 cases) and tibia DRGs (77 cases). However, we note that an additional 3,258 cases involving the off-label use of rhBMPs were found in 47 DRGs in the FY 2004 MedPAR data. We also note that, in our analysis of the FY 2003 MedPAR data, an additional 890 cases of off-label use (identified by the presence of ICD–9–CM code 84.52) were found in 36 DRGs. Therefore, we note E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules that the use of rhBMPs, made by Medtronic or otherwise, has penetrated the cost data that were used to set the FY 2005 and FY 2006 DRG weights. Whether or not it is possible to differentiate between patient populations that would be eligible to receive the OP–1 Implant for nonunions or the INFUSE TM bone graft for open tibia fractures, the patient populations both fall into the same DRGs. In addition, we have determined that the costs associated with the two products are comparable (69 FR 49009). Therefore, because BMP products have been used in treating both types of fractures included in the same DRGs since 2001, we continue to believe that the hospital charge data used in developing the relative weights reflect the costs of these products. Comment: In our Federal Register announcement of the February 23, 2005 new technology town hall meeting, held on February 23, 2005, we solicited comments on the issue of when products should be considered substantially similar. As a result, Medtronic recommended several criteria for determining whether two or more products are substantially similar and requested that we apply these criteria in determining whether OP–1 and INFUSE TM are similar for new technology add-on payment purposes. The three criteria recommended by Medtronic are: • The technologies or services in question use the same, or a similar, mechanism of action to achieve the therapeutic outcome. • The technologies or services are indicated for use in the same population for the same condition. • The technologies or services achieve the same level of substantial improvement. Medtronic has also argued that, according to its proposed criteria, OP– 1 would fail on two of the three proposed tests for substantial similarity: • According to Medtronic, the OP–1 implant ‘‘arguably’’ uses the same or a similar mechanism of action to achieve the therapeutic outcome. • OP–1 and INFUSE TM are indicated for use in different population and different conditions. According to Medtronic, INFUSE TM Bone Graft has an indication for acute, open tibia fractures only, used within 14 days, and is to be used with an intramedullary (IM) nail as part of the primary procedure. There is no limitation on the number of patients that can receive the technology. OP–1 Implant is indicated only for recalcitrant long-bone nonunions that have failed to heal. The HDE approval also specifies that use of OP– VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 1 is limited to secondary procedures (as would be expected with nonunions). The number of patients able to receive the device is limited to 4,000 patients per year and with oversight from an Institutional Review Board. • Medtronic argues the products do not achieve the same level of substantial improvement (as discussed above). Response: We agree with Medtronic that the first proposed criterion has some relevance in determining whether products are substantially similar. In evaluating the application for new technology add-on payments last year, we made the determination that, while these products are not identical chemically, the products do use the same mechanism of action to achieve the therapeutic outcome. However, we do not agree that the other two criteria recommended by Medtronic are relevant considerations for this purpose. As we have discussed above, we believe that whether cases involving different products are assigned to the same DRGs is a more relevant consideration than whether the products have the same specific indications. In addition, as we have already stated, we continue to believe that the hospital charge data used in developing the relative weights of the relevant DRGs reflect the costs of these products. Furthermore, we do not necessarily agree that considerations about the degrees of clinical improvements offered by different products should enter into decisions about whether products are new. We have always based our decisions about new technology add-on payments on a logical sequence of determinations, moving from the newness criterion to the cost criterion and finally to the substantial clinical improvement criterion. Specifically, we do not make determinations about substantial improvement unless a product has already been determined to be new and to meet the cost criterion. Therefore, we are reluctant to import substantial clinical improvement considerations into the logical prior decision about whether technologies are new. Furthermore, while we may sometimes need to make separate determinations about whether similar products meet the substantial clinical improvement criterion, we do not believe that it would be appropriate to make determinations about whether one product or another is clinically superior. However, we welcome comments while we continue to consider these issues. Comment: Medtronic suggested revisions to the application process that are designed to assist in identifying substantially similar products and provide the public with opportunity for PO 00000 Frm 00055 Fmt 4701 Sfmt 4702 23359 comment on specific instances in which substantial similarity is an issue. The suggested proposed revisions are: • After receipt of all new applications for a fiscal year, CMS should publish a Federal Register notice specifically asking manufacturers to identify if they wish to receive consideration for products that may be substantially similar to applications received. Such notice would probably occur in January. Responses would be required by a date certain in advance of the new technology town hall meeting, and would include justification of how the products meet the ‘‘substantial similarity’’ criteria. • The new technology town hall meeting should include a discussion of products identified by manufacturers as ‘‘substantially similar’’ to other approved products or pending applications. • CMS should publish initial findings about ‘‘substantial similarity’’ in the proposed hospital inpatient rule, with opportunity for public comment. • CMS should publish ultimate findings in the inpatient final rule. Alternatively, Medtronic suggested that, if a manufacturer identifies a product that may be substantially similar to a technology with an approved add-on payment, the manufacturer may choose to submit an application under the normal deadlines for the add-on payment program. Response: We appreciate Medtronic’s suggestions for evaluating similar technologies for new technology add-on payment. We have stated on several occasions that we wish to avoid creating situations in which similar products receive different treatment because only one manufacturer has submitted an application for new technology add-on payments. As we discussed in the September 7, 2001 Federal Register (66 FR 46915), an approval of a new technology for special payment should extend to all technologies that are substantially similar. Otherwise, our payment policy would bestow an advantage to the first applicant to receive approval for a particular new technology. In addition, we note that commenters on the FY 2005 proposed rule placed a great deal of emphasis on the fact that many manufacturers developing new technologies are not aware of the existence of the add-on payment provision or lack the resources to apply for add-on payment. Therefore, commenters on that proposed rule argued that the regulations we have established are already too stringent and cumbersome, especially for small manufacturers to access the new E:\FR\FM\04MYP2.SGM 04MYP2 23360 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules technology add-on payment process. The proposal by Medtronic would place further burden on these small manufacturers, both to know that an application has been made for a similar product and to make representations on a product that may or may not be on the market. Therefore, we are reluctant to adopt a process that places the formal burden on a competitor to seek equal treatment. However, we welcome comments while we continue to consider these issues. We note that Medtronic submitted data on 236 cases using INFUSE TM for open tibia fractures in the FY 2003 MedPAR data file, as identified by procedure code 79.36 (Reduction, fracture, open, internal fixation, tibia and fibula) and diagnosis codes of either 823.30 (Fracture of tibia alone, shaft, open) or 823.32 (Fracture of fibula and tibia, shaft, open). Medtronic also noted that the patients in clinical trials with malunion fractures (diagnosis code 733.81) or nonunion fractures (diagnosis code 733.82) would also be likely candidates to receive INFUSE TM. Based on the data submitted by the applicant, INFUSE TM would be used primarily in two different DRGs: 218 and 219 (Lower Extremity and Humerus Procedures Except Hip, Foot, Femur Age > 17, With and Without CC, respectively). The analysis performed by the applicant resulted in a case-weighted cost threshold of $24,461 for these DRGs. The average case-weighted standardized charge for cases using INFUSE TM in these DRGs would be $39,537. Therefore, the applicant maintains that INFUSE TM for open tibia fractures meets the cost criterion. However, because the costs of INFUSE TM and OP–1 are already reflected in the relevant DRGs, these products cannot be considered new. Therefore, we are proposing to deny new technology add-on payments for INFUSE TM bone graft for open tibia fractures for FY 2006. b. AquadexTM System 100 Fluid Removal System (System 100) CHF Solutions, Inc. resubmitted an application (previously submitted for consideration for FY 2005) for the approval of the System 100 for new technology add-on payments for FY 2006. The System 100 is designed to remove excess fluid (primarily excess water) from patients suffering from severe fluid overload through the process of ultrafiltration. Fluid retention, sometimes to an extreme degree, is a common problem for patients with chronic congestive heart failure. This technology removes excess fluid without causing hemodynamic VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 instability. It also avoids the inherent nephrotoxicity and tachyphylaxis associated with aggressive diuretic therapy, the mainstay of current therapy for fluid overload in congestive heart failure. The System 100 consists of: (1) An S– 100 console; (2) a UF 500 blood circuit; (3) an extended length catheter (ELC); and (4) a catheter extension tubing. The System 100 is designed to monitor the extracorporeal blood circuit and to alert the user to abnormal conditions. Vascular access is established via the peripheral venous system, and up to 4 liters of excess fluid can be removed in an 8-hour period. On June 3, 2002, FDA approved the System 100 for use with peripheral venous access. On November 20, 2003, FDA approved the System 100 for expanded use with central venous access and catheter extension use for infusion or withdrawal circuit line with other commercially applicable venous catheters. According to the applicant, although the FDA first approved System 100 in June 2002, it was not used by hospitals until August 2002 because of the substantial amount of time necessary to market and sell the device to hospitals. The applicant presented data and evidence demonstrating that the System 100 was not marketed until August 2002. We note the applicant submitted an application for FY 2005 and was denied new technology add-on payments. Our review indicated that the applicant did not present sufficient objective clinical evidence to determine that the System 100 meets the substantial clinical improvement criterion (such as a large prospective, randomized clinical trial) even though it is indicated for use in patients with congestive heart failure, a common condition in the Medicare population. However, for FY 2006, we are proposing to deny System 100 new technology add-on payments on the basis of our determination that it is no longer new. Technology is no longer considered new 2 to 3 years after data reflecting its costs begin to become available. Because data on the costs of the System 100 first became available in 2002, the costs are currently reflected in the DRG weights and the device is no longer new. The applicant also submitted information for the cost and substantial clinical improvement criteria. As stated last year, it is important to note at the outset of the cost analysis that the console is reusable and is, therefore, a capital cost. Only the circuits and catheters are components that represent operating expenses. Section 1886(d)(5)(K)(i) of the Act requires that PO 00000 Frm 00056 Fmt 4701 Sfmt 4702 the Secretary establish a mechanism to recognize the costs of new medical services or technologies under the payment system established under subsection (d) of section 1886, which establishes the system for paying for the operating costs of inpatient hospital services. The system of payment for capital costs is established under section 1886(g) of the Act, which makes no mention of any add-on payments for a new medical service or technology. Therefore, it is not appropriate to include capital costs in the add-on payments for a new medical service or technology and these costs should also not be considered in evaluating whether a technology meets the cost criterion. The applicant has applied for add-on payments for only the circuits and catheter, which represent the operating expenses of the device. However, as stated in the FY 2005 IPPS final rule, we believe that the catheters cannot be considered new technology for this device. As a result, we considered only the UF 500 disposable blood circuit as relevant to the evaluation of the cost criterion. The applicant submitted data from the FY 2003 MedPAR file in support of its application for new technology add-on payments for FY 2006. The applicant used a combination of diagnosis codes to determine which cases could potentially use the System 100. The applicant found 28,155 cases with the following combination of ICD–9-CM diagnosis codes: 428.0 through 428.9 (Heart Failure), 402.91 (Unspecified with Heart Failure), or 402.11 (Hypertensive Heart Disease with Heart Failure), in combination with 276.6 (Fluid Overload) and 782.3 (Edema). The 28,155 cases were found among 148 DRGs with 50.1 percent of cases mapped across DRGs 88, 89, 127, 277 and 316. The applicant eliminated those DRGs with less than 150 cases, which resulted in a total of 22,620 cases that could potentially use the System 100. The case-weighted average standardized charge across all DRGs was $13,619.32. The case-weighted threshold across all DRGs was $16,125.42. Although the case-weighted threshold is greater than the case-weighted standardized charge, it is necessary to include the standardized charge for the circuits used in each case. In order to establish the charge per circuit, the applicant submitted data regarding 76 actual cases that used the System 100. Based on these 76 cases, the standardized charge per circuit was $2,591. The applicant also stated that an average of two circuits are used per case. Therefore, adding $5,182 for the charge of the two E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules circuits to the case-weighted average standardized charge of $13,619.32 results in a total case-weighted standardized charge of $18,801.32. This amount is greater than the caseweighted threshold of $16,125.42. The applicant contended that the System 100 represents a substantial clinical improvement for the following reasons: It removes excess fluid without the use of diuretics; it does not lead to electrolyte imbalance, hemodynamic instability or worsening renal function; it can restore diuretic responsiveness; it does not adversely affect the reninangiotensin system; it reduces length of hospital stay for the treatment of congestive heart failure, and it requires only peripheral venous access. The applicant also noted that there are some clinical trials that have demonstrated the clinical safety and effectiveness as well as cost effectiveness of the System 100 in treating patients with fluid overload. However, as stated above, we are proposing to deny new technology addon payments for the System 100 because it does not meet the newness criterion. We received no public comments regarding this application for add-on payments. c. CHARITETM Artificial Disc (CHARITETM) DePuy SpineTM submitted an application for new technology add-on payments for the CHARITETM Artificial Disc for FY 2006. This device is a prosthetic intervertebral disc. DePuy SpineTM stated that the CHARITETM Artificial Disc is the first artificial disc approved for use in the United States. It is a 3-piece articulating medical device consisting of a sliding core that is placed between two metal endplates. The sliding core is made from a medical grade plastic and the endplates are made from medical grade cobalt chromium alloy. The endplates support the core and have small teeth that are secured to the vertebrae above and below the disc space. The sliding core fits in between the endplates. On October 26, 2004, the FDA approved the CHARITETM Artificial Disc for single level spinal arthroplasty in skeletally mature patients with degenerative disc disease (DDD) between L4 and S1. The FDA further stated that DDD is defined as discogenic back pain with degeneration of the disc confirmed by patient history and radiographic studies. These DDD patients should have no more than 3 mm of spondylolisthesis at an involved level. Patients receiving the CHARITETM Artificial Disc should have failed at least 6 months of conservative treatment VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 prior to implantation of the CHARITETM Artificial Disc. Because the device is within the statutory timeframe of 2 to 3 years and data is not yet reflected within the DRGs, we consider the CHARITETM Artificial Disc to meet the newness criterion. We note that an ICD–9–CM code was effective October 1, 2004, for IPPS tracking purposes. The code assigned to the CHARITETM was 84.65 (Insertion of total spinal disc prosthesis, lumbosacral). For analysis of the cost criterion, the applicant submitted two sets of data: one that used actual cases and one that used FY 2003 MedPAR cases. The applicant expects that cases using the CHARITETM will map to DRGs 499 and 500. The applicant submitted 68 actual cases from 35 hospitals that used the CHARITETM. Of these 68 cases, only 3 were Medicare patients; the remaining cases were privately insured patients or patients for whom the payer was unknown. Using data from the 68 actual cases, the average standardized charge was $40,722. The applicant maintained that this figure is well in excess of the thresholds for DRGs 499 and 500 (regardless of a case weighted threshold) of $24,828 and $17,299 respectively. Based on this analysis, the applicant ´ maintained that the CHARITETM meets the cost criterion because the average standardized charge exceeds the charge thresholds for DRGs 499 and 500. In addition, as stated above, the applicant submitted cases from the FY 2003 MedPAR file. The applicant searched the MedPAR file for ICD–9– CM procedure codes 81.06, 81.07, and 81.08 in combination with diagnosis codes 722.10, 722.2, 722.5, 722.52, 722.6, 722.7, 722.73 and 756.12, to identify a patient population that could be eligible for the CHARITETM Artificial Disc and found a total of 12,680 cases. However, these cases are from the FY 2003 MedPAR file and precede the effective date of ICD–9–CM code 84.65 that is currently used to track the device. Of these 12,680 cases, 55.5 percent were reported in DRG 497, and 44.5 percent were reported in DRG 498. The applicant stated that cases using the CHARITETM device group to the DRGs for back and neck procedures that exclude spinal fusions (DRGs 499 and 500). However, the applicant argues that the CHARITETM could be a substitute for spinal fusion procedures found in DRGs 497 and 498 and, therefore, used cases from these DRGs to evaluate whether the CHARITETM meets the cost criterion and to argue that procedures using the technology should be grouped to the spinal fusion DRGs. The average standardized charge per case was PO 00000 Frm 00057 Fmt 4701 Sfmt 4702 23361 $50,098 for DRG 497 and $41,290 for DRG 498. Using revenue codes 272 and 278 from the MedPAR file, the applicant then subtracted the charges for surgical and medical supplies used in connection with spinal fusion procedures, which resulted in a standardized charge of all other charges of $24,333 for DRG 497 and $22,183 for DRG 498. Based on the actual cases above, the applicant then estimated the average standardized charge for surgical and medical supplies per case for the CHARITETM was $20,033. The applicant estimated that charges have grown by 15 percent from FY 2003 to FY 2005 and, therefore, deflated the average standardized charge for surgical and medical supplies of the CHARITETM by 15 percent to $17,420. The applicant then added the average standardized charge for surgical and medical supplies of the CHARITETM to the standardized charge of all other charges for DRG 497 and 498 and also inflated the charges by 15 percent in order to update the data to FY 2005 charge levels. This amounted to a case-weighted average standardized charge of $46,256. Although the analysis was completed with DRGs 497 and 498, it is necessary to compare the average standardized charge to the thresholds of DRGs 499 and 500 because the GROUPER maps these cases to DRGs 499 and 500. As a result, the case-weighted threshold was $21,480. Similar to the analysis above, the applicant stated that the caseweighted average standardized charge is greater than the case-weighted threshold and, as a result, the applicant maintained that the CHARITETM meets the cost criterion. The applicant also contended that the CHARITETM represents a substantial clinical improvement over existing technology. Use of the CHARITETM may eliminate the need for spinal fusion and the use of autogenous bone, and the applicant stated that, based on the Investigational Device Exemption (IDE) study, ‘‘A Prospective Randomized Multicenter Comparison of Artificial Disc vs. Fusion for Single Level Lumbar Degenerative Disc Disease’’ (Blumenthal, S, et al, National American Spine Society 2004 Abstract) that patients who received the CHARITETM Artificial Disc were discharged from the hospital after an average of 3.7 days compared to 4.2 days in the fusion group. Furthermore, the applicant stated that patients who received the CHARITETM Artificial Disc had a statistically greater improvement in Oswetry Disability Index scores and Visual Analog Scale Pain scores compared to the fusion group at 6 weeks E:\FR\FM\04MYP2.SGM 04MYP2 23362 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules and 3, 6 and 12 months. The study also showed greater improvement from baseline compared to the fusion group on the Physical Component Score at 3, 6, and 23 months. In addition, the applicant states that patients receiving the CHARITETM Artificial Disc returned to normal activities in half the time, compared to patients who underwent fusion, and at the 2 year follow up, 15 percent of patients who underwent a fusion were dissatisfied with the postoperative improvements compared to 2 percent who received the CHARITETM Artificial Disc. Also, patients who received the CHARITETM Artificial Disc returned to work on average of 12.3 weeks after surgery compared to 16.3 weeks after circumferential fusion and 14.4 weeks with Bagby and Kuslich cages. The applicant finally stated that the motion preserving technology of the CHARITETM Artificial Disc may reduce the risk of increase of degenerative disc disease (DDD). The applicant explained that degeneration of adjacent discs due to increased stress has been strongly associated with spinal fusion utilizing instrumentation. In a followup of 100 patients (minimum 10 years) who received the CHARITETM Artificial Disc, the incidence of adjacent level DDD was 2 percent. We are continuing to review the information on whether the CHARITE TM Artificial Disc would appear to represent a substantial clinical improvement over existing technology for certain patient populations. Based on the studies submitted to the FDA and CMS, we remain concerned that the information presented may not definitively substantiate whether the CHARITE TM Artificial Disc is a substantial clinical improvement over spinal fusion. In addition, we are concerned that the cited IDE study enrolled no patients over 60 years of age, which excludes much of the Medicare population, and we are concerned that the device is contraindicated in patients with ‘‘significant osteoporosis,’’ which is quite common in the Medicare population. We invite comment on both of these points and on the more general question of whether the device satisfies the substantial clinical improvement criterion. Despite the issues mentioned above, we are still considering whether it is appropriate to approve new technology add-on payment status for the CHARITE TM Artificial Disc for FY 2006. If approved for add-on payments, the device would be reimbursed up to half of the costs for the device. Because the manufacturer has stated that the cost for VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 the CHARITE TM Artificial Disc would be $11,500, the maximum add-on payment for the device would be $5,750. In the final rule, we will make a final determination on whether the CHARITE TM Artificial Disc should receive new technology add-on payments for FY 2006 based on public comments and our continuing analyses. We finally note that the applicant requested a DRG reassignment for cases of the CHARITE TM Artificial Disc from DRGs 499 (Back and Neck Procedures Except Spinal Fusion With CC) and 500 (Back and Neck Procedures Except Spinal Fusion Without CC) to DRGs 497 (Spinal Fusion Except Cervical With CC) and 498 (Spinal Fusion Except Cervical Without CC). The applicant argued that the costs associated with an artificial disc surgery are similar to spinal fusion and inclusion in DRGs 497 and 498 would obviate the need to make a new technology add-on payment. On October 1, 2004, we created new codes for the insertion of spinal disc prostheses (codes 84.60 through 84.69). In the FY 2005 IPPS proposed rule and the final rule, we described the new DRG assignments for these new codes in Table 6B of the Addendum to the rules. We received a number of comments recommending that we change the DRG assignments from DRGs 499 and 500 in MDC 8 to the DRGs for spinal fusion (DRGs 497 and 498). In the FY 2005 IPPS final rule (69 FR 48938), we indicated that DRGs 497 and 498 are limited to spinal fusion procedures. Because the surgery involving the CHARITE TM is not a spinal fusion, we decided not to include this procedure in these DRGs. However, we will continue to analyze this issue and are interested in public comments on both the new technology application for the CHARITE TM and the DRG assignment for spinal disc prostheses. We received no public comments regarding this application for new technology add-on payments. d. Endovascular Graft Repair of the Thoracic Aorta Endovascular stent-grafting of the descending thoracic aorta (TA) provides a less invasive alternative to the traditional open surgical approach required for the management of descending thoracic aortic aneurysms. 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 GORE TAG device is a tubular stent-graft mounted on a catheter-based delivery system, and it replaces the synthetic graft normally PO 00000 Frm 00058 Fmt 4701 Sfmt 4702 sutured in place during open surgery. The device is identified using ICD–9– CM procedure code 39.79 (Other endovascular repair (of aneurysm) of other vessels). The applicant has requested a unique ICD–9–CM procedure code. At this point the time of the initial application, the FDA hads not yet approved this technology for general use. Subsequently, however, we were notified that FDA approval was granted on March 23, 2005. Although we discuss some of the data submitted with the application for new technology addon payments below, we are unable to include a detailed analysis of cost data and substantial clinical improvement data in this proposed rule because FDA approval occurred too late for us to conduct a complete analysis. The applicant submitted cost threshold information for the GORE TAG device. According to the manufacturer, cases using the GORE TAG device would fall into DRGs 110 and 111 (Major Cardiovascular Procedures With and Without CC, respectively). The applicant identified 185 cases in the FY 2003 MedPAR using procedure code 39.79 (Other endovascular repair (of aneurysm) of other vessels) and primary diagnosis codes 441.2 (Thoracic aneurysm, without mention of rupture), 441.1 (Thoracic aneurysm, ruptured), or 441.01 (Dissection of aorta, thoracic). The case-weighted standardized charge for 177 of these cases was $60,905. According to the manufacturer, the caseweighted cost threshold for these DRGs is $49,817. Based on this analysis, the manufacturer maintained that the technology meets our cost threshold. The manufacturer argued that the GORE TAG represents a substantial clinical improvement over existing technology, primarily by avoiding the traditional open aneurysm repair procedure with its associated high morbidity and mortality. The applicant argued that a descending thoracic aorta aneurysm is a potentially life threatening condition that currently requires a major operative procedure for its treatment. The mortality and complication rates associated with this surgery are very high, and the surgery is frequently performed under urgent or emergent conditions. The applicant noted that such complications can increase the length of the hospital stay and can include neurological damage, paralysis, renal failure, pulmonary emboli, hemorrhage, and sepsis. The average time for patients undergoing surgical repair to return to normal activity is 3 to 4 months, but can be significantly longer. E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules In comparison, the applicant argued that endovascular stent-grafting done with the GORE TAG thoracic endoprosthesis is minimally invasive. The manufacturer noted that patients treated with the endovascular technique experience far less aneurysm-related mortality and morbidity, compared to those patients that receive the open procedure resulting in reduced overall length-of-stay, less intensive care unit days and less operative complications. We received the following public comments, in accordance with section 503(b)(2) of Pub. L. 108–173, regarding this application for add-on payments. Comment: Several commenters expressed support for approval of new technology add-on payments for the GORE TAG device. These commenters noted that the data presented to the FDA advisory panel for consideration for FDA approval of the device clearly demonstrate the safety and efficacy of the GORE TAG device. They also noted that nearly 200 patients have been treated with the endografts, with a highly significant difference in both postoperative mortality and a reduction in the incidence of spinal cord ischemic complications, with some commenters noting the trial results, which showed a reduction in the rate of paraplegia from 14 percent to 3 percent, compared to open surgery. The commenters also stressed the rigorous nature of the open surgery, which requires a left lateral thoracotomy, resulting in significant morbidity. The commenters further argued that, since many of the patients with degenerative aneurysm of the thoracic aorta are elderly or present with significant comorbidities, or both, it is ‘‘a common circumstance in clinical practice to deny repair to such patients because of the magnitude of the conventional open surgery.’’ Other commenters stated that the 5-year mortality in all patients diagnosed with thoracic aortic aneurysm is as high as 80 percent in some groups of patients. Therefore, the commenters argued, the GORE TAG device for thoracic aortic aneurysm satisfies the criteria for substantial clinical improvement. Response: We appreciate the commenters’ input on this criterion. We will consider these comments regarding the substantial clinical improvement criterion in the final rule if we determine that the technology meets the other two criteria. Comment: A representative of another device manufacturer stated at the town hall meeting that the manufacturer has a similar product awaiting FDA approval. Response: As we discussed in the September 7, 2001 Federal Register (66 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 FR 46915), an approval of a new technology for special payment should extend to all technologies that are substantially similar. Otherwise, our payment policy would bestow an advantage to the first applicant to receive approval for a particular new technology. In this case, we will determine whether the GORE TAG device qualifies for new technology addon payments in the FY 2006 final rule. In the event that this technology satisfies all the criteria, we would extend new technology payments to any substantially similar technology that also receives FDA approval prior to publication of the FY 2006 final rule. We welcome comments regarding this technology in light of its recent FDA approval, particularly with regard to the cost threshold and the substantial clinical improvement criteria. e. Restore Rechargeable Implantable Neurostimulator Medtronic Neurological submitted an application for new technology add-on payments for its Restore Rechargeable Implantable Neurostimulator. The Restore Rechargeable Implantable Neurostimulator is designed to deliver electrical stimulation to the spinal cord for treatment of chronic, intractable pain. Neurostimulation is designed to deliver electrical stimulation to the spinal cord to block the sensation of pain. The current technology standard for neurostimulators utilizes 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 Rechargeable Implantable Neurostimulator ‘‘represents the next generation of 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 rechargeable battery is 9 years, compared to an average life of 3 years for conventional neurostimulator batteries. The applicant stated that this represents a significant clinical improvement because patients can use any power settings that are necessary to achieve pain relief with less concern for battery depletion and subsequent battery replacement. This device has not yet received approval for use by the FDA; however, another manufacturer has received approval for a similar device. PO 00000 Frm 00059 Fmt 4701 Sfmt 4702 23363 (Advanced Bionics’ Precision Rechargeable Neurostimulator was approved by the FDA on April 27, 2004.) Medtronic Neurological also provided data to determine whether the Restore Rechargeable Implantable Neurostimulator meets the cost criterion. Medtronic Neurological stated that the cases involving use of the device would primarily fall into DRGs 499, 500, 531 and 532, which have a case-weighted threshold of $24,090. The manufacturer stated that the anticipated average standardized charge per case involving the Restore technology is $59,265. This manufacturer derived this estimate by identifying cases in the FY 2003 MedPAR that reported procedure code 03.93 (Insertion or replacement of spinal neurostimulators). The manufacturer then added the total cost of the Restore Rechargeable Implantable Neurostimulator to the average standardized charges for those cases. Of the applicable charges for the Restore Rechargeable Implantable Neurostimulator, only the components that the applicant identified as new would be eligible for new technology add-on payments. Medtronic Neurological submitted information that distinguished the old and new components of the device and submitted data indicating that the neurostimulator itself is $17,995 and the patient recharger, antenna, and belt are $3,140. Thus, the total cost for new components would be $21,135, with a maximum add-on amount of $10,568 if the product were to be approved for new technology payments. We note that we reviewed a technology for add-on payments for FY 2003 called RenewTM Radio Frequency Spinal Cord Stimulation (SCS) Therapy, made by Advanced Neuromodulation Systems (ANS). In the FY 2003 final rule, we discussed and subsequently denied an application for new technology add-on payment for RenewTM SCS because ‘‘RenewTM SCS was introduced in July 1999 as a device for the treatment of chronic intractable pain of the trunk and limbs.’’ (67 FR 50019) We also noted, ‘‘[t]his system only requires one surgical placement and does not require additional surgeries to replace batteries as do other internal SCS systems.’’ The applicant also stated in its application for Restore that cases where it is used will be identified by ICD–9–CM procedure code 03.93 (Insertion or replacement of spinal neurostimulators). As we discussed in the FY 2003 final rule (67 FR 50019), the RenewTM SCS is identified by the same ICD–9–CM procedure code. The E:\FR\FM\04MYP2.SGM 04MYP2 23364 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules applicant has also applied for a new ICD–9–CM code for rechargeable neurostimulator pulse generator (We refer readers to Tables 6A through 6H in the Addendum to this proposed rule for information regarding ICD–9–CM codes.) Because both technologies are similar, we asked Medtronic to provide information that would demonstrate how the products were substantially different. The applicant noted that the RenewTM SCS, while programmable and rechargeable, is not a good option for those patients who have high energy requirements because of chronic intractable pain that will result in more battery wear and subsequent surgery to replace the device. Both systems rely on rechargeable batteries, and in the case of RenewTM SCS the energy is transmitted through the skin from a radiofrequency source for the purpose of recharging. The manufacturer of the Restore device contends that it is superior to the RenewTM device because RenewTM requires an external component that uses a skin adhesive that is uncomfortable and inconvenient (causes skin irritation, is affected by moisture that will come from bathing, sweating, swimming, etc.), leading to patient noncompliance. Because FDA approval has not yet been received for this device, we are making no decision concerning the Restore application at this time. We will make a formal determination if FDA approval occurs in sufficient time for full consideration in the final FY 2006 rule. However, we have reservations about whether this technology is new for purposes of the new technology add-on payments because of its similarity to other products that are also used to treat the same conditions. Although we recognize the benefits of a more easily rechargeable neurostimulator system, we believe that the Restore device may not be sufficiently different from predecessor devices to meet the newness criterion for the new technology add-on payment. As we discussed above, similar products have been on the market since 1999. Therefore, these technologies are already represented in the DRG weights and are not considered new for the purposes of the new technology add-on payment provision. We welcome comments on this issue, specifically regarding how the Restore device may or may not be significantly different from previous devices. We also seek comments on whether the product meets the cost and significant improvement criteria. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 We received no public comments regarding this application for add-on payments. f. Safe-Cross Radio Frequency Total Occlusion Crossing System (SafeCross) Intraluminal Therapeutics submitted an application for the Safe Cross Radio Frequency (RF) Total Occlusion Crossing System. This device performs the function of a guidewire during percutaneous transluminal angioplasty of chronic total occlusions of peripheral and coronary arteries. Using fiberoptic guidance and radiofrequency ablation, it is able to cross lesions where a standard guidewire is unsuccessful. On November 21, 2003, the FDA approved the Safe Cross for use in iliac and superficial femoral arteries. The device was approved by the FDA for all native peripheral arteries except carotids in August 2004. In January 2004, the FDA approved the Safe Cross for coronary arteries as well. Because the device is within the statutory timeframe of 2 to 3 years for all approved uses and data regarding the cost of this device are not yet reflected within the DRG weights, we consider the Safe Cross to meet the newness criterion. We note that the applicant submitted an application for a distinctive ICD–9– CM code. The applicant noted in its application that the device is currently coded with ICD–9–CM procedure codes 36.09 (Other removal of coronary artery obstruction) and 39.50 (Angioplasty or atherectomy of other noncoronary vessels). As we stated in last year’s final rule, section 1886(d)(5)(K)(i) of the Act requires that the Secretary establish a mechanism to recognize the costs of new medical services or technologies under the payment system established under subsection (d) of section 1886, which establishes the system for paying for the operating costs of inpatient hospital services. The system of payment for capital costs is established under section 1886(g) of the Act, which makes no mention of any add-on payments for a new medical service or technology. Therefore, it is not appropriate to include capital costs in the add-on payments for a new medical service or technology, and these costs should not be considered in evaluating whether a technology meets the cost criterion. As a result, we consider only the Safe Cross crossing wire, ground pad, and accessories to be operating equipment that is relevant to the evaluation of the cost criterion. The applicant submitted the following two analyses on the cost criterion. The first analysis contained 27 actual cases PO 00000 Frm 00060 Fmt 4701 Sfmt 4702 from two hospitals. Of these 27 cases, 25.1 percent of the cases were reported in DRGs 24 (Seizure and Headache Age >17 With CC), 107 (Coronary Bypass With Cardiac Catheterization), 125 (Circulatory Disorders Except AMI, With Cardiac Catheterization and Without Complex Diagnosis), 518 (Percutaneous Cardiovascular Procedure Without Coronary Artery Stent or AMI), and 526 (Percutaneous Cardiovascular Procedure With Drug-Eluting Stent With AMI); and 74.9 percent were reported in DRG 527 (Percutaneous Cardiovascular Procedure With Drug-Eluting Stent Without AMI). This resulted in a caseweighted threshold of $35,956 and a case-weighted average standardized charge of $40,319. Because the caseweighted average standardized charge is greater than the case-weighted threshold, the applicant maintained that the Safe Cross meets the cost criterion. The applicant also submitted cases from the FY 2003 MedPAR. The applicant found a total of 1,274,535 cases that could be eligible for the Safe Cross using diagnosis codes 411 through 411.89 (Other acute and subacute forms of ischemic heart disease) or 414 through 414.19 (Other forms of chronic ischemic heart disease) in combination with any of the following procedure codes: 36.01 (Single vessel percutaneous transluminal coronary angioplasty (PTCA) or coronary atherectomy without mention of thrombolytic agent), 36.02 (Single vessel PTCA or coronary atherectomy with mention of thrombolytic agent), 36.05 (Multiple vessel PTCA or coronary atherectomy performed during the same operation with or without mention of thrombolytic agent), 36.06 (Insertion of nondrug-eluting coronary artery stent(s)), 36.07 (Insertion of drug-eluting coronary artery stent(s)) and 36.09 (Other removal of coronary artery obstruction). A total of 59.40 percent of these cases fell into DRG 517 (Percutaneous Cardiovascular Procedure With Nondrug-Eluting Stent Without AMI), 16.4 percent of cases into DRG 516 (Percutaneous Cardiovascular Procedure With AMI), and 16.2 percent of cases into DRG 527, while the rest of the cases fell into the remaining DRGs 124, 518 and 526. The average caseweighted standardized charge per case was $40,318. This amount included an extra $6,000 for the charges related to the Safe Cross. The case-weighed threshold across the DRGs mentioned above was $35,955. Similar to the analysis above, because the caseweighted average standardized charge is greater than the case-weighted E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules threshold, the applicant maintained that the Safe Cross meets the cost criterion. The applicant maintained that the device meets the substantial clinical improvement criterion. The applicant explained that many traditional guidewires fail to cross a total arterial occlusion due to difficulty in navigating the vessel and to the fibrotic nature of the obstructing plaque. By using fiberoptic guidance and radiofrequency ablation, the Safe Cross succeeds where standard guidewires fail. The applicant further maintained that in clinical trials where traditional guidewires failed, the Safe Cross succeeded in 54 percent of cases of coronary artery chronic total occlusions (CTOs), and in 76 percent of cases of peripheral artery CTOs. However, we note that we use similar standards to evaluate substantial clinical improvement in the IPPS and OPPS. The IPPS regulations provide that technology may be approved for add-on payments when it ‘‘represents an advance in medical technology that substantially improves, relative to technologies previously available, the diagnosis or treatment of Medicare beneficiaries’’ (66 FR 46912). Under the OPPS, the standard for approval of new devices is ‘‘a substantial improvement in medical benefits for Medicare beneficiaries compared to the benefits obtained by devices in previously established (that is, existing or previously existing) categories or other available treatments’’ (67 FR 66782). Furthermore, the OPPS and IPPS employ identical language (for IPPS, see 66 FR 46914, and for OPPS, see 67 FR 66782) to explain and elaborate on the kinds of considerations that are taken into account in determining whether a new technology represents substantial improvement. In both systems, we employ the following kinds of considerations in evaluating particular requests for special payment for new technology: • The device offers a treatment option for a patient population unresponsive to, or ineligible for, currently available treatments. • The device offers the ability to diagnose a medical condition in a patient population where that medical condition is currently undetectable or offers the ability to diagnose a medical condition earlier in a patient population than allowed by currently available methods. There must also be evidence that use of the device to make a diagnosis affects the management of the patient. • Use of the device significantly improves clinical outcomes for a patient population as compared to currently VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 available treatments. Some examples of outcomes that are frequently evaluated in studies of medical devices are the following: —Reduced mortality rate with use of the device. —Reduced rate of device-related complications. —Decreased rate of subsequent diagnostic or therapeutic interventions (for example, due to reduced rate of recurrence of the disease process). —Decreased number of future hospitalizations or physician visits. —More rapid beneficial resolution of the disease process treatment because of the use of the device. —Decreased pain, bleeding, or other quantifiable symptom. —Reduced recovery time. In a letter to the applicant dated October 25, 2004, we denied approval of the Safe Cross for pass-through payments for the OPPS on the basis that the technology did not meet the substantial clinical improvement criterion. In particular, we found that studies failed to show long-term or intermediate-term results, and the device had a relatively low rate of successfully opening occlusions. Since that initial determination, the applicant has requested reconsideration for passthrough payments under the IPPS. However, on the basis of the original findings under the OPPS, we do not now believe that the technology can qualify for new technology add-on payments under the IPPS. Therefore, we are proposing to deny new technology add-on payment for FY 2006 for Safe Cross on the grounds that it does not appear to be a substantial clinical improvement over existing technologies. We welcome further information on whether this device meets the substantial clinical improvement criterion, and we will consider any further information prior to making our final determination in the final rule. We received no public comments regarding this application for add-on payments. g. Trident Ceramic Acetabular System Stryker Orthopaedics submitted an application for new technology add-on payments for the Trident Ceramic Acetabular System. This system is used to replace the ‘‘ball and socket’’ joint of a hip when a total hip replacement is performed for patients suffering from arthritis or related conditions. The applicant stated that, unlike conventional hip replacement systems, the Trident system utilizes alumina ceramic-on-ceramic bearing surfaces PO 00000 Frm 00061 Fmt 4701 Sfmt 4702 23365 rather than metal-on-plastic or metal-onmetal. Alumina ceramic is the hardest material next to diamond. The Trident System is a patented design that captures the ceramic insert in a titanium sleeve. This design increases the strength of the ceramic insert by 50 percent over other designs. The manufacturer stated that the alumina ceramic bearing of the device is a substantial clinical improvement because it is extremely hard and scratch resistant, has a low coefficient of friction and excellent wear resistance, has improved lubrication over metal or polyethylene, has no potential for metal ion release, and has less alumina particle debris. The manufacturer also stated that fewer hip revisions are needed when this product is used (2.7 percent of ceramic versus 7.5 percent for polyethylene). Stryker stated that the ceramic implant also causes less osteolysis (or bone loss from particulate debris). Due to these improvements over traditional hip implants, the manufacturer stated the Trident Ceramic Acetabular System has demonstrated significantly lower wear versus the conventional plastic/metal system in the laboratory; therefore, it is anticipated that these improved wear characteristics will extend the life of the implant. The Trident Ceramic Acetabular System received FDA approval in February 3, 2003. However, this product was not available on the market until April 2003. The period that technologies are eligible to receive new technology add-on payment is no less than 2 years but not more than 3 years from the point the product comes on the market. At this point, we begin to collect charges reflecting the cost of the device in the MedPAR data. Because the device became available on the market in April 2003, charges reflecting the cost of the device may have been included in the data used to calculate the DRG weights in FY 2005 and the proposed DRG weights for FY 2006. Therefore, the technology may no longer be considered new for the purposes of new technology add-on payments. For this reason, we are proposing to deny add-on payments for the Trident Ceramic Acetabular System for FY 2006. Although we are proposing not to approve this application because the Trident Ceramic Acetabular System does not meet the newness criterion, we note that the applicant submitted information on the cost and substantial clinical improvement criteria. The applicant submitted cost threshold information for the Trident Ceramic Acetabular System, stating that cases using the system would be E:\FR\FM\04MYP2.SGM 04MYP2 23366 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules included in DRG 209 (Major Joint and Limb Reattachment Procedures of Lower Extremity). The manufacturer indicated that there is not an ICD–9–CM code specific to ceramic hip arthroplasty, but it is currently reported using code 81.51 (Total hip replacement). Of the applicable charges for the Trident Ceramic Acetabular System, only the components that the applicant identified as new would be eligible for new technology add-on payments. The estimated cost of the new portions of the device, according to the information provided in the application, is $6,009. The charge threshold for DRG 209 is $34,195. The data submitted by Stryker Orthopaedics showed an average standardized charge, assuming a 28 percent implant markup, of $34,230. Regarding the issue of substantial clinical improvement, we recognize that the Trident Ceramic Acetabular System represents an incremental advance in prosthetic hip technology. However, we also recognize that there are a number of other new prostheses available that utilize a variety of bearing surface materials that also offer increased longevity and decreased wear. For this reason, we do not believe that the Trident system has demonstrated itself to be a clearly superior new technology. We received the following public comments, in accordance with section 503(b)(2) of Pub. L. 108–173, regarding this application for add-on payments. Comment: One commenter noted that clinical outcomes for the Trident Ceramic Acetabular System are not a significant clinical improvement over similar devices on the market. A member of the orthopedic community noted at the new technology town hall meeting that this system is not the only new product that promises significantly improved results because of enhancements to materials and design. This commenter suggested that it may be inappropriate to recognize only one of these new hip replacement products for new technology add-on payments. Response: We appreciate the commenter’s input on this criterion. We will consider these comments regarding the substantial clinical improvement criterion. However, based on the observations provided at the town hall meeting, we are considering alternative methods of recognizing technological improvements in this area other than approving only one of these new technologies for add-on payments. For example, as discussed in section II.B.6.a. of the preamble to this proposed rule, we are proposing to split DRG 209 to create a new DRG for revisions of hip and knee replacements. We would leave VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 all other replacements and attachment procedures in a separate, new DRG. We also stated that we will be reviewing these DRGs based on new procedure codes that will provide more detailed data on the specific nature of the revision procedures performed. In addition, we are creating new procedure codes that will identify the type of bearing surface of a hip replacement. As we obtain data from these new codes, we will consider additional DRG revisions to better capture the various types of joint procedures. We may consider a future restructuring of the joint replacement and revision DRGs that would better capture the higher costs of products that offer greater durability, extended life, and improved outcomes. In doing so, of course, we may need to create additional, more precise ICD–9–CM codes. We welcome comments on this issue, and generally on whether the Trident Ceramic Acetabular System meets the criteria to qualify for new technology add-on payments. h. Wingspan TM Stent System with Gateway TM PTA Balloon Catheter Boston Scientific submitted an application for the Wingspan TM Stent System with Gateway TM PTA Balloon Catheter for new technology add-on payments. The device is designed for the treatment of patients with intracranial atherosclerotic disease who suffer from recurrent stroke despite medical management. The device consists of the following: a selfexpanding nitinol stent, a multilumen over the wire delivery catheter, and a Gateway PTA Balloon Catheter. The device is used to treat stenoses that occur in the intracranial vessels. Prior to stent placement, the Gateway 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 January 9, 2004, the FDA designated the Wingspan TM as a Humanitarian Use Designation (HUD). The manufacturer has also applied for Humanitarian Device Exemption (HDE) status and expects approval from the FDA in July 2005. It is important to note that currently CMS has a noncoverage policy for percutaneous transluminal angioplasty to treat lesions of intracranial vessels. The applicant is PO 00000 Frm 00062 Fmt 4701 Sfmt 4702 working closely with CMS to review this decision upon FDA approval. Because the device is neither FDAapproved nor Medicare-covered, we do not believe it is appropriate to present our full analysis on whether the technology meets the individual criteria for the new technology add-on payment. However, we note that the applicant did submit the following information below on the cost criterion and substantial clinical improvement criterion. The manufacturer submitted data from MedPAR and non-MedPAR databases. The non-MedPAR data was from the 2003 patient discharge data from California’s Office of Statewide Health Planning and Development database for hospitals in California and from the 2003 patient data from Florida’s Agency for Health Care Administration for hospitals in Florida. The applicant identified cases that had a diagnosis code of 437.0 (Cerebral atherosclerosis), 437.1 (Other generalized ischemic cerebrovascular disease) or 437.9 (Unspecified) or any diagnosis code that begins with the prefix of 434 (Occlusion of cerebral arteries) in combination with procedure code 39.50 (Angioplasty or atherectomy of noncoronary vessel) or procedure code 39.90 (Insertion of nondrugeluting, noncoronary artery stents). The applicant used procedure codes 39.50 and 39.90 because procedure codes 00.62 and 00.65 were not available until FY 2005. The applicant found cases in DRG 5 (Extracranial Vascular Procedures) (which previously existed under the Medicare IPPS DRG system prior to a DRG split) and in DRGs 533 (Extracranial Procedure with CC) and 534 (Extracranial Procedure Without CC). Even though DRG 5 was split into DRGs 533 and 534 in FY 2003, some hospitals continued to use DRG 5 for non-Medicare cases. The applicant found 22 cases that had an intracranial PTA with a stent. The average (nonstandardized) charge per case was $78,363. The applicant also submitted data from the FY 2002 and FY 2003 MedPAR files. Using the latest data from the FY 2003 MedPAR and the same combination of diagnosis and procedure codes mentioned above to identify cases of intracranial PTA with stenting, the applicant found 116 cases in DRG 533 and 20 cases in DRG 534. The caseweighted average standardized charge per case was $51,173. The average caseweighted threshold was $25,394. Based on this analysis, the applicant maintained that the technology meets the cost criteria since the average caseweighted standardized charge per case E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules is greater than the average caseweighted threshold. The applicant also maintained that the technology meets the substantial clinical improvement criterion. Currently, there is no available surgical or medical treatment for recurrent stroke that occurs despite optimal medical management. The Wingspan TM is the first commercially available PTA/stent system designed specifically for the intracranial vasculature. However, because the Wingspan TM does not have FDA approval or Medicare coverage, as stated above, we are proposing to deny add-on payment for this new technology. We received no public comments regarding this application for add-on payments. 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 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 2006 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 should measure the earnings and paid hours of employment by occupational category, and 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 2006 is discussed in section II.B. of the Addendum to this proposed rule. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 As discussed below in section III.G. 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 the wage index. 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 2006 is discussed in section II.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 proposed occupational mix adjustment that we are proposing to apply beginning October 1, 2005 (the proposed FY 2006 wage index) appears under section III.C. of this preamble. B. Core-Based Statistical Areas Used for the Proposed Hospital Wage Index (If you choose to comment on issues in this section, please include the caption ‘‘CBSAs’’ at the beginning of your comment.) 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). OMB defines a CBSA, beginning in 2003, as ‘‘a geographic entity associated with at least one core of 10,000 or more population, plus adjacent territory that has a high degree of social and economic integration with the core as measured by commuting ties.’’ The standards designate and define two categories of CBSAs: Metropolitan Statistical Areas (MSAs) and Micropolitan Statistical Areas (65 FR 82235). According to OMB, MSAs are based on urbanized areas of 50,000 or more population, and Micropolitan Statistical Areas (referred to in this discussion as Micropolitan Areas) are based on urban clusters with a population of at least 10,000 but less than 50,000. Counties that do not fall within CBSAs are PO 00000 Frm 00063 Fmt 4701 Sfmt 4702 23367 deemed ‘‘Outside CBSAs.’’ In the past, OMB defined MSAs around areas with a minimum core population of 50,000, and smaller areas were ‘‘Outside MSAs.’’ The general concept of the CBSAs is that of an area containing a recognized population nucleus and adjacent communities that have a high degree of integration with that nucleus. The purpose of the standards is to provide nationally consistent definitions for collecting, tabulating, and publishing Federal statistics for a set of geographic areas. CBSAs include adjacent counties that have a minimum of 25 percent commuting to the central counties of the area. (This is an increase over the minimum commuting threshold of 15 percent for outlying counties applied in the previous MSA definition.) The new CBSAs established by OMB comprised MSAs and the new Micropolitan Areas based on Census 2000 data. (A copy of the announcement may be obtained at the following Internet address: https:// www.whitehouse.gov/omb/bulletins/ fy04/b04–03.html.) The definitions recognize 49 new MSAs and 565 new Micropolitan Areas, and extensively revised the composition of many of the existing MSAs. The new area designations resulted in a higher wage index for some areas and lower wage index for others. Further, some hospitals that were previously classified as urban are now in rural areas. 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 (69 FR 49027 through 49034). As part of that transition, we allowed urban hospitals that became rural under the new definitions to maintain their assignment to the Metropolitan Statistical Area (MSA) where they were previously located for the 3-year period of FY 2005, FY 2006, and FY 2007. Specifically, these hospitals were assigned the wage index of the urban area to which they previously belonged. (For purposes of wage index computation, the wage data of these hospitals remained assigned to the statewide rural area in which they are located.) The hospitals receiving this transition will not be considered urban hospitals; rather they will maintain their status as rural hospitals. Thus, the hospital would not be eligible, for example, for a large urban add-on payment under the capital PPS. In other words, it is the wage index, but not the urban or rural status, of these hospitals that is being affected by this transition. The higher wage indices that these hospitals are receiving are also being taken into consideration in determining E:\FR\FM\04MYP2.SGM 04MYP2 23368 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules whether they qualify for the outcommuting adjustment discussed in section III.I. of this preamble and the amount of any adjustment. FY 2006 will be the second year of this transition period. We will continue to assign the wage index for the urban area in which the hospital was previously located through FY 2007. In order to ensure this provision remains budget neutral, we will continue to adjust the standardized amount by a transition budget neutrality factor to account for these hospitals. Doing so is consistent with the requirement of section 1886(d)(3)(E) of the Act that any ‘‘adjustments or updates [to the adjustment for different area wage levels] * * * shall be made in a manner that assures that aggregate payments * * * are not greater or less than those that would have been made in the year without such adjustment.’’ Beginning in FY 2008, these hospitals will receive their statewide rural wage index, although they will be eligible to apply for reclassification by the MGCRB, both during this transition period as well as in subsequent years. In addition, in the FY 2005 IPPS final rule (69 FR 49032 through 49033), we provided a 1-year transition blend for hospitals that, due solely to the changes in the labor market definitions, experienced a decrease in their FY 2005 wage index compared to the wage index they would have received using the labor market areas included in calculating their FY 2004 wage index. Hospitals that experienced a decrease in their wage index as a result of adoption of the new labor market area changes received a wage index based on 50 percent of the CBSA labor market area definitions and 50 percent of the wage index that the provider would have received under the FY 2004 MSA boundaries (in both cases using the FY 2001 wage data). This blend applied to any provider experiencing a decrease VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 due to the new definitions, including providers who were reclassifying under MGCRB requirements, section 1886(d)(8)(B) of the Act, or section 508 of Pub. L. 108–173. In the FY 2005 IPPS final rule (69 FR 49027 through 49033), we described the determination of this blend in detail. We noted that this blend would not prevent a decrease in wage index due to any reason other than adoption of CBSAs, nor did it apply to hospitals that benefited from a higher wage index due to the new labor market definitions. Consistent with the FY 2005 IPPS final rule, we are proposing that hospitals receive 100 percent of their wage index based upon the new CBSA configurations beginning in FY 2006. Specifically, we will determine for each hospital a new wage index employing wage index data from FY 2002 hospital cost reports and using the CBSA labor market definitions. C. Proposed Occupational Mix Adjustment to FY 2006 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 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 PO 00000 Frm 00064 Fmt 4701 Sfmt 4702 associated with these choices reflect hospital management decisions rather than geographic differences in the costs of labor. 1. Development of Data for the Proposed Occupational Mix Adjustment In the FY 2005 IPPS final rule (69 FR 49034), we discussed in detail the data we used to calculate the occupational mix adjustment to the FY 2005 wage index. For the FY 2006 wage index, we are proposing to use the same CMS Wage Index Occupational Mix Survey and Bureau of Labor Statistics (BLS) data that we used for the FY 2005 wage index, with two exceptions. The CMS survey requires hospitals to report the number of total paid hours for directly hired and contract employees in occupations that provide the following services: nursing, physical therapy, occupational therapy, respiratory therapy, medical and clinical laboratory, dietary, and pharmacy. These services each include several standard occupational classifications (SOCs), as defined by the BLS’ Occupational Employment Statistics (OES) survey. For the proposed FY 2006 wage index, we used revised survey data for 20 hospitals that took advantage of the opportunity we afforded hospitals to submit changes to their occupational mix data during the FY 2006 wage index data collection process (see discussion of wage data corrections process under section III.J. of this preamble). We also excluded survey data for hospitals that became designated as CAHs since the original survey data were collected and hospitals for which there are no corresponding cost report data for the proposed FY 2006 wage index. The proposed FY 2006 wage index includes occupational mix data from 3,563 out of 3,765 hospitals (94.6 percent response rate). The results of the occupational mix survey are included in the chart below: E:\FR\FM\04MYP2.SGM 04MYP2 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00065 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 23369 EP04my05.026</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23370 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 2. Calculation of the Proposed FY 2006 Occupational Mix Adjustment Factor and the Proposed FY 2006 Occupational Mix Adjusted Wage Index For the proposed FY 2006 wage index, we are proposing to use the same methodology that we used to calculate the occupational mix adjustment to the FY 2005 wage index (69 FR 49042). We are proposing to use the following steps for calculating the proposed FY 2006 occupational mix adjustment factor and the occupational mix adjusted wage index: Step 1—For each hospital, the percentage of the general service category attributable to an SOC is determined by dividing the SOC hours by the general service category’s total hours. Repeat this calculation for each of the 19 SOCs. Step 2—For each hospital, the weighted average hourly rate for an SOC is determined by multiplying the percentage of the general service category (from Step 1) by the national average hourly rate for that SOC from the 2001 BLS OES survey, which was used in calculating the occupational mix adjustment for the FY 2005 wage index. The 2001 OES survey is BLS’ latest available hospital-specific survey. (See Chart 4 in the FY 2005 IPPS final rule, 69 FR 49038.) Repeat this calculation for each of the 19 SOCs. Step 3—For each hospital, the hospital’s adjusted average hourly rate for a general service category is computed by summing the weighted hourly rate for each SOC within the general category. Repeat this calculation for each of the 7 general service categories. Step 4—For each hospital, the occupational mix adjustment factor for a general service category is calculated by dividing the national adjusted average hourly rate for the category by the hospital’s adjusted average hourly rate for the category. (The national adjusted average hourly rate is computed in the same manner as Steps 1 through 3, using instead, the total SOC and general service category hours for all hospitals in the occupational mix survey database.) Repeat this calculation for each of the 7 general service categories. If the hospital’s adjusted rate is less than the national adjusted rate (indicating the hospital employs a less costly mix of employees within the category), the occupational mix adjustment factor will be greater than 1.0000. If the hospital’s adjusted rate is greater than the national adjusted rate, the occupational mix adjustment factor will be less than 1.0000. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Step 5—For each hospital, the occupational mix adjusted salaries and wage-related costs for a general service category is calculated by multiplying the hospital’s total salaries and wagerelated costs (from Step 5 of the unadjusted wage index calculation in section F) by the percentage of the hospital’s total workers attributable to the general service category and by the general service category’s occupational mix adjustment factor (from Step 4 above). Repeat this calculation for each of the 7 general service categories. 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 for occupational mix. Step 6—For each hospital, the total occupational mix adjusted salaries and wage-related costs for a hospital are calculated by summing the occupational mix adjusted salaries and wage-related costs for the 7 general service categories (from Step 5) and the unadjusted portion of the hospital’s salaries and wage-related costs for all other employees. 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 F). Step 7—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 8—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. The proposed national occupational mix adjusted average hourly wage for FY 2006 is $27.9988. Step 9—To compute the occupational mix adjusted wage index, divide each area’s occupational mix adjusted average hourly wage (Step 7) by the national occupational mix adjusted average hourly wage (Step 8). Step 10—To compute the Puerto Rico specific occupational mix adjusted wage index, follow the Steps 1 through 9 above. The proposed Puerto Rico occupational mix adjusted average hourly wage for FY 2006 is $12.9875. PO 00000 Frm 00066 Fmt 4701 Sfmt 4702 An example of the occupational mix adjustment was included in the FY 2005 IPPS final rule (69 FR 49043). For the FY 2005 final wage index, we used the unadjusted wage data for hospitals that did not submit occupational mix survey data. For calculation purposes, this equates to applying the national SOC mix to the wage data for these hospitals, because hospitals having the same mix as the Nation would have an occupational mix adjustment factor equaling 1.0000. In the FY 2005 IPPS final rule (69 FF 49035), we noted that we would revisit this matter with subsequent collections of the occupational mix data. Because we are using essentially the same survey data for the proposed FY 2006 occupational mix adjustment that we used for FY 2005, with the only exceptions as stated in section III.C.1. of this preamble, we are proposing to treat the wage data for hospitals that did not respond to the survey in this same manner for the proposed FY 2006 wage index. In implementing an occupational mix adjusted wage index based on the above calculation, the proposed wage index values for 14 rural areas (29.8 percent) and 206 urban areas (53.5 percent) would decrease as a result of the adjustment. Six (6) rural areas (12.8 percent) and 111 urban areas (28.8 percent) would experience a decrease of 1 percent or greater in their wage index values. The largest negative impact for a rural area would be 1.9 percent and for an urban area, 4.3 percent. Meanwhile, 33 rural areas (70.2 percent) and 179 urban areas (46.5 percent) would experience an increase in their wage index values. Although these results show that rural hospitals would gain the most from an occupational mix adjustment to the wage index, their gains may not be as great as might have been expected. Further, it might not have been anticipated that almost onethird of rural hospitals would actually fare worse under the adjustment. Overall, a fully implemented occupational mix adjusted wage index would have a redistributive effect on Medicare payments to hospitals. In the FY 2005 IPPS, we indicated that, for future data collections, we would revise the occupational mix survey to allow hospitals to provide both salaries and hours data for each of the employment categories that are included on the survey. We also indicated that we would assess whether future occupational mix surveys should be based on the calendar year or if the data should be collected on a fiscal year basis as part of the Medicare cost report. (One logistical problem is that cost E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules report data are collected yearly, but occupational mix survey data are collected only every 3 years.) We are currently reviewing options for revising the occupational mix survey and improving the data collection process. We will publish any changes we make to the occupational mix survey in a Federal Register notice. In our continuing efforts to meet the information needs of the public, we are providing three additional public use files for the proposed occupational mix adjusted wage index: (1) A file including each hospital’s unadjusted and adjusted average hourly wage (FY 2006 Proposed Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wage by Provider); (2) a file including each CBSA’s adjusted and unadjusted average hourly wage (FY 2006 Proposed Rule Occupational Mix Adjusted and Unadjusted Average Hourly Wage and Pre-Reclassified Wage Index by CBSA); and (3) a file including each hospital’s occupational mix adjustment factors by occupational category (Provider Occupational Mix Adjustment Factors for Each Occupational Category). These additional files are being released concurrently with the publication of this proposed rule and are posted on the Internet, at https://www.cms.hhs.gov/ providers/hipps/ippswage.asp. We will also post these files with future applications of the occupational mix adjustment. D. Worksheet S–3 Wage Data for the Proposed FY 2006 Wage Index Update (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 2006 wage index values (effective for hospital discharges occurring on or after October 1, 2005 and before October 1, 2006) in section VI. 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 2002 (the FY 2005 wage index was based on FY 2001 wage data). The proposed FY 2006 wage index includes the following categories of data associated with costs paid under the IPPS (as well as outpatient costs): • Salaries and hours from short-term, acute care hospitals (including paid lunch hours and hours associated with military leave and jury duty). • Home office costs and hours. • Certain contract labor costs and hours (which includes direct patient care, certain top management, pharmacy, laboratory, and nonteaching physician Part A services). VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 • Wage-related costs, including pensions and other deferred compensation costs. The September 1, 1994 Federal Register (59 FR 45356) included a list of core wage-related costs that are included in the wage index, and discussed criteria for including other wage-related costs. In that discussion, we instructed hospitals to use generally accepted accounting principles (GAAPs) in developing wage-related costs for the wage index for cost reporting periods beginning on or after October 1, 1994. We discussed our rationale that ‘‘the application of GAAPs for purposes of compiling data on wage-related costs used to construct the wage index will more accurately reflect relative labor costs, because certain wage-related costs (such as pension costs), as recorded under GAAPs, tend to be more static from year to year.’’ Since publication of the September 1, 1994 rule, we have periodically received inquiries for more specific guidance on developing wage-related costs for the wage index. In response, we have provided clarifications in the IPPS rules (for example, health insurance costs (66 FR 39859)) and in the cost report instructions (Provider Reimbursement Manual (PRM), Part II, Section 3605.2). Due to recent questions and concerns we received regarding inconsistent reporting and overreporting of pension and other deferred compensation plan costs, as a result of an ongoing Office of Inspector General review, we are clarifying in this proposed rule that hospitals must comply with the PRM, Part I, sections 2140. 2141, and 2142 and related Medicare program instructions for developing pension and other deferred compensation plan costs as wage-related costs for the wage index. The Medicare instructions for pension costs and other deferred compensation costs combine GAAPs, Medicare payment principles, and other Federal labor requirements. We believe that the Medicare instructions allow for consistent reporting among hospitals and for the development of reasonable deferred compensation plan costs for purposes of the wage index. Beginning with the FY 2007 wage index, hospitals and fiscal intermediaries must ensure that pension, post-retirement health benefits, and other deferred compensation plan costs for the wage index are developed according to the above terms. Consistent with the wage index methodology for FY 2005, the proposed wage index for FY 2006 also excludes the direct and overhead salaries and hours for services not subject to IPPS payment, such as SNF services, home PO 00000 Frm 00067 Fmt 4701 Sfmt 4702 23371 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 2006 wage index 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). 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 rehabilitation, psychiatric, and long-term care hospitals, and for hospital outpatient services. In the August 11, 2004 final rule, we stated that a commenter had asked CMS to designate provider-based clinics as IPPS-excluded areas in order to remove the costs from the wage index (69 FR 49049). The commenter noted that provider-based clinics are like physician private offices, which are excluded from the wage index calculation, and that services provided in the provider-based clinics are paid for not through the IPPS, but rather under the hospital outpatient PPS. In response to the comment, we stated that we were not prepared to grant the commenter’s request without first studying the issue, and that we would explore the matter of salaries related to provider-based clinics in a future rule. Regulations at 42 CFR 413.65 describe the criteria and procedures for determining whether a facility or organization is provider-based. Historically, under the Medicare program, some providers, referred to as ‘‘main providers,’’ have functioned as single entities while owning and operating multiple provider-based departments, locations, and facilities that are treated as part of the main provider for Medicare purposes. Section 413.65(a)(2) defines various types of provider-based facilities, including ‘‘department of a provider.’’ A ‘‘department of a provider’’ means a facility or organization that is either created by, or acquired by, a main provider for the purposes of furnishing health care services of the same type as those furnished by the main provider under the name, ownership, and financial and administrative control of the main provider * * * a department E:\FR\FM\04MYP2.SGM 04MYP2 23372 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules of a provider may not itself be qualified to participate in Medicare as a provider under § 489.2 * * * the term ‘department of a provider’ does not include an RHC or * * * an FQHC.’’ Thus, if a facility offers services that are similar to those provided in a freestanding physician’s office, and the facility meets the criteria to become provider-based under § 413.65, the facility would be considered a ‘‘department of a provider.’’ More specifically, the facility would be part of the main provider’s outpatient department, since the facility offers health care services of the same type as those furnished by the main provider, and because a physician’s office would not be subject to a provider agreement or receive a Medicare provider number under § 489.2. (We note that a providerbased RHC or FQHC may, by itself, be qualified to participate in Medicare as a provider under § 489.2 and, thus, would be classified not as a ‘‘department of a provider’’ but as a ‘‘provider-based entity,’’ as defined at § 413.65(a)(2)). This provider-based facility, or provider-based clinic, as the commenter referred to it, would be reported on the main provider’s Medicare cost report as an outpatient service cost center, on Worksheet A, line 60. With the exception of RHC and FQHC salaries that have been excluded from the wage index beginning with FY 2004 (68 FR 45395, August 1, 2003), the salaries attributable to employees working in these outpatient service cost centers, including emergency departments, are included in the main provider’s total salaries on Worksheet S–3, Part II, line 1, and accordingly, are included in the wage index calculation. We have historically included the salaries and wages of hospital employees working in the outpatient departments in the calculation of the hospital wage index since these employees often work in both the IPPS and in the outpatient areas of the hospital. Consistent with this longstanding treatment of outpatient salary costs in the wage index calculation, we believe it is appropriate to continue to include the salaries and wages of employees working in outpatient departments, including provider-based clinics, in the wage index calculation. E. Verification of Worksheet S–3 Wage Data (If you choose to comment on issues in this section, please include the caption ‘‘Wage Data’’ at the beginning of your comment.) The wage data for the proposed FY 2006 wage index were obtained from Worksheet S–3, Parts II and III of the FY VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 2002 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 2002 data submitted to us as of February 23, 2005. As in past years, we performed an intensive review of the wage data, mostly through the use of edits designed to identify aberrant data. We asked our fiscal intermediaries to revise or verify data elements that resulted in specific edit failures. Some unresolved data elements are included in the calculation of the proposed FY 2006 wage index, pending their resolution before calculation of the final FY 2006 index. We instructed the fiscal intermediaries to complete their data verification of questionable data elements and to transmit any changes to the wage data no later than April 15, 2005. We believe all unresolved data elements will be resolved by the date the final rule is issued. The revised data will be reflected in the final rule. Also, as part of our editing process, we removed the data for 438 hospitals from our database: 402 hospitals became CAHs by the time we published the February public use file, and 28 hospitals were low Medicare utilization hospitals or failed edits that could not be corrected because the hospitals terminated the program or changed ownership. In addition, we removed the wage data for 8 hospitals with incomplete or inaccurate data resulting in zero or negative, or otherwise aberrant, average hourly wages. We have notified the fiscal intermediaries of these hospitals and will continue to work with the fiscal intermediaries to correct these data until we finalize our database to compute the final wage index. The data for these hospitals will be included in the final wage index if we receive corrected data that passes our edits. As a result, the proposed FY 2006 wage index is calculated based on FY 2002 wage data from 3,765 hospitals. In constructing the proposed FY 2006 wage index, we include the wage data for facilities that were IPPS hospitals in FY 2002, 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). The proposed wage index in this PO 00000 Frm 00068 Fmt 4701 Sfmt 4702 proposed rule excludes hospitals that are designated as CAHs by February 1, 2005, the date of the latest available Medicare CAH listing at the time we released the proposed wage index public use file on February 25, 2005. F. Computation of the Proposed FY 2006 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.) The method used to compute the proposed FY 2006 wage index without an occupational mix adjustment follows: Step 1—As noted above, we based the proposed FY 2006 wage index on wage data reported on the FY 2002 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, 2001 and before October 1, 2002. In addition, we included data from some hospitals that had cost reporting periods beginning before October 2001 and reported a cost reporting period covering all of FY 2002. These data were 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 2002 data. We note that, if a hospital had more than one cost reporting period beginning during FY 2002 (for example, a hospital had two short cost reporting periods beginning on or after October 1, 2001 and before October 1, 2002), we included 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 included 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 subtracted 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 excluded salaries reported on Lines 8 and 8.01 (that is, direct salaries attributable to SNF services, home health services, and other subprovider components not E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules subject to the IPPS). We also subtracted from Line 1 the salaries for which no hours were reported. To determine total salaries plus wage-related costs, we added 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 wagerelated costs reported by the 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 were 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 computed 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 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 then allocated overhead costs to areas of the hospital excluded from the wage index calculation. First, we determined 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 computed 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 computed the amounts of overhead wage-related costs to be allocated to excluded areas using three steps: (1) We determined 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 computed 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 multiplied the computed overhead wage-related costs by the above excluded area hours ratio. Finally, we subtracted the computed overhead salaries, wage-related costs, and hours PO 00000 Frm 00069 Fmt 4701 Sfmt 4702 23373 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 adjusted the total salaries plus wagerelated costs to a common period to determine total adjusted salaries plus wage-related costs. To make the wage adjustment, we estimated the percentage change in the employment cost index (ECI) for compensation for each 30-day increment from October 14, 2001 through April 15, 2003 for private industry hospital workers from the Bureau of Labor Statistics’ 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. The factors used to adjust the hospital’s data were based on the midpoint of the cost reporting period, as indicated below. E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules For example, the midpoint of a cost reporting period beginning January 1, 2002 and ending December 31, 2002 is June 30, 2002. An adjustment factor of 1.03083 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 2002 and covered a period of less than 360 days or more than 370 days, we annualized 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 was 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 added the total adjusted salaries plus wage-related costs obtained in Step 5 for all hospitals in VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 that area to determine the total adjusted salaries plus wage-related costs for the labor market area. Step 7—We divided 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 added the total adjusted salaries plus wage-related costs obtained in Step 5 for all hospitals in the nation and then divided the sum by the national 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 $27.9730. Step 9—For each urban or rural labor market area, we calculated the hospital wage index value by dividing the area average hourly wage obtained in Step 7 by the national average hourly wage computed in Step 8. PO 00000 Frm 00070 Fmt 4701 Sfmt 4702 Step 10—Following the process set forth above, we developed 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 added the total adjusted salaries plus wage-related costs (as calculated in Step 5) for all hospitals in Puerto Rico and divided the sum by the total hours for Puerto Rico (as calculated in Step 4) to arrive at an overall proposed average hourly wage of $12.9957 for Puerto Rico. For each labor market area in Puerto Rico, we calculated 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. E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.027</GPH> 23374 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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. Furthermore, this wage index floor is to be implemented in such a manner as to ensure that aggregate IPPS payments are not greater or less than those that would have been made in the year if this section did not apply. For FY 2006, this change affects 147 hospitals in 52 urban areas. The areas affected by this provision are identified by a footnote in Table 4A in the Addendum of this proposed rule. G. Computation of the Proposed FY 2006 Blended Wage Index (If you choose to comment on issues in this section, please include the caption ‘‘Blended Wage Index’’ at the beginning of your comments.) For the final FY 2005 wage index, we used a blend of the occupational mix adjusted wage index and the unadjusted wage index. Specifically, we adjusted 10 percent of the FY 2005 wage index adjustment factor by a factor reflecting occupational mix. Given that 2003–2004 was the first time for the administration of the occupational mix survey, hospitals had a short timeframe for collecting their occupational mix survey data and documentation, the wage data were not in all cases from a 1-year period, and there was no baseline data for purposes of developing a desk review program, we found it prudent not to adjust the entire wage index factor by the occupational mix. However, we did find the data sufficiently reliable for applying an adjustment to 10 percent of the wage index. We found the data reliable because hospitals were given an opportunity to review their survey data and submit changes in the Spring of 2004, hospitals were already familiar with the BLS OES survey categories, hospitals were required to be able to provide documentation that could be used by fiscal intermediaries to verify survey data, and the results of our survey were consistent with the findings of the 2001 BLS OES survey, especially for nursing and physical therapy categories. In addition, we noted that we were moving cautiously with implementing the occupational mix adjustment in recognition of changing trends in hiring nurses, the largest group in the survey. We noted that some States had recently established floors on the minimum level of registered nurse staffing in hospitals in order to maintain licensure. In addition, in some rural VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 areas, we believed that hospitals might be accounting for shortages of physicians by hiring more registered nurses. (A complete discussion of the FY 2005 wage index adjustment factor can be found in section III.G. of the FY 2005 IPPS final rule (69 FR 49052)). In the FY 2005 final rule, we noted that while the statute required us to collect occupational mix data every 3 years, the statute does not specify how the occupational mix adjustment is to be constructed or applied. We are clarifying in this proposed rule that the October 1, 2004 deadline for implementing an occupational mix adjustment is not codified in section 1886(d)(3)(E) of the Act, which requires only a collection and measurement of occupational mix data, but rather stems from the effective date provisions in section 304(c) of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000, Pub. L. 106–554 (BIPA). Although we believe that applying the occupational mix to 10 percent of the wage index factor fully implements the occupational mix adjustment, we also interpret BIPA as requiring only that we begin applying an adjustment by October 1, 2004. BIPA required the Secretary to complete, ‘‘by not later than September 30, 2003, for application beginning October 1, 2004,’’ both the collection of occupational mix data and the measurement of such data. (BIPA, section 304(c)(3).) Thus, even if adjusting 10 percent of the wage index for occupational mix were not (as we believe it to be) considered to be full implementation of the BIPA effective date, we certainly began our application of the adjustment as of October 1, 2004. In addition, section 1886(d)(3)(E) of the Act provides broad authority for us to establish the factor we use to adjust hospital costs to take into account area differences in wage levels. The statute is clear that the wage index factor is to be ‘‘established by the Secretary.’’ The occupational mix is only one part of this wage index factor, which, for the most part, is calculated on the basis of average hourly wage data submitted by all hospitals in the United States. In exercising the Secretary’s broad discretion to establish the factor that adjusts for geographic wage differences, in FY 2005 we adjusted 10 percent of such factor to account for occupational mix. Indeed, we have often used percentage figures or blended amounts in exercising the Secretary’s authority to establish the factor that adjusts for wage differences. For example, in the FY 2005 final rule, we implemented new mapping boundaries for assigning PO 00000 Frm 00071 Fmt 4701 Sfmt 4702 23375 hospitals to the geographic labor market areas used for calculating the wage index. For hospitals that were harmed by the new geographic boundaries, we used a blended rate based on 50 percent of the wage index that would apply using the new geographic boundaries effective for FY 2005 and 50 percent of the wage index that would apply using the old geographic boundaries that were effective during FY 2004 (69 FR 49033). Similarly, beginning with FY 2000, we began phasing out costs related to GME and CRNAs from the wage index (64 FR 41505). Thus, for example, the FY 2001 wage index was based on a blend of 60 percent of an average hourly wage including these costs, and 40 percent of an average hourly wage excluding these costs (65 FR 47071). For FY 2006, we are again proposing to adjust 10 percent of the wage index factor for occupational mix. In computing the occupational mix adjustment for the proposed FY 2006 wage index, we used the occupational mix survey data that we collected for the FY 2005 wage index, replacing the survey data for 20 hospitals that submitted revised data, and excluding the survey data for hospitals with no corresponding Worksheet S–3 wage data for FY 2006 wage index. While we considered adjusting 100 percent of the wage index by the occupational mix, we did not believe it was appropriate to use first-year survey data to make such a large adjustment. As hospitals gain additional experience with the occupational mix survey, and as we develop more information upon which to audit the data we receive, we expect to increase the portion of the wage index that is adjusted. We also acknowledge the District Court opinion in Bellevue Hospital Center v. Leavitt, No. 04–8639 (S.D.N.Y, March 2005) finding that the statute requires full implementation of the occupational mix adjustment beginning October 1, 2004, and granting summary judgment to plaintiffs on the matter. At the time this proposed rule was written, an appeal had not yet been heard in the Circuit Court. Thus, because it was not yet clear whether the decision would be appealed, we determined that, for FY 2006, we would continue to propose the policy we believe to be most prudent in light of the survey data being used to adjust the wage index. With 10 percent of the proposed FY 2006 wage index adjusted for occupational mix, the wage index values for 13 rural areas (27.7 percent) and 204 urban areas (53.0 percent) would decrease as a result of the adjustment. These decreases would be minimal; the largest negative impact for E:\FR\FM\04MYP2.SGM 04MYP2 23376 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules a rural area would be 0.19 percent and for an urban area, 0.42 percent. Conversely, 34 rural areas (72.3 percent) and 181 urban areas (47.0 percent) would benefit from this adjustment, with 1 urban area increasing 2.1 percent and 1 rural area increasing 0.39 percent. As there are no significant differences between the FY 2005 and the FY 2006 occupational mix survey data and results, we believe it is appropriate to again apply the occupational mix to 10 percent of the proposed FY 2006 wage index. (See Appendix A to this proposed rule for further analysis of the impact of the occupational mix adjustment on the proposed FY 2006 wage index.) The 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 occupational mix adjustment. H. Proposed Revisions to the Wage Index Based on Hospital Redesignation (If you choose to comment on issues in this section, please include the caption ‘‘Hospital Redesignations and Reclassifications’’ at the beginning of your comment.) 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. 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. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 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 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 below under section III.H.5. of this preamble. 2. Effects of Reclassification 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,3 the wage index values were 3 Although section 1886(d)(8)(C)(iv)(I) of the Act also provides that the wage index for an urban area may not decrease as a result of redesignated hospitals if the urban area wage index is already below the wage index for rural areas in the State in which the urban area is located, the provision was effectively made moot by section 4410 of Pub. L. 105–33, which 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 in that State. Also, section 1886(d)(8)(C)(iv)(II) of the Act provides that an urban area’s wage index may not decrease as a result of redesignated hospitals if the urban area is located in a State that is composed of a single urban area. PO 00000 Frm 00072 Fmt 4701 Sfmt 4702 determined by considering the following: • 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. • 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. • 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. • 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. • 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. 3. Proposed Application of Hold Harmless Protection for Certain Urban Hospitals Redesignated as Rural Section 401(a) of Pub. L. 106–113 (the Balanced Budget Refinement Act of 1999) amended section 1886(d)(8) of the Act by adding paragraph (E). Section 401(a) created a mechanism that permits an urban hospital to apply to the Secretary to be treated, for purposes of subsection (d), as being located in the rural area of the State in which the hospital is located. A hospital that is granted redesignation under section 1886(d)(8)(E) of the Act, as added by section 401 of Pub. L. 106–113 is, therefore, treated as a rural hospital for E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules all purposes of payment under the Medicare IPPS, including the standardized amount, wage index, and disproportionate share calculations as of the effective date of the redesignation. Under current policy, as a result of an approved redesignation of an urban hospital as a rural hospital, the wage index data are excluded from the wage index calculation for the area where the urban hospital is geographically located and included in the rural hospital wage index calculation. Last year, we became aware of an instance where the approved redesignation of an urban hospital as rural under section 1886(d)(8)(E) of the Act resulted in the hospital’s data having an adverse impact on the rural wage index. We received a public comment noting that specific ‘‘hold harmless’’ provisions apply to reclassifications that occur under section 1886(d)(8)(B) and section 1886(d)(10) of the Act. That is, if a hospital is granted geographic reclassification under section 1886(d)(8)(B) or section 1886(d)(10) of the Act, there are certain rules that apply when the inclusion of the hospital’s data results in a reduction of the reclassification area’s wage index, and these rules are slightly different for urban areas versus rural areas. These rules are more fully described in the FY 2005 IPPS final rule (69 FR 49053). Generally stated, these rules prevent a rural area from being adversely affected as a result of reclassification. That is, if excluding the reclassifying hospitals’ wage data would decrease the wage index of the rural area, the reclassifying hospitals are included in the rural area’s wage index. Otherwise, the reclassifying hospitals are excluded. For hospitals reclassifying out of urban areas, the rules provide that the wage data for the reclassified urban hospital is included in the wage index calculation of the urban area where the hospital is physically located. The commenter recommended that we revise our regulations and apply similar hold harmless provisions and treat hospitals redesignated under 1886(d)(8)(E) of the Act in the same manner as reclassifications under section 1886(d)(8)(B) and section 1886(d)(10) of the Act. In our continued effort to promote consistency, equity and to simplify our rules with respect to how we construct the wage indexes of rural and urban areas, we are persuaded that there is a need to modify our policy when hospital redesignations occur under section 1886(d)(8)(E) of the Act. Therefore, for the FY 2006 wage index, we are proposing to apply the hold harmless rule that currently applies VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 when rural hospitals are reclassifying out of the rural area (from rural to urban) to situations where hospitals are reclassifying into the rural area (from urban to rural under section 1886(d)(8)(E) of the Act). Thus, the rule would be that the wage data of the urban hospital reclassifying into the rural area is included in the rural area’s wage index, if including the urban hospital’s data increases the wage index of the rural area. Otherwise, the wage data is excluded. Similarly, we are proposing to apply to these cases the rule that currently applies when urban hospitals reclassify under the MGCRB process. Thus, the wage data for an urban hospital reclassifying under section 1886(d)(8)(E) of the Act is always included in the wage index of the urban area where the hospital is located, and can also be included in the wage index of the rural area to which it is reclassifying (if doing so increases the rural area’s wage index). We believe this proposal provides uniformity in the way geographic areas are treated under all types of reclassifications. In addition, our proposal promotes predictability by alleviating fluctuations in the wage indexes due to a section 401 redesignation. We are including in the Addendum to this proposed rule Table 9C, which shows hospitals redesignated under section 1886(d)(8)(E) of the Act. 4. FY 2006 MGCRB Reclassifications At the time this proposed rule was constructed, the MGCRB had completed its review of FY 2006 reclassification requests. There were 295 hospitals approved for wage index reclassifications by the MGCRB for FY 2006. Because MGCRB wage index reclassifications are effective for 3 years, hospitals reclassified during FY 2004 or FY 2005 are eligible to continue to be reclassified based on prior reclassifications to current MSAs during FY 2006. There were 395 hospitals reclassified for wage index for FY 2005, and 94 hospitals reclassified for wage index in FY 2004. Some of the hospitals that reclassified in FY 2004 and FY 2005 have elected not to continue their reclassifications in FY 2006 because, under the new 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 2004, FY 2005, and FY 2006, 672 hospitals will be in a reclassification status for FY 2006. 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 PO 00000 Frm 00073 Fmt 4701 Sfmt 4702 23377 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 RRCs 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.) 5. Proposed FY 2006 Redesignations 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 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 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. On June 6, 2003, OMB announced the new CBSAs based on Census 2000 data. For FY 2005, we used 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. We presented this listing, effective for discharges occurring on or after October 1, 2004 (FY 2005), in Chart 6 of the FY 2005 final rule (69 FR 49057). However, Chart 6 in the FY 2005 final rule contained a printing error in which we misidentified rural counties that qualified for redesignation under E:\FR\FM\04MYP2.SGM 04MYP2 23378 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules section 1886(d)(8)(B) of the Act. The list of rural counties qualifying to be urban in that Chart 6 incorrectly included Monroe, PA and Walworth, WI. This error was made only in the chart and not in the application of the rules; that is, we correctly applied the rules to the correct rural counties qualifying to be urban for FY 2005. In addition, we discovered that, in the FY 2005 IPPS final rule, we had erroneously printed the names of the VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 entire Metropolitan Statistical Areas rather than the Metropolitan Division names. Because we recognized Metropolitan Divisions as MSAs in the FY 2005 IPPS final rule (69 FR 49029), we should have printed the division names for the following counties: Henry, FL; Starke, IN; Henderson, TX; Fannin, TX; and Island, WA. The chart below contains the corrected listing of the rural counties designated as urban under section PO 00000 Frm 00074 Fmt 4701 Sfmt 4702 1886(d)(8)(B) of the Act that we are proposing to use for FY 2006. We are proposing that, for discharges occurring on or after October 1, 2005, 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. BILLING CODE 4120–01–P E:\FR\FM\04MYP2.SGM 04MYP2 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00075 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 23379 EP04MY05.028</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23380 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00076 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.029</GPH> BILLING CODE 4120–01–C 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 of 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 MGCRB reclassification within 45 days of the publication of this proposed rule. 6. Reclassifications Under Section 508 of Pub. L. 108–173 Under section 508 of Pub. L. 108–173, a qualifying hospital could appeal the 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 are applicable to discharges occurring during the 3-year period beginning April 1, 2004 and ending March 31, 2007. Under section 508(b), reclassifications under this process do not affect the wage index computation for any area or for any other hospital and cannot be effected in a budget neutral manner. We show the reclassifications effective under the one-time appeal process in Table 9B in the Addendum to this proposed rule. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 I. Proposed FY 2006 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, 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 IPPS budget neutrality requirements at section 1886(d)(3)(E) or section 1886(d)(8)(D) of the Act. Hospitals located in counties that qualify for the wage index adjustment are to receive an increase in the wage PO 00000 Frm 00077 Fmt 4701 Sfmt 4702 23381 index that is equal to the average of the differences between the wage indexes of the labor market area(s) with higher wage indexes 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. We have employed the prereclassified wage indexes in making these calculations. We are proposing that hospitals located in the qualifying counties identified in Table 4J in the Addendum to this proposed rule that have not already reclassified through section 1886(d)(10) of the Act, redesignated through section 1886(d)(8) of the Act, received a section 508 reclassification, or requested to waive the application of the out-migration adjustment would receive the wage index adjustment listed in the table for FY 2006. We used the same formula described in the FY 2005 final rule (69 FR 49064) to calculate the out-migration adjustment. This proposed adjustment was calculated as follows: Step 1. Subtract the wage index for the qualifying county from the wage index for the higher wage area(s). 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. 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 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.030</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23382 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules employed in any higher wage index area. The proposed adjustments calculated for qualifying hospitals are listed in Table 4J in the Addendum to this proposed rule. These proposed adjustments would be effective for each county for a period of 3 fiscal years. Hospitals that received the adjustment in FY 2005 will be eligible to retain that same adjustment for FY 2006 and FY 2007. For hospitals in newly qualified counties, adjustments to the wage index would be effective for 3 years, beginning with discharges occurring on or after October 1, 2005. As previously noted, hospitals receiving the wage index adjustment under section 1886(d)(13)(F) of the Act are not eligible for reclassification under section 1886(d)(10) of the Act or reclassifications under section 508 of Pub. L. 108–173. Hospitals that wish to waive the application of this wage index adjustment must notify CMS within 45 days of the publication of this proposed rule. Waiver notification 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. We will assume that hospitals that have been redesignated under section 1886(d)(8) of the Act or reclassified under section 886(d)(10) of the Act or under section 508 of Pub. L. 108–173 would prefer to keep their redesignation/reclassification unless they explicitly notify CMS that they would like to receive the out-migration adjustment instead. In addition, hospitals that wish to retain their redesignation/reclassification (instead of receiving the out-migration adjustment) for FY 2006 do not need to submit a formal request to CMS, and will automatically retain their redesignation/ reclassification status for FY 2006. However, consistent with § 412.273, hospitals that have been reclassified by the MGCRB are permitted to withdraw their applications within 45 days of the publication of this proposed rule. Hospitals that have been reclassified by the MGCRB (including reclassifications under section 508 of Pub. L. 108–173) may terminate an existing 3-year reclassification within 45 days of the publication of this proposed rule in order to receive the wage index adjustment under this provision. Hospitals that are eligible to receive the wage index adjustment and that withdraw their application for reclassification will then automatically receive the wage index adjustment listed in Table 4J in the Addendum to VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 this proposed rule. The request for withdrawal of an application for reclassification or termination of an existing 3-year reclassification that would be effective in FY 2006 must be received by the MGCRB within 45 days of the publication of this proposed rule. Hospitals should carefully review the wage index adjustment that they would receive under this provision (as listed in Table 2 in the Addendum to this proposed rule) in comparison to the wage index adjustment that they would receive under the MGCRB reclassification (Table 9 in the Addendum to this proposed rule). J. 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.) In the FY 2005 IPPS final rule (68 FR 27194), we revised the process and timetable for application for development of the wage index, beginning with the FY 2005 wage index. The preliminary and unaudited Worksheet S–3 wage data and occupational mix survey files were made available on October 8, 2004 through the Internet on the CMS Web site at: https://cms.hhs.gov/providers/ hipps/ippswage.asp. In a memorandum dated October 6, 2004, we instructed all Medicare 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 8, 2004 wage and occupational mix data files, the hospital was to submit corrections along with complete, detailed supporting documentation to its fiscal intermediary by November 29, 2004. 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, 2004 memorandum referenced above. In the October 6, 2004 memorandum, we also specified that a hospital could only request revisions to the occupational mix data for the reporting period that the hospital used in its original FY 2005 wage index occupational mix survey. That is, a hospital that submitted occupational PO 00000 Frm 00078 Fmt 4701 Sfmt 4702 mix data for the 12-month reporting period could not switch to submitting data for the 4-week reporting period and vice versa. Further, a hospital could not submit an occupational mix survey for the periods beginning before January 1, 2003, or after January 11, 2004. In addition, a hospital that did not submit an occupational mix survey for the FY 2005 wage index was not permitted to submit a survey for the FY 2006 wage index. The fiscal intermediaries notified the hospitals by mid-February 2005 of any changes to the wage index data as a result of the desk reviews and the resolution of the hospitals’ late November 2004 change requests. The fiscal intermediaries also submitted the revised data to CMS by mid-February 2005. CMS published the proposed wage index public use files that included hospitals’ revised wage data on February 25, 2005. In a memorandum also dated February 25, 2005, we instructed fiscal intermediaries 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 14, 2005 to submit requests to the fiscal intermediaries for reconsideration of adjustments made by the fiscal intermediaries as a result of the desk review, and to correct errors due to CMS’s or the fiscal intermediary’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 are to submit any additional revisions resulting from the hospitals’ reconsideration requests by April 15, 2005. The deadline for a hospital to request CMS intervention in cases where the hospital disagrees with the fiscal intermediary’s policy interpretations is April 22, 2005. Hospitals should also examine Table 2 in the Addendum to this proposed rule. Table 2 contains each hospital’s adjusted average hourly wage used to construct the wage index values for the past 3 years, including the FY 2002 data used to construct the FY 2006 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 23, 2005. We will release a final wage index data public use file in early May 2005 to hospital associations and the public on the Internet at https:// www.cms.hhs.gov/providers/hipps/ E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules ippswage.asp. The May 2005 public use file will be made available solely for the limited purpose of identifying any potential errors made by CMS or the fiscal intermediary in the entry of the final wage data that result from the correction process described above (revisions submitted to CMS by the fiscal intermediaries by April 15, 2005). If, after reviewing the May 2005 final file, a hospital believes that its wage data were incorrect due to a fiscal intermediary or CMS error in the entry or tabulation of the final wage data, it should send a letter to both its fiscal intermediary and CMS that outlines why the hospital believes an error exists and provide all supporting information, including relevant dates (for example, when it first became aware of the error). CMS and the fiscal intermediaries must receive these requests no later than June 10, 2005. 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. The fiscal intermediary 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 2005 wage index data file, changes to the hospital wage data will only be made in those very limited situations involving an error by the fiscal intermediary or CMS that the hospital could not have known about before its review of the final wage index data file. Specifically, neither the intermediary nor CMS will approve the following types of requests: • Requests for wage data corrections that were submitted too late to be included in the data transmitted to CMS by fiscal intermediaries on or before April 15, 2005. • Requests for correction of errors that were not, but could have been, identified during the hospital’s review of the February 25, 2005 wage index data file. • Requests to revisit factual determinations or policy interpretations made by the fiscal intermediary or CMS during the wage index data correction process. Verified corrections to the wage index received timely by CMS and the fiscal intermediaries (that is, by June 10, 2005) will be incorporated into the final wage index to be published by August 1, 2005, and to be effective October 1, 2005. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 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 2006 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 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 Hospital v. Shalala, No. 99–CV–75202–DT (E.D. Mich. 2001), also Palisades General Hospital v. Thompson, No. 99–1230 (D.D.C. 2003)). Again, we believe the wage index data correction process described above provides hospitals with sufficient opportunity to bring errors in their wage index data to the fiscal intermediaries’ attention. Moreover, because hospitals will have access to the final wage index data by early May 2005, they have the opportunity to detect any data entry or tabulation errors made by the fiscal intermediary or CMS before the development and publication of the final FY 2006 wage index by August 1, 2005, and the implementation of the FY 2006 wage index on October 1, 2005. If hospitals avail themselves of the opportunities afforded to provide and make corrections to the wage 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 10, 2005, 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 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 PO 00000 Frm 00079 Fmt 4701 Sfmt 4702 23383 CMS makes the wage data available to a hospital on the CMS website prior to publishing both the proposed and final IPPS rules, and the fiscal intermediaries notify hospitals directly of any wage data changes after completing their desk reviews, we do not expect that midyear corrections would be necessary. However, under our current policy, if the correction of a data error changes the wage index value for an area, the revised wage index value will be effective prospectively from the date the correction is made. We are proposing to revise § 412.64(k)(2) to specify that 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 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 and CMS correct the error using the established process and within the established schedule for requesting corrections to the wage data, before the beginning of the fiscal year for the applicable IPPS update (that is, by the June 10, 2005 deadline for the FY 2006 wage index); and (3) CMS agreed that the fiscal intermediary or CMS made an error in tabulating the hospital’s wage data and the wage index should be corrected. We are proposing this change because there may be instances in which a hospital identifies an error in its wage data and submits a correction request using all appropriate procedures and by the June deadline, CMS agrees that the fiscal intermediary or CMS caused the error in the hospital’s wage data and that the wage index must be corrected, but CMS fails to publish or implement the corrected wage index value by the beginning of the Federal fiscal year. We believe that the above proposed revision to § 412.64(k)(2) is appropriate and fair. We also believe that unlike a generalized retroactive policy, the situations where this will occur will be minimal, thus minimizing the administrative burden associated with such retroactive corrections. In those circumstances where a hospital requests a correction to its wage 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 data caused by CMS’s or the fiscal intermediary’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, this provision would not be available to a hospital seeking to revise another E:\FR\FM\04MYP2.SGM 04MYP2 23384 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules hospital’s data. In addition, the provision could not be used to correct prior years’ wage data; it could only be used for the current Federal fiscal year. In other situations, we continue to believe that it is appropriate to make prospective corrections to the wage index in those circumstances where a hospital could not have known about or did not have the opportunity to correct the fiscal intermediary’s or CMS’s error before the beginning of the fiscal year (that is, by the June deadline). We are proposing to make this change to § 412.64(k)(2) effective on October 1, 2005, that is, beginning with the FY 2006 wage index. We note that, as with prospective changes to the wage index, the proposed retroactive correction would 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 would still apply in those instances where a judicial decision reverses a CMS denial of a hospital’s wage data revision request. In addition, we are proposing to correct the FY 2005 wage index retroactively (that is, from October 1, 2004) on a one-time only basis for a limited circumstance using the authority provided under section 903(a)(1) of Pub. L. 108–173. This provision authorizes the Secretary to make retroactive changes to items and services if failure to apply such changes would be contrary to the public interest. However, as indicated, our current regulations at § 412.64(k)(1) allow only for a prospective correction to the hospitals’ area wage index values. We are proposing to correct the FY 2005 wage index retroactively in the limited circumstance where a hospital meets all of the following criteria: (1) The fiscal intermediary or CMS made an error in tabulating a hospital’s FY 2005 wage index data; (2) the hospital informed the fiscal intermediary or CMS, or both, about the error, following the established schedule and process for requesting corrections to its FY 2005 wage index data; and (3) CMS agreed before October 1 that the fiscal intermediary or CMS made an error in tabulating the hospital’s wage data and the wage index should be corrected by the beginning of the Federal fiscal year (that is, by October 1, 2004), but CMS was unable to publish the correction by the beginning of the fiscal year. On December 30, 2004, we published in the Federal Register a correction notice to the FY 2005 IPPS final rule that included the corrected wage data for four hospitals that meet all of the three above stated criteria (69 FR 78526). These corrections were effective VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 January 1, 2005. As noted, our current regulations allow only for a prospective correction to the hospitals’ area wage index values. However, we believe that, in the limited circumstance mentioned above, a retroactive correction to the FY 2005 wage index is appropriate and meets the condition of section 903(a)(1) of Pub. L. 108–173 that ‘‘failure to apply the change retroactively would be contrary to the public interest.’’ IV. Proposed Rebasing and Revision of the Hospital Market Baskets (If you choose to comment on issues in this section, please include the caption ‘‘Hospital Market Basket’’ at the beginning of your comment.) A. Background Effective for cost reporting periods beginning on or after July 1, 1979, we developed and adopted a hospital input price index (that is, the hospital market basket for operating costs). Although ‘‘market basket’’ technically describes the mix of goods and services used to produce hospital care, this term is also commonly used to denote the input price index (that is, cost category weights and price proxies combined) derived from that market basket. Accordingly, the term ‘‘market basket’’ as used in this document refers to the hospital input price index. The terms ‘‘rebasing’’ and ‘‘revising,’’ while often used interchangeably, actually denote different activities. ‘‘Rebasing’’ means moving the base year for the structure of costs of an input price index (for example, in this proposed rule, we are proposing to shift the base year cost structure for the IPPS hospital index from FY 1997 to FY 2002). ‘‘Revising’’ means changing data sources, or price proxies, used in the input price index. The percentage change in the market basket reflects the average change in the price of goods and services hospitals purchase in order to furnish inpatient care. We first used the market basket to adjust hospital cost limits by an amount that reflected the average increase in the prices of the goods and services used to provide hospital inpatient care. This approach linked the increase in the cost limits to the efficient utilization of resources. Since the inception of the IPPS, the projected change in the hospital market basket has been the integral component of the update factor by which the prospective payment rates are updated every year. An explanation of the hospital market basket used to develop the prospective payment rates was published in the Federal Register on September 1, 1983 (48 FR 39764). We PO 00000 Frm 00080 Fmt 4701 Sfmt 4702 also refer the reader to the August 1, 2002 Federal Register (67 FR 50032) in which we discussed the previous rebasing of the hospital input price index. The hospital market basket is a fixed weight, Laspeyres-type price index that is constructed in three steps. First, a base period is selected (in this proposed rule, FY 2002) and total base period expenditures are estimated for a set of mutually exclusive and exhaustive spending categories based upon type of expenditure. Then the proportion of total operating costs that each category represents is determined. These proportions are called cost or expenditure weights. Second, each expenditure category is matched to an appropriate price or wage variable, referred to as a price proxy. In nearly every instance, these price proxies are price levels derived from publicly available statistical series that are published on a consistent schedule, preferably at least on a quarterly basis. Finally, the expenditure weight for each cost category is multiplied by the level of its respective price proxy. The sum of these products (that is, the expenditure weights multiplied by their price levels) for all cost categories yields the composite index level of the market basket in a given period. Repeating this step for other periods produces a series of market basket levels over time. Dividing an index level for a given period by an index level for an earlier period produces a rate of growth in the input price index over that time period. The market basket is described as a fixed-weight index because it describes the change in price over time of the same mix of goods and services purchased to provide hospital services in a base period. The effects on total expenditures resulting from changes in the quantity or mix of goods and services (intensity) purchased subsequent to the base period are not measured. For example, shifting a traditionally inpatient type of care to an outpatient setting might affect the volume of inpatient goods and services purchased by the hospital, but would not be factored into the price change measured by a fixed weight hospital market basket. In this manner, the market basket measures only the pure price change. Only when the index is rebased using a more recent base period would the quantity and intensity effects be captured in the cost weights. Therefore, we rebase the market basket periodically so the cost weights reflect changes in the mix of goods and services that hospitals purchase (hospital inputs) to furnish inpatient care between base periods. We last E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules B. Rebasing and Revising the Hospital Market Basket 1. Development of Cost Categories and Weights a. Medicare Cost Reports The major source of expenditure data for developing the proposed rebased and revised hospital market basket cost weights is the FY 2002 Medicare cost b. Other Data Sources In addition to the Medicare cost reports, other sources of data used in developing the market basket weights are the Benchmark Input-Output Tables (I–Os) created by the Bureau of Economic Analysis, U.S. Department of Commerce, and the Business Expenses Survey developed by the Bureau of the Census, U.S. Department of Commerce, from its Economic Census. New data for these Census sources are scheduled for publication every 5 years, but often take up to 7 years after the reference year. Only an Annual I–O is produced each year, but the Annual I– O contains less industry detail than does the Benchmark I–O. When we rebased the market basket using FY 1997 data in the FY 2003 IPPS final rule, the 1997 Benchmark I–O was not yet available. Therefore, we did not incorporate data from that source into the FY 1997-based market basket (67 FR 50033). However, we did use a secondary source, the 1997 Annual Input-Output tables. The third source of data, the 1997 Business Expenditure Survey (now known as the Business Expenses Survey) was used to develop weights for the utilities and telephone services categories. The 1997 Benchmark I–O data are a much more comprehensive and complete set of data than the 1997 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Annual I–O estimates. The 1997 Annual I–O is an update of the 1992 I–O tables, while the 1997 Benchmark I–O is an entirely new set of numbers derived from the 1997 Economic Census. The 2002 Benchmark Input-Output tables are not yet available. Therefore, we are proposing to use the 1997 Benchmark I– O data in the proposed FY 2002-based market basket, to be effective for FY 2006. Instead of using the less detailed, less accurate Annual I–O data, we aged the 1997 Benchmark I–O data forward to FY 2002. The methodology we used to age the data involves applying the annual price changes from the price proxies to the appropriate cost categories. We repeat this practice for each year. The ‘‘all other’’ cost category is further divided into other hospital expenditure category shares using the 1997 Benchmark Input-Output tables. Therefore, the ‘‘all other’’ cost category expenditure shares are proportional to their relationship to ‘‘all other’’ totals in the I–O tables. For instance, if the cost for telephone services were to represent 10 percent of the sum of the ‘‘all other’’ I–O (see below) hospital expenditures, then telephone services would represent 10 percent of the market basket’s ‘‘all other’’ cost category. PO 00000 Frm 00081 Fmt 4701 Sfmt 4702 reports. These cost reports are from IPPS hospitals only. They do not reflect data from hospitals excluded from the IPPS or CAHs. The IPPS cost reports yield seven major expenditure or cost categories: wages and salaries, employee benefits, contract labor, pharmaceuticals, professional liability insurance (malpractice), blood and blood products, and a residual ‘‘all other.’’ 2. PPS—Selection of Price Proxies After computing the FY 2002 cost weights for the proposed rebased hospital market basket, it is necessary to select appropriate wage and price proxies to reflect the rate-of-price change for each expenditure category. With the exception of the Professional Liability proxy, all the indicators are based on Bureau of Labor Statistics (BLS) data and are grouped into one of the following BLS categories: • Producer Price Indexes—Producer Price Indexes (PPIs) measure price changes for goods sold in other than retail markets. PPIs are preferable price proxies for goods that hospitals purchase as inputs in producing their outputs because the PPIs would better reflect the prices faced by hospitals. For example, we use a special PPI for prescription drugs, rather than the Consumer Price Index (CPI) for prescription drugs because hospitals generally purchase drugs directly from the wholesaler. The PPIs that we use measure price change at the final stage of production. • Consumer Price Indexes— Consumer Price Indexes (CPIs) measure change in the prices of final goods and services bought by the typical consumer. Because they may not represent the price faced by a producer, we used CPIs only if an appropriate PPI E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.031</GPH> rebased the hospital market basket cost weights effective for FY 2003 (67 FR 50032, August 1, 2002), with FY 1997 data used as the base period for the construction of the market basket cost weights. 23385 23386 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules was not available, or if the expenditures were more similar to those of retail consumers in general rather than purchases at the wholesale level. For example, the CPI for food purchased away from home is used as a proxy for contracted food services. • Employment Cost Indexes— Employment Cost Indexes (ECIs) measure the rate of change in employee wage rates and employer costs for employee benefits per hour worked. These indexes are fixed-weight indexes and strictly measure the change in wage VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 rates and employee benefits per hour. Appropriately, they are not affected by shifts in employment mix. We evaluated the price proxies using the criteria of reliability, timeliness, availability, and relevance. Reliability indicates that the index is based on valid statistical methods and has low sampling variability. Timeliness implies that the proxy is published regularly, at least once a quarter. Availability means that the proxy is publicly available. Finally, relevance means that the proxy is applicable and representative of the PO 00000 Frm 00082 Fmt 4701 Sfmt 4702 cost category weight to which it is applied. The CPIs, PPIs, and ECIs selected meet these criteria. Chart 2 sets forth the complete proposed market basket including cost categories, weights, and price proxies. For comparison purposes, the corresponding FY 1997-based market basket is listed as well. A summary outlining the choice of the various proxies follows the chart. BILLING CODE 4120–01–P E:\FR\FM\04MYP2.SGM 04MYP2 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00083 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 23387 EP04MY05.032</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23388 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00084 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.033</GPH> BILLING CODE 4120–01–C Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules f. Water and Sewerage a. Wages and Salaries For measuring the price growth of wages in the proposed FY 2002-based market basket, we are proposing to use the ECI for wages and salaries for civilian hospital workers as the proxy for wages in the hospital market basket. This same proxy was used for the 1997based market basket. b. Employee Benefits The proposed FY 2002-based hospital market basket uses the ECI for employee benefits for civilian hospital workers. This is the same proxy that was used in the FY 1997-based market basket. c. Nonmedical Professional Fees The ECI for compensation for professional and technical workers in private industry is applied to this category because it includes occupations such as management and consulting, legal, accounting and engineering services. The same proxy was used in the FY 1997-based market basket. d. Fuel, Oil, and Gasoline The percentage change in the price of gas fuels as measured by the PPI (Commodity Code #0552) is applied to this component. The same proxy was used in the FY 1997-based market basket. e. Electricity The percentage change in the price of commercial electric power as measured by the PPI (Commodity Code #0542) is applied to this component. The same proxy was used in the FY 1997-based market basket. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 h. Pharmaceuticals The percentage change in the price of water and sewerage maintenance as measured by the CPI for all urban consumers (CPI Code #CUUR0000SEHG01) is applied to this component. The same proxy was used in the FY 1997-based market basket. The percentage change in the price of prescription drugs as measured by the PPI (PPI Code #PPI283D#RX) is used as a proxy for this category. This is a special index produced by BLS and is the same proxy used in the 1997-based index. g. Professional Liability Insurance i. Food: Direct Purchases The proposed FY 2002-based index uses the percentage change in the hospital professional liability insurance (PLI) premiums as estimated by the CMS Hospital Professional Liability Index, which we use as a proxy in the Medicare Economic Index (68 FR 63244), for the proxy of this category. Similar to the Physicians Professional Liability Index, we attempt to collect commercial insurance premiums for a fixed level of coverage, holding nonprice factors constant (such as a change in the level of coverage). In the FY 1997-based market basket, the same price proxy was used. We continue to research options for improving our proxy for professional liability insurance. This research includes exploring various options for expanding our current survey, including the identification of another entity that would be willing to work with us to collect more complete and comprehensive data. We are also exploring other options such as third party or industry data that might assist us in creating a more precise measure of PLI premiums. At this time, we have not yet identified a preferred option. Therefore, we are not proposing to make any changes to the proxy in this proposed rule. PO 00000 Frm 00085 Fmt 4701 Sfmt 4702 The percentage change in the price of processed foods and feeds as measured by the PPI (Commodity Code #02) is applied to this component. The same proxy was used in the FY 1997-based market basket. j. Food: Contract Services The percentage change in the price of food purchased away from home as measured by the CPI for all urban consumers (CPI Code #CUUR0000SEFV) is applied to this component. The same proxy was used in the FY 1997-based market basket. k. Chemicals The percentage change in the price of industrial chemical products as measured by the PPI (Commodity Code #061) is applied to this component. While the chemicals hospitals purchase include industrial as well as other types of chemicals, the industrial chemicals component constitutes the largest proportion by far. Thus, we believe that Commodity Code #061 is the appropriate proxy. The same proxy was used in the FY 1997-based market basket. l. Medical Instruments The percentage change in the price of medical and surgical instruments as E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.034</GPH> BILLING CODE 4120–01–C 23389 23390 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules measured by the PPI (Commodity Code #1562) is applied to this component. The same proxy was used in the FY 1997-based market basket. m. Photographic Supplies The percentage change in the price of photographic supplies as measured by the PPI (Commodity Code #1542) is applied to this component. The same proxy was used in the FY 1997-based market basket. n. Rubber and Plastics The percentage change in the price of rubber and plastic products as measured by the PPI (Commodity Code #07) is applied to this component. The same proxy was used in the FY 1997-based market basket. o. Paper Products The percentage change in the price of converted paper and paperboard products as measured by the PPI (Commodity Code #0915) is used. The same proxy was used in the FY 1997based market basket. p. Apparel The percentage change in the price of apparel as measured by the PPI (Commodity Code #381) is applied to this component. The same proxy was used in the FY 1997-based market basket. q. Machinery and Equipment The percentage change in the price of machinery and equipment as measured by the PPI (Commodity Code #11) is applied to this component. The same proxy was used in the FY 1997-based market basket. r. Miscellaneous Products The percentage change in the price of all finished goods less food and energy as measured by the PPI (Commodity VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Code #SOP3500) is applied to this component. Using this index removes the double-counting of food and energy prices, which are already captured elsewhere in the market basket. The same proxy was used in the FY 1997based index. The weight for this cost category is higher than in the FY 1997based index because the weight for blood and blood products (1.082) is added to it. In the FY 1997-based market basket, we included a separate cost category for blood and blood products, using the BLS PPI (Commodity Code #063711) for blood and derivatives as a price proxy. A review of recent trends in the PPI for blood and derivatives suggests that its movements may not be consistent with the trends in blood costs faced by hospitals. While this proxy did not match exactly with the product hospitals are buying, its trend over time appears to be reflective of the historical price changes of blood purchased by hospitals. However, an apparent divergence over recent periods led us to reevaluate whether the PPI for blood and derivatives was an appropriate measure of the changing price of blood. We ran test market baskets classifying blood in three separate cost categories: blood and blood products, contained within chemicals as was done for the FY 1992-based index, and within miscellaneous products. These categories use as proxies the following PPIs: The PPI for blood and blood products, the PPI for chemicals, and the PPI for finished goods less food and energy, respectively. Of these three proxies, the PPI for finished goods less food and energy moved most like the recent blood cost and price trends. In addition, the impact on the overall market basket by using different proxies for blood was negligible, mostly due to the relatively small weight for blood in the market basket. Therefore, we chose PO 00000 Frm 00086 Fmt 4701 Sfmt 4702 the PPI for finished goods less food and energy for the blood proxy because we believe it will best be able to proxy price changes (not quantities or required tests) associated with blood purchased by hospitals. We will continue to evaluate this proxy for its appropriateness and will explore the development of alternative price indexes to proxy the price changes associated with this cost. s. Telephone The percentage change in the price of telephone services as measured by the CPI for all urban consumers (CPI Code # CUUR0000SEED) is applied to this component. The same proxy was used in the FY 1997-based market basket. t. Postage The percentage change in the price of postage as measured by the CPI for all urban consumers (CPI Code # CUUR0000SEEC01) is applied to this component. The same proxy was used in the FY 1997-based market basket. u. All Other Services: Labor Intensive The percentage change in the ECI for compensation paid to service workers employed in private industry is applied to this component. The same proxy was used in the FY 1997-based market basket. v. All Other Services: Nonlabor Intensive The percentage change in the allitems component of the CPI for all urban consumers (CPI Code # CUUR0000SA0) is applied to this component. The same proxy was used in the FY 1997-based market basket. For further discussion of the rationales for choosing many of the specific price proxies, we refer the reader to the August 1, 2002 final rule (67 FR 50037). E:\FR\FM\04MYP2.SGM 04MYP2 3. Labor-Related Share (If you choose to comment on issues in this section, please include the caption ‘‘Labor-Related Share’’ at the beginning of your comment.) Under section 1886(d)(3)(E) of the Act, the Secretary estimates from time to time the proportion of payments 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 proportion of hospitals’ costs that are attributable to wages and wage-related costs as the ‘‘labor-related share.’’ 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. We are proposing to continue to use our current methodology of defining the laborrelated share as the national average proportion of operating costs that are related to, influenced by, or vary with the local labor markets. We believe that the operating cost categories that are related to, influenced by, or vary with the local labor markets are wages and salaries, fringe benefits, professional fees, contract labor, and labor intensive services. Therefore, we are proposing to calculate the labor-related share by adding the relative weights for these VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 operating cost categories. After we reviewed all cost categories in the proposed IPPS market basket using this definition of labor-related, we removed postage costs from the proposed FY 2002-based labor-related share because we no longer believe these costs are likely to vary with the local labor market. Using the cost category weights that we determined in section IV.B. of this preamble, we calculated a laborrelated share of 69.731 percent, using the FY 2002-based PPS market basket. Accordingly, we are proposing to implement a labor-related share of 69.7 percent for discharges occurring on or after October 1, 2005. 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 labor-related share unless this employment ‘‘would result in lower payments than would otherwise be made.’’ We also are proposing an update to the labor-related share for Puerto Rico. Consistent with our methodology for determining the national labor-related share, we are proposing to add the Puerto Rico-specific relative weights for wages and salaries, fringe benefits, and contract labor. Because there are no Puerto Rico-specific relative weights for professional fees and labor intensive services, we are proposing to use the PO 00000 Frm 00087 Fmt 4701 Sfmt 4702 23391 national weights. Alternatively, we could apply the national labor-related share to the Puerto Rico-specific rate. We note that we are still reviewing our data and have not yet calculated the updated Puerto Rico-specific laborrelated share percentage. Therefore, the labor-related and nonlabor-related portions of the Puerto Rico-specific standardized amount listed in Table 1C of the Addendum to this proposed rule reflect the current (FY 2005) laborrelated share for Puerto Rico of 71.3 percent. Once we have calculated the updated labor-related share for Puerto Rico, we will post it on the CMS website at https://www.cms.hhs.gov/providers/ hipps. In addition, if we adopt this proposal, we would publish the updated Puerto Rico labor-related share in the IPPS final rule. We welcome comments on our proposal to update the laborrelated share for Puerto Rico. Unlike the 1997 Annual I–O which was based on Standard Industrial Codes (SIC), the 1997 Benchmark I–O is categorized using the North American Industrial Classification System (NAICS). This change required us to classify all cost categories under NAICS, including a reevaluation of labor-related costs on the NAICS definitions. Chart 4 compares the FY 1992-based laborrelated share, the current measure, with the FY 2002-based labor-related share. When we rebased the market basket to E:\FR\FM\04MYP2.SGM 04MYP2 EP04my05.035</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23392 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules Therefore, the FY 1992-based laborrelated share is the current measure. Although we are proposing to continue to calculate the labor-related share by adding the relative weights of the labor-related operating cost categories, we continue to evaluate alternative methodologies. In the May 9, 2002 Federal Register (67 FR 31447), we discussed our research on the methodology for the labor-related share. This research involved analyzing the compensation share (the sum of wages and salaries and benefits) 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 laborrelated. Our original analysis, which appeared in the May 9, 2002 Federal Register (67 FR 31447) and which focused mainly on edited FY 1997 hospital data, found that the compensation share of costs for hospitals in rural areas was higher on average than the compensation share for hospitals in urban areas. We also researched whether only a proportion of the costs in professional fees and laborintensive services should be considered labor-related, not the entire cost categories. However, there was not enough information available to make this determination. Our finding that the average compensation share of costs for rural hospitals was higher than the average compensation for urban hospitals was validated consistently through our regression analysis. Regression analysis is a statistical technique that determines the relationship between a dependent variable and one or more independent variables. We tried several regression specifications in an effort to determine the proportion of costs that are influenced by the area wage index. Furthermore, MedPAC raised the possibility that regression may be an alternative to the current market basket methodology. Our initial regression specification (in log form) was Medicare operating cost per Medicare discharge as the dependent variable and the independent variables being the area wage index, the case-mix index, the ratio of residents per bed (as proxy for IME status), and a dummy variable that equals one if the hospital is located in a metropolitan area with a population of 1 million or more. (A dummy variable represents the presence or absence of a particular characteristic.) This regression produced a coefficient for all hospitals for the area wage index of 0.638 (which is equivalent to the labor share and can be interpreted as an elasticity because of the log specification) with an adjusted Rsquared of 64.3. (Adjusted R-squared is a measure of how well the regression model fits the data.) While, on the surface, this appeared to be a reasonable result, this same specification for urban hospitals had a coefficient of 0.532 (adjusted R-squared = 53.2) and a coefficient of 0.709 (adjusted R-squared = 36.4) for rural hospitals. This VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00088 Fmt 4701 Sfmt 4702 highlighted some apparent problems with the specification because the overall regression results appear to be masking underlying problems. It did not seem reasonable that urban hospitals would have a labor share below their actual compensation share or that the discrepancy between urban and rural hospitals would be this large. When we standardized the Medicare operating cost per Medicare discharge for case mix, the fit, as measured by adjusted Rsquared, fell dramatically and the urban/rural discrepancy became even larger. Based on this initial result, we tried two modifications to the FY 1997 regressions to correct for the underlying problems. First, we edited the data differently to determine if a few reports were causing the inconsistent results. We found when we tightened the edits, the wage index coefficient was lower and the fit was worse. When we loosened the edits, we found higher wage index coefficients and still a worse fit. Second, we added additional variables to the regression equation to attempt to explain some of the variation that was not being captured. We found the best fit occurred when the following variables were added: The occupancy rate, the number of hospital beds, a dummy variable that equals one if the hospital is privately owned and zero otherwise, a dummy variable that equals one if the hospital is governmentcontrolled and zero otherwise, the Medicare length-of-stay, the number of FTEs per bed, and the age of fixed E:\FR\FM\04MYP2.SGM 04MYP2 EP04my05.036</GPH> reflect FY 1997 data, we did not change the labor-related share (67 FR 50041). Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules assets. The result of this specification was a wage index coefficient of 0.620 (adjusted R-squared = 68.7), with the regression on rural hospitals having a coefficient of 0.772 (adjusted R-squared = 45.0) and the regression on urban hospitals having a coefficient of 0.474 (adjusted R-squared = 60.9). Neither of these alternatives seemed to help the underlying difficulties with the regression analysis. Subsequent to the work described above, we have undertaken the research necessary to reevaluate the current assumptions used in determining the labor-related share. We ran regressions applying the previous specifications to more recent data (FY 2001 and FY 2002), and, as described below, we ran regressions using alternative specifications. Once again we encourage comments on this research and any information that is available to help determine the most appropriate measure. The first step in our regression analysis to determine the proportion of hospitals’ costs that varied with laborrelated costs was to edit the data, which had significant outliers in some of the variables we used in the regressions. We originally began with an edit that excluded the top and bottom 5 percent of reports based on average Medicare cost per discharge and number of discharges. We also used edits to exclude reports that did not meet basic criteria for use, such as having costs greater than zero for total, operating, and capital for the overall facility and just the Medicare proportion. We also required that the hospital occupancy rate, length-of-stay, number of beds, FTEs, and overall and Medicare discharges be greater than zero. Finally, we excluded reports with occupancy rates greater than one. Our regression specification (in log form) was Medicare operating cost per Medicare discharge as the dependent variable (the same dependent variable we used in the regression analysis described in the May 9, 2002 Federal Register) with the independent variables being the compensation per FTE, the ratio of interns and residents per bed (as proxy for IME status), the occupancy rate, the number of hospital beds, a dummy variable that equals one if the hospital is privately owned and is zero otherwise, a dummy variable that equals one if the hospital is governmentcontrolled and is zero otherwise, the Medicare length-of-stay, the number of FTEs per bed, the age of fixed assets, and a dummy variable that equals one if the hospital is located in a metropolitan area with a population of 1 million or more. This is a similar VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 model to the one described in the May 9, 2002 Federal Register (67 FR 31447) as having the best fit, with two notable exceptions. First, the area wage index is replaced by compensation per FTE, where compensation is the sum of hospital wages and salaries, contract labor costs, and benefits. The area wage index is a payment variable computed by averaging wages across all hospitals within each MSA, whereas compensation per FTE differs from one hospital to the next. Second, the casemix index is no longer included as a regressor because it is correlated with other independent variables in the regression. In other words, the other independent variables are capturing part of the effect of the case-mix index. We made these two specification changes in an attempt to only use cost variables to explain the variation in Medicare operating costs per discharge. We believe this is appropriate in order to compare to the results we are getting from the market basket methodology, which is based solely on cost data. As we will show below, the use of payment variables on the right-hand side of the equation appears to be producing less reasonable results when cost data are used. The revised specification for FY 2002 produced a coefficient for all hospitals for compensation per FTE of 0.673 (which is roughly equivalent to the labor share and can be interpreted as an elasticity because of the log specification) with an adjusted Rsquared of 63.7. The coefficient result for FY 2001 is 64.5, with an adjusted Rsquared of 65.2. (For comparison, a separate regression for FY 2002 with the log area wage index and log case-mix index included in the set of regressors displays a log area wage index coefficient of 75.6 (adjusted R-squared = 67.7).) For FY 2001, the coefficient for the log area wage index is 72.3 (adjusted R-squared = 67.9). On the surface, these seem to be reasonable results. However, a closer look reveals some problems. In FY 2001, the coefficient for urban hospitals was 59.6 (adjusted R-squared = 57.3), and the coefficient for rural hospitals was 61.3 (adjusted R-squared = 50.6). On the other hand, in FY 2002, the coefficient for urban hospitals increased to 69.2 (adjusted R-squared = 55.9), and the coefficient for rural hospitals decreased to 58.2 (adjusted R squared = 46.0). The results for FY 2001 seem reasonable, but not when compared with the results for FY 2002. Furthermore, for FY 2002 the compensation share of costs for hospitals in rural areas was higher on average than the compensation share for PO 00000 Frm 00089 Fmt 4701 Sfmt 4702 23393 hospitals in urban areas. Rural areas had an average compensation share of 63.3 percent, while urban areas had a share of 60.5 percent. This compares to a share of 61.2 percent for all hospitals. Due to these problems, we do not believe the regression analysis is producing sound enough evidence at this point for us to make the decision to change from the current method for calculating the labor-related share. We continue to analyze these data and work on alternative specifications, including working with MedPAC, who in the past have done similar analysis in their studies of payment adequacy. Comments on this approach would be welcomed, given the difficulties we have encountered. We also continue to look into ways to refine our market basket approach to more accurately account for the proportion of costs influenced by the local labor market. Specifically, we are looking at the professional fees and labor-intensive cost categories to determine if only a proportion of the costs in these categories should be considered labor-related, not the entire cost category. Professional fees include management and consulting fees, legal services, accounting services, and engineering services. Labor-intensive services are mostly building services, but also include other maintenance and repair services. We conducted preliminary research into whether the various types of professional fees are more or less likely to be purchased in local labor markets. Through contact with a handful of hospitals in only two States, we asked for the percentages of their advertising, legal, and management and consulting services that they purchased in either local, regional, or national labor markets. The results were quite consistent across all of the hospitals, indicating most advertising and legal services are purchased in local or regional markets and nearly all management and consulting services are purchased in national labor markets. This suggested we may be appropriately reflecting advertising and legal services in the labor-related share, but we plan to investigate further whether management and consulting services are appropriately reflected. We do not believe that this limited effort produced enough evidence for us to change our methodology. However, we do plan to expand our efforts in this area to ensure we appropriately determine the laborrelated share. We are soliciting data or studies that would be helpful in this analysis. We are unsure if we will be able to finish this analysis in time for inclusion in the FY 2006 IPPS final rule. E:\FR\FM\04MYP2.SGM 04MYP2 23394 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules As mentioned previously, we are proposing to continue to calculate the labor-related share by adding the relative weights of the operating cost categories that are related to, influenced by, or vary with the local labor markets. These categories include wages and salaries, fringe benefits, professional fees, contract labor and labor-intensive services. Since we no longer believe that postage costs meet our definition of labor-related, we are excluding them from the labor-related share. Using this methodology, we calculated a laborrelated share of 69.731. Therefore, we are proposing a labor-related share of 69.731. C. Separate Market Basket for Hospitals and Hospital Units Excluded from the IPPS (If you choose to comment on issues in this section, please include the caption ‘‘Excluded Hospital Market Basket’’ at the beginning of your comment.) 1. Hospitals Paid Based on Their Reasonable Costs On August 7, 2001, we published 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. On August 30, 2002, we published 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. On November 15, 2004, we published a final rule in the Federal Register (69 FR 66922) establishing the PPS for the IPFs, effective for cost reporting periods beginning on or after January 1, 2005. Prior to being paid under a PPS, IRFs, LTCHs, and IPFs were reimbursed solely under the reasonable cost-based system under § 413.40 of the regulations, which impose rate-ofincrease limits. Children’s and cancer hospitals and religious nonmedical health care institutions (RNHCIs) are still reimbursed solely under the reasonable cost-based system, subject to the rate-of-increase limits. Under these limits, an annual target amount (expressed in terms of the inpatient operating cost per discharge) is set for each hospital based on the hospital’s own historical cost experience trended forward by the applicable rate-ofincrease percentages. To the extent a LTCH or IPF receives a blend of reasonable cost-based payment and the Federal prospective payment rate amount, the reasonable cost portion of the payment is also subject to the applicable rate-of-increase percentage. Section 1886(b)(3)(B)(ii) of the Act sets VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 the percentage increase of the limits, which in certain years was based upon the market basket percentage increase. Beginning in FY 2003 and subsequent years, the applicable rate-of-increase is the market basket percentage increase. The market basket currently (and historically) used is the excluded hospital operating market basket, representing the cost structure of rehabilitation, long-term care, psychiatric, children’s, and cancer hospitals (FY 2003 final rule, 67 FR 50042). Because IRFs, LTCHs, and some IPFs are now paid under a PPS, we are considering developing a separate market basket for these hospitals that contains both operating and capital costs. We would publish any proposal to use a revised separate market basket for each of these types of hospitals when we propose the nest update of their respective PPS rates. Children’s and cancer hospitals are two of the remaining three types of hospitals excluded from the IPPS that are still being paid based solely on their reasonable costs, subject to target amounts. (RNHCIs, the third type of IPPS-excluded entity still subject to target amounts, are reimbursed under § 403.752(a) of the regulations.) Because there are a small number of children’s and cancer hospitals and RNHCIs, which receive in total less than 1 percent of all Medicare payments to hospitals and because these hospitals provide limited Medicare cost report data, we are not proposing to create a separate market basket specifically for these hospitals. Under the broad authority in sections 1886(b)(3)(A) and (B), 1886(b)(3)(E), and 1871 of the Act, we are proposing to use the proposed FY 2002 IPPS operating market basket percentage increase to update the target amounts for children’s and cancer hospitals reimbursed under sections 1886(b)(3)(A) and (b)(3)(E) of the Act and the market basket for RNHCIs under § 403.752(a) of the regulations. This proposal reflects our belief that it is best to use an index that most closely represents the cost structure of children’s and cancer hospitals and RNHCIs. The FY 2002 cost weights for wages and salaries, professional liability, and ‘‘all other’’ for children’s and cancer hospitals are noticeably closer to those in the IPPS operating market basket than those in the excluded hospital market basket, which is based on the cost structure of IRFs, LTCHs, IPFs, and children’s and cancer hospitals and RNHCIs. Therefore, we believe it is more appropriate to use the IPPS operating market basket for PO 00000 Frm 00090 Fmt 4701 Sfmt 4702 children’s and cancer hospitals and RNHCIs. However, when we compare the weights for LTCHs and IPFs to the weights for IPPS hospitals, we did not find them comparable. Therefore, we do not believe it is appropriate to use the IPPS market basket for LTCHs and IPFs. For similar reasons, we are considering at some other date proposing a separate market basket to update the adjusted Federal payment amount for IRFs, LTCHs, and IPFs. We expect that these changes would be proposed in separate proposed rules for each of these three hospital types. We envision that these changes should apply to the adjusted Federal payment rate, and not the portion of the payment that is based on a facility-specific (or reasonable cost) payment to the extent such a hospital or unit is paid under a blend methodology. In other words, to the extent any of these hospitals are paid under a blend methodology whereby a percentage of the payment is based on reasonable cost principles, we would not propose to make changes to the existing methodology for developing the market basket for the reasonable cost portion of the payment because this portion of the payment is being phased out, if it is not already a nonexistent feature of the PPSs for IRFs, LTCHs, and IPFs. We do not believe that it makes sense to propose to create an entirely new methodology for creating the market basket index which updates the ‘‘reasonable cost’’ portion of a blend methodology since the ‘‘reasonable cost portion’’ will last at most for just 1 or 3 additional years (1 year for LTCHs paid under a blend methodology since LTCHs only have 1 year remaining in their transition, and 3 years for IPFs since IPFs paid under a blend methodology only have 3 years remaining under a blend methodology). However, the same cannot be said for the adjusted Federal payment amount. In the case of the IRF PPS, all IRFs are paid at 100 percent of the adjusted Federal payment amount and will continue to be paid based on 100 percent of this amount for perpetuity. In the LTCH PPS, most LTCHs (98 percent) are already paid at 100 percent of the adjusted Federal payment amount. In the case of the few LTCHs that are paid under a blend methodology for cost reporting periods beginning on or after October 1, 2006, payment will be based entirely on the adjusted Federal prospective payment rate. In the case of IPFs, new IPFs (as defined in § 412.426(c)) will be paid at 100 percent of the adjusted Federal prospective payment rate (the Federal per diem payment amount), while all others will E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23395 Although the percent change in the IPPS operating market basket is typically lower than the percent change in the FY 2002-based excluded hospital market basket (see charts), we believe it is important to propose using the market basket that most closely reflects the cost structure of children’s and cancer hospitals. We invite comments on our proposal to use the proposed FY 2002 IPPS operating market basket to update the target amounts for children’s and cancer hospitals reimbursed under sections 1886(b)(3)(A) and (b)(3)(E) of the Act and the market basket for RNHCIs under § 403.752(a) of the regulations. Chart 5 shows the historical and forecasted updates under both the proposed FY 2002-based IPPS operating market basket and the proposed FY 2002-based excluded hospital market basket. The forecasts are based on Global Insight, Inc. 4th quarter, 2004 forecast with historical data through the 3rd quarter of 2004. Global Insight, Inc. is a nationally recognized economic and financial forecasting firm that contracts with CMS to forecast the components of the market baskets. 2. Excluded Hospitals Paid Under a Blend Methodology LTCHs and most IPFs are or will be transitioning from reasonable cost-based payments (subject to the TEFRA limits) to prospective payments under their respective PPSs. Under the respective transition period methodologies for the LTCH PPS and the IPF PPS, which are described below, payment is based, in part, on a decreasing percentage of the reasonable cost-based payment amount, which is subject to the TEFRA limits and an increasing percentage of the Federal prospective payment rate. For those LTCHs and IPFs whose PPS payment is comprised in part of a reasonable cost-based payment will have those reasonable cost-based payment amounts limited by the hospital’s TEFRA ceiling. Effective for cost reporting periods beginning on or after October 1, 2002, LTCHs are paid under the LTCH PPS, As we discuss in greater detail in Appendix B to this proposed rule, in the past, hospitals and hospital units excluded from the IPPS have been paid based on their reasonable costs, subject to TEFRA limits. However, some of these categories of excluded hospitals and hospital units are now paid under their own PPSs. Specifically, some VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00091 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.037</GPH> continue to transition to 100 percent of the Federal per diem payment amount. In any event, even those transitioning will be at 100 percent of the adjusted Federal prospective payment rate in 3 years. Chart 5 compares the updates for the FY 2002-based IPPS operating market basket, our proposed index used to update the target amounts for children’s and cancer hospitals, and RNHCIs, with a FY 2002-based excluded hospital market basket that is based on the current methodology (that is, based on the cost structure of IRFs, LTCHs, IPFs, and children’s and cancer hospitals). Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules which was implemented with a 5-year transition period, transitioning existing LTCHs to a payment based on the fully Federal prospective payment rate (August 30, 2002; 67 FR 55954). However, a LTCH may elect to be paid at 100 percent of the Federal prospective rate at the start of any of its cost reporting periods during the 5-year transition period. A ‘‘new’’ LTCH, as defined in § 412.23(e)(4), are paid based on 100 percent of the standard Federal rate. Effective for cost reporting periods beginning on or after January 1, 2005, IPFs are paid under the IPF PPS under which they receive payment based on a prospectively determined Federal per diem rate that is based on the sum of the average routine operating, ancillary, and capital costs for each patient day of psychiatric care in an IPF, adjusted for budget neutrality. During a 3-year transition period, existing IPFs are paid based on a blend of the reasonable costbased payments and the Federal prospective per diem base rate. For cost reporting periods beginning on or after January 1, 2008, existing IPFs are to be paid based on 100 percent of the Federal per diem rate. A ‘‘new’’ IPF, as defined in § 412.426(c), are paid based on 100 percent of the Federal per diem payment amount. Any LTCHs or IPFs that receive a PPS payment that includes a reasonable cost-based payment during its respective transition period will have that portion of its payment subject to the TEFRA limits. Under the broad authority of section 1886(b)(3)(A) and (b)(3)(B) of the Act, for LTCHs and IPFs that are transitioning to the fully Federal prospective payment rate, we are proposing to use the rebased FY 2002 based-excluded hospital market basket to update the reasonable cost-based VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 portion of their payments. The proposed market basket update is described in detail below. We do not believe the IPPS operating market basket should be used for the proposed update to the reasonable cost-based portion of the payments to LTCHs or IPFs because this market basket does not reflect the cost structure of LTCHs and IPFs. 3. Development of Cost Categories and Weights for the Proposed FY 2002Based Excluded Hospital Market Basket a. Medicare Cost Reports The major source of expenditure data for developing the proposed rebased and revised excluded hospital market basket cost weights is the FY 2002 Medicare cost reports. We choose FY 2002 as the base year because we believe this is the most recent, relatively complete year (with a 90-percent reporting rate) of Medicare cost report data. These cost reports are from rehabilitation, psychiatric, long-term care, children’s, cancer, and religious nonmedical excluded hospitals. They do not reflect data from IPPS hospitals or CAHs. These are the same hospitals included in the FY 1997-based excluded hospital market basket, except for religious nonmedical hospitals. Due to insufficient Medicare cost report data for these excluded hospitals, their cost reports yield only four major expenditure or cost categories: Wages and salaries, pharmaceuticals, professional liability insurance (malpractice), and a residual ‘‘all other.’’ Since the cost weights for the FY 2002-based excluded hospital market basket are based on facility costs, we are proposing to use those cost reports for IRFs, LTCHs, and children’s, cancer, and RNHCIs whose Medicare average length of stay is within 15 percent (that PO 00000 Frm 00092 Fmt 4701 Sfmt 4725 is, 15 percent higher or lower) of the total facility average length of stay for the hospital. We are proposing to use a less stringent edit for Medicare length of stay for IPFs, requiring the average length of stay to be within 30 or 50 percent (depending on the total facility average length of stay) of the total facility length of stay. This allows us to increase our sample size by over 150 reports and produce a cost weight more consistent with the overall facility. The edit we applied to IPFs when developing the FY 1997-based excluded hospital market basket was based on the best available data at the time. We believe that limiting our sample to hospitals with a Medicare average length of stay within a comparable range of the total facility average length of stay provides a more accurate reflection of the structure of costs for Medicare treatments. Our method results in including in our data set hospitals with a share of Medicare patient days relative to total patient days that was approximately three times greater than for those hospitals excluded from our sample. Our goal is to measure cost shares that are reflective of case-mix and practice patterns associated with providing services to Medicare beneficiaries. Cost weights for benefits, contract labor and blood and blood products were derived using the proposed FY 2002-based IPPS market basket. This is necessary because these data are poorly reported in the cost reports for non-IPPS hospitals. For example, the ratio of the benefit cost weight to the wages and salaries cost weight was applied to the proposed excluded hospital wages and salaries cost weight to derive a benefit cost weight for the proposed excluded hospital market basket. E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.038</GPH> 23396 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules b. Other Data Sources In addition to the Medicare cost reports, the other source of data used in developing the excluded hospital market basket weights is the Benchmark Input-Output Tables (I–Os) created by the Bureau of Economic Analysis, U.S. Department of Commerce. New data for this source are scheduled for publication every 5 years, but often take up to 7 years after the reference year. Only an Annual I–O is produced each year, but the Annual I– O contains less industry detail than does the Benchmark I–O. When we rebased the excluded hospital market basket using FY 1997 data in the FY 2003 IPPS final rule, the 1997 Benchmark I–O was not yet available. Therefore, we did not incorporate data from that source into the FY 1997-based excluded hospital market basket (67 FR 50033). However, we did use a secondary source the 1997 Annual Input-Output tables. The third source of data, the 1997 Business Expenditure Survey (now known as the Business Expenses Survey), was used to develop weights for the utilities and telephone services categories. The 1997 Benchmark I–O data are a much more comprehensive and complete set of data than the 1997 Annual I–O estimates. The 1997 Annual I–O is an update of the 1992 I–O tables, while the 1997 Benchmark I–O is an entirely new set of numbers derived from the 1997 Economic Census. The 2002 Benchmark Input-Output tables are not yet available. Therefore, we are proposing to use the 1997 Benchmark I– O data in the proposed FY 2002-based excluded hospital market basket, to be effective for FY 2006. Instead of using the less detailed, less accurate Annual I–O data, we aged the 1997 Benchmark I–O data forward to FY 2002. The methodology we used to age the data involves applying the annual price changes from the price proxies to the appropriate cost categories. We repeat this practice for each year. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 The ‘‘all other’’ cost category is further divided into other hospital expenditure category shares using the 1997 Benchmark Input-Output tables. Therefore, the ‘‘all other’’ cost category expenditure shares are proportional to their relationship to ‘‘all other’’ totals in the I–O tables. For instance, if the cost for telephone services were to represent 10 percent of the sum of the ‘‘all other’’ I–O (see below) hospital expenditures, then telephone services would represent 10 percent of the market basket’s ‘‘all other’’ cost category. The remaining detailed cost categories under the residual ‘‘all other’’ cost category were derived using the 1997 Benchmark Input-Output Tables aged to FY 2002 using relative price changes. 4. Proposed 2002–Based Excluded Hospital Market Basket—Selection of Price Proxies After computing the FY 2002 cost weights for the proposed rebased excluded hospital market basket, it is necessary to select appropriate wage and price proxies to reflect the rate-ofprice change for each expenditure category. With the exception of the Professional Liability proxy, all the indicators are based on Bureau of Labor Statistics (BLS) data and are grouped into one of the following BLS categories: • Producer Price Indexes—Producer Price Indexes (PPIs) measure price changes for goods sold in other than retail markets. PPIs are preferable price proxies for goods that hospitals purchase as inputs in producing their outputs because the PPIs would better reflect the prices faced by hospitals. For example, we use a special PPI for prescription drugs, rather than the Consumer Price Index (CPI) for prescription drugs because hospitals generally purchase drugs directly from the wholesaler. The PPIs that we use measure price change at the final stage of production. • Consumer Price Indexes— Consumer Price Indexes (CPIs) measure PO 00000 Frm 00093 Fmt 4701 Sfmt 4702 23397 change in the prices of final goods and services bought by the typical consumer. Because they may not represent the price faced by a producer, we used CPIs only if an appropriate PPI was not available, or if the expenditures were more similar to those of retail consumers in general rather than purchases at the wholesale level. For example, the CPI for food purchased away from home is used as a proxy for contracted food services. • Employment Cost Indexes— Employment Cost Indexes (ECIs) measure the rate of change in employee wage rates and employer costs for employee benefits per hour worked. These indexes are fixed-weight indexes and strictly measure the change in wage rates and employee benefits per hour. Appropriately, they are not affected by shifts in employment mix. We evaluated the price proxies using the criteria of reliability, timeliness, availability, and relevance. Reliability indicates that the index is based on valid statistical methods and has low sampling variability. Timeliness implies that the proxy is published regularly, at least once a quarter. Availability means that the proxy is publicly available. Finally, relevance means that the proxy is applicable and representative of the cost category weight to which it is applied. The CPIs, PPIs, and ECIs selected meet these criteria and, therefore, we believe they continue to be the best measure of price changes for the cost categories to which they are applied. Chart 7 sets forth the complete proposed FY 2002-based excluded hospital market basket including cost categories, weights, and price proxies. For comparison purposes, the corresponding FY 1997-based excluded hospital market basket is listed as well. A summary outlining the choice of the various proxies follows the charts. BILLING CODE 4120–01–P E:\FR\FM\04MYP2.SGM 04MYP2 VerDate Aug<04>2004 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00094 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.039</GPH> 23398 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules b. Employee Benefits a. Wages and Salaries For measuring the price growth of wages in the proposed FY 2002-based excluded hospital market basket, we are proposing to use the ECI for wages and salaries for civilian hospital workers as the proxy for wages. This same proxy was used for the FY 1997-based excluded hospital market basket. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 c. Nonmedical Professional Fees The proposed FY 2002-based excluded hospital market basket uses the ECI for employee benefits for civilian hospital workers. This is the same proxy that was used in the FY 1997-based excluded hospital market basket. The ECI for compensation for professional and technical workers in private industry is applied to this category because it includes occupations such as management and consulting, legal, accounting and engineering services. The same proxy was used in the FY 1997-based excluded hospital market basket. PO 00000 Frm 00095 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.040</GPH> BILLING CODE 4120–01–C 23399 23400 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules d. Fuel, Oil, and Gasoline The percentage change in the price of gas fuels as measured by the PPI (Commodity Code #0552) is applied to this component. The same proxy was used in the FY 1997-based excluded hospital market basket. e. Electricity The percentage change in the price of commercial electric power as measured by the PPI (Commodity Code #0542) is applied to this component. The same proxy was used in the FY 1997-based excluded hospital market basket. f. Water and Sewerage The percentage change in the price of water and sewerage maintenance as measured by the CPI for all urban consumers (CPI Code # CUUR0000SEHG01) is applied to this component. The same proxy was used in the FY 1997-based excluded hospital market basket. g. Professional Liability Insurance The proposed FY 2002-based excluded hospital market basket uses the percentage change in the hospital professional liability insurance (PLI) premiums as estimated by the CMS Hospital Professional Liability Index for the proxy of this category. Similar to the Physicians Professional Liability Index, we attempt to collect commercial insurance premiums for a fixed level of coverage, holding nonprice factors constant (such as a change in the level of coverage). In the FY 1997-based excluded hospital market basket, the same price proxy was used. We continue to research options for improving our proxy for professional liability insurance. This research includes exploring various options for expanding our current survey, including the identification of another entity that would be willing to work with us to collect more complete and comprehensive data. We are also exploring other options such as third party or industry data that might assist us in creating a more precise measure of PLI premiums. At this time, we have not yet identified a preferred option. Therefore, we are not proposing to make any changes to the proxy in this proposed rule. h. Pharmaceuticals The percentage change in the price of prescription drugs as measured by the PPI (PPI Code #PPI283D#RX) is used as a proxy for this category. This is a special index produced by BLS and is the same proxy used in the FY 1997based excluded hospital market basket. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 i. Food: Direct Purchases The percentage change in the price of processed foods and feeds as measured by the PPI (Commodity Code #02) is applied to this component. The same proxy was used in the FY 1997-based excluded hospital market basket. j. Food: Contract Services The percentage change in the price of food purchased away from home as measured by the CPI for all urban consumers (CPI Code # CUUR0000SEFV) is applied to this component. The same proxy was used in the FY 1997-based excluded hospital market basket. k. Chemicals The percentage change in the price of industrial chemical products as measured by the PPI (Commodity Code #061) is applied to this component. While the chemicals hospitals purchase include industrial as well as other types of chemicals, the industrial chemicals component constitutes the largest proportion by far. Thus, we believe that Commodity Code #061 is the appropriate proxy. The same proxy was used in the FY 1997-based excluded hospital market basket. l. Medical Instruments The percentage change in the price of medical and surgical instruments as measured by the PPI (Commodity Code #1562) is applied to this component. The same proxy was used in the FY 1997-based excluded hospital market basket. m. Photographic Supplies The percentage change in the price of photographic supplies as measured by the PPI (Commodity Code #1542) is applied to this component. The same proxy was used in the FY 1997-based excluded hospital market basket. n. Rubber and Plastics The percentage change in the price of rubber and plastic products as measured by the PPI (Commodity Code #07) is applied to this component. The same proxy was used in the FY 1997-based excluded hospital market basket. o. Paper Products The percentage change in the price of converted paper and paperboard products as measured by the PPI (Commodity Code #0915) is used. The same proxy was used in the FY 1997based excluded hospital market basket. p. Apparel The percentage change in the price of apparel as measured by the PPI PO 00000 Frm 00096 Fmt 4701 Sfmt 4702 (Commodity Code #381) is applied to this component. The same proxy was used in the FY 1997-based excluded hospital market basket. q. Machinery and Equipment The percentage change in the price of machinery and equipment as measured by the PPI (Commodity Code #11) is applied to this component. The same proxy was used in the FY 1997-based excluded hospital market basket. r. Miscellaneous Products The percentage change in the price of all finished goods less food and energy as measured by the PPI (Commodity Code #SOP3500) is applied to this component. Using this index removes the double-counting of food and energy prices, which are already captured elsewhere in the market basket. The same proxy was used in the FY 1997based excluded hospital market basket. The weight for this cost category is higher than in the FY 1997-based index because it also includes blood and blood products. In the FY 1997-based excluded hospital market basket, we included a separate cost category for blood and blood products, using the BLS PPI (Commodity Code #063711) for blood and derivatives as a price proxy. A review of recent trends in the PPI for blood and derivatives suggests that its movements may not be consistent with the trends in blood costs faced by hospitals. While this proxy did not match exactly with the product hospitals are buying, its trend over time appears to be reflective of the historical price changes of blood purchased by hospitals. However, an apparent divergence over recent periods led us to reevaluate whether the PPI for blood and derivatives was an appropriate measure of the changing price of blood. We ran test market baskets classifying blood in three separate cost categories: blood and blood products, contained within chemicals as was done for the FY 1992-based index, and within miscellaneous products. These categories use as proxies the following PPIs: the PPI for blood and blood products, the PPI for chemicals, and the PPI for finished goods less food and energy, respectively. Of these three proxies, the PPI for finished goods less food and energy moved most like the recent blood cost and price trends. In addition, the impact on the overall market basket by using different proxies for blood was negligible, mostly due to the relatively small weight for blood in the market basket. Therefore, we chose the PPI for finished goods less food and energy for the blood proxy because we believe it will best be able to proxy price E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules s. Telephone The percentage change in the price of telephone services as measured by the CPI for all urban consumers (CPI Code #CUUR0000SEED) is applied to this component. The same proxy was used in the FY 1997-based excluded hospital market basket. D. Frequency of Updates of Weights in IPPS Hospital Market Basket Section 404 of Pub. L. 108–173 (MMA) requires CMS to report in this proposed rule the research that has been done to determine a new frequency for rebasing the hospital market basket. Specifically, section 404 states: ‘‘(a) More frequent updates in weights. After revising the weights used in the hospital market basket under section 1886(b)(3)(B)(iii) of the Social Security Act (42 U.S.C. 1395ww(b)(3)(B)(iii)) to reflect the most current data available, the Secretary shall establish a frequency for revising such weights, including the labor share, in such market basket to reflect the most current data available VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 t. Postage The percentage change in the price of postage as measured by the CPI for all urban consumers (CPI Code #CUUR0000SEEC01) is applied to this component. The same proxy was used in the FY 1997-based excluded hospital market basket. used in the FY 1997-based excluded hospital market basket. v. All Other Services: Nonlabor Intensive The percentage change in the ECI for compensation paid to service workers employed in private industry is applied to this component. The same proxy was The percentage change in the allitems component of the CPI for all urban consumers (CPI Code #CUUR0000SA0) is applied to this component. The same proxy was used in the FY 1997-based excluded hospital market basket. For further discussion of the rationale for choosing many of the specific price proxies, we refer the reader to the August 1, 2002 final rule (67 FR 50037). more frequently than once every 5 years; and ‘‘(b) Incorporation of explanation in rulemaking. The Secretary shall include in the publication of the final rule for payment for inpatient hospitals services under section 1886(d) of the Social Security Act (42 U.S.C. 1395ww(d)) for fiscal year 2006, an explanation of the reasons for, and options considered, in determining the frequency established under subsection (a).’’ This section of the proposed rule discusses the research we have done to fulfill this requirement, and proposes a rebasing frequency that makes optimal use of available data. Our past practice has been to monitor the appropriateness of the market basket on a consistent basis in order to rebase and revise the index when necessary. The decision to rebase and revise the index has been driven in large part by the availability of the data necessary to produce a complete index. In the past, we have supplemented the Medicare cost report data that are available on an annual basis with Bureau of the Census hospital expense data that are typically available only every 5 years (usually in years ending in 2 and 7). Because of this, we have generally rebased the index every 5 years. However, prior to the requirement associated with section 404 of Pub. L. 108–173, there was no legislative requirement regarding the timing of rebasing the hospital market basket nor was there a hard rule that we u. All Other Services: Labor Intensive PO 00000 Frm 00097 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.041</GPH> changes (not quantities or required tests) associated with blood purchased by hospitals. We will continue to evaluate this proxy for its appropriateness and will explore the development of alternative price indexes to proxy the price changes associated with this cost. 23401 23402 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules used in determining this frequency. ProPAC, one of MedPAC’s predecessor organizations, did a report to the Secretary on April 1, 1985, that supported periodic rebasing at least every 5 years. The most recent rebasing of the hospital market basket was just 3 years ago, for the FY 2003 update. Since its inception with the hospital PPS in FY 1984, the hospital market basket has been rebased several times (FY 1987 update, FY 1991 update, FY 1997 update, FY 1998 update, and FY 2003 update). One of the reasons we believe it appropriate to rebase the index on a periodic basis is that rebasing (as opposed to revising, as explained in section IV.A. of this preamble) tends to have only a minor impact on the actual percentage increase applied to the PPS update. There are two major reasons for this: (1) The cost category weights tend to be relatively stable over shorter term periods (3 to 5 years); and (2) the update is based on a forecast, which means the individual price series tend not to grow as differently as they have in some historical periods. We focused our research in two major areas. First, we reviewed the frequency and availability of the data needed to produce the market basket. Second, we analyzed the impact on the market basket of determining the market basket weights under various frequencies. We did this by developing market baskets that had base years for every year between 1997 and 2002, and then analyzed how different the market VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 basket percent changes were over various periods. We used the results from these areas of research to assist in our determination of a new rebasing frequency. Based on this analysis, we are proposing to rebase the hospital market basket every 4 years. This would mean the next rebasing would occur for the FY 2010 update. As we have described in numerous Federal Register documents over the past few decades, the hospital market basket weights are the compilation of data from more than one data source. When we are discussing rebasing the weights in the hospital market basket, there are two major data sources: (1) The Medicare cost reports; and (2) expense surveys from the Bureau of the Census (the Economic Census is used to develop data for the Bureau of Economic Analysis’ input-output series). We will explore the future availability of each of these data sources. Each Medicare-participating hospital submits a Medicare cost report to CMS on an annual basis. It takes roughly 2 years before ‘‘nearly complete’’ Medicare cost report data are available. For example, approximately 90 percent of FY 2002 Medicare cost report data were available in October 2004 (only 50 percent of FY 2003 data was available), although only 20 percent of these reports were settled. We choose FY 2002 as the base year because we believe this is the most recent, relatively complete year (with a 90 percent reporting rate) of Medicare cost report data. In PO 00000 Frm 00098 Fmt 4701 Sfmt 4702 developing the hospital market basket weights, we have used the Medicare cost reports to determine the weights for six major cost categories (wages, benefits, contract labor, pharmaceuticals, professional liability, and blood). In FY 2002, these six categories accounted for 68.5 percent of the hospital market basket. Therefore, it is possible to develop a new set of market basket weights for these categories on an annual basis, but with a substantial lag (for the FY 2006 update, we consider the latest year of historical data to be FY 2002). The second source of data is the U.S. Department of Commerce, Bureau of Economic Analysis’ Benchmark InputOutput (I–O) table. These data are published every 5 years with a more significant lag than the Medicare cost reports. For example, the 1997 Benchmark I–O tables were not published until the beginning of 2003. We have sometimes used data from a third data source, the Bureau of the Census’ Business Expenses Survey (BES), which is also published every 5 years. The BES data are used as an input into the I–O data, and thus are published a few months prior to the release of the I–O. However, the BES contains only a fraction of the detail contained in the I–O. Chart 9 below takes into consideration the expected availability of these major data sources and summarizes how they could be incorporated into the development of future market basket weights. E:\FR\FM\04MYP2.SGM 04MYP2 It would be necessary to age the I–O or BES data to the year for which cost report data are available using the price changes between those periods. While not a preferred method in developing the market basket weights, we have done this in the past when rebasing the index. We are proposing to age the 1997 Benchmark I–O data for this proposed rule. As the table clearly indicates, the most optimal rebasing frequency from a data availability standpoint is every 5 years. That is, if we were to next rebase for the FY 2011 update, we could use the 2002 Benchmark I–O data that would recently be available. In order to match the Medicare cost report data that would be available at that time (FY 2007 data), we would have to age the I–O data to FY 2007. However, this would be aging the data only 5 years, whereas if the rebasing frequency was determined to be every 4 years, we would have to age 1997 I–O data to FY 2006. While aging data over 5 years is problematic VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 (there can be significant utilization and intensity changes over that length period, as opposed to only a year or two), it would be significantly worse to age data over an 8-year or 9-year period. If we were on a 5-year rebasing frequency, for the FY 2016 update, we would use cost report data for FY 2012 and the newly available 2007 I–O data. Again, the I–O data would have to be aged only 5 years to match the cost report data. We can look at the implications of determining a rebasing frequency of every 3 or 4 years. Considering a frequency of 3 years first, we would next rebase for the FY 2009 update using FY 2005 Medicare cost report data and 1997 I–O data (the same data currently being used in the proposed FY 2002-based market basket). This is problematic because the 1997 I–O data would need to be aged 8 years to match the cost report data. The next two rebasings would be for the FY 2012 update (using FY 2008 cost report data PO 00000 Frm 00099 Fmt 4701 Sfmt 4702 23403 and 2002 I–O data) and FY 2015 (using FY 2011 cost report data and 2002 I–O data). This means that while we are making optimal use of the Medicare cost report data, we would be forced to use the same I–O data in consecutive rebasings and would have to age that data as much as 9 years to use the same year as the cost report data. For a rebasing frequency of every 4 years, our next rebasing would be for the FY 2010 update using FY 2006 Medicare cost report data and 1997 I–O data. This is also problematic because the 1997 I–O data would need to be aged 9 years to match the cost report data. The next two rebasings would be for the FY 2014 update (using FY 2010 cost report data and 2002 I–O data) and FY 2018 (using FY 2014 cost report data and 2007 I–O data). Again, this frequency would make optimal use of the Medicare cost report data but would require aging of the I–O data between 7 and 9 years in order to match the cost report data. E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.042</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23404 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules It is clear from this analysis that neither the 3-year nor 4-year rebasing frequencies makes as good use of all the data as rebasing every 5 years. In addition, when comparing the 3-year and 4-year rebasing frequencies, no one method stands out as being significantly improved over another. Thus, this analysis does not lead us to draw any definitive conclusions as to a rebasing frequency more appropriate than every 5 years. Our second area of research in determining a new rebasing frequency was to analyze the impact on the market basket of determining the market basket weights under various frequencies. We VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 did this by using the current historical data that are available (both Medicare cost report and I–O) to develop market baskets with base year weights for each year between FY 1997 and FY 2002. We then analyzed how differently the market baskets moved over various historical periods. Approaching the analysis this way allowed us to develop six hypothetical market baskets with different base years (FY 1997, FY 1998, FY 1999, FY 2000, FY 2001, and FY 2002). As we have done when developing the official market baskets, we used Medicare cost report data where available. Thus, cost report data were used to determine the PO 00000 Frm 00100 Fmt 4701 Sfmt 4702 weights for wages and salaries, benefits, contract labor, pharmaceuticals, blood and blood products, and all other costs. We used the 1997 Benchmark I–O data to fill out the remainder of the market basket weights (note that this produces a different index for FY 1997 than the official FY 1997-based hospital market basket that used the Annual 1997 I–O data), aging the data to the appropriate year to match the cost report data. This means the FY 2002-based index used in this analysis matches the FY 2002-based market basket we are proposing in this rule. Chart 10 shows the weights from these hypothetical market baskets: E:\FR\FM\04MYP2.SGM 04MYP2 Note that the weights remain relatively stable between periods. It is for this reason that we believe defining the market basket as a Laspeyres-type, fixed-weight index is appropriate. Because the weights in the market basket are generally for aggregated costs (for example, wages and salaries for all employees), there is not much volatility in the weights between periods, especially over shorter time spans. As VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 the results of this analysis will show, it is for this reason that rebasing the market basket more frequently than every 5 years is expected to have little impact on the overall percent change in the hospital market basket. Using these hypothetical market baskets, we can produce market basket percent changes over historical periods to determine what is the impact of using various base periods. In our analysis, we PO 00000 Frm 00101 Fmt 4701 Sfmt 4702 23405 consider the hypothetical FY 1997based index to be the benchmark measure and the other indexes to indicate the impact of rebasing over various frequencies. The hypothetical FY 2000-based index would reflect the impact of rebasing every 3 years, the hypothetical FY 2001-based index would reflect the impact of rebasing every 4 years, and the hypothetical FY 2002-based index would reflect the E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.043</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23406 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 11 shows the results of these comparisons. It is clear from this comparison that there is little difference between the indexes, and, for some FYs, there would be no difference in the market basket update factor if we had rebased the market basket more frequently. In particular, there is no difference in the hypothetical indexes based between FY 2000 and FY 2002. This suggests that setting the rebasing frequency to 3, 4, or 5 years will have little or no impact on the resulting market basket. As we found when analyzing data availability, this portion of our research does not suggest that rebasing the market basket more frequently than every 5 years results in an improved market basket or that there is any noticeable difference between rebasing every 3 or 4 years. Market basket rebasing is a 1-year to 2-year long process that includes data processing, analytical work, methodology reevaluation, and regulatory process. After developing a rebased and revised market basket, there are extensive internal review processes that a rule must undergo, both in proposed and final form. Once the proposed rule has been published, there is a 60-day comment period set aside for the public to respond to the proposed rule. After comments are received, we then need adequate time to research and reply to all comments submitted. The last part of the regulatory process is the 60-day requirement—the final rule must be published 60 days before the provisions of the rule can become effective. We would like to rebase all of our indexes (PPS operating, PPS capital, excluded hospital with capital, SNFs, HHAs, and Medicare Economic Index) on a regular schedule. Therefore, if we were to choose a 3-year rebasing schedule, we would have to rebase more than one index at a time. This may potentially limit the amount of time we could devote to the market basket rebasing process. In addition, we recognize that, in the future, we may be required to develop additional market baskets that would require frequent rebasing. Given the number of market baskets we are responsible for rebasing and revising, the regulatory process for each, and the availability of source data, we believe that while it is not necessary, rebasing and revising the hospital market baskets every 4 years is the most appropriate frequency to meet the legislative requirement. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 E. Capital Input Price Index Section The Capital Input Price Index (CIPI) was originally described in the September 1, 1992 Federal Register (57 FR 40016). There have been subsequent discussions of the CIPI presented in the May 26, 1993 (58 FR 30448), September 1, 1993 (58 FR 46490), May 27, 1994 (59 PO 00000 Frm 00102 Fmt 4701 Sfmt 4702 FR 27876), September 1, 1994 (59 FR 45517), June 2, 1995 (60 FR 29229), September 1, 1995 (60 FR 45815), May 31, 1996 (61 FR 27466), and August 30, 1996 (61 FR 46196) issues of the Federal Register. The August 1, 2002 (67 FR 50032) rule discussed the most recent revision and rebasing of the CIPI to a FY 1997 base year, which reflects the capital cost structure facing hospitals in that year. We are proposing to revise and rebase the CIPI to a FY 2002 base year to reflect the more recent structure of capital costs in hospitals. Unlike the PPS operating market basket, we do not have FY 2002 Medicare cost report data available for the development of the capital cost weights, due to a change in the FY 2002 cost reporting requirements. Rather, we used hospital capital expenditure data for the capital cost categories of depreciation, interest, and other capital expenses for FY 2001 and aged these data to a FY 2002 base year using the relevant vintage-weighted price proxies. As with the FY 1997-based index, we have developed two sets of weights in order to calculate the proposed FY 2002-based CIPI. The first set of proposed weights identifies the proportion of hospital capital expenditures attributable to each expenditure category, while the second set of proposed weights is a set of relative vintage weights for depreciation E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.044</GPH> impact of rebasing every 5 years. Chart Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 are distributed among the cost categories of depreciation, interest, and other, reflecting the assumption that the underlying cost structure of leases is similar to capital costs in general. As was done in previous rebasings of the CIPI, we assumed 10 percent of lease expenses are overhead and assigned them to the other capital expenses cost category as overhead. The remaining lease expenses were distributed to the three cost categories based on the proportion of depreciation, interest, and other capital expenses to total capital costs excluding lease expenses. Depreciation contains two subcategories: building and fixed equipment and movable equipment. The split between building and fixed equipment and movable equipment was determined using the Medicare cost reports. This methodology was also used to compute the FY 1997-based index. Total interest expense cost category is split between government/nonprofit and profit interest. The FY 1997-based CIPI allocated 85 percent of the total interest cost weight to government/nonprofit PO 00000 Frm 00103 Fmt 4701 Sfmt 4725 interest, proxied by average yield on domestic municipal bonds, and 15 percent to for-profit interest, proxied by average yield on Moody’s Aaa bonds (67 FR 50044). The methodology used to derive this split is explained in the June 2, 1995 issue of the Federal Register (60 FR 29233). We are proposing to derive the split using the relative FY 2001 Medicare cost report data on interest expenses for government/nonprofit and profit hospitals. Based on these data, we are proposing a 75/25 split between government/nonprofit and profit interest. We believe it is important that this split reflects the latest relative cost structure of interest expenses. The proposed split of 75/25 had little (less than 0.1 percent in any given year) or no effect on the annual capital market basket percent change in both the historical and forecasted periods. Chart 12 presents a comparison of the proposed FY 2002-based CIPI capital cost weights and the FY 1997-based CIPI capital cost weights. E:\FR\FM\04MYP2.SGM 04MYP2 EP04my05.045</GPH> and interest. The set of vintage weights is used to identify the proportion of capital expenditures within a cost category that is attributable to each year over the useful life of the capital assets in that category. A more thorough discussion of vintage weights is provided later in this section. Both sets of proposed weights are developed using the best data sources available. In reviewing source data, we determined that the Medicare cost reports provided accurate data for all capital expenditure cost categories. We are proposing to use the FY 2001 Medicare cost reports for PPS hospitals, aged to FY 2002, excluding expenses from hospital-based subproviders, to determine weights for all three cost categories: depreciation, interest, and other capital expenses. We compared the weights determined from the Medicare cost reports to the 2002 Bureau of the Census’ Business Expenses Survey and found the weights to be similar to those developed from the Medicare cost reports. Lease expenses are not broken out as a separate cost category in the CIPI, but 23407 23408 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules Because capital is acquired and paid for over time, capital expenses in any given year are determined by both past and present purchases of physical and financial capital. The vintage-weighted CIPI is intended to capture the longterm consumption of capital, using vintage weights for depreciation (physical capital) and interest (financial capital). These vintage weights reflect the proportion of capital purchases attributable to each year of the expected life of building and fixed equipment, movable equipment, and interest. We used the vintage weights to compute vintage-weighted price changes associated with depreciation and interest expense. Vintage weights are an integral part of the CIPI. Capital costs are inherently complicated and are determined by complex capital purchasing decisions, over time, based on such factors as interest rates and debt financing. In addition, capital is depreciated over time instead of being consumed in the same period it is purchased. The CIPI accurately reflects the annual price changes associated with capital costs, and is a useful simplification of the actual capital investment process. By accounting for the vintage nature of capital, we are able to provide an accurate, stable annual measure of price changes. Annual nonvintage price changes for capital are unstable due to the volatility of interest rate changes and, therefore, do not reflect the actual annual price changes for Medicare capital-related costs. CMS’ CIPI reflects the underlying stability of the capital acquisition process and provides hospitals with the ability to plan for changes in capital payments. To calculate the vintage weights for depreciation and interest expenses, we needed a time series of capital purchases for building and fixed equipment and movable equipment. We found no single source that provides the best time series of capital purchases by hospitals for all of the above components of capital purchases. The early Medicare cost reports did not have sufficient capital data to meet this need. While the AHA Panel Survey provided a consistent database back to 1963, it did not provide annual capital purchases. The AHA Panel Survey provided a time series of depreciation expenses through 1997 which could be used to infer capital purchases over time. From 1998 to 2001, hospital depreciation expenses were calculated by multiplying the AHA Annual Survey total hospital expenses by the ratio of depreciation to total hospital expenses from the Medicare cost reports. Beginning in 2001, the AHA Annual VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Survey began collecting depreciation expenses. We hope to be able to use these data in future rebasings. In order to estimate capital purchases from AHA data on depreciation expenses, the expected life for each cost category (building and fixed equipment, movable equipment, and interest) is needed to calculate vintage weights. We used FY 2001 Medicare cost reports to determine the expected life of building and fixed equipment and movable equipment. The expected life of any piece of equipment can be determined by dividing the value of the asset (excluding fully depreciated assets) by its current year depreciation amount. This calculation yields the estimated useful life of an asset if depreciation were to continue at current year levels, assuming straight-line depreciation. From the FY 2001 cost reports, the expected life of building and fixed equipment was determined to be 23 years, and the expected life of movable equipment was determined to be 11 years. The FY 1997-based CIPI showed the same expected life for the two categories of depreciation. Although we are proposing to use this methodology for deriving the useful life of an asset, we intend to conduct a further review of the methodology between the publication of this proposed rule and the final rule. We plan to review alternate data sources, if available, and analyze in more detail the hospital’s capital cost structure reported in the Medicare cost reports. We are proposing to use the building and fixed equipment and movable equipment weights derived from FY 2001 Medicare cost reports to separate the depreciation expenses into annual amounts of building and fixed equipment depreciation and movable equipment depreciation. Year-end asset costs for building and fixed equipment and movable equipment were determined by multiplying the annual depreciation amounts by the expected life calculations from the FY 2001 Medicare cost reports. We then calculated a time series back to 1963 of annual capital purchases by subtracting the previous year asset costs from the current year asset costs. From this capital purchase time series, we were able to calculate the vintage weights for building and fixed equipment and movable equipment. Each of these sets of vintage weights is explained in detail below. For building and fixed equipment vintage weights, the real annual capital purchase amounts for building and fixed equipment derived from the AHA Panel Survey were used. The real annual purchase amount was used to PO 00000 Frm 00104 Fmt 4701 Sfmt 4702 capture the actual amount of the physical acquisition, net of the effect of price inflation. This real annual purchase amount for building and fixed equipment was produced by deflating the nominal annual purchase amount by the building and fixed equipment price proxy, the Boeckh Institutional Construction Index. Because building and fixed equipment have an expected life of 23 years, the vintage weights for building and fixed equipment are deemed to represent the average purchase pattern of building and fixed equipment over 23-year periods. With real building and fixed equipment purchase estimates available back to 1963, we averaged sixteen 23-year periods to determine the average vintage weights for building and fixed equipment that are representative of average building and fixed equipment purchase patterns over time. Vintage weights for each 23-year period are calculated by dividing the real building and fixed capital purchase amount in any given year by the total amount of purchases in the 23-year period. This calculation is done for each year in the 23-year period, and for each of the sixteen 23-year periods. We are proposing to use the average of each year across the sixteen 23-year periods to determine the 2002 average building and fixed equipment vintage weights for the FY 2002-based CIPI. For movable equipment vintage weights, the real annual capital purchase amounts for movable equipment derived from the AHA Panel Survey were used to capture the actual amount of the physical acquisition, net of price inflation. This real annual purchase amount for movable equipment was calculated by deflating the nominal annual purchase amount by the movable equipment price proxy, the PPI for Machinery and Equipment. Based on our determination that movable equipment has an expected life of 11 years, the vintage weights for movable equipment represent the average expenditure for movable equipment over an 11-year period. With real movable equipment purchase estimates available back to 1963, twenty-eight 11-year periods were averaged to determine the average vintage weights for movable equipment that are representative of average movable equipment purchase patterns over time. Vintage weights for each 11year period are calculated by dividing the real movable capital purchase amount for any given year by the total amount of purchases in the 11-year period. This calculation was done for each year in the 11-year period, and for E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23409 determined that hospital debt instruments have an expected life of 23 years, the vintage weights for interest are deemed to represent the average purchase pattern of total equipment over 23-year periods. With nominal total equipment purchase estimates available back to 1963, sixteen 23-year periods were averaged to determine the average vintage weights for interest that are representative of average capital purchase patterns over time. Vintage weights for each 23-year period are calculated by dividing the nominal total capital purchase amount for any given year by the total amount of purchases in the 23-year period. This calculation is done for each year in the 23-year period and for each of the sixteen 23-year periods. We are proposing to use the average of each year across the sixteen 23-year periods to determine the average interest vintage weights for the FY 2002based CIPI. The vintage weights for the FY 1997 CIPI and the proposed FY 2002 CIPI are presented in Chart 13. After the capital cost category weights were computed, it was necessary to select appropriate price proxies to reflect the rate of increase for each expenditure category. Our proposed price proxies for the FY 2002-based CIPI are the same as those used in the FY 1997-based CIPI. We still believe these are the most appropriate proxies for VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00105 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.046</GPH> each of the twenty-eight 11-year periods. We are proposing to use the average of each year across the twentyeight 11-year periods to determine the average movable equipment vintage weights for the FY 2002-based CIPI. For interest vintage weights, the nominal annual capital purchase amounts for total equipment (building and fixed, and movable) derived from the AHA Panel and Annual Surveys were used. Nominal annual purchase amounts were used to capture the value of the debt instrument. Because we have 23410 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules Moody’s Baa bonds average yield as proxy for the for-profit interest cost category. There was no difference in the two sets of index percent changes either historically or forecasted. The rationale for selecting these price proxies is explained more fully in the August 30, 1996 final rule (61 FR 46196). The proposed proxies are presented in Chart 14. Global Insight, Inc. forecasts a 0.7 percent increase in the FY 2002-based CIPI for 2006, as shown in Chart 15. This is the result of a 1.3 percent increase in projected depreciation prices (building and fixed equipment, and movable equipment) and a 2.7 percent increase in other capital expense prices, partially offset by a 2.3 percent decrease in vintage-weighted interest rates in FY 2006, as indicated in Chart 15. Accordingly, we are proposing a 0.7 percent increase in the CIPI. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00106 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.047</GPH> hospital capital costs that meet our selection criteria of relevance, timeliness, availability, and reliability. We ran the proposed FY 2002-based index using the Moody’s Aaa bonds average yield and then using the Rebasing the CIPI from FY 1997 to FY 2002 decreased the percent change in the FY 2006 forecast by 0.1 percentage point, from 0.8 to 0.7, as shown in Chart 12. The difference is caused mostly by changes in the relationships between the cost category weights within depreciation and interest. The fixed depreciation cost weight relative to the movable depreciation cost weight and the nonprofit/government interest cost weight relative to the for-profit interest cost weight are both less in the FY 2002based CIPI. The changes in these relationships have a small effect on the FY 2002-based CIPI percent changes. However, when added together, they are responsible for a negative one-tenth percentage point difference between the FY 2002-based CIPI and the FY 1997based CIPI. V. Other Decisions and Proposed Changes to the IPPS for Operating Costs and GME Costs A. Postacute Care Transfer Payment Policy (§ 412.4) (If you choose to comment on issues in this section, please include the VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 caption ‘‘Postacute Care Transfers’’ at the beginning of your comment.) 1. Background 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, and § 412.4(c) defines transfers to certain postacute care providers. Our policy provides that, in transfer situations, full payment is made to the final discharging hospital and 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 PO 00000 Frm 00107 Fmt 4701 Sfmt 4702 23411 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 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. 2. Changes to DRGs Subject to the Postacute Care Transfer Policy (§§ 412.4(c) and (d)) Section 1886(d)(5)(J) of the Act provides that, effective for discharges on or after October 1, 1998, a ‘‘qualified discharge’’ from one of 10 DRGs selected by the Secretary to a postacute care provider would be treated as a transfer case. This section required the Secretary to define and pay as transfers all cases assigned to one of 10 DRGs selected by the Secretary, if the E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.048</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23412 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules individuals are discharged to one of the following postacute care settings: • A hospital or hospital unit that is not a subsection 1886(d) hospital. (Section 1886(d)(1)(B) of the Act identifies the hospitals and hospital units that are excluded from the term ‘‘subsection (d) hospital’’ as psychiatric hospitals and units, rehabilitation hospitals and units, children’s hospitals, long-term care hospitals, and cancer hospitals.) • A SNF (as defined at section 1819(a) of the Act). • Home health services provided by a home health agency, if the services relate to the condition or diagnosis for which the individual received inpatient hospital services, and if the home health services are provided within an appropriate period (as determined by the Secretary). In the July 31, 1998 IPPS final rule (63 FR 40975 through 40976), we specified that a patient discharged to home would be considered transferred to postacute care if the patient received home health services within 3 days after the date of discharge. In addition, in the July 31, 1998 final rule, we did not include patients transferred to a swing-bed for skilled nursing care in the definition of postacute care transfer cases (63 FR 40977). Section 1886(d)(5)(J) of the Act directed the Secretary to select 10 DRGs based upon a high volume of discharges to postacute care and a disproportionate use of postacute care services. As discussed in the July 31, 1998 final rule, these 10 DRGs were selected in 1998 based on the MedPAR data from FY 1996. Using that information, we identified and selected the first 20 DRGs that had the largest proportion of discharges to postacute care (and at least 14,000 such transfer cases). In order to select 10 DRGs from the 20 DRGs on our list, we considered the volume and percentage of discharges to postacute care that occurred before the mean length of stay and whether the discharges occurring early in the stay were more likely to receive postacute care. We identified 10 DRGs to be subject to the postacute care transfer rule starting in FY 1999. Section 1886(d)(5)(J)(iv) of the Act authorizes the Secretary to expand the postacute care transfer policy for FY 2001 or subsequent fiscal years to additional DRGs based on a high volume of discharges to postacute care facilities and a disproportionate use of postacute care services. In the FY 2004 IPPS final rule (68 FR 45412), we expanded the postacute care transfer policy to include additional DRGs. We established the following criteria that a VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 DRG must meet, for both of the 2 most recent years for which data are available, in order to be included under the postacute care transfer policy: • At least 14,000 postacute care transfer cases; • At least 10 percent of its postacute care transfers occurring before the geometric mean length of stay; • A geometric mean length of stay of at least 3 days; and • If a DRG is not already included in the policy, a decline in its geometric mean length of stay during the most recent 5-year period of at least 7 percent. In the FY 2004 IPPS final rule, we identified 21 new DRGs that met these criteria. We also determined that one DRG from the original group of 10 DRGs (DRG 263) no longer met the volume criterion of 14,000 transfer cases. Therefore, we removed DRGs 263 and 264 (DRG 264 is paired with DRG 263) from the policy and expanded the postacute care transfer policy to include payments for transfer cases in the new 21 DRGs, effective October 1, 2003. As a result, a total of 29 DRGs were subject to the postacute care transfer policy in FY 2004. In the FY 2004 IPPS final rule, we indicated that we would review and update this list periodically to assess whether additional DRGs should be added or existing DRGs should be removed (68 FR 45413). For FY 2005, we analyzed the available data from the FY 2003 MedPAR file. For the 2 most recent years of available data (FY 2002 and FY 2003), we found that no additional DRGs qualified under the four criteria set forth in the IPPS final rule for FY 2004. We also analyzed the DRGs included under the policy for FY 2004 to determine if they still met the criteria to remain under the policy. In addition, we analyzed the special circumstances arising from a change to one of the DRGs included under the policy in FY 2004. In the FY 2005 IPPS final rule (69 FR 48942), we deleted DRG 483 (Tracheostomy With Mechanical Ventilation 96+ Hours or Principal Diagnosis Except Face, Mouth, and Neck Diagnosis) and established the following new DRGs as replacements: DRG 541 (Tracheostomy With Mechanical Ventilation 96+ Hours or Principal Diagnosis Except Face, Mouth and Neck Diagnoses With Major O.R. Procedure) and DRG 542 (Tracheostomy with Mechanical Ventilation 96+ Hours or Principal Diagnosis Except Face, Mouth and Neck Diagnoses Without Major O.R. Procedure). Cases in the existing DRG 483 were assigned to the new DRGs 541 and 542 based on the presence or absence of a major O.R. PO 00000 Frm 00108 Fmt 4701 Sfmt 4702 procedure, in addition to the tracheostomy code that was previously required for assignment to DRG 483. Specifically, if the patient’s case involves a major O.R. procedure (a procedure whose code is included on the list that is assigned to DRG 468 (Extensive O.R. Procedure Unrelated to Principal Diagnosis), except for tracheostomy codes 31.21 and 31.29), the case is assigned to the DRG 541. If the patient does not have an additional major O.R. procedure (that is, if there is only a tracheostomy code assigned to the case), the case is assigned to DRG 542. Based on data analysis, we determined that neither DRG 541 nor DRG 542 would have enough cases to meet the existing threshold of 14,000 transfer cases for inclusion in the postacute care transfer policy. Nevertheless, we believed the cases that would be incorporated into these two DRGs remained appropriate candidates for application of the postacute care transfer policy and that the subdivision of DRG 483 should not change the original application of the postacute care transfer policy to the cases once included in that DRG. Therefore, for FY 2005, we proposed alternate criteria to be applied in cases where DRGs do not satisfy the existing criteria, for discharges occurring on or after October 1, 2004 (69 FR 28273 and 28374). The proposed new criteria were designed to address situations such as those posed by the split of DRG 483, where there remain substantial grounds for inclusion of cases within the postacute care transfer policy, although one or more of the original criteria may no longer apply. Under the proposed alternate criteria, DRGs 430, 541, and 542 would have qualified for inclusion in the postacute care transfer policy. In the response to comments on our FY 2005 proposal, we decided not to adopt the proposed alternate criteria for including DRGs under the postacute care transfer policy in the FY 2005 IPPS final rule. Instead we adopted the policy of simply grandfathering, for a period of 2 years, any cases that were previously included within a DRG that has split, when the split DRG qualified for inclusion in the postacute care transfer policy for both of the previous 2 years. Under this policy, the cases that were previously assigned to DRG 483 and that now fall into DRGs 541 and 542 continue to be subject to the policy. Therefore, effective for discharges on or after October 1, 2004, 30 DRGs, including new DRGs 541 and 542, are subject to the postacute care transfer policy. We indicated that we would monitor the frequency with which these E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules cases are transferred to postacute care settings and the percentage of these cases that are short-stay transfer cases. Because we did not adopt the proposed alternate criteria for DRG inclusion in the postacute care transfer policy, DRG 430 (Psychoses) did not meet the criteria for inclusion and has not been subject to the postacute care transfer policy for FY 2005. We also invited comments on how to treat the cases formerly included in a split DRG after the grandfathering period. We note that some commenters also suggested that, in place of the proposed alternate criteria, we should adopt a policy of permanently applying the postacute care transfer policy to a DRG once it has initially qualified for inclusion in the policy. These commenters noted that removing DRGs from the postacute care transfer policy makes the payment system less stable and results in inconsistent incentives over time. They also argued that ‘‘a drop in the number of transfers to postacute care settings is to be expected after the VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 transfer policy is applied to a DRG, but the frequency of transfers may well rise again if the DRG is removed from the policy.’’ We indicated that we would consider adopting this general policy once we had evaluated the experience with the specific cases that are subject to the grandfathering policy for FY 2005 and FY 2006. In the May 18, 2004 proposed rule, we also called attention to the data concerning DRG 263, which was subject to the postacute care transfer policy until FY 2004. We removed DRG 263 from the postacute care transfer policy for FY 2004 because it did not have the minimum number of cases (14,000) transferred to postacute care (13,588 transfer cases in FY 2002, with more than 50 percent of transfer cases being short-stay transfers). The FY 2003 MedPAR data show that there were 15,602 transfer cases in the DRG in FY 2003, of which 46 percent were shortstay transfers. Because we removed the DRG from the postacute care transfer policy in FY 2004, it must meet all PO 00000 Frm 00109 Fmt 4701 Sfmt 4702 23413 criteria to be included under the policy in subsequent fiscal years. Because the geometric mean length of stay for DRG 263 showed only a 6-percent decrease since 1999, DRG 263 did not qualify to be added to the policy for FY 2005 under the existing criteria that were included in last year’s rule. DRG 263 would have qualified under the volume threshold and percent of short-stay transfer cases under the proposed new alternate criteria contained in the FY 2005 proposed rule. However, it still would not have met the proposed required decline in length of stay to qualify to be added to the policy for FY 2005. We indicated that we would continue to monitor the experience with DRG 263, especially in light of the comment that recommended a general policy of grandfathering cases that qualify under the criteria for inclusion in the postacute care transfer policy. The table below displays the 30 DRGs that are included in the postacute care transfer policy, effective for discharges occurring on or after October 1, 2004. E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules For this year’s proposed rule, we have conducted an extensive analysis of the FY 2003 and FY 2004 MedPAR data to monitor the effects of the postacute care transfer policy. We have also conducted an overall assessment of the postacute care transfer policy since its inception in FY 1999. Specifically, we have VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 examined the relationship between rates of postacute care utilization and the geometric mean length of stay and the relationship between a high volume and a high proportion of postacute care transfers within a DRG in light of experience under the current policy. Specifically, we examined whether a PO 00000 Frm 00110 Fmt 4701 Sfmt 4702 decline in the geometric mean length of stay is associated with an increase in the volume and proportion of total cases in a DRG that are discharges to postacute care. We analyzed these data as part of determining whether to retain the criteria that a DRG must have a decline in the geometric mean length of stay of E:\FR\FM\04MYP2.SGM 04MYP2 EP04my05.049</GPH> 23414 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23415 in the DRG’s geometric mean length of stay during the most recent 5-year period. It has come to our attention that not all DRGs that experience an increase in postacute care utilization also experience a decrease in geometric mean length of stay. In fact, some DRGs with increases in postacute care utilization during the past several years have also experienced an increase in the geometric mean length of stay. The table below lists a number of DRGs that experienced increases in postacute care utilization and increases in the geometric mean length of stay from FY 2002 through FY 2004: Our current criteria also include a requirement that a DRG have at least 14,000 total postacute care transfer cases in order to be included in the policy. We have examined the data on the numbers of transfers and the percentage of postacute care transfer cases across DRGs. Among the 30 DRGs currently included within the postacute care transfer policy, the percentage of postacute care transfer cases ranges from a low of 15 percent to a high of 76 percent. Among DRGs that are not currently included within the policy, many have a relatively high percentage of postacute care transfer cases in proportion to the total volume of cases for the DRG or a relatively high volume of discharges to postacute care facilities, or both. For this reason, we reviewed the data for all DRGs before proposing a change to the postacute care transfer payment policy. As part of this review, we found that: • Of 550 DRGs, 26 have been deactivated and 17 have no cases in the FY 2004 MedPAR files. We are not proposing any changes for these DRGs because application of the postacute care transfer policy to them would have no effect. • Of the remaining 507 DRGs, 220 have geometric mean lengths of stay that are less than 3.0 days. Because the transfer payment policy provides 2 times the per diem rate for the first day of care (due to the large proportion of charges incurred on the first day of a patient’s treatment), including these DRGs in the transfer policy would be relatively meaningless as they would all receive a full DRG payment. For this reason, we are not proposing any VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00111 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04my05.050</GPH> at least 7 percent in the previous 5-year period to be included under the postacute care transfer policy. Our current criteria for inclusion in the postacute care transfer policy include a requirement that, if a DRG is not already included in the policy, there must be a decline of at least 7 percent 23416 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules changes to the postacute care transfer policy for these DRGs. • Of the remaining 287 DRGs, 64 have fewer than 100 short-stay transfer cases. In addition, 39 of these 64 DRGs have fewer than 50 short-stay transfer cases. Consistent with the statutory guidance, we are not proposing any change to how we apply the postacute care transfer payment policy to these DRGs because we believe that these DRGs do not have a high volume of discharges to postacute care facilities or involve a disproportionate use of postacute care services. Once we eliminated the DRGs cited above from consideration for the postacute care transfer policy, we examined the characteristics of the remaining 223 DRGs. We found that these DRGs had three common characteristics: • The DRG had at least 2,000 total postacute care transfer cases. • At least 20 percent of all cases in the DRG were discharged to postacute care settings. • 10 percent of all discharges to postacute care were prior to the geometric mean length of stay for the DRG. Consistent with the statutory guidance giving the Secretary the authority to make a DRG subject to the postacute care transfer policy based on a high volume of discharges to postacute care facilities and a disproportionate use of postacute care services, we believe these DRGs have characteristics that make them appropriate for inclusion in the postacute care transfer policy. As a result of our analysis, we believe that it is appropriate to consider major revisions to the criteria for including a DRG within the postacute care transfer policy. First, our analysis calls into question the requirement that a DRG experience a decline in the geometric mean length of stay over the most recent 5-year period. Our findings that some DRGs with increases in postacute care utilization during the past several years have also experienced increases in geometric mean length of stay indicate that this criterion is no longer effective to identify those DRGs that should be subject to the postacute care transfer policy. In addition, our findings about the number of DRGs with relatively high volumes (at least 2,000 cases) and relatively high proportions (at least 20 percent) of postacute care utilization suggest that we should revise the VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 requirement that a DRG have at least 14,000 total postacute care transfer cases to be included within the postacute care transfer policy. Our analysis does confirm that it is appropriate to maintain the requirement that a DRG must have a geometric mean length of stay of at least 3.0 days in order to be included within the postacute care transfer policy. We believe that this policy should be retained because, under the transfer payment methodology, hospitals receive the entire payment for cases in these DRGs in the first 2 days of the stay. Lowering the limit below 3.0 days would, therefore, have no effect on payment for DRGs with geometric mean lengths-of-stay in this range. For the reasons discussed in the May 19, 2003 proposed rule (68 FR 27199) and because it is a common characteristic of DRGs with a large number of cases discharged to postacute care, we also continue to believe that it is appropriate to retain the criterion that at least 10 percent of all cases that are transferred to postacure care should be short-stay cases where the patient is transferred before the geometric mean length of stay for the DRG. We also continue to believe that both DRGs in a CC/non-CC pair should be subject to the postacute care transfer policy if one of the DRGs meets the criteria for inclusion. By including both DRGs in a CC/non-CC pair, our policy will preclude an incentive for hospitals to code cases in ways designed to avoid triggering the application of the policy, for example, by excluding codes that would identify a complicating or comorbid condition in order to assign a case to a non-CC DRG that is not subject to the policy. Therefore, we are considering substantial revisions to the four criteria that are currently used to determine whether a DRG qualifies for inclusion in the postacute care transfer policy. The current criteria provide that, in order to be included within the policy, a DRG must have, for both of the 2 most recent years for which data are available: • At least 14,000 total postacute care transfer cases; • At least 10 percent of its postacute care transfers occurring before the geometric mean length of stay; • A geometric mean length of stay of at least 3 days; • If a DRG is not already included in the policy, a decline in its geometric mean length of stay during the most PO 00000 Frm 00112 Fmt 4701 Sfmt 4702 recent 5-year period of at least 7 percent; and • If the DRG is one of a paired set of DRGs based on the presence or absence of a comorbidity or complication, both paired DRGs are included if either one meets the first three criteria above. As a result of our analysis, we considered two options for revising the current criteria. Option 1 is to include all DRGs within the postacute care transfer policy. This option has the advantage of providing consistent treatment of all DRGs. However, as we discussed above, our analysis tends to indicate that, at a minimum, it may be appropriate to maintain the requirement that a DRG must have a geometric mean length of stay of at least 3.0 days because, under the transfer payment methodology, hospitals receive the entire payment for these DRGs in the first 2 days of the stay. Lowering the limit below 3.0 days, would therefore have little or no effect on payment for DRGs with geometric mean lengths of stay in this range. Option 2 that we considered is to expand the application of the postacute care transfer policy by applying the policy to any DRG that meets the following criteria: • The DRG has at least 2,000 postacute care transfer cases; • At least 20 percent of the cases in the DRG are discharged to postacute care; • Out of the cases discharged to postacute care, at least 10 percent occur before the geometric mean length of stay for the DRG;. • The DRG has a geometric mean length of stay of at least 3.0 days; • If the DRG is one of a paired set of DRGs based on the presence or absence of a comorbidity or complication, both paired DRGs are included if either one meets the first three criteria above. Option 2 would expand the application of the postacute care transfer policy to 223 DRGs that have both a relatively high volume and a relatively high proportion of postacute care utilization. The proposed change would also avoid applying the postacute care transfer policy to DRGs with only a small number or proportion of cases transferred to postacute care. The table below shows the DRGs that would be included in the postacute care transfer policy under this option: E:\FR\FM\04MYP2.SGM 04MYP2 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00113 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 23417 EP04MY05.051</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules VerDate Aug<04>2004 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00114 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.052</GPH> 23418 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00115 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 23419 EP04MY05.053</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules VerDate Aug<04>2004 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00116 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.054</GPH> 23420 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00117 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 23421 EP04MY05.055</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules VerDate Aug<04>2004 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00118 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.056</GPH> 23422 We believe that the analysis that we have conducted suggest that substantial revisions to the criteria for including a DRG within the postacute care transfer policy are warranted. In this proposed rule, we are formally proposing Option 2 as presented above. However, we invite comments on both of these options and on the analysis that we have presented. The impact section in Appendix A of this proposed rule discusses our findings on the effects of adopting VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Option 2. The proposed DRG relative weights included in Tables 5 and 7 of the Addendum to this proposed rule also include the effect of changing the postacute care transfer policy as described in Option 2 above. We note that if we adopt either option discussed above, or a variation based on comments submitted, we would follow procedures similar to those that are currently followed for treating cases identified as transfers in the DRG recalibration process. That is, as described in the PO 00000 Frm 00119 Fmt 4701 Sfmt 4702 23423 discussion of DRG recalibration in section II.C. of the preamble to this proposed rule, additional transfer cases would be counted as a fraction of a case based on the ratio of a hospital’s transfer payment under the per diem payment methodology to the full DRG payment for nontransfer cases. Section 1886(d)(5)(J)(i) of the Act recognizes that, in some cases, a substantial portion of the cost of care is incurred in the early days of the inpatient stay. Similar to the policy for E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.057</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23424 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules transfers between two acute care hospitals, transferring hospitals receive twice the per diem rate for the first day of treatment and the per diem rate for each following day of the stay before the transfer, up to the full DRG payment, for cases discharged to postacute care. However, three of the DRGs subject to the postacute care transfer policy exhibit an even higher share of costs very early in the hospital stay in postacute care transfer situations. For these DRGs, hospitals receive 50 percent of the full DRG payment plus the single per diem (rather than double the per diem) for the first day of the stay and 50 percent of the per diem for the remaining days of the stay, up to the full DRG payment. In previous years, we determined that DRGs 209 and 211 met this cost threshold and qualified to receive this special payment methodology. Because DRG 210 is paired with DRG 211, we include payment for cases in that DRG for the same reason we include paired DRGs in the postacute care transfer policy (to eliminate any incentive to code incorrectly in order to receive higher payment for those cases). The FY 2004 MedPAR data show that DRGs 209 and 211 continue to have charges on the first day of the stay that are higher than 50 percent of the average charges in the DRGs. In addition, several of the DRGs that may be added to the postacute care transfer policy under the options that we are considering may also meet the 50 percent threshold in their average charges. We have identified those additional DRGs that are subject to the special payment methodology in Tables 5 and 7 of the Addendum to this proposed rule. B. 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 document.) 1. Background Section 1886(b)(3)(B)(vii) of the Act, as added by section 501(b) of Pub. L. 108–173 revised the mechanism used to update the standardized amount of payment for inpatient hospital operating costs. Specifically, the statute provides for a reduction of 0.4 percentage points to the update percentage increase (also known as the market basket update) for each of FYs 2005 through 2007 for any ‘‘subsection (d) hospital’’ that does not submit data on a set of 10 quality indicators established by the Secretary as of November 1, 2003. The statute also provides that any reduction will apply VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 only to the fiscal year involved, and will not be taken into account in computing the applicable percentage increase for a subsequent fiscal year. This measure establishes an incentive for IPPS hospitals to submit data on the quality measures established by the Secretary. We initially implemented section 1886(b)(3)(B)(vii) of the Act in the FY 2005 IPPS final rule (August 11, 2004, 69 FR 49078) in continuity with the Department’s Hospital Quality Initiative as described at the CMS Web site: https://www.cms.hhs.gov/quality/ hospitals. At a press conference on December 12, 2002, the Secretary of the Department of Health and Human Services (HHS) announced a series of steps that HHS and its collaborators were taking to promote public reporting of hospital quality information. These collaborators include the American Hospital Association, the Federation of American Hospitals, the Association of American Medical Colleges, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the National Quality Forum, the American Medical Association, the ConsumerPurchaser Disclosure Project, the American Association of Retired Persons, the American Federation of Labor-Congress of Industrial Organizations, the Agency for Healthcare Research and Quality, as well as CMS, Quality Improvement Organizations (QIOs), and others. In July 2003, CMS began the National Voluntary Hospital Reporting Initiative (NVHRI), now known as the Hospital Quality Alliance (HQA): Improving Care through Information. Data from this initiative have been used to populate a professional Web site providing data to healthcare professionals. This website will be followed by the development of a consumer Web site in an easy-to-use format. The consumer Web site is intended to be an important tool for individuals to use in making decisions about health care options. This information will assist beneficiaries by providing comparison information for consumers who need to select a hospital. It will also serve as a way to encourage accountability of hospitals for the care they provide to patients. The 10 measures that were employed in this voluntary initiative as of November 1, 2003, are: • Heart Attack (Acute Myocardial Infarction) Was aspirin given to the patient upon arrival to the hospital? Was aspirin prescribed when the patient was discharged? Was a beta-blocker given to the patient upon arrival to the hospital? Was a beta-blocker prescribed when the patient was discharged? PO 00000 Frm 00120 Fmt 4701 Sfmt 4702 Was an ACE inhibitor given for the patient with heart failure? • Heart failure Did the patient get an assessment of his or her heart function? Was an ACE inhibitor given to the patient? • Pneumonia Was an antibiotic given to the patient in a timely way? Had a patient received a pneumococcal vaccination? Was the patient’s oxygen level assessed? These measures have been endorsed by the National Quality Forum (NQF) and are a subset of the same measures currently collected for the JCAHO by its accredited hospitals. The Secretary adopted collection of data on these 10 quality measures in order to: (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. Many hospitals are currently participating in the National Voluntary Hospital Reporting Initiative (NVHRI), and are submitting data to the QIO Clinical Warehouse for that purpose. Over the next several years, hospitals are encouraged to take steps toward the adoption of electronic medical records (EMRs) that will allow for reporting of clinical quality data from the electronic record directly to a CMS data repository. CMS intends 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 currently exists. The Department is presently working cooperatively with other Federal agencies in the development of Federal health architecture data standards. CMS encourages hospitals that are developing systems to conform them to both industry standards and the Federal health architecture data standards, and to ensure that they would capture the data necessary for quality measures. Ideally, such systems will also provide point-of-care 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. We are exploring requirements for the submission of electronically produced data and other options to encourage the submission of such data, and invite comments on this issue. E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 2. Requirements for Hospital Reporting of Quality Data The procedures for participating in the Reporting Hospital Quality Data for the Annual Payment Update (RHQDAPU) program created in accordance with section 501(b) of Pub. L. 108–173 can be found on the QualityNet Exchange at the Web site: https://www.qnetexchange.org in the ‘‘Reporting Hospital Quality Data for Annual Payment Update Reference Checklist’’. This checklist also contains all of the forms to be completed by hospitals participating in the program. In order to participate in the hospital reporting initiative, hospitals must follow these steps: • The hospital must identify a QualityNet Exchange Administrator who follows the registration process and submits the information through the QIO. This must be done regardless of whether the hospital uses a vendor for transmission of data. • All participants must first register with the QualityNet Exchange, regardless of the method used for data submission. If a hospital is currently participating in the voluntary reporting initiative, re-registration on QualityNet Exchange is unnecessary. However, the hospital must complete the Reporting Hospital Quality Data for Annual Payment Update Notice of Participation form. All hospitals must send this form to their QIOs. • The hospital must collect data for all 10 measures and submit the data to the QIO Clinical Warehouse either using the CMS Abstraction & Reporting Tool (CART), the JCAHO Oryx Core Measures Performance Measurement System (PMS), or another third-party vendor that has met the measurement specification requirements for data transmission to QualityNet Exchange. The QIO Clinical Warehouse will submit the data to CMS on behalf of the hospitals. The submission will be done through QualityNet Exchange, which is a secure site that voluntarily meets or exceeds all current Health Insurance Portability and Accountability Act (HIPAA) requirements, while maintaining QIO confidentiality as required under the relevant regulations and statutes. The information in the Clinical Warehouse is considered QIO data and, therefore, is subject to the stringent QIO confidentiality regulations in 42 CFR Part 480. For the first year of the program, FY 2005, hospitals were required to begin the submission of data by July 1, 2004, under the provisions of section 1886(b)(3)(B)(vii)(II) of the Act, as added by section 501(b) of Pub. L. 108–173. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Because section 501(b) of Pub. L. 108– 173 granted a 30-day grace period for submission of data for purposes of the FY 2005 update, hospitals were given until August 1, 2004, for completed submissions to be successfully accepted into the QIO Clinical Warehouse. Hospitals were required to submit data for the first calendar quarter of 2004. We received data from over 98 percent of the eligible hospitals. For FY 2006, we are proposing that hospitals must continuously submit the required 10 measures each quarter according to the schedule found on the Web site at https:// www.qnetexchange.org. New facilities must submit the data using the same schedule, as dictated by the quarter they begin discharging patients. We will expect that all hospitals will have submitted data to the QIO Clinical Warehouse for discharges through the fourth quarter of calendar year 2004 (October to December 2004). Hospitals have 41⁄2 months from the end of the fourth quarter until the closing of the warehouse (from December 31, 2004, until May 15, 2005) to make sure there are no errors in the submitted data. The warehouse is closed at that time in order to draw the validation sample and to begin preparing the public file for Hospital Compare public reporting. Data from fourth quarter 2004 discharges (October through December 2004) will be the last quarter of data with a submission deadline (May 15, 2005) that precedes our deadline for certifying the hospitals eligible to receive the full update for FY 2006. As we required for FY 2005, the data for each quarter must be submitted on time and pass all of the edits and consistency checks required in the clinical warehouse. Hospitals that do not treat a condition or have very few discharges will not be penalized and will receive the full annual payment update if they submit all the data they do possess. New hospitals should begin collecting and reporting data immediately and complete the registration requirements for the RHQDAPU. New hospitals will 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. The annual payment updates would be based on the successful submission of data to CMS via the QIO Clinical Warehouse by the established deadlines. For FY 2005, hospitals could withdraw from RHQDAPU at any time up to August 1, 2004. Hospitals withdrawing from the program did not receive the full market basket update and, instead, received a reduction of 0.4 PO 00000 Frm 00121 Fmt 4701 Sfmt 4702 23425 percentage points in their update. By law, a hospital’s actions each year will not affect its update in a subsequent year. Therefore, a hospital must meet the requirements for RHQDAPU each year the program is in effect. Failure of a hospital to receive the full update in one year does not affect its update in a succeeding year. For the first year, FY 2005, there were no chart-audit validation criteria in place. Based upon our experience from the FY 2005 submissions, and upon our requirement for reliable and valid data, we are proposing to place the following additional requirements on hospitals for the data for the FY 2006 payment update. These requirements, as well as additional information on validation requirements, will be placed on QualityNet Exchange. • The hospital must have passed our validation requirement of a minimum of 80 percent reliability, based upon our chart-audit validation process, for the third quarter data of calendar year 2004 in order to receive the full market basket update in FY 2006. These data were due to the clinical warehouse by February 15, 2005. We will use appropriate confidence intervals to determine if a hospital has achieved an 80-percent reliability. The use of confidence intervals will allow us to establish an appropriate range below the 80-percent reliability threshold that will demonstrate a sufficient level of validity to allow the data to still be considered valid. We will 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, the hospital data will be considered validated. We are proposing to use the design specific estimate of the variance for the confidence interval calculation, which, in this case, is a single stage cluster sample, with unequal cluster sizes. (For reference, see Cochran, William G. (1977) Sampling Techniques, John Wiley & Sons, New York, chapter 3, section 3.12.) We will use a two-step process to determine if a hospital is submitting valid data. At the first step, we will calculate the percent agreement for all of the variables submitted in all of the charts, whether or not they are related to the 10 measures. If a hospital falls below the 80 percent cutoff, we will then restrict the comparison to those variables associated with the 10 measures required under section 501(b) of Pub. L. 108–173. We will recalculate the percent agreement and the estimated 95 percent confidence interval and again compare to the 80 percent cutoff E:\FR\FM\04MYP2.SGM 04MYP2 23426 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules point. If a hospital passes under this restricted set of variables, the hospital will be considered to be submitting valid data for purposes of this proposed rule. Under the standard appeal process, all hospitals are given the detailed results of the Clinical Data Abstraction Center (CDAC) reabstraction along with their estimated percent reliability and the upper bound of the 95 percent confidence interval. If a hospital disagrees with any of the abstraction results from the CDAC, the hospital has 10 days to appeal these results to their QIO. The QIO will review the appeal with the hospital and, if the QIO review agrees with the hospitals original abstraction, the QIO will forward the appeal to the CDAC for a final determination. If the QIO does not agree with the hospital’s appeal, then the original results stand. When the CDAC has made its final determination, the new results will be provided to the hospital through the usual processes and the validation described previously will be repeated. This process is described in detail at the following Web site: https://www.qnetexchange.org. Hospitals that fail to receive the required 80-percent reliability after the standard appeals process may ask that CMS accept the fourth quarter of calendar year 2004 validation results as a final attempt to present evidence of reliability. However, in order to process the fourth quarter data in time to meet our internal deadlines, these hospitals will need to submit the charts requested for reabstraction as soon as possible, but no later than August 1, 2005, in order for us to guarantee consideration of this information. Hospitals that make the early submission of these data and pass the 80-percent reliability minimum level will satisfy this requirement. In reviewing the data for these hospitals, we plan to combine the 5 cases from the third quarter and the 5 cases from the fourth quarter into a single sample to determine whether the 80 percent reliability level is met. This gives us the greatest accuracy when estimating the reliability level. The confidence interval approach accounts for the variation in coding among the 5 charts pulled each quarter and for the entire year around the overall hospital mean score (on all individual data elements compared). The closer each case’s reliability score is to the hospital mean score, the tighter the confidence interval established for that hospital. A hospital may code each chart equally inaccurately, achieve a tight confidence interval, and fail to pass even though its overall score is just below the passing threshold (75 percent, VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 for example). A hospital with more variation among charts will achieve a broader confidence interval, which may allow it to pass even though some charts score very low and others very high. As we gain experience with this system, we will adjust it as appropriate over time as we build our sample of validated cases and learn more about hospital performance against the thresholds we establish. We believe we have adopted the most suitable statistical tests for the hospital data we are trying to validate, but we invite public comments on this and any other approaches hospitals choose to comment on. We are particularly interested in comments from hospitals on the initial starting points for the passing threshold, the confidence interval established, and the sampling approach. Because we will be receiving data each quarter from hospitals, our information on the sampling methodology will improve with each quarter’s submissions. We will analyze this information to determine if any changes in our methodology are required. We will make any necessary revisions to the sampling methodology and the statistical approach through manual issuances and other guidance to hospitals. • The hospital must have two consecutive quarters of publishable data. The information collected by CMS through this rule will be displayed for public viewing on the Internet. Prior to this display, hospitals are permitted to preview their information as we have it recorded. In our previous experience, a number of hospitals requested that this information not be displayed due to errors in the submitted data that were not of the sort that could be detected by the normal edit and consistency checks. We acquiesced to these requests in the public interest and because of our own desire to present correct data. However, we still believe that the hospital bears the responsibility of submitting correct data that can serve as valid and reliable information. Therefore, in order to receive the full market basket update for IPPS, we are proposing to establish a requirement for two consecutive quarters of publishable data. We published the first quarter of calendar year 2004 data in November 2004. The first two quarters of calendar year 2004 data were published in March 2005. Our plans are to publish the first three quarters of calendar year 2004 in August 2005. For the FY 2006 update, we will expect that all hospitals receiving the full market basket update for FY 2006 to have published data for all of the required 10 measures for both the March and August 2005 publications. PO 00000 Frm 00122 Fmt 4701 Sfmt 4702 Allowances would be made for hospitals that do not treat a particular condition and for new hospitals that have not had the opportunity to provide the required data. C. Sole Community Hospitals (SCHs) and Medicare Dependent Hospitals (MDHs) (§§ 412.73, 412.75, 412.77, 412.92 and 412.108) (If you choose to comment on issues in this section, please include the caption ‘‘Sole Community Hospitals and Medicare Dependent Hospitals’’ at the beginning of your comments.) 1. Background Under the IPPS, special payment protections are provided to a sole community hospital (SCH). Section 1886(d)(5)(D)(iii) of the Act defines an SCH as a hospital that, by reason of factors such as isolated location, weather conditions, travel conditions, absence of other like hospitals (as determined by the Secretary), or historical designation by the Secretary as an essential access community hospital, is the sole source of inpatient hospital services reasonably available to Medicare beneficiaries. The regulations that set forth the criteria that a hospital must meet to be classified as an SCH are located in § 412.92 of the regulations. Although SCHs and MDHs are paid under a special payment methodology, they are hospitals that are paid under section 1886(d) of the Act. Like all IPPS hospitals paid under section 1886(d) of the Act, SCHs and MDHs are paid for their discharges based on the DRG weights calculated under section 1886(d)(4) of the Act. Effective with hospital cost reporting periods beginning on or after October 1, 2000, section 1886(d)(5)(D)(i) of the Act (as amended by section 6003(e) of Pub. L. 101–239) and section 1886(b)(3)(I) of the Act (as added by section 405 of Pub. L. 106–113 and further amended by section 213 of Pub. L. 106–554), provide that SCHs are paid based on whichever of the following rates yields the greatest aggregate payment to the hospital for the cost reporting period: • The Federal rate applicable to the hospital; • 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. For purposes of payment to SCHs for which the FY 1996 hospital-specific rate yields the greatest aggregate payment, payments for discharges during FYs 2001, 2002, and 2003 were based on a E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules blend of the FY 1996 hospital-specific rate and the greater of the Federal rate or the updated FY 1982 or FY 1987 hospital-specific rate. For discharges during FY 2004 and subsequent fiscal years, payments based on the FY 1996 hospital-specific rate are 100 percent of the updated FY 1996 hospital-specific rate. For each cost reporting period, the fiscal intermediary determines which of the payment options will yield the highest rate of payment. Payments are automatically made at the highest rate using the best data available at the time the fiscal intermediary makes the determination. However, it may not be possible for the fiscal intermediary to determine in advance precisely which of the rates will yield the highest payment by year’s end. In many instances, it is not possible to forecast the outlier payments, the amount of the DSH adjustment, or the IME adjustment, all of which are applicable only to payments based on the Federal rate. The fiscal intermediary makes a final adjustment at the close of the cost reporting period to determine precisely which of the payment rates would yield the highest payment to the hospital. If a hospital disagrees with the fiscal intermediary’s determination regarding the final amount of program payment to which it is entitled, it has the right to appeal the fiscal intermediary’s decision in accordance with the procedures set forth in subpart R of part 400, which concern provider payment determinations and appeals. Under section 1886(d)(5)(G) of the Act, Medicare dependent hospitals (MDHs) are 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 do not have the option to use their FY 1996 hospital-specific rate. The regulations that set forth the criteria that a hospital must meet to be classified as an MDH are located in § 412.108. 2. Budget Neutrality Adjustment to Hospital Payments Based on HospitalSpecific Rate Under section 1886(d)(4)(C)(i) of the Act, beginning in FY 1988 and for each fiscal year thereafter, the Secretary is required to adjust the DRG classifications and weighting factors established under sections 1886(d)(4)(A) and (d)(4)(B) of the Act to reflect changes in treatment patterns, technology, and other factors that may change the use of hospital resources. For discharges beginning in FY 1991, VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 section 1886(d)(4)(C)(iii) of the Act requires the Secretary to ensure that adjustments to DRG classifications and weighting factors result in aggregate DRG payments that are budget neutral (not greater or less than the aggregate payments without the adjustments). In addition, section 1886(d)(3)(E) of the Act requires the Secretary to update the hospital wage index annually in a manner that does not affect aggregate payments to hospitals under section 1886(d) of the Act. As discussed in the May 9, 1990 IPPS proposed rule (55 FR 19466), we normalize the proposed recalibrated DRG weights by an adjustment factor so that the average case weight after recalibration is equal to the average case weight prior to recalibration. While this adjustment is intended to ensure that recalibration does not affect total payments to hospitals under section 1886(d) of the Act, our analysis has indicated that the normalization adjustment does not achieve budget neutrality with respect to aggregate payments to hospitals under section 1886(d) of the Act. In order to comply with the requirement of section 1886(d)(4)(C)(iii) of the Act that the DRG reclassification changes and recalibration of the relative weights be budget neutral and the requirement of section 1886(d)(3)(E) of the Act that the updated wage index be implemented in a budget neutral manner, we compare the estimated aggregate payments using the current year’s relative weights and wage index factors to aggregate payments using the prior year’s weights and factors. Based on this comparison, we compute a budget neutrality adjustment factor. This budget neutrality adjustment factor is then applied to the standardized per discharge payment amount. Beginning in FY 1994, in applying the current year’s budget neutrality adjustment factor to both the standard Federal rate and hospital-specific rates, we do not remove the prior years’ budget neutrality adjustment factors because estimated aggregate payments after the changes in the DRG relative weights and wage index factors must equal estimated aggregate payments prior to the changes. If we removed the prior year adjustment, we would not satisfy this condition. (58 FR 30269) We are bound by the Act to ensure that aggregate payments to hospitals under section 1886(d) of the Act are projected to neither increase nor decrease as a result of the annual updates to the DRG classifications and weighting factors and for the updated wage indices. However, we have broad authority under the statute to determine PO 00000 Frm 00123 Fmt 4701 Sfmt 4702 23427 the method for implementing budget neutrality. We have maintained since 1991 that the budget neutrality adjustment is applied, as described above, to all hospitals paid under section 1886(d) of the Act, including those that are paid based on a hospitalspecific rate. Thus, the budget neutrality factor applies to payments to SCHs and MDHs. Hospitals that are paid under section 1886(d) of the Act based on a hospitalspecific rate are subject to the DRG reclassification and recalibration factor component of the budget neutrality adjustment because, as IPPS hospitals, they are paid based on DRGs. As described above, changes in DRG relative weights from one year to the next affect aggregate SCH and MDH payments, which in turn affect total Medicare payments to hospitals under section 1886(d) of the Act. Because SCHs and MDHs are paid under section 1886(d) of the Act, we believe their DRG payments should be factored into the DRG reclassification and recalibration factor component of the budget neutrality adjustment to ensure that recalibration does not affect total payments to hospitals under section 1886(d) of the Act. Therefore, we continue to believe it is appropriate to apply the DRG reclassification and recalibration factor component of the budget neutrality adjustment to SCHs and MDHs. Furthermore, consistent with the requirement of section 1886(d)(4)(C)(iii) of the Act that DRG reclassification changes and recalibration of relative weights be budget neutral, we continue to believe it is appropriate to apply this adjustment without removing the previous year’s adjustment factor. In the May 9, 1990 proposed rule (55 FR 19466), we discussed the rationale behind our decision to apply the wage index portion of the budget neutrality adjustment factors to hospitals that are paid under section 1886(d) of the Act based on a hospital-specific rate. We described how, even though the wage index is only applicable to those hospitals that are paid based on the Federal rate, the changes in wage index can cause changes in the payment basis for some SCHs, and MDHs. That is, depending on the size of the increase in their wage index values, some hospitals that had been paid based on the hospital-specific rate could now be paid based on the Federal rate when the wage index-adjusted Federal rate exceeds the hospital-specific rate. In some instances, hospitals that had previously been paid based on the Federal rate may be paid based on the hospital-specific rate if the Federal rate is adjusted by a lower wage E:\FR\FM\04MYP2.SGM 04MYP2 23428 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules index and the hospital-specific rate now exceeds the Federal rate. These shifts in the payment basis affect aggregate program payments and, therefore, are taken into account in the budget neutrality adjustment. In addition, we maintained that because we apply the adjustment to all hospitals paid based on the Federal rate under section 1886(d) of the Act, it would be fair to apply it to hospitals that are paid under section 1886(d) of the Act based on hospital-specific rates. We believed that if we did not apply the budget neutrality factor to hospitals paid based on their hospital-specific rate, hospitals that are paid on the Federal rate would be subject to larger reductions to make up for not adjusting payments to hospitals that are paid based on hospital-specific rates. Concerns have been raised that hospitals under section 1886(d) of the Act whose reimbursement is based on a hospital-specific rate should not be subject to the wage index component of the budget neutrality adjustment. Hospital-specific rates reflect the effects of hospitals’ area wage levels and, therefore, are not adjusted by an area wage index. Accordingly, the concern is that a budget neutrality factor for changes in the wage index should not be applied to hospitals that are paid based on a hospital-specific rate. In addition, it has been suggested that the budget neutrality adjustment that CMS applies to hospitals paid on a hospital-specific rate should be similar to the budget neutrality adjustment made to hospitals in Puerto Rico. Hospitals in Puerto Rico that are paid under the IPPS are paid based on a blend of the national prospective payment rate and the Puerto Rico-specific prospective payment rate (42 CFR 412.212). Beginning in FY 1991, the Puerto Rico-specific standardized amount became subject to a budget neutrality adjustment. This budget neutrality adjustment included both the DRG reclassification and recalibration factor component and the wage index component. However, beginning in FY 1998, the Puerto Ricospecific rate has been subject only to the DRG reclassification and recalibration factor component of the budget neutrality adjustment (62 FR 46038) and not to the wage index component of the budget neutrality adjustment. In other words, beginning in FY 1998, the budget neutrality adjustment for the Puerto Rico-specific rate reflects only the DRG reclassification and recalibration factor component. This adjustment is computed, as described above, for all hospitals paid under section 1886(d) of VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 the Act, without removing the previous year’s budget neutrality adjustment. We have considered the concern that it is inappropriate to apply a budget neutrality factor that includes a component for changes in the wage index to a hospital with a payment rate that is not adjusted by a wage index adjustment. In cases in which a hospital’s payments are ultimately based on a hospital-specific rate, that portion of the payment is not adjusted by a wage index. We believe that our current policy is valid, for the reasons indicated above and in previous rulemaking documents, but we recognize that there are also valid grounds to review the regulations and consider other approaches. Accordingly, we are revisiting this policy. After further consideration of these issues, we are proposing to remove the wage index component from the budget neutrality adjustment applied to the hospitalspecific rate for hospitals paid under section 1886(d) of the Act. The DRG reclassification and recalibration factor component of the budget neutrality adjustment would still apply to these hospitals, as payments to SCHs and MDHs are based on DRGs and affect total Medicare payments to hospitals under section 1886(d) of the Act. In applying this budget neutrality adjustment factor, which would include only the DRG reclassification and recalibration factor component, to the hospital-specific rate, we would not remove the prior years’ budget neutrality adjustment factors. This would satisfy the statutory requirement that estimated aggregate payments after the changes in the DRG relative weights equal estimated aggregate payments prior to the changes. We are proposing that the wage index portion of the budget neutrality adjustment would not be applied to hospital-specific amounts, as these amounts are not adjusted by an area wage index. While this may result in a slightly higher budget neutrality adjustment applied to all other IPPS hospitals, because these hospitals actually are paid based on the revised wage indices and are affected by wage index changes, we believe this is appropriate. In addition, we note that in FY 1990 when this policy was first discussed, we did not calculate a budget neutrality factor that reflected only the DRG changes. Because we now calculate such a budget neutrality factor for Puerto Rico hospitals, it would not be administratively burdensome to apply the same budget neutrality factor to SCHs and MDHs. We are proposing to add a new paragraph (f) to § 412.73, a new paragraph (i) to § 412.75, and a new PO 00000 Frm 00124 Fmt 4701 Sfmt 4702 paragraph (j) to § 412.77 relating to the computation of the hospital-specific rate to clarify our longstanding policy that CMS makes an adjustment to the hospital-specific rate to ensure that changes to the DRG reclassifications and recalibrations of the DRG relative weights are made in a manner so that aggregate payments to hospitals under section 1886(d) of the Act are not affected, and that this adjustment is made without removing the budget neutrality adjustment for the prior year. These provisions are cross-referenced in § 412.92 for SCHs and § 412.108 for MDHs for purposes of computing the hospital-specific rates for these hospitals. This proposed regulatory text will reflect the proposed changes to the way CMS applies the budget neutrality adjustment to hospitals paid under section 1886(d) of the Act based on the hospital-specific rate. Specifically, it would indicate that the budget neutrality adjustment made to hospitals paid under section 1886(d) of the Act based on the hospital-specific rate will only account for the DRG reclassification and recallibration factor component. The budget neutrality adjustment would no longer include the wage index factor component. 3. Technical Change In the September 4, 1990 IPPS final rule (55 FR 36056), we made changes to the regulations at § 412.92 to incorporate the provisions of section 6003(e) of Pub. L. 101–239. Section 6003(e) of Pub. L. 101–239 provided for a permanent payment methodology for SCHs that recognized distortions in operating costs in years subsequent to the implementation of the IPPS and provided for opportunity for payment based on a new base year. As a result of this legislation, we deleted from the regulations a special provision that we had included under § 412.92(g) that provided for a payment adjustment to compensate SCHs reasonably for the increased operating costs resulting from the addition of new services or facilities. We have discovered that, in making the changes to § 412.92 in the September 4, 1990 final rule to remove paragraph (g), we inadvertently failed to make a conforming change to paragraph (d)(3) that references the provisions of paragraph (g) relating to a payment adjustment for significant increases in a SCH’s operating costs. In this proposed rule, we are proposing to make this technical correction by revising paragraph (d)(3). D. Rural Referral Centers (§ 412.96) (If you choose to comment on issues in this section, please include the E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules caption ‘‘Rural Referral Centers’’ at the beginning of your document.) 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 a rural referral center. For discharges occurring before October 1, 1994, rural referral centers 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, rural referral centers 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 rural referral centers. Other rural hospitals with less than 500 beds are subject to a 12-percent cap on DSH payments. Rural referral centers are not subject to the 12.0 percent cap on DSH payments that is applicable to other rural hospitals (with the exception of rural hospitals with 500 or more beds). Rural referral centers 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 a rural referral center by the Secretary * * * for fiscal year 1991 shall be classified as such a rural referral center for fiscal year 1998 and each subsequent year.’’ In the August 29, 1997 final rule with comment period (62 FR 45999), we also reinstated rural referral center status for all hospitals that lost the status due to triennial review or MGCRB reclassification, but not to hospitals that lost rural referral center status because VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 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 a rural referral center and lost their status due to OMB redesignation of the county in which they are located from rural to urban to be reinstated as a rural referral center. Otherwise, a hospital seeking rural referral center status must satisfy the applicable criteria. For FYs 1984 through 2004, we used the definitions of ‘‘urban’’ and ‘‘rural’’ in § 412.63. For FY 2005 and subsequent years, the revised definitions of ‘‘urban’’ and ‘‘rural’’ in § 412.64 apply. One of the criteria under which a hospital may qualify as a rural referral center 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 a rural referral center if the hospital meets two mandatory prerequisites (a minimum case-mix index 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 a rural referral center if— • The hospital’s case-mix index is at least equal to the lower of the median case-mix index for urban hospitals in its census region, excluding hospitals with approved teaching programs, or the median case-mix index for all urban hospitals nationally; and • 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 PO 00000 Frm 00125 Fmt 4701 Sfmt 4702 23429 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.) 1. Case-Mix Index Section 412.96(c)(1) provides that CMS will establish updated national and regional case-mix index values in each year’s annual notice of prospective payment rates for purposes of determining rural referral center status. The methodology we use to determine the proposed national and regional casemix index values is set forth in regulations at § 412.96(c)(1)(ii). The proposed national median case-mix index value for FY 2006 includes all urban hospitals nationwide, and the proposed regional values for FY 2006 are the median 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). These proposed values are based on discharges occurring during FY 2004 (October 1, 2003 through September 30, 2004) and include bills posted to CMS’ records through December 2004. We are proposing that, in addition to meeting other criteria, if they are to qualify for initial rural referral center status for cost reporting periods beginning on or after October 1, 2005, rural hospitals with fewer than 275 beds must have a case-mix index value for FY 2004 that is at least— • 1.3659; or • The median case-mix index value (not transfer-adjusted) for urban hospitals (excluding hospitals with approved teaching programs as identified in § 412.105) calculated by CMS for the census region in which the hospital is located. The proposed median case-mix index values by region are set forth in the following table: E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules The preceding numbers will be revised in the final rule to the extent required to reflect the updated FY 2004 MedPAR file, which will contain data from additional bills through March 31, 2005. Hospitals seeking to qualify as rural referral centers or those wishing to know how their case-mix index value compares to the criteria should obtain hospital-specific case-mix index 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 case-mix index values are computed based on all VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Medicare patient discharges subject to DRG-based payment. 2. 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 rural referral center 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 2002 (that is, October 1, 2001 through September 30, 2002), which is the latest PO 00000 Frm 00126 Fmt 4701 Sfmt 4725 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 rural referral center status for cost reporting periods beginning on or after October 1, 2005, must have as the number of discharges for its cost reporting period that began during FY 2002 a figure that is at least— • 5,000 (3,000 for an osteopathic hospital); or • The median number of discharges for urban hospitals in the census region in which the hospital is located, as indicated in the following table: E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.058</GPH> EP04MY05.059</GPH> 23430 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules These numbers will be revised in the final rule based on the latest available cost report data. We reiterate that if an osteopathic hospital is to qualify for rural referral center status for cost reporting periods beginning on or after October 1, 2005, the hospital would be required to have at least 3,000 discharges for its cost reporting period that began during FY 2002. 3. Technical Change In the FY 1998 IPPS final rule (62 FR 46028), we removed paragraph (f) from § 412.96. Paragraph (f) was removed when the requirement for triennial reviews of rural referral centers was terminated (62 FR 45998 through 45600, 46028 through 46029). However, we inadvertently failed to address all of the related cross-references to paragraph (f) in the entire § 412.96. Therefore, we are proposing to revise § 412.96 to remove paragraphs (h)(4) and (i)(4), consistent with the removal of paragraph (f). E. Payment Adjustment for Low-Volume Hospitals (§ 412.101) (If you choose to comment on issues in this section, please include the caption ‘‘Low-Volume Hospital Payment Adjustment’’ at the beginning of your comment.) Section 1886(d)(12) of the Act, as added by section 406 of Pub. L. 108– 173, provides for a payment adjustment to account for the higher costs per discharge of low-volume hospitals under the IPPS. Section 1886(d)(12)(C)(i) of the Act defines a low-volume hospital as a ‘‘subsection (d) hospital * * * that the Secretary determines is located more than 25 road miles from another subsection (d) hospital and that has less than 800 discharges during the fiscal year.’’ Section 1886(d)(12)(C)(ii) of the Act further stipulates that the term ‘‘discharge’’ refers to total discharges, and not merely to Medicare discharges. Specifically, the term refers to the ‘‘inpatient acute care discharge of an individual regardless of whether the individual is entitled to benefits under part A.’’ Finally, the provision requires the Secretary to determine an applicable percentage increase for these lowvolume hospitals based on the ‘‘empirical relationship’’ between ‘‘the standardized cost-per-case for such hospitals and the total number of discharges of these hospitals and the amount of the additional incremental costs (if any) that are associated with such number of discharges.’’ The statute thus mandates the Secretary to develop an empirically justifiable adjustment based on the relationship between costs VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 and discharges for these low-volume hospitals. The statute also limits the adjustment to no more than 25 percent. According to the analysis conducted for the FY 2005 IPPS final rule (69 FR 49099 through 49102), a 25 percent lowvolume adjustment to all qualifying hospitals with less than 200 discharges was found to be most consistent with the statutory requirement to provide relief to low-volume hospitals where there is empirical evidence that higher incremental costs are associated with low numbers of total discharges. However, we acknowledged that the empirical evidence did not provide robust support for that conclusion and indicated that we would reexamine the empirical evidence for the FY 2006 IPPS final rule with the intention of modifying or even eliminating the adjustment if the empirical evidence indicates that it is appropriate to do so. In the FY 2005 IPPS final rule (69 FR 49102), we indicated that our analysis showed that there are fewer than 100 hospitals with less than 200 total discharges. At that time, we were unable to determine how many of these hospitals also meet the requirement that a low-volume hospital be more than 25 road miles from the nearest IPPS hospital in order to qualify for the adjustment. Our data systems currently indicate that 10 hospitals are receiving the low-volume adjustment. As indicated in the FY 2005 IPPS final rule, we have now conducted a more detailed multivariate analysis on the empirical basis for a low-volume adjustment for FY 2006. In order to further evaluate the need for a proposed change in the development of the lowvolume adjustment, we replicated much of the analysis conducted for the FY 2005 IPPS final rule, using updated data. We again empirically modeled the relationship between hospital costs-percase and total discharges in several ways. We used both regression analysis and straight-line statistics to examine this relationship. We conducted three different regression analyses. For all of the analyses, we simulated the FY 2005 cost environment by inflating FY 2002 and FY 2003 hospital cost report data to FY 2005 using the full hospital market basket updates. We note that, at the time of this analysis, we only had cost report data from FY 2003 for approximately 57 percent of the IPPS hospitals. Therefore, we have placed a greater weight on the results from the simulated FY 2002 cost data, which are significantly more complete. We again simulated the FY 2005 payment environment because payments have undergone several changes between FY 2002 and FY 2003 PO 00000 Frm 00127 Fmt 4701 Sfmt 4702 23431 and FY 2005, making the results of the earlier data less relevant. Furthermore, many of these policy changes may already have helped increase payments to low-volume hospitals. We were unable to simulate the FY 2006 environment because payment factors for FY 2006 were not available at the time of our analysis. In the first regression analysis, we used a dummy variable approach to model the relationship between standardized costs and total discharges. Using FY 2002 cost data, we found some evidence for a low-volume payment adjustment for hospitals with up to 199 discharges, consistent with our current policy. Using FY 2003 cost data, the empirical evidence only supported an adjustment for hospitals with up to 99 total discharges. We also used a descriptive analysis approach to understand empirically the relationship between costs and total discharges. We grouped all hospitals by their total discharges and compared the mean Medicare per discharge payment to Medicare per discharge cost ratios. Hospitals with less than 800 total discharges were split into 24 cohorts based on increments of 25 discharges. When using the FY 2002 cost report data, the mean payment-to-cost ratios were below one (implying that Medicare per discharge costs exceeded Medicare per discharge payments) for all cohorts of hospitals with less than 200 discharges, after which the ratio was consistently above one. When using the FY 2003 cost report data, the mean payment-to-cost ratios were below one for all but two cohorts up to those with less than 175 total discharges, after which the ratio was consistently above one. No obvious increasing trend in the ratios, from which it would be possible to infer a formula to generate adjustments for hospitals based upon the number of discharges, was evident. Because more than 70 percent of hospitals with less than 200 discharges had ratios below 0.80, this analysis supports applying the highest payment adjustment to all providers with less than 200 discharges that are eligible for the low-volume adjustment. The second regression analysis modeled the Medicare per discharge cost to Medicare per discharge payment ratio as a function of total discharges. The cost-to-payment ratio model more explicitly accounts for the relative values of per discharge costs and per discharge payments. These models provided some evidence for a statistically significant negative relationship between the cost-topayment ratio and total discharges. However, that result was limited to FY E:\FR\FM\04MYP2.SGM 04MYP2 23432 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 2002 data. FY 2003 data displayed no significant relationship between the cost-to-payment ratio and total discharges. The third regression analysis employed per discharge costs minus per discharge payments as the dependent variable and total discharges as an explanatory variable. The results of this analysis were similar to the other regression analyses: some evidence was provided for an adjustment with the FY 2002 data, but not with the FY 2003 data, simulated for FY 2005. In fact, the FY 2003 data results suggest (with a positive intercept and positive coefficient on total discharges) that payments are greater than costs for all hospitals, including the low-volume hospitals. Based upon these multivariate analyses using the FY 2002 cost report data, a case can be made that hospitals with fewer than 200 total discharges have per discharge costs that are statistically significantly higher relative to their Medicare per discharge payments in comparison to hospitals with 200 or more total discharges. Therefore, we are proposing to extend the existing low-volume adjustment for FY 2006. That is, a low-volume adjustment would again be provided for qualifying hospitals with less than 200 discharges. As noted above, the descriptive data do not reveal any pattern that could provide a formula for calculating an adjustment in relation to the number of discharges. However, the descriptive analysis of the data does indicate that, for a large majority of the hospitals with less than 200 discharges, the maximum adjustment of 25 percent would be appropriate because, for example, the payment-to-cost ratios for more than 70 percent of these hospitals are 0.80 or less. The maximum adjustment of 25 percent would still leave most of these hospitals with payment-to-cost ratios below 1.00. Because a large majority of hospitals with less than 200 discharges have payment-to-cost ratios below 1.00, we are proposing to again provide hospitals with less than 200 total discharges in the most recent submitted cost report an adjustment of 25 percent on each Medicare discharge. This policy is consistent with the existing language in § 412.101(a) and (b). However, the initial analysis of the FY 2003 data does not seem to provide strong empirical evidence for a relationship between Medicare per discharge costs and total discharges. Therefore, we will reevaluate the appropriateness of the low-volume adjustment in the FY 2007 proposed rule. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 F. 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 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 IME adjustment to the DRG payment is based in part on the 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 × [{1 + r} .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. 2. IME Adjustment for TEFRA Hospitals Converting to IPPS Hospitals 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) 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. When these provisions were enacted, hospitals reported their weighted FTE resident count for direct GME and their unweighted FTE resident count for IME on the Medicare cost report. The cost report was subsequently modified to require reporting of unweighted FTE resident counts for both direct GME and IME. However, for cost reporting periods ending on or before December 31, 1996 (the cost report on which the FTE limit is based), hospitals were not PO 00000 Frm 00128 Fmt 4701 Sfmt 4702 required to report unweighted FTE resident counts for direct GME purposes. Therefore, a separate data collection effort was required to obtain the unweighted FTE resident counts. The fiscal intermediaries worked with hospitals to determine the unweighted FTE resident counts for direct GME for cost reporting periods ending on or before December 31, 1996, for purposes of implementing the FTE cap. During this process, the fiscal intermediaries did not determine IME FTE resident counts for hospitals that were excluded from the IPPS (that is, psychiatric hospitals, LTCHs, rehabilitation hospitals, children’s hospitals, and cancer hospitals) because these hospitals were not paid under the IPPS and, therefore, did not receive any IME payment adjustments. Only the FTE resident data related to direct GME payments were relevant for these excluded hospitals and, therefore, only those data were collected. However, it has come to our attention that some hospitals that were excluded from the IPPS during the cost reporting period ending on or before December 31, 1996 (that is, the cost reporting period during which the hospital’s FTE resident limit was established under section 1886(h)(4)(F) of the Act for purposes of direct GME payments) have either failed to continue to qualify for exclusion from the IPPS or deliberately changed their operations in a way to become subject to the IPPS and, as a result, have subsequently become subject to the IME payment adjustment provisions of the IPPS. For example, a provider that was a rehabilitation hospital during its cost reporting period ending on December 31, 1996, but no longer meets the regulatory criteria to qualify as a rehabilitation hospital would become subject to the IPPS and be able to receive IME payments. However, because no IME FTE resident count for the cost reporting period ending on or before December 31, 1996, was determined, such a hospital does not have an unweighted FTE resident limit for IME. To address this situation, we are proposing to incorporate in the regulations (proposed § 412.105(f)(1)(xiii)) CMS’ existing policy in such situations which provides for the establishment of an IME FTE cap for a hospital that was excluded from the IPPS during its base year and that subsequently became subject to the IPPS. We are clarifying and proposing to adopt into regulations our existing policy that, in such a situation, the fiscal intermediary would determine an IME FTE cap for the hospital, applicable beginning with the E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules hospital’s payments under the IPPS, based on the FTE count of residents during the cost reporting period(s) used to determine the hospital’s direct GME FTE cap in accordance with existing § 412.105(f) of the regulations. The new IPPS hospital’s IME FTE cap would be subject to the same rules and adjustments as any IPPS hospital’s IME FTE cap in accordance with § 412.105(f) of the regulations. While calculation of the IME FTE cap for a TEFRA hospital that converts to an IPPS hospital may require that fiscal intermediaries obtain information from cost reporting periods that are closed, allowing a fiscal intermediary to obtain this information should not be understood as allowing a fiscal intermediary to reopen closed cost reports that are beyond the normal reopening period in order to carry out the provisions of this proposed regulation. Finally, there may be situations where the data necessary to carry out this policy are not available. For example, under this proposal, if a children’s hospital converts to an IPPS hospital on July 1, 2007, the fiscal intermediary may need to determine the count of FTE residents for IME purposes training at the hospital during the most recent cost reporting period ending on or before December 31, 1996, in order to establish an IME FTE cap for the hospital, effective for discharges occurring on or after October 1, 2007. However, the count of FTE residents for IME purposes from the cost reporting period ending on or before December 31, 1996, may no longer be available, as the minimum time that hospitals are required to retain records is 5 years from the date the hospital submits the cost report. We believe this problem may not occur with sufficient frequency to warrant specific regulatory action. We are specifically soliciting comments as to whether and how hospitals believe this is a problem that needs to be addressed. In some cases, a hospital that was previously excluded from the IPPS may become subject to the IPPS as a result of a merger between two or more hospitals where the surviving hospital is subject to the IPPS (and not creating an IPPS hospital with an excluded unit). In such cases, CMS policy is that the FTE resident cap for the surviving hospital should reflect the combined FTE resident caps for the hospitals that merged. If two or more hospitals merge after the conclusion of each hospital’s base year for purposes of calculating resident FTE caps, the surviving hospital’s FTE resident cap is an aggregation of the FTE resident cap for each hospital participating in the VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 merger. When a merger involves an IPPS-excluded hospital, the base year IME FTE count for the IPPS-excluded hospital has not been determined. We are clarifying and proposing to codify in regulations our existing policy that, in such cases, the fiscal intermediary would determine an IME FTE cap for the IPPS-excluded hospital for purposes of determining the merged hospital’s IME FTE cap in accordance with § 412.105(f) of the regulations. Once this cap is determined, the aggregate IME FTE cap of the surviving entity may be calculated in accordance with existing CMS policy for mergers. We note that we would compute an IME cap for an IPPS-excluded hospital only in cases of a merger between an IPPS-excluded hospital and an acute care IPPS hospital, where the entire surviving entity is subject to the IPPS. No such IME FTE cap would be computed for an IPPS-excluded hospital in instances where an IPPS-excluded hospital and an acute care IPPS hospital agree to form a Medicare GME affiliated group for purposes of aggregating FTE resident caps. In cases where an IPPSexcluded hospital enters into a Medicare GME affiliation agreement with other IPPS hospitals, the IPPSexcluded hospital can contribute only its direct GME FTE cap to the aggregate FTE cap for the group. This is because, as long as a hospital remains excluded from the IPPS, that hospital will not have an FTE resident cap established for purposes of IME. Under no circumstances may an IPPS-excluded hospital be considered to contribute any FTE residents to a Medicare GME affiliation group for purposes of the aggregate IME FTE resident cap. IPPSexcluded hospitals do not currently, and would not under this proposed policy, have an IME FTE resident cap. 3. Section 1886(d)(8)(E) Teaching Hospitals That Withdraw Rural Reclassification In section V.I. of this preamble, we discuss situations in which an urban hospital may become rural under a reclassification request under section 1886(d)(8)(E) of the Act. Under section 1886(d)(8)(E) of the Act, an urban hospital may file an application to be treated as being located in a rural area. Becoming rural under this provision affects only payments under section 1886(d) of the Act. If the hospital is a teaching hospital, the hospital could not receive adjustments to its direct GME FTE cap because payments for direct GME are made under section 1886(h) of the Act and the section 1886(d)(8)(E) reclassifications affect only the payments that are made under section PO 00000 Frm 00129 Fmt 4701 Sfmt 4702 23433 1886(d) of the Act. Therefore, an urban hospital that reclassifies as rural under this provision may receive the 130percent adjustment to its IME FTE resident cap. In addition, its IME FTE cap may be adjusted for any new programs (similar to a hospital that is actually located in an area designated as rural) under section 1886(d)(5)(B)(v) of the Act, as amended by section 407 of Pub. L. 106–113 (BBRA). An urban hospital treated as rural under section 1886(d)(8)(E) of the Act may subsequently withdraw its election and return to its urban status under the regulations at § 412.103. We are proposing that, effective with discharges occurring on or after October 1, 2005, hospitals that rescind their section 1886(d)(8)(E) reclassifications and return to being urban would not be eligible for permanent increases in their IME caps. Rather, any adjustments the hospitals received to their IME caps due to their rural status would be forfeited upon returning to urban status. Although we read the relevant IME FTE cap provisions in section 1886(d)(5)(B) of the Act as effecting a permanent increase to the FTE cap, we believe we have the statutory authority under section 1886(d)(5)(I) of the Act to make necessary adjustments to these caps that we believe are appropriate. Section 1886(d)(5)(I)(i) of the Act grants the Secretary authority to provide by regulation for ‘‘such other exceptions and adjustments to such payment amounts under this subsection as the Secretary deems appropriate.’’ We believe it is appropriate that a section 1886(d)(8)(E) hospital forfeit the adjustments it received solely due to its reclassification to rural status when it returns to being urban. Otherwise, urban hospitals might reclassify to rural areas under section 1886(d)(8)(E) of the Act for a short period of time solely as a means of receiving an increase to their IME FTE caps. These hospitals could reclassify for as little as one year, simply in order to receive a permanent increase to their IME FTE caps. Because section 1886(d)(8)(E) hospitals have control over when they switch in and out of rural status, we believe any other policy would be subject to gaming and inappropriate usage of the section 1886(d)(8)(E) authority. In contrast, hospitals that become urban due to the OMB-revised labor area designations have no control in the matter, and therefore would not be subject to the same type of manipulation of payment rates we believe would exist with the section 1886(d)(8)(E) hospitals. (We note that the above proposed policy would have no effect on rural track resident training programs. E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules Section 1886(h)(4)(H)(iv) of the Act, which governs direct GME, provides that an urban hospital may receive adjustments to its FTE caps for establishing ‘‘separately accredited approved medical residency training programs (or rural tracks) in an [sic] rural area.’’ The provisions governing IME state that ‘‘Rules similar to the rules of subsection (h)(4)(H) shall apply for purposes of’’ determining FTE resident caps (section 1886(d)(5)(B)(viii) of the Act). Since the requirement that the hospital be located in a rural area is found in the provisions governing direct GME (section 1886(h) of the Act), not the provision governing IME, and since hospitals cannot reclassify as rural for purposes of section 1886(h) of the Act, we believe that, as provided in section 1886(h) of the Act, the hospital with which the urban hospital establishes the rural track must be physically located in an area designated as rural. We do not believe we would be properly incorporating the rules of section 1886(h) of the Act or creating a rule similar to that used in section 1886(h) of the Act if we were to allow counting of such reclassified hospitals.) For the reasons stated above, we are proposing to amend the regulations at § 412.105 by adding a new paragraph (f)(1)(xiv) to provide that a hospital that rescinds its section 1886(d)(8)(E) reclassification will forfeit any DSH Patient = Percentage 2. Implementation of Section 951 of Pub. L. 108–173 (MMA) Section 951 of Pub. L. 108–173 requires the Secretary to arrange to furnish the data necessary for hospitals to compute the number of patient days used in calculating the disproportionate patient percentages. The provision is not specific as to whether it applies to the patient day data used to determine the Medicare fraction or the Medicaid fraction. We are interpreting section 951 to require the Secretary to arrange to furnish to hospitals the data necessary to calculate both the Medicare and Medicaid fractions. With respect to both the Medicare and Medicaid fractions, we also are interpreting section 951 to require CMS to arrange to furnish the personally identifiable information that would enable a hospital to compare and verify its records, in the case of the Medicare fraction, against the CMS’ records, and in the case of the Medicaid fraction, against the State Medicaid VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 adjustments to its IME FTE cap it received due to its rural status. Thus, for example, a hospital that reclassified as rural under section 1886(d)(8)(e) of the Act with an IME FTE cap of 10 would have received a 130 percent adjustment to its IME cap (that is, 10 FTEs × 1.3). Furthermore, if this hospital, while reclassified as rural, started a new 3year residency program with 2 residents in each program year, its FTE cap would have been increased by an additional 6 FTEs to 19 FTEs (that is, 13 FTEs + 6 FTEs). However, once this hospital rescinds its reclassification under section 1886(d)(8)(E) of the Act to become urban again, its IME FTE cap would return to 10 FTEs (its original pre-reclassification IME FTE cap). G. Payment to Disproportionate Share Hospitals (DSHs) (§ 412.106) (If you choose to comment on issues in this section, please include the caption ‘‘DSH Adjustment Data’’ at the beginning of your comment.) 1. Background Section 1886(d)(5)(F) of the Act provides for additional payments to subsection (d) hospitals that serve a disproportionate share of low-income patients. The Act specifies two methods for a hospital to qualify for the Medicare disproportionate share hospital (DSH) adjustment. Under the first method, Medicare, SSI Days Total Medicare Days + Medicaid, Non-Medicare Days Total Patient Days agency’s records. Currently, as explained in more detail below, CMS provides the Medicare SSI days to certain hospitals that request these data. Hospitals are currently required under the regulation at § 412.106(b)(4)(iii) to provide the data adequate to prove eligibility for the Medicaid, nonMedicare days. As indicated above, the numerator of the Medicare fraction includes the number of patient days furnished by the hospital to patients who were entitled to both Medicare Part A and SSI benefits. This number is divided by the hospital’s total number of patient days furnished to patients entitled to benefits under Medicare Part A. In order to determine the numerator of this fraction for each hospital, CMS obtains a data file from the Social Security Administration (SSA). CMS matches personally identifiable information from the SSI file against its Medicare Part A entitlement information for the fiscal year to determine the number of PO 00000 Frm 00130 Fmt 4701 hospitals that are located in an urban area and have 100 or more beds may receive a DSH payment adjustment if the hospital can demonstrate that, during its cost reporting period, more than 30 percent of its net inpatient care revenues are derived from State and local government payments for care furnished to indigent patients. These hospitals are commonly known as ‘‘Pickle hospitals.’’ The second method, which is also the most commonly used method for a hospital to qualify, is based on a complex statutory formula under which payment adjustments are based on the level of the hospital’s DSH patient percentage, which is the sum of two fractions: the ‘‘Medicare fraction’’ and the ‘‘Medicaid fraction.’’ The Medicare fraction is computed by dividing the number of patient days that are furnished to patients who were entitled to both Medicare Part A and Supplemental Security Income (SSI) benefits by the total number of patient days furnished to patients entitled to benefits under Medicare Part A. The Medicaid fraction is computed by dividing the number of patient days furnished to patients who, for those days, were eligible for Medicaid but were not entitled to benefits under Medicare Part A by the number of total hospital patient days in the same period. Sfmt 4702 Medicare SSI days for each hospital during each fiscal year. These data are maintained in the MedPAR Limited Data Set (LDS) as described in more detail below and discussed in a notice published on August 18, 2000 in the Federal Register (65 FR 50548). The number of patient days furnished by the hospital to Medicare beneficiaries entitled to SSI is divided by the hospital’s total number of Medicare days (the denominator of the Medicare fraction). CMS determines this number from Medicare claims data; hospitals also have this information in their records. The Medicare fraction for each hospital is posted on the CMS Web site (https://www.cms.hhs.gov) under the SSI/Medicare Part A Disproportionate Share Percentage File. Under current regulations at § 412.106(b)(3), a hospital may request to have its Medicare fraction recomputed based on the hospital’s cost reporting period if that year differs from the Federal fiscal year. This request may be made only once per E:\FR\FM\04MYP2.SGM 04MYP2 EP04my05.088</GPH> 23434 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules cost reporting period, and the hospital must accept the resulting DSH percentage for that year, whether or not it is a more favorable number than the DSH percentage based on the Federal fiscal year. In accordance with section 951 of Pub. L. 108–173, we are proposing to change the process that we use to make Medicare data used in the DSH calculation available to hospitals. Currently, as stated above, CMS calculates the Medicare fraction for each section 1886(d) hospital using data from the MedPAR LDS (as established in a notice published in the August 18, 2000 Federal Register (65 FR 50548)). The MedPAR LDS contains a summary of all services furnished to a Medicare beneficiary, from the time of admission through discharge, for a stay in an inpatient hospital or skilled nursing facility, or both; SSI eligibility information; and enrollment data on Medicare beneficiaries. The MedPAR LDS is protected by the Privacy Act of 1974 (5 U.S.C. 552a) and the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (Pub. L. 104–191). The Privacy Act allows us to disclose information without an individual’s consent if the information is to be used for a purpose that is compatible with the purpose(s) for which the information was collected. Any such compatible use of data is known as a ‘‘routine use.’’ In order to obtain this privacy-protected data, the hospital must qualify under the routine use that was described in the August 18, 2000 Federal Register. Currently, a hospital qualifies under the routine use if it has an appeal properly pending before the Provider Reimbursement Review Board (PRRB) or before an intermediary on the issue of whether it is entitled to DSH payments, or the amount of such payments. Once determined eligible to receive the data under the routine use, the hospital is then required to sign a data use agreement with CMS to ensure that the data are appropriately used and protected, and pay the requisite fee. Beginning with cost reporting periods that include December 8, 2004 (within one year of the date of enactment of Pub. L. 108–173), we are proposing to furnish MedPAR LDS data for a hospital’s patients eligible for both SSI and Medicare at the hospital’s request, regardless of whether there is a properly pending appeal relating to DSH payments. We are proposing to make the information available for either the Federal fiscal year or, if the hospital’s fiscal year differs from the Federal fiscal year, for the months included in the two Federal fiscal years that encompass the VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 hospital’s cost reporting period. Under our proposal, the hospital could use these data to calculate and verify its Medicare fraction, and to decide whether it prefers to have the fraction determined on the basis of its fiscal year rather than a Federal fiscal year. The data set made available to hospitals would be the same data set CMS uses to calculate the Medicare fractions for the Federal fiscal year. Because we interpret section 951 to require the Secretary to arrange to furnish these data, we do not believe that it will continue to be appropriate to charge hospitals to access the data. These proposed changes would require CMS to modify the current routine use for the MedPAR LDS to reflect changes in the data provided and the circumstances under which they are made available to hospitals. In a future Federal Register document, we will publish the details of any necessary modifications to the current routine use to implement section 951 of Pub. L. 108–173. We welcome comments on all aspects of these proposed changes. The numerator of the Medicaid fraction includes hospital inpatient days that are furnished to patients who, for those days, were eligible for Medicaid but were not entitled to benefits under Medicare Part A. Under the regulation at § 412.106(b)(4)(iii), hospitals are responsible for proving Medicaid eligibility for each Medicaid patient day and verifying with the State that patients were eligible for Medicaid on the claimed days. The number of Medicaid, non-Medicare days is divided by the hospital’s total number of inpatient days in the same period. Total inpatient days are reported on the Medicare cost report. (This number is also available in the hospital’s own records.) Much of the data used to calculate the Medicaid fraction of the DSH patient percentage are available to hospitals from their own records or from the States. We recognize that Medicaid State plans are only permitted to use and disclose information concerning applicants and recipients for ‘‘purposes directly connected with the administration of the [State] plan’’ under section 1902(a)(7) of the Act. Regulations at 42 CFR 431.302 define these purposes to include establishing eligibility (§ 431.302(a)) and determining the amount of medical assistance (§ 431.302(b)). Thus, State plans are permitted under the currently applicable statutory and regulatory provisions governing the disclosure of individually identifiable data on Medicaid applicants and recipients to provide hospitals the data needed to PO 00000 Frm 00131 Fmt 4701 Sfmt 4702 23435 meet their obligation under § 412.106(b)(4)(iii) in the context of either an ‘‘eligibility inquiry’’ with the State plan or in order to assist the hospital, and thus the State plan, in determining the amount of medical assistance. In the process of developing a plan for implementing section 951 with respect to the data necessary to calculate the Medicaid fraction, we asked our regional offices to report on the availability of this information to hospitals and on any problems that hospitals face in obtaining the information that they need. The information we received suggested that, in the vast majority of cases, there are established procedures for hospitals or their authorized representatives to obtain the information needed for hospitals to meet their obligation under § 412.106(b)(4)(iii) and to calculate their Medicaid fraction. There is no uniform national method for hospitals to verify Medicaid eligibility for a specific patient on a specific day. For instance, some States, such as Arizona, have secure online systems that providers may use to check eligibility information. However, in most States, providers send a list of patients to the State Medicaid office for verification. Other States, such as Hawaii, employ a third party private company to maintain the Medicaid database and run eligibility matches for providers. The information that providers submit to State plans (or third party contractors) differs among States as well. Most States require the patient’s name, date of birth, gender, social security number, Medicaid identification, and admission and discharge dates. States or the third parties may respond with either ‘‘Yes/ No’’ or with more detailed Medicaid enrollment and eligibility information such as whether or not the patient is a dual-eligible, whether the patient is enrolled in a fee-for-service or HMO plan, and under which State assistance category the individual qualified for Medicaid.4 We note that we have been made aware of at least one instance in which a State is concerned about providing hospitals with the requisite eligibility data. We understand that the basis for the State’s objections is section 1902(a)(7) of the Act. The State is concerned that section 1902(a)(7) of the Act prohibits the State from providing eligibility data for any purpose other than a purpose related to State plan 4 Bear in mind that States and hospitals should, in keeping with the HIPAA Privacy Rule, limit the data exchanged in the context of these inquiries and responses to the minimum necessary to accomplish the task E:\FR\FM\04MYP2.SGM 04MYP2 23436 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules administration. However, as described above, we believe that States are permitted to verify Medicaid eligibility for hospitals as a purpose directly related to State plan administration under § 431.302. In addition, we believe it is reasonable to continue to place the burden of furnishing the data adequate to prove eligibility for each Medicaid patient day claimed for DSH percentage calculation purposes on hospitals because, since they have provided inpatient care to these patients for which they billed the relevant payors, including the State Medicaid plan, they will necessarily already be in possession of much of this information. We continue to believe hospitals are best situated to provide and verify Medicaid eligibility information. Although we believe the mechanisms are currently in place to enable hospitals to obtain the data necessary to calculate their Medicaid fraction of the DSH patient percentage, there is currently no mandatory requirement imposed upon State Medicaid agencies to verify eligibility for hospitals. At this point, we believe there is no need to modify the Medicaid State plan regulations to require that State plans verify Medicaid eligibility for hospitals. However, should we find that States are not voluntarily providing or verifying Medicaid eligibility information for hospitals, we will consider amending the State plan regulations to add a requirement that State plans provide certain eligibility information to hospitals. H. Geographic Reclassifications (§§ 412.103 and 412.230) (If you choose to comment on issues in this section, please include the caption ‘‘Geographic Reclassifications’’ at the beginning of your comment.) 1. Background With the creation of the MGCRB, beginning in FY 1991, under section 1886(d)(10) of the Act, hospitals could request reclassification from one geographic location to another for the purpose of using the other area’s standardized amount for inpatient operating costs or the wage index value, or both (September 6, 1990 interim final rule with comment period (55 FR 36754), June 4, 1991 final rule with comment period (56 FR 25458), and June 4, 1992 proposed rule (57 FR 23631)). As a result of legislative changes under section 402(b) of Pub. L. 108–7, Pub. L. 108–89, and section 401 of Pub. L. 108–173, the standardized amount reclassification criterion for large urban and other areas is no longer VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 necessary or appropriate and has been removed from our reclassification policy (69 FR 49103). We implemented this provision in the FY 2005 IPPS final rule (69 FR 49103). As a result, hospitals can request reclassification for the purposes of the wage index only and not the standardized amount. Implementing regulations in Subpart L of Part 412 (§§ 412.230 et seq.) set forth criteria and conditions for reclassifications for purposes of the wage index from rural to urban, rural to rural, or from an urban area to another urban area, with special rules for SCHs and rural referral centers. Under section 1886(d)(8)(E) of the Act, an urban hospital may file an application to be treated as being located in a rural area if certain conditions are met. The regulations implementing this provision are located under § 412.103. Effective with reclassifications for FY 2003, section 1886(d)(10)(D)(vi)(II) of the Act provides that the MGCRB must use the average of the 3 years of hourly wage data from the most recently published data for the hospital when evaluating a hospital’s request for reclassification. The regulations at § 412.230(d)(2)(ii) stipulate that the wage data are taken from the CMS hospital wage survey used to construct the wage index in effect for prospective payment purposes. To evaluate applications for wage index reclassifications for FY 2006, the MGCRB used the 3-year average hourly wages published in Table 2 of the August 11, 2004 IPPS final rule (69 FR 49295). These average hourly wages are taken from data used to calculate the wage indexes for FY 2003, FY 2004, and FY 2005, based on cost reporting periods beginning during FY 1999, FY 2000, and FY 2001, respectively. 2. Multicampus Hospitals (§ 412.230) As discussed in section III.B. of this preamble, on June 6, 2003, the OMB announced the new CBSAs, comprised of Metropolitan Statistical Areas (MSAs) and Micropolitan Statistical Areas, based on Census 2000 data. Effective October 1, 2004, for the IPPS, we implemented new labor market areas based on the CBSA definitions of MSAs. In some cases, the new CBSAs resulted in previously existing MSAs being divided into two or more separate labor market areas. In the FY 2005 IPPS final rule (69 FR 48916), we acknowledged that the implementation of the new MSAs would have a considerable impact on hospitals. Therefore, we made every effort to implement transitional provisions that would mitigate the negative effects of the new labor market areas on hospitals that PO 00000 Frm 00132 Fmt 4701 Sfmt 4702 request reclassification to another area for purposes of the wage index and on all hospitals. Subsequent to the publication of the FY 2005 IPPS final rule, we became aware of a situation in which, as a result of the new labor market areas, a multicampus hospital previously located in a single MSA is now located in more than one CBSA. Under our current policy, a multicampus hospital with campuses located in the same labor market area receives a single wage index. However, if the campuses are located in more than one labor market area, payment for each discharge is determined using the wage index value for the MSA (or metropolitan division, where applicable) in which the campus of the hospital is located. In addition, the current provision set forth in section 2779F of the Medicare State Operations Manual provides that, in the case of a merger of hospitals, if the merged facilities operate as a single institution, the institution must submit a single cost report, which necessitates a single provider identification number. This provision does not differentiate between merged facilities in a single wage index area or in multiple wage index areas. As a result, the wage index data for the merged facility is reported for the entire entity on a single cost report. The current criteria for a hospital being reclassified to another wage area by the MGCRB do not address the circumstances under which a single campus of a multicampus hospital may seek reclassification. That is, a hospital must provide data from the CMS hospital wage survey for the average hourly wage comparison that is used to support a request for reclassification. However, because a multicampus hospital is required to report data for the entire entity on a single cost report, there is no wage survey data for the individual hospital campus that can be used in a reclassification application. In an effort to remedy this situation, for FY 2007 and subsequent year reclassifications, we are proposing to allow a campus of a multicampus hospital system that wishes to seek geographic reclassification to another labor market area to report campusspecific wage data using a supplemental Form S–3 (CMS’ manual version of Worksheet S–3) for purposes of the wage data comparison. These data would then constitute the appropriate wage data under § 412.232(d)(2) for purposes of comparing the hospital’s wages to the wages of hospitals in the area to which it seeks reclassification as well as the area in which it is located. Before the data could be used in a reclassification application, the E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules hospital’s fiscal intermediary would have to review the allocation of the entire hospital’s wage data among the individual campuses. For FY 2006 reclassification applications, we are proposing to allow a campus of a multicampus hospital system to use the average hourly wage data submitted for the entire multicampus hospital system as its appropriate wage data under § 412.232(d)(2). We are establishing this special rule for FY 2006 reclassifications because the deadline for submitting an application to the MGCRB was September 1, 2004, and there no longer is an opportunity to provide a Supplemental Form S–3 that allocates the wage data by individual hospital campus. This special rule will be applied only to an individual campus of a multicampus hospital system that made an application for reclassification for FY 2006 and that otherwise meets all of the reclassification criteria. We do not believe that the special rule is necessary for reclassifications for FY 2007 because the deadline for making those applications has not yet passed and a hospital seeking reclassification will be able to provide the Supplemental Form S–3 that allocates the wage data by individual hospital campus. We are proposing to apply these new criteria to geographic reclassification applications that were received by September 1, 2004, and that will take effect for FY 2006. We are proposing to revise the regulations at § 412.230(d)(2) by redesignating paragraph (d)(2)(iii) as paragraph (d)(2)(v) and adding new paragraph (d)(2))(iii) and (d)(2)(iv) to incorporate the proposed new criteria for multicampus hospitals. 3. Urban Group Hospital Reclassifications In FY 2005 IPPS final rule (69 FR 49104), we set forth, under § 412.234(a)(3)(ii), revised criteria for urban hospitals to be reclassified as a group. After the publication of the final rule, we became aware that portions of our policy discussion with respect to the implementing decision were inadvertently omitted. This policy was corrected in the October 7, 2004, correction to the final rule (69 FR 60248). The correction specified that ‘‘hospitals located in counties that are in the same Combined Statistical Area (under the MSA definitions announced by the OMB on June 6, 2003); or in the same Consolidated Metropolitan Statistical Area (CMSA) (under the standards published by the OMB on March 30, 1990) as the urban area to which they seek redesignation qualify as VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 meeting the proximity requirement for reclassification to the urban area to which they seek redesignation.’’ In making the determination to revise our urban group reclassification policy, we took into consideration the magnitude of the changes that would have resulted from our adoption of the new labor market areas. The resulting policy was intended to preserve the reclassification opportunities for urban county groups; in other words, an eligible urban county group would have to meet either the CSA or CMSA criteria, but not both to be eligible for consideration. As a result of adopting the new labor market area definitions, we reexamined the appropriateness of the FY 2005 changes with emphasis on determining whether including ‘‘* * * or in the same Consolidated Metropolitan Statistical Area (CMSA) (under the standards published by the OMB on March 30, 1990)’’ as a qualifying criterion, is necessary or consistent with our plans to fully implement the new labor area market definitions. Based on our experiences now that the new labor market areas are in effect and since we revised the urban county group regulations, we no longer think it is necessary to retain use of a 1990based standard as a criterion for determining whether an urban county group is eligible for reclassification. We believe it is reasonable to use the area definitions that are based on the most recent statistics; in other words, the CSA standard. Therefore, we are proposing to delete § 412.234(a)(3)(ii) to remove reference to the CMSA eligibility criterion. Beginning with FY 2006, we are proposing to require that hospitals must be located in counties that are in the same Combined Statistical Area (under the MSA definitions announced by the OMB on June 6, 2003) as the urban area to which they seek redesignation to qualify as meeting the proximity requirement for reclassification to the urban area to which they seek redesignation. We believe that this proposed change would improve the overall consistency of our policies by using a single labor market area definition for all aspects of the wage index and reclassification. 4. Clarification of Goldsmith Modification Criterion for Urban Hospitals Seeking Reclassification as Rural Under section 1886(d)(8)(E) of the Act, certain urban hospitals may file an application for reclassification as rural if the hospital meets certain criteria. One of these criteria is that the hospital is located in a rural census tract of a PO 00000 Frm 00133 Fmt 4701 Sfmt 4702 23437 CBSA, as determined under the most recent version of the Goldsmith Modification as determined by the Office of Rural Health Policy. This provision is implemented in our regulations at § 412.103(a)(1). The original Goldsmith Modification was developed using data from the 1980 census. In order to more accurately reflect current demographic and geographic characteristics of the Nation, the Office of Rural Health Policy, in partnership with the Department of Agriculture’s Economic Research Service and the University of Washington, has developed the RuralUrban Commuting Area codes (RUCAs) (69 FR 47518 through 47529, August 5, 2004). Rather than being limited to large area metropolitan counties (LAMCs), RUCAs use urbanization, population density, and daily commuting data to categorize every census tract in the country. RUCAs are the updated version of the Goldsmith Modification and are used to identify rural census tracts in all metropolitan counties. We are proposing to update the Medicare regulations at § 412.103(a)(1) to incorporate this change in the identification of rural census tracts. We are also proposing to update the website and the agency location at which the RUCA codes are accessible. 5. Cross-Reference Changes In the FY 2005 IPPS final rule, in conjunction with changes made by various sections of Pub. L. 108–173 and changes in the OMB standards for defining labor market areas, we established a new § 412.64 governing rules for establishing Federal rates for inpatient operating costs for FY 2005 and subsequent years. In this new section, we included definitions of ‘‘urban’’ and ‘‘rural’’ for the purpose of determining the geographic location or classification of hospitals under the IPPS. These definitions were previous located in § 412.63(b), applicable to FYs 1985 through 2004, and in § 412.62(f), applicable to FY 1984. References to the definitions under § 412.62(f) and § 412.63(b), appear throughout 42 CFR Chapter IV. However, when we finalized the provisions of § 412.64, we inadvertently omitted updating some of these cross-references to reflect the change in the location of the two definitions for FYs 2005 and subsequent years. We are proposing to change the cross-references to the definitions of ‘‘urban’’ and ‘‘rural’’ to reflect their current locations in Subpart D of Part 412, as applicable. E:\FR\FM\04MYP2.SGM 04MYP2 23438 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules I. Payment for Direct Graduate Medical Education (§ 413.79) (If you choose to comment on issues in this section, please include the caption ‘‘Graduate Medical Education’’ at the beginning of your comment.) 1. Background Section 1886(h) of the Act, as added by section 9202 of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 (Pub. L. 99–272) and implemented in regulations at existing §§ 413.75 through 413.83, establishes a methodology for determining payments to hospitals for the costs of approved graduate medical education (GME) programs. Section 1886(h)(2) of the Act, as added by COBRA, sets forth a payment methodology for the determination of a hospital-specific, base-period per resident amount (PRA) that is calculated by dividing a hospital’s allowable costs of GME for a base period by its number of residents in the base period. The base period is, for most hospitals, the hospital’s cost reporting period beginning in FY 1984 (that is, the period of beginning between October 1, 1983, through September 30, 1984). Medicare direct GME payments are calculated by multiplying the PRA times the weighted number of full-time equivalent (FTE) residents working in all areas of the hospital (and nonhospital sites, when applicable), and the hospital’s Medicare share of total inpatient days. In addition, as specified in section 1886(h)(2)(D)(ii) of the Act, for cost reporting periods beginning on or after October 1, 1993, through September 30, 1995, each hospitalspecific PRA for the previous cost reporting period is not updated for inflation for any FTE residents who are not either a primary care or an obstetrics and gynecology resident. As a result, hospitals that train primary care and obstetrics and gynecology residents, as well as nonprimary care residents in FY 1994 or FY 1995, have two separate PRAs: One for primary care and obstetrics and gynecology residents and one for nonprimary care residents. Pub. L. 106–113 amended section 1886(h)(2) of the Act to establish a methodology for the use of a national average PRA in computing direct GME payments for cost reporting periods beginning on or after October 1, 2000, and on or before September 30, 2005. Pub. L. 106–113 established a ‘‘floor’’ for hospital-specific PRAs equal to 70 percent of the locality-adjusted national average PRA. In addition, the BBRA established a ‘‘ceiling’’ that limited the annual adjustment to a hospital-specific PRA if the PRA exceeded 140 percent of VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 a. Background the definition of approved programs * * * is counted toward the initial residency period limitation.’’ Section 1886(h)(5)(F) of the Act further provides that ‘‘the initial residency period shall be determined, with respect to a resident, as of the time the resident enters the residency training program.’’ The IRP is determined as of the time the resident enters the ‘‘initial’’ or first residency training program and is based on the period of board eligibility associated with that medical specialty. Thus, these provisions limit the amount of FTE resident time that may be counted for a resident who, after entering a training program in one specialty, switches to a program in a specialty with a longer period of board eligibility or completes training in one specialty training program and then continues training in a subspecialty (for example, cardiology and gastroenterology are subspecialties of internal medicine). As we have generally described above, the amount of direct GME payment to a hospital is based in part on the number of FTE residents the hospital is allowed to count for direct GME purposes during a year. The number of FTE residents, and thus the amount of direct GME payment to a hospital, is directly affected by CMS policy on how ‘‘initial residency periods’’ are determined for residents. Section 1886(h)(4)(C)(ii) of the Act, implemented at § 413.79(b)(1), provides that while a resident is in the ‘‘initial residency period’’ (IRP), the resident is weighted at 1.00. Section 1886(h)(4)(C)(iii) of the Act, implemented at § 413.79(b)(2), requires that if a resident is not in the resident’s IRP, the resident is weighted at .50 FTE resident. Section 1886(h)(5)(F) of the Act defines ‘‘initial residency period’’ as the ‘‘period of board eligibility,’’ and, subject to specific exceptions, limits the initial residency period to an ‘‘aggregate period of formal training’’ of no more than 5 years for any individual. Section 1886(h)(5)(G) of the Act generally defines ‘‘period of board eligibility’’ for a resident as ‘‘the minimum number of years of formal training necessary to satisfy the requirements for initial board eligibility in the particular specialty for which the resident is training.’’ Existing § 413.79(a) of the regulations generally defines ‘‘initial residency period’’ as the ‘‘minimum number of years required for board eligibility.’’ Existing § 413.79(a)(5) provides that ‘‘time spent in residency programs that do not lead to certification in a specialty or subspecialty, but that otherwise meet b. Direct GME Initial Residency Period Limitation: Simultaneous Match We understand that there are numerous programs, including anesthesiology, dermatology, psychiatry, and radiology, that require a year of generalized clinical training to be used as a prerequisite for the subsequent training in the particular specialty. For example, in order to become board eligible in anesthesiology, a resident must first complete a generalized training year and then complete 3 years of training in anesthesiology. This first year of generalized residency training is commonly known as the ‘‘clinical base year.’’ Often, the clinical base year requirement is fulfilled by completing either a preliminary year in internal medicine (although the preliminary year can also be in other specialties such as general surgery or family practice), or a transitional year program (which is not associated with any particular medical specialty). In many cases, during the final year of medical school, medical students apply for training in specialty residency training programs. Typically, a medical student who wants to train to become a specialist is ‘‘matched’’ to both the clinical base year program and the specialty residency training program at the same time. For example, the medical student who wants to become an anesthesiologist will apply and ‘‘match’’ simultaneously for a clinical base year in an internal medicine program for year 1 and for an anesthesiology training program beginning in year 2. Prior to October 1, 2004, CMS’ policy was that the IRP is determined for a the locality-adjusted national average PRA. Section 511 of the BIPA (Pub. L. 106–554) increased the floor established by the BBRA to equal 85 percent of the locality-adjusted national average PRA. Existing regulations at § 413.77(d)(2)(iii) specify that, for purposes of calculating direct GME payments, each hospitalspecific PRA is compared to the floor and the ceiling to determine whether a hospital-specific PRA should be revised. Section 1886(h)(4)(F) of the Act established limits on the number of allopathic and osteopathic residents that hospitals may count for purposes of calculating direct GME payments. For most hospitals, the limits were the number of allopathic and osteopathic FTE residents training in the hospital’s most recent cost reporting period ending on or before December 31, 1996. 2. Direct GME Initial Residency Period (IRP) § 413.79(a)(10) PO 00000 Frm 00134 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules resident based on the program in which he or she participates in the resident’s first year of training, without regard to the specialty in which the resident ultimately seeks board certification. Therefore, for example, a resident who chooses to fulfill the clinical base year requirement for an anesthesiology program with a preliminary year in an internal medicine program will be ‘‘labeled’’ with the IRP associated with internal medicine, that is, 3 years (3 years of training are required to become board eligible in internal medicine), even though the resident may seek board certification in anesthesiology, which requires a minimum of 4 years of training to become board eligible. As a result, this resident would have an IRP of 3 years and, therefore, be weighted at 0.5 FTE in his or her fourth year of anesthesiology training for purposes of direct GME payment. Effective with cost reporting periods beginning on or after October 1, 2004, to address programs that require a clinical base year, we revised our policy in the FY 2005 IPPS final rule (69 FR 49170 through 49174) concerning the IRP. Specifically, under the revised policy, if a hospital can document that a particular resident matches simultaneously for a first year of training in a clinical base year in one medical specialty, and for additional year(s) of training in a different specialty program, the resident’s IRP will be based on the period of board eligibility associated with the specialty program in which the resident matches for the subsequent year(s) of training and not on the period of board eligibility associated with the clinical base year program. This change in policy is codified at § 413.79(a)(10) of the regulations. This policy applies regardless of whether the resident completes the first year of training in a separately accredited transitional year program or in a preliminary (or first) year in another residency training program such as internal medicine. In addition, because programs that require a clinical base year are nonprimary care specialties, we specified in § 413.79(a)(10) that the nonprimary care PRA would apply for the entire duration of the initial residency period. By treating the first year as part of a nonprimary care specialty program, the hospital will be paid at the lower nonprimary care PRA rather than the higher primary care PRA, even if the residents are training in a primary care program during the clinical base year. In the FY 2005 IPPS final rule (69 FR 49170 and 49171), we also defined VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 ‘‘residency match’’ to mean, for purposes of direct GME, a national process by which applicants to approved medical residency programs are paired with programs on the basis of preferences expressed by both the applicants and the program directors. These policy changes, which were effective October 1, 2004, are only applicable to residents that simultaneously match in both a clinical base year program and a longer specialty residency program. We have become aware of situations where residents, upon completion of medical school, only match for a program beginning in the second residency year in an advanced specialty training program but fail to match for a clinical base year of training. Residents that match into an advanced program but fail to match into a clinical base year program may independently pursue unfilled residency positions in preliminary year programs after the match process is complete. However, because these residents do not ‘‘simultaneously match’’ into both a preliminary year and an advanced program, currently their IRP cannot be determined based on the period of board eligibility associated with the advanced program, as specified in § 413.79(a)(10). Rather, the IRP for such residents would continue to be determined based on the specialty associated with the preliminary year program. For example, a student in the final year of medical school may match into a radiology program that begins in the second residency year, but not match with any clinical base year program. Under our current policy, if subsequent to conclusion of the match process, this resident secured a preliminary year position in an internal medicine program, the resident would not have met the requirements at § 413.79(a)(10) for a simultaneous match and the IRP for this resident would be based on the length of time required to complete an internal medicine program (3 years) rather than the length of the radiology program (4 years). The intent of the ‘‘simultaneous match’’ provision of § 413.79(a)(10) is to identify in a verifiable manner the specialty associated with the program in which the resident will initially train and seek board certification. It is also the intent of § 413.79(a)(10) that a resident’s IRP would not change if the resident, after initially entering a training program in one specialty, changes programs to train in another medical specialty. The ‘‘simultaneous match’’ provisions of § 413.79(a)(10) allow CMS to both identify the specialty associated with the program in which the resident is ultimately expected to PO 00000 Frm 00135 Fmt 4701 Sfmt 4702 23439 train and seek board certification and prevent inappropriate revision of the IRP in cases where a resident changes specialties subsequent to beginning residency training. However, we note that when a medical student in his or her final year of medical school matches into an advanced program (for example, anesthesiology) for the second program year, but fails to match in a clinical base year, and obtains a preliminary year position outside the match process, we can still identify the specialty associated with the program in which the resident is ultimately expected to train and seek board certification and prevent inappropriate changes to the IRP if the resident changes specialties subsequent to beginning residency training. Therefore, we are proposing to revise § 413.79(a)(10) to state that, when a hospital can document that a resident matched in an advanced residency training program beginning in the second residency year prior to commencement of any residency training, the resident’s IRP will be determined based on the period of board eligibility for the specialty associated with the advanced program, without regard to the fact that the resident had not matched for a clinical base year training program. We note that this proposed policy change would not result in a policy to determine the IRP for all residents who must complete a clinical base year during the second residency training year based on the specialty associated with that second residency training year. That is, we are not proposing that, for any resident whose first year of training is completed in a program that provides a general clinical base year as required by the ACGME for certain specialties, an IRP should be assigned in the second year based on the specialty the resident enters in the second year of training. As we stated in the FY 2005 IPPS final rule (69 FR 49172), a ‘‘second year’’ policy would not allow CMS to distinguish between those residents who, in their second year of training, match in a specialty program prior to their first year of training, those residents who participated in a clinical base year in a specialty and then continued training in that specialty, and those residents who simply switched specialties in their second year. Rather, we are proposing that, if a hospital can document that a particular resident had matched in an advanced specialty program that requires completion of a clinical base year prior to the resident’s first year of training, the IRP would not be determined based on the period of board eligibility for the specialty associated with the clinical base year E:\FR\FM\04MYP2.SGM 04MYP2 23440 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules program, for purposes of direct GME payment. Rather, under those circumstances, the IRP would be determined based upon the period of board eligibility associated with the specialty program in which the resident has matched and is expected to begin training in the second program year. 3. New Teaching Hospitals’ Participation in Medicare GME Affiliated Groups (§ 413.79(e)(1)) In the August 29, 1997 final rule (62 FR 46005 through 46006) and the May 12, 1998 final rule (63 FR 26331 through 23336), we established rules for applying the FTE resident limit (or ‘‘FTE cap’’) for calculating Medicare direct GME and IME payments to hospitals. We added regulations, currently at § 413.79(e), to provide for an adjustment to the FTE cap for certain hospitals that begin training residents in new medical residency training programs. For purposes of this provision, a new program is one that receives initial accreditation or begins training residents on or after January 1, 1995. Although we refer only to the direct GME provision throughout the remainder of this discussion, a similar cap adjustment is made under § 412.105(f) for IME purposes. Therefore, this proposal applies to both IME and direct GME. A new teaching hospital is one that had no allopathic or osteopathic residents in its most recent cost reporting period ending on or before December 31, 1996. Under § 413.79(e)(1), if a new teaching hospital establishes one or more new medical residency training programs, the hospital’s unweighted FTE caps for both direct GME and IME will be based on the product of the highest number of FTE residents in any program year in the third year of the hospital’s first new program and the number of years in which residents are expected to complete the program(s), based on the minimum number of years of training that are accredited for the type of program(s). The regulations at § 413.79(e)(1)(iv) specify that hospitals in urban areas that qualify for an FTE cap adjustment for residents in newly approved programs under § 413.79(e)(1) are not permitted to be part of a Medicare GME affiliated group for purposes of establishing an aggregate FTE cap. (A Medicare GME affiliated group is defined in the regulations at § 413.75(b).) We established this policy because of our concern that hospitals with existing medical residency training programs could otherwise, with the cooperation of new teaching hospitals, circumvent the VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 statutory FTE resident caps by establishing new medical residency programs in the new teaching hospitals solely for the purpose of affiliating with the new teaching hospitals to receive an upward adjustment to their FTE cap under an affiliation agreement. This would effectively allow existing teaching hospitals to achieve an increase in their FTE resident caps beyond the number allowed by their statutory caps. In contrast, hospitals in rural areas that qualify for an adjustment under § 413.79(e)(1)(v) are allowed to enter into a Medicare GME affiliation. Although we recognize that rural hospitals would not be immune from the kind of ‘‘gaming’’ arrangement described above, we allow new rural teaching hospitals that begin training residents in new programs, and thereby increase their FTE cap, to affiliate because we understand that rural hospitals may not have a sufficient volume of patient care utilization at the rural hospital site to be able to support a training program that meets accreditation standards. Securing sufficient patient volumes to meet accreditation requirements may necessitate rotations of the residents to another hospital. Accordingly, the regulations allow new teaching hospitals in rural areas to enter into Medicare GME affiliation agreements. However, an affiliation is only permitted if the rural hospital provides training for at least one-third of the FTE residents participating in all of the joint programs of the affiliated hospitals because, as we stated in the May 12, 1998 Federal Register (63 FR 26333), we believe that requiring at least one-third of the training to take place in the rural area allows operation of programs that focus on, but are not exclusively limited to, training in rural areas. Through comment and feedback from industry trade groups and hospitals, we understand that, while these rules were meant to prevent gaming on the part of existing teaching hospitals, they could also preclude affiliations that clearly are designed to facilitate additional training at the new teaching hospital. For example, Hospital A had no allopathic or osteopathic residents in its most recent cost reporting period ending on or before December 31, 1996. As such, Hospital A’s caps for direct GME and IME are both zero. Hospital A and Hospital B enter into a Medicare GME affiliation for the academic year beginning on July 1, 2003, and ending on June 30, 2004. On July 1, 2003, Hospital A begins training residents from an existing family medicine program located at Hospital B. This PO 00000 Frm 00136 Fmt 4701 Sfmt 4702 rotation will result in 5 FTE residents training at Hospital A. Through the affiliation agreement, Hospital A receives a positive adjustment of 5 FTE’s for both its direct GME and IME caps. Hospital B receives a corresponding negative adjustment of 5 FTEs under the affiliation agreement. Hospital A’s Board of Directors is interested in starting a new residency program in Internal Medicine that would begin training residents at Hospital A on July 1, 2005. If Hospital A establishes the new program, under existing Medicare regulations, Hospital A will have its direct GME and IME caps (which were both previously established at zero) permanently adjusted to reflect the additional residents training in the newly approved program in accordance with § 413.79(e)(1). However, under existing regulations, Hospital A may no longer enter into an affiliation with Hospital B after it receives the adjustment to its FTE caps under § 413.79(e)(1). We are proposing to revise § 413.79(e)(1)(iv) so that new urban teaching hospitals that qualify for an adjustment under § 413.79(e)(1) may enter into a Medicare GME affiliation agreement under certain circumstances. Specifically, a new urban teaching hospital that qualifies for an adjustment to its FTE caps for a newly approved program may enter into a Medicare GME affiliation agreement, but only if the resulting adjustments to its direct GME and IME caps are ‘‘positive adjustments.’’ ‘‘Positive adjustment’’ means, for the purpose of this policy, that there is an increase in the new teaching hospital’s caps as a result of the affiliation agreement. At no time would the caps of a hospital located in an urban area that qualifies for adjustment to its FTE caps for a new program under § 413.79(e)(1), be allowed to decrease as a result of a Medicare GME affiliation agreement. We believe this proposed policy change would allow new urban teaching hospitals flexibility to start new teaching programs without jeopardizing their ability to count additional FTE residents training at the hospital under an affiliation agreement. We remain concerned that hospitals with existing medical residency training programs could cooperate with a new teaching hospital to circumvent the statutory FTE caps by establishing new programs at the new teaching hospital, and, through a Medicare GME affiliation agreement, moving most or all of the new residency program to its own hospital, thereby receiving an upward adjustment to its FTE caps. For this reason, we are proposing to revise E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules § 413.79(e)(1)(iv) of the regulations to provide that a hospital that qualifies for an adjustment to its caps under § 413.79(e)(1) would not be permitted to enter into an affiliation agreement that would produce a negative adjustment to its FTE resident cap. Continuing the example shown above, under the proposed change in policy, Hospital A and Hospital B would be able to continue the Medicare GME affiliation agreement under which Hospital A trained residents from Hospital B’s family practice program because Hospital A would receive an increase in its direct GME or IME caps under an affiliation after qualifying for a new program adjustment under § 413.79(e)(1). However, Hospital B would not be able to receive an increase in its caps as a result of a Medicare GME affiliation agreement with Hospital A. Thus, we are proposing the above policy change to provide some flexibility to hospitals that are currently prohibited from entering into a Medicare GME affiliation agreement, while continuing to protect the statutory FTE resident caps from being undermined by gaming. We solicit comments on the proposed change. 4. GME FTE Cap Adjustment for Rural Hospitals (§ 413.79(c) and (k)) As stated earlier under section V.I.1. of this preamble, Medicare makes both direct and indirect GME payments to hospitals for the training of residents. Direct GME payments are made in accordance with section 1886(h) of the Act, based generally on the hospitalspecific PRA, the number of FTE residents a hospital trains, and the hospital’s percentage of Medicare inpatient utilization. Indirect GME payments (referred to as IME) are made in accordance with section 1886(d)(5)(B) of the Act as an adjustment to DRG payment and are based generally on the ratio of the hospital’s FTE residents to the number of hospital beds. It is wellestablished that the calculation of both direct GME and IME payments is affected by the number of FTE residents a hospital is allowed to count; generally, the greater the number of FTE residents a hospital counts, the greater the amount of Medicare direct GME and IME payments the hospital will receive. Effective October 1, 1997, Congress instituted caps on the number of allopathic and osteopathic residents a hospital is allowed to count for direct GME and IME purposes at sections 1886(h)(4)(F) (direct GME) and 1886(d)(5)(B)(v) (IME) of the Act. These caps were instituted in an attempt to end the implicit incentive for hospitals to increase the number of FTE residents. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Dental and podiatric residents were not included in these statutorily mandated caps. Congress provided certain exceptions for rural hospitals when establishing the 1996 caps ‘‘with the intent of encouraging physician training and practice in rural areas’’ (65 FR 47032). For example, the statute states at section 1886(h)(4)(H)(i) that, in promulgating rules regarding application of the FTE caps to training programs established after January 1, 1995, ‘‘the Secretary shall give special consideration to facilities that meet the needs of underserved rural areas.’’ Accordingly, in implementing this provision, we provided in the regulations under § 413.86(g)(6)(i)(C) (now § 413.79(e)(1)(iii)) that ‘‘except for rural hospitals, the cap will not be adjusted for new programs established more than 3 years after the first program begins training residents. In other words, only hospitals located in rural areas (that is, areas that are not designated as an MSA), receive adjustments to their unweighted FTE caps to reflect residents in new medical residency training programs past the third year after the first residency program began training in that hospital (62 FR 46006). Section 413.79(e)(1) specifies the new program adjustment as the ‘‘product of the highest number of residents in any program year during the third year of the * * * program’s existence * * * and the number of years in which residents are expected to complete the program based on the minimum accredited length for the type of program.’’ The regulation applies only to new programs (as defined under § 413.79(1)) established by rural hospitals, not for expansion of previously existing programs. For example, if a rural hospital has an unweighted FTE cap for direct GME of 100 and begins training residents in a new 3-year residency program that has 10 residents in each of its first 3 program years (for a total of 30 residents in the entire program in the program’s third year), the hospital’s direct GME FTE cap of 100 would be permanently adjusted at the conclusion of the third program year by 30, and the hospital’s new FTE cap would be 130. A similar adjustment would be made to the hospital’s FTE cap for IME in accordance with the regulations at § 412.105(f)(1)(iv)(A). However, the rural hospital would not be able to receive adjustments to its FTE cap for any expansion of a preexisting program. In 1999, Congress passed an additional provision under section 407 of Pub. L. 106–113 (BBRA) to promote physician training in rural areas. PO 00000 Frm 00137 Fmt 4701 Sfmt 4702 23441 Section 407 of the Pub. L. 106–113 amended the FTE caps provision at sections 1886(h)(4)(F) and 1886(d)(5)(B)(v) of the Act to provide that ‘‘effective for cost reporting periods beginning on or after April 1, 2000, [a rural hospital’s FTE cap] is 130 percent of the unweighted FTE count * * * for those residents for the most recent cost reporting period ending on or before December 31, 1996.’’ In other words, the otherwise applicable FTE caps for rural hospitals were multiplied by 1.3 to encourage rural hospitals to expand preexisting residency programs. (As described above, even prior to the BBRA change, rural hospitals were able to receive FTE cap adjustments for new programs.) For example, a hospital that was rural as of April 1, 2000, and had a direct GME cap of 100 FTEs would receive a permanent cap adjustment of 30 FTEs (100 FTEs × 1.3 = 130 FTEs) and effective for cost reporting periods beginning on or after April 1, 2000, its FTE for direct GME would be 130. (A similar adjustment would be made to the FTE cap for IME for discharges occurring on or after April 1, 2000.) We recently received questions regarding the application of the 130percent FTE cap adjustment and the new program adjustment for rural hospitals in instances in which a rural teaching hospital is later redesignated as an urban hospital or reclassifies back to being an urban hospital after having been classified as rural. We are aware of two circumstances when a rural hospital may subsequently be reclassified as urban. The first circumstance involves labor market area changes, and the second involves urban hospitals, after having been reclassified as rural through section 1886(d)(8)(E) of the Act, that elect to be considered urban again. In both situations, if the hospital in question was a teaching hospital, its FTE caps would have been subject to the 130 percent and new program FTE cap adjustments while it was designated or classified as rural. The issue is whether the adjusted caps would continue to apply after the hospital becomes urban or returns to being treated as urban. Below we first address hospitals that lost their status as urban hospitals due to new labor market areas. We then address hospitals that rescinded their section 1886(d)(8)(E) reclassifications. (We note that reclassification by the MGCRB under section 1886(d)(10) of the Act, as well as reclassifications under section 1886(d)(8)(B) of the Act, are effective only for purposes of the wage index and would not affect the hospital’s IME or direct GME payments). E:\FR\FM\04MYP2.SGM 04MYP2 23442 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules a. Formerly Rural Hospitals That Became Urban Due to the New CBSA Labor Market Areas In the FY 2005 IPPS final rule, we adopted the new CBSA-based labor market areas announced by OMB on June 6, 2003, and these areas became effective October 1, 2004. As a result of these new labor market areas, a number of hospitals that previously were located outside of an MSA and therefore considered rural are now located in a CBSA that is designated as urban and considered urban. We believe that previously rural hospitals that received adjustments due to establishing new medical training programs should not now be required to forego such adjustments simply because they have now been redesignated as urban. Such hospitals added and received accreditation for new medical training programs under the assumption that such programs would effect a permanent increase in their FTE caps. Indeed, we believe it would be nonsensical to view the fact that these hospitals are now urban as causing them to lose the adjustments that stemmed directly from the permissible and encouraged establishment of new medical training programs. Such hospitals cannot reach back into the past and alter whether they added the new programs or not. Nor would it be reasonable to prohibit them from counting FTE residents training in new programs that they worked to accredit. (We note that the hospitals would not be required to close the programs. Rather, if they were not permitted to retain the adjustments to their FTE caps they received as a result of having established new programs, they would no longer be permitted to count FTE residents that exceeded their original, preadjustment FTE caps for purposes of direct GME and IME payments. The effect might be that the hospital would have to close the program(s) as a result of decreased Medicare funding, but the hospital would be free to continue to operate the programs(s).) For these reasons, we believe the best reading of our regulation at § 413.79(e)(3), which states that if a hospital ‘‘is located in a rural area,’’ it may adjust its FTE cap to reflect residents training in new programs, is that hospitals were permitted to receive a permanent adjustment to their FTE caps if, at the time of adding a new program, the hospitals were rural. A hospital’s subsequent designation as urban or rural due to labor market area changes becomes irrelevant, because the central question is whether the hospital is rural at the time it adds the new VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 programs. Therefore, we are clarifying in this proposed rule our policy that hospitals that became urban in FY 2005 due to the new labor market areas would nevertheless be permitted to retain the adjustments they received for new programs as long as they were rural at the time they received them. (Once such hospitals receive a designation as ‘‘urban,’’ they may no longer seek FTE cap adjustments relating to new training programs; they may only retain the adjustments they received for the new programs they added when they were rural.) Similarly, we believe that rural hospitals that received the statutorily mandated 130 percent adjustment to their FTE caps would be disadvantaged if we were to rescind this adjustment due to new urban designation. Such hospitals expanded their already existing training programs under the assumption that these expansions would cause a permanent increase in their FTE caps. Many of these hospitals expanded their programs only once the BBRA became effective (in 2000). Thus, they have had only a few years to expand their programs and receive the cap adjustment mandated by statute. For these reasons, we believe it is permissible to read sections 1886(h)(4)(F)(i) and 1886(d)(5)(B)(v) of the Act as permitting a permanent adjustment to the FTE caps at the time a rural hospital adds residents to its already existing program(s). The language states that the total number of FTE residents with respect to a ‘‘hospital’s approved medical residency training program in the fields of allopathic medicine and osteopathic medicine may not exceed the number (or, 130 percent of such number in the case of a hospital located in a rural area) of such full-time equivalent residents for the hospital’s most recent cost reporting period ending on or before December 31, 1996.’’ As with the addition of new programs, we interpret the language ‘‘130 percent of such number in the case of a hospital located in a rural area,’’ as meaning only that the hospital was required to be rural at the time it received the 30-percent increase. Once the hospital received such increase, the increase became a permanent increase in the FTE cap and should not be rescinded based on subsequent designation as an urban hospital. We believe our interpretations are consistent with legislative intent. Congress provided for these FTE cap adjustments for rural hospitals with the intent of encouraging physician training and practice in rural areas. If rural hospitals had believed that new CBSAs PO 00000 Frm 00138 Fmt 4701 Sfmt 4702 would cause them to lose the adjustments, they would not have had the incentives Congress wished to increase the number of FTE residents training in their programs. These hospitals might have feared losing the adjustments as a result of new labor market areas, and therefore not carried out Congress’ intent to expand their already existing residency training programs or add new residency training programs. To provide an example of the how the above statutory interpretations would be applied, a hospital located in a rural area prior to October 1, 2004, with an unweighted direct GME FTE cap of 100 would have received a 30-percent increase in its FTE cap so that its adjusted cap was 130 FTEs. The rural hospital also could have received an adjustment for any new medical residency program. If this hospital, while rural, started a new 3-year residency program with 10 residents in each program year, its FTE cap would have been increased by an additional 30 FTEs to 160 FTEs (that is, (100 FTEs × 1.3) + 30 FTEs = 160 FTEs). Under our reading of the statute, if this hospital is now located in an urban area due to the new CBSAs, it would retain this cap of 160 FTEs. We also believe that the statute should be interpreted as permitting urban hospitals with rural track training programs to retain the adjustment they received for such programs at § 413.79(k), even if the ‘‘rural’’ tracks as of October 1, 2004, are now located in urban areas due to the new OMB labor market areas. As explained in the FY 2001 IPPS final rule (66 FR 47033), we provided that an urban hospital that establishes a separately accredited medical residency training program in a rural area (that is, a rural track) may receive an adjustment to reflect the number of residents in that program (existing § 413.79(k)). Section 1886(h)(4)(H)(iv) of the Act states: ‘‘In the case of a hospital that is not located in a rural area but establishes separately accredited approved medical residency training programs (or rural tracks) in an (sic) rural area or has an accredited training program with an integrated rural track, the Secretary shall adjust the limitation under subparagraph (F) in an appropriate manner insofar as it applies to such programs in such rural areas in order to encourage the training of physicians in rural areas.’’ Again, we believe that the reading that best carries out Congressional intent is one that allows the adjustment for rural tracks to remain permanent as long as the rural track training programs continue, even if the once-rural tracks E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules are now urban due to new labor market area boundaries. Congress clearly intended to encourage the training of physicians in the rural tracks identified by the statute. However, if the FTE cap adjustments were merely temporary, and hospitals could not rely on retaining the adjustments relating to the rural training programs in which they invested, then Congress’ wishes to encourage rural training programs might not have been realized. Hospitals would always need to speculate as to whether the FTE cap adjustments relating to the rural track programs they established would be lost each time new labor market areas were adopted (which normally occurs once every 10 years). Thus, we believe the statutory language should be interpreted as allowing an urban hospital to retain its FTE cap adjustment for rural track programs as long as the tracks were actually located in rural areas at the time the urban hospital received its adjustment. However, if the urban hospital wants to receive a cap adjustment for a new rural track residency program, the rural track must involve rural hospitals that are located in rural areas based on the most recent OMB labor market designations as specified in the FY 2005 IPPS final rule. We are proposing to add a new paragraph (k)(7) to § 413.79 to incorporate this proposal. b. Section 1886(d)(8)(E) Hospitals As stated above, a second situation exists where a hospital that is treated as rural returns to being urban under section 1886(d)(8)(E) of the Act (§ 412.103 of the regulations). Under this provision, an urban hospital may file an application to be treated as being located in a rural area. A hospital’s reclassification as located in a rural area under this provision affects only payments under section 1886(d) of the Act. Accordingly, a hospital that is treated as rural under this provision can receive the FTE cap adjustments that any other rural hospital receives, but only to the FTE cap that applies for purposes of IME payments, which are made under section 1886(d) of the Act. The hospital could not receive adjustments to its direct GME FTE cap because payments for direct GME are made under section 1886(h) of the Act and the section 1886(d)(8)(E) reclassifications affect only the payments that are made under that section 1886(d) of the Act. Therefore, a hospital that reclassifies as rural under section 1886(d)(8)(E) of the Act may receive the 130-percent adjustment to its IME FTE cap and its IME FTE cap may be adjusted for any new programs, similar to hospitals that are actually VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 located in a rural location. A hospital treated as rural under section 1886(d)(8)(E) of the Act may subsequently withdraw its election and return to its urban status under the regulations at § 412.103. We are proposing that, effective with discharges occurring on or after October 1, 2005, a different policy should apply for hospitals that reclassify under section 1886(d)(8)(E) of the Act than the policy that applies to rural hospitals redesignated as urban due to changes in labor market areas, as discussed in section IV.F.3 of this preamble. 5. Technical Changes: Cross References • In the FY 2005 IPPS final rule (69 FR 49234), we redesignated the contents of § 413.86 as §§ 413.75 through 413.83. We also updated cross-references to § 413.86 that were located in various sections under 42 CFR Parts 400 through 499. We inadvertently did not capture all of the needed cross-reference changes. In this proposed rule, we are proposing to correct the additional cross-references in 42 CFR Parts 405, 412, 413, 415, 419, and 422 that were not made in the August 11, 2004 final rule. • When we redesignated § 413.86 as §§ 413.75 through 413.83 in the FY 2005 IPPS final rule, we also made a corresponding redesignation of § 413.80 as § 413.89. We are proposing to correct cross-references to § 413.80 in 42 CFR Parts 412, 413, 417, and 419 to reflect the redesignation of this section as § 413.89. J. Provider-Based Status of Facilities and Organizations Under Medicare (If you choose to comment on issues in this section, please include the caption ‘‘Provider-Based Entities’’ at the beginning of your comment.) 1. Background Since the beginning of the Medicare program, some providers, which we refer to as ‘‘main providers,’’ have functioned as a single entity while owning and operating multiple provider-based departments, locations, and facilities that were treated as part of the main provider for Medicare purposes. Having clear criteria for provider-based status is important because this designation can result in additional Medicare payments for services furnished at the provider-based facility, and may also increase the coinsurance liability of Medicare beneficiaries for those services. To set forth Medicare policies with regard to the provider-based status of facilities and organizations, we have PO 00000 Frm 00139 Fmt 4701 Sfmt 4702 23443 published a number of Federal Register documents as follows: • In a proposed rule published in the Federal Register on September 8, 1998 (63 FR 47552), we proposed specific and comprehensive criteria for determining whether a facility or organization is provider-based. In the preamble to the proposed rule, we explained why we believed meeting each criterion would be necessary to a finding that a facility or organization qualifies for providerbased status. After considering public comments on the September 8, 1998 proposed rule and making appropriate revisions, on April 7, 2000 (65 FR 18504), we published a final rule setting forth the provider-based regulations at 42 CFR 413.65. • Before the regulations that were issued on April 7, 2000 could be implemented, Congress enacted the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), Pub. L. 106–544. Section 404 of BIPA delayed implementation of the April 7, 2000 provider-based rules with respect to many providers, and mandated changes in the criteria at § 413.65 for determining provider-based status. • In order to conform our regulations to the requirements of section 404 of BIPA and to codify certain clarifications of provider-based policy that had previously been posted on the CMS Web site, we published another proposed rule on August 24, 2001 (66 FR 44672). After considering public comments on the August 24, 2001 proposed rule and making appropriate revisions, we published a final rule on November 30, 2001 setting forth the provider-based regulations (66 FR 59909). • On May 9, 2002, we proposed further significant revisions to the provider-based regulations at § 413.65 (67 FR 31480). After considering public comments on the May 9, 2002 proposed rule and making appropriate revisions, on August 1, 2002, we published a final rule specifying the criteria that must be met to qualify for provider-based status (67 FR 50078). These regulations remain in effect and continue to be codified at § 413.65. Following is a discussion of the major provisions of the provider-based regulations: Section 413.65(a) of the regulations describes the scope of that section and provides definitions of key terms used in the regulations. Paragraph (b) describes the procedure for making provider-based determinations, and paragraph (c) imposes requirements for reporting material changes in relationships between main providers and provider-based facilities or organizations. In paragraph (d), we E:\FR\FM\04MYP2.SGM 04MYP2 23444 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules specify the requirements that are applicable to all facilities or organizations seeking provider-based status, and in paragraph (e), we describe the additional requirements applicable to off-campus facilities or organizations (generally, those located more than 250 yards from the provider’s main buildings). Paragraphs (f) through (o) set forth policies regarding joint ventures, obligations of provider-based facilities, facilities operated under management contracts or providing all services under arrangements, procedures in connection with certain provider-based determinations, and specific types of facilities such as Indian Health Service (IHS) and Tribal facilities and Federally qualified health centers (FQHCs). 2. Limits on the Scope of the ProviderBased Regulations—Facilities for Which Provider-Based Determinations Will Not Be Made In § 413.65(a) (1)(ii), we list specific types of facilities and organizations for which determinations of provider-based status will not be made. We previously concluded that provider-based determinations should not be made for these facilities because the outcome of the determination (that is, whether a facility, unit, or department is found to be freestanding or provider-based) would not affect the methodology used to make Medicare or Medicaid payment, the scope of benefits available to a Medicare beneficiary in or at the facility, or the deductible or coinsurance liability of a Medicare beneficiary in or at the facility. We have now concluded that, under the principle stated above, rural health clinics affiliated with hospitals having 50 or more beds should be added to the list of facilities for which providerbased status determinations are not made. Therefore, we are proposing to revise § 413.65(a)(1)(ii) to add rural health clinics with hospitals having 50 or more beds to the listing of the types of facilities for which a provider-based status determination will not be made. We believe this proposed revision to § 413.65(a)(1)(ii) is appropriate because all rural health clinics affiliated with hospitals having 50 or more beds are paid on the same basis as rural health clinics not affiliated with any hospital, and the scope of Medicare Part B benefits and beneficiary liability for Medicare Part B deductible and coinsurance amounts would be the same, regardless of whether the rural health clinic was found to be providerbased or freestanding. In setting forth this proposal, we recognize that rural health clinics affiliated with hospitals report their VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 costs using the hospital’s cost report rather than by filing a separate rural health clinic cost report, and that whether or not a rural health clinic is hospital-affiliated will affect the selection of a fiscal intermediary for the clinic. However, we do not believe these administrative differences provide a sufficient reason to make provider-based determinations for such rural health clinics. 3. Location Requirement for Off-Campus Facilities: Application to Certain Neonatal Intensive Care Units As we stated in the preamble to May 9, 2002 proposed rule for changes in the provider-based rules (67 FR 31485), we recognize that provider-based status is not limited to on-campus facilities or organizations and that facilities or organizations located off the main provider campus may also be sufficiently integrated with the main provider to justify a provider-based designation. However, the off-campus location of the facilities or organizations may make such integration harder to achieve, and such integration should not simply be presumed to exist. Therefore, to ensure that off-campus facilities or organizations seeking provider-based status are appropriately integrated, we have adopted certain requirements regarding the location of off-campus facilities or organizations. These requirements are set forth in § 413.65(e)(3). Section 413.65(e)(3) specifies that a facility or organization not located on the main campus of the potential main provider can qualify for provider-based status only if it is located within a 35-mile radius of the campus of the hospital or CAH that is the potential main provider, or meets any one of the following requirements. • The facility or organization is owned and operated by a hospital or CAH that has a disproportionate share adjustment (as determined under § 412.106) greater than 11.75 percent or is described in § 412.106(c)(2) of the regulations which implement section 1886(e)(5)(F)(i)(II) of the Act and is— —Owned or operated by a unit of State or local government; —A public or nonprofit corporation that is formally granted governmental powers by a unit of State or local government; or —A private hospital that has a contract with a State or local government that includes the operation of clinics located off the main campus of the hospital to assure access in a welldefined service area to health care services for low-income individuals who are not entitled to benefits under Medicare (or medical assistance under PO 00000 Frm 00140 Fmt 4701 Sfmt 4702 a Medicaid State plan). (§ 413.65(e)(3)(i)) • The facility or organization demonstrates a high level of integration with the main provider by showing that it meets all of the other provider-based criteria and demonstrates that it serves the same patient population as the main provider, by submitting records showing that, during the 12-month period immediately preceding the first day of the month in which the application for provider-based status is filed with CMS, and for each subsequent 12-month period— —At least 75 percent of the patients served by the facility or organization reside in the same zip code areas as at least 75 percent of the patients served by the main provider (§ 413.65(e)(3)(ii)(A)); or —At least 75 percent of the patients served by the facility or organization who required the type of care furnished by the main provider received that care from that provider (for example, at least 75 percent of the patients of a rural health clinic seeking provider-based status received inpatient hospital services from the hospital that is the main provider (§ 413.65(e)(3)(ii)(B)). Section 413.65(e)(3)(ii)(C) of the regulations allows new facilities or organizations to qualify as providerbased entities. Under this section, if a facility or organization is unable to meet the criteria in § 413.65(e)(3)(ii)(A) or (e)(3)(ii)(B) because it was not in operation during all of the 12-month period before the start of the period for which provider-based status is sought, the facility or organization may nevertheless meet the location requirement of paragraph (e)(3) of § 413.65 if it is located in a zip code area included among those that, during all of the 12-month period before the start of the period for which provider-based status is sought, accounted for at least 75 percent of the patients served by the main provider. CMS has been advised that, in some cases, the location requirements in current regulations may inadvertently impede the delivery of intensive care services to newborn infants in areas where there is no nearby children’s hospital with a neonatal intensive care unit (NICU). According to those who expressed this concern, hospitals participating in the Medicare program as children’s hospitals establish off-site neonatal intensive care units (NICUs) which they operate and staff but which are located in space leased from other hospitals. The hospitals in which the offsite NICUs are housed typically are E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules short-term, acute care hospitals located in rural areas. According to comments that CMS has received, the nearest children’s hospital in a rural area is usually located a considerable distance from individual rural communities, which prevents infants in these rural communities from having ready access to the specialized care offered by NICUs. We have received a suggestion that this configuration (that of a hospital participating in the Medicare program as a hospital whose inpatients are predominantly individuals under 18 years of age under section 1886(d)(1)(B)(iii) of the Act, establishing an offsite NICU which it operates and staffs but which is located in space leased from another hospital) can be very helpful in making neonatal intensive care more quickly available in areas where community hospitals are located. In addition, this configuration can offer relief to families who otherwise would be required to travel long distances to obtain this care for their infants. However, offsite NICUs would not be able to qualify for provider-based status under the location criteria in our current regulations if they are located more than 35 miles from the children’s hospital that would be the main provider, are not owned and operated by a hospital meeting the requirements of § 413.65(e)(3)(i), and cannot meet either of the ‘‘75 percent tests’’ for service to the same patient population as the potential main provider that are specified in existing § 413.65(e)(3)(ii)(A) and § 413.65(e)(3)(ii)(B). We understand the concern that requiring a patient to be transported to an NICU located on the campus of a distant children’s hospital could create an unacceptable medical risk to the life of a newborn at a most critical time. To help us better understand this issue and determine what action, if any, CMS should take on it, we are soliciting specific public comment on the following question: • Is the problem as described above actually occurring and, if so, in what locations? We are particularly interested in learning which areas of which States are experiencing such a problem, and in receiving specific information, such as the rates of transfer of newborns from community hospitals to children’s hospital on-campus NICUs relative to adult or non-neonatal pediatric transfers for intensive care services, which describe the problem objectively. Such objective information will be much more useful than expressions of opinion or anecdotes. We also wish to ask those who believe such a problem is currently occurring to VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 comment on which of the following approaches would be most effective in resolving it. The proposed approaches on which we are soliciting specific comments are: I A change in the Medicare providerbased regulations to create an exception to the location requirements for NICUs located in community hospitals that are more than 35 miles from the children’s hospital that is the potential main provider. The exception might take the form of a more generous mileage allowance (such as being within 50 miles of the potential main provider) or could require other criteria to be met. However, the exception would be available only if there is no other NICU within 35 miles of the community hospital. I A change in the national Medicaid regulations to allow off-campus NICUs that meet other provider-based requirements under § 413.65 to qualify as provider-based for purposes of payment under Medicaid, even though those facilities would not qualify as provider-based under Medicare. (We note that under 42 CFR 440.10(a)(3)(iii), services are considered to be ‘‘inpatient hospital services’’ under the Medicaid program only if they are furnished in an institution that meets the requirements for participation in Medicare as a hospital. Because of the age of the patients they serve, NICUs typically have no Medicare utilization but a substantial proportion of their patients may be Medicaid patients.) I A change in individual State’s Medicaid plans that would provide enhanced financial incentives for community hospitals to establish NICUs, possibly in collaboration with children’s hospitals. I The establishment of children’s hospitals that meet the requirements for being hospitals-within-hospitals under 42 CFR 412.22(e). (We note that this option, unlike the three above, would not require any revision of Medicare or Medicaid regulations or individual State Medicaid plans). We also welcome suggestions for specific options other than those listed above. 4. Technical and Clarifying Changes to § 413.65 a. Definitions. In paragraph (a)(2) of § 413.65, we state that the term ‘‘Provider-based entity’’ means a provider of health care services, or an RHC as defined in § 405.2401(b), that is either created by, or acquired by, a main provider for the purpose of furnishing health care services of a different type from those of the main provider under the name, ownership and administrative PO 00000 Frm 00141 Fmt 4701 Sfmt 4702 23445 and financial control of the main provider, in accordance with the provisions of § 413.65. In recognition of the fact that provider-based entities, unlike departments of a provider, offer a type of services different from those of the main provider and participate separately in Medicare, we are proposing to revise this requirement by deleting the word ‘‘name’’ from this definition. This change would simplify compliance with the provider-based criteria since entities that do not now operate under the potential main provider’s name will not be obligated to change their names in order to be treated as provider-based. b. Provider-based determinations. In paragraph (b)(3)(ii) of § 413.65, we state that, in the case of a facility not located on the campus of the potential main provider, the provider seeking a determination would be required to submit an attestation stating that the facility meets the criteria in paragraphs (d) and (e) of § 413.65, and if the facility is operated as a joint venture or under a management contract, the requirements of paragraph (f) or paragraph (h) of § 413.65, as applicable. However, paragraph (f), which sets forth rules regarding provider-based status for joint ventures, states clearly that a facility or organization operated as a joint venture may qualify for providerbased status only if it is located on the main campus of the potential main provider. To avoid any misunderstanding regarding the content of attestations for off-campus facilities, we are proposing to revise paragraph (b)(3)(ii) by removing the reference to compliance with requirements in paragraph (f) for joint ventures. We also are proposing to add a sentence to paragraph (b)(3)(i), regarding attestations for on-campus facilities, to state that if the facility is operated as a joint venture, the attestation by the potential main provider regarding that facility would also have to include a statement that the provider will comply with the requirements of paragraph (f) of § 413.65. c. Additional requirements applicable to off-campus facilities or organizations—Operation under the ownership and control of the main provider. In paragraph (e)(1)(i), regarding 100 percent ownership by the main provider of the business enterprise that constitutes the facility or organization seeking provider-bases status, we are proposing to add the word ‘‘main’’ before the word ‘‘provider’’, to clarify that the main provider must own and control the facility or organization seeking provider-based status. We are also proposing, for purposes of E:\FR\FM\04MYP2.SGM 04MYP2 23446 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules clarifying the requirements in paragraph (e)(1), to add the word ‘‘main’’ before the word ‘‘provider’’ in paragraphs (e)(1)(ii) and (e)(1)(iii). d. Additional requirements applicable to off-campus facilities or organizations—Location. We are proposing several clarifying changes to this paragraph, as follows: Currently, the opening sentence of § 413.65(e)(3) states that a facility or organization for which provider-based status is sought must be located within a 35-mile radius of the campus of the hospital or CAH that is the potential main provider, except when the requirements in paragraph (e)(3)(i), (e)(3)(ii), or (e)(3)(iii) of that section are met. However, the regulation text that follows does not contain a paragraph designation as paragraph (e)(3)(iii). We are proposing to correct this error by redesignating existing paragraph (e)(3)(ii)(C) as paragraph (e)(3)(iv). We are also proposing to revise this sentence to state that the facility or organization must meet the requirements in paragraph (e)(3)(i), (e)(3)(ii), (e)(3)(iii), (e)(3)(iv) or, in the case of an RHC, paragraph (e)(3)(v) of § 413.65 and the requirements in paragraph (e)(3)(vi) of § 413.65. We are proposing to revise the opening sentence of § 413.65(e)(3) to reflect the changes in the coding of this paragraph as described above. We are also proposing to redesignate paragraph (v) of § 413.65(e)(3) as paragraph (e)(3)(vi) and correct a drafting error by adding the word ‘‘that’’ before ‘‘has fewer than 50 beds’’. This proposed addition is a grammatical change that is intended only to clarify the size of the hospital with which a rural health clinic must have a providerbased relationship in order to qualify under the special location requirement in that paragraph. e. Paragraph (g)—Obligations of hospital outpatient departments and hospital-based entities. We are proposing to revise the first sentence of paragraph (g)(7), regarding beneficiary notices of coinsurance liability, to clarify that notice must be given only if the service is one for which the beneficiary will incur a coinsurance liability for both an outpatient visit to the hospital and the physician service. This should help to make it clear that notice is not required for visits that do not result in additional coinsurance liability. In addition, we are proposing to reorganize the subsequent paragraphs of that section for clarity. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 K. Rural Community Hospital Demonstration Program (If you choose to comment on issues in this section, please include the caption ‘‘Rural Community Hospital Demonstration Program’’ 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 (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— • Is located in a rural area (as defined in section 1886(d)(2)(D) of the Act) or treated as being so located under section 1886(d)(8)(E) of the Act; • Has fewer than 51 beds (excluding beds in a distinct part psychiatric or rehabilitation unit) as reported in its most recent cost report; • Provides 24-hour emergency care services; and • 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 (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) Thirteen rural community hospitals located within these States are participating in the demonstration. Under the demonstration, 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. Payment will be the lesser amount of 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 PO 00000 Frm 00142 Fmt 4701 Sfmt 4702 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 means inpatient hospital services (defined in section 1861(b) of the Act) and includes 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 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 on a budget neutral basis, the demonstration is budget neutral in its own terms; in other words, 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. This form of budget neutrality is viable when, by changing payments or aligning incentives to improve overall efficiency, or both, a demonstration may reduce the use of some services or eliminate the need for others, resulting in reduced expenditures for the demonstration participants. These reduced expenditures offset increased payments elsewhere under the demonstration, thus ensuring that the demonstration as a whole is budget neutral or yields savings. However, the small scale of this demonstration, in conjunction with the payment methodology, makes it extremely unlikely that this demonstration could be viable under the usual form of budget neutrality. Specifically, cost-based payments to 13 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 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, we are proposing to adjust national inpatient PPS rates by an amount sufficient to account for the added costs of this demonstration. In other words, we apply budget neutrality E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules across the payment system as a whole rather than merely across the participants of this demonstration. As we discussed in the FY 2005 IPPS final rule (69 FR 49183), 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 2006, using the most recent cost report data (that is, data for FY 2003), adjusted for increased estimated cost for the 13 participating hospitals, we are proposing that the estimated adjusted amount would be $12,706,334. This adjusted amount reflects the estimated difference between cost and IPPS payment based on data from hospitals’ cost reports. We discuss the proposed payment rate adjustment that would be required to ensure the budget neutrality of the demonstration in section II.A.4. of the Addendum to this proposed rule. The data collection instrument for the demonstration has been approved by OMB under the title ‘‘Medicare Waiver Demonstration Application,’’ under OMB approval number 0938–0880, with a current expiration date of July 30, 2006. L. Definition of a Hospital in Connection With Specialty Hospitals (If you choose to comment on issues in this section, please include the caption ‘‘Specialty Hospitals’’ at the beginning of your comment.) Section 1861(e) of the Act provides a definition for a ‘‘hospital’’ for purposes of participating in the Medicare program. In order to be a Medicareparticipating hospital, an institution must, among other things, be primarily engaged in furnishing services to inpatients. This requirement is incorporated in our regulations on conditions of participation for hospitals at 42 CFR 482.1. An institution that applies for a Medicare provider agreement as a hospital but is unable to meet this requirement will have its application denied in accordance with our authority at 42 CFR 489.12. In addition, institutions that have a Medicare hospital provider agreement but are no longer primarily engaging in furnishing services to inpatients are subject to having their provider agreements terminated pursuant to 42 CFR 489.53. Although compliance with this requirement is not problematic for most hospitals, the issue of whether an institution is primarily engaged in providing care to inpatients has recently come to our attention in two arisen two contexts. First, an institution has applied to be certified as an ‘‘emergency hospital,’’ yet the institution has 29 outpatient beds for emergency patients, VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 including observation and postanesthesia care, and only 2 inpatient beds. Emergency treatment by nature does not usually involve overnight stays. Second, the issue has also arisen in the area of ‘‘specialty hospitals.’’ (For purposes of this discussion, ‘‘specialty hospitals’’ are those hospitals specifically defined as such in section 507 of Pub. L. 108–173 (MMA), that is, those hospitals that are primarily or exclusively engaged in the care and treatment of: (i) Patients with a cardiac condition; (ii) patients with an orthopedic condition; or (iii) patients receiving a surgical procedure.) ‘‘Specialty hospitals’’ are of interest partly because of section 507 of Pub. L. 108–173, which amended the hospital ownership exception to the physician self-referral prohibition statute, section 1877 of the Act. Prior to the enactment of Pub. L. 108–173, the ‘‘whole hospital’’ exception contained in section 1877(d)(3) of the Act allowed a physician to refer Medicare patients to a hospital in which the physician (or an immediate family member of the physician) had an ownership or investment interest, if the physician was authorized to perform services at the hospital and the ownership or investment interest was in the entire hospital and not a subdivision of the hospital. Section 507 of Pub. L. 108–173 added an additional criterion to the whole hospital exception, specifying that for the 18-month period beginning on December 8, 2003 and ending on June 8, 2005, physician ownership and investment interests in ‘‘specialty hospitals’’ would not qualify for the whole hospital exception. The term ‘‘specialty hospital’’ does not include any hospital determined by the Secretary to be in operation or ‘‘under development’’ as of November 18, 2003. In our advisory opinions that we issue as to whether a requesting entity is subject to the 18-month moratorium described above, we inform the requesting entity that, among other things, it must meet the definition of a hospital that is contained in section 1861(e) of the Act. It has come to our attention that some institutions entities that describe themselves as surgical or orthopedic specialty hospitals may be primarily primarily engaged in furnishing services to outpatients, and thus would might not meet the definition of a hospital as contained in section 1861(e) of the Act. Therefore, although an institution entity may satisfy the ‘‘under development’’ criteria for purposes of being excepted from the moratorium on physician-owner referrals to specialty hospitals, if we PO 00000 Frm 00143 Fmt 4701 Sfmt 4702 23447 were to determine such entity is not primarily engaged in inpatient care at the time it seeks certification to participate in the Medicare program, its application for a provider agreement as a hospital would will be denied and it would not be eligible for the whole hospital exception to the prohibition on physician self-referrals. Further, if we were to determine that a specialty hospital that is operating under an existing Medicare provider agreement but is not, or is no longer, primarily engaged in treating inpatients, the hospital is subject to having its provider agreement terminated; in this event, it could no longer take advantage of and lose the protection of the whole hospital exception. VI. PPS for Capital-Related Costs (If you choose to comment on issues in this section, please include the caption ‘‘Capital-Related Costs’’ at the beginning of your comment.) In this proposed rule, we are not proposing any changes in the policies governing the determination of the payment rates for capital-related costs for short-term acute care hospitals under the IPPS. However, for the readers’ benefit, we are providing a summary of the statutory basis for the PPS for hospital capital-related costs and the methodology used to determine capitalrelated payments to hospitals. A discussion of the proposed rates and factors for FY 2006 (determined under our established methodology) can be found in section III. of the Addendum of this proposed rule. 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 PPS established by the Secretary.’’ Under the statute, the Secretary has broad authority in establishing and implementing the PPS for hospital inpatient capital-related costs. We initially implemented the PPS for capital-related costs in the August 30, 1991 IPPS final rule (56 FR 43358), in which we established a 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). Federal fiscal year (FY) 2001 was the last year of the 10-year transition period established to phase in the PPS for hospital inpatient capital-related costs. For cost reporting periods beginning in FY 2002, capital PPS 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 E:\FR\FM\04MYP2.SGM 04MYP2 23448 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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) × (DRG Weight) × (Geographic Adjustment Factor (GAF)) × (Large Urban Add-on, if applicable) × (COLA Adjustment for hospitals located in Alaska and Hawaii) × (1 + Capital DSH Adjustment Factor + Capital IME Adjustment Factor, if applicable) Hospitals also may receive outlier payments for those cases that qualify under the thresholds 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 exceptions payment for extraordinary circumstances in § 412.348(f) can be found in the FY 2005 IPPS final rule (69 FR 49185 through 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 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 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 PPS 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).) Under the PPS 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 see the August 30, 1991 final rule (56 FR 43418).) During the 10-year transition period, a new hospital was exempt from the capital PPS 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 allowable Medicare inpatient hospital capital-related costs through its first 2 years of operation, unless the new hospital elects to receive fullyprospective payment based on 100 percent of the Federal rate. (Refer 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 PPS, 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 PPS Puerto PO 00000 Frm 00144 Fmt 4701 Sfmt 4702 Rico rate and the applicable capital PPS Federal rate. Prior to FY 1998, hospitals in Puerto Rico were paid a blended capital PPS rate that consisted of 75 percent of the applicable capital PPS Puerto Rico specific rate and 25 percent of the applicable capital PPS Federal rate. However, effective October 1, 1997 (FY 1998), in conjunction with the change to the operating PPS blend percentage for Puerto Rico hospitals required by section 4406 of Pub. L. 105–33, we revised the methodology for computing capital PPS payments to hospitals in Puerto Rico to be based on a blend of 50 percent of the Puerto Rico rate and 50 percent of the Federal rate. Similarly, effective beginning in FY 2005, in conjunction with the change in operating PPS 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 PPS payments to hospitals in Puerto Rico to be based on a blend of 25 percent of the Puerto Rico rate and 75 percent of the Federal rate for discharges occurring on or after October 1, 2004. VII. Proposed Changes for Hospitals and Hospital Units Excluded From the IPPS (If you choose to comment on issues in this section, please include the caption ‘‘Excluded Hospitals and Units’’ at the beginning of your comment.) A. Payments to Existing Hospitals and Hospital Units (§§ 413.40(c), (d), and (f)) 1. Payments to Existing Excluded Hospitals and Hospital Units Section 1886(b)(3)(H) of the Act (as amended by section 4414 of Pub. L. 105–33) established caps on the target amounts for cost reporting periods beginning on or after October 1, 1997 through September 30, 2002, for certain existing hospitals and hospital units excluded from the IPPS. Section 413.40(c)(4)(iii) of the implementing regulations states that ‘‘In the case of a psychiatric hospital or unit, rehabilitation hospital or unit, or longterm care hospital, the target amount is the lower of amounts specified in paragraph (c)(4)(iii)(A) or (c)(4)(iii)(B) of this section.’’ Accordingly, in general, for hospitals and units within these three classes of providers for the applicable 5-year period, the target amount is the lower of either: the hospital-specific target amount (§ 413.40(c)(4)(iii)(A)) or the 75th percentile cap (§ 413.40(c)(4)(iii)(B)). (We note that, in the case of LTCHs, for cost reporting periods beginning during E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules FY 2001, the hospital-specific target amount is the net allowable cost in a base period increased by the applicable update factors multiplied by 1.25.) Questions have been raised as to whether § 413.40(c)(4)(iii) (specifically paragraph (c)(4)(iii)(A)) continues to apply beyond FY 2002. In order to clarify the policy for periods after FY 2002, we note that § 413.40(c)(4)(iii) applies only to cost reporting periods beginning on or after October 1, 1997 through September 30, 2002, for psychiatric hospitals and units, rehabilitation hospitals and units, and LTCHs. We discussed this applicable time period in the May 12, 1998 Federal Register (63 FR 26344) when we discussed implementing the caps. Specifically, we clarified our regulations to indicate that the target amount for FYs 1998 through 2002 is equal to the lower of the hospital-specific target amount or the 75th percentile of target amounts for hospitals in the same class for cost reporting periods ending during FY 1996, increased by the applicable market basket percentage for the subject period. We did not intend for the provisions of § 413.40(c)(4)(iii) to apply beyond FY 2002, as we specifically included an ending date; that is, we stated that the target amount calculation provisions were for FYs 1998 through 2002. More recently, in the FY 2003 IPPS final rule (67 FR 50103), we clarified again how the target amount for FY 2003 was to be determined by stating that: ‘‘* * * for cost reporting periods beginning in FY 2003, the hospital or unit should use its previous year’s target amount, updated by the appropriate rate-of-increase percentage.’’ Thus, the time-limited provision of § 413.40(c)(4)(iii) is neither a new policy nor a change in policy. For cost reporting periods beginning on or after October 1, 2002, to the extent one of the above-mentioned excluded hospitals or units has all or a portion of its payment determined under reasonable cost principles, the target amounts for the reasonable cost-based portion of the payment are determined in accordance with section 1886(b)(3)(A)(ii) of the Act and the regulations at § 413.40(c)(4)(ii). Section 413.40(c)(4)(ii) states, ‘‘Subject to the provisions of [§ 413.40] paragraph (c)(4)(iii) of this section, for subsequent cost reporting periods, the target amount equals the hospital’s target amount for the previous cost reporting period increased by the update factor for the subject cost reporting period unless the provisions of [§ 413.40] paragraph (c)(5)(ii) of this section apply.’’ Thus, since § 413.40(c)(4)(ii) indicates that the provisions of that paragraph are subject VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 to the provisions of § 413.40(c)(4)(iii), which are applicable only for cost reporting periods beginning on or after October 1, 1997 through September 30, 2002, the target amount for FY 2003 is determined by updating the target amount for FY 2002 (the target amount from the previous period) by the applicable update factor. Accordingly, we are proposing to make a change to the language in § 413.40(c)(4)(iii) to clarify that the provisions of this paragraph relating to the caps on target amounts are for a specific period of time only, that is, cost reporting periods beginning on or after October 1, 1997, and before October 1, 2002. The inpatient operating costs of children’s hospitals and cancer hospitals that are excluded from the IPPS are subject to the rate-of-increase limits established under the authority of section 1886(b) of the Act and implemented in the regulations at § 413.40. Under these limits, an annual target amount (expressed in terms of the inpatient operating cost per discharge) is set for each hospital, based on the hospital’s own historical cost experience, trended forward by the applicable percentage increase. This target amount is applied as a ceiling on the allowable costs per discharge for the hospital’s cost reporting period. (We note that, in accordance with § 403.752(a) of the regulations, RNHCIs are also subject to the rate-of-increase limits established under § 413.40 of the regulations.) 2. Updated Caps for New Excluded Hospitals and Units Section 1886(b)(7) of the Act established the method for determining the payment amount for new rehabilitation hospitals and units, psychiatric hospitals and units, and LTCHs that first received payment as a hospital or unit excluded from the IPPS on or after October 1, 1997. However, effective for cost reporting periods beginning on or after October 1, 2002, this payment amount (or ‘‘new provider cap’’) no longer applies to any new rehabilitation hospital or unit because they now are paid 100 percent of the Federal prospective rate under the IRF PPS. In addition, LTCHs that meet the definition of a new LTCH under § 412.23(e)(4) are also paid 100 percent of the fully Federal prospective payment rate under the LTCH PPS. In contrast, those ‘‘new’’ LTCHs that meet the criteria under § 413.40(f)(2)(ii) (that is, that were not paid as an excluded hospital prior to October 1, 1997), but were paid as a LTCH before October 1, 2002, may be paid under the LTCH PPS PO 00000 Frm 00145 Fmt 4701 Sfmt 4702 23449 transition methodology with the reasonable cost portion of the payment subject to § 413.40(f)(2)(ii). Finally, LTCHs that existed prior to October 1, 1997, may also be paid under the LTCH PPS transition methodology with the reasonable cost portion of the payment subject to § 413.40(c)(4)(ii). (The last LTCHs that were subject to the payment amount limitation for ‘‘new’’ LTCHs were new LTCHs that had their first cost reporting period beginning on September 30, 2002. In that case, the payment amount limitation remained applicable for the next 2 years— September 30, 2002 through September 29, 2003, and September 30, 2003 through September 29, 2004. This is because, under existing regulations at § 413.40(f)(2)(ii), a ‘‘new hospital’’ would be subject to the same payment (target amount) in its second cost reporting period that was applicable to the LTCH in its first cost reporting period. Accordingly, for these hospitals, the updated payment amount limitation that we published in the FY 2003 IPPS final rule (67 FR 50103) applied through September 29, 2004. Consequently, there is no longer a need to publish updated payment amounts for new (§ 413.40(f)(2)(ii)) LTCHs. A discussion of how the payment limitations were calculated can be found in the August 29, 1997 final rule with comment period (62 FR 46019); the May 12, 1998 final rule (63 FR 26344); the July 31, 1998 final rule (63 FR 41000); and the July 30, 1999 final rule (64 FR 41529). A freestanding inpatient rehabilitation hospital, an inpatient rehabilitation unit of an acute care hospital, and an inpatient rehabilitation unit of a CAH are referred to as IRFs. Effective for cost reporting periods beginning on or after October 1, 2002, this payment limitation is also no longer applicable to new rehabilitation hospitals and units because they are paid 100 percent of the Federal prospective rate under the IRF PPS. Therefore, it is also no longer necessary to update the payment limitation for new rehabilitation hospitals or units. For psychiatric hospitals and units, under the IPF PPS, there is a 3-year transition period during which existing IPFs will receive a blended payment of the Federal per diem payment amount and the payment amount that IPFs would receive under the reasonable cost-based payment (TEFRA) methodology. However, new IPFs (those facilities that under present or previous ownership (or both) have their first cost reporting period as an IPF begin on or after January 1, 2005, are paid the fully Federal per diem payment amount rather than a blended payment amount. E:\FR\FM\04MYP2.SGM 04MYP2 23450 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules (See section VII.A.5. of the preamble of this proposed rule for further discussion of the IPF PPS.) Thus, the payment limitations under the TEFRA payment system are not applicable for new IPFs that meet the definition in § 412.426(c). However, ‘‘new’’ IPFs that meet the criteria under § 413.40(f)(2)(ii) (that is, that were not paid as an excluded hospital prior to October 1, 1997), but were paid as an IPF before January 1, 2005, are paid under the IPF PPS transition methodology with the reasonable cost portion of the payment determined according to § 413.40(f)(2)(ii), that is, subject to the payment amount limitation. The last ‘‘new’’ IPFs that were subject to the payment amount limitation were IPFs that had their first cost reporting period beginning on December 31, 2004. For these hospitals, the payment amount limitation that was published in the FY 2005 IPPS final rule (69 FR 49189) for cost reporting periods beginning on or after October 1, 2004, and before January 1, 2005, remains applicable for the IPF’s first two cost reporting periods. IPFs with a first cost reporting period beginning on or after January 1, 2005, are paid 100 percent of the Federal rate and are not subject to the payment amount limitation. Therefore, since the last IPFs eligible for a blended payment have a cost reporting period beginning on December 31, 2004, the payment limitation published for FY 2005 remains applicable for these IPFs, and publication of the updated payment amount limitation is no longer needed. We note that IPFs that existed prior to October 1, 1997, may also be paid under the IPF transition methodology with the reasonable cost portion of the payment subject to § 413.40(c)(4)(ii). The payment limitations for new hospitals under TEFRA do not apply to new LTCHs, IRFs, or IPFs, that is, these hospitals with their first cost reporting period beginning on or after the date that the particular class of hospitals implemented their respective PPS. Therefore, for the reasons noted above, we are proposing to discontinue publishing Tables 4G and 4H (PreReclassified Wage Index for Urban and Rural Areas, respectively) in the annual proposed and final IPPS rules. 3. Implementation of a PPS for IRFs Section 1886(j) of the Act, as added by section 4421(a) of Pub. L. 105–33, provided for the phase-in of a case-mix adjusted PPS for inpatient hospital services furnished by a rehabilitation hospital or a rehabilitation hospital unit (referred to in the statute as rehabilitation facilities) for cost reporting periods beginning on or after VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 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 rehabilitation facilities 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 rehabilitation facilities, 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 inpatient rehabilitation facilities, 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 Federal prospective payment rate determined under the IRF PPS. 4. Implementation of a PPS for LTCHs In accordance with the requirements of section 123 of Pub. L. 106–113, as modified by section 307(b) of Pub. L. 106–554, we established a per discharge, DRG-based PPS for LTCHs as described in section 1886(d)(1)(B)(iv) of the Act for cost reporting periods beginning on or after October 1, 2002, in a final rule issued on August 30, 2002 (67 FR 55954). The LTCH PPS uses information from LTCH hospital patient records to classify patients into distinct LTC-DRGs based on clinical characteristics and expected resource needs. Separate payments are calculated for each LTC-DRG with additional adjustments applied. We published in the Federal Register on May 7, 2004, a final rule (69 FR 25673) that updated the payment rates for the upcoming rate year LTCH PPS and made policy changes effective as of July 1, 2004. The 5-year transition period to the fully Federal prospective rate will end with cost reporting periods beginning on or after October 1, 2005 and before October 1, 2006. For cost reporting periods beginning on or after October 1, 2006, payment is based entirely on the adjusted Federal prospective payment rate. However, existing hospitals can elect payment under 100 percent of the adjusted PO 00000 Frm 00146 Fmt 4701 Sfmt 4702 Federal prospective payment rate. Moreover, LTCHs as defined in § 412.23(e)(4) are paid under 100 percent of the adjusted Federal prospective payment rate. 5. Implementation of a PPS for IPFs In accordance with section 124 of the BBRA and section 405(g)(2) of Pub. L. 108–173, we established a PPS for inpatient hospital services furnished in psychiatric hospitals and psychiatric units of acute care hospitals and CAHs (inpatient psychiatric facilities (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 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, and day 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 cost-of-living adjustments for IPFs located in Alaska and Hawaii. We have established a 3-year transition period during which IPFs will be paid based on a blend of reasonable cost-based payment and IPF PPS payments. For cost reporting periods beginning on or after January 1, 2008, IPFs will be paid 100 percent of the Federal per diem payment amount. B. Critical Access Hospitals (CAHs) (If you choose to comment on issues in this section, please include the caption ‘‘Critical Access Hospitals’’ at the beginning of your comment.) 1. Background Section 1820 of the Act provides for the establishment of Medicare Rural Hospital Flexibility Programs (MRHFPs), under which individual States may designate certain facilities as critical access hospitals (CAHs). Facilities that are so designated and meet the CAH conditions of participation (CoPs) under 42 CFR Part 485, Subpart F, will be certified as CAHs by CMS. Regulations governing payments to CAHs for services to Medicare beneficiaries are located in 42 CFR Part 413. E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 2. Proposed Policy Change Relating to Continued Participation by CAHs in Lugar Counties Criteria for the designation of a CAH under the MRHFP at section 1820(c)(2)(b)(i) of the Act require that a hospital be located in a rural area as defined in section 1886(d)(2)(D) of the Act or be treated as being located in a rural area in accordance with section 1886(d)(8)(E) of the Act. The regulations at § 485.610 further define ‘‘rural area’’ for purposes of being a CAH. Under § 485.610(b), a CAH must meet any one of the following three location requirements. First, a CAH must not be located in an MSA as defined by the Office of Management and Budget, not be deemed to be located in an urban area under 42 CFR 412.63(b), and not be reclassified by CMS or the MGCRB as urban for purposes of the standardized payment amount, nor be a member of a group of hospitals reclassified to an urban area under 42 CFR 412.232. Second, if a CAH does not meet the first criterion, if located in an MSA, a CAH will be treated as rural if it has reclassified under 42 CFR 412.103. Third, as we stated in the FY 2005 IPPS final rule, if the CAH cannot meet either of the first two requirements and is located in a revised labor market area (CBSA) under the standards announced by OMB on June 6, 2003 and adopted by CMS effective October 1, 2004, it has until September 30, 2006, to meet one of the other classification requirements without losing its CAH status. Under section 1886(d)(8)(B) of the Act, hospitals that are located in a rural county that is adjacent to one or more urban counties are considered to be located in the urban MSA to which the greatest number of workers in the county commute, if certain conditions, specified in section 1886(d)(8)(B) of the Act, are met. Regulations implementing this provision are set forth in 42 CFR 412.62(f)(1) (for FY 1984), 42 CFR 412.63(b)(3) (for FYs 1985 through 2004), and at 42 CFR 412.64(b)(3) (for FY 2005 and subsequent fiscal years). The provision (section 1886(d)(8)(B) of the Act) is referred to as the ‘‘Lugar provision’’ and the counties described by it are referred to as the ‘‘Lugar counties.’’ As explained more fully in the FY 2005 IPPS final rule (69 FR 48916), certain counties that previously were not considered Lugar counties were, effective October 1, 2004, redesignated as Lugar counties as a result of the most recent census data and the new labor market area definitions announced by OMB on June 6, 2003. Some CAHs located in these newly designated Lugar VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 counties are now unable to meet the rural location requirements described above, even though they were in full compliance with the location requirements in effect at the time they converted from short-term acute care hospital to CAH status. We have received comments that suggest that it would be inappropriate for a facility to be required to terminate participation as a CAH and resume participating as a short-term acute care hospital because of a change in county classification that did not result from any change in functioning by the CAH. After consideration of these comments, we are clarifying our policy with respect to facilities located in Lugar counties. As we noted in the FY 2005 IPPS final rule, we believe it is appropriate to allow facilities located in counties that began to be considered part of MSAs effective October 1, 2004, as a result of data from the 2000 census and implementation of the new labor market area definitions announced by OMB on June 6, 2003, an opportunity to obtain rural designations under applicable State law or regulations from their State legislatures or regulatory agencies. Similarly, we believe that when a CAH’s status as being located in a Lugar county occurs as a result of changes that the CAH did not originate and that were beyond its control, such as a change in the OMB standards for labor market area definitions, it is appropriate for the CAH to be allowed a reasonable opportunity to reclassify to rural status. Thus, we are clarifying our policy to note that CAHs in counties that were designated as Lugar counties effective October 1, 2004, because of implementation of the new labor market area definitions announced by OMB on June 6, 2003, are to be given the same reclassification opportunity. Of course, the opportunity to reclassify would not be available to a CAH if the CAH itself were to initiate some change, such as a redesignation as urban rather than rural under State law or regulations, which would invalidate a prior § 412.103 reclassification. As a result, we are proposing to make changes to § 485.610(b) of the regulations that would permit CAHs located in a county that, in FY 2004, was not part of a Lugar county, but as of FY 2005 was included in such a county as a result of the new labor market area definitions, to maintain their CAH status until September 30, 2006. These changes, if adopted in final form, would permit CAHs in newly designated Lugar counties to continue participating in Medicare as CAHs until September 30, 2006. We expect that this will provide these CAHs with sufficient PO 00000 Frm 00147 Fmt 4701 Sfmt 4702 23451 time to seek reclassification as rural facilities under the current regulations at § 412.103. In other words, after October 1, 2006, these facilities must meet at least one of the criteria in § 412.103(a)(1) through (a)(3) to be eligible to reclassify from urban to rural status. Once the § 412.103 reclassification is approved, the facilities would meet the CAH rural location requirements in § 485.610(b)(2). In addition, consistent with the clarification of the policy, we are proposing to amend the regulations at § 412.103(a)(4) to reflect the proposed change in the text of the CAH location regulations at § 485.610(b)(3). In addition, we are making a technical amendment to § 485.610(b)(1)(ii) by replacing the reference to 42 CFR 412.63(b) with 42 CFR 412.64(b). This proposed technical amendment would conform the regulations to reflect the rules governing geographic reclassification (found at § 412.64) that are already in place for fiscal years beginning on or after October 1, 2004 (69 FR 49242). 3. Proposed Policy Change Relating to Designation of CAHs as Necessary Providers Section 405(h) of Pub. L. 108–173 amended section 1820(c)(2)(B)(i)(II) of the Act by adding language that terminated a State’s authority to waive the location requirement for a CAH by designating the CAH as a necessary provider, effective January 1, 2006. Currently, a CAH is required to be located more than a 35-mile drive (or in the case of mountainous terrain or secondary roads, a 15-mile drive) from a hospital or another CAH, unless the CAH is certified by the State as a necessary provider of health care services to residents in the area. Under this provision, after January 1, 2006, States will no longer be able to designate a CAH based upon a determination that it is a necessary provider of health care. In addition, section 405(h) of Pub. L. 108–173 amended section 1820(h) of the Act to include a grandfathering provision for CAHs that are certified as necessary providers prior to January 1, 2006. In the FY 2005 IPPS final rule (69 FR 49220), we incorporated these amendments in our regulations at § 485.610 (c). Under that regulation, any CAH that is designated as a necessary provider in its State rural health plan prior to January 1, 2006, will be permitted to maintain its necessary provider designation. However, the regulations are limited to CAHs that were necessary providers as of January 1, 2006, and does not address the E:\FR\FM\04MYP2.SGM 04MYP2 23452 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules situation where the CAH is no longer the same facility due to relocation, cessation of business, or a substitute facility. Currently, CMS Regional Offices make the decision for continued certification following relocation of a certified facility on a case-by-case basis. The criteria used to qualify a CAH as a necessary provider were established by each State in its MRHFP. The State’s MRHFP defined those CAHs that provide necessary services to a particular patient community in the event that the facility did not meet the required 35-mile (or 15-mile with stated exceptions) distance requirement from the nearest hospital or CAH. Each State’s criteria are different, but the criteria share certain similarities and all define a necessary provider related to the facility location. Therefore, it becomes crucial to define whether the necessary provider designation remains pertinent in the event the certified CAH builds in a different location. Accordingly, the first step of this process is to determine whether building a new CAH facility in a different location is a replacement of an existing facility in essentially the same location, a relocation of the facility in a new location, or a cessation of business at one location and establishment of new business at another location. a. Determination of the Relocation Status of a CAH (1) Replacement in the same location. Under this approach, we are proposing that, if the CAH is constructing renovation of the same building in the same location, the renovation is considered to be a replacement of the same provider and not relocation. We would consider a construction of the CAH to be a replacement if construction was undertaken within 250 yards of the current building, as set by prior precedence in defining a hospital campus. In addition, if the replacement is constructed on land that is contiguous to the current CAH, and that land was owned by the CAH prior to enactment of Pub. L. 108–173, and the CAH is operating under a State-issued necessary provider waiver that is grandfathered by Pub. L. 108–173, we would consider that construction to be a replacement of the existing provider and the provisions of the grandfathered necessary provider designation would continue to apply regardless of when the construction or renovation work commenced and was completed. (2) Relocation of a CAH. Under our proposed approach, if the CAH is constructing a new facility in a location that does not qualify the construction as replacement of an existing facility in the VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 same location under the criteria in the preceding paragraph, we would need to determine if this building would be a relocation of the current provider or a cessation of business at one location and establishment of a new business at another location. In the event of relocation, the CAH must ensure that the provider is functioning as essentially the same provider in order to operate under the same provider agreement. A provider that is changing location is considered to have closed the old facility if the original community or service area can no longer be expected to be served at the new location. The distance of the moved CAH from its old location will be considered, but it will not be the sole determining factor in granting the relocation of a CAH under the same provider agreement. For example, a specialty hospital may move a considerable distance and still care for generally the same inpatient population, while the relocation of a CAH at a relatively short distance within a rural area may greatly affect the community served. In the event that CMS determines the rebuilding of the CAH in a different location to be a relocation, the provider agreement would continue to apply to the CAH at the new location. In addition to the relocation being within the same service area, serving the same population, the CAH would need to be providing essentially the same services with the same staff; that is, at least 75 percent of the same staff and 75 percent of the range of services are maintained in the new location as the same provider of services. We are proposing the use of a 75-percent threshold because we believe it indicates that the CAH that is relocating demonstrates that it will maintain a high level of involvement, as opposed to just a majority involvement, in the current community. We note that CMS has also used a 75-percent threshold in other provider designation policies such as the provider-based policies at § 413.65(e)(3)(ii). In all cases of relocation, the CAH must continue to meet all of the CoPs found at 42 CFR Part 485, Subpart F, including location in a rural area as provided for at § 485.610. (3) Cessation of business at one location. Under existing CMS policy, if the CAH relocation results in the cessation of furnishing services to the same community, we would not consider this to be a relocation, but instead would consider such a scenario a cessation of business at one location and establishment of a new business at another location. Cessation of business is a basis for voluntary termination of the provider agreement under 42 CFR PO 00000 Frm 00148 Fmt 4701 Sfmt 4702 Part 489. If the proposed move constitutes a cessation of business, the CMS Regional Office may assist the provider in obtaining an agreement to participate under a new provider number. Furthermore, in such a situation, the regulations require the provider to give advanced notice to CMS and the public regarding its intent to stop providing medical services to the community. There is no appeals process for a voluntary termination. Under our current policies, the cessation of business by a CAH automatically terminates the CAH designation, regardless of whether the designation was obtained through a necessary provider determination. b. Relocation of a CAH Using a Necessary Provider Designation To Meet the CoP for Distance Once it has been determined that constructing a new facility will cause the CAH to relocate, the second step is to determine if the CAH that has a necessary provider designation can maintain this designation after relocating. We recognize that § 485.610(c) relating to location relative to other facilities or necessary provider certification states that, after January 1, 2006, the ‘‘necessary provider’’ designation will no longer be used to waive the mileage requirements. In addition, CMS policy regarding a change of size or location of a provider states that there may be situations where the facility relocation is so far removed from the originally approved site that we would conclude that this is a different provider or supplier, for example, it has different employees, services, and patients. Furthermore, the language of section 1820(c)(2)(i) of the Act allows a State to waive the mileage requirement and designate a facility as a necessary provider of health care services to residents in the area. We have interpreted ‘‘services to residents in the area’’ to mean that the necessary provider designation does not automatically follow the provider if the facility relocates to a different location because it is no longer furnishing ‘‘services to patients’’ in the area determined to need a necessary provider. We do not intend to change this policy. Our proposal, noted below, is intended to establish a methodology to be used by all CMS Regional Offices in making such a decision consistent with the statutory provisions concerning necessary provider designation. In this proposed rule, we are proposing to amend the regulations at § 485.610 to set forth the criteria by E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules which those relocated CAHs designated as necessary providers that embarked on a replacement facility project before the sunset provision was enacted on December 8, 2003, but find that they cannot be operational in the replacement facility by January 1, 2006, can retain their necessary provider status. As required by statute, no additional CAHs will be certified as a necessary provider on or after January 1, 2006. We recognize that the statute refers to a facility designated as a CAH while relocation of a facility may result in a different building. However, to provide flexibility for a facility designated as a CAH whose location may change, but is essentially the same facility in a different location, we are proposing to amend the regulations to account for this scenario. Essentially, we recognize that the necessary provider designation may need to be applied to certain relocated CAHs. To this end, we are proposing to use the specified relocation criteria as the initial step to determine continuing necessary provider status. Specifically, in this proposed rule, we are proposing that, when a CAH is determined to have relocated, it may nonetheless continue to operate under its necessary provider designation that exempts the distance from other providers only if the following conditions are met: (1) The relocated CAH has submitted an application to the State agency for relocation prior to the January 1, 2006, sunset date. If the CAH is applying under a grandfathered status under section 1820(h)(3) of the Act, the following items would need to be included in the application: • A demonstration that the CAH will meet the same State criteria for the necessary provider designation that were established when the waiver was originally issued. For example, if the location waiver was granted because the CAH was located in a health professional shortage area (HPSA), the CAH must remain in that HPSA. • Assurance that, after the relocation, the CAH will be servicing the same community and will be operating essentially the same services with essentially the same staff (that is, a demonstration that it is serving at least 75 percent of the same service area, with 75 percent of the same services offered, and staffed by 75 percent of the same staff, including medical staff, contracted staff, and employees). This is essentially the same criteria used in determining whether the CAH has relocated. • Assurance that the CAH will remain in compliance with all of the CoPs at 42 CFR Part 485 in the new location. Compliance will be established with a VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 full survey in the new location to include the Life Safety Code and would include any off-site locations and rehabilitation or psychiatric distinct part units. • A demonstration that construction plans were ‘‘under development’’ prior to the effective date of Pub. L. 108–173 (December 8, 2003) in the application the CAH submits to continue using a necessary provider designation. Supporting documentation could include the drafting of architectural specifications, the letting of bids for construction, the purchase of land and building supplies, documented efforts to secure financing for construction, expenditure of funds for construction, and compliance with state requirements for construction such as zoning requirements, application for a certificate of need, and architectural review. However, we recognize that it may not have been feasible for a CAH to have completed all of these activities noted above as examples prior to December 8, 2003. Thus, we expect the CMS Regional Offices to consider all of the criteria and make case-by-case determinations of whether a relocated CAH continues to warrant necessary provider status. We note that we have also used the above documentation guidelines in Publication 100–20 for grandfathered specialty hospitals to determine if construction plans were ‘‘under development.’’ In proposing these criteria, our intent in clarifying the sunset of the necessary provider designation provision is to allow CAHs to complete construction projects that were initiated prior to the enactment of Pub. L. 108–173, which we believe is consistent with the statutory language of section 405(h) of Pub. L. 108–173. (2) In the application, the CAH demonstrates that the replacement will facilitate the access to care and improve the delivery of services to Medicare beneficiaries. We are soliciting comments on how a necessary provider CAH should demonstrate that the replacement will improve access to care. These guidelines are meant to be applied to the relocated CAH that meets the CoP in the new location and wishes to maintain a necessary provider designation in order to meet the distance requirement at § 485.610(c). They are not meant to preclude a CAH from relocating at any time if the CAH does not seek to maintain the necessary provider designation. Any CAH may relocate at any time if the CAH meets the definition of relocation and can meet all the CoPs at 42 CFR part 485, subpart F, as determined by the CMS Regional Offices on a case-by-case basis. PO 00000 Frm 00149 Fmt 4701 Sfmt 4702 23453 Accordingly, we are proposing to revise § 485.610 of the regulations by adding a new paragraph (d) to incorporate this proposal. Specifically, the proposed new paragraph (d) would specify that a CAH may maintain its necessary provider certification provided for under § 485.610(c) if the new facility meets the requirements for either a replacement facility that is constructed within 250 yards of the current building or contiguous to the current CAH on land owned by the CAH prior to December 8, 2003; or as a relocated CAH if, at the relocated site, the CAH provides essentially (75 percent) the same services to the same service area with essentially the same staff. The CAH that plans to relocate must provide documentation demonstrating that its plans to rebuild in the relocated area were undertaken prior to December 8, 2003. We are also proposing that if a CAH that has a necessary provider certification from the State places a new facility in service on or after January 1, 2006, and does not meet either the requirements for a replacement facility or a relocated facility, as specified in the regulations, the action will be considered a cessation of business. VIII. Payment for Blood Clotting Factor Administered to Hemophilia Inpatients (If you choose to comment on issues in this section, please include the caption ‘‘Blood Clotting Factor’’ at the beginning of your comment.) Section 1886(a)(4) of the Act excludes the costs of administering blood clotting factors to individuals with hemophilia from the definition of ‘‘operating costs of inpatient hospital services.’’ Section 6011(b) of Pub. L. 101–239 (the Omnibus Budget Reconciliation Act of 1989) states that the Secretary of Health and Human Services shall determine the payment amount made to hospitals under Part A of Title XVIII of the Act for the costs of administering blood clotting factors to individuals with hemophilia by multiplying a predetermined price per unit of blood clotting factor by the number of units provided to the individual. The regulations governing payment for blood clotting factor furnished to hospital inpatients are located in §§ 412.2(f)(8) and 412.115(b). Consistent with the rates paid under section 1842(o) of the Act for Medicare Part B drugs (including blood clotting factor furnished to individuals who are not inpatients), in FY 2005, we made payments for blood clotting factors furnished to inpatients at 95 percent of average wholesale price (AWP). Section 303 of Pub. L. 108–173 established E:\FR\FM\04MYP2.SGM 04MYP2 23454 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules section 1847A of the Act which requires that almost all Medicare Part B drugs not paid on a cost or prospective basis be paid at 106 percent of average sales price (ASP) and provided for payment of a furnishing fee for blood clotting factor, effective January 1, 2005. On November 15, 2004, we issued regulations in the Federal Register (69 FR 66299) that implemented the provisions of section 1847A for payment for Medicare Part B drugs using the 106 percent of ASP payment methodology and for payment of the furnishing fee. These regulations are codified at 42 CFR 410.63 and subpart K of Part 414. To ensure consistency in payment for Medicare Part A and Medicare Part B drugs, we are proposing to revise §§ 412.2(f)(8) and 412.115(b) of the regulations governing the IPPS to specify that, for discharges occurring on or after October 1, 2005, the additional payment for the blood clotting factor administered to hemophilia inpatients is made based on the average sales price methodology specified in subpart K of 42 CFR part 414 and the furnishing fee specified in § 410.63. The proposed payment amount per unit and the unit payment for the furnishing fee for blood clotting factor administered to hospital inpatients who have hemophilia that we are proposing to apply under the IPPS for FY 2006 are specified in section V. of the Addendum to this proposed rule. for hospitals and distinct-part hospital units excluded from the IPPS is discussed in Appendix B to this proposed rule. Recommendation 4A: The Congress should establish a quality incentive payment policy for hospitals in Medicare. Response: We are exploring provider payment policies that link quality to Medicare reimbursement in a cost neutral manner under our demonstration authority. We currently have demonstrations underway that will identify and examine the components of such a policy. B. Physician-Owned Specialty Hospitals Recommendation 1: The Secretary should improve payment accuracy in the hospital inpatient PPS by: • Refining the current DRGs 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. • Basing the weights on the national average of hospitals’ relative values in each DRG. In making this recommendation, MedPAC recognized several implementation issues regarding potential low volume DRGs and potential changes in hospital coding and reporting behavior. In particular, MedPAC recommended that the IX. MedPAC Recommendations Secretary project the likely effect of reporting improvements on total (If you choose to comment on issues payments and make an offsetting in this section, please include the caption ‘‘MedPAC Recommendations’’ at adjustment to the standardized amounts. the beginning of your comment.) Response: We expect to make changes We are required by section to the DRGs to better reflect severity of 1886(e)(4)(B) of the Act to respond to illness. The following discussion briefly MedPAC’s IPPS recommendations in describes some of the options we are our annual proposed IPPS rule. In considering. As we discussed in section March 2005, MedPAC released the II.B. of this preamble, there is a standard following two reports to Congress, which included IPPS recommendations: list of diagnoses that are considered complications or comorbidities (CC). ‘‘Report to Congress: Medicare Payment These conditions, when present as a Policy’’ and ‘‘Report to Congress: secondary diagnosis, may result in Physician-Owned Specialty Hospitals.’’ payment using a higher weighted DRG. We have reviewed each of these reports Currently, 3,285 diagnosis codes on this and have given them careful list, and 121-paired DRGs are consideration in conjunction with the differentiated based on the presence or policies set forth in this document. absence of a CC. Our analysis indicates These recommendations and our that the majority of cases assigned to responses are set forth below. For further information relating specifically these DRGs fall into the ‘‘with CC’’ DRGs. We believe that it is possible that to the MedPAC reports or to obtain a the CC distinction has lost much of its copy of the reports, contact MedPAC at (202) 653–7220, or visit MedPAC’s Web ability to differentiate the resource needs of patients, given the long period site at: https://www.medpac.gov. of time since the original CC list was A. Medicare Payment Policy developed and the incremental nature of subsequent changes in an environment MedPAC’s Recommendation 2A–1 of major changes in the way inpatient concerning the update factor for care is delivered. inpatient hospital operating costs and VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00150 Fmt 4701 Sfmt 4702 We are planning a comprehensive and systematic review of the CC list for the IPPS rule for FY 2007. As part of this process, we will consider revising the standard for determining when a condition is a CC. For instance, we expect to use an alternative to the current method of classifying a condition as a CC based on how it affects the length of stay of a case. Similar to other aspects of the DRG system, we expect to consider the effect of a specific secondary diagnosis on the charges or costs of a case to evaluate whether to include the condition on the CC list. Another option we are considering is a selective review of the specific DRGs, such as cardiac, orthopedic, and surgical DRGs, that are alleged to be overpaid and that create incentives for physicians to form specialty hospitals. We expect to selectively review particular DRGs based on statistical criteria such as the range or standard deviation among charges for cases included within the DRG. It is possible specific DRGs have high variation in resource costs and that a better recognition of severity would reduce incentives for hospitals to select the least costly and most profitable patients within these DRGs. Any analysis we perform would balance the goal of making payment based on an accurate coding system that recognizes severity of illness with the premise that the IPPS is a system of payment based on averages. We agree with MedPAC that, in refining the DRGs, we must continue to be mindful of issues such as the instability of small volume DRGs and the potential impact of changes in hospital coding and reporting behavior. As MedPAC noted, previous refinements to DRG definitions have led to unanticipated increases in payment because of more complete reporting of patients’ diagnoses and procedures. As part of our analysis of possible refinements to the DRGs, we have concerns with our ability to account for the effect of changes in coding behavior on payment. We are also considering the use of alternative DRG systems such as the all patient refined diagnosis related groups (APR–DRGs) in place of Medicare’s current DRG system. The APR–DRGs have a greater number of DRGs that could relate payment rates more closely to patient resource needs, and thus reduce the advantages of selection of desirable patients within DRGs by specialty hospitals. However, any large change to the DRGs could have substantial effects across all hospitals. Therefore, we believe we must thoroughly analyze such options and E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules their impacts on the various types of hospitals before making any proposal. In addition, as noted above, we are concerned about our ability to account for the effect of changes in coding behavior on payment if we were to significantly expand the number of DRGs. Therefore, in light of the above, we must consider how to mitigate the risk of paying significantly more for the alternatives discussed above while measuring the benefit for Medicare beneficiaries. In response to MedPAC’s recommendation that we improve payment accuracy by basing the DRG relative weights on the estimated cost of providing care rather than on charges, we note that we do not have access to any information that would provide a direct measure of the costs of individual discharges. Claims filed by hospitals do provide information on the charges for individual cases. At present, we use this information to set the relative weights for the DRGs. We obtain information on costs from the hospital cost reports, but this information is at best at the department level; it does not include information about the costs of individual cases. Consequently, the most straightforward way to estimate costs of an individual case is to calculate a cost-to-charge ratio for some body of claims (for example, for a hospital’s radiology department), and then apply this ratio to the charges for that department. However, this procedure is not without disadvantages because assignment of costs to departments is not uniform from hospital to hospital, given the variability of hospital accounting systems, and because cost information is not available until a year or more after claims information. In addition, the application of a cost-tocharge ratio that is uniform across any body of claims may result in biased estimates of individual costs if hospital charging behavior is not uniform. Thus, it is alleged that hospitals mark up lower cost services less than higher cost services, and to the extent they do so, application of a uniform cost-to-charge ratio will result in underestimates of the costs of higher cost services and vice versa. We use estimated costs, based on hospital-specific, department-level costto-charge ratios, in the hospital outpatient prospective payment system. The accuracy of this procedure has generated some concern, and without further analysis, the extent to which accuracy of inpatient payments would be improved by adopting this method is not obvious. We will closely analyze the impact of such a change from the current charge- VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 based DRG weights to cost-based DRG weights. We note that such a change is complex and would require further analysis. With this in mind, CMS will consider the following issues in performing this analysis: • The effect of using cost-to-charge ratio data, which is frequently older than the claims data we use to set the charge-based weights, and the impact on these data of any changes in hospitals’ charging behavior that resulted from the recent modifications to the outlier payment methodology (68 FR 34494; June 9, 2003); • Whether using this method has different effects on DRGs that have experienced substantial technological change compared to DRGs with more stable procedures for care; • The effect of using a routine cost-tocharge ratio and department-level ancillary cost-to-charge data as compared to either an overall hospital cost-to-charge ratio or a routine cost-tocharge ratio and an overall ancillary cost-to-charge ratio, particularly in considering earlier studies performed for the Prospective Payment Assessment Commission, the predecessor to MedPAC, indicating that an overall ancillary cost-to-charge ratio led to more accurate estimates of case level costs; 5 • Whether developing relative weights by estimating costs from charges multiplied by cost-to-charge ratios versus whether the sole use of charges improves payment accuracy; and • How payments to hospitals would be affected by MedPAC’s suggestion intended to simplify recalibration, to recalibrate weights based on costs every few years, and to calculate an adjustment to charge-based weights for the intervening periods. In response to the recommendation that the Secretary should improve payment accuracy in the IPPS by basing the weights on the national average of hospitals’ relative values in each DRG, we note that presently we set the relative weights using standardized charges (adjusted to remove the effects of differences in area wage costs and in IME and DSH payments). In contrast, MedPAC proposes that Medicare set the DRG relative weights using unstandardized, hospital-specific charges. Each hospital’s unstandardized 5 Cost Accounting for Health Care Organizations, Technical Report Series, 1–93–01, ProPAC, March 1993, page 6. Using a cost report package, the contractor simulated single and multiple ancillary cost-to-charge ratios and found that inpatient ancillary costs were 2.5 percent understated relative to what hospitals thought their costs were with the single cost-to-charge ratio, and 4.9 percent understated with the multiple cost-to-charge ratios. PO 00000 Frm 00151 Fmt 4701 Sfmt 4702 23455 charges would become the basis for determining the relative weights for the DRGs for that hospital. These relative weights would be adjusted by the hospital’s case-mix index when combining each hospital’s relative weights to determine a national relative weight for all hospitals. This adjustment is designed to reduce the influence that a single hospital’s charge structure could have on determining the relative weight when it provides a high proportion of the total, nationwide number of discharges in a particular DRG. We will analyze the possibility of moving to hospital specific relative values while conducting the analysis outlined above in response to the recommendations regarding improved severity adjustment and using charges adjusted to estimated cost using cost-tocharge ratios to set the relative weights. We note that we use this method at present to set weights for the LTCH PPS. We use this method for LTCHs because of the small volume of providers and the possibility that only a few providers provide care for certain DRGs. The charges of one or a few hospitals could thus materially affect the relative weights for these DRGs. In this event, looking at relative values within hospitals first can smooth out the hospital-specific effects on DRG weights. A 1993 Rand Report on hospital specific relative values noted the possibility of DRG compression (or the undervaluing of high-cost cases and the overvaluing of low-cost cases) if we were to shift to a hospital-specific relative value method from the current method for determining DRG weights. We will need to consider whether the resultant level of compression is appropriate. Recommendation 2: The Congress should amend the law to give the Secretary authority to adjust the DRG relative weights to account for differences in the prevalence of highcost outlier cases. Response: While MedPAC’s language suggests that the law would need to be amended for us to adopt this suggestion, we believe the statute may give the Secretary broad discretion to consider all factors that change the relative use of hospital resources in calculating the DRG relative weights. We believe that MedPAC’s recommendation springs from a concern that including highcharge outlier cases in the relativeweight calculation results in overvaluing DRGs that have a high prevalence of outlier cases. However, we believe that excluding outlier cases completely in calculating the relative weights would be inappropriate. Doing E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules so would undervalue the relative weight for a DRG with a high percentage of outliers by not including that portion of hospital charges that is above the median but below the outlier threshold. We believe it would be preferable to adjust the charges used for calculating the relative weights to exclude the portion of charges above the outlier threshold but to include the charges up to the outlier threshold. At this time, we expect to further analyze these ideas as we consider the other changes recommended by MedPAC and welcome public comments on this issue. Finally, we believe that the recommendations made by MedPAC, or some variants of them, have significant promise in improving the accuracy of rates in the inpatient payment prospective payment system. We agree with MedPAC that they should be pursued even in the absence of concerns about the proliferation of specialty hospitals. However, until we have completed further analysis of these options and their effects, we cannot predict the extent to which they will provide payment equity between specialty and general hospitals. In fact, we must caution that any system that groups cases and provides a standard payment for cases in the group (that is, the IPPS among other Medicare payment systems) will always present some opportunities for providers to specialize in cases where they believe margins may be better. Improving payment accuracy should reduce these opportunities, and it may do so to the extent that Medicare payments no VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 longer provide a significant impetus to further development of specialty hospitals. Recommendation 3: The Congress and the Secretary should implement the case-mix measurement and outlier policies over a transitional period. Response: Before proposing any changes to the DRGs, we would need to model the impact of any specific proposal and our authority under the statute to determine whether any changes should be implemented immediately or over a period of time. We do note that with regard to revising the existing DRG system with a new DRG system that fully captures differences in severity, there would likely be unique complexities in creating a transition from one DRG system to another. Our payment would be a blend of two different relative weights that would have to be determined using two different systems of DRGs. The systems and legal implications of such a transition or any other major change to the DRGs could be significant. C. Other MedPAC Recommendations MedPAC also made the following recommendations that we will address in our Report to Congress on Specialty Hospitals: Recommendation 4: The Congress should extend the current [Pub. L. 108– 173] moratorium on physician-owned single specialty hospitals until January 1, 2007. Recommendation 5: The Congress should grant the Secretary the authority to allow gainsharing arrangements PO 00000 Frm 00152 Fmt 4701 Sfmt 4725 between physicians and hospitals and to regulate those arrangements to protect the quality of care and minimize financial incentives that could affect physician referrals. X. 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 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. 1. CMS Wage Data This file contains the hospital hours and salaries for FY 2002 used to create the FY 2006 prospective payment system wage index. The file will be available by the beginning of February for the NPRM and the beginning of May for the final rule. E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.060</GPH> 23456 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 2. CMS Hospital Wages Indices (Formerly: Urban and Rural Wage Index Values Only) This file contains a history of all wage indices since October 1, 1983. Media: Diskette/most recent year on the Internet. File Cost: $165.00 per year. Periods Available: FY 2006 PPS Update. 3. FY 2006 Proposed Rule Occupational Mix Adjusted and Unadjusted AHW by Provider This file includes each hospital’s adjusted and unadjusted average hourly wage. Media: Internet. Periods Available: FY 2006 PPS Update. (Note: The PPS–XIII, PPS–XIV, PPS–XV, PPS–XVI, PPS–XVII, PPS–XVIII, and PPS– XIX Minimum Data Sets are part of the PPS– XIII, PPS–XIV, PPS–XV, PPS–XVI, PPS–XVII, PPS–XVIII, PPS–XIX, and PPS–XX Hospital Data Set Files (refer to item 7 below).) VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 4. FY 2006 Proposed Rule Occupational Mix Adjusted and Unadjusted AHW and Pre-Reclassified Wage Index by CBSA This file includes each CBSA’s adjusted and unadjusted average hourly wage. Media: Internet. Periods Available: FY 2006 PPS Update. 7. Reclassified Hospitals New Wage Index (Formerly: Reclassified Hospitals by Provider Only) This file contains a list of hospitals that were reclassified for the purpose of assigning a new wage index. Two versions of these files are created each year. They support the following: • NPRM published in the Federal Register. • Final Rule published in the Federal Register. Media: Diskette/Internet. File Cost: $165.00 per year. Periods Available: FY 2006 PPS Update. 5. Provider Occupational Mix Adjustment Factors for Each Occupational Category This file contains each hospital’s occupational mix adjustment factors by occupational category. Media: Internet. Periods Available: FY 2006 PPS Update. 8. PPS–IV to PPS–XII Minimum Data Set 6. PPS SSA/FIPS MSA 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, and a historical list of Metropolitan Statistical Areas (MSAs). Media: Diskette/Internet. File Cost: $165.00 per year. Periods Available: FY 2006 PPS 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: Tape/Cartridge. File Cost: $770.00 per year. 9. PPS–IX to PPS–XII Capital Data Set The Capital Data Set contains selected data for capital-related costs, interest expense and related information and complete balance sheet data from the Medicare hospital cost report. The data set includes only the most current cost report (as submitted, final settled or reopened) submitted for Medicare certified 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: Tape/Cartridge. Fine Cost: $770.00 per year. PO 00000 Frm 00153 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.061</GPH> These files support the following: • NPRM published in the Federal Register. • Final Rule published in the Federal Register. Media: Diskette/most recent year on the Internet. File Cost: $165.00 per year. Periods Available: FY 2006 PPS Update. 23457 23458 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules (Note: The PPS–XIII, PPS–XIV, PPS–XV, PPS–XVI, PPS–XVII, PPS–XVIII, and PPS– XIX Capital Data Sets are part of the PPS– XIII, PPS–XIV, PPS–XV, PPS–XVI, PPS–XVII, PPS–XVIII, PPS–XIX, and PPS–XX Hospital Data Set Files (refer to item 7 below).) 10. PPS–XIII to PPS–XX Capital Data Set The file contains costs, statistical, financial, and other data from the Medicare Hospital Cost Report. The data set includes only the most current cost report (as submitted, final settled or reopened) submitted for Medicare- certified 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: Diskette/Internet. Fine Cost: $2,500.00. 11. Provider-Specific File • NPRM published in the Federal Register. • Final rule published in the Federal Register. Media: Diskette/most recent year on Internet. Price: $165.00 per year/per file. Periods Available: FY 1985 through FY 2006. 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. This file is available for release 1 month after the proposed and final rules are published in the Federal Register. Media: Diskette/Internet. File Cost: $165.00. Periods Available: FY 2006 PPS Update. 12. CMS Medicare Case-Mix Index File This file contains the Medicare casemix index by provider number as published in 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: VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 13. DRG Relative Weights (Formerly Table 5 DRG) This file contains a listing of DRGs, DRG narrative description, relative weights, and geometric and arithmetic mean lengths of stay as published in the Federal Register. The hard copy image has been copied to diskette. There are two versions of this file as published in the Federal Register: • NPRM. • Final rule. Media: Diskette/Internet. File Cost: $165.00. Periods Available: FY 2006 PPS Update. 14. 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 PO 00000 Frm 00154 Fmt 4701 Sfmt 4702 15. 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 refers to statistical outliers, not payment outliers.) Two versions of this file are created each year. They support the following: • NPRM published in the Federal Register. • Final rule published in the Federal Register. Media: Diskette/Internet. File Cost: $165.00. Periods Available: FY 2006 PPS Update. E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.062</GPH> EP04MY05.063</GPH> 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: Diskette/Internet. File Cost: $265.00. Periods Available: FY 2006 PPS Update. Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 16. 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: • NPRM published in the Federal Register. • Final rule published in the Federal Register. Media: Internet. File Cost: No charge. Periods Available: FY 2006 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 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 evaluate fairly whether an information collection should be approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 requires that we solicit comment on the following issues: • The need for the information collection and its usefulness in carrying out the proper functions of our agency. • The accuracy of our estimate of the information collection burden. • The quality, utility, and clarity of the information to be collected. • Recommendations to minimize the information collection burden on the affected public, including automated collection techniques. Therefore, we are soliciting public comments on each of these issues for the information collection requirements discussed below. The following information collection requirements included in this proposed rule and their associated burdens are subject to the PRA. Section 412.64 Federal Rates for Inpatient Operating Costs for Federal Fiscal Year 2005 and Subsequent Fiscal Years Section 412.64(d)(2) requires hospitals to submit quality data on a VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 quarterly basis to CMS, as specified by CMS. In this document, we are setting out the specific requirements related to the data that must be submitted. The burden associated with this section is the time and effort associated with collecting, copying and submitting this data. We estimate that there will be approximately 4,000 respondents per year. Of this number, approximately 3,600 hospitals are JCAHO accredited and are currently collecting measures and submitting data to the JCAHO on a quarterly basis. Of the JCAHO accredited hospitals, approximately 3,300 are collecting the same measures CMS will be collecting for public reporting. Therefore, there will be no additional burden for these hospitals. Only approximately 300 of the JCAHO accredited hospitals will need to collect an additional topic in addition to the data already collected for maintaining JCAHO accreditation. In addition, there are approximately 400 hospitals that do not participate in the JCAHO accreditation process. These hospitals will have the additional burden of collecting data on all three topics. For JCAHO accredited hospitals that are not already collecting all of the required measures, we estimate it will take 25 hours per month per topic for collection. We expect the burden for all of these hospitals to total 102,000 hours per year, including time allotted for overhead. For non-JCAHO accredited hospitals, we estimate the burden to be 136,000 hours per year. This estimate also includes overhead. The total number of burden hours for all hospitals combined is 238,000. The number of responders will vary according to the level of voluntary participation. One hundred percent of the data may be collected electronically. In the preamble to this proposed rule, we are proposing additional validation criteria to ensure that the quality data being sent to CMS are accurate. Our validation process requires participating hospitals to submit five charts per quarter. The burden associated with this requirement is the time and effort associated with collecting, copying, and submitting these charts. It will take approximately 2 hours per hospital to submit the 5 charts per quarter. There will be a total of approximately 19,000 charts (3,800 hospitals × charts per hospital) submitted by the hospitals to CMS per quarter for a total burden of 7,600 hours per quarter and a total annual burden of 30,400 hours. PO 00000 Frm 00155 Fmt 4701 Sfmt 4702 23459 Section 413.65 Requirements for a Determination That a Facility or an Organization Has Provider-Based Status Proposed § 413.65(b)(3)(i) requires potential main providers seeking a determination of provider-based status for a facility that is located on the campus of the potential main provider to submit an attestation stating that the facility meets the criteria in paragraph (d) of § 413.65 and, if it is a hospital, to also attest that it will fulfill the obligations of hospital outpatient departments and hospital-based entities described in paragraph (g) of § 413.65. We are also proposing to amend this paragraph to require that in the case of a facility that is operated as a joint venture, the potential main provider attest that it will comply with the requirements of paragraph (f) of § 413.65. Proposed § 413.65(b)(3)(ii) provides that, if a facility is not located on the campus of the potential main provider, the potential main provider must submit an attestation stating that the facility meets the criteria in paragraph (d) and (e) of § 413.65 and, if it is a hospital, to also attest that it will fulfill the obligations of hospital outpatient departments and hospital-based entities described in paragraph (g) of § 413.65. If the facility is operated under a management contract, the potential main provider also attest that the facility meets the requirements of paragraph (h) of § 413.65. Proposed § 413.65(e)(3) requires that a facility or organization for which provider-based status is sought that is not located on the campus of a potential main provider must (i) be located within a 35-mile radius of the campus of the hospital or CAH that is the potential main provider, or (ii) be owned and operated by a hospital or CAH that has a disproportionate share adjustment (as determined under § 412.106 of this chapter) greater than 11.75 percent and is described in § 412.106(c)(2) of this chapter implementing section 1886(e)(5)(F)(i)(II) of the Act and is (A) owned or operated by a unit of State or local government, (B) a public or nonprofit corporation formally granted governmental powers by a unit of State or local government; or (C) a private hospital having a contract with a State or local government that includes the operation of clinics located off the main campus of the hospital to assure access in a well-defined service area to health care services for low-income individuals who are not entitled to benefits under Medicare (or medical assistance under a Medicaid State plan), or (iii) demonstrate a high level of integration E:\FR\FM\04MYP2.SGM 04MYP2 23460 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules with the main provider by showing that it meets all of the other provider-based criteria and demonstrate that it serves the same patient population as the main provider, by submitting certain records showing the information contained in paragraphs (e)(3)(iii)(A) and (e)(3)(iii)(B) of this section or (iv) if the facility or organization is unable to meet the criteria in paragraph (e)(3)(iii)(A) or paragraph (e)(3)(iii)(B) because it was not in operation during all of the 12month period described in paragraph (e)(3)(iii), be located in a zip code area included among those that, during all of the 12-month period described in paragraph (e)(3)(iii), accounted for at least 75 percent of the patients served by the main provider, or (v) in the case of an RHC, (A) be an RHC that is otherwise qualified as a provider-based entity of a hospital that has fewer than 50 beds, and (B) the hospital with which the facility or organization has a provider-based relationship be located in a rural area, and (vi) be located in the same State as the main provider or, when consistent with the laws of both States, in adjacent States. Section 413.65(g)(7) provides that when a Medicare beneficiary is treated in a hospital outpatient department that is not located on the main provider’s campus, the treatment is not required to be provided by the antidumping rules of section 489.24, and the beneficiary will incur a coinsurance liability for an outpatient visit to the hospital, as well as for the physician service the hospital must provide written notice to the beneficiary, before delivery of services of the amount of the beneficiary’s potential financial liability. If the exact type and extent of care is not known, the hospital must provide written notice to the beneficiary that explains that the beneficiary will incur a coinsurance liability to the hospital that he or she would not incur if the facility were not provider-based, an estimate based on typical or average charges for visits to the facility, and a statement that the patient’s actual liability will depend upon the actual services furnished by the hospital. While the information collection requirements contained in this section are subject to the PRA, the burden associated with this requirement is currently approved under OMB approval no. 0938–0798. Section 485.610 Condition of Participation: Status and Location In order to be considered a relocation, we are proposing under § 485.610(d)(2)(ii) to require a CAH to provide documentation demonstrating that its plans to rebuild in a relocated VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 area were undertaken prior to December 8, 2003. This requirement does impose an information collection requirement. However, because this burden would be imposed on less than 10 CAHs, under 5 CFR 1320.2(c), these requirements are exempt from the PRA. We have submitted a copy of this proposed rule to OMB for its review of the information collection requirements described above. If you have any comments on the information collection and recordkeeping requirements, please mail the copies directly to the following: Centers for Medicare & Medicaid Services, Office of Strategic Operations and Regulatory Affairs, Security and Standards Group, Regulations Development and Issuances Group, Room C4–24–02, 7500 Security Boulevard, Baltimore, MD 21244–1850, Attn.: James Wickliffe, CMS–1500–P. Office of Information and Regulatory Affairs, Office of Management and Budget, Room 3001, New Executive Office Building, Washington, DC 20503, Attn: Christopher Martin, CMS Desk Officer. Comments submitted to OMB may also be e-mailed to the following address: Christopher_Martin@omb.eop.gov; or faxed to OMB at (202) 395–6974 or (202) 395–5167. Attn.: CMS–1500–P. C. Public Comments Because of the large number of items of correspondence we normally receive on a proposed rule, we are not able to acknowledge or respond to them individually. However, in preparing the final rule, we will consider all comments concerning the provisions of this proposed rule that we receive by the date and time specified in the DATES section of this preamble and respond to those comments in the preamble to that rule. We emphasize that section 1886(e)(5) of the Act requires the final rule for FY 2006 to be published by August 1, 2005, and we will consider only those comments that deal specifically with the matters discussed in this proposed rule. List of Subjects 42 CFR Part 405 Administrative practice and procedure, Health facilities, Health professions, Kidney diseases, Medicare, Reporting and recordkeeping requirements, Rural area, X-rays. 42 CFR Part 412 Administrative practice and procedure, Health facilities, Medicare, PO 00000 Frm 00156 Fmt 4701 Sfmt 4702 Puerto Rico, Reporting and recordkeeping requirements. 42 CFR Part 413 Health facilities, Kidney diseases, Medicare, Puerto Rico, Reporting and recordkeeping requirements. 42 CFR Part 415 Health facilities, Health professions, Medicare, and reporting and recordkeeping requirements. 42 CFR Part 419 Hospitals, Medicare, Reporting and recordkeeping requirements. 42 CFR Part 422 Health maintenance organizations (HMO), Medicare+Choice, Provider sponsored organizations (PSO). 42 CFR Part 485 Grant programs-health, Health facilities, Medicaid, 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 405—FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED A. Part 405 is amended as follows: 1. The authority citation for Part 405 continues to read as follows: Authority: Secs. 1102, 1861, 1862(a), 1871, 1874, 1881, and 1886(k) of the Social Security Act (42 U.S.C. 1302, 1395x, 1395y(a), 1395hh, 1395kk, 1395rr, and 1395ww(k)), and sec. 353 of the Public Health Service Act (42 U.S.C. 263a). § 405.2468 [Amended] 2. In § 405.2468(f)(1), the reference ‘‘§ 413.86(b)’’ is removed and the reference ‘‘§ 413.75(b)’’ is added in its place. PART 412—PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES B. Part 412 is amended as follows: 1. The authority citation for Part 412 continues to read as follows: Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). § 412.1 [Amended] 2. In § 412.1(a)(1), the reference ‘‘§ 413.86’’ is removed and the reference ‘‘§§ 413.75 through 413.83’’ is added in its place. § 412.2 [Amended] 3. In § 412.2— E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules a. In paragraph (f)(7), remove the reference ‘‘§ 413.86’’ and add in its place the reference ‘‘§§ 413.75 through 413.83’’. b. At the end of paragraph (f)(8), add the following sentence: ‘‘For discharges occurring on or after October 1, 2005, the additional payment is made based on the average sales price methodology specified in Subpart K, Part 414 of this subchapter and the furnishing fee specified in § 410.63 of this subchapter.’’ 4. Section 412.64 is amended by revising paragraph (k)(2) to read as follows: § 412.64 Federal rates for inpatient operating costs for Federal fiscal year 2005 and subsequent fiscal years. * * * * * (k) Midyear corrections to the wage index. * * * * * (2)(i) Except as provided in paragraph (k)(2)(ii) of this section, a midyear correction to the wage index is effective prospectively from the date the change is made to the wage index. (ii) Effective October 1, 2005, a change to the wage index may be made retroactively to the beginning of the Federal fiscal year, if, for the fiscal year in question, CMS determines all of the following— (A) The fiscal intermediary or CMS made an error in tabulating data used for the wage index calculation; (B) The hospital knew about the error in its wage data and requested the fiscal intermediary and CMS to correct the error both within the established schedule for requesting corrections to the wage data (which is at least before the beginning of the fiscal year for the applicable update to the hospital inpatient prospective payment system) and using the established process; and (C) CMS agreed before October 1 that the fiscal intermediary or CMS made an error in tabulating the hospital’s wage data and the wage index should be corrected. * * * * * 5. Section 412.73 is amended by adding a new paragraph (f) to read as follows: § 412.73 Determination of the hospitalspecific rate based on a Federal fiscal year 1982 base period. * * * * * (f) Maintaining budget neutrality. CMS makes an adjustment to the hospital-specific rate to ensure that changes to the DRG classifications and recalibrations of the DRG relative weights are made in a manner so that aggregate payments to section 1886(d) hospitals are not affected. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 23461 6. Section 412.75 is amended by adding a new paragraph (i) to read as follows: § 412.75 Determination of the hospitalspecific rate for inpatient operating costs based on a Federal fiscal year 1987 base period. b. Revising paragraph (d)(1)(i). c. Revising paragraph (d)(3). The revisions and addition read as follows: § 412.92 Special treatment: Sole community hospitals. * * * * * (i) Maintaining budget neutrality. CMS makes an adjustment to the hospital-specific rate to ensure that changes to the DRG classifications and recalibrations of the DRG relative weights are made in a manner so that aggregate payments to section 1886(d) hospitals are not affected. 7. Section 412.77 is amended by— a. Revising paragraph (a)(1). b. Adding a new paragraph (j). The revision and addition read as follows: § 412.77 Determination of the hospitalspecific rate for inpatient operating costs for sole community hospitals based on a Federal fiscal year 1996 base period. (a) Applicability. (1) This section applies to a hospital that has been designated as a sole community hospital, as described in § 412.92. If the 1996 hospital-specific rate exceeds the rate that would otherwise apply, that is, either the Federal rate under § 412.64 (or under § 412.63 for periods prior to FY 2005) or the hospital-specific rates for either FY 1982 under § 412.73 or FY 1987 under § 412.75, this 1996 rate will be used in the payment formula set forth in § 412.92(d)(1). * * * * * (j) Maintaining budget neutrality. CMS makes an adjustment to the hospital-specific rate to ensure that changes to the DRG classifications and recalibrations of the DRG relative weights are made in a manner so that aggregate payments to section 1886(d) hospitals are not affected. 8. Section 412.90 is amended by revising paragraph (e)(1) to read as follows: § 412.90 * * * * (e) Hospitals located in areas that are reclassified from urban to rural. (1) CMS adjusts the rural Federal payment amounts for inpatient operating costs for hospitals located in geographic areas that are reclassified from urban to rural as defined in subpart D of this part. This adjustment is set forth in § 412.102. * * * * * 9. Section 412.92 is amended by— a. In paragraph (a) introductory text, removing the reference ‘‘§ 412.83(b)’’ and adding in its place the reference ‘‘§ 412.64’’. PO 00000 Frm 00157 Fmt 4701 Sfmt 4702 * * * * (d) Determining prospective payment rates for inpatient operating costs for sole community hospitals. (1) * * * (i) The Federal payment rate applicable to the hospitals as determined under subpart D of this part. * * * * * (3) Adjustment to payments. A sole community hospital may receive an adjustment to its payments to take into account a significant decrease in the number of discharges, as described in paragraph (e) of this section. * * * * * 10. Section 412.96 is amended by— a. Revising paragraph (b)(1) introductory text. b. Revising paragraph (c) introductory text. c. In paragraph (c)(1) introductory text, removing the reference ‘‘paragraph (g)’’ and adding in its place the reference ‘‘paragraph (h)’’. d. In paragraph (c)(2)(i), removing the reference ‘‘paragraph (h)’’ and adding in its place the reference ‘‘paragraph (i)’’. e. Revising paragraph (g)(1). f. In the introductory text of paragraph (h), removing the phrase ‘‘paragraphs (g)(1) through (g)(4)’’ and adding in its place the phrase ‘‘paragraphs (h)(1) through (h)(4)’’. g. In paragraph (h)(2), removing the reference ‘‘(g)(1)’’ and adding in its place the reference ‘‘(h)(1)’’. h. Removing paragraph (h)(4). i. In paragraph (i)(2), removing the reference ‘‘(h)(1)’’ and adding in its place the reference ‘‘(i)(1)’’. j. Removing paragraph (i)(4). The revisions read as follows: § 412.96 Special treatment: Referral centers. * General rules. * * * * * * (b) Criteria for cost reporting periods beginning on or after October 1, 1983.* * * (1) The hospital is located in a rural area (as defined in subpart D of this part) and has the following number of beds, as determined under the provisions of § 412.105(b) available for use: * * * * * (c) Alternative criteria. For cost reporting periods beginning on or after October 1, 1985, a hospital that does not meet the criteria of paragraph (b) of this section is classified as a referral center if it is located in a rural area (as defined E:\FR\FM\04MYP2.SGM 04MYP2 23462 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules in subpart D of this part) and meets the criteria specified in paragraphs (c)(1) and (c)(2) of this section and at least one of the three criteria specified in paragraphs (c)(3), (c)(4), and (c)(5) of this section. * * * * * (g) Hospital cancellation of referral center status. (1) A hospital may at any time request cancellation of its status as a referral center and be paid prospective payments per discharge based on the applicable rural rate, as determined in accordance with subpart D of this part. * * * * * 11. Section 412.103 is amended by revising paragraphs (a)(1) and (a)(4) to read as follows: § 412.103 Special treatment: Hospitals located in urban areas and that apply for reclassification as rural. (a) * * * (1) The hospital is located in a rural census tract of a Metropolitan Statistical Area (MSA) as determined under the most recent version of the Goldsmith Modification, the Rural-Urban Commuting Area codes, as determined by the Office of Rural Health Policy (ORHP) of the Health Resources and Services Administration, which is available via the ORHP Web site at: https://www.ruralhealth.hrsa.gov or from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Rural Health Policy, 5600 Fishers Lane, Room 9A–55, Rockville, MD 20857. * * * * * (4) For any period after September 30, 2004 and before October 1, 2006, a CAH in a county that, in FY 2004, was not part of an MSA as defined by the Office of Management and Budget and was not considered to be urban under § 412.64(b)(3) of this chapter, but as of FY 2005 was included as part of an MSA or was considered to be urban under § 412.64(b)(3) of this chapter as a result of the most recent census data and implementation of the new MSA definitions announced by OMB on June 6, 2003, may be reclassified as being located in a rural area for purposes of meeting the rural location requirement under § 485.610(b) of this chapter if it meets any of the requirements in paragraphs (a)(1), (a)(2), or (a)(3) of this section. * * * * * 12. Section 412.105 is amended by— a. Adding a new paragraph (f)(1)(iv)(D). b. Adding a new paragraph (f)(1)(xiii). c. Adding a new paragraph (f)(1)(xiv). The additions read as follows: VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 § 412.105 Special treatment: Hospitals that incur indirect costs for graduate medical education programs. * * * * * (f) Determining the total number of full-time equivalent residents for cost reporting periods beginning on or after July 1, 1991. (1) * * * (iv) * * * (D) A rural hospital redesignated as urban after September 30, 2004, as a result of the most recent census data and implementation of the new labor market area definitions announced by OMB on June 6, 2003, may retain the increases to its full-time equivalent resident cap that it received under paragraphs (f)(1)(iv)(A) and (f)(1)(vii) of this section while it was located in a rural area. * * * * * (xiii) For a hospital that was excluded from the hospital inpatient prospective payment system under Part 413 of this chapter and that subsequently changed to a hospital subject to the hospital inpatient prospective payment system for cost reporting periods ending on or before December 31, 1996, the total number of full-time equivalent residents for payment purposes is determined in accordance with the provisions of this paragraph (f). In the case of a merger of two or more hospitals, for purposes of this paragraph, the surviving hospital’s number of full-time equivalent residents for payment purposes is equal to the aggregate number of the full-time equivalent resident count of each of the merged hospitals as determined in accordance with the provisions of this paragraph (f). (xiv) Effective for discharges occurring on or after October 1, 2005, an urban hospital that reclassifies to a rural area under § 412.103 and then subsequently elects to revert back to urban classification will not be allowed to retain the adjustment to its IME FTE resident cap that it received as a result of being reclassified as rural. * * * * * 13. Section 412.108 is amended by revising paragraph (c)(1) to read as follows: § 412.108 Special treatment: Medicaredependent, small rural hospitals. * * * * * (c) Payment methodology. * * * (1) The Federal payment rate applicable to the hospital, as determined under subpart D of this part, subject to the regional floor defined in § 412.70(c)(6). * * * * * 14. Section 412.109 is amended by revising paragraph (b)(2) to read as follows: PO 00000 Frm 00158 Fmt 4701 Sfmt 4702 § 412.109 Special treatment: Essential access community hospitals (EACHs). * * * * * (b) Location in a rural area. * * * (2) Is not deemed to be located in an urban area under subpart D of this part. * * * * * § 412.113 [Amended] 15. In § 412.113— a. In paragraph (b)(2), the reference ‘‘§ 413.86 of this chapter.’’ is removed and the reference ‘‘§§ 413.75 through 413.83 of this subchapter.’’ is added in its place. b. In paragraph (b)(3), the reference ‘‘§ 413.86(c) of this chapter,’’ is removed and the reference ‘‘§ 413.75(c) of this subchapter,’’ is added in its place. § 412.115 [Amended] 16. In § 412.115— a. In paragraph (a), the reference ‘‘§ 413.80’’ is removed and the reference ‘‘§ 413.89’’ is added in its place. b. At the end of paragraph (b), add the following sentence: ‘‘For discharges occurring on or after October 1, 2005, the additional payment is made based on the average sales price methodology specified in subpart K, part 414 of this chapter and the furnishing fee specified in § 410.63 of this subchapter.’’ 17. Section 412.230 is amended by— a. Redesignating paragraph (d)(2)(iii) as paragraph (d)(2)(v). b. Adding new paragraphs (d)(2)(iii) and (d)(2)(iv). The additions read as follows: § 412.230 Criteria for an individual hospital seeking redesignation to another rural area or an urban area. * * * * * (d) Use of urban or other rural area’s wage index.—* * * (2) Appropriate wage data. * * * (iii) For applications submitted for reclassifications effective in FY 2006, a campus of a multicampus hospital system may seek reclassification to another CBSA. As part of its reclassification request, the requesting entity may submit the composite wage data for the entire multicampus hospital system as its hospital-specific data. (iv) For applications submitted for reclassifications effective in FY 2007 and subsequent years, a campus of a multicampus hospital system may seek reclassification to another CBSA. As part of its reclassification request, the requesting entity must submit campusspecific wage data for purposes of the wage index comparison. * * * * * 18. Section 412.234 is amended by— a. In paragraph (a)(3)(ii), removing the phrase ‘‘fiscal years 2006 and thereafter’’ E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules and adding in its place the phrase ‘‘fiscal year 2006’’. b. Adding a new paragraph (a)(3)(iii). c. In paragraph (b)(1), removing the phrase ‘‘or NECMA’’. The addition reads as follows: § 412.234 Criteria for all hospitals in an urban county seeking redesignation to another urban area. (a) * * * (3) * * * (iii) For Federal fiscal year 2007 and thereafter, hospitals located in counties that are in the same Consolidated Statistical Area (CSA) (under the MSA definitions announced by the OMB on June 6, 2003) as the urban area to which they seek redesignation qualify as meeting the proximity requirement for reclassification to the urban area to which they seek redesignation. * * * * * § 412.278 [Amended] 19. In § 412.278(b)(1), the phrase ‘‘Office of Payment Policy’’ is removed and the phrase ‘‘Hospital and Ambulatory Policy Group’’ is added in its place. 20. Section 412.304 is amended by revising paragraph (a) to read as follows: § 412.304 Implementation of the capital prospective payment system. (a) General rule. As described in §§ 412.312 through 412.370, effective with cost reporting periods beginning on or after October 1, 1991, CMS pays an amount determined under the capital prospective payment system for each inpatient hospital discharge as defined in § 412.4. This amount is in addition to the amount payable under the prospective payment system for inpatient hospital operating costs as determined under subpart D of this part. * * * * * § 412.521 [Amended] 21. In § 412.521— a. Under paragraph (b)(2)(i), the reference ‘‘§§ 413.85, 413.86, and 413.87 of this subchapter.’’ is removed and the reference ‘‘§§ 413.75 through 413.83, 413.85, and 413.87 of this subchapter.’’ is added in its place. b. Under paragraph (b)(2)(ii), the reference ‘‘§ 413.80’’ is removed and the reference ‘‘§ 413.89’’ is added in its place. PART 413—PRINCIPLES OF REASONABLE COST REIMBURSEMENT; PAYMENT FOR END-STAGE RENAL DISEASE SERVICES; PROSPECTIVELY DETERMINED PAYMENT RATES FOR SKILLED NURSING FACILITIES C. Part 413 is amended as follows: VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 1. The authority citation for Part 413 continued to read as follows: 23463 Provider-based entity means a provider of health care services, or an RHC as defined in § 405.2401(b) of this Authority: Secs. 1102, 1812(d), 1814(b), chapter, that is either created by, or 1815, 1833(a), (i), and (n), 1871, 1881, 1883, acquired by, a main provider for the and 1886 of the Social Security Act (42 purpose of furnishing health care U.S.C. 1302, 1395d(d), 1395f(b), 1395g, 1395l(a), (i), and (n), 1395hh, 1395rr, 1395tt, services of a different type from those of and 1395ww). the main provider under the ownership and administrative and financial control § 413.13 [Amended] of the main provider, in accordance 2. In § 413.13 (d)(1), the reference with the provisions of this section. A ‘‘§ 413.80’’ is removed and the reference provider-based entity comprises both ‘‘§ 413.89’’ is added in its place. the specific physical facility that serves 3. Section 413.40 is amended by— as the site of services of a type for which a. In paragraph(a)(3), under the payment could be claimed under the definition of ‘‘Net inpatient operating Medicare or Medicaid program, and the costs’’, removing the reference personnel and equipment needed to ‘‘§§ 413.85 and 413.86’’ and adding in its deliver the services at that facility. A place the reference ‘‘§§ 413.75 through provider-based entity may, by itself, be 413.83 and 413.85’’. qualified to participate in Medicare as a b. Revising paragraph (c)(4)(iii). provider under § 489.2 of this chapter, and the Medicare conditions of § 413.40 Ceiling on the rate of increase in participation do apply to a providerhospital inpatient costs. based entity as an independent entity. * * * * * * * * * (c) Costs subject to the ceiling—* * * * (4) Target amounts. * * * (b) Provider-based determinations.— (iii) For cost reporting periods * * * beginning on or after October 1, 1997 (3)(i) Except as specified in through September 30, 2002, in the case paragraphs (b)(2) and (b)(5) of this of a psychiatric hospital or unit, section, if a potential main provider rehabilitation hospital or unit, or longseeks a determination of provider-based term care hospital, the target amount is status for a facility that is located on the the lower of the amounts specified in campus of the potential main provider, paragraph (c)(4)(iii)(A) or paragraph the provider would be required to (c)(4)(iii)(B) of this section. submit an attestation stating that the facility meets the criteria in paragraph * * * * * (d) of this section and, if it is a hospital, 4. Section 413.65 is amended by— also attest that it will fulfill the a. Reprinting the introductory text of obligations of hospital outpatient paragraph (a)(1)(ii) and adding a new departments and hospital-based entities paragraph (a)(1)(ii)(L). described in paragraph (g) of this b. Revising the definition of ‘‘Provider-based entity’’ under paragraph section. The provider seeking such a determination would also be required to (a)(2). maintain documentation of the basis for c. Revising paragraphs (b)(3)(i) and its attestations and to make that (b)(3)(ii). documentation available to CMS and to d. Revising paragraphs (e)(1) CMS contractors upon request. If the introductory text and (e)(1)(i). facility is operated as a joint venture, e. Revising paragraph (e)(3). the provider would also have to attest f. Revising paragraph (g)(7). that it will comply with the The addition and revision read as requirements of paragraph (f) of this follows: section. § 413.65 Requirements for a determination (ii) If the facility is not located on the that a facility or an organization has campus of the potential main provider, provider-based status. the provider seeking a determination (a) Scope and definitions. * * * would be required to submit an (1) * * * attestation stating that the facility meets (ii) The determinations of providerthe criteria in paragraphs (d) and (e) of based status for payment purposes this section, and if the facility is described in this section are not made operated under a management contract, as to whether the following facilities are the requirements of paragraph (h) of this provider-based: section. If the potential main provider is * * * * * a hospital, the hospital also would be (L) Rural health clinics (RHCs) required to attest that it will fulfill the affiliated with hospitals having 50 or obligations of hospital outpatient more beds. departments and hospital-based entities described in paragraph (g) of this * * * * * section. The provider would be required (2) Definitions. * * * PO 00000 Frm 00159 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 23464 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules to supply documentation of the basis for its attestations to CMS at the time it submits its attestations. * * * * * (e) * * * (1) Operation under the ownership and control of the main provider. The facility or organization seeking provider-based status is operated under the ownership and control of the main provider, as evidenced by the following: (i) The business enterprise that constitutes the facility or organization is 100 percent owned by the main provider. * * * * * (3) Location. The facility or organization meets the requirements in paragraph (e)(3)(i), (e)(3)(ii), (e)(3)(iii), (e)(3)(iv), or, in the case of an RHC, paragraph (e)(3)(v) of this section, and the requirements in paragraph (e)(3)(vi) of this section. (i) The facility or organization is located within a 35-mile radius of the campus of the hospital or CAH that is the potential main provider. (ii) The facility or organization is owned and operated by a hospital or CAH that has a disproportionate share adjustment (as determined under § 412.106 of this chapter) greater than 11.75 percent and is described in § 412.106(c)(2) of this chapter implementing section 1886(e)(5)(F)(i)(II) of the Act and is— (A) Owned or operated by a unit of State or local government; (B) A public or nonprofit corporation that is formally granted governmental powers by a unit of State or local government; or (C) A private hospital that has a contract with a State or local government that includes the operation of clinics located off the main campus of the hospital to assure access in a well-defined service area to health care services for low-income individuals who are not entitled to benefits under Medicare (or medical assistance under a Medicaid State plan). (iii) The facility or organization demonstrates a high level of integration with the main provider by showing that it meets all of the other provider-based criteria and demonstrates that it serves the same patient population as the main provider, by submitting records showing that, during the 12-month period immediately preceding the first day of the month in which the application for provider-based status is filed with CMS, and for each subsequent 12-month period— (A) At least 75 percent of the patients served by the facility or organization reside in the same zip code areas as at VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 least 75 percent of the patients served by the main provider; or (B) At least 75 percent of the patients served by the facility or organization who required the type of care furnished by the main provider received that care from that provider (for example, at least 75 percent of the patients of an RHC seeking provider-based status received inpatient hospital services from the hospital that is the main provider). (iv) If the facility or organization is unable to meet the criteria in paragraph (e)(3)(iii)(A) or paragraph (e)(3)(iii)(B) of this section because it was not in operation during all of the 12-month period described in paragraph (e)(3)(iii) of this section, the facility or organization is located in a zip code area included among those that, during all of the 12-month period described in paragraph (e)(3)(iii) of this section, accounted for at least 75 percent of the patients served by the main provider. (v) Both of the following criteria are met: (A) The facility or organization is an RHC that is otherwise qualified as a provider-based entity of a hospital that has fewer than 50 beds, as determined under § 412.105(b) of this chapter; and (B) The hospital with which the facility or organization has a providerbased relationship is located in a rural area, as defined in Subpart D of Part 412 of this subchapter. (vi) A facility or organization may qualify for provider-based status under this section only if the facility or organization and the main provider are located in the same State or, when consistent with the laws of both States, in adjacent States. * * * * * (g) Obligations. * * * (7) When a Medicare beneficiary is treated in a hospital outpatient department that is not located on the main provider’s campus, the treatment is not required to be provided by the antidumping rules in § 489.24 of this chapter, and the beneficiary will incur a coinsurance liability for an outpatient visit to the hospital as well as for the physician service, the following requirements must be met: (i) The hospital must provide written notice to the beneficiary, before the delivery of services, of— (A) The amount of the beneficiary’s potential financial liability; or (B) If the exact type and extent of care needed are not known, an explanation that the beneficiary will incur a coinsurance liability to the hospital that he or she would not incur if the facility were not provider-based, an estimate based on typical or average charges for PO 00000 Frm 00160 Fmt 4701 Sfmt 4702 visits to the facility, and a statement that the patient’s actual liability will depend upon the actual services furnished by the hospital. (ii) The notice must be one that the beneficiary can read and understand. (iii) If the beneficiary is unconscious, under great duress, or for any other reason unable to read a written notice and understand and act on his or her own rights, the notice must be provided, before the delivery of services, to the beneficiary’s authorized representative. (iv) In cases where a hospital outpatient department provides examination or treatment that is required to be provided by the antidumping rules of § 489.24 of this chapter, notice, as described in this paragraph (g)(7), must be given as soon as possible after the existence of an emergency has been ruled out or the emergency condition has been stabilized. * * * * * 5. Section 413.75 is amended in paragraph (b) by revising paragraph (1) under the definition of ‘‘Medicare GME affiliated group’’ to read as follows: § 413.75 Direct GME payments: General requirements. * * * * * (b) * * * Medicare GME affiliated group means— (1) Two or more hospitals that are located in the same urban or rural area (as those terms are defined in subpart D of part 412 of this subchapter. * * * * * § 413.77 [Amended] 6. In § 413.77, under paragraph (e)(1)(iii), the reference ‘‘§ 412.62(f)(1)(i) of this chapter.’’ is removed and the reference ‘‘subpart D of part 412 of this subchapter’’. is added in its place. 7. Section 413.79 is amended by— a. Revising paragraph (a)(10). b. Revising the introductory text of paragraph (c)(2). c. In paragraph (c)(3)(i), removing the reference ‘‘§ 412.62(f)(iii)’’ and adding in its place the reference ‘‘subpart D of part 412 of this subchapter’’. d. Adding a new paragraph (c)(6). e. Revising paragraph (e)(1)(iv). f. In the introductory text of paragraph (k), removing the reference ‘‘(k)(6)’’ and adding in its place the reference ‘‘(k)(7)’’. g. Adding a new paragraph (k)(7). The revisions and additions read as follows: § 413.79 Direct GME payments: Determination of the weighted number of FTE residents. * E:\FR\FM\04MYP2.SGM * * 04MYP2 * * Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules (a) * * * (10) Effective for portions of cost reporting periods beginning on or after October 1, 2004, if a hospital can document that a resident simultaneously matched for one year of training in a particular specialty program, and for a subsequent year(s) of training in a different specialty program, the resident’s initial residency period will be determined based on the period of board eligibility for the specialty associated with the program for which the resident matched for the subsequent year(s) of training. Effective for cost reporting periods beginning on or after October 1, 2005, if a hospital can document that a particular resident, prior to beginning the first year of residency training, matched in a specialty program for which training would begin at the conclusion of the first year of training, that resident’s initial residency period will be determined in the resident’s first year of training based on the period of board eligibility associated with the specialty program for which the resident matched for subsequent training year(s). * * * * * (c) Unweighted FTE counts. * * * (2) Determination of the FTE resident cap. Subject to the provisions of paragraphs (c)(3) through (c)(6) of this section and § 413.81, for purposes of determining direct GME payment— * * * * * (6) FTE resident caps for rural hospitals that are reclassified as urban. A rural hospital redesignated as urban after September 30, 2004, as a result of the most recent census data and implementation of the new MSA definitions announced by OMB on June 6, 2003, may retain the increases to its FTE resident cap that it received under paragraphs (c)(2)(i), (e)(1)(iii), and (e)(3) of this section while it was located in a rural area. * * * * * (e) New medical residency training programs. * * * (1) * * * (iv) An urban hospital that qualifies for an adjustment to its FTE cap under paragraph (e)(1) of this section is permitted to be part of a Medicare GME affiliated group for purposes of establishing an aggregate FTE cap only if the adjustment that results from the affiliation is an increase to the urban hospital’s FTE cap. * * * * * (k) Residents training in rural track programs. * * * (7) If an urban hospital had established a rural track training program under the provisions of this VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 paragraph (k) with a hospital located in a rural area and that rural area subsequently becomes an urban area due to the most recent census data and implementation of the new labor market area definitions announced by OMB on June 6, 2003, the urban hospital may continue to adjust its FTE resident limit in accordance with this paragraph (k) for the rural track programs established prior to the adoption of such new labor market area definitions. In order to receive an adjustment to its FTE resident cap for a new rural track residency program, the urban hospital must establish a rural track program with hospitals that are designated rural based on the most recent geographical location designations adopted by CMS. * * * * * § 413.87 [Amended] 8. In § 413.87(d) introductory text, the reference ‘‘§ 413.86(d)(4)’’ is removed and the reference ‘‘§ 413.76(d)(4)’’ is added in its place. § 413.178 [Amended] 9. In § 413.178— a. In paragraph (a), the reference ‘‘§ 413.80(b)’’ is removed and the reference ‘‘§ 413.89(b)’’ is added in its place. b. In paragraph (b), the reference ‘‘§ 413.80’’ is removed and the reference ‘‘§ 413.89’’ is added in its place. PART 415—SERVICES FURNISHED BY PHYSICIANS IN PROVIDERS, SUPERVISING PHYSICIANS IN TEACHING SETTINGS, AND RESIDENTS IN CERTAIN SETTINGS D. Part 415 is amended as follows: 1. The authority citation for part 415 continued to read as follows: 23465 ‘‘§§ 413.75 through 413.83’’ is added in its place. § 415.152 [Amended] 6. In § 415.152— a. In paragraph (2) of the definition of ‘‘Approved graduate medical education (GME) program’’, the reference ‘‘§ 413.86(b)’’ is removed and the reference ‘‘§ 413.75(b)’’ is added in its place. b. In the definition of ‘‘Teaching setting’’, the reference ‘‘§ 413.86,’’ is removed and the reference ‘‘§§ 413.75 through 413.83,’’ is added in its place. § 415.160 [Amended] 7. In § 415.160— a. In paragraph (c)(2), the reference ‘‘§ 413.86’’ is removed and the reference ‘‘§ 413.78’’ is added in its place. b. In paragraph (d)(2), the reference ‘‘§ 413.86’’ is removed and the reference ‘‘§§ 413.75 through 413.83’’ is added in its place. § 415.174 [Amended] 8. In § 415.174(a)(1), the reference ‘‘§ 413.86.’’ is removed and the phrase ‘‘§§ 413.75 through 413.83.’’ is added in its place. § 415.200 [Amended] 9. In § 415.200(a), the reference ‘‘§ 413.86’’ is removed and the reference ‘‘§§ 413.75 through 413.83’’ is added in its place. § 415.204 [Amended] 10. In § 415.204(a)(2), the reference ‘‘§ 413.86’’ is removed and the reference ‘‘§§ 413.75 through 413.83’’ is added in its place. § 415.206 [Amended] Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). 11. In § 415.206(a), the reference ‘‘§ 413.86(f)(1)(iii)’’ is removed and the reference ‘‘§ 413.78’’ is added in its place. § 415.55 § 415.208 [Amended] 2. In § 415.55(a)(5), the reference ‘‘§ 413.86’’ is removed and the reference ‘‘§§ 413.75 through 413.83’’ is added in its place. § 415.70 [Amended] 3. In § 415.70(a)(2), the reference ‘‘§ 413.86’’ is removed and the reference ‘‘§§ 413.75 through 413.83’’ is added in its place. § 415.102 [Amended] 4. In § 415.102(c)(1), the reference ‘‘§ 413.86’’ is removed and the reference ‘‘§§ 413.75 through 413.83’’ is added in its place. § 415.150 [Amended] 5. In § 415.150(b), the reference ‘‘§ 413.86’’ is removed and the phrase PO 00000 Frm 00161 Fmt 4701 Sfmt 4702 [Amended] 12. In § 415.208— a. In paragraph (b)(1), the reference ‘‘§ 413.86’’ is removed and the reference ‘‘§§ 413.75 through 413.83’’ is added in its place. b. In paragraph (b)(4), the reference ‘‘§ 413.86’’ is removed and the reference ‘‘§§ 413.75 through 413. 83’’ is added in its place. PART 419—PROSPECTIVE PAYMENT SYSTEM FOR OUTPATIENT DEPARTMENT SERVICES F. Part 419 is amended as follows: 1. The authority citation for part 419 continues to read as follows: Authority: Secs. 1102, 1833(t), and 1871 of the Social Security Act (42 U.S.C. 1302, 1395l(t), and 1395hh). E:\FR\FM\04MYP2.SGM 04MYP2 23466 § 419.2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules [Amended] 2. In § 419.2— a. In paragraph (c)(1), the reference ‘‘§ 413.86’’ is removed and the reference ‘‘§§ 413.75 through 413.83’’ is added in its place. b. In paragraph (c)(6), the reference ‘‘§ 413.80(b)’’ is removed and the reference ‘‘§ 413.89(b)’’ is added in its place. PART 422—SPECIAL RULES FOR SERVICES FURNISHED BY NONCONTRACT PROVIDERS G. Part 422 is amended as follows: 1. The authority citation of part 422 continues to read as follows: Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh). § 422.214 [Amended] 2. In § 422.214— a. In paragraph (b), the phrase ‘‘§§ 412.105(g) and 413.86(d))’’ is removed and the phrase ‘‘§§ 412.105(g) and 413.76))’’ is added in its place. b. In paragraph (b), the phrase ‘‘Section 413.86 (d)’’ is removed and the phrase ‘‘Section 413.76’’ is added in its place. § 422.216 [Amended] 3. In § 422.216(a)(4), the reference ‘‘§§ 412.105(g) and 413.86(d)’’ is removed and the reference ‘‘§§ 412.105(g) and 413.76’’ is added in its place. PART 485—CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS G. Part 485 is amended as follows: 1. The authority citation for Part 485 continues to read as follows: Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395(hh)). 2. Section 485.610 is amended by— a. In paragraph (b)(1)(i), removing the reference ‘‘§ 412.62(f)’’ and adding in its place the reference ‘‘§ 412.64(b)’’. b. In paragraph (b)(1)(ii), removing the reference ‘‘§ 412.63(b)’’ and adding in its place the reference ‘‘§ 412.64(b)’’. c. Revising paragraph (b)(3). d. Adding a new paragraph (d). The revisions and additions read as follows: § 485.610 Condition of participation: Status and location. * * * * * (b) * * * (3) Effective only for October 1, 2004 through September 30, 2006, the CAH does not meet the location requirements in either paragraph (b)(1) or paragraph VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 (b)(2) of this section and is located in a county that, in FY 2004, was not part of a Metropolitan Statistical Area as defined by the Office of Budget Management and was not considered to be urban under § 412.63(b)(3) of this chapter, but as of FY 2005 was included as part of such an MSA or was considered to be urban under § 412.64(b)(3) of this chapter, as a result of the most recent census data and implementation of the new MSA definitions announced by OMB on June 6, 2003. * * * * * (d) Standard: Relocation of CAHs with a necessary provider designation. A CAH that has a necessary provider certification from the State and places a new facility in service after January 1, 2006, can continue to meet the location requirement of paragraph (c) of this section based on the necessary provider certification only if the new facility meets either the requirement for replacement in the same location in paragraph (d)(1) of this section or the requirement for a relocation of a CAH in paragraph (d)(2) of this section. (1) A new construction of a CAH will be considered as a replacement facility if the construction is undertaken within 250 yards of the current building or contiguous to the current CAH on land owned by the CAH prior to December 8, 2003. (2) A new facility CAH will be considered as a relocation of a CAH if, at the relocated site— (i) The CAH serves at least 75 percent of the same service area that it served prior to its relocation, provides at least 75 percent of the same services that it provided prior to the relocation, and is staffed by 75 percent of the same staff (including medical staff, contracted staff, and employees); and (ii) The CAH provides documentation demonstrating that its plans to rebuild in the relocated area were undertaken prior to December 8, 2003. (3) If a CAH that has a necessary provider certification from the State places a new facility in service on or after January 1, 2006, and does not meet either the requirements in paragraph (d)(1) or paragraph (d)(2) of this section, the action will be considered a cessation of business as described in § 489.52(b)(3). (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program) PO 00000 Frm 00162 Fmt 4701 Sfmt 4702 Dated: April 19, 2005. Mark B. McClellan, Administrator, Centers for Medicare & Medicaid Services. Dated: April 22, 2005. Michael O. Leavitt, Secretary. [Editorial Note: The following Addendum and appendixes will not appear in the Code of Federal Regulations.] Addendum—Proposed Schedule of Standardized Amount Effective With Discharges Occurring On or After October 1, 2005 and Update Factors and Rate-of-Increase Percentages Effective With Cost Reporting Periods Beginning On or After October 1, 2005 (If you choose to comment on issues in this section, please include the caption ‘‘Operating Payment Rates’’ at the beginning of your comment.) I. Summary and Background In this Addendum, we are setting forth the proposed amounts and factors for determining prospective payment rates for Medicare hospital inpatient operating costs and Medicare hospital inpatient capitalrelated costs. We are also setting forth the proposed rate-of-increase percentages for updating the target amounts for hospitals and hospital units excluded from the IPPS. For discharges occurring on or after October 1, 2005, except for SCHs, MDHs, and hospitals located in Puerto Rico, each hospital’s payment per discharge under the IPPS will be based on 100 percent of the Federal national rate, which will be based on the national adjusted standardized amount. This amount reflects the national average hospital costs 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 are 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 do not have the option to use their FY 1996 hospital-specific rate. 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 2006. The proposed changes, to be applied E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules prospectively effective with discharges occurring on or after October 1, 2005, affect the calculation of the Federal rates. 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 2006. Section IV. of this Addendum sets forth our proposed changes for determining the rate-ofincrease limits for hospitals excluded from the IPPS for FY 2006. Section V. of this Addendum sets forth policies on payment for blood clotting factors administered to hemophilia patients. The tables to which we refer in the preamble of this proposed rule are presented in section VI. of this Addendum. II. Proposed Changes to Prospective Payment Rates for Hospital Inpatient Operating Costs for FY 2006 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. In summary, the proposed standardized amounts set forth in Tables 1A, 1B, 1C, and 1D of section VI. of this Addendum reflect— • 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)(XIX) and 1886(b)(3)(B)(vii) of the Act. • The two labor-related shares that are applicable to the standardized amounts, depending on whether the hospital’s payments would be higher with a lower (in the case of a wage index below 1.0000) or higher (in the case of a wage index above 1.0000) labor share, as provided for under sections 1886(d)(3)(E) and 1886(d)(9)(C)(iv) of the Act; • Updates of 3.2 percent for all areas (that is, the full market basket percentage increase of 3.2 percent, as required by section 1886(b)(3)(B)(i)(XIX) of the Act, and reflecting the requirements of section 1886(b)(3)(B)(vii) of the Act to reduce the applicable percentage increase by 0.4 percentage points for hospitals that fail to submit data, in a form and manner specified by the Secretary, relating to the quality of inpatient care furnished by the hospital; • An adjustment to ensure the proposed DRG recalibration and wage index update and changes are budget neutral, as provided for under sections 1886(d)(4)(C)(iii) and 1886(d)(3)(E) of the Act, by applying new budget neutrality adjustment factors to the standardized amount; • An adjustment to ensure the effects of the special transition measures adopted in relation to the implementation of new labor market areas are budget neutral; VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 • 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 2005 budget neutrality factor and applying a revised factor; • An adjustment to apply the new outlier offset by removing the FY 2005 outlier offset and applying a new offset; • 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. A. Calculation of the Adjusted Standardized Amount 1. Standardization of Base-Year Costs or Target Amounts 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. Under section 1886(d)(3)(E) of the Act, the Secretary estimates, from time-to-time, the proportion of hospitals’ costs that are attributable to wages and wage-related costs. The standardized amount is divided into labor-related and nonlabor-related amounts; only the proportion considered the laborrelated amount is adjusted by the wage index. Section 403 of Pub. L. 108–173 revises the proportion of the standardized amount that is considered labor-related. Specifically, section 1886(d)(3)(E) of the Act (as amended by section 403 of Pub. L. 108–173) 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 403(b) of Pub. L. 108–173 extended this provision to the Puerto Rico standardized amounts.) We are proposing to update the labor-related share to 69.7 percent for FY 2006, as discussed in section IV.B.3. of the preamble to this proposed rule. We note that the revised labor-related share that we are proposing for FY 2006 was determined to be 69.731, as discussed in PO 00000 Frm 00163 Fmt 4701 Sfmt 4702 23467 section IV of the preamble to this proposed rule. We are proposing to continue with our previous methodology and round the laborrelated share to 69.7 percent for purposes of establishing the labor-related and nonlaborrelated portions of the standardized amount. As discussed in section IV. of the preamble to this proposed rule, we are also proposing to rebase the current labor-related share for the Puerto Rico-specific amounts for FY 2006. Since the proposed rebased Puerto Rico labor-related share has not yet been calculated, the proposed standardized amounts that appear in Table 1C of this Addendum for providers with a wage index greater than 1.0000 reflect the current (FY 2005) labor-related share for the Puerto Ricospecific amounts of 71.3 percent for FY 2006. However, in the final rule, if we adopt our proposal to rebase the labor-related share for Puerto Rico, these amounts would reflect this revised labor-related share. We are proposing to adjust 62 percent of the national standardized amount and 62 percent of the Puerto Rico-specific amount by the wage index for all hospitals whose wage indexes are less than or equal to 1.0000. For all hospitals whose wage values are greater than 1.0000, we are proposing to adjust the national standardized amount by a laborrelated share of 69.7 percent. 2. Computing the Average Standardized Amount Sections 1886(d)(3)(A)(iv) of the Act previously required the Secretary to compute the following two average standardized amounts for discharges occurring in a fiscal year: One for hospitals located in large urban areas and one for hospitals located in other areas. In accordance with section 1886(b)(3)(B)(i) of the Act, the large urban average standardized amount was 1.6 percent higher than the other area average standardized amount. In addition, under sections 1886(d)(9)(B)(iii) and 1886(d)(9)(C)(i) of the Act, the average standardized amounts per discharge were determined for hospitals located in urban and rural areas in Puerto Rico. Section 402(b) of Pub. L. 108–7 required that, effective for discharges occurring on or after April 1, 2003, and before October 1, 2003, the Federal rate for all IPPS hospitals would be based on the large urban standardized amount. Subsequently, Pub. L. 108–89 extended section 402(b) of Pub. L. 108–7 beginning with discharges on or after October 1, 2003 and before March 31, 2004. Finally, section 401(a) of Pub. L. 108–173 amended section 1886(d)(3)(A)(iv) of the Act to require 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. This provision in effect makes permanent the equalization of the standardized amounts at the level of the previous standardized amount for large urban hospitals. Section 401(c) of Pub. L. 108–173 also amended section 1886(d)(9)(A) of the Act to equalize the Puerto Rico-specific urban and rural area rates. Accordingly, we are providing in this proposed rule for a single national standardized amount and a E:\FR\FM\04MYP2.SGM 04MYP2 23468 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules single Puerto Rico standardized amount for FY 2006. 3. Updating the Average Standardized Amount In accordance with section 1886(d)(3)(A)(iv)(II) of the Act, we are proposing to update the equalized standardized amount for FY 2006 by the full estimated market basket percentage increase for hospitals in all areas, as specified in section 1886(b)(3)(B)(i)(XIX) of the Act, as amended by section 501 of Pub. L. 108–173. 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 2006 is 3.2 percent. Thus, for FY 2006, the proposed update to the average standardized amount is 3.2 percent for hospitals in all areas. 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)(vii) of the Act, as amended by section 501(b) of Pub. L. 108–173, provides for a reduction of 0.4 percentage points to the update percentage increase (also known as the market basket update) for each of FYs 2005 through 2007 for any ‘‘subsection (d) hospital’’ that does not submit data on a set of 10 quality indicators established by the Secretary as of November 1, 2003. The statute also provides that any reduction will apply only to the fiscal year involved, and will not be taken into account in computing the applicable percentage increase for a subsequent fiscal year. This measure establishes an incentive for hospitals to submit data on quality measures established by the Secretary. The proposed standardized amounts in Tables 1A through 1D of section VI. of this Addendum reflect these differential amounts. Although the update factors for FY 2006 are set by law, we are required by section 1886(e)(3) of the Act to report to the Congress our initial recommendation of update factors for FY 2006 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 as Appendix B of this proposed rule. 4. Other Adjustments to the Average Standardized Amount As in the past, we are proposing to adjust the FY 2006 standardized amount to remove the effects of the FY 2005 geographic reclassifications and outlier payments before applying the FY 2006 updates. We then apply the new offsets for outliers and geographic reclassifications to the standardized amount for FY 2006. 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 section 1886(d)(4)(C)(iii) 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 this condition. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Budget neutrality is determined by comparing aggregate IPPS payments before and after making the changes that are required to be budget neutral (for example, reclassifying and recalibrating the DRGs, updating the wage data, and geographic reclassifications). We include outlier payments in the payment simulations because outliers may be affected by changes in these payment parameters. We are also proposing to adjust the standardized amount this year by an amount estimated 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. a. 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, 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 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. For FY 2006, we are proposing to continue to adjust 10 percent of the wage index factor for occupational mix. We describe the proposed occupational mix adjustment in section III.C. of the preamble to this proposed rule. Because section 1886(d)(3)(E) of the Act requires us to update the wage index on a budget neutral basis, we are including the effects of this proposed occupational mix adjustment on the wage index in our budget neutrality calculations. In FY 2005, those urban hospitals that became rural under the new labor market area definitions were assigned the wage index of the urban area in which they were located under the previous labor market definitions for a 3-year period of FY 2005, FY 2006, and FY 2007. Because we are in the second year of this 3-year transition, we are proposing to adjust the standardized amounts for FY 2006 to ensure budget neutrality for this policy. We discuss this adjustment in section III.B. of the preamble to this proposed rule. PO 00000 Frm 00164 Fmt 4701 Sfmt 4702 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 not located in a rural area may not be less than the area wage index applicable to hospitals located in rural areas in that State. This provision is required by section 4410(b) of Pub. L. 105–33 to be budget neutral. Therefore, we include the effects of this provision in our calculation of the wage update budget neutrality factor. As discussed in the FY 2005 IPPS final rule (69 FR 49110), we are in the second year of the 3-year provision that uses an imputed wage index floor for States that have no rural areas and States that have geographic rural areas, but that have no hospitals actually classified as rural. We are also adjusting for the effects of this provision in our calculation of the wage update budget neutrality factor. To comply with the requirement that DRG reclassification and recalibration of the relative weights be budget neutral, and the requirement that the updated wage index be budget neutral, we used FY 2004 discharge data to simulate payments and compared aggregate payments using the FY 2005 relative weights and wage index to aggregate payments using the proposed FY 2006 relative weights and wage index. The same methodology was used for the FY 2005 budget neutrality adjustment. Based on this comparison, we computed a proposed budget neutrality adjustment factor equal to 1.002494. We also are proposing to adjust the Puerto Rico-specific standardized amount for the effect of DRG reclassification and recalibration. We computed a proposed budget neutrality adjustment factor for the Puerto Rico-specific standardized amount equal to 0.999003. These proposed budget neutrality adjustment factors are applied to the standardized amounts without removing the effects of the FY 2005 budget neutrality adjustments. In addition, as discussed in section V.C.2. of the preamble to this proposed rule, we are proposing to apply the same DRG reclassification and recalibration budget neutrality factor of 0.999003 to the hospital-specific rates that are effective for cost reporting periods beginning on or after October 1, 2005. Using the same data, we calculated a transition budget neutrality adjustment to account for the ‘‘hold harmless’’ policy under which urban hospitals that became rural under the new labor market area definitions were assigned the wage index of the urban area in which they were located under the previous labor market area definitions for a 3-year period of FY 2005, FY 2006, and FY 2007 (see Table 2 in section VI. of this Addendum). Using the prereclassified wage index, we simulated payments under the new labor market area definitions and compared them to simulated payments under the ‘‘hold harmless’’ policy. Based on this comparison, we computed a proposed transition budget neutrality adjustment of 0.999529. 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 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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 neither the wage index reclassifications provided under section 508 of Pub. L. 108–173 nor the wage index adjustments provided under section 505 of Pub. L. 108–173 are budget neutral. Section 508(b) of Pub. L. 108–173 provides that the wage index reclassifications approved under section 508(a) of Pub. L. 108–173 ‘‘shall not be effected in a budget neutral manner.’’ Section 505(a) of Pub. L. 108–173 similarly provides that any increase in a wage index under that section 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 this proposed budget neutrality factor, we used FY 2004 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 are proposing to apply an adjustment factor of 0.992905 to ensure that the effects of this reclassification are budget neutral. The proposed adjustment factor is applied to the standardized amount after removing the effects of the FY 2005 budget neutrality adjustment factor. We note that the proposed FY 2006 adjustment reflects FY 2006 wage index reclassifications approved by the MGCRB or the Administrator, and the effects of MGCRB reclassifications approved in FY 2004 and FY 2005 (section 1886(d)(10)(D)(v) of the Act makes wage index reclassifications effective for 3 years). c. 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 above a fixed-loss cost threshold amount (a dollar amount by which the costs of a case must exceed payments in order to qualify for outlier payment). To determine whether the costs of a case exceed the fixedloss threshold, a hospital’s cost-to-charge ratio is applied to the total covered charges for the case to convert the charges to costs. Payments for eligible cases are then made based on a marginal cost factor, which is a percentage of the costs above the threshold. 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, VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 section 1886(d)(9)(B)(iv) of the Act requires the Secretary to reduce the average standardized amounts 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/providers/hipps/ ippsotlr.asp. i. Proposed FY 2006 outlier fixed-loss threshold. For FY 2006, we are proposing a new methodology to calculate the outlier fixed-loss threshold. For FY 2004, we simulated outlier payments by applying FY 2004 rates and policies using cases from the FY 2002 MedPAR file. In order to determine the FY 2004 outlier fixed-loss threshold, it was necessary to inflate the charges on the MedPAR claims by 2 years, from FY 2002 to FY 2004. In order to determine the FY 2004 threshold, we used the 2-year average annual rate-of-change in charges per case to inflate FY 2002 charges to approximate FY 2004 charges. (We refer the reader to the FY 2004 IPPS final rule (67 FR 45476) for a complete discussion of the FY 2004 methodology.) In the IPPS proposed rule for FY 2005 (69 FR 28376), we proposed to use the same methodology we used for determining the FY 2004 outlier fix-loss threshold to determine the FY 2005 outlier threshold. We further noted that the rate-of-increase in the 2-year average annual rate-of-change in charges derived from the period before the changes we made to the policy affecting the applicable cost-to-charge ratios (68 FR 34494) and, therefore, they may have represented rates-of-increase that could be higher than the rates-of-increase under our new policy. As a result, we welcomed comments on the data we were using to update charges for purposes of the threshold and specifically encouraged commenters to provide recommendations for data that might better reflect current trends in charge increases. In response to the many comments we received on this proposed FY 2005 methodology, in the IPPS final rule for FY 2005 (69 FR 49275), we revised that proposed methodology and used the following methodology to calculate the final FY 2005 outlier fixed-loss threshold. Instead of using the 2-year average annual rate-of-change in charges per case from FY 2001 to FY 2002 and FY 2002 to FY 2003, we used more recent data to determine the annual rate-ofchange in charges for the FY 2005 outlier threshold. Specifically, we compared the rate-of-increase in charges from the first halfyear of FY 2003 to the first half-year of FY 2004. We stated that we believed this methodology would result in a more accurate determination of the rate-of-change in charges per case between FY 2003 and FY 2005. Although a full year of data was available for FY 2003, we did not have a full year of FY 2004 data at the time we set the FY 2005 outlier threshold. Therefore, we stated that we believed it was optimal to employ comparable periods in determining the rate-of-change from one year to the next. We also stated that we believed this methodology was the best methodology for determining the rate-of-change in charges per case because it used the most recent charge data available. Using this methodology, we PO 00000 Frm 00165 Fmt 4701 Sfmt 4702 23469 established a fixed-loss cost outlier threshold for FY 2005 equal to the prospective payment rate for the DRG, plus any IME and DSH payment, and any add-on payment for new technology, plus $25,800. For FY 2006, we are proposing to use a new methodology to calculate the outlier threshold that will take into account the lower inflation in hospital charges that is occurring as a result of the June 9, 2003 outlier final rule (68 FR 34505), which changed our methodology for determining outlier payments by implementing the use of more current and accurate cost-to-charge ratios when paying for outliers. As we have done in the past, to calculate the proposed FY 2006 outlier thresholds, we simulated payments by applying proposed FY 2006 rates and policies using cases from the FY 2004 MedPAR files. Therefore, in order to determine the appropriate proposed FY 2006 outlier threshold, it was necessary to inflate the charges on the MedPAR claims by 2 years, from FY 2004 to FY 2006. However, we are not proposing to inflate charges using a 2-year average annual rate-ofchange in charges per case from FY 2002 to FY 2003 and FY 2003 to FY 2004 because of the distortion in FY 2002 and FY 2003 charge data caused by the exceptionally high rate of hospital charge inflation during those years. Instead, we are proposing to use more recent data that reflect changes under the new outlier policy. However, we will continue to consider other methodologies in the future when calculating the outlier threshold once we have 2 complete years of charge data under the new outlier policy. Specifically, we are proposing to establish the proposed FY 2006 outlier threshold as follows: Using the latest data available, the 1year average annualized rate-of-change in charges per case from the last quarter of FY 2003 in combination with the first quarter of FY 2004 (July 1, 2003 through December 31, 2003) to the last quarter of FY 2004 in combination with the first quarter of FY 2005 (July 1, 2004 through December 31, 2004) was 8.65 percent (1.0865), or 18.04 percent (1.1804) over 2 years. As we have done in the past, we are proposing to use hospital costto-charge ratios from the most recent Provider Specific File, in this case the December 2004 update, in establishing the proposed FY 2006 outlier threshold. This file includes cost-to-charge ratios that reflect implementation of the changes to the policy for determining the applicable cost-to-charge ratios that became effective August 8, 2003 (68 FR 34494). Using this methodology, we are proposing to establish a fixed-loss cost outlier threshold for FY 2006 equal to the prospective payment rate for the DRG, plus any IME and DSH payments, and any add-on payments for new technology, plus $26,675. In addition, as stated in the June 9, 2003 outlier final rule (68 FR 34505), we believe the use of charge inflation is more appropriate than our previous methodology of cost inflation because charges tend to increase at a much faster rate than costs. Although charges have increased at a slower rate since the implementation of changes to our outlier payment methodology in 2003, we believe the use of charges is still appropriate because this trend is still evident. E:\FR\FM\04MYP2.SGM 04MYP2 23470 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules cost reporting period are different than the interim cost-to-charge ratios used to calculate outlier payments when a bill is processed. Our simulations assume cost-to-charge ratios accurately measure hospital costs and, therefore, are more reflective of postreconciliation than pre-reconciliation outlier payments. As a result, we omitted any assumptions about the effects of reconciliation from the outlier threshold calculation. ii. Other changes concerning outliers. As stated in the September 1, 1993 final rule (58 FR 46348), 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 project that the proposed thresholds for FY 2006 will result in outlier payments equal to 5.1 percent of operating DRG payments and 5.03 percent of capital payments based on the Federal rate. In accordance with section 1886(d)(3)(B) of the Act, we reduced the proposed FY 2005 standardized amount by the same percentage to account for the projected proportion of payments paid to outliers. The proposed outlier adjustment factors that would be applied to the standardized amount for FY 2006 are as follows: We are proposing to apply the outlier adjustment factors to the FY 2006 rates after removing the effects of the FY 2005 outlier adjustment factors on the standardized amount. To determine whether a case qualifies for outlier payments, we apply hospital-specific cost-to-charge ratios to the total covered charges for the case. Operating and capital costs for the case are calculated separately by applying separate operating and capital costto-charge ratios. These costs are then combined and compared with the fixed-loss outlier threshold. The June 9, 2003 outlier final rule (68 FR 34494) eliminated the application of the statewide average for hospitals whose cost-tocharge ratios fall below 3 standard deviations from the national mean cost-to-charge ratio. However, for those hospitals for which the fiscal intermediary computes operating costto-charge ratios greater than 1.220 or capital cost-to-charge ratios greater than 0.169, or hospitals for whom the fiscal intermediary is unable to calculate a cost-to-charge ratio (as described at § 412.84(i)(3) of our regulations), we are still using statewide average ratios to calculate costs to determine whether a hospital qualifies for outlier payments.6 Table 8A in section VI. of this Addendum contains the proposed statewide average operating cost-to-charge ratios for urban hospitals and for rural hospitals for which the fiscal intermediary is unable to compute a hospital-specific cost-to-charge ratio within the above range. Effective for discharges occurring on or after October 1, 2005, these proposed statewide average ratios would replace the ratios published in the IPPS final rule for FY 2005 (69 FR 49687). Table 8B in section VI. of this Addendum contains the proposed comparable statewide average capital cost-to-charge ratios. Again, the proposed cost-to-charge ratios in Tables 8A and 8B would be used during FY 2006 when hospital-specific cost-to-charge ratios based on the latest settled cost report are either not available or are outside the range noted above. iii. FY 2004 and FY 2005 outlier payments. In the FY 2005 IPPS final rule, we stated that, based on available data, we estimated that actual FY 2004 outlier payments would be approximately 3.6 percent of actual total DRG payments (69 FR 49278, as corrected at 69 FR 60252). This estimate was computed based on simulations using the FY 2003 MedPAR file (discharge data for FY 2003 bills). That is, the estimate of actual outlier payments did not reflect actual FY 2004 bills, but instead reflected the application of FY 2004 rates and policies to available FY 2003 bills. Our current estimate, using available FY 2004 bills, is that actual outlier payments for FY 2004 were approximately 3.5 percent of actual total DRG payments. Thus, the data indicate that, for FY 2004, the percentage of actual outlier payments relative to actual total payments is lower than we projected before FY 2004 (and, thus, is less than the percentage by which we reduced the standardized amounts for FY 2004). We note that, for FY 2005, the outlier threshold was lowered to $25,800 compared to $31,000 for FY 2004. The outlier threshold was lower in FY 2005 than FY 2004 as a result of slower growth in hospital charge inflation. We believe that this slower growth was due to changes in hospital charge practices following implementation of the outlier final rule published on June 9, 2003. Nevertheless, consistent with the policy and statutory interpretation we have maintained since the inception of the IPPS, we do not plan to make retroactive adjustments to outlier payments to ensure that total outlier payments for FY 2004 are equal to 5.1 percent of total DRG payments. We currently estimate that actual outlier payments for FY 2005 will be approximately 4.4 percent of actual total DRG payments, 0.7 percentage points lower than the 5.1 percent we projected in setting outlier policies for FY 2005. This estimate is based on simulations using the FY 2004 MedPAR file (discharge data for FY 2004 bills). We used these data to calculate an estimate of the actual outlier percentage for FY 2005 by applying FY 2005 rates and policies, including an outlier threshold of $25,800 to available FY 2004 bills. d. 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 V.K. of the preamble to this proposed rule, we are proposing to satisfy 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 $977,410. 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 13 participating hospitals, the total annual impact of the demonstration program is estimated to be $12,706,334. The required adjustment to the Federal rate used in calculating Medicare inpatient prospective payments as a result of the demonstration is 0.999863. 6 These figures represent 3.0 standard deviations from the mean of the log distribution of cost-tocharge ratios for all hospitals. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00166 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04my05.064</GPH> As we did in establishing the FY 2005 outlier threshold (69 FR 49278), we are not including in the calculation of the outlier threshold the possibility that hospitals’ costto-charge ratios and outlier payments may be reconciled upon cost report settlement. We believe that, due to the policy implemented in the June 9, 2003 outlier final rule, cost-tocharge ratios will no longer fluctuate significantly and, therefore, few hospitals, if any, will actually have these ratios reconciled upon cost report settlement. In addition, it is difficult to predict which specific hospitals will have cost-to-charge ratios and outlier payments reconciled in their cost reports in any given year. We also note that reconciliation occurs because hospitals’ actual cost-to-charge ratios for the Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules In order to achieve budget neutrality, we are proposing to adjust national IPPS rates by an amount sufficient to account for the added costs of this demonstration. In other words, we are proposing to apply budget neutrality across the payment system as a whole rather than merely across the participants of this demonstration. We believe that the language of the statutory budget neutrality requirement permits the agency to implement the budget neutrality provision in this manner. This is because the statutory language requires that ‘‘aggregate payments made by the Secretary do not exceed the amount which the Secretary would have paid if the demonstration * * * was not implemented,’’ but does not identify the range across which aggregate payments must be held equal. 5. Proposed FY 2006 Standardized Amount The adjusted standardized amount is divided into labor-related and nonlaborrelated 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 amounts shown in the two tables differ only in that the labor-related share applied to the standardized amounts in VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Table 1A is 69.7 percent, and the laborrelated share applied to the standardized amounts in 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 the 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. The effect of this proposed application is that the labor-related share of the standardized amount is 62 percent for all hospitals whose wage indexes are less than or equal to 1.0000. As discussed in section IV.B.3. of the preamble to this proposed rule (reflecting the Secretary’s current estimate of the proportion of costs that are attributable to wages and wage-related costs), we are proposing to set the labor-related share of the standardized amount at 69.7 percent for hospitals whose wage indexes are greater than 1.0000. In addition, Tables 1A and 1B include proposed standardized amounts reflecting the full 3.2 percent update for FY 2006, and proposed standardized amounts reflecting the 0.4 percentage point reduction to the update applicable for hospitals that fail to submit quality data consistent with section 501(b) of Pub. L. 108–173. (Tables 1C and 1D show the PO 00000 Frm 00167 Fmt 4701 Sfmt 4702 23471 proposed standardized amounts for Puerto Rico for FY 2006, reflecting the different labor-related shares that apply, that is, 71.3 percent or 62 percent.) The following table illustrates the proposed changes from the FY 2005 national average standardized amount. The first column shows the proposed changes from the FY 2005 standardized amounts for hospitals that satisfy the quality data submission requirement for receiving the full update (3.2 percent). The second column shows the proposed changes for hospitals receiving the reduced update (2.8 percent). The first row of the table shows the proposed updated (through FY 2005) average standardized amount after restoring the FY 2005 offsets for outlier payments, demonstration budget neutrality, the wage index transition budget neutrality and geographic reclassification budget neutrality. The DRG reclassification and recalibration and wage index budget neutrality factor is cumulative. Therefore, the FY 2005 factor is not removed from the amount in the table. We have added separate rows to this table to reflect the different labor-related shares that apply to hospitals. E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 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 71.3 percent, or 62 percent, depending on which is more advantageous to the hospital. (Section 1886(d)(9)(C)(iv) of the Act, as amended by PO 00000 Frm 00168 Fmt 4701 Sfmt 4702 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.) E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.065</GPH> 23472 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules Tables 1A through 1D, as set forth in section VI. of this Addendum, contain the labor-related and nonlabor-related shares that we are proposing to use to calculate the prospective payment rates for hospitals located in the 50 States, the District of Columbia, and Puerto Rico. 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. Adjustment for Area Wage Levels Sections 1886(d)(3)(E) and 1886(d)(9)(C)(iv) of the Act require that we C. DRG Relative Weights As discussed in section II. of the preamble, we have developed a classification system for all hospital discharges, assigning them into DRGs, and have developed relative weights for each DRG that reflect the resource utilization of cases in each DRG relative to Medicare cases in other DRGs. Table 5 of section VI. of this Addendum contains the relative weights that we are proposing to use for discharges occurring in FY 2006. These factors have been recalibrated as explained in section II. of the preamble of this proposed rule. D. Calculation of Proposed Prospective Payment Rates for FY 2006 General Formula for Calculation of Prospective Payment Rates for FY 2006 The proposed operating prospective payment rate for all hospitals paid under the IPPS located outside of Puerto Rico, except SCHs and MDHs, equals the Federal rate based on the corresponding amounts in Table 1A or Table 1B in section VI. of this Addendum. The proposed prospective payment rate for SCHs equals the higher of the applicable Federal rate (from Table 1A or Table 1B) or the hospital-specific rate as described below. The proposed prospective payment rate for VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 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 2006 wage index. The proposed FY 2006 wage indexes are set forth in Tables 4A, 4B, 4C, and 4F of section VI. of this Addendum. 2. 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 2006, 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 appropriate adjustment factor contained in the table below. If the Office of Personnel Management releases revised cost-of-living adjustment factors before July 1, 2005, we will publish them in the final rule and use them in determining FY 2006 payments. MDHs equals the higher of the Federal rate, or the Federal rate plus 50 percent of the difference between the Federal rate and the hospital-specific rate as described below. The proposed prospective payment rate for Puerto Rico equals 25 percent of the Puerto Rico rate plus 75 percent of the applicable national rate from Table 1C or Table 1D in section VI. of this Addendum. the hospital is reclassified (see Tables 4A, 4B, and 4C of section VI. of this Addendum). Step 3—For hospitals in Alaska and Hawaii, multiply the nonlabor-related portion of the standardized amount by the appropriate cost-of-living adjustment factor. Step 4—Add the amount from Step 2 and the nonlabor-related portion of the standardized amount (adjusted, if appropriate, under Step 3). Step 5—Multiply the final amount from Step 4 by the relative weight corresponding to the appropriate 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. 1. Federal Rate For discharges occurring on or after October 1, 2005 and before October 1, 2006, except for SCHs, MDHs, and hospitals in Puerto Rico, payment under the IPPS is based exclusively on the Federal rate. The Federal rate is determined as follows: Step 1—Select the appropriate average standardized amount considering the applicable wage index (Table 1A for wage indexes greater than 1.0000 and Table 1B for wage indexes less than or equal to 1.0000) and whether the hospital has submitted qualifying quality data (full update for qualifying hospitals, update minus 0.4 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 PO 00000 Frm 00169 Fmt 4701 Sfmt 4702 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. E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.066</GPH> B. Adjustments for Area Wage Levels and Cost-of-Living 23473 23474 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules Section 1886(d)(5)(G) of the Act provides that MDHs are paid based on whichever of the following rates yields the greatest aggregate payment: The Federal rate or the Federal rate plus 50 percent of the difference between the Federal rate and the greater of the updated hospital-specific rates based on either FY 1982 or FY 1987 costs per discharge. MDHs do not have the option to use their FY 1996 hospital-specific rate. 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. For a more detailed discussion of the calculation of the hospitalspecific rates, we refer the reader to the September 1, 1983 interim final rule (48 FR 39772); the April 20, 1990 final rule with comment (55 FR 15150); the September 4, 1990 final rule (55 FR 35994); and the August 1, 2000 final rule (65 FR 47082). In addition, for both SCHs and MDHs, the hospitalspecific rate is adjusted by the proposed budget neutrality adjustment factor (that is, by the recalibration budget neutrality factor of 0.999003) as discussed in section V.C.2. of the preamble to this proposed rule. The resulting rate would be used in determining the payment rate an SCH or MDH would receive for its discharges beginning on or after October 1, 2005. b. Updating the FY 1982, FY 1987, and FY 1996 Hospital-Specific Rates for FY 2005 We are proposing to increase the hospitalspecific rates by 3.2 percent (the hospital market basket percentage increase) for SCHs and MDHs for FY 2006. Section 1886(b)(3)(C)(iv) of the Act provides that the update factor applicable to the hospitalspecific 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 2006, is the market basket rate of increase. 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 2006, 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, 2005 and Before October 1, 2006 Under section 504 of Pub. L. 108–173, effective for discharges 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 appropriate average standardized amount considering the applicable wage index (see Table 1C). Step 2—Multiply the labor-related portion of the standardized amount by the appropriate Puerto Rico-specific wage index (see Table 4F of section VI. of the Addendum). VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 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 appropriate DRG relative weight. Step 5—Multiply the result in Step 4 by 25 percent (see Table 5 of section VI. of the Addendum). b. National Rate The national prospective payment rate is determined as follows: Step 1—Select the appropriate average standardized amount considering the applicable wage index (see Table 1C). Step 2—Add the amount from Step 1 and the nonlabor-related portion of the national average standardized amount. Step 3—Multiply the amount from Step 2 by the appropriate DRG relative weight (see Table 5 of section VI. of the Addendum). Step 4—Multiply the result in Step 3 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 2006 (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 2006, which would be effective for discharges occurring on or after October 1, 2005. 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 PO 00000 Frm 00170 Fmt 4701 Sfmt 4702 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, and before October 1, 2002, the unadjusted capital standard Federal rate is reduced by 17.78 percent. 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. 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 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, effective with cost reporting periods beginning in FY 2002, payments are no longer being made under the regular exception policy, 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 PPS 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 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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, 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 2005 IPPS final rule (69 FR 49283) and corrected in a December 30, 2004 correction notice (69 FR 78532), we established a capital Federal rate of $416.53 for FY 2005. In the discussion that follows, we explain the factors that were used to determine the proposed FY 2006 capital Federal rate. In particular, we explain why the proposed FY 2006 capital Federal rate would increase 0.7 percent compared to the FY 2005 capital Federal rate. We also estimate aggregate capital payments would decrease by 0.1 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 percent during this same period. This decrease is due to several factors, including a projected decrease in the number of Medicare fee-for-service hospital admissions, and a decrease in the proposed geographic adjustment factor (GAF) values (which are based on the proposed wage index values). Our Office of the Actuary projects a decrease in Medicare fee-for-service Part A enrollment, in part, because of a projected increase in Medicare managed care enrollment as a result of the implementation of several provisions of Pub. L. 108–173. We are projecting a slight increase in the proposed GAF values (based on the proposed wage index) for some hospitals as a result of the completion of the transition to the CBSAbased labor market area definitions (as discussed in section III. of the preamble of this proposed rule). Thus, we are projecting that capital PPS payments would remain relatively unchanged from FY 2005 to FY 2006. 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. Aggregate payments under the capital IPPS are estimated to decrease slightly in FY 2006 compared to FY 2005, as discussed above. 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 2006 under that framework is 0.7 percent based on the best data available at this time. The proposed update factor is based on a projected 0.7 percent increase in the CIPI, a 0.0 percent adjustment for intensity, a 0.0 percent adjustment for case-mix, a 0.0 percent adjustment for the FY 2004 DRG 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 2006 CIPI projection in that same section of this Addendum. Below we describe the proposed policy adjustments that have been applied. 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: • The average resource use of Medicare patients changes (‘‘real’’ case-mix change); PO 00000 Frm 00171 Fmt 4701 Sfmt 4702 23475 • Changes in hospital coding of patient records result in higher weight DRG assignments (‘‘coding effects’’); and • 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, 2005 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 III. of Appendix B of this proposed rule.) For FY 2006, we are projecting a 1.0 percent total increase in the case-mix index. We estimate that the real case-mix increase would also equal 1.0 percent in FY 2006. The net adjustment for change in case-mix is the difference between the projected increase in real case-mix and the projected total increase in real case-mix. Therefore, the net proposed adjustment for case-mix change in FY 2006 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 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 2004 DRG reclassification and recalibration as part of our proposed update for FY 2006. We estimate that FY 2004 DRG reclassification and recalibration would result in a 0.0 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 0.0 percent adjustment for DRG reclassification and recalibration in the update for FY 2006 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 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules lag between the forecast and the measurement of the forecast error. A forecast error of -0.1 percentage points was calculated for the FY 2004 update. That is, current historical data indicate that the forecasted FY 2004 CIPI used in calculating the FY 2004 update factor (0.7 percent) slightly overstated the actual realized price increases (0.6 percent) by 0.1 percentage points. This slight overprediction was mostly due to a prediction of the cuts in the interest rate by the Federal Reserve Board in 2004. However, the Federal Reserve Board did not cut interest rates during 2004, which impacted the interest component of the CIPI. However, since 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 2006. Under the capital IPPS system framework, we also make an adjustment for changes in intensity. We calculate this adjustment using the same methodology and data that are used in the framework for the operating PPS. 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 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 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 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 case-mix change was not dependent on total change, but was usually a fairly steady 1.0 to 1.4 percent per year. 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. Using the methodology described above, for FY 2006 we examined the change in total PO 00000 Frm 00172 Fmt 4701 Sfmt 4725 charges per admission, adjusted for price level changes (the CPI for hospital and related services), and changes in real casemix for FYs 1999 through 2004. We found that, over this period and in particular the last 4 years of this period (FYs 2000 through 2003), the charge data appear to be skewed. More specifically, we found a dramatic increase in hospital charges for FYs 2000 through 2004 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 and FY 2005 update recommendations as discussed in the FY 2004 IPPS final rule (68 FR 45482) and the FY 2005 IPPS final rule (69 FR 49285), 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 2005 IPPS final rule (69 FR 49285), 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 2005. We believed that it was appropriate to apply a zero intensity adjustment until we believe that any increase in charges can be tied to intensity rather than to attempts to maximize outlier payments. As discussed above, we believe that the most recently available charge data used to make this determination may still be inappropriately skewed. Therefore, we are proposing a 0.0 percent adjustment for intensity for FY 2006. 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 propose to apply a zero intensity adjustment for FY 2006 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 0.7 percent capital update factor for FY 2006 as shown in the table below. E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.067</GPH> 23476 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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 2005 Report to Congress, MedPAC did not make an update recommendation for capital PPS payments for FY 2006. However, in that same report, MedPAC made an update recommendation for hospital inpatient and outpatient services (page 40). MedPAC reviews inpatient and outpatient services together since they are so closely interrelated. MedPAC recommended an increase in the payment rate for the operating IPPS by the projected increase in the hospital market basket index, less 0.4 percent for FY 2006, based on their assessment of beneficiaries’ access to care, volume of services, access to capital, quality of care, and the relationship of Medicare payments and costs. In addition, the Commission considered the efficient provision of services in making its FY 2006 update recommendations. (MedPAC’s Report to the Congress: Medicare Payment Policy, March 2005, page 44.) 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 FY 2005 IPPS final rule (69 FR 49286), we estimate that outlier payments for capital will equal 4.94 percent of inpatient capital-related payments based on the capital Federal rate in FY 2005. Based on the thresholds as set forth in section II.A.4.c. of this Addendum, we estimate that outlier payments for capital would equal 5.03 percent for inpatient capital-related payments based on the proposed Federal rate in FY 2006. Therefore, we are proposing to apply an outlier adjustment factor of 0.9497 to the capital Federal rate. Thus, the percentage of capital outlier payments to total capital standard payments for FY 2006 would be higher than the percentages for FY 2005. The outlier reduction factors are not built permanently into the capital rates; that is, they are not applied cumulatively in VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 determining the capital Federal rate. The proposed FY 2006 outlier adjustment of 0.9497 is a ¥0.09 percent change from the FY 2005 outlier adjustment of 0.9506. The net change in the proposed outlier adjustment to the capital Federal rate for FY 2006 is 0.9991 (0.9497/0.9506). Thus, the proposed outlier adjustment decreases the FY 2006 capital Federal rate by 0.09 percent compared with the FY 2005 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. Since 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 2006, we compared (separately for the national capital rate and the Puerto Rico capital rate) estimated aggregate capital Federal rate payments based on the FY 2005 DRG relative weights and the average FY 2005 GAF (that is, the weighted average of PO 00000 Frm 00173 Fmt 4701 Sfmt 4702 23477 the GAFs applied from October 2004 through December 2004 and the GAFs applied from January 2005 through September 2005) to estimated aggregate capital Federal rate payments based on the proposed FY 2006 relative weights and the proposed FY 2006 GAF. As we established in the FY 2005 IPPS final rule (69 FR 49287), the budget neutrality factors were 0.9914 for the national capital rate and 0.9895 for the Puerto Rico capital rate for discharges occurring on or after October 1, 2004 through December 31, 2004 (the first quarter of FY 2005). As a result of the corrections to the FY 2005 GAF values established in the December 30, 2004 correction notice (69 FR 78531), effective for January 1, 2005 through September 30, 2005 (the last three quarters of FY 2005), the budget neutrality factor for the national capital rate is 0.9912 and the budget neutrality factor for the Puerto Rico capital rate remained unchanged (0.9895). For FY 2005, the weighted average budget neutrality adjustment factors were 0.9912 (0.9914 × 1⁄4 + 0.9912 × 3⁄4) for the national capital rate (calculations were done on unrounded numbers) and 0.9895 for the Puerto Rico capital rate. In making the comparison, we set the regular and special exceptions reduction factors to 1.00. To achieve budget neutrality for the changes in the national GAF, based on calculations using updated data, we are proposing to apply an incremental budget neutrality adjustment of 1.0022 for FY 2006 to the weighted average of the previous cumulative FY 2005 adjustments of 0.9912 (yielding a proposed adjustment of 0.9934) through FY 2006 (calculations done on unrounded numbers). For the Puerto Rico GAF, we are proposing to apply an incremental budget neutrality adjustment of 1.0240 for FY 2006 to the previous cumulative FY 2005 adjustment of 0.9895, yielding a proposed cumulative adjustment of 1.0132 through FY 2006. We then compared estimated aggregate capital Federal rate payments based on the FY 2005 DRG relative weights and the average FY 2005 GAF to estimated aggregate capital Federal rate payments based on the proposed FY 2006 DRG relative weights and the proposed FY 2006 GAF. The proposed incremental adjustment for DRG classifications and changes in relative weights is 0.9998 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 2005 are 0.9931 nationally and 1.013 for Puerto Rico. The following table summarizes the adjustment factors for each fiscal year: E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules The methodology used to determine the proposed recalibration and geographic (DRG/ GAF) budget neutrality adjustment factor for FY 2006 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 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 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. PO 00000 Frm 00174 Fmt 4701 Sfmt 4702 In the FY 2005 IPPS final rule (69 FR 49288), we calculated a GAF/DRG budget neutrality factor of 1.0006 for FY 2005. As we noted above, as a result of the revisions to the GAF effective for discharges occurring on or after January 1, 2005 established in the December 30, 2004 correction notice (69 FR 78351), we calculated a GAF/DRG budget neutrality factor of 1.0004 for discharges occurring in the remainder of FY 2005. For FY 2006, we are proposing a GAF/DRG budget neutrality factor of 1.0019. The GAF/ E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.068</GPH> 23478 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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 proposed incremental change in the adjustment from the average from FY 2005 to FY 2006 is 1.0019. The proposed cumulative change in the capital Federal rate due to this adjustment is 0.9931 (the product of the incremental factors for FYs 1993 through 2005 and the proposed incremental factor of 1.0019 for FY 2006). (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 0.9931 for FY 2006.) This proposed factor accounts for DRG reclassifications and recalibration and for changes in the GAF. It also incorporates the effects on the GAF of FY 2006 geographic reclassification decisions made by the MGCRB compared to FY 2005 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. Proposed 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 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 proposed FY 2006 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 special exceptions VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 adjustment used in calculating the proposed FY 2006 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). Since we have cost reports ending in FY 2004 for all of these hospitals, we calculated the proposed adjustment based on actual cost experience. Using data from cost reports ending in FY 2004 from the December 2004 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 2004, this ratio is rounded to 0.0003. Because we have not received all cost reports ending in FY 2004, we also divided the FY 2004 special exceptions payments by the total capital PPS payment amounts for all hospitals with cost reports ending in FY 2003. This ratio also rounds to 0.0003. Because special exceptions are budget neutral, we are proposing to offset the capital Federal rate by 0.03 percent for special exceptions payments for FY 2006. Therefore, the proposed exceptions adjustment factor is equal to 0.9997 (1¥0.0003) to account for special exceptions payments in FY 2006. In the FY 2005 IPPS final rule (69 FR 49288), we estimated that total (special) exceptions payments for FY 2005 would equal 0.04 percent of aggregate payments based on the capital Federal rate. Therefore, we applied an exceptions adjustment factor of 0.9996 (1¥0.0004) in determining the FY 2005 capital Federal rate. As we stated above, we estimate that exceptions payments in FY 2006 would equal 0.03 percent of aggregate payments based on the proposed FY 2006 capital Federal rate. Therefore, we are proposing to apply an exceptions payment adjustment factor of 0.9997 to the capital Federal rate for FY 2006. The proposed exceptions adjustment factor for FY 2006 is 0.01 percent higher than the factor for FY 2005 published in the FY 2005 IPPS final rule (69 FR 49288). The exceptions reduction factors are not built permanently into the PO 00000 Frm 00175 Fmt 4701 Sfmt 4702 23479 capital rates; that is, the factors are not applied cumulatively in determining the capital Federal rate. Therefore, the proposed net change in the exceptions adjustment factor used in determining the proposed FY 2006 capital Federal rate is 1.0001 (0.9997/ 0.9996). 5. Proposed Capital Standard Federal Rate for FY 2006 In the FY 2005 IPPS final rule (69 FR 49283) and corrected in a December 30, 2004 correction notice (69 FR 78532), we established a capital Federal rate of $416.53 for FY 2005. In this proposed rule, we are proposing to establish a capital Federal rate of $419.90 for FY 2006. The proposed capital Federal rate for FY 2006 was calculated as follows: • The proposed FY 2006 update factor is 1.0070; that is, the update is 0.7 percent. • The proposed FY 2006 budget neutrality adjustment factor that is applied to the capital standard Federal payment rate for changes in the DRG relative weights and in the GAF is 1.0019. • The proposed FY 2006 outlier adjustment factor is 0.9497. • The proposed FY 2006 (special) exceptions payment adjustment factor is 0.9997. 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 proposing to make no additional adjustments in the capital standard Federal rate for these factors, other than the budget neutrality factor for changes in the DRG relative weights and the GAF. We are providing a chart that shows how each of the proposed factors and adjustments for FY 2006 affected the computation of the proposed FY 2006 capital Federal rate in comparison to the average FY 2005 capital Federal rate. The proposed FY 2006 update factor has the effect of increasing the capital Federal rate by 0.70 percent compared to the average FY 2005 Federal rate. The proposed GAF/DRG budget neutrality factor has the effect of increasing the capital Federal rate by 0.19 percent. The proposed FY 2006 outlier adjustment factor has the effect of decreasing the capital Federal rate by 0.09 percent compared to the average FY 2005 capital Federal rate, and the proposed FY 2006 exceptions payment adjustment factor has the effect of increasing the capital Federal rate by 0.01 percent compared to the exceptions payment adjustment factor for the FY 2005 capital Federal rate. The combined effect of all the proposed changes is to increase the capital Federal rate by 0.81 percent compared to the average FY 2005 capital Federal rate. E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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 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. Under the broad authority of section 1886(g) of the Act, as discussed in section VI. of the preamble of this proposed rule, beginning with discharges occurring on or after October 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 1.0240, while VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 the proposed DRG adjustment is 0.9998, for a combined cumulative adjustment of 1.0130. 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 2005, before application of the GAF, the special capital rate for Puerto Rico hospitals was $199.01 for discharges occurring on or after October 1, 2004 through September 30, 2005. With the changes we are proposing to the factors used to determine the capital rate, the proposed FY 2006 special capital rate for Puerto Rico is $205.64. B. Calculation of Proposed Inpatient CapitalRelated Prospective Payments for FY 2006 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 2006. The applicable proposed capital Federal rate was determined by making adjustments as follows: • For outliers, by dividing the proposed capital standard Federal rate by the proposed outlier reduction factor for that fiscal year; and • For the payment adjustments applicable to the hospital, by multiplying the hospital’s proposed GAF, disproportionate share adjustment factor, and IME adjustment factor, when appropriate. For purposes of calculating payments for each discharge during FY 2006, the capital standard Federal rate is adjusted as follows: PO 00000 Frm 00176 Fmt 4701 Sfmt 4702 (Standard Federal Rate) × (DRG weight) × (GAF) × (Large Urban Add-on, if applicable) × (COLA adjustment for hospitals located in Alaska and Hawaii) × (1 + Disproportionate Share Adjustment Factor + IME Adjustment Factor, if applicable). The result is the adjusted capital Federal rate. 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 2006 are in section II.A.4.c. of this Addendum. For FY 2006, 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 $26,675. 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 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.069</GPH> 23480 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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 PPS 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 hospitals under the appropriate transition methodology. If the hold-harmless methodology were applicable, the hold-harmless 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 1997 in the FY 2003 IPPS final rule (67 FR 50044). (We note that we are proposing a rebasing to FY 2002 in section IV. of the preamble of this proposed rule.) 2. Forecast of the CIPI for FY 2006 Based on the latest forecast by Global Insight, Inc. (first quarter of 2005), we are forecasting the CIPI to increase 0.7 percent in FY 2006. This reflects a projected 1.3 percent increase in vintage-weighted depreciation prices (building and fixed equipment, and movable equipment) and a 2.7 percent increase in other capital expense prices in FY 2006, partially offset by a 2.3 percent decline in vintage-weighted interest expenses in FY 2006. The weighted average of these three VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 factors produces the 0.7 percent increase for the CIPI as a whole in FY 2006. 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 comment.) A. Payments to Existing Excluded Hospitals and Units As discussed in section VII. of the preamble of this proposed rule, in accordance with section 1886(b)(3)(H)(i) of the Act and effective for cost reporting periods beginning on or after October 1, 2002, payments to existing psychiatric hospitals and units, rehabilitation hospitals and units, and long-term care hospitals (LTCHs) excluded from the IPPS are no longer subject to a cap on a hospital-specific target amount (expressed in terms of the inpatient operating cost per discharge under TEFRA) that is set for each hospital, based on the hospital’s own historical cost experience trended forward by the applicable percentage increase. However, the inpatient operating costs of children’s hospitals and cancer hospitals that are excluded from the IPPS continue to be subject to the rate-of-increase limits established under the authority of section 1886(b) of the Act and § 413.40 of the regulations. This target amount is applied as a ceiling on the allowable costs per discharge for the hospital’s cost reporting period. Effective for cost reporting periods beginning on or after October 1, 2002, rehabilitation hospitals and units are paid 100 percent of the adjusted Federal prospective payment rate under the IRP PPS. Effective for cost reporting periods beginning on or after October 1, 2002, LTCHs also are no longer paid on a reasonable cost basis, but are paid under a LTCH DRG-based PPS. In implementing the LTCH PPS for existing LTCHs, we established a 5-year transition period from reasonable cost-based payments (subject to the TEFRA limit) to fully Federal prospective payment amounts during which a LTCH may receive a blended payment consisting of two payment components—one based on reasonable cost under the TEFRA payment system, and the other based on the standard Federal prospective payment rate. However, an existing LTCH may elect to be paid based on 100 percent of the standard Federal prospective payment rate during the transition period. IPFs that have their first cost reporting period beginning on or after January 1, 2005, are not paid on a reasonable cost basis but paid under a prospective per diem payment system. As part of the PPS for existing IPFs, we have established a 3-year transition period during which IPFs will be paid based on a blend of reasonable cost-based payment (subject to the TEFRA limit) and the prospective per diem payment rate. For cost reporting periods beginning on or after January l, 2008, IPFs will be paid 100 percent of the Federal prospective per diem payment amount. Excluded psychiatric hospitals and units as well as LTCHs that are paid under a blended PO 00000 Frm 00177 Fmt 4701 Sfmt 4702 23481 methodology will have the reasonable costbased portion of their payment subject to a hospital target amount and, if applicable, the payment amount limitation. B. Updated Caps for New Excluded Hospitals and Units Section 1886(b)(7) of the Act established the method for determining the payment amount for new rehabilitation hospitals and units, psychiatric hospitals and units, and LTCHs that first received payment as a hospital or unit excluded from the IPPS on or after October 1, 1997. However, due to the implementation of the IRF PPS, effective for cost reporting periods beginning on or after October 1, 2002, this payment amount (or ‘‘new provider cap’’) no longer applies to any new rehabilitation hospital or unit because they now are paid 100 percent of the Federal prospective rate under the IRF PPS. In addition, LTCHs that meet the definition of a new LTCH under § 412.23(e)(4) are paid 100 percent of the fully Federal prospective payment rate. In contrast, those ‘‘new’’ LTCHs that meet the criteria under § 413.40(f)(2)(ii) (that is, that were not paid as an excluded hospital prior to October 1, 1997, but were paid as a LTCH before October 1, 2002), may be paid under the LTCH PPS transition methodology, with the reasonable cost portion of the payment subject to § 413.40(f)(2)(ii). Finally, LTCHs that existed prior to October 1, 1997, may also be paid under the LTCH PPS transition methodology, with the reasonable cost portion subject to § 413.40(c)(4)(ii). (The last LTCHs that were subject to the payment amount limitation for ‘‘new’’ LTCHs were new LTCHs that had their first cost reporting period beginning on September 30, 2002. In that case, the payment amount limitation remained applicable for the next 2 years— September 30, 2002 through September 29, 2003, and September 30, 2003 through September 29, 2004. This is because, under existing regulations at § 413.40(f)(2)(ii), the ‘‘new hospital’’ would be subject to the same payment (target amount) in its second cost reporting period that was applicable to the LTCH in its first cost reporting period. Accordingly, for this hospital, the updated payment amount limitation that we published in the FY 2003 IPPS final rule (67 FR 50103) applied through September 29, 2004. Consequently, there is no longer a need to publish updated payment amounts for new (§ 413.40(f)(2)(ii)) LTCHs. A discussion of how the payment limitations were calculated can be found in the August 29, 1997 final rule with comment period (62 FR 46019); the May 12, 1998 final rule (63 FR 26344); the July 31, 1998 final rule (63 FR 41000); and the July 30, 1999 final rule (64 FR 41529). With the implementation of the LTCH PPS, payment limitations do not apply to any new LTCHs that meet the definition at § 412.23(e)(4) because they are paid 100 percent of the Federal prospective payment rate. A freestanding inpatient rehabilitation hospital, an inpatient rehabilitation unit of an acute care hospital, and an inpatient rehabilitation unit of a CAH are referred to as IRFs. Effective for cost reporting periods beginning on or after October 1, 2002, this E:\FR\FM\04MYP2.SGM 04MYP2 23482 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules payment limitation is also no longer applicable to new rehabilitation hospitals and units because they are paid 100 percent of the Federal prospective rate under the IRF PPS. Therefore, it is also no longer necessary to update the payment limitation for new rehabilitation hospitals or units. Under the IPF PPS, there is a 3-year transition period during which existing IPFs will receive a blended payment of the Federal per diem payment amount and the payment amount that IPFs would receive under the reasonable cost-based payment (TEFRA) methodology. IPFs that were ‘‘new’’ under § 413.40(f)(2)(ii) (that is, that were not paid as an excluded hospital prior to October 1, 1997, but were paid as an IPF prior to January 1, 2005), would have the reasonable cost portion of the transition period payment subject to the payment amount limitation as determined according to § 413.40(f)(2)(ii). The last ‘‘new’’ IPFs that were subject to the payment amount limitation were IPFs that had their first cost reporting period beginning on December 31, 2004. For these hospitals, the payment amount limitation that was published in the FY 2005 IPPS final rule (69 FR 49189) for cost reporting periods beginning on or after October 1, 2004, and before January 1, 2005, remains applicable for the IPF’s first two cost reporting periods. IPFs with a first cost reporting period beginning on or after January 1, 2005, are paid 100 percent of the Federal rate and are not subject to the payment amount limitation. Therefore, since the last IPFs eligible for a blended payment have a cost reporting period beginning on December 31, 2004, the payment limitation published for FY 2005 remains applicable for these IPFs, and publication of the updated payment amount limitation is no longer needed. We note that IPFs that existed prior to October 1, 1997, may also be paid under the IPF transition methodology with the reasonable cost portion of the payment subject to § 413.40(c)(4)(ii). The payment limitations for new hospitals under TEFRA do not apply to new LTCHs, IRFs, or IPFs, that is, these hospitals with their first cost reporting period beginning on or after the date that the particular class of hospitals implemented the respective PPS. Therefore, for the reasons noted above, we are proposing to discontinue publishing Tables 4G and 4H (Pre-Reclassified Wage Index for Urban and Rural Areas, respectively) in the annual proposed and final IPPS rules. V. Payment for Blood Clotting Factor Administered to Hemophilia Inpatients (If you choose to comment on issues in this section, please include the caption ‘‘Payment for Blood Clotting Factor’’ at the beginning of your comments.) As discussed in section VIII. of the preamble to this proposed rule, section 1886(a)(4) of the Act excludes the costs of administering blood clotting factors to individuals with hemophilia from the definition of ‘‘operating costs of inpatient hospital services.’’ Section 6011(b) of Pub. L. 101–239 (the Omnibus Budget Reconciliation Act of 1989) provides that the Secretary shall determine the payment amount made to VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 hospitals under Part A of Title XVIII of the Act for the costs of administering blood clotting factors to individuals with hemophilia by multiplying a predetermined price per unit of blood clotting factor by the number of units provided to the individual. Currently, we use the average wholesale price (AWP) methodology used to determine rates paid for Medicare Part B drugs to price blood clotting factors administered to inpatients who have hemophilia under Medicare Part A. Section 303 of Pub. L. 108– 173 amended the Act by adding section 1847A, which changed the drug pricing system under Medicare Part B. Effective January 1, 2005, section 1847A of the Act established a payment methodology based on average sales price (ASP) under which almost all Medicare Part B drugs and biologicals not paid on a cost or prospective basis are paid at 106 percent of the ASP. In the FY 2005 IPPS final rule (69 FR 49292), we had instructed the fiscal intermediaries for FY 2005 to continue to use the Single Drug Pricer (SDP) to establish the pricing limits for the blood clotting factor administered to hemophilia inpatients at 95 percent of the AWP. We did not use the new ASP pricing methodology for Part A blood clotting factor in FY 2005 because the IPPS final rule was published in advance of final regulations implementing the ASP payment methodology for Part B drugs and biologicals. Final regulations establishing the ASP methodology and the furnishing fee for blood clotting factor under Medicare Part B were published on November 15, 2004 (69 FR 66299). Therefore, we believe that a consistent methodology should be used to pay for blood clotting factor administered under both Medicare Part A and Part B. For this reason, we are proposing for FY 2006 that the fiscal intermediaries make payment for blood clotting factor using 106 percent of ASP and make payment for the furnishing fee at $0.14 per individual unit (I.U.) that is currently used for Medicare Part B drugs. The ASP will be updated quarterly. The furnishing fee will be updated annually based on the consumer price index. VI. 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, 4F, 4J, 5, 6A, 6B, 6C, 6D, 6E, 6F, 6G, 6H, 7A, 7B, 8A, 8B, 9A, 9B, 9C, 10, and 11 are presented below. 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 PO 00000 Frm 00178 Fmt 4701 Sfmt 4702 Year 2004; Hospital Average Hourly Wage for Federal Fiscal Years 2004 (2000 Wage Data), 2005 (2001 Wage Data), and 2006 (2002 Wage Data) Wage Indexes and 3-Year Average of Hospital Average Hourly Wages; Table 3A—FY 2006 3-Year Average Hourly Wage for Urban Areas by CBSA; Table 3B—FY 2006 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; Table 4B—Wage Index and Capital Geographic Adjustment Factor (GAF) for Rural Areas by CBSA; Table 4C—Wage Index and Capital Geographic Adjustment Factor (GAF) for Hospitals That Are Reclassified by CBSA; Table 4F—Puerto Rico Wage Index and Capital Geographic Adjustment Factor (GAF) by CBSA; Table 4J—Out-Migration Adjustment—FY 2006; Table 5—List of Diagnosis Related Groups (DRGs), Relative Weighting Factors, 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 Exclusions List; Table 6H—Deletions from the CC Exclusions List; Table 7A—Medicare Prospective Payment System Selected Percentile Lengths of Stay FY 2004 MedPAR Update December 2004 GROUPER V22.0; Table 7B—Medicare Prospective Payment System Selected Percentile Lengths of Stay FY 2004 MedPAR Update December 2004 GROUPER V23.0; Table 8A—Statewide Average Operating Cost-to-Charge Ratios—March 2005; Table 8B—Statewide Average Capital Cost-toCharge Ratios—March 2005; Table 9A—Hospital Reclassifications and Redesignations by Individual Hospital and CBSA—FY 2006; Table 9B—Hospital Reclassifications and Redesignations by Individual Hospital Under Section 508 of Pub. L. 108–173— FY 2006; Table 9C—Hospitals Redesignated as Rural under Section 1886(s)(8)(E) of the Act— FY 2006; 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 Diagnosis-Related Groups (DRGs)— March 2005; Table 11—Proposed FY 2006 LTC-DRGs, Relative Weights, Geometric Average Length of Stay, and 5/6ths of the Geometric Average Length of Stay. E:\FR\FM\04MYP2.SGM 04MYP2 23483 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / 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 (3.2 Percent) Labor-related Reduced update (2.8 Percent) Nonlabor-related $3,286.14 Labor-related $1,428.55 Nonlabor-related $3,273.40 $1,423.01 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 (3.2 Percent) Labor-related Reduced update (2.8 Percent) Nonlabor-related $2,923.11 Labor-related $1,791.58 Nonlabor-related $2,911.78 $1,784.63 TABLE 1C.—ADJUSTED OPERATING STANDARDIZED AMOUNTS FOR PUERTO RICO, LABOR/NONLABOR Rates if wage index less than or equal to 1 Rates if wage index greater than 1 Labor National ............................................................................................................................ uerto Rico ........................................................................................................................ Nonlabor $3,286.14 $1,608.99 $1,428.55 $647.66 Labor $2,923.11 $1,431.24 Nonlabor $1,791.58 $812.25 TABLE 1D.—CAPITAL STANDARD FEDERAL PAYMENT RATE Rate National .................................................................................................................................................................................................... Puerto Rico .............................................................................................................................................................................................. $419.90 $205.64 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES Case-mix index Provider number 010001 ............................................................................. 010004 ............................................................................. 010005 h ........................................................................... 010006 ............................................................................. 010007 ............................................................................. 010008 ............................................................................. 010009 ............................................................................. 010010 h ........................................................................... 010011 ............................................................................. 010012 ............................................................................. 010015 ............................................................................. 010016 ............................................................................. 010018 ............................................................................. 010019 ............................................................................. 010021 h ........................................................................... 010022 ............................................................................. 010023 ............................................................................. 010024 ............................................................................. 010025 ............................................................................. 010027 ............................................................................. 010029 ............................................................................. 010031 ............................................................................. 010032 ............................................................................. 010033 ............................................................................. 010034 ............................................................................. 010035 ............................................................................. 010036 ............................................................................. 010038 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00179 1.4678 *** 1.1407 1.4394 1.0619 0.9712 0.9770 1.0191 1.5689 1.2232 0.9785 1.3257 1.3369 1.2272 1.1869 0.9401 1.8430 1.5884 1.3235 0.7634 1.5415 *** 0.8730 2.0553 0.9588 1.2540 1.1183 1.3277 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.7743 * 0.8872 0.8305 0.7495 0.8276 0.8517 0.9124 0.8979 0.9099 0.7495 0.8979 0.8979 0.8305 0.7743 0.9414 0.8600 0.8600 0.8402 0.7495 0.8402 * 0.7495 0.8979 0.8600 0.8872 0.7495 0.7702 19.4061 22.2674 19.6063 19.0976 17.5462 19.6573 20.4309 19.2644 25.8231 20.0896 18.8890 21.7918 19.2071 18.9177 17.7596 22.2267 20.4901 18.5942 19.3649 14.0975 20.9868 21.0176 16.4713 24.5088 14.9333 21.6182 19.2501 18.6578 20.6563 22.7585 20.4937 21.0241 16.8811 23.8333 21.6422 22.3021 24.8166 21.7622 20.4732 23.0414 20.5888 20.1336 20.7108 25.8797 23.7791 20.0067 19.8561 14.9585 21.6724 20.9463 18.5073 25.5165 17.1625 23.1319 20.5125 20.3935 21.3753 * 22.4906 23.4823 18.2430 20.4591 23.2229 22.3366 27.4850 22.7020 22.1736 25.1502 22.2990 22.0906 18.6785 24.5670 27.3303 20.7265 21.2674 15.3704 22.6976 * 19.1555 26.4666 16.9686 22.2870 22.9747 21.4509 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 20.5001 22.4801 20.9007 21.1655 17.5458 21.3782 21.7690 21.3489 26.0626 21.5233 20.6719 23.3217 20.6865 20.4039 19.0123 24.2502 23.6794 19.7702 20.1430 14.7992 21.8061 20.9818 18.1219 25.5126 16.3417 22.3532 20.9446 20.2189 23484 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 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 h ........................................................................... 010084 ............................................................................. 010085 ............................................................................. 010086 ............................................................................. 010087 ............................................................................. 010089 ............................................................................. 010090 ............................................................................. 010091 ............................................................................. 010092 ............................................................................. 010095 ............................................................................. 010097 ............................................................................. 010098 ............................................................................. 010099 ............................................................................. 010100 h ........................................................................... 010101 ............................................................................. 010102 ............................................................................. 010103 ............................................................................. 010104 ............................................................................. 010108 ............................................................................. 010109 ............................................................................. 010110 ............................................................................. 010112 ............................................................................. 010113 ............................................................................. 010114 ............................................................................. 010115 ............................................................................. 010118 ............................................................................. 010119 ............................................................................. 010120 ............................................................................. 010121 ............................................................................. 010125 ............................................................................. 010126 ............................................................................. 010128 ............................................................................. 010129 h ........................................................................... 010130 ............................................................................. 010131 ............................................................................. 010134 ............................................................................. 010138 ............................................................................. 010139 ............................................................................. 010143 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00180 1.6315 1.4605 1.0587 1.0475 1.0959 1.4626 0.8793 1.0828 1.0401 0.8969 0.8624 1.0098 1.0570 1.4983 1.5206 0.8800 1.0562 0.9666 1.0674 1.7183 1.4288 0.8327 1.2192 1.0478 1.1391 0.9330 1.3809 1.1647 1.2094 1.5531 1.2261 1.0771 1.9176 1.2348 1.6643 0.9178 1.5079 0.8622 0.7734 1.1131 0.9798 1.6637 1.1105 0.8953 1.8475 1.7281 1.0770 0.9471 0.7216 0.9699 1.6431 1.3235 0.8225 1.2436 *** 0.9483 *** 1.0257 1.1015 0.8325 0.9813 0.9433 1.3281 *** 0.6035 1.5206 1.1648 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.9124 0.7974 0.8979 0.8872 0.8872 0.7974 0.7495 0.7495 0.8979 0.8724 0.7495 0.7495 0.8517 0.7743 0.8979 0.8979 0.8517 0.7495 0.7743 0.8979 0.8276 0.7495 0.8979 0.7495 0.7702 0.7495 0.7702 0.9124 0.8089 0.8979 0.8517 0.7495 0.7902 0.8979 0.7902 0.7495 0.8724 0.8724 0.8600 0.7495 0.7495 0.8089 0.7702 0.7495 0.8979 0.8979 0.8600 0.7495 0.7495 0.7495 0.7902 0.8979 0.7495 0.8276 * 0.7902 * 0.7495 0.8276 0.7495 0.7902 0.8979 0.9124 0.7495 0.7495 0.8979 0.8872 23.0339 20.7779 19.9012 25.8560 22.7713 19.6754 16.1695 16.2973 20.7398 14.3006 11.9019 17.3238 20.6382 18.9664 21.1104 17.7800 20.5534 17.0447 17.1786 22.2280 17.2698 14.8696 18.3308 17.0957 18.8807 14.9826 20.1447 20.7401 19.8524 21.6522 22.5282 18.0122 19.7620 19.5783 20.0287 17.4672 19.9351 12.5243 15.1593 15.1629 16.3307 19.8146 19.0718 16.4637 22.5709 20.9391 20.7787 18.2235 16.0015 17.9243 19.4106 20.1763 15.7872 19.5302 20.5245 19.4368 17.1640 16.8622 19.9647 14.7646 16.4905 18.7190 22.9969 17.7717 14.2025 22.8390 20.5639 23.4151 21.6708 19.5422 23.0220 20.5658 20.8935 19.5937 17.7801 21.5625 14.7053 21.3673 17.4160 23.1894 19.1847 22.7183 20.3182 23.6963 20.5683 18.1323 25.4345 20.0108 17.0935 17.5690 19.6317 21.5419 16.4043 21.0633 20.4254 20.2166 22.5219 23.7007 19.4332 21.6226 22.2508 21.4322 19.4222 22.0709 13.4426 17.1735 19.6717 18.1849 20.0027 21.0085 19.9196 24.2201 24.1929 23.7803 21.7128 19.2706 17.2963 20.4181 21.5319 17.5985 18.8560 21.8215 20.5855 17.0329 16.8419 23.1856 17.9354 18.7821 18.4944 24.2197 * 13.5082 24.9410 22.1312 25.8594 22.8851 22.5945 21.4036 20.0357 21.6965 21.0604 20.2413 22.1584 15.2208 16.4959 19.0108 22.5554 22.6828 23.7144 18.5537 21.3237 21.9374 18.3435 26.1110 21.2363 17.6152 19.0789 21.3608 21.8169 16.4168 21.5616 21.8199 22.3041 24.7127 24.4710 18.6081 22.5225 22.7508 23.6948 18.6912 24.6542 13.9326 16.7548 14.3076 18.7909 21.2915 21.6593 21.0903 26.1163 24.9226 28.4624 21.7997 18.6633 16.8902 21.4209 22.3431 29.1465 19.7673 * 20.9450 24.0867 18.4114 23.1381 21.4201 21.3555 23.2488 25.7837 * 13.8475 25.3014 22.0215 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 24.1509 21.7864 20.7320 23.2608 20.9382 20.8067 18.8438 18.1494 21.5077 14.7351 15.4174 17.9166 22.1149 20.2397 22.5773 18.9295 21.8874 19.8090 17.8796 24.2542 19.5522 16.5083 18.3440 19.4027 20.7331 15.9303 20.9141 21.0143 20.7945 22.9810 23.5499 18.6721 21.2536 21.4924 21.7237 18.5367 22.1991 13.3037 16.2912 16.0844 17.7973 20.4113 20.5878 19.1526 24.2529 23.2581 24.2639 20.5179 18.1283 17.3960 20.4385 21.3345 19.5466 19.4467 21.1743 20.3424 18.5589 17.3762 22.1149 18.0579 19.1436 20.0658 24.4029 17.7717 13.8713 24.4108 21.5734 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23485 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 010144 ............................................................................. 010145 ............................................................................. 010146 ............................................................................. 010148 ............................................................................. 010149 ............................................................................. 010150 ............................................................................. 010152 ............................................................................. 010157 ............................................................................. 010158 ............................................................................. 010161 ............................................................................. 020001 ............................................................................. 020004 ............................................................................. 020005 ............................................................................. 020008 ............................................................................. 020010 ............................................................................. 020013 ............................................................................. 020017 ............................................................................. 020024 ............................................................................. 030001 ............................................................................. 030002 ............................................................................. 030003 ............................................................................. 030007 ............................................................................. 030009 ............................................................................. 030010 ............................................................................. 030011 ............................................................................. 030012 ............................................................................. 030013 ............................................................................. 030014 ............................................................................. 030016 ............................................................................. 030017 ............................................................................. 030018 ............................................................................. 030019 ............................................................................. 030022 ............................................................................. 030023 ............................................................................. 030024 ............................................................................. 030027 ............................................................................. 030030 ............................................................................. 030033 ............................................................................. 030036 ............................................................................. 030037 ............................................................................. 030038 ............................................................................. 030040 ............................................................................. 030043 ............................................................................. 030044 ............................................................................. 030055 h ........................................................................... 030059 ............................................................................. 030060 ............................................................................. 030061 ............................................................................. 030062 ............................................................................. 030064 ............................................................................. 030065 ............................................................................. 030067 ............................................................................. 030068 ............................................................................. 030069 h ........................................................................... 030080 ............................................................................. 030083 ............................................................................. 030085 ............................................................................. 030087 ............................................................................. 030088 ............................................................................. 030089 ............................................................................. 030092 ............................................................................. 030093 ............................................................................. 030094 ............................................................................. 030099 ............................................................................. 030100 ............................................................................. 030101 h ........................................................................... 030102 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00181 1.5626 1.2572 1.0392 0.8756 1.3179 1.0456 1.1957 1.1130 1.0822 *** 1.6973 1.1807 0.9509 1.2368 *** *** 1.9426 1.1382 1.3278 2.0596 *** 1.3390 0.8821 1.3277 1.4456 1.2863 1.3235 1.4420 1.2336 1.9999 1.2176 1.3058 1.5630 1.6295 1.9347 0.9159 1.6344 1.1959 1.3185 2.1135 1.5694 0.9316 1.3135 0.8987 1.3518 *** 1.1006 1.6076 1.1689 1.9175 1.5581 1.0095 1.0906 1.3425 1.5124 1.2683 1.5138 1.5725 1.3763 1.5398 1.3775 1.2260 1.3354 0.8991 1.9686 1.3930 2.4590 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.7902 0.8724 0.7702 0.7495 0.8600 0.7495 0.7902 0.8305 0.8517 * 1.2110 1.1977 1.1977 1.1977 1.1977 1.1977 1.2110 1.1977 1.0139 1.0139 * 0.8991 0.9007 0.9007 0.9007 0.9884 0.9102 1.0139 1.0139 1.0139 1.0139 1.0139 1.0139 1.2094 1.0139 0.8991 1.0139 1.1713 1.0139 1.0139 1.0139 0.8991 0.8991 0.8991 1.1416 * 0.8991 1.0139 0.8991 0.9007 1.0139 0.8991 0.8991 1.1416 0.9007 1.0139 0.9007 1.0139 1.0139 1.0139 1.0139 1.0139 1.0139 0.8991 0.9007 1.1416 1.0139 19.1497 22.1394 21.3083 17.6829 21.0086 21.2360 21.6038 19.6977 18.5464 * 30.1452 27.3516 32.7936 33.4543 20.7929 30.6423 30.3017 28.0930 25.7513 25.6038 22.1436 26.1551 19.9131 20.7204 21.0028 24.2366 21.9766 23.3663 24.3380 21.8792 24.9216 23.2973 24.9941 28.6627 26.7641 19.4583 25.2425 26.3814 24.9432 23.0542 25.2632 21.2717 23.5172 21.9503 22.8612 * 21.7685 22.9706 21.1639 22.8009 24.6064 18.4003 19.7097 24.5432 22.8953 24.3273 21.8196 25.6351 23.5761 24.5055 24.0515 23.2485 24.5992 20.3310 27.6299 23.7661 27.9419 20.6425 23.1976 19.9944 18.5309 23.1593 20.6738 22.1626 21.3574 22.4440 27.5119 31.6091 29.9926 * 34.5856 * * 32.9281 27.9799 27.7572 27.9628 * 26.9442 21.4065 22.8647 22.8422 25.5205 23.5229 25.1189 27.1583 24.4055 24.4308 28.4917 25.1461 28.4112 28.3470 21.0527 24.6005 26.6009 26.5708 30.3907 26.5178 22.5130 26.0825 19.5714 23.1837 24.7676 22.3551 23.4722 21.9849 24.6732 25.6738 19.1332 19.7030 25.6243 24.3573 24.9269 23.2070 26.3878 23.2478 26.2166 25.4127 23.5623 26.9985 26.7996 * 25.0077 * 20.7433 25.1442 20.8917 20.5294 26.5854 21.6377 22.6202 24.3560 24.3531 * 33.6407 32.0966 * 35.9236 * * 33.5852 33.0644 29.9840 29.0519 * 29.6174 22.3992 24.8275 25.1361 26.3859 25.7050 25.6259 26.7003 26.2452 28.9476 27.3156 26.4404 33.8333 31.6658 20.4031 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 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 20.2040 23.5267 20.7213 19.0227 23.4663 21.1783 22.1446 21.7462 21.6528 27.5119 31.9031 29.8229 32.7936 34.6652 20.7929 30.6423 32.3606 29.9221 27.8499 27.5075 22.1436 27.6578 21.1294 22.8055 23.0075 25.4550 23.8047 24.7232 26.0910 24.0378 25.9371 26.2053 25.5437 30.2808 28.9293 20.3074 26.5838 26.5511 27.3868 27.0409 27.6724 22.8703 24.8113 20.6512 23.5684 24.7676 22.7950 24.0363 22.3433 24.2954 25.8836 19.2370 20.1346 25.5167 24.1500 25.6343 23.3008 26.2197 24.5472 26.0965 25.7452 24.3686 27.0516 24.0344 28.4177 25.0150 28.5553 23486 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 030103 030104 030106 040001 040002 040003 040004 040007 040010 040011 040014 040015 040016 040017 040018 040019 040020 040021 040022 040024 040026 040027 040029 040032 040035 040036 040039 040041 040042 040045 040047 040050 040051 040053 040054 040055 040062 040066 040067 040069 040071 040072 040074 040075 040076 040077 040078 040080 040081 040084 040085 040088 040091 040100 040105 040107 040114 040118 040119 040126 040132 040134 040137 040138 040140 040141 040142 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00182 1.6379 *** 1.5145 1.0582 1.1265 1.0545 1.5197 1.6581 1.3488 1.0063 1.3420 1.0378 1.6546 1.0968 0.9839 1.1290 1.5076 1.2489 1.6031 1.0523 1.4887 1.3418 1.5379 0.9581 0.9080 1.5682 1.3369 1.1827 1.3549 0.9321 1.0748 1.0797 0.9177 0.9720 1.0287 1.5474 1.5855 1.0396 1.0244 1.0357 1.5128 1.0728 1.1860 0.9521 1.0208 0.9549 1.5395 0.9908 0.8047 1.0773 0.9955 1.3084 1.1599 1.3376 1.0117 0.7276 1.7030 1.4016 1.4402 0.8718 *** 2.4142 1.1908 1.2572 *** 0.7691 1.2882 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 1.0139 * 1.0139 0.8615 0.7478 0.7478 0.8615 0.8768 0.8615 0.7478 0.8552 0.7478 0.8768 0.8251 0.8231 0.9108 0.9108 0.8768 0.8615 0.7478 0.9066 0.8251 0.8768 0.7478 0.7478 0.8768 0.7793 0.8552 0.9346 0.7478 0.7793 0.7478 0.7478 0.7478 0.7478 0.8231 0.8231 0.7478 0.7478 0.9108 0.8552 0.8552 0.8768 0.7478 0.8552 0.7478 0.8552 0.7793 0.7478 0.8768 0.7478 0.8767 0.8293 0.8552 0.7478 0.7478 0.8768 0.7968 0.8552 0.7478 * 0.8768 0.8768 0.8615 * 0.8615 0.9066 29.1105 34.6028 * 18.7141 18.0776 16.3918 21.2335 23.3992 20.7114 18.8346 22.4970 18.8513 21.2198 17.7545 22.0408 21.1711 18.6419 23.5620 21.4194 17.5750 22.7699 19.3388 22.1882 16.2781 11.8237 21.6742 15.9673 20.4646 16.2285 19.5572 21.6323 15.1428 17.6964 19.2586 16.5573 19.7336 21.9336 21.7766 16.0516 20.5968 19.4324 19.3079 22.0800 15.7875 23.5947 16.7832 21.4854 18.4470 13.2797 20.1163 15.5811 20.0032 20.6688 17.8889 15.4697 17.6695 21.6849 21.7913 19.9013 13.3832 29.2343 24.4646 24.7813 22.3523 * * * 28.2832 * 30.4791 23.1475 19.3429 18.5000 23.3504 23.4565 22.0984 19.0319 24.0846 18.0793 22.7219 19.4365 23.8515 21.5316 20.9136 24.7771 23.7462 20.1101 24.3053 19.9348 22.8770 18.5171 13.4265 24.2851 17.7976 22.0188 18.9550 18.7952 21.5334 15.4782 18.8943 20.8153 16.7370 22.2237 21.6403 23.4616 15.1441 21.7607 22.9350 20.8269 22.6147 16.2583 21.0442 18.3261 24.4589 21.3483 13.7148 22.6441 18.0756 21.2974 23.0252 19.3560 15.8171 * 23.5628 24.2547 20.1631 12.5944 36.5525 * 23.4672 23.3615 25.1224 * * 30.1994 * 34.7222 23.7718 20.1384 * 25.0286 25.7142 23.0274 17.9740 25.3451 19.2831 22.1228 21.9875 23.6044 23.7328 21.6603 25.6917 25.3039 * 25.4072 21.1412 24.0704 * * 26.3226 19.5998 22.1531 19.9627 17.6742 21.9163 16.3930 19.1401 20.7824 18.2684 23.3156 23.1543 * 16.8799 24.4662 24.3824 19.9009 25.2423 18.3254 20.6272 17.1210 24.5378 22.3392 15.1081 24.7225 29.8444 22.6183 23.0080 20.0460 18.2182 * 24.8992 24.7363 21.0103 14.0701 28.1390 27.3412 25.2907 25.7513 * 24.0901 27.9695 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 29.2117 34.6028 32.1177 21.8056 19.2037 17.3854 23.2843 24.1728 21.9856 18.5849 23.9535 18.7435 22.0244 19.7066 23.2404 22.1722 20.4199 24.7363 23.4686 18.8371 24.2169 20.1077 23.0869 17.4291 12.6475 24.0976 17.8170 21.5535 18.3286 18.6280 21.6924 15.6589 18.6103 20.2863 17.1740 21.7960 22.2707 22.6592 16.0038 22.2668 22.1870 19.9951 23.2187 17.1733 21.3785 17.3842 23.4806 20.6867 14.0348 22.5619 19.6100 21.3215 22.2365 19.1639 16.4079 17.6695 23.4046 23.6447 20.3637 13.3074 31.3524 25.9794 24.5263 23.9295 25.1224 24.0901 27.9695 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23487 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 050002 050006 050007 050008 050009 050013 050014 050015 050016 050017 050018 050022 050024 050025 050026 050028 050029 050030 050032 050038 050039 050040 050042 050043 050045 050046 050047 050054 050055 050056 050057 050058 050060 050061 050063 050065 050067 050068 050070 050071 050072 050073 050075 050076 050077 050078 050079 050082 050084 050088 050089 050090 050091 050093 050096 050097 050099 050100 050101 050102 050103 050104 050107 050108 050110 050111 050112 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00183 1.3621 1.6269 1.4885 1.3528 1.7971 2.0269 1.1326 1.2904 1.2223 1.9454 1.1521 1.5867 1.0894 1.8083 1.5241 1.2262 *** 1.2312 *** 1.5479 1.6010 1.2018 1.3668 1.6285 1.2751 1.2116 1.7028 1.1776 1.2386 1.3348 1.6190 1.5358 1.4954 0.8559 1.3227 1.7399 1.2228 *** 1.2848 1.3395 1.3403 1.3622 1.2439 2.0351 1.6700 1.2906 1.4307 1.6699 1.5479 *** 1.3648 1.2969 1.1034 1.5128 1.3036 *** 1.5210 1.7200 1.2944 1.3036 1.5463 1.4057 1.3890 1.9703 1.2602 1.2835 1.5361 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 1.5474 1.1909 1.4970 1.4970 1.3955 1.3955 1.2953 1.0848 1.1357 1.2953 1.1762 1.1297 1.1417 1.1417 1.1417 1.0848 * 1.0848 * 1.5114 1.0848 1.1762 1.1909 1.5474 1.0848 1.1660 1.4970 1.1297 1.4970 1.1762 1.0848 1.1762 1.0848 1.1525 1.1762 1.1660 1.1885 * 1.4970 1.5474 1.5474 1.5474 1.5474 1.5474 1.1417 1.1762 1.5474 1.1660 1.1333 1.1357 1.1660 1.4739 1.1762 1.0848 1.1762 * 1.1660 1.1417 1.4888 1.1297 1.1762 1.1762 1.1525 1.2953 1.1525 1.1762 1.1762 30.9729 25.4604 34.1406 32.4067 30.2740 29.8401 27.7646 27.5652 25.5508 28.4911 17.9621 28.1312 25.1425 29.8262 24.2564 18.7866 30.2538 21.9251 28.8046 36.1619 26.8993 30.7426 27.6765 37.3217 22.1691 25.5490 34.4427 21.3495 36.1182 27.1458 24.2759 25.9389 22.9491 25.3042 28.6093 28.8369 27.8867 21.9031 39.5178 40.1344 39.2529 38.6763 40.2265 40.8075 27.1234 24.1091 38.8981 27.5022 26.0607 27.1103 24.7857 27.4193 29.2522 29.2642 23.0525 24.6726 27.1282 25.6798 32.9866 25.5763 27.8079 26.1592 22.6900 28.5244 21.9297 23.7715 31.9797 31.9709 27.6176 37.5804 36.9371 35.5384 31.7637 29.5726 30.1398 25.5735 30.5863 20.3179 28.2773 26.9378 31.7242 26.6406 21.5448 34.3934 22.9148 * 35.0441 29.8179 31.8983 29.8062 39.6054 22.7051 25.2786 39.3993 27.1437 36.9386 29.4829 26.2099 27.3584 26.5515 * 32.0515 33.8223 29.6982 * 40.5645 41.1036 40.8108 41.3430 43.7101 43.0845 29.6264 25.6814 42.7385 28.9139 28.2664 26.4093 29.4884 31.1774 30.1534 31.1083 24.2277 26.6788 28.7711 28.0303 35.4655 24.9381 28.7375 29.1240 27.6002 31.4271 20.0769 26.6345 34.0258 34.1948 30.5373 38.7033 39.1539 39.6393 31.9837 33.0373 30.7940 26.2162 36.8978 22.3472 29.8632 27.5587 36.1622 28.3027 26.6160 * 24.9707 * 38.7527 31.6734 32.7413 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 * 45.3382 45.3882 44.2651 45.9765 47.2356 46.4990 32.0245 27.9269 47.8597 37.7783 33.0179 25.7385 33.5323 32.9584 30.8560 33.4119 24.6680 * 31.0437 29.6949 39.5330 29.1364 34.2529 29.7326 33.1358 35.5711 22.4428 28.1588 36.8026 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 32.4064 27.9248 36.8959 36.3445 35.2947 31.2570 30.2311 29.4852 25.7788 31.9726 20.1629 28.8610 26.6747 32.6605 26.5474 21.9931 31.9320 23.2719 28.8046 36.6692 29.4369 31.8084 30.4516 40.0134 22.8906 25.5104 38.4201 24.0051 36.9364 28.1647 26.6650 29.0264 25.6824 28.5425 31.3845 32.3405 29.7844 21.9031 41.9509 42.3609 41.6223 42.1975 44.0053 43.5903 29.6181 25.7615 43.4884 31.5037 29.0525 26.4472 29.3416 30.4520 30.1209 31.3614 23.9648 25.5991 29.0188 27.8627 36.1079 26.2832 30.2688 28.3301 27.7768 32.0693 21.4435 26.1803 34.4310 23488 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 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 050148 050149 050150 050152 050153 050155 050158 050159 050167 050168 050169 050170 050173 050174 050175 050177 050179 050180 050186 050189 050191 050192 050193 050194 050195 050196 050197 050204 050205 050207 050211 050214 050215 050217 050219 050222 050224 050225 050226 050228 050230 050231 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00184 1.2729 1.3830 1.4364 1.5151 1.2630 1.1710 1.3350 1.5372 1.2385 1.3685 1.3912 1.3401 1.5403 1.7571 1.2972 1.4262 1.4967 0.9765 1.2106 1.2468 1.9167 1.2908 1.4660 1.4053 1.3142 1.1060 1.4351 1.1785 1.4009 1.5352 0.9838 1.2377 1.3232 1.3635 1.6244 1.4269 *** 1.2514 1.6425 1.2918 1.2491 1.2005 1.5845 *** 0.9939 1.4343 0.9731 1.1968 1.3119 1.5170 1.0762 1.9645 1.4068 1.2244 1.2714 1.2713 *** 1.6351 1.1451 1.0993 1.6663 1.7203 1.5203 1.5875 1.3521 1.3593 1.6236 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 1.4970 1.1762 1.1417 1.1762 1.1123 1.1885 1.0848 1.1333 1.1762 1.5114 1.1762 1.2953 1.1417 1.1660 1.4970 1.1762 1.0951 1.1762 1.4739 1.1762 1.1762 1.1762 1.1660 1.1762 1.4140 1.0848 1.1762 1.2953 1.4970 1.5114 1.1762 1.1762 1.1660 1.1333 1.1660 1.1762 * 1.1660 1.4739 1.1762 1.1660 1.1885 1.5474 * 1.4140 1.1762 1.0848 1.1660 1.5159 1.5474 1.0848 1.4970 1.1762 1.1762 1.0951 1.5474 1.1762 1.5114 1.0848 1.1762 1.1417 1.1660 1.0848 1.1660 1.5474 1.1660 1.1762 32.6932 28.1938 24.1481 28.2924 24.7555 28.9358 25.0858 29.1534 23.0843 35.6573 27.7126 21.8719 28.7668 25.2780 37.7845 27.8805 25.1948 * 31.6146 35.0503 43.0858 33.8749 36.1708 30.3679 37.5722 17.3908 28.0500 26.7728 34.5694 34.5870 21.2068 30.6598 27.4051 23.2022 27.5313 25.6896 29.4075 27.7070 33.5204 26.9627 23.1575 23.0583 36.9905 27.6638 32.3513 28.1689 19.5327 24.6307 28.1413 42.1735 20.7257 * 24.9458 25.2841 25.1863 34.3396 22.4773 36.6063 22.2055 21.8649 25.2922 26.2108 25.0219 26.0826 38.6751 30.0380 27.8896 34.2851 29.2858 27.5207 28.8193 28.2227 33.0650 25.5962 29.7629 26.7065 40.9218 29.6203 23.6208 28.3278 27.8488 38.6834 29.4317 27.6030 24.9415 35.2834 36.5409 43.8671 35.1013 37.5473 32.4042 39.5676 24.7063 30.1596 31.5333 40.3464 40.4446 21.8829 33.6400 30.8069 25.9850 30.8036 26.2864 * 27.6097 36.3117 31.5615 24.7531 25.8072 40.8101 * 20.0709 * 21.2448 30.7341 38.6750 43.9696 25.2168 40.8832 25.2512 28.0504 27.0216 38.3319 24.4785 41.6886 23.6286 22.9226 26.3882 26.7916 29.5184 29.2259 40.1362 34.1417 30.1298 33.8064 31.1294 30.9288 34.5110 32.4414 35.4044 27.9537 34.2416 28.0288 41.7020 26.4194 26.0500 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 * 30.3582 40.1747 30.5733 25.1442 27.1155 39.8123 * 29.1280 34.2091 27.0424 29.6421 40.9096 48.4358 32.1933 48.9052 28.6423 27.8611 29.5215 41.2166 23.9972 43.7985 24.9606 22.4065 29.1094 29.3143 29.9656 30.6541 42.4226 32.9555 30.9607 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 33.6092 29.5973 27.6106 30.5901 28.3268 32.6634 26.3210 31.1709 25.9680 39.5040 27.8473 23.7297 29.4553 28.7272 39.0707 30.7495 28.2112 24.6796 34.8123 36.7225 44.6742 35.5604 37.8550 32.1636 39.8846 22.6027 30.4737 29.9321 39.6060 39.3912 21.6128 33.3121 29.8120 25.9911 30.5684 26.5104 29.4075 28.5541 36.7717 29.6977 24.3743 25.4092 39.2517 27.6638 26.2226 31.2052 22.7189 28.4881 35.6972 44.9294 25.8088 44.8389 26.2829 27.0700 27.2272 37.8840 23.6229 40.7257 23.6369 22.4391 27.0242 27.4653 28.1785 28.6959 40.4482 32.4641 29.7082 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23489 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 050232 050234 050235 050236 050238 050239 050240 050242 050243 050245 050248 050251 050253 050254 050256 050257 050261 050262 050264 050267 050270 050272 050276 050277 050278 050279 050280 050281 050283 050286 050289 050290 050291 050292 050295 050296 050298 050299 050300 050301 050305 050308 050309 050312 050313 050315 050320 050324 050325 050327 050329 050331 050333 050334 050335 050336 050342 050348 050349 050350 050351 050352 050353 050355 050357 050359 050360 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00185 1.4386 1.1726 1.5578 1.3813 1.4440 1.5765 1.6442 1.3378 1.6214 1.3020 1.0286 1.0004 *** 1.2166 1.5778 0.9814 1.3007 2.1232 1.3196 *** 1.3272 1.3628 1.1883 1.0330 1.5907 1.2108 1.6443 1.4863 1.5233 *** 1.5691 1.6177 1.8090 0.9624 1.5134 1.1551 1.1272 1.2244 1.5741 1.2254 1.4519 1.4919 1.3873 1.4865 1.2403 1.2710 1.2238 1.9289 1.1756 1.6847 1.2743 1.1721 1.0706 1.6937 1.4438 1.1664 1.2238 1.6959 0.9453 1.3661 1.5133 1.2358 1.5568 *** 1.4494 1.1442 1.4616 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 1.1357 1.1417 1.1762 1.1660 1.1762 1.1762 1.1762 1.5159 1.1297 1.1660 1.4140 1.0848 1.1564 1.2953 1.1762 1.0848 1.0848 1.1762 1.5474 * 1.1417 1.1660 1.5474 1.1762 1.1762 1.1660 1.2207 1.1762 1.5474 * 1.4970 1.1762 1.4739 1.1297 1.0848 1.5114 1.1660 1.1762 1.1660 1.0848 1.5474 1.5114 1.2953 1.2207 1.1333 1.0848 1.5474 1.1417 1.0848 1.1660 1.1297 1.4739 1.0848 1.4140 1.0848 1.1333 1.0848 1.1660 1.0848 1.1762 1.1762 1.2953 1.1762 1.0848 1.1525 1.0848 1.4970 25.3439 24.0754 27.2838 27.0687 26.0312 27.0866 32.8542 34.4412 28.5626 25.7585 29.1192 24.4552 23.9246 23.3358 26.8618 17.4909 21.4693 33.0425 37.4742 26.6558 27.9871 24.0921 34.7422 35.6323 26.0331 23.5145 28.5504 25.7832 35.1831 19.7352 34.9645 31.9510 28.3451 27.6114 25.4332 33.5948 26.1707 26.9870 26.3182 25.7167 38.7597 31.6790 25.5367 28.2557 25.3372 23.6638 31.4570 28.4931 26.6325 33.0549 26.6341 21.5193 15.6929 37.2336 24.9274 23.2687 23.0282 28.9864 15.6043 27.2573 27.4042 32.6572 25.4309 * 25.2126 22.9175 35.9032 24.4383 29.2421 27.8965 28.1969 29.1481 28.2327 35.2284 39.7629 31.8153 27.0949 31.6240 26.5021 22.2450 24.1512 28.4728 20.8367 25.3005 36.1162 41.3478 26.7060 30.0540 25.9103 41.2251 35.8246 28.0351 25.5299 30.6723 26.2623 38.5600 19.4973 38.6875 32.6388 29.6162 27.0775 31.5960 34.9952 25.8232 27.7535 28.3862 28.5769 40.9978 38.0564 28.9181 32.6846 27.5321 26.1224 36.3252 30.9958 30.2280 29.8327 26.8021 20.9847 15.3119 38.7635 27.4046 25.3062 24.7654 33.2676 16.9251 29.4262 29.3082 24.2931 26.6332 11.2498 26.7265 23.6030 38.8658 27.4099 29.6560 29.2979 32.1647 31.1764 31.0963 35.5735 44.3130 31.4883 28.6527 35.3864 27.2675 24.0044 26.3150 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 42.8618 * 41.1061 34.5482 35.3653 26.8879 36.1950 39.0061 27.7416 31.5435 30.7148 31.9995 44.8630 43.0691 34.4278 33.9022 31.4999 27.6037 40.2352 32.9792 30.6117 33.0087 26.2120 20.2692 23.4009 40.7467 26.2576 28.5659 26.8507 37.7898 17.4791 31.1833 30.8661 33.9362 29.1630 5.0506 32.3095 24.7311 37.0769 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 25.6865 27.4243 28.1654 29.0012 28.8569 28.8857 34.6528 39.6054 30.6830 27.2127 32.0261 26.0899 23.3808 24.6804 28.4077 19.7770 24.7145 37.8981 39.9496 26.6806 30.2697 25.7666 38.5361 34.3014 28.0988 25.5685 31.5494 26.5030 39.0003 19.6057 38.2220 33.0758 31.1027 27.1685 30.7774 36.0343 26.6026 28.9060 28.5022 28.7858 41.5654 37.5162 29.9079 31.7615 28.4222 25.8181 36.0082 30.9355 29.1581 31.8986 26.5339 20.9637 17.5306 38.9455 26.2253 25.7519 24.9581 33.4975 16.6299 29.2715 29.2314 30.0053 27.0686 7.4928 27.5322 23.7960 37.3332 23490 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 050366 050367 050369 050373 050376 050377 050378 050379 050380 050382 050385 050390 050391 050392 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 050468 050469 050470 050471 050476 050477 050478 050481 050485 050488 050491 050492 050494 050496 050497 050498 050502 050503 050506 050510 050512 050515 050516 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00186 1.2256 1.4438 1.3974 1.4860 1.4575 *** 0.9702 *** 1.5471 1.4204 1.3521 1.1788 1.3048 1.0187 1.3163 1.4938 1.5902 0.8283 1.1949 0.9616 1.4055 1.3026 1.2841 1.3330 1.1285 0.9475 1.9635 1.3899 1.3183 0.9585 1.5149 0.9214 1.1299 1.0952 1.5305 1.9649 1.3319 0.8880 1.1326 1.8679 1.6861 1.2166 1.6122 1.6731 1.4533 1.0831 1.0907 1.7659 1.3587 1.4963 0.9760 1.4169 1.5976 1.3096 *** 1.4025 1.3712 1.7798 *** 1.2871 1.7452 1.4596 1.7058 1.2059 1.4016 1.3200 1.4489 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 1.0848 1.4888 1.1762 1.1762 1.1762 * 1.1762 1.0848 1.5114 1.1762 1.4739 1.1297 1.1762 1.0848 1.1762 1.1660 1.1525 1.0848 1.4970 * 1.1762 1.2953 1.0848 1.1909 1.1762 1.1297 1.1417 1.2953 1.1660 1.0848 1.1762 1.0848 1.0848 1.1417 1.1762 1.5114 1.1123 1.1417 1.0848 1.4970 1.0848 1.1762 1.4970 1.1885 1.1762 1.0848 1.0848 1.1762 1.0848 1.1762 1.1525 1.1762 1.1762 1.5474 1.1564 1.0848 1.0848 1.5474 * 1.2953 1.1762 1.1417 1.1357 1.5474 1.5474 1.1417 1.2953 23.4696 32.6760 28.0909 30.7301 30.3530 14.3892 30.4937 27.5151 35.8014 26.8950 * 25.7881 20.2887 21.8139 26.4918 25.1869 28.4161 24.7279 33.2894 19.8436 35.5207 28.2381 24.5360 26.4357 26.7537 26.5188 27.5273 37.7347 30.9610 31.5170 28.1105 14.3846 * 22.6618 26.5535 36.6680 23.5299 25.7274 26.6967 34.4813 24.1694 23.7594 37.4570 31.4768 17.8128 25.7995 21.6981 32.3570 26.0482 32.1676 28.3894 30.3890 27.1437 37.2438 29.2987 23.7384 30.8706 35.7115 14.4481 28.2196 28.0102 26.7924 30.4731 39.6005 39.0767 36.3131 30.0985 25.7692 34.4959 27.1327 32.2315 30.7562 20.2484 33.9087 31.7645 39.1098 26.0927 25.5735 28.7761 21.3012 22.7209 28.2369 26.0074 30.5470 27.4716 35.6035 19.4995 37.3817 28.8561 25.2930 28.4471 26.1838 28.5944 29.9133 38.5317 30.0077 24.6684 30.3547 20.7565 25.9506 32.2183 26.4668 38.2823 27.6971 21.8552 25.0983 36.8383 24.5314 22.1675 40.2725 37.1342 29.4280 27.3281 18.4689 34.5484 30.9974 34.6400 30.9865 31.9177 28.8459 40.5313 30.6461 27.4933 35.1457 38.2871 15.9501 28.2667 28.7200 29.2001 32.4509 44.3883 41.8921 37.4251 29.4936 31.1854 38.7604 29.5697 32.2596 32.5870 * 34.2417 32.9575 42.0782 27.4131 34.5184 26.0066 18.1004 * 30.0661 27.2543 33.5699 28.1640 37.9066 21.3814 37.8064 34.6532 29.5031 33.3125 24.9401 30.6416 31.0730 42.4177 30.6899 25.0607 30.8030 23.0806 26.1621 28.0306 27.2662 42.9765 30.5504 25.2573 27.9759 43.3278 21.8846 22.5630 45.5829 37.3692 29.5448 28.9079 23.6649 34.5211 34.6585 34.6995 33.3998 33.7446 31.4233 42.9904 32.1379 27.1540 34.8963 42.2672 * 32.7708 29.5615 31.6418 36.0164 47.5510 46.9233 38.9978 36.2618 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 26.8679 35.6778 28.2751 31.7447 31.2266 16.9896 32.8674 30.5157 38.9514 26.8049 29.9098 26.7871 19.7304 22.2790 28.2139 26.2043 30.9065 26.7356 35.6609 20.2094 36.9551 30.6007 26.5285 29.3954 25.8686 28.6936 29.4697 39.7789 30.5313 26.4412 29.8170 19.1896 26.0550 27.3138 26.7804 39.2937 27.3177 24.1974 26.6380 38.3744 23.4157 22.8117 41.0011 35.4838 24.3346 27.4122 21.2384 33.8184 30.3567 33.8960 30.9361 32.0928 29.1407 40.3037 30.5664 26.2639 33.6068 38.6931 15.1581 29.8260 28.8118 29.3049 33.1455 44.1129 42.8915 37.6365 31.8675 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23491 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 050517 050522 050526 050528 050531 050534 050535 050537 050539 050541 050542 050545 050546 050547 050548 050549 050550 050551 050552 050557 050559 050561 050567 050568 050569 050570 050571 050573 050575 050577 050578 050579 050580 050581 050583 050584 050585 050586 050588 050589 050590 050591 050592 050594 050597 050598 050601 050603 050604 050608 050609 050615 050616 050618 050623 050624 050625 050630 050633 050636 050641 050644 050662 050663 050667 050668 050674 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00187 1.0642 *** 1.2090 1.1389 1.0915 1.2648 1.3449 1.3781 1.2398 1.5362 1.0327 0.6959 0.7147 0.8260 0.7101 1.5565 1.3762 1.2853 1.1118 1.5548 *** 1.2178 1.5865 1.2251 1.3462 1.5162 1.2578 1.7100 1.2597 1.2157 1.7450 1.4291 1.2595 1.4452 1.5670 1.2914 1.1457 1.1583 1.3347 1.2362 1.2814 1.1623 1.1716 1.9876 1.2330 *** 1.5414 1.3839 1.2162 1.3821 1.3707 1.3061 1.3796 1.0245 *** 1.2620 1.7422 *** 1.2315 1.3084 1.2243 0.8876 0.7678 1.0263 0.8884 0.9981 1.2840 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 1.1660 * 1.1660 1.0848 1.1762 1.1297 1.1660 1.2953 1.0848 1.5474 1.0848 1.1762 1.0848 1.4739 1.1660 1.1604 1.1660 1.1660 1.1762 1.1885 * 1.1762 1.1660 1.0848 1.3480 1.1660 1.1762 1.1297 1.1762 1.1762 1.1762 1.1762 1.1660 1.1762 1.1417 1.1660 1.1660 1.1660 1.1762 1.1660 1.2953 1.1762 1.1660 1.1660 1.1762 * 1.1762 1.1660 1.5114 1.0848 1.1660 1.1762 1.1660 1.0848 1.1762 1.1762 1.1762 * 1.1357 1.1417 1.1762 1.1762 1.5114 1.1762 1.3955 1.5474 1.2953 23.4131 38.9157 29.0004 23.9177 22.7311 26.7941 29.7904 25.1291 25.3328 41.1980 21.2846 33.4322 42.8052 40.6483 32.3944 31.8525 29.0938 28.6834 24.9755 25.8719 25.3299 35.9611 27.8475 20.8324 27.7955 29.9470 29.1716 27.2328 23.1358 26.4806 30.4934 34.9794 27.2431 28.9696 30.0427 24.5544 26.0595 25.7172 30.5453 27.9845 27.0620 28.6151 25.9545 30.8028 24.5542 24.6875 32.3033 25.0996 42.0018 20.7955 37.4563 29.4323 23.1748 22.3481 29.9553 23.3492 30.8013 27.7051 30.2883 23.2573 21.5030 28.4054 40.9242 22.9161 31.4906 55.9594 36.8871 23.6034 * 29.9495 28.6273 25.0157 29.7546 32.3646 27.4196 28.0586 43.7765 * 42.9451 52.7180 45.1842 37.1314 33.8288 31.1918 31.6782 26.8274 28.3111 26.9662 37.5863 30.1167 22.5008 30.4874 32.6896 32.1656 30.5249 23.2447 28.7060 31.5953 40.2740 29.4337 32.0823 33.5209 24.5757 27.2982 25.3551 32.3603 30.6273 31.5987 28.5915 32.5000 34.6747 25.4868 * 35.0325 28.6982 45.4433 22.1999 38.4561 32.8786 28.5636 25.4500 29.6550 28.1941 33.5137 28.0726 33.4771 27.2360 20.4720 25.6614 47.5065 25.1493 25.9250 * 38.4454 23.9007 * 31.3744 29.6838 26.9420 29.8603 32.3723 31.4527 29.6856 46.1121 * 30.5554 30.2329 33.2205 * 34.9818 30.2302 31.6165 27.1744 31.1871 * 38.8651 32.9829 24.4061 33.0259 34.0171 33.6156 33.3268 25.2513 30.8841 33.8825 39.4976 31.6256 32.1801 33.3697 24.8180 22.7121 27.4173 32.8212 30.9547 32.1654 28.8549 24.4542 34.7946 27.5691 * 34.7409 30.2464 49.9429 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 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 23.6377 38.9157 30.1287 27.7337 24.9597 28.8863 31.6438 28.1309 27.7611 43.8355 21.2846 35.4562 41.5266 39.9154 34.6019 33.6342 30.2108 30.7425 26.5471 28.6462 26.0948 37.5449 30.4114 22.5795 30.5066 32.2949 31.7338 30.3962 23.9658 28.7176 31.9512 38.3190 29.3950 31.1581 32.3610 24.6565 24.9986 26.0841 31.9715 29.9199 30.1866 28.6959 27.4073 33.5328 25.8776 24.6875 34.0841 28.0787 45.9484 22.1922 39.1280 31.8903 29.6253 25.0614 30.4768 27.6796 33.6260 28.9666 33.1070 27.0926 21.1520 27.1915 40.4932 24.4728 27.9100 41.1707 39.5960 23492 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 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 050719 050723 050724 050725 050726 050727 050728 050729 050730 060001 060003 060004 060006 060007 060008 060009 060010 060011 060012 060013 060014 060015 060016 060018 060020 060022 060023 060024 060027 060028 060029 060031 060032 060033 060036 060041 060043 060044 060049 060050 060054 060057 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00188 1.4811 1.2324 1.2133 0.8920 1.1341 1.2605 1.2096 1.5618 1.2343 1.2978 1.1914 1.1012 2.0751 1.0277 *** 1.2779 1.0120 1.3813 1.6591 1.2193 1.4396 1.2543 1.3580 1.0612 1.0152 *** 1.2353 2.1341 0.9684 1.6664 1.2727 1.3207 1.4238 1.2649 1.5772 1.3962 1.1960 1.3423 1.0128 1.1014 1.4646 1.7149 1.4232 1.4557 1.3659 1.7846 1.7206 1.1655 1.2136 1.5388 1.5930 1.6438 1.7403 1.5666 1.3838 *** 1.5393 1.5419 0.9865 1.1170 0.9219 0.9477 1.1417 1.2784 1.1981 1.4335 1.0788 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 1.1762 1.1660 1.4888 1.0848 1.1297 1.1297 1.5114 1.5474 1.4739 1.1660 1.1297 1.1333 1.1762 1.2207 * 1.1297 1.1762 1.4970 1.0848 1.1660 1.0848 1.1762 1.5159 1.1762 1.1297 * 1.1762 1.0848 1.1762 1.1885 1.1762 1.4739 1.1762 1.1762 1.0517 1.0517 1.0710 0.9379 0.9379 0.9379 1.0710 1.0146 1.0710 0.9379 0.9379 1.0710 1.0710 0.9379 0.9379 0.9379 0.9457 0.9578 1.0710 1.0517 1.0710 0.9379 0.9457 1.0710 0.9379 0.9379 0.9379 0.9379 1.0517 1.0146 0.9379 0.9590 0.9379 36.2702 27.1337 32.7065 23.0984 23.7443 37.3033 36.5555 37.5449 41.1385 32.6638 25.8298 27.8742 29.9410 18.6962 26.0909 28.4650 24.6072 27.7366 22.1606 22.7897 33.7204 19.0071 30.3263 33.0719 21.7835 22.0998 33.0797 23.7567 20.6592 25.8742 * * * * 23.1548 23.0807 25.0037 21.8609 21.4244 19.8803 24.7920 25.8475 25.8919 22.6374 23.3954 27.0326 27.6338 22.9300 21.0581 20.9025 24.7928 24.3749 25.2409 25.1480 27.1303 19.7379 23.8781 27.1783 16.7266 19.4144 20.8746 19.1085 25.6112 25.3425 20.4386 21.1281 24.3982 37.3389 29.1159 35.6614 21.7264 25.2575 38.5595 41.3305 40.3815 43.9228 34.8040 26.7041 30.1226 36.9314 19.2603 25.6818 29.6896 24.6609 32.4877 21.2163 21.9079 34.8311 20.7448 32.4491 34.5519 15.4037 * 34.9814 * 22.0946 27.0928 23.7179 31.4768 * * 24.9410 24.7856 28.0656 22.7493 21.4792 21.8037 27.0511 27.2290 26.1958 24.1557 24.9708 29.6744 30.1158 23.9655 23.6620 22.2052 25.7832 26.7285 28.7231 26.6348 27.9686 * 25.6207 28.2234 * 20.4635 22.7123 20.0939 25.2471 26.8089 21.9108 23.5803 26.9891 38.7984 30.7220 38.3946 21.7791 26.4234 40.9486 41.9325 42.2018 47.2769 35.0621 28.9544 35.6549 35.9220 25.1984 26.8210 29.6253 25.3488 34.0550 22.5034 25.6119 39.9858 20.2803 33.6676 38.0796 21.4996 * 35.0119 34.4267 21.7816 27.8433 23.9437 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 * 26.3650 30.4247 * 20.7131 23.4978 18.7896 25.0360 29.0598 * 22.3490 * Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 37.5511 29.1295 35.9028 22.0865 25.2119 39.0574 39.9230 40.1932 44.3743 34.2547 27.1978 31.4872 34.4812 20.8006 26.1958 29.3536 24.8998 31.4563 21.9751 23.3937 36.4647 19.9969 32.2064 35.2375 18.9377 22.0998 34.4384 28.5323 21.6358 27.0367 23.8301 33.6891 34.2580 51.5425 25.0779 24.0730 27.8289 23.0964 21.4535 21.7601 26.9116 27.4402 0126.4630 24.3434 24.0758 29.2315 29.4109 24.2479 23.4747 21.9753 25.7483 26.3625 27.7028 26.7085 28.4352 19.7379 25.3306 28.6396 16.7266 20.1878 22.3670 19.3418 25.3737 27.1748 21.1679 22.3633 25.7472 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23493 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 060064 ............................................................................. 060065 ............................................................................. 060070 ............................................................................. 060075 ............................................................................. 060076 ............................................................................. 060096 ............................................................................. 060100 ............................................................................. 060103 ............................................................................. 060104 ............................................................................. 060107 ............................................................................. 060108 ............................................................................. 060111 ............................................................................. 070001 ............................................................................. 070002 ............................................................................. 070003 ............................................................................. 070004 ............................................................................. 070005 ............................................................................. 070006 2 ........................................................................... 070007 ............................................................................. 070008 ............................................................................. 070009 ............................................................................. 070010 ............................................................................. 070011 ............................................................................. 070012 ............................................................................. 070015 ............................................................................. 070016 ............................................................................. 070017 ............................................................................. 070018 2 ........................................................................... 070019 ............................................................................. 070020 ............................................................................. 070021 ............................................................................. 070022 ............................................................................. 070024 ............................................................................. 070025 ............................................................................. 070027 ............................................................................. 070028 ............................................................................. 070029 ............................................................................. 070031 ............................................................................. 070033 ............................................................................. 070034 2 ........................................................................... 070035 ............................................................................. 070036 ............................................................................. 070038 ............................................................................. 070039 ............................................................................. 080001 ............................................................................. 080002 ............................................................................. 080003 ............................................................................. 080004 ............................................................................. 080006 ............................................................................. 080007 ............................................................................. 090001 ............................................................................. 090002 ............................................................................. 090003 ............................................................................. 090004 ............................................................................. 090005 ............................................................................. 090006 ............................................................................. 090007 ............................................................................. 090008 ............................................................................. 090011 ............................................................................. 100001 ............................................................................. 100002 ............................................................................. 100004 ............................................................................. 100006 ............................................................................. 100007 ............................................................................. 100008 ............................................................................. 100009 ............................................................................. 100010 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00189 1.4680 1.2936 *** 1.2070 1.2848 1.5124 1.6735 1.1833 1.3558 1.4178 *** *** 1.6316 1.8165 1.0898 1.1896 1.3796 1.3118 1.2843 1.2463 1.1856 1.8269 1.3577 1.1771 1.4329 1.3424 1.3696 1.3351 1.2584 1.3392 1.2614 1.7784 1.3851 1.8564 1.2911 1.5983 1.2773 1.2393 1.2635 1.3877 1.2964 1.6654 1.1608 0.9382 1.6701 *** 1.5462 1.3741 1.2769 1.3900 1.7108 *** 1.2607 1.9783 1.3818 1.3806 *** 1.4284 2.0113 1.5628 1.3511 0.9314 1.6100 1.6285 1.6365 1.4157 *** Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 1.0710 1.0710 0.9379 0.9379 0.9379 1.0517 1.0710 1.0517 1.0710 1.0710 * * 1.1790 1.1790 1.1790 1.1790 1.1790 1.2607 1.1790 1.1790 1.1790 1.2607 1.1790 1.1790 1.1790 1.1790 1.1790 1.2607 1.1790 1.1790 1.1790 1.1790 1.1790 1.1790 1.1790 1.2607 1.1790 1.1790 1.3191 1.2607 1.1790 1.1790 * 1.1790 1.0652 * 1.0652 1.0652 0.9606 1.0289 1.0935 * 1.0935 1.0935 1.0935 1.0935 * 1.0935 1.0935 0.9303 1.0061 0.8613 0.9446 0.9446 0.9757 0.9757 * 29.1806 29.2377 22.6894 27.7835 23.6266 26.4167 28.0561 26.6863 26.7683 * 19.0011 * 29.9592 28.1101 29.8684 25.7207 29.8173 33.3814 29.0336 24.3907 25.6072 30.4192 24.9457 34.9099 30.0614 29.7505 29.2978 33.8654 27.9838 28.4084 30.3254 29.7376 28.3460 28.3017 36.9700 28.2078 25.8107 25.5880 34.3904 32.8074 26.1693 35.0701 * 32.6059 28.0859 23.7309 24.8199 24.2251 23.6838 23.4964 29.5432 23.5158 22.7014 28.7417 28.6142 23.7241 25.8430 19.3212 31.7710 22.6150 22.5982 15.6306 23.3745 24.3305 22.7706 24.7811 25.5614 30.0963 28.5282 * 30.7835 25.5406 27.4085 29.7690 28.8063 30.8625 26.8267 * 31.2571 32.2718 29.0663 31.3716 27.3004 29.3265 33.9310 30.3648 24.9176 28.8649 33.1535 27.5391 40.3337 30.9728 29.6662 30.3951 35.7189 29.6290 29.9507 31.4397 32.3625 30.8308 29.2540 27.3487 29.5653 26.3871 27.2359 35.5355 35.6831 27.1816 34.0555 31.1133 35.0164 30.2463 26.4192 27.1131 26.0092 24.4204 24.6485 31.3552 29.6780 27.0514 29.9785 30.2504 25.9086 30.1419 29.6744 32.4412 25.2381 22.1269 16.2637 26.2372 25.4333 25.7377 24.4666 26.9486 31.3105 31.1987 * 32.7563 26.8236 30.0602 32.1537 30.3002 32.0889 26.1883 * * 34.0302 31.1530 32.7173 29.2292 32.1668 36.8469 31.7097 26.4806 30.2706 32.5798 29.9105 44.1424 33.4595 31.0903 31.7223 37.6081 31.8148 31.0935 33.2357 33.9804 32.0430 30.9938 31.8018 31.5036 27.7213 28.9190 37.1929 36.2719 27.5585 36.1610 25.7516 31.2269 30.0242 27.9670 29.2266 27.4735 25.6160 27.0074 35.0413 * 29.2660 32.0186 30.7728 29.5590 * 29.1059 34.0693 24.4060 25.3389 16.5974 26.2258 26.5612 27.4314 25.9381 * Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 30.2470 29.6323 22.6894 30.4907 25.4496 27.9908 30.0220 28.6961 29.9703 26.4984 19.0011 31.2571 32.0467 29.4722 31.3528 27.3764 30.4848 34.7695 30.4054 25.2986 28.2076 32.0648 27.3901 39.6372 31.5141 30.2000 30.4949 35.8796 29.8448 29.8423 31.7179 32.0199 30.4352 29.5451 31.4568 29.7843 26.6692 27.3126 35.7524 34.9418 26.9760 35.1155 26.9407 32.9340 29.4815 26.0445 26.9651 25.9428 24.5955 25.0565 32.0128 25.5760 26.1789 30.3834 29.9417 26.3083 27.7359 25.7761 32.7262 24.0790 23.3729 16.2012 25.3340 25.5135 25.4374 25.0983 26.2759 23494 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 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 100056 100057 100061 100062 100063 100067 100068 100069 100070 100071 100072 100073 100075 100076 100077 100080 100081 100084 100086 100087 100088 100090 100092 100093 100098 100099 100102 100103 100105 100106 100107 100108 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00190 1.6376 1.2930 1.3050 1.5188 1.6120 1.6412 1.3242 1.7131 1.4290 1.2486 1.6929 1.6114 1.2106 1.2795 1.1347 1.2887 1.6962 1.8227 1.5678 1.8717 1.3916 1.6805 1.2649 1.4156 1.3130 1.2283 1.6670 0.9388 1.1939 1.1699 1.3249 1.3546 1.2271 1.1950 1.3505 *** 1.4813 1.5361 1.7092 1.2093 1.4142 1.7170 1.3251 1.6333 1.2241 1.3679 1.6820 1.4565 1.2340 1.4278 1.7259 1.0413 1.7911 1.2082 1.8721 1.6620 1.4618 1.5036 1.6987 1.0859 1.0146 1.0412 0.9567 1.3654 0.9426 1.1491 0.7656 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.9333 0.9307 0.9292 0.9307 1.0115 0.9826 0.9757 1.0508 0.9446 0.9757 0.8613 0.8613 0.8613 0.9826 0.9757 0.9446 0.9292 0.9757 0.9554 1.0508 1.0508 0.9303 0.9292 1.0162 0.9446 0.9292 0.9274 0.8613 0.8934 0.9757 0.9446 0.8934 0.9757 0.8877 0.9292 * 0.9446 0.9757 0.8955 0.9292 0.9292 0.9307 0.9292 0.9554 0.9292 0.9307 1.0508 0.9292 0.9757 0.9274 1.0061 0.8672 0.9446 1.0508 0.9554 0.9303 0.9303 0.9826 0.8613 0.8613 0.8934 0.8613 0.8613 0.9458 0.8613 0.9333 0.8613 24.2602 21.7566 22.1272 21.1905 24.1885 24.2888 23.5303 27.9072 21.8111 24.4070 21.2568 20.1602 23.8982 21.8879 24.6814 21.8567 21.6415 23.1111 22.6349 25.7948 23.8060 22.4679 21.7738 23.9952 25.2285 24.2746 24.3522 17.5533 21.8679 20.0405 20.0231 20.5916 23.7837 22.0352 19.6350 25.9245 24.6417 26.1273 24.9807 21.5620 23.8892 23.7840 19.6037 23.5524 21.7675 23.5362 23.5843 22.3890 19.6444 22.3755 22.8704 16.8087 24.1122 25.2375 26.5915 23.6270 22.5894 25.4630 20.2949 20.0639 18.5287 21.6772 20.3633 24.5464 20.3417 23.3789 14.8039 24.5762 22.3054 22.5781 22.9545 27.8582 25.5566 23.6106 29.0519 21.4015 27.6476 21.1174 21.3533 12.0314 23.7818 26.9307 22.4887 23.0174 24.4064 25.3590 27.4422 26.6016 23.5372 22.8963 26.3208 23.0520 26.6169 24.4212 18.3767 22.9532 20.6893 22.3311 20.9078 27.3383 25.7279 22.1051 25.7945 22.6038 26.7673 24.1413 21.5566 23.9333 24.9025 22.4386 23.7746 23.4176 24.2934 25.3685 23.3503 21.0777 24.3478 26.3596 16.9168 25.4140 26.4817 25.9909 24.8729 24.0501 26.0856 21.1547 21.2505 20.4328 22.8850 21.7494 24.9503 20.2882 24.4484 16.3757 26.3798 24.5862 24.6038 26.1580 28.1191 27.5435 23.8785 29.9345 23.0074 30.2395 22.1580 21.3651 16.1223 26.8661 27.5844 24.0943 25.2033 25.9415 26.9407 29.8583 28.4627 23.6443 25.2273 28.3596 26.9641 26.3673 25.0404 18.8771 22.9810 19.8713 23.2764 22.3920 27.3224 28.0512 23.5332 * 25.3897 29.2565 25.2340 24.7026 25.4597 25.9202 24.3111 24.9751 24.9682 26.0379 30.3358 25.1691 21.9483 26.0347 27.0126 15.6662 26.3475 28.2641 26.4999 25.9182 24.2422 28.4789 21.3524 * 21.3036 23.8596 22.9256 26.8091 24.0389 26.1337 22.0750 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 25.1067 22.8508 23.0946 23.5300 26.7581 25.8847 23.6811 29.0212 22.0889 27.3189 21.5429 20.9595 16.3797 24.1693 26.4439 22.9211 23.3437 24.5360 24.9239 27.7714 26.3398 23.2382 23.3549 26.2570 25.0756 25.8723 24.6186 18.2575 22.6230 20.2035 22.0397 21.3174 26.2170 25.3241 21.7040 25.8574 24.1823 27.4077 24.7789 22.5862 24.4499 25.2289 22.1685 24.0912 23.4234 24.6995 26.4443 23.6907 20.8673 24.2410 25.4415 16.4022 25.2653 26.6950 26.3569 24.8465 23.6608 26.7319 20.9431 20.6613 20.1035 22.8413 21.7001 25.4381 21.6406 24.6951 17.7359 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23495 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 100109 ............................................................................. 100110 ............................................................................. 100113 ............................................................................. 100114 ............................................................................. 100117 ............................................................................. 100118 ............................................................................. 100121 ............................................................................. 100122 ............................................................................. 100124 ............................................................................. 100125 ............................................................................. 100126 ............................................................................. 100127 ............................................................................. 100128 ............................................................................. 100130 ............................................................................. 100131 ............................................................................. 100132 ............................................................................. 100134 ............................................................................. 100135 ............................................................................. 100137 ............................................................................. 100139 ............................................................................. 100140 ............................................................................. 100142 ............................................................................. 100147 ............................................................................. 100151 ............................................................................. 100154 ............................................................................. 100156 ............................................................................. 100157 ............................................................................. 100160 ............................................................................. 100161 ............................................................................. 100162 ............................................................................. 100167 ............................................................................. 100168 ............................................................................. 100169 ............................................................................. 100173 ............................................................................. 100175 ............................................................................. 100176 ............................................................................. 100177 ............................................................................. 100179 ............................................................................. 100180 ............................................................................. 100181 ............................................................................. 100183 ............................................................................. 100187 ............................................................................. 100189 ............................................................................. 100191 ............................................................................. 100200 ............................................................................. 100204 ............................................................................. 100206 ............................................................................. 100208 ............................................................................. 100209 ............................................................................. 100210 ............................................................................. 100211 ............................................................................. 100212 ............................................................................. 100213 ............................................................................. 100217 ............................................................................. 100220 ............................................................................. 100223 ............................................................................. 100224 ............................................................................. 100225 ............................................................................. 100226 ............................................................................. 100228 ............................................................................. 100229 ............................................................................. 100231 ............................................................................. 100232 h ........................................................................... 100234 ............................................................................. 100236 ............................................................................. 100237 ............................................................................. 100238 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00191 1.2500 1.5138 1.9521 1.3471 1.1856 1.3280 1.0708 1.2187 1.1623 1.1807 1.4012 1.6390 2.1468 1.1903 1.2656 1.2174 0.9426 1.5934 1.1612 0.8526 1.1665 1.2175 *** 1.7655 1.5497 1.1022 1.5782 1.1887 1.5792 *** 1.2864 1.3732 *** 1.7343 0.9876 1.8792 1.3177 1.7603 1.3719 1.0880 1.1753 1.2686 1.3096 1.3075 1.3785 1.5254 1.2968 *** 1.3575 1.5359 1.1787 1.4636 1.5843 1.1771 1.6524 1.5843 1.2340 1.2707 1.2697 1.3187 *** 1.6878 1.2214 1.3110 1.3623 1.9568 1.5077 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.9446 0.9446 0.9461 0.9757 0.9303 0.9303 0.8934 0.8877 0.8613 0.9757 0.9292 0.9292 0.9292 1.0061 0.9757 0.9292 0.8613 0.8712 0.8934 0.9461 0.9303 0.8613 0.8613 0.9303 0.9757 0.8613 0.9292 0.8613 0.9446 * 1.0508 1.0061 * 0.9292 0.8613 1.0162 0.9826 0.9303 0.9292 0.9757 0.9757 0.9757 1.0508 0.9292 1.0508 0.9461 0.9292 * 0.9757 1.0508 0.9292 0.8955 0.9554 1.0162 0.9333 0.8877 1.0508 1.0508 0.9303 1.0508 * 0.8613 0.9303 1.0061 0.9274 1.0508 0.9292 23.0779 24.4533 24.3614 25.3699 23.9134 24.1104 23.1100 24.1820 24.3048 22.4185 21.7977 21.0153 24.4104 20.2478 25.4811 21.1538 18.3391 20.4915 20.4007 18.2204 22.5124 20.0689 17.1045 26.6470 23.0820 20.6928 23.1045 23.4877 24.6268 23.8001 26.4517 24.6276 23.4575 19.7190 21.0474 26.8740 24.5078 24.1801 24.9433 18.1320 24.4575 23.4760 26.6846 24.1911 24.8120 22.2613 22.8782 24.1482 23.8502 26.0933 24.3243 22.6584 24.4467 24.0291 24.9733 21.2434 23.0804 23.9971 23.8701 26.2593 21.0038 23.5418 21.8105 24.9141 23.9781 26.7664 24.6513 23.8836 28.3699 25.0067 27.7413 26.0451 23.6669 24.0937 21.2597 21.6483 25.3532 23.2996 21.3223 25.6763 22.8324 25.8316 23.0428 19.5337 22.3071 23.3692 14.5046 24.8165 20.7219 * 26.1848 26.3703 22.2757 25.9133 27.2019 28.3607 * 26.8584 26.0864 * 22.4866 22.0666 29.8326 25.3973 26.6537 26.3299 19.5022 26.7893 26.1394 26.5763 24.3553 28.0926 24.4697 23.0340 24.9854 25.0778 28.6449 * 24.2669 25.1893 25.2635 25.0154 23.4556 23.3593 27.9473 27.8003 27.2873 * 24.6994 23.9405 25.2574 25.9282 25.6112 27.1748 24.9951 29.1494 26.6479 29.2195 26.4536 28.0569 24.8579 23.4751 22.7023 26.7452 24.0192 23.8920 29.4979 24.2046 29.2462 24.3293 20.9244 24.0024 25.1974 17.5489 26.4720 22.9577 * 28.1322 27.6127 26.7092 27.3851 26.9851 28.8077 * 30.3694 27.1292 * 24.5390 23.5455 31.2694 26.6781 29.5619 27.1804 21.8540 27.4951 27.3653 28.4136 26.6340 29.8963 25.7537 25.2196 * 26.6246 28.9486 24.7095 24.7566 27.1983 25.2907 26.0905 24.7015 24.8077 28.4316 29.3317 29.8952 * 25.5175 24.9322 26.3601 26.6585 31.3543 28.4302 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 24.0208 27.5406 25.3817 27.4364 25.5634 25.5448 24.0497 22.8811 22.7933 24.9756 23.0655 22.0931 26.6451 22.4252 26.9103 22.8670 19.6271 22.2526 23.1447 16.8211 24.7189 21.2432 17.1045 27.0891 25.8181 23.2451 25.4671 25.9544 27.4143 23.8001 27.8827 25.9577 23.4575 22.2987 22.2224 29.3692 25.6089 26.9037 26.1924 19.8108 26.3276 25.7401 27.3048 25.0785 27.6635 24.2423 23.7228 24.5807 25.2683 27.9114 24.5352 23.9351 25.6153 24.8791 25.3692 23.2004 23.7932 26.8326 27.1288 28.0013 21.0038 24.6455 23.5285 25.5144 25.5663 27.7849 26.8154 23496 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 100239 100240 100242 100243 100244 100246 100248 100249 100252 100253 100254 100255 100256 100258 100259 100260 100262 100264 100265 100266 100267 100268 100269 100275 100276 100277 100279 100281 100284 100286 100287 100288 100289 100290 100292 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 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00192 1.2789 0.9534 1.3586 1.5324 1.3330 1.6049 1.4986 1.2539 1.1974 1.3797 1.5814 1.1947 1.9673 1.4847 1.2244 1.3413 *** 1.2531 1.2774 1.4031 1.2776 1.1529 1.3034 1.2616 1.2369 1.3339 1.2334 1.2641 1.0813 1.5579 1.3676 1.5140 1.7415 1.1280 1.2103 1.2172 1.2471 1.2762 1.2242 1.1543 1.4983 1.5952 1.3541 2.1112 1.1841 1.1253 1.1938 1.1764 1.2808 1.3725 1.3712 1.4319 1.1005 1.0627 1.7504 1.6515 1.1953 1.2600 1.1631 1.3973 1.6993 1.4949 1.7799 1.5400 1.4119 1.1097 1.2580 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.9554 0.9757 0.8613 0.9292 0.9333 1.0162 0.9292 0.8955 1.0162 1.0061 0.8712 0.9292 0.9292 1.0061 0.9292 1.0162 * 0.9292 0.9292 0.8613 0.9554 1.0061 1.0061 1.0061 1.0508 0.9757 0.9333 1.0508 0.9757 1.0115 1.0061 1.0061 1.0508 0.8613 0.8672 0.9637 0.9637 0.9303 0.9099 0.9637 0.9813 0.8645 0.9637 0.9637 0.9637 0.9637 0.7684 0.9637 0.9637 0.9637 0.9483 0.9303 0.7684 0.7684 0.9567 0.9637 0.9637 0.9637 0.7684 0.9637 0.9567 0.9637 0.9483 0.8420 0.9567 0.9637 0.9684 25.0509 23.0650 20.4681 23.2812 23.4876 26.7630 23.8742 21.3942 22.6475 23.6939 23.2794 22.9793 24.1969 24.5699 24.1148 23.5164 23.8006 22.4800 21.0688 21.5258 23.3760 26.0297 24.9002 23.1419 25.4557 25.2985 24.8484 25.3382 22.3046 * * * * * * 24.0561 20.4502 19.7061 21.8791 23.6146 23.8762 28.2025 22.6308 27.2029 23.2149 23.2280 18.8228 24.7007 23.3004 23.5673 22.1471 29.0965 19.3201 19.8351 25.9474 22.7981 22.2341 22.8695 18.0744 24.1447 24.0791 24.2581 24.4788 20.1710 17.0608 17.3095 20.8080 26.9668 23.4830 21.5130 25.2987 24.1515 27.6382 25.9170 23.4021 24.9860 24.4051 25.0192 22.2341 26.0629 31.8772 24.9404 25.2630 26.3954 25.0250 23.4758 22.6614 26.5059 29.8289 25.3228 24.3059 27.2589 47.3905 25.4909 27.0864 22.5927 27.1051 28.2229 37.4785 28.4504 * * 25.1164 21.8616 20.0968 22.7929 22.3645 25.0719 30.7430 23.4662 28.7690 25.4620 25.5661 18.8376 25.6485 24.8735 25.3746 23.8091 31.5253 20.5740 19.2323 25.1836 25.2335 25.0842 24.1711 20.7211 25.2326 24.4141 25.7562 25.4854 20.5880 19.4032 18.8744 21.5402 27.7592 25.3265 24.0990 26.1131 25.2584 28.9894 27.7797 23.2084 25.8540 25.7121 25.7338 24.1169 28.8856 31.2482 26.0175 27.5188 * 25.5489 23.6151 23.2340 27.3768 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 25.9093 25.2695 25.3897 21.4002 23.9911 22.8082 28.6090 23.8785 27.0198 29.7142 26.0899 26.6610 21.7610 28.2431 26.8501 27.3029 25.7205 26.1311 21.2826 20.2175 27.9184 24.8893 26.4770 26.0384 21.9407 28.3210 27.0099 27.5532 26.8789 21.2138 19.7892 19.7509 23.4074 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 26.6605 24.0024 22.0856 24.9766 24.3502 27.8151 25.9263 22.6697 24.5257 24.6472 24.6995 23.1055 26.4333 29.0443 25.0705 25.5518 25.1412 24.4115 22.8276 22.5196 25.7444 28.4053 25.7303 24.5544 27.6322 24.0477 25.7747 27.1929 22.9628 28.3288 28.2858 35.4781 28.8970 23.5080 25.9093 24.8146 22.5380 20.4029 22.8563 22.9077 25.8225 27.0990 24.4256 28.5850 24.9213 25.2080 19.7802 26.2640 25.0177 25.5307 23.8901 28.6493 20.4005 19.7328 26.3393 24.3542 24.7162 24.4325 20.2437 25.8930 25.1876 25.9518 25.6507 20.6802 18.7582 18.6568 21.9417 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23497 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 110042 110043 110044 110045 110046 110049 110050 110051 110054 110056 110059 110061 110064 110069 110071 110073 110074 110075 110076 110078 110079 110080 110082 110083 110086 110087 110089 110091 110092 110095 110096 110100 110101 110104 110105 110107 110109 110111 110112 110113 110115 110118 110121 110122 110124 110125 110128 110129 110130 110132 110135 110136 110142 110143 110146 110149 110150 110153 110155 110163 110164 110165 110166 110168 110169 110172 110177 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00193 1.0979 1.7289 1.1609 1.1384 1.1501 0.9635 1.0937 1.1347 1.4875 0.9430 1.0697 *** 1.4700 1.2734 0.9739 1.0759 1.4999 1.2670 1.4563 2.0424 1.3966 1.2439 1.9154 1.9070 1.3847 1.4065 1.1502 1.2996 1.0125 1.3953 0.9779 0.9643 1.0706 1.0494 1.3229 1.8630 1.0104 1.1313 0.9374 1.0686 1.6816 *** 1.0384 1.5295 1.0742 1.2373 1.2076 1.5230 0.9412 1.0349 1.2847 1.0675 0.9587 1.3701 1.0472 1.3335 1.2656 1.1467 *** 1.4114 1.5149 1.3808 *** 1.8280 *** 1.1832 1.6699 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.9637 0.9483 0.7684 0.9637 0.9637 0.7684 0.9033 0.7684 0.9637 0.7684 0.7684 0.8873 0.8570 0.9087 0.7684 0.7684 0.9813 0.9316 0.9637 0.9637 0.9637 0.9637 0.9637 0.9637 0.7684 0.9637 0.7684 0.9637 0.7684 0.8710 0.7684 0.7684 0.7684 0.7684 0.7684 0.9485 0.7684 0.9567 0.7684 0.9567 0.9637 0.7684 0.7684 0.8420 0.7684 0.9087 0.9316 0.8570 0.7684 0.7684 0.7684 0.7684 0.7684 0.9637 0.7684 0.9637 0.9087 0.9087 * 0.8645 0.9485 0.9637 0.9485 0.9637 * 0.9637 0.9567 25.5588 22.7589 19.2562 19.7746 21.6201 18.9096 * 17.6816 20.5387 21.7608 19.9802 18.6696 21.7636 21.0518 15.2336 15.2711 24.4094 20.4634 23.8211 28.2149 22.8017 24.1958 27.2931 24.6460 18.8751 25.7908 20.6757 24.3354 16.9116 20.1024 18.5513 15.1316 13.3943 17.9805 19.2156 21.8167 18.7397 20.9535 20.4565 18.0770 26.3274 17.7344 19.5230 20.4184 19.7004 19.8695 28.4943 21.8204 17.5272 17.2924 18.5125 21.1235 16.3359 24.3898 17.2250 25.3619 22.7366 21.5300 16.1785 21.9411 23.7801 23.4071 23.6665 23.3426 24.7083 25.2396 24.0700 26.8321 25.2788 19.6940 21.3922 24.0022 19.8706 25.6020 19.0995 22.2250 23.0080 18.7097 * 23.8739 22.3006 13.3731 16.3610 27.5836 20.9973 25.2424 27.8627 24.5255 21.5482 28.9731 26.2604 20.8557 26.2872 21.2013 26.3857 18.7397 21.8709 19.4498 16.5833 14.4630 19.5575 20.6270 26.0763 20.4726 20.5577 21.0612 16.7641 29.8699 * 21.2534 22.0210 20.9334 22.1458 23.2576 22.4202 17.6529 18.9927 20.0057 22.7715 17.3328 25.4932 19.9221 24.7686 23.8157 22.8660 * 25.5461 26.4450 24.3897 25.2264 24.6321 * 27.0240 25.0129 23.4645 26.7522 20.9654 24.9821 23.8292 * * 19.4276 25.7085 * 20.5565 * 24.2739 24.1669 18.0224 18.6336 27.0337 22.0935 26.3506 24.8746 23.1024 22.3213 29.8366 27.8245 21.1509 28.0471 21.9509 26.5523 18.5527 23.4846 * 16.5600 16.4270 18.7951 21.1077 26.2526 21.4280 29.2190 24.2463 19.1753 32.0197 * 21.6637 23.7589 22.7058 22.4238 24.4596 23.3631 18.7549 19.2307 20.4411 15.3030 18.1980 24.2240 23.9067 27.1477 22.6624 24.5368 * 26.0764 27.0600 26.8378 26.8070 27.0022 * 29.1703 26.7504 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 25.2397 24.9357 19.9819 22.1119 23.2190 19.4074 25.6020 18.7634 22.7254 22.3710 19.6943 18.6696 23.3486 22.5324 15.4555 16.6863 26.3402 21.2149 25.1774 26.9445 23.4646 22.5788 28.7072 26.3029 20.2673 26.7332 21.2887 25.8218 18.0853 21.8636 19.0000 16.0845 14.7428 18.8040 20.3365 24.6977 20.2690 22.9282 21.7104 18.0155 29.3454 17.7344 20.8173 22.1314 21.1178 21.5044 24.9779 22.5595 18.0115 18.5224 19.6750 19.7964 17.2921 24.6996 20.1122 25.8232 23.0726 22.9872 16.1785 24.4314 25.7931 24.9170 25.1758 25.0628 24.7083 27.1002 25.3590 23498 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 110179 110183 110184 110186 110187 110188 110190 110191 110192 110193 110194 110198 110200 110201 110203 110205 110209 110212 110215 110218 110219 120001 120002 120004 120005 120006 120007 120010 120011 120014 120016 120019 120022 120025 120026 120027 120028 130002 130003 130005 130006 130007 130011 130013 130014 130018 130021 130022 130025 130026 130028 130036 130045 130060 130062 130063 140001 140002 140003 140005 140008 140010 140011 140012 140013 140015 140016 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00194 *** 1.2345 1.2007 1.3771 1.2237 *** 1.0046 1.2930 1.3222 1.4229 0.9346 1.3834 1.8830 1.3894 0.9912 1.0674 0.5352 1.0406 1.2618 *** 1.3845 1.7853 1.2134 1.2673 1.2757 1.2232 1.6776 1.6785 1.4508 1.2099 1.6705 1.2043 1.8525 *** 1.2887 1.2295 1.2577 1.3569 1.3696 *** 1.7884 1.7321 1.2145 1.2894 1.1794 1.5937 *** 1.1803 1.1842 1.1103 1.3641 *** *** *** *** 1.4243 1.0825 1.2711 1.0209 *** 1.4951 1.4434 1.1508 1.2283 1.4165 1.3843 1.0074 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 * 0.9637 0.9637 0.8570 0.9637 * 0.7684 0.9637 0.9637 0.9637 0.7684 0.9637 0.8570 0.9485 0.9637 0.9637 0.7684 0.8873 0.9637 * 0.9637 1.1206 1.0598 1.1206 1.0598 1.1206 1.1206 1.1206 1.1206 1.0598 * 1.0598 1.1206 1.0598 1.1206 1.1206 1.1206 0.9048 1.0061 * 0.9048 0.9048 0.8810 0.9048 0.9048 0.8810 0.8810 0.8810 0.8810 0.8810 0.9348 * 0.9183 * 0.9409 0.9048 0.8285 0.8953 0.8285 0.8285 1.0846 1.0846 0.8285 1.0698 0.8844 0.8953 0.8285 26.0365 26.4248 24.3379 21.1176 23.2571 24.4785 21.9008 24.0572 24.3823 25.1779 16.8075 28.0634 20.1816 24.1171 30.2609 23.1969 17.4145 18.7651 22.5679 * * 30.0871 24.2715 26.8010 23.0113 28.1562 27.8497 25.4050 30.9308 25.3682 39.1173 24.4036 22.4951 40.2473 26.3653 24.9464 29.5070 20.1143 23.9403 24.4844 22.8567 22.8475 23.1120 23.5316 21.6495 22.2249 18.0006 21.5602 18.7814 24.4976 21.1492 18.5921 19.0270 24.6773 24.0494 18.8782 20.0247 23.0207 19.2097 13.2365 26.3287 29.0224 19.0903 24.4070 19.9800 21.4328 16.3417 26.1173 27.6020 25.5420 23.2348 22.5730 * 19.1054 25.8409 25.7406 27.8223 16.3148 30.8014 21.2177 27.0388 25.8951 20.6150 19.1000 20.9365 23.9657 26.1073 27.1880 31.7108 26.9900 28.3569 26.9053 29.6751 28.7964 27.1265 31.7447 28.0786 52.1034 28.9661 24.7875 48.7148 28.5048 26.4630 31.3195 21.6626 25.4904 25.2550 24.3982 24.8764 22.9336 26.3118 23.4789 23.9798 18.9400 * 19.7066 25.4020 25.2938 16.7907 * 26.7516 16.7951 20.9502 21.4779 24.4908 22.6230 * 27.2211 31.5774 20.6338 24.3675 22.6022 22.2266 17.1372 26.0759 26.8591 23.3803 25.0299 24.2933 * 14.2517 26.8277 26.7852 27.3341 18.4776 31.7748 22.3249 28.2232 26.8768 19.7409 19.0450 40.5120 25.7886 * 27.0362 34.6602 29.9913 28.6527 29.3405 31.1372 30.4247 30.1659 34.1643 28.6416 19.6034 30.3809 26.6100 30.2358 30.3293 28.4378 30.3794 23.6078 27.6345 25.7523 25.3221 24.9562 * 27.9209 24.3884 26.4125 16.1658 * 20.1452 * 26.3443 * * * 20.6642 22.5904 22.3170 24.6954 * * 28.5297 36.6365 22.4091 28.6564 23.3065 23.0600 18.1242 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 26.0760 26.9602 24.3763 23.1796 23.3967 24.4785 17.7557 25.5872 25.7103 26.8213 17.2529 30.3084 21.2486 26.3653 27.4232 21.0203 18.5793 27.9394 24.2458 26.1073 27.1115 32.1463 27.2572 27.9367 26.3828 29.6846 29.0434 27.2823 32.3199 27.3772 33.6763 27.8836 24.7024 39.7283 28.4200 26.4965 30.4272 21.8876 25.7287 25.1326 24.2894 24.2827 23.0196 25.9669 23.2115 24.2860 17.7607 21.5602 19.5513 24.9502 24.2492 17.6689 19.0270 25.7861 20.3051 20.7967 21.3141 24.0687 20.9305 13.2365 27.3790 32.6197 20.7429 25.7920 21.9604 22.2778 17.2195 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23499 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 140018 140019 140024 140026 140027 140029 140030 140032 140033 140034 140037 140043 140045 140046 140048 140049 140051 140052 140053 140054 140058 140059 140061 140062 140063 140064 140065 140066 140067 140068 140070 140077 140079 140080 140082 140083 140084 140088 140089 140090 140093 140094 140095 140100 140101 140102 140103 140105 140109 140110 140113 140114 140115 140116 140117 140118 140119 140120 140121 140124 140125 140127 140129 140132 140135 140137 140140 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00195 1.4161 0.9635 0.9981 1.1611 1.1589 1.5505 1.6859 1.1817 1.2115 1.2308 0.8583 1.2327 1.0328 1.4582 1.2496 1.5568 1.5044 1.1992 1.8567 1.4302 1.2547 1.0783 0.9751 1.2085 1.3649 1.1568 1.3774 1.1153 1.8344 1.1769 *** 0.9555 *** 1.4264 1.3940 1.0155 1.1998 1.8091 1.1918 *** 1.1539 1.0354 1.2149 1.2204 1.1371 1.0407 1.2439 1.2336 1.1423 1.0533 1.5519 1.4645 1.1252 1.2744 1.5049 1.6963 1.7432 1.2478 1.6002 1.2606 1.2180 1.5733 *** *** 1.3954 1.0383 1.0049 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 1.0846 0.8285 0.8285 0.8285 0.8285 1.0846 1.0846 0.8953 1.0444 0.8953 0.8285 0.9667 0.8285 0.8953 1.0846 1.0846 1.0846 0.8953 0.8879 1.0846 0.8953 0.8953 0.8953 1.0846 1.0846 0.8844 1.0846 0.8953 0.8844 1.0846 * 0.8953 * 1.0846 1.0846 1.0846 1.0444 1.0846 0.8285 * 0.9048 1.0846 1.0846 1.0444 1.0846 0.8285 1.0846 1.0846 0.8285 1.0698 0.9591 1.0846 1.0846 1.0846 1.0846 1.0846 1.0846 0.8844 0.8844 1.0846 0.8953 0.9083 0.8285 * 0.8285 0.8953 0.8285 24.3285 17.4206 15.6616 20.4084 20.9855 25.0485 26.5733 20.6273 23.4279 20.9635 15.5578 23.3751 18.9587 21.7969 25.9122 21.9546 24.2472 21.8161 22.6099 35.5659 20.5089 19.9777 22.7515 30.7005 30.5430 20.6505 26.3521 18.0915 21.9579 24.1316 25.2960 18.0487 25.7090 24.4056 25.0474 23.2822 25.4818 28.4219 20.7632 35.0300 21.5376 24.2166 24.7706 27.1868 24.6106 19.8678 21.2404 27.3323 16.4261 21.9880 25.6621 24.1926 25.3410 26.8924 23.3531 26.7350 31.3486 20.3237 17.6019 30.9648 19.5359 21.3102 21.6495 23.0595 19.7919 21.6017 19.1636 27.3334 18.4554 16.9672 21.6847 22.6208 27.7304 28.7623 22.8157 26.1553 22.1003 * 26.0330 21.0042 22.5022 27.0874 26.6533 27.9935 22.2588 23.5477 31.7265 22.1269 22.7121 30.9925 31.2359 26.5584 21.7470 26.1904 20.4353 23.5906 25.8963 * 19.0922 29.3040 26.0109 26.8077 24.6491 27.6819 31.0364 22.1227 * 22.1540 25.3678 29.9746 32.8743 25.4784 21.2278 21.7512 26.3054 17.8103 25.6561 23.5337 25.7968 26.3677 30.5166 25.6314 27.7392 33.6302 22.5795 * 35.2798 20.7189 22.8172 * * 21.2104 20.5053 21.4710 27.7548 18.9228 17.5249 23.0470 * 28.9717 29.3100 24.0574 25.6068 23.0034 * 26.7996 20.6548 23.2127 28.2222 27.4009 27.7901 23.5662 24.8455 31.8564 22.8423 22.4651 20.8063 34.7113 27.8306 22.0407 34.6406 19.4775 25.3986 27.3956 * 19.1363 * 23.2575 25.6645 26.5562 29.2515 32.4978 23.3401 * 25.3127 27.0578 27.6799 37.0819 28.5365 * 23.3258 27.4531 19.5675 27.9844 26.7969 28.3014 25.1498 31.9902 26.8973 29.7570 36.1419 22.7375 * 36.1327 20.4014 24.1658 * * 22.3264 21.4700 * Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 26.4350 18.2432 16.7192 21.6994 21.8225 27.3787 28.2629 22.5257 25.0497 21.9987 15.5578 25.3939 20.2345 22.5567 27.0819 25.3465 26.6740 22.5560 23.6468 32.8769 21.8133 21.7552 24.6734 32.2167 28.2367 21.4911 28.8914 19.2927 23.6801 25.8156 25.2960 18.7657 27.5634 24.4826 25.8332 24.8886 27.5306 30.6729 22.0452 35.0300 22.9099 25.5410 27.5947 32.5610 26.3107 20.5493 22.1297 27.0018 17.9602 25.2166 25.2477 26.1695 25.6313 29.9696 25.3122 28.1023 33.6518 21.8812 17.6019 34.0784 20.2151 22.7988 21.6495 23.0595 21.1811 21.1955 20.3063 23500 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 140141 ............................................................................. 140143 ............................................................................. 140144 ............................................................................. 140145 ............................................................................. 140147 ............................................................................. 140148 ............................................................................. 140150 ............................................................................. 140151 ............................................................................. 140152 ............................................................................. 140155 2 ........................................................................... 140158 ............................................................................. 140160 ............................................................................. 140161 ............................................................................. 140162 ............................................................................. 140164 ............................................................................. 140165 ............................................................................. 140166 ............................................................................. 140167 ............................................................................. 140168 ............................................................................. 140170 ............................................................................. 140171 ............................................................................. 140174 ............................................................................. 140176 ............................................................................. 140177 ............................................................................. 140179 ............................................................................. 140180 ............................................................................. 140181 ............................................................................. 140182 ............................................................................. 140184 ............................................................................. 140185 ............................................................................. 140186 2 ........................................................................... 140187 ............................................................................. 140189 ............................................................................. 140190 ............................................................................. 140191 ............................................................................. 140193 ............................................................................. 140197 ............................................................................. 140199 ............................................................................. 140200 ............................................................................. 140202 ............................................................................. 140203 ............................................................................. 140205 ............................................................................. 140207 ............................................................................. 140208 ............................................................................. 140209 ............................................................................. 140210 ............................................................................. 140211 ............................................................................. 140213 ............................................................................. 140215 ............................................................................. 140217 ............................................................................. 140223 ............................................................................. 140224 ............................................................................. 140228 ............................................................................. 140231 ............................................................................. 140233 ............................................................................. 140234 ............................................................................. 140239 ............................................................................. 140240 ............................................................................. 140242 ............................................................................. 140245 ............................................................................. 140246 ............................................................................. 140251 ............................................................................. 140252 ............................................................................. 140258 ............................................................................. 140271 ............................................................................. 140275 ............................................................................. 140276 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00196 1.0111 1.1472 0.9464 1.1245 1.1208 1.7042 1.5763 0.8471 1.1463 1.2537 1.3922 1.2262 1.1181 1.5842 1.7335 1.0648 1.1685 1.0308 1.1558 0.9276 *** 1.4550 1.2096 0.8782 1.3651 1.2658 1.1677 1.4864 1.2150 1.4160 1.4842 1.4808 1.1406 1.0678 1.3038 0.9615 1.2361 1.0379 1.4887 1.5458 1.0810 0.5846 1.3693 1.6342 1.5435 1.0967 1.3023 1.1645 *** 1.4239 1.4296 1.3921 1.5304 1.4741 1.5549 1.0501 1.5495 1.3929 1.4842 0.9866 *** 1.2806 1.3977 1.5252 0.8733 1.2740 1.7772 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.8953 0.8844 1.0846 0.8953 0.8285 0.8879 1.0846 1.0846 1.0846 1.0991 1.0846 0.9667 1.0698 0.9083 0.8953 0.8285 0.8285 0.8285 0.8953 0.8285 0.8285 1.0846 1.0846 1.0846 1.0846 1.0846 1.0846 1.0846 0.8285 0.8953 1.0991 0.8953 0.9335 0.8285 1.0846 0.8285 1.0846 0.8285 1.0846 1.0444 1.0846 0.9975 1.0846 1.0846 0.8844 0.8285 1.0846 1.0846 * 1.0846 1.0846 1.0846 0.9975 1.0846 1.0698 0.8844 0.9975 1.0846 1.0846 0.8285 0.8285 1.0846 1.0846 1.0846 0.8285 0.8716 1.0846 20.3706 22.0009 26.9258 19.6429 18.2692 21.5777 32.9291 21.5167 28.5468 25.2034 22.5638 20.9986 22.2191 22.6426 19.7774 17.0666 20.7849 19.5959 18.7504 17.0665 17.3214 23.6893 25.6824 20.8526 24.1539 25.4022 23.7308 32.1969 20.6499 20.0903 26.0970 20.5829 22.5875 17.9193 24.5446 20.5958 19.2980 19.7888 24.1358 26.2460 26.5789 25.1010 23.3197 27.4671 22.0813 15.5339 25.8556 27.4607 18.6962 24.7146 27.4355 27.1725 22.9899 25.5536 24.7103 20.8676 23.9205 25.0325 28.8686 15.2537 16.1305 24.8256 28.3479 27.5741 17.5174 23.1871 25.3222 23.0515 23.8255 27.8046 21.6168 19.5896 23.0022 33.9013 22.4842 29.6882 27.6610 23.8542 22.7002 24.1071 26.0312 22.0424 15.9312 21.7776 19.7610 20.0225 17.1608 * 24.7011 28.9378 19.3328 26.3200 27.4366 23.6034 28.0337 20.1279 22.0222 28.1977 22.0674 25.6954 18.8530 25.2817 22.9443 21.8060 21.3464 24.9217 27.4336 28.2212 * 25.7331 27.6586 23.3886 16.6729 29.5114 29.1649 22.3097 29.3711 29.2540 29.0350 25.0074 28.3545 27.3379 23.2604 24.2112 27.2654 30.4005 16.0772 * 26.7266 30.2656 27.9478 18.8535 25.2824 27.5936 21.7871 26.2954 * 23.4608 19.8541 25.2030 35.2711 23.4879 27.6086 28.9724 28.6818 24.5373 23.1647 27.4472 23.7457 16.6304 23.1005 22.8911 * * * 27.8131 31.3490 22.5610 27.6376 28.3649 25.0100 28.2211 21.1802 23.8531 31.7593 23.2892 23.7198 19.8297 25.8813 * 23.0684 22.0315 26.6881 29.7870 * * 24.1048 29.4708 24.4266 19.2639 29.7054 30.2945 * 31.5324 30.4923 28.2177 25.6419 30.6410 28.6305 23.6928 29.0092 31.8945 32.0522 * * 27.1870 33.3885 30.2639 * 26.1473 29.1983 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 21.7302 24.0154 27.3474 21.6090 19.2467 23.2104 34.0702 22.5018 28.6011 27.2937 24.8001 22.7502 23.1691 25.4182 21.8696 16.5175 21.8859 20.7477 19.4021 17.1147 17.3214 25.3970 28.8390 20.9656 26.0525 27.0717 24.1182 28.8901 20.6885 22.0093 28.8521 21.9710 24.0159 18.8585 25.2456 21.7731 21.2577 21.0597 25.2459 27.9702 27.4338 25.1010 24.4812 28.2131 23.3169 17.1406 28.4947 29.0178 20.4262 28.5274 29.0769 28.1560 24.5738 28.2754 26.9841 22.6766 25.6976 27.8715 30.5576 15.6642 16.1305 26.2433 30.8286 28.6430 18.2163 24.8583 27.3299 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23501 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 140280 ............................................................................. 140281 ............................................................................. 140285 ............................................................................. 140286 ............................................................................. 140288 ............................................................................. 140289 ............................................................................. 140290 ............................................................................. 140291 ............................................................................. 140292 ............................................................................. 140294 ............................................................................. 140300 ............................................................................. 140301 ............................................................................. 150001 ............................................................................. 150002 ............................................................................. 150003 ............................................................................. 150004 ............................................................................. 150005 ............................................................................. 150006 ............................................................................. 150007 ............................................................................. 150008 ............................................................................. 150009 ............................................................................. 150010 ............................................................................. 150011 ............................................................................. 150012 ............................................................................. 150013 ............................................................................. 150014 ............................................................................. 150015 ............................................................................. 150017 ............................................................................. 150018 ............................................................................. 150019 ............................................................................. 150021 ............................................................................. 150022 ............................................................................. 150023 ............................................................................. 150024 ............................................................................. 150026 ............................................................................. 150027 ............................................................................. 150029 ............................................................................. 150030 ............................................................................. 150031 ............................................................................. 150034 ............................................................................. 150035 ............................................................................. 150037 ............................................................................. 150038 ............................................................................. 150042 ............................................................................. 150044 ............................................................................. 150045 h ........................................................................... 150046 ............................................................................. 150047 ............................................................................. 150048 ............................................................................. 150049 ............................................................................. 150051 ............................................................................. 150052 h ........................................................................... 150056 ............................................................................. 150057 ............................................................................. 150058 ............................................................................. 150059 ............................................................................. 150060 ............................................................................. 150061 ............................................................................. 150062 ............................................................................. 150063 ............................................................................. 150064 ............................................................................. 150065 ............................................................................. 150067 ............................................................................. 150070 ............................................................................. 150072 ............................................................................. 150073 ............................................................................. 150075 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00197 1.4521 1.6920 *** 1.1088 1.5237 1.3248 1.3237 1.2597 1.1534 1.1263 1.1599 1.1555 1.1532 1.3813 1.6528 1.5181 1.1975 1.2943 1.2960 1.4015 1.3653 1.3255 1.1602 1.5342 0.9799 1.2880 1.3161 1.8224 1.6280 1.0534 1.7262 1.0471 1.5248 1.3936 1.2781 0.9951 1.4269 1.2034 1.0678 1.4639 1.4585 1.2877 1.0995 1.3907 1.3121 1.0499 1.4135 1.7002 1.3259 1.1169 1.5540 1.0320 1.8253 2.0135 1.5550 1.5671 1.0728 1.1040 1.1136 *** 1.1597 1.2439 1.0162 0.9415 1.1999 *** 1.0759 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.8716 1.0846 0.8879 1.0846 1.0846 0.8953 1.0846 1.0698 1.0846 0.8285 1.0846 1.0846 0.9922 1.0698 0.8730 1.0698 0.9922 0.9785 0.9555 1.0698 0.9264 0.9555 0.9776 0.9785 0.8632 0.9922 1.0698 0.9797 0.9616 0.8632 0.9797 0.8632 0.8632 0.9922 0.9616 0.9922 0.9785 0.9776 0.8632 0.9366 0.9366 0.9922 0.9922 0.8632 0.9264 0.9797 0.8632 0.9797 0.9604 0.8632 0.8632 0.9264 0.9922 0.9922 0.9785 0.9922 0.8632 0.8632 0.8632 * 0.8632 0.9776 0.8632 0.8632 0.8632 * 0.9797 21.7004 27.9115 * 25.5805 26.3572 20.7506 29.9098 27.6675 26.4077 21.7473 30.5172 * 25.4897 22.3327 21.0944 23.6169 23.8818 23.1779 22.1098 23.8916 19.4763 22.5445 22.1559 23.1644 19.8564 24.3754 23.1616 22.7979 24.6138 17.3170 24.3658 22.2973 20.6926 21.7593 23.2169 21.5766 25.2067 23.0196 18.9180 22.8812 23.5468 24.4997 21.6608 23.7838 20.5156 23.0361 20.3453 24.8786 22.5181 18.4942 21.4009 19.1070 24.7841 28.0884 24.9479 25.6738 19.8990 19.2826 22.9214 24.4091 21.2512 23.0636 21.4374 20.7413 18.5447 14.8287 20.1119 21.9302 29.2602 17.7824 28.4378 26.9581 22.3274 28.6926 28.2338 26.1781 22.6123 33.3983 * 27.1021 23.3804 23.3196 24.8884 25.4443 24.8976 23.5841 23.6953 20.4993 23.9740 23.2249 22.9314 19.7689 26.5785 24.3015 23.7180 24.7048 * 27.8168 22.8035 23.1253 24.7879 23.7185 21.2855 23.4103 24.4361 * 23.9388 26.0952 27.7009 24.4188 21.9917 23.1200 24.2899 21.0417 24.5455 24.5864 20.2178 22.6866 19.6073 27.6754 22.7804 26.9753 27.0792 23.2409 21.3640 23.5550 19.0377 21.6370 24.4451 * 22.6260 20.3191 * 24.2085 23.4343 30.4849 20.7576 29.1543 29.3988 22.6211 31.7341 29.8958 27.6230 23.4504 34.8568 31.7073 29.6844 25.0063 25.3458 26.8458 27.2369 26.4061 26.6073 26.6928 22.2147 26.8524 24.3490 27.3031 21.8465 * 26.2434 25.2342 26.3289 * 29.6967 22.6773 23.7159 27.1589 28.1127 17.4862 26.9680 26.9533 * 26.0465 26.6620 28.5451 28.8054 23.0102 23.7065 25.2225 21.9369 25.8349 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 * * 20.5111 * 24.0745 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 22.3632 29.2420 19.1679 27.7906 27.5648 21.9308 30.1371 28.6610 26.7673 22.6034 32.8808 31.7073 27.4774 23.5866 23.2610 25.1066 25.6152 24.8616 24.2353 24.7814 20.7473 24.4792 23.2593 24.2924 20.4949 25.4309 24.6064 23.9446 25.2344 17.3170 27.2581 22.6089 22.4697 24.7582 25.1166 19.9164 25.0754 24.8565 18.9180 24.3610 25.4702 26.8949 24.9650 22.8781 22.4683 24.2205 21.1254 25.1035 24.7509 20.2342 22.5941 19.7871 26.9368 24.9551 26.5322 27.1975 22.6276 20.9919 23.7293 21.8339 22.2400 24.5094 21.4374 21.7117 19.8274 14.8287 22.8038 23502 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 150076 ............................................................................. 150078 ............................................................................. 150079 ............................................................................. 150082 ............................................................................. 150084 ............................................................................. 150086 ............................................................................. 150088 ............................................................................. 150089 ............................................................................. 150090 ............................................................................. 150091 h ........................................................................... 150096 ............................................................................. 150097 ............................................................................. 150100 ............................................................................. 150101 ............................................................................. 150102 ............................................................................. 150104 ............................................................................. 150106 h ........................................................................... 150109 ............................................................................. 150112 ............................................................................. 150113 ............................................................................. 150115 ............................................................................. 150122 ............................................................................. 150123 ............................................................................. 150124 ............................................................................. 150125 ............................................................................. 150126 ............................................................................. 150128 ............................................................................. 150129 ............................................................................. 150130 ............................................................................. 150132 ............................................................................. 150133 ............................................................................. 150134 ............................................................................. 150136 ............................................................................. 150146 ............................................................................. 150147 ............................................................................. 150148 ............................................................................. 150149 ............................................................................. 150150 ............................................................................. 150151 ............................................................................. 150152 ............................................................................. 160001 ............................................................................. 160002 ............................................................................. 160005 ............................................................................. 160008 ............................................................................. 160013 ............................................................................. 160014 ............................................................................. 160016 ............................................................................. 160020 ............................................................................. 160024 ............................................................................. 160026 ............................................................................. 160028 ............................................................................. 160029 ............................................................................. 160030 ............................................................................. 160031 ............................................................................. 160032 ............................................................................. 160033 ............................................................................. 160034 ............................................................................. 160039 ............................................................................. 160040 ............................................................................. 160043 ............................................................................. 160045 ............................................................................. 160047 ............................................................................. 160048 ............................................................................. 160050 ............................................................................. 160057 ............................................................................. 160058 ............................................................................. 160064 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00198 1.2278 0.9426 1.0871 1.7137 1.7636 1.2074 1.2662 1.4706 1.4690 1.0853 0.9741 1.0577 1.6892 1.0267 1.0711 1.0414 1.0517 1.3698 1.4147 1.1907 1.3246 1.1182 *** 1.1187 1.4937 1.4161 1.3711 1.1881 1.0196 1.3880 1.2457 1.0951 *** 1.0119 1.1985 *** 0.9756 1.2639 *** *** 1.1965 *** 1.1819 1.0624 1.2044 0.9866 1.5746 1.0649 1.5772 0.9843 1.3058 1.6068 1.2629 0.9566 1.0533 1.7259 0.9398 0.9260 1.2162 *** 1.6924 1.3599 1.0546 1.1022 1.2499 1.8388 1.5830 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.9785 0.8632 0.9264 0.8735 0.9922 0.9604 0.9776 0.8952 1.0698 0.9797 0.8632 0.9922 0.8735 0.9797 0.9366 0.9922 0.9797 0.8730 0.9776 0.9776 0.8632 0.8632 0.8735 0.8632 1.0698 1.0698 0.9922 0.9922 0.8735 1.0698 0.9797 0.9264 0.9922 0.9797 1.0698 * 0.8735 0.9797 * 0.9922 0.9231 0.8563 0.8563 0.8563 0.8563 0.8563 0.9413 0.8563 0.9650 0.9231 0.9555 0.9751 0.9546 0.8563 0.8563 0.8716 0.8563 0.8563 0.8564 0.8563 0.8605 0.9555 0.8563 0.8563 0.9574 0.9751 0.8563 25.4519 20.1259 19.3860 21.0651 27.8354 21.5815 22.2627 21.6806 24.9021 26.4248 19.7975 22.4564 21.2980 26.1271 21.3313 21.0799 19.1976 23.4642 23.5151 21.2412 20.3863 22.2752 15.5997 17.9063 23.1464 24.1917 20.9869 34.3166 18.5578 22.2707 21.8807 20.7680 25.8467 25.1827 * 26.2188 * * * * 22.8426 19.9607 20.3313 17.9463 21.0541 18.3097 21.8400 16.6092 22.4256 22.8967 25.1998 23.7268 23.3687 17.8994 20.5024 22.2660 19.0684 19.8851 20.0567 15.5765 22.1285 22.1550 18.1174 21.6247 20.8345 23.5663 23.8367 24.1434 21.2476 20.6486 22.2054 28.7722 22.4471 23.0998 22.6545 24.6758 27.8087 21.9091 24.4179 22.2687 27.9745 22.6870 21.8172 20.9955 24.3786 24.7455 23.0450 20.5215 24.2471 15.3050 18.8218 24.3872 25.5585 23.1660 35.4311 21.5678 24.2559 21.8839 22.1085 25.7004 26.1168 32.3336 27.2081 23.8554 26.5138 * * 23.8657 * 21.1745 19.8066 23.0163 19.2447 21.2785 19.0043 24.2385 24.2045 26.0052 24.9493 24.9920 18.5281 22.3837 23.4148 19.4837 20.9623 21.8187 * 24.4957 24.5000 19.5701 23.8830 22.0472 25.5244 27.6301 28.1874 21.9771 21.4067 25.5860 29.3905 23.9404 23.6253 25.0449 26.2899 30.6209 23.8092 25.0367 24.3530 29.1657 24.5923 25.5871 20.9387 23.5865 26.5643 24.8760 19.3411 26.0173 * 21.3933 26.7666 26.9887 26.4976 29.9099 21.7399 25.6257 22.7293 23.8526 26.2703 29.3383 22.8456 * 23.6361 25.5331 38.1446 44.7143 25.1220 * 21.8950 20.7200 23.7163 20.9256 23.3031 19.5752 26.2392 24.7424 26.2948 27.9277 26.7068 19.7585 23.4727 24.6768 19.3503 22.1629 23.9053 * 25.4153 25.2072 19.6431 24.5403 23.2913 27.1646 28.6139 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 25.9085 21.1303 20.5165 22.9776 28.6939 22.7151 23.0168 23.0977 25.3163 28.2762 21.8206 24.0346 22.6387 27.6430 22.8112 22.8454 20.4063 23.8124 24.9478 23.1460 20.0486 24.2508 15.4580 19.4269 24.8140 25.6255 23.5710 32.9368 20.5294 24.1021 22.1682 22.2228 25.9403 26.7878 26.0420 26.7661 23.7419 26.0172 38.1446 44.7143 23.9155 19.9607 21.1337 19.4883 22.5118 19.5050 22.1576 18.4226 24.3248 23.9779 25.8671 25.5651 25.0247 18.7487 22.1329 23.4865 19.3060 21.0029 21.9454 15.5765 24.0445 23.9813 19.1317 23.3364 22.0638 25.4595 26.8350 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23503 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 160066 160067 160069 160072 160076 160079 160080 160081 160082 160083 160089 160090 160091 160092 160093 160104 160106 160107 160110 160112 160113 160114 160116 160117 160118 160122 160124 160126 160131 160143 160147 160153 170001 170006 170008 170010 170012 170013 170014 170015 170016 170017 170018 170019 170020 170022 170023 170024 170026 170033 170034 170040 170041 170052 170054 170056 170068 170070 170074 170075 170077 170082 170086 170090 170093 170094 170097 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00199 1.0921 1.3469 1.4317 *** 0.9917 1.4983 1.3105 1.1704 1.7449 1.6465 1.2795 0.9949 0.9514 0.9582 *** 1.3676 1.1242 1.0394 1.6369 1.2659 0.9601 0.9804 1.0412 1.2747 1.0219 1.0854 1.1255 1.0455 0.9332 1.0569 1.2103 1.5766 1.1572 1.2459 *** 1.2414 1.6156 1.5825 0.9823 1.0532 1.6153 1.1022 0.8898 1.2134 1.5747 1.0924 1.4742 *** *** 1.3844 0.8698 1.8787 *** 1.1985 0.9966 *** 1.1985 1.0679 1.1969 0.8302 *** *** 1.5458 0.9249 0.8184 0.9938 0.8884 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.8563 0.8564 0.9116 0.8563 0.8563 0.8605 0.9667 0.8563 0.9650 0.9650 0.9413 0.8563 0.8563 0.8563 0.8605 0.8716 0.8563 0.8563 0.8564 0.8563 0.8563 0.8563 0.8563 0.9116 0.8563 0.8563 0.8563 0.8563 0.8563 0.8563 0.9231 0.9360 0.8032 0.8458 0.8032 0.8313 0.8946 0.8946 0.9454 0.8032 0.8921 0.9156 0.8032 0.8032 0.8946 0.9454 0.8946 0.8032 0.8032 0.8946 0.8032 0.9454 0.8032 0.8032 0.8032 0.8032 0.9165 0.8032 0.8032 0.8032 0.8032 0.8032 0.8921 0.8032 0.8032 0.8032 0.8032 20.4609 19.9422 21.7197 15.8236 20.1603 21.6562 21.1713 20.4415 21.6230 23.4670 19.9688 19.6767 16.1660 20.4731 22.8553 23.2832 19.8905 19.5111 21.9299 20.4038 16.7574 19.1743 19.6923 22.3228 16.9466 21.2843 21.2279 20.0149 18.0486 19.0623 22.7993 23.5212 19.8149 19.4488 18.2352 20.6294 21.8587 21.4954 21.3416 18.0485 22.9479 21.6323 16.9169 18.7916 20.6658 21.1947 21.6273 16.1196 17.0836 20.0627 18.1074 24.5234 13.9709 15.8809 18.5239 17.1872 20.5512 15.0539 18.5446 15.6809 14.6377 15.9973 22.1067 16.3550 15.0307 20.1253 18.9865 21.4631 21.9418 22.7514 * 20.9749 22.5299 23.5721 21.3614 23.8181 25.0617 21.5693 21.2753 18.0630 22.0841 * 24.0075 21.4912 21.3754 24.1762 21.8901 18.6599 * 22.2019 23.4250 18.3322 22.9565 22.7223 20.3748 * * 26.6577 26.3671 20.9837 20.6460 * 21.2131 22.6869 23.1159 22.9772 19.1902 24.2336 23.3030 17.9497 20.3243 22.2571 22.9313 23.2690 * * 20.0801 * 27.1771 * 17.3794 17.5500 * 20.8771 16.4767 20.4936 16.2047 * * 22.7737 15.9807 16.8710 20.3678 20.3391 22.7453 23.4060 25.8067 * * 22.4291 23.0138 23.1930 26.2453 28.2193 22.6551 * 17.9255 * * 24.9134 * * 24.9434 23.0673 * * * 25.0278 19.7764 22.5810 23.1690 19.6296 * * 25.1228 28.9881 21.9131 21.9019 * 24.0008 24.7392 24.9709 23.5960 20.2367 25.9482 24.7771 17.2199 22.0251 23.1800 22.2878 22.5551 * * 20.5954 * 28.2856 * 18.5291 * * 22.6087 16.0162 21.0565 16.5444 * * 24.0812 * 16.5553 21.3887 * Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 21.6034 21.8952 23.4426 15.8236 20.5825 22.2178 22.5698 21.6437 23.8567 25.6738 21.4092 20.4851 17.3725 21.2805 22.8553 24.0516 20.6919 20.4402 23.7256 21.8008 17.7162 19.1743 20.9445 23.6002 18.4025 22.2832 22.3848 20.0068 18.0486 19.0623 24.8830 26.3386 20.9143 20.7240 18.2352 21.9435 23.0750 23.1630 22.6522 19.1620 24.4090 23.3226 17.3753 20.4068 22.0586 22.1486 22.4908 16.1196 17.0836 20.2325 18.1074 26.8014 13.9709 17.3370 18.0250 17.1872 21.3531 15.8428 20.0516 16.1586 14.6377 15.9973 23.0117 16.1812 16.1514 20.6420 19.6594 23504 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 170098 170099 170103 170104 170105 170109 170110 170113 170116 170120 170122 170123 170133 170137 170142 170143 170144 170145 170146 170147 170148 170151 170171 170176 170180 170182 170183 170185 170186 170187 170188 170189 170191 170192 170193 170194 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 180041 180043 180044 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00200 1.0009 0.8971 1.2452 1.5039 1.0723 0.9921 0.9659 1.0330 0.9958 1.2748 1.6149 1.6579 1.0482 1.2299 1.3359 1.1294 *** 1.0646 1.5346 1.2185 *** 1.0014 *** 1.2996 *** 1.4072 1.9491 1.2969 2.9412 1.1355 2.0008 *** 1.1514 2.0555 1.2126 1.6735 1.2733 1.0456 1.0968 1.1514 0.8988 1.4096 1.6162 1.9470 1.3310 1.4989 1.4422 1.3138 1.2408 1.3264 1.1667 1.0301 1.0255 1.1362 1.0433 1.1055 1.2138 0.8828 1.2700 1.5412 1.1727 1.2780 1.3465 2.0835 1.0740 1.1986 1.5046 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.8032 0.8032 0.9156 0.9454 0.8032 0.9454 0.8032 0.8032 0.8032 0.8458 0.9156 0.9156 0.9454 0.8032 0.8785 0.8032 * 0.8032 0.9454 0.9156 * 0.8032 * 0.9454 * 0.9454 0.9156 0.9454 0.9156 0.8032 0.9454 * 0.8032 0.9156 0.8032 0.9454 0.9604 0.7788 0.7788 0.9119 0.7788 0.9060 0.9482 0.9060 0.8830 0.9264 0.9492 0.9264 0.8286 0.8830 0.9604 0.7788 0.7788 0.9264 0.9264 0.7788 0.8092 0.9119 0.8095 0.9604 0.9482 0.9264 0.8806 0.9264 0.7788 0.7788 0.9119 18.6676 15.8117 20.1263 23.6589 18.3824 20.7580 16.5883 19.9957 20.8800 18.5895 22.2681 25.0073 20.0593 21.4394 19.8269 18.0308 23.9180 20.5143 27.0312 18.2480 26.3491 15.7242 14.7251 25.5404 25.0935 23.2115 19.6919 26.8307 28.5602 20.8289 25.2504 28.1996 * * * * 22.2674 20.5135 19.8552 22.6704 14.4066 21.3545 22.4450 22.6846 18.8056 20.2758 21.0512 20.5203 18.0329 17.5670 20.8416 20.9964 17.6331 22.3922 18.3306 15.5354 20.5017 20.6324 20.4262 24.3874 22.2389 22.7893 20.6888 23.2341 19.1325 20.6498 21.8163 20.0078 * 21.4985 26.1866 19.6687 22.7166 21.8904 * 23.1127 19.8723 24.5826 26.4676 21.7748 22.7676 22.4095 19.7643 24.4259 21.4472 28.1965 23.1610 * * * 24.2283 * 24.3820 22.8633 24.8478 30.5157 21.0780 27.2225 * 24.9599 * * * 24.7647 21.6843 19.0834 22.8871 15.7136 21.8724 24.0971 16.6893 22.3183 22.9096 21.4728 22.2148 19.0694 18.3314 22.0379 22.3477 17.9346 23.6826 17.4781 15.8431 22.1072 21.4766 21.2110 26.7702 23.1636 24.4451 22.2750 24.5590 18.5483 18.8436 21.6837 19.8881 * 22.8707 26.6100 21.4422 23.2626 22.2650 * * 21.0499 25.3981 27.2239 22.9309 23.8863 22.5778 20.4459 24.6260 21.2071 28.8062 20.7436 * * * 26.2366 25.1366 25.7443 24.5539 26.7797 31.7896 23.3702 29.9751 * 21.3069 27.0380 24.7430 27.9904 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 24.7968 23.0536 29.8438 25.1154 25.7361 24.6348 26.2125 * 19.0617 23.0971 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 19.5154 15.8117 21.5590 25.5135 19.8723 22.2703 20.1717 19.9957 21.9980 19.8632 24.1100 26.2255 21.5574 22.7099 21.6027 19.4072 24.3634 21.0600 28.0903 20.6771 26.3491 15.7242 14.7251 25.2863 25.1166 24.4497 22.4468 26.1506 30.4381 21.8354 27.6756 28.1996 23.1771 27.0380 24.7430 27.9904 24.1342 21.7424 19.4871 23.3888 14.9439 21.9873 24.0052 20.7808 21.2726 22.6125 21.8902 22.0005 19.3296 18.3166 22.3292 21.7537 18.0522 25.9352 18.3232 16.5328 22.1722 22.1418 21.5776 27.1206 23.5250 24.4985 22.4970 24.7248 18.8494 19.4791 22.1791 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23505 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 180045 ............................................................................. 180046 ............................................................................. 180047 ............................................................................. 180048 ............................................................................. 180049 h ........................................................................... 180050 ............................................................................. 180051 ............................................................................. 180053 ............................................................................. 180054 ............................................................................. 180055 h ........................................................................... 180056 ............................................................................. 180063 ............................................................................. 180064 ............................................................................. 180066 ............................................................................. 180067 ............................................................................. 180069 ............................................................................. 180070 ............................................................................. 180072 ............................................................................. 180079 ............................................................................. 180080 ............................................................................. 180087 ............................................................................. 180088 ............................................................................. 180092 ............................................................................. 180093 ............................................................................. 180094 ............................................................................. 180099 ............................................................................. 180102 ............................................................................. 180103 ............................................................................. 180104 ............................................................................. 180105 ............................................................................. 180106 ............................................................................. 180108 ............................................................................. 180116 ............................................................................. 180117 ............................................................................. 180120 ............................................................................. 180124 ............................................................................. 180126 ............................................................................. 180127 ............................................................................. 180128 ............................................................................. 180129 ............................................................................. 180132 ............................................................................. 180134 ............................................................................. 180138 ............................................................................. 180139 ............................................................................. 180141 ............................................................................. 180143 ............................................................................. 190001 ............................................................................. 190002 ............................................................................. 190003 ............................................................................. 190004 ............................................................................. 190005 ............................................................................. 190006 ............................................................................. 190007 ............................................................................. 190008 ............................................................................. 190009 ............................................................................. 190010 ............................................................................. 190011 ............................................................................. 190013 ............................................................................. 190014 ............................................................................. 190015 ............................................................................. 190017 h ........................................................................... 190018 ............................................................................. 190020 ............................................................................. 190025 ............................................................................. 190026 ............................................................................. 190027 ............................................................................. 190034 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00201 1.3290 1.0500 0.8429 1.2624 1.3812 1.1118 1.3901 1.0384 0.9619 1.0038 1.0631 1.1680 1.2463 1.0468 1.9180 1.0456 1.1131 *** 1.1252 1.3087 1.1742 1.5651 1.1282 1.4227 0.9602 *** 1.5476 2.2069 1.6243 0.8484 0.9458 *** 1.2066 0.9835 0.7761 1.3086 1.0372 1.2754 0.9399 *** 1.3264 1.0635 1.2100 1.0372 1.7146 1.4820 1.0754 1.7155 1.4560 1.2890 1.4326 1.2504 1.1174 1.6429 1.2155 1.1212 1.0256 1.3334 1.1677 1.3076 1.3418 *** 1.1401 1.2473 1.5166 1.6352 1.1567 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.9604 0.9060 0.7788 0.9264 0.9060 0.7788 0.8272 0.7788 0.7788 0.9060 0.8735 0.7788 0.7788 0.9492 0.9060 0.9119 0.7788 * 0.7788 0.8470 0.7788 0.9264 0.9060 0.8508 0.7788 0.7788 0.8092 0.9060 0.8092 0.7788 0.7788 0.7788 0.8285 0.7788 0.7788 0.9492 0.7788 0.9264 0.7788 0.7788 0.8830 0.7788 0.9264 0.8830 0.9264 0.9060 0.9003 0.8429 0.8429 0.7903 0.9003 0.8429 0.7445 0.7903 0.8048 0.7445 0.8044 0.7847 0.7445 0.9003 0.8429 0.7445 0.8605 0.7445 0.8048 0.7847 0.7445 22.1027 23.1139 17.8574 20.0114 18.5188 19.9082 18.8186 17.6239 19.1340 17.8704 19.4072 15.5078 21.1067 21.1884 22.0056 20.3982 16.9892 17.5411 18.0472 18.9582 16.4726 23.7217 19.6790 18.8469 15.7640 14.0115 20.1885 21.3867 21.3866 18.3521 15.4937 16.7327 20.5453 17.7885 20.4507 20.5369 14.5644 20.0059 19.8502 14.1861 19.9358 * 23.0996 20.6287 22.6722 20.1309 20.4946 20.7172 20.7505 20.5272 20.0551 18.8115 17.9392 20.3278 17.5144 18.1797 15.4699 18.7538 17.0630 20.6167 18.3528 19.2055 18.5659 19.9969 19.9229 19.4057 16.8439 24.5856 24.7562 20.4768 22.3601 19.4488 21.7150 19.2100 18.6610 19.0657 21.1989 21.4695 15.9185 15.3819 24.6359 24.0551 20.8797 17.4266 * 19.5783 20.1651 17.7758 24.6053 22.4864 19.2748 * * 19.1136 25.1577 22.8911 19.5364 15.7851 * 21.8698 20.5952 * 21.4270 15.1776 21.4633 20.5575 * 22.2101 17.3449 25.1789 21.3797 24.3140 14.2734 19.5680 21.7000 21.8156 22.1835 20.7987 19.4573 18.7854 21.4137 18.8295 19.9788 18.1525 19.6346 17.4740 22.1046 18.6962 * 19.8505 20.4651 21.3386 21.2449 17.5002 25.8349 27.2244 21.8037 21.6571 23.3407 22.6473 21.3312 19.1578 * 20.7237 22.8910 17.9741 16.2638 24.9543 25.4080 22.3674 20.1308 * 19.7791 21.7380 18.4331 27.5767 22.5679 20.5422 * * 18.4388 26.9407 24.9441 19.7615 17.8020 * 22.7353 21.1854 * 23.1917 * 23.4765 20.8406 * 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 * 21.6136 20.8950 22.5087 21.2526 19.6943 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 24.1325 25.0514 20.0588 21.3621 20.4067 21.3727 19.7863 18.5083 19.0979 19.9661 21.2490 16.5674 17.3349 23.6588 23.7960 21.2166 18.1917 17.5411 19.1405 20.2813 17.6017 25.3642 21.6047 19.5520 15.7640 14.0115 19.1595 24.4722 23.1113 19.2381 16.4485 16.7327 21.7465 19.7909 20.4507 21.6877 14.8844 21.6735 20.4307 14.1861 21.9796 18.0324 25.1767 21.8425 24.1450 19.0124 19.8963 21.4744 22.0368 21.9727 21.0635 20.1618 18.8587 21.9572 18.6932 19.9508 17.7235 19.7509 18.7727 21.9289 19.4006 19.2055 19.9828 20.4776 0121.3125 20.6470 18.0127 23506 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 190036 ............................................................................. 190037 ............................................................................. 190039 ............................................................................. 190040 ............................................................................. 190041 ............................................................................. 190043 ............................................................................. 190044 h ........................................................................... 190045 ............................................................................. 190046 ............................................................................. 190048 ............................................................................. 190049 ............................................................................. 190050 ............................................................................. 190053 ............................................................................. 190054 ............................................................................. 190059 ............................................................................. 190060 ............................................................................. 190064 ............................................................................. 190065 ............................................................................. 190077 ............................................................................. 190078 h ........................................................................... 190079 ............................................................................. 190081 ............................................................................. 190083 ............................................................................. 190086 ............................................................................. 190088 h ........................................................................... 190089 ............................................................................. 190090 ............................................................................. 190095 ............................................................................. 190098 ............................................................................. 190099 ............................................................................. 190102 ............................................................................. 190106 ............................................................................. 190109 ............................................................................. 190110 h ........................................................................... 190111 ............................................................................. 190114 ............................................................................. 190115 ............................................................................. 190116 ............................................................................. 190118 ............................................................................. 190122 ............................................................................. 190124 ............................................................................. 190125 ............................................................................. 190128 ............................................................................. 190130 ............................................................................. 190131 ............................................................................. 190133 ............................................................................. 190135 ............................................................................. 190140 ............................................................................. 190144 h ........................................................................... 190145 ............................................................................. 190146 ............................................................................. 190147 ............................................................................. 190149 ............................................................................. 190151 ............................................................................. 190152 ............................................................................. 190156 ............................................................................. 190158 ............................................................................. 190160 ............................................................................. 190161 ............................................................................. 190162 ............................................................................. 190164 ............................................................................. 190167 ............................................................................. 190175 ............................................................................. 190176 ............................................................................. 190177 ............................................................................. 190182 ............................................................................. 190183 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00202 1.6456 0.9457 1.4625 1.3133 1.4459 1.0017 1.2058 1.5902 1.4233 1.0523 1.0149 1.0741 1.1232 1.3671 0.8367 1.5006 1.5577 1.4890 0.8526 1.0049 1.2488 0.8882 0.8728 1.2357 1.0702 0.9609 1.0843 *** 1.5840 1.0296 1.6258 1.2114 1.1376 0.8513 1.5580 1.0513 1.1772 1.2394 0.9389 1.1878 1.5270 1.6350 1.0700 0.9482 1.1718 0.8895 1.4454 0.9845 1.1367 0.9459 1.5445 *** 0.9266 1.0072 1.3530 0.8717 1.3600 1.4780 1.1157 *** 1.1345 1.2264 1.3314 1.7308 1.5627 0.9036 1.1870 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.9003 0.7847 0.9003 0.9003 0.8767 0.7445 0.8429 0.9003 0.9003 0.7445 0.7445 0.7445 0.7445 0.7445 0.8605 0.7847 0.8605 0.8605 0.8044 0.8429 0.9003 0.7445 0.7445 0.8767 0.8767 0.7445 0.7445 * 0.8767 0.8470 0.8429 0.8048 0.7903 0.8429 0.8767 0.7445 0.8767 0.7445 0.8767 0.8605 0.9003 0.8044 0.8605 0.7445 0.9003 0.7445 0.9003 0.7445 0.8767 0.7445 0.9003 0.7445 0.7445 0.7445 0.9003 0.7445 0.9003 0.8044 0.7847 0.9003 0.8048 0.7445 0.9003 0.9003 0.9003 0.9003 0.7903 23.3903 15.6062 20.4900 22.9262 21.9983 15.7333 17.7460 22.8709 21.1019 18.1698 19.3768 18.6663 13.8037 19.9370 18.3334 20.2207 21.1262 20.3583 17.0480 19.8607 20.5000 11.4756 18.4954 18.2005 18.6738 15.5151 19.0519 16.9519 20.7537 23.1606 22.0190 20.3114 16.6515 16.5007 24.4380 13.6101 25.4984 17.8297 17.5060 17.7811 23.3859 21.5692 23.8786 15.2678 21.3154 13.4062 24.4908 15.4030 21.3838 17.4407 22.1502 16.3596 18.4197 17.3402 25.1136 18.0528 23.2361 19.8428 16.5322 20.7350 20.2791 17.2643 22.7574 25.2536 22.3318 23.6016 17.1805 23.7356 16.7629 23.3105 23.8076 23.9082 16.8944 19.5304 24.0490 22.2884 18.6148 20.1229 18.5287 15.7258 20.3525 19.2396 22.1499 21.5514 23.0523 18.4043 21.5782 21.8158 14.9141 19.2683 18.8306 22.5045 16.2961 20.0745 18.7302 23.0802 21.1657 23.4618 21.5643 17.4842 19.0611 25.2370 14.6258 26.0272 18.6074 19.0200 19.3131 23.4862 22.3976 24.7842 16.6910 22.5032 14.3089 26.9920 17.0371 21.1658 17.3361 23.7721 * 17.1671 17.8741 27.4708 18.3702 26.2352 20.0025 17.8794 22.1781 21.4247 17.8604 24.6790 25.8482 25.4769 25.0837 18.3151 24.8359 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 20.3844 19.7025 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 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 24.0024 17.0499 23.2338 24.3506 23.4433 16.6784 18.9595 24.1220 22.4847 18.7855 19.7625 18.7685 15.3819 20.1339 18.7888 21.9859 22.0132 22.3992 18.0986 20.9721 21.1972 13.9838 18.9013 18.9783 20.9939 15.9103 19.8076 17.8930 22.7792 21.4552 23.6255 21.2163 17.5941 17.8105 24.7275 14.6821 26.0395 18.9443 18.7558 20.0706 23.8477 22.6514 25.5637 15.9880 22.9740 13.7628 26.1247 16.7104 21.4426 17.9319 24.0255 16.3596 18.1219 17.9597 26.7879 18.2089 25.4140 20.5204 17.8227 22.6102 21.6241 19.7786 25.0038 25.6097 25.2171 25.6314 18.4205 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23507 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 190184 ............................................................................. 190185 ............................................................................. 190190 ............................................................................. 190191 h ........................................................................... 190196 ............................................................................. 190197 ............................................................................. 190199 ............................................................................. 190200 ............................................................................. 190201 ............................................................................. 190202 ............................................................................. 190203 ............................................................................. 190204 ............................................................................. 190205 ............................................................................. 190206 ............................................................................. 190207 ............................................................................. 190218 ............................................................................. 190236 ............................................................................. 190240 ............................................................................. 190241 ............................................................................. 190242 ............................................................................. 190243 ............................................................................. 190245 ............................................................................. 200001 ............................................................................. 200002 ............................................................................. 200007 ............................................................................. 200008 ............................................................................. 200009 ............................................................................. 200012 ............................................................................. 200013 ............................................................................. 200018 ............................................................................. 200019 ............................................................................. 200020 ............................................................................. 200021 ............................................................................. 200024 ............................................................................. 200025 ............................................................................. 200026 ............................................................................. 200027 ............................................................................. 200028 ............................................................................. 200031 ............................................................................. 200032 ............................................................................. 200033 ............................................................................. 200034 ............................................................................. 200037 ............................................................................. 200039 ............................................................................. 200040 ............................................................................. 200041 ............................................................................. 200050 ............................................................................. 200052 ............................................................................. 200063 ............................................................................. 200066 ............................................................................. 210001 ............................................................................. 210002 ............................................................................. 210003 ............................................................................. 210004 ............................................................................. 210005 ............................................................................. 210006 ............................................................................. 210007 ............................................................................. 210008 ............................................................................. 210009 ............................................................................. 210010 ............................................................................. 210011 ............................................................................. 210012 ............................................................................. 210013 ............................................................................. 210015 ............................................................................. 210016 ............................................................................. 210017 ............................................................................. 210018 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00203 1.0174 1.3314 0.8693 1.3627 0.8706 1.3476 1.1533 1.5526 1.2736 1.2371 1.5000 1.4751 1.7106 1.6684 *** 1.1570 1.4154 0.9780 1.2944 1.1208 *** 2.1960 1.2980 1.1625 1.0638 1.2535 1.9724 1.1372 1.1001 1.1627 1.2839 1.2562 1.1892 1.5272 1.0696 1.0384 1.2155 1.0270 1.3580 1.2155 1.8521 1.3802 1.1932 1.2758 1.2240 1.1389 1.2560 1.0527 1.1744 1.2279 1.4095 1.9808 1.6574 1.4432 1.2836 1.0893 1.8793 1.3153 1.8013 *** 1.4100 1.5973 1.2668 1.3230 1.8143 1.1663 1.2267 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.7445 0.9003 0.7445 0.8470 0.8429 0.8044 0.8605 0.9003 0.7847 0.8605 0.9003 0.9003 0.8429 0.9003 * 0.7445 0.8767 0.7445 0.7903 0.8605 * 0.8044 0.9985 0.9884 1.0382 1.0382 1.0382 0.8840 0.8840 0.8840 1.0382 1.0503 1.0382 0.9884 1.0382 0.8840 0.8840 0.8840 0.8840 0.8840 0.9985 0.9884 0.8840 0.9884 1.0382 0.8840 0.9985 0.8840 0.9884 0.8840 0.9528 0.9892 1.0935 1.1471 1.1471 0.9892 0.9892 0.9892 0.9892 0.9099 0.9892 0.9892 0.9892 0.9892 1.1471 0.9099 1.1471 20.6096 29.7870 16.2819 21.9141 20.7601 21.6908 19.7776 24.1667 21.4335 22.4062 24.9518 26.1231 20.2374 24.2892 21.5325 21.6206 24.4661 15.4026 24.2462 18.6672 * * 21.6050 22.0700 21.0603 25.1115 24.9041 21.8529 22.8909 21.1330 23.1114 27.0798 24.9925 22.9698 22.9023 19.7172 21.0156 21.2180 18.8262 23.0487 25.1723 23.5415 22.6534 22.1333 21.8528 21.3816 23.4391 19.0535 23.0135 19.5890 22.6614 25.6975 23.0790 29.4841 24.7185 24.7327 27.5104 24.6569 23.4889 23.7761 22.3262 25.2892 23.0151 23.8419 27.2632 19.0248 25.3112 21.3191 24.4176 14.0052 22.3755 21.9355 22.9631 18.5317 26.4258 22.5588 21.8900 26.9099 28.8777 21.7696 26.9117 * 23.9182 23.8233 13.9888 28.9620 20.5937 30.6060 * 23.2210 24.1446 22.3920 25.1741 28.1409 24.1243 23.9048 24.3294 24.0926 28.7351 25.1027 24.6484 24.3646 21.9997 23.2912 24.3061 20.6202 24.2221 26.8727 26.1150 23.3490 24.0474 23.6791 23.6797 25.5233 22.7763 24.7235 21.6354 26.3144 25.2859 32.3042 29.4300 27.1276 25.6396 28.4496 26.3008 24.6332 24.5071 24.8373 25.7934 23.9875 25.8532 28.6992 21.3983 27.5431 23.9609 24.7912 16.1195 23.5734 24.7135 24.3735 14.1410 27.5681 24.5877 24.7944 26.8795 28.3684 24.4540 26.0139 * 25.0356 23.6824 * 23.9700 23.0072 * 27.1786 25.1145 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 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 25.7850 27.5031 27.4103 25.1348 28.2029 32.2081 23.2168 29.2153 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 21.8425 25.8807 15.4593 22.6642 22.5497 23.0241 17.3575 25.9873 22.9165 23.0825 26.2979 27.8932 22.1979 25.7960 21.5325 23.6192 23.9582 14.7116 25.7012 20.7608 30.6060 27.1786 23.3710 23.9468 21.7470 25.9041 28.0391 23.9787 23.7685 23.0851 24.1296 29.2990 24.8792 24.6372 24.4151 20.8927 23.4478 23.3297 20.4626 24.3050 26.9328 25.3574 23.0870 23.8217 23.6763 23.3316 25.2144 21.2769 24.2686 20.6005 25.5750 25.8584 28.0698 31.0347 26.8963 25.2468 28.7829 25.4086 24.8136 24.6945 24.9589 26.2116 24.0450 25.9683 29.4293 21.2523 27.3955 23508 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 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 220010 220011 220012 220015 220016 220017 220019 220020 220024 220025 220028 220029 220030 220031 220033 220035 220036 220041 220046 220049 220050 220051 220052 220058 220060 220062 220063 220065 220066 220067 220070 220071 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00204 1.7403 1.4002 1.4502 1.6742 1.2278 1.4821 1.0800 1.2469 1.2604 1.1336 1.1618 1.2910 1.3279 1.1827 1.2100 1.1063 1.2556 1.3070 1.3455 1.0505 1.3334 1.2251 1.3202 1.3345 1.1840 1.3191 1.4185 1.0819 1.1664 1.2457 1.2068 1.3775 1.1465 1.5005 1.2473 1.2849 1.1320 1.4769 1.1789 1.1162 1.3302 1.1847 1.2561 1.2397 1.1085 1.4399 1.1188 1.1096 1.5358 1.1835 1.3734 1.4886 *** 1.3512 1.1526 1.1149 1.2065 1.1597 1.0018 1.1851 0.5670 1.1890 1.2103 1.2809 1.1716 1.1474 1.8635 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.9099 1.1471 0.9892 0.9892 0.9310 0.9310 0.9099 0.9892 0.9099 1.0652 0.9892 0.9892 1.0935 0.9099 0.9892 1.0935 0.9892 0.9892 0.9892 0.9099 0.9892 0.9892 1.0935 1.0935 1.0935 0.9892 1.1471 0.9892 1.0935 0.9099 1.1233 1.1233 1.1233 1.0525 1.0952 1.1233 1.1233 1.2518 1.0259 1.0259 1.1537 1.1233 1.0952 1.0259 1.1233 1.1233 1.1233 1.0259 1.1537 1.1233 1.1233 1.1537 * 1.0183 1.1233 1.0259 1.0183 1.1537 1.1233 1.2254 1.1233 1.1233 1.0259 1.0259 1.1537 1.1233 1.1537 23.5259 27.6680 26.7837 24.8939 22.8882 19.3517 22.4054 26.2082 20.7802 20.3407 25.0301 22.8827 21.6973 23.5536 26.5696 24.0987 25.4729 22.2177 23.8101 11.8350 24.4328 24.7148 25.7103 27.3551 27.4218 23.5881 27.3520 22.0351 25.8377 22.5455 25.8030 26.3348 18.8150 27.1576 25.6647 24.5020 32.2266 32.0521 25.0272 25.7740 28.9024 21.6620 23.5737 24.1071 23.2374 31.4858 27.4792 20.0816 30.8324 25.4500 26.8486 28.2182 28.8184 26.1955 26.7688 23.7326 22.2965 26.3043 22.4885 29.6960 22.6598 23.3704 22.4143 27.5575 22.4968 26.2697 27.7773 24.9252 30.1470 29.0844 27.1756 23.8943 23.9255 24.1265 31.2888 27.5507 25.7138 26.6113 26.3896 24.5198 24.1913 28.3414 25.8415 28.3723 24.3070 24.8083 15.0867 25.0617 25.9342 27.3692 24.6658 28.0014 26.6884 29.2233 24.8576 28.7531 24.1369 27.3238 28.9722 20.5790 29.5946 27.1675 27.4161 32.6624 32.9791 25.5449 26.8798 28.8264 22.2294 24.2279 25.5837 24.5186 31.3592 28.1432 23.6257 32.2660 26.8049 27.5533 29.6296 29.7464 27.7726 27.0464 24.9945 26.5575 28.0925 25.0598 30.8242 21.9489 25.5840 24.8737 26.2561 28.5220 28.9100 31.8322 26.1824 33.8015 30.4656 29.5579 26.0771 26.0111 25.9221 27.9741 29.5702 26.1829 29.0420 28.4308 26.1082 24.8719 29.5979 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 28.9854 30.3598 22.0549 30.7583 30.1043 29.7998 33.6258 36.2075 28.3397 28.0609 29.7108 23.2544 26.3475 27.3488 23.0637 32.0980 28.6970 24.4289 34.7388 28.1859 28.6238 31.5184 * 28.1396 27.7517 26.3768 29.8380 29.8577 24.9642 32.3362 24.2779 27.3967 26.5513 27.1317 29.8911 31.9283 32.2591 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 24.9054 30.5481 28.8005 27.2560 24.3114 22.9283 24.1901 28.3176 25.7230 23.9925 26.9838 25.7800 24.1712 24.2175 28.1851 25.8514 27.8674 24.7038 25.7966 14.3653 26.0370 25.9278 27.5052 26.0806 28.5097 26.3638 29.7939 25.5191 27.8143 23.5086 27.3824 28.5921 20.5049 29.2881 27.7253 27.3015 32.9286 33.8319 26.3904 26.8986 29.1461 22.3943 24.7620 25.6784 23.5753 31.6438 28.1288 22.7602 32.5988 26.8967 27.6997 29.8330 29.2230 27.3951 27.2011 25.0718 26.3369 28.1429 24.1665 31.0565 22.9699 25.3936 24.6535 26.9786 26.7470 28.7436 30.6680 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23509 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 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 ............................................................................. 220163 ............................................................................. 220171 ............................................................................. 220174 ............................................................................. 230001 ............................................................................. 230002 ............................................................................. 230003 ............................................................................. 230004 ............................................................................. 230005 h ........................................................................... 230006 ............................................................................. 230013 ............................................................................. 230015 ............................................................................. 230017 ............................................................................. 230019 ............................................................................. 230020 ............................................................................. 230021 ............................................................................. 230022 ............................................................................. 230024 ............................................................................. 230027 ............................................................................. 230029 ............................................................................. 230030 ............................................................................. 230031 ............................................................................. 230032 ............................................................................. 230035 ............................................................................. 230036 ............................................................................. 230037 ............................................................................. 230038 ............................................................................. 230040 ............................................................................. 230041 ............................................................................. 230042 ............................................................................. 230046 ............................................................................. 230047 ............................................................................. 230053 ............................................................................. 230054 ............................................................................. 230055 ............................................................................. 230058 ............................................................................. 230059 ............................................................................. 230060 ............................................................................. 230065 ............................................................................. 230066 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00205 1.2181 1.2979 1.3687 *** 1.7008 1.2093 1.2445 1.1182 1.2198 1.7240 1.8430 1.2383 1.2019 1.0909 1.1705 1.2709 1.3268 1.2174 1.2235 2.0895 1.1852 2.0126 1.1414 1.1438 *** 1.3023 1.0112 1.0325 1.6217 1.7280 1.1830 1.1145 1.2858 1.1978 1.6865 1.2420 1.1260 1.3537 1.0330 1.6186 1.5499 1.6718 1.5066 1.1968 1.5303 1.0785 1.6353 1.2551 1.3778 *** 1.2892 1.3478 1.1932 1.6544 1.1923 1.4739 1.1899 1.8546 1.3775 1.5876 2.0368 1.2813 1.1454 1.4370 1.2849 *** 1.3075 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 1.0952 1.1537 1.1537 1.1078 1.1085 1.1233 1.1233 1.1537 1.1233 1.1537 1.1537 1.1233 1.1233 1.1233 1.1233 1.1537 1.1233 1.1233 1.1537 1.1537 1.1537 1.1537 1.1537 1.1537 * 1.2518 1.0259 1.1537 1.1233 1.1233 1.1233 0.8923 1.0453 0.9133 0.9677 1.0885 0.9786 0.9858 0.8923 1.0403 0.9858 1.0453 0.8923 1.0628 1.0453 0.9398 0.9858 0.9090 0.9858 * 0.9398 0.8923 1.0628 0.9398 0.9398 0.9535 0.9133 1.0885 1.0453 1.0453 0.9439 0.8923 0.8923 0.9398 0.8923 1.0453 0.9677 27.9309 25.7840 26.0527 24.8040 27.0946 24.7399 23.9542 28.3533 26.8596 29.4911 26.5849 28.9252 26.5552 23.7629 26.2287 27.0265 26.9992 26.7570 26.0166 33.0445 27.7395 30.9871 25.9789 26.9853 33.0819 31.9159 * 25.6069 29.9312 27.2647 * 22.0875 23.7972 22.4322 23.0827 20.3750 22.0733 20.4633 21.7640 26.1609 24.7472 25.8267 22.0757 22.2179 24.7364 21.2223 26.7646 19.9853 22.1874 23.8366 18.0735 25.9801 24.4115 23.4685 21.8062 24.2297 21.8241 28.2320 24.3622 26.1415 23.0818 20.9350 22.4516 21.2743 22.3512 26.3217 23.9696 29.2399 27.5763 27.9503 27.2534 28.0935 27.1578 24.8060 29.9001 29.0505 31.7482 28.5711 32.4409 29.7945 24.9871 26.8538 28.4848 31.0834 30.0892 29.0804 35.4242 28.9092 32.2337 27.8372 26.7660 31.2981 31.3246 18.9267 30.9009 30.5056 28.9733 30.3356 24.3660 27.0305 25.2596 25.5573 22.1018 22.7656 22.7014 23.4512 27.3259 27.6563 26.8516 23.4663 22.2528 27.6555 22.5736 27.9012 20.9867 23.2910 * 20.9197 26.5854 24.7875 25.2499 21.9813 25.2518 24.3640 29.2683 26.2447 28.3030 24.0137 23.7671 21.9308 23.1451 24.5073 27.9179 25.8517 31.2591 28.4930 29.1588 29.7507 30.2684 28.9101 26.9841 32.9143 32.5711 34.1236 28.5462 31.1708 30.8685 27.4273 28.8314 29.6912 33.1690 31.9421 30.6252 36.6043 31.1850 32.9988 28.2844 28.7805 33.6003 32.1205 * 28.6462 33.6484 29.5666 31.7572 * 28.7861 26.1278 26.7206 24.1902 23.8835 23.7822 24.6570 29.5178 28.4575 29.2869 24.9551 23.3000 30.0866 23.5511 29.0935 22.3174 25.4678 * 21.2317 28.3622 26.0167 26.3480 24.2349 26.1760 26.2037 30.3591 28.1351 29.9871 24.9905 25.4143 24.0657 25.5350 25.5015 28.4631 27.4928 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 29.4595 27.3187 27.7387 27.1315 28.5352 27.0523 25.2609 30.3719 29.5958 31.7544 27.9606 30.8836 29.1558 25.3894 27.2888 28.4369 30.4912 29.7099 28.5516 35.0919 29.2950 32.0845 27.4417 27.5408 32.6683 31.7903 18.9267 28.0721 31.2574 28.6148 31.0464 23.2049 26.5792 24.6604 25.1973 22.4061 22.9495 22.3686 23.3267 27.7392 26.9496 27.3788 23.5352 22.6032 27.3402 22.4431 27.9121 21.1301 23.7275 23.8366 19.9973 26.9984 25.1030 25.2371 22.7262 25.1852 24.1687 29.3515 26.3210 28.0856 24.0601 23.4450 22.7966 23.3695 24.1280 27.5421 25.8295 23510 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 230069 ............................................................................. 230070 ............................................................................. 230071 ............................................................................. 230072 ............................................................................. 230075 ............................................................................. 230077 ............................................................................. 230078 ............................................................................. 230080 ............................................................................. 230081 ............................................................................. 230082 ............................................................................. 230085 ............................................................................. 230086 ............................................................................. 230087 ............................................................................. 230089 ............................................................................. 230092 ............................................................................. 230093 ............................................................................. 230095 ............................................................................. 230096 ............................................................................. 230097 ............................................................................. 230099 ............................................................................. 230100 ............................................................................. 230101 ............................................................................. 230103 ............................................................................. 230104 ............................................................................. 230105 ............................................................................. 230106 ............................................................................. 230108 ............................................................................. 230110 ............................................................................. 230117 ............................................................................. 230118 ............................................................................. 230119 ............................................................................. 230120 h ........................................................................... 230121 ............................................................................. 230124 ............................................................................. 230130 ............................................................................. 230132 ............................................................................. 230133 ............................................................................. 230135 ............................................................................. 230141 ............................................................................. 230142 ............................................................................. 230143 ............................................................................. 230144 ............................................................................. 230146 ............................................................................. 230149 ............................................................................. 230151 ............................................................................. 230153 ............................................................................. 230155 ............................................................................. 230156 ............................................................................. 230165 ............................................................................. 230167 ............................................................................. 230169 ............................................................................. 230171 ............................................................................. 230172 ............................................................................. 230174 ............................................................................. 230175 ............................................................................. 230180 ............................................................................. 230184 ............................................................................. 230186 ............................................................................. 230188 ............................................................................. 230190 ............................................................................. 230193 ............................................................................. 230195 ............................................................................. 230197 ............................................................................. 230204 ............................................................................. 230207 ............................................................................. 230208 ............................................................................. 230212 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00206 1.1753 1.5701 0.8485 1.3590 1.3133 1.9292 1.0254 1.2619 1.1862 1.0168 1.2173 1.1453 *** 1.3414 1.2758 1.1471 1.2485 1.1644 1.7922 1.2029 1.0901 1.0867 0.9926 1.5316 1.9274 1.1151 1.1539 1.2559 1.8428 1.0609 1.2750 1.1085 1.2547 1.3011 1.7348 1.3708 1.4219 1.1067 1.6290 1.2390 1.2372 *** 1.2340 0.9394 1.3038 1.0978 1.0445 1.5897 1.6979 1.6158 *** 1.0700 1.2263 1.3089 *** 1.0957 1.2135 *** 0.9259 1.0114 1.2672 1.4253 1.5717 1.2871 1.3574 1.1926 1.0168 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 1.0654 0.9474 0.9858 0.9133 0.9492 1.0654 0.8923 0.9090 0.8923 0.8923 1.0403 0.8923 * 1.0453 0.9300 0.9398 0.8923 1.0403 0.8923 1.0628 0.8923 0.8923 0.9786 1.0453 0.9535 0.9398 0.8923 0.8923 1.0403 0.8923 1.0453 1.0885 0.9786 0.8923 0.9858 1.0654 0.8923 1.0453 1.0654 1.0453 0.8923 1.0885 1.0453 0.8923 0.9858 0.9786 0.8923 1.0885 1.0453 0.9786 1.0453 0.8923 1.0403 0.9133 * 0.8923 0.9300 * 0.8923 1.0403 0.9858 1.0453 1.0654 1.0453 0.9858 0.9398 1.0885 26.0438 22.8588 23.6674 22.9626 22.6799 29.2041 20.5427 20.2405 20.4289 21.3100 24.2802 27.8923 22.2688 23.3847 22.3122 25.1213 19.1810 26.7156 22.9902 23.5490 19.8016 22.3310 19.4434 27.4119 23.9851 23.1962 19.9842 21.5523 28.1220 22.2208 25.3562 22.7243 22.3708 22.0097 23.7854 29.0292 20.4801 19.8290 23.9885 22.9036 19.5446 23.6959 21.3539 20.8933 23.8527 22.8584 18.0743 27.7164 25.9534 24.7935 24.9265 19.9097 23.0023 24.4671 22.5964 20.9832 21.4031 21.6147 18.8076 27.3430 22.8916 25.3285 26.9840 24.4095 22.2848 20.3171 26.0656 27.6815 25.1587 24.7707 24.1560 24.1482 27.3117 21.9200 21.2840 20.6777 23.1240 22.2569 20.8759 * 23.9486 24.3768 24.5055 19.2244 26.7578 25.2104 25.0390 20.4565 23.1349 18.4304 27.8864 24.6853 24.1128 22.4966 22.7621 29.6361 21.4886 29.2509 21.7894 23.4394 23.0508 26.9907 29.9106 21.2273 23.9000 30.4643 25.6044 19.5387 * 24.3891 21.4753 26.4669 22.3404 24.0404 29.4855 27.3164 26.6828 27.1172 22.0635 24.0236 26.2770 * 22.5454 21.9346 27.1126 * 28.7365 24.3181 27.1266 28.3439 25.9871 22.2854 20.9420 27.3686 29.5556 24.2342 26.3907 24.4933 27.6193 30.3431 23.9901 21.2314 23.0788 22.2165 22.7314 22.2965 16.9168 28.7015 26.3584 26.4967 21.3915 28.7681 26.5773 26.4882 21.8895 24.3772 21.6609 30.5570 27.2705 24.3980 18.4063 28.7704 29.4775 22.3636 30.4910 24.1485 24.5220 * 26.6076 30.5074 22.7380 25.8406 28.6326 26.9433 21.4083 * 26.3432 * 27.1965 22.8644 * 31.1909 28.9636 27.3362 31.8442 * 25.7402 27.6920 * 24.7358 23.6707 26.2282 * 29.9604 23.3565 28.2892 30.0367 29.1466 24.4641 21.9651 29.7980 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 27.8051 24.0769 24.9681 23.9114 24.8869 28.9610 22.2077 20.9185 21.3975 22.1964 23.1872 23.4562 19.0752 25.3973 24.3257 25.3702 19.9401 27.4077 24.9608 25.0486 20.6965 23.3147 19.7646 28.5801 25.3146 23.9236 20.1757 24.4693 29.0873 22.0278 28.0624 22.9095 23.4095 22.5308 25.8001 29.8111 21.5235 23.1673 27.6090 25.2019 20.1494 23.6959 24.1395 21.1778 25.8699 22.6896 20.6336 29.5181 27.4184 26.2749 27.6798 20.9931 24.2756 26.1839 22.5964 22.8206 22.3438 24.5338 18.8076 28.6717 23.5189 26.9865 28.4836 26.3875 22.9909 21.0908 27.6833 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23511 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 230216 ............................................................................. 230217 ............................................................................. 230222 h ........................................................................... 230223 ............................................................................. 230227 ............................................................................. 230230 ............................................................................. 230235 ............................................................................. 230236 ............................................................................. 230239 ............................................................................. 230241 ............................................................................. 230244 ............................................................................. 230254 ............................................................................. 230257 ............................................................................. 230259 ............................................................................. 230264 ............................................................................. 230269 ............................................................................. 230270 ............................................................................. 230273 ............................................................................. 230275 ............................................................................. 230276 ............................................................................. 230279 ............................................................................. 230283 ............................................................................. 230288 ............................................................................. 230290 ............................................................................. 230291 ............................................................................. 230292 ............................................................................. 240001 ............................................................................. 240002 ............................................................................. 240004 ............................................................................. 240006 ............................................................................. 240007 ............................................................................. 240010 ............................................................................. 240011 ............................................................................. 240013 ............................................................................. 240014 ............................................................................. 240016 ............................................................................. 240017 ............................................................................. 240018 ............................................................................. 240019 ............................................................................. 240020 ............................................................................. 240021 ............................................................................. 240022 ............................................................................. 240025 ............................................................................. 240027 ............................................................................. 240029 ............................................................................. 240030 ............................................................................. 240031 ............................................................................. 240036 ............................................................................. 240037 ............................................................................. 240038 ............................................................................. 240040 ............................................................................. 240043 ............................................................................. 240044 ............................................................................. 240045 ............................................................................. 240047 ............................................................................. 240050 ............................................................................. 240052 ............................................................................. 240053 ............................................................................. 240056 ............................................................................. 240057 ............................................................................. 240059 ............................................................................. 240061 ............................................................................. 240063 ............................................................................. 240064 ............................................................................. 240066 ............................................................................. 240069 ............................................................................. 240071 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00207 1.5428 1.2812 1.3221 1.2599 1.5008 1.4934 1.0134 1.4098 1.2173 1.1712 1.3245 1.3405 1.0228 1.2092 2.1560 1.3453 1.2537 1.4149 0.4478 *** 0.5281 0.8624 *** *** *** *** 1.5054 1.8195 1.5291 1.0536 1.1446 2.0425 1.0425 1.2687 1.0309 1.2584 1.2467 1.2293 1.1105 1.0806 0.8545 1.1064 1.0776 0.9440 1.0819 1.3564 0.9494 1.6880 1.0359 1.5291 1.0854 1.1301 1.1203 1.1212 1.5649 1.0196 1.1991 1.4186 1.2420 1.8473 1.0902 1.7485 1.5546 1.2568 1.3913 1.1378 1.1486 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.9858 0.9786 0.9474 0.9858 1.0453 0.9786 0.9090 0.9398 0.8923 0.9858 1.0453 0.9858 1.0453 1.0885 1.0453 0.9858 1.0453 1.0453 0.9474 * 1.0654 1.0453 * * * 0.9474 1.1055 1.0224 1.1055 1.1128 0.9183 1.1128 0.9183 1.0905 0.9183 0.9183 0.9183 1.0905 1.0224 1.1055 0.9183 0.9183 0.9183 0.9183 0.9183 0.9785 1.0905 1.0905 0.9183 1.1055 1.0224 0.9183 0.9183 1.0224 1.0224 1.1055 0.9183 1.1055 1.1055 1.1055 1.1055 1.1128 1.1055 1.0224 1.1055 1.1128 1.1128 23.4262 24.3650 24.6101 28.5549 27.7510 23.9568 19.9118 25.7463 19.8370 24.2063 23.9004 24.2594 24.8069 24.8598 17.4847 25.3367 22.8842 25.8466 29.4180 23.4928 21.2467 25.0038 30.3422 * * * 28.2239 24.7674 26.8197 29.5789 21.4367 29.0955 24.0364 27.3855 26.5144 25.2629 21.6243 27.3634 25.1331 24.7516 23.9568 23.4702 21.2597 18.3340 21.2342 22.0200 23.4389 23.4857 21.8392 28.9676 21.3870 19.5532 22.7482 25.9223 29.6184 24.7589 23.5898 26.7122 28.5169 27.7600 27.0517 28.7372 26.7960 24.9928 27.4066 25.6943 24.8036 26.1468 26.7929 24.8925 27.1503 28.1105 25.4471 19.6046 26.3988 21.1643 25.8671 25.3817 26.4431 25.4086 24.3067 19.9992 27.4732 26.1113 30.2209 30.2244 * 23.1636 24.9272 * 29.4792 * * 29.9123 26.9608 27.8796 30.2330 23.7588 30.4139 22.9561 28.7202 28.3788 24.9211 23.3314 27.9218 27.5441 28.1568 23.7096 23.7368 27.8656 20.2531 24.3017 23.3753 26.7242 27.0821 24.3986 29.8465 26.3177 20.7155 24.3009 26.1743 29.1211 26.6687 24.9870 28.4733 30.8619 29.4870 28.6340 30.0031 29.9603 26.6996 30.2716 27.4990 26.4780 27.5230 28.5002 26.3990 29.2853 29.6068 27.9607 21.8777 28.4754 22.1040 27.4890 26.4326 28.1216 27.8197 26.8677 19.2398 28.8187 27.8488 29.9307 23.1095 * 24.7673 26.2622 * * 30.9655 31.8943 31.5753 28.9860 30.8072 30.1950 24.7344 31.3733 * 28.3860 29.8623 26.7814 24.4417 25.6484 28.6723 31.2443 27.1235 25.2066 * 18.2481 25.3568 24.7154 26.7778 28.0812 * 31.0779 27.4895 21.8685 22.5843 27.5013 28.8288 26.4854 26.4256 29.5315 31.6623 30.6258 29.7916 30.6383 32.3487 29.9662 33.4532 28.9496 28.0585 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 25.7787 26.7214 25.3118 28.3304 28.4994 25.8281 20.4653 26.9289 21.0930 25.8668 25.2154 26.2901 25.8794 25.3750 19.0176 27.2692 25.6802 28.6762 27.7059 23.4928 22.9663 25.3910 30.3422 29.4792 30.9655 31.8943 29.9731 26.9851 28.5006 30.0237 23.3456 30.3196 23.3835 28.1704 28.2985 25.7376 23.1535 26.6329 27.1439 28.0203 24.8433 24.1392 24.3444 18.8765 23.3870 23.4178 25.6303 26.3323 23.1115 30.0073 24.8843 20.7481 23.1864 26.5626 29.1562 26.0710 25.0236 28.3118 30.4153 29.3431 28.5358 29.8381 29.6692 27.5790 30.4657 27.4534 26.4808 23512 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 240075 240076 240077 240079 240080 240083 240084 240087 240088 240089 240094 240097 240101 240103 240104 240106 240107 240109 240115 240117 240121 240123 240124 240127 240128 240132 240133 240135 240137 240139 240141 240143 240145 240154 240162 240166 240179 240187 240196 240207 240210 240211 240213 250001 250002 250004 250006 250007 250009 250010 250012 250015 250017 250018 250019 250020 250021 250023 250025 250027 250030 250034 250035 250036 250037 250038 250039 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00208 1.1988 1.1046 *** 0.9411 1.6892 1.2481 1.1252 1.0235 1.2698 *** 1.0759 *** 1.1412 1.0495 1.1424 1.4870 0.9093 0.9472 1.6156 1.1377 0.9139 1.0528 0.9638 *** 1.0138 1.2654 1.1406 *** 1.1919 1.0798 1.0222 0.8521 *** 1.0199 1.1601 1.1135 0.8255 1.2137 0.8421 1.2007 1.2500 0.9023 1.3095 1.8170 0.8813 1.8313 1.0428 1.2343 1.2453 0.9833 0.9469 1.0268 1.0970 0.9215 1.5528 0.9918 *** 0.8443 1.0405 0.9794 *** 1.5307 0.8545 1.0038 0.8638 0.9832 0.9125 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.9785 1.1055 0.9183 1.1521 1.1055 0.9183 1.0224 0.9183 0.9785 0.9183 1.1055 * 0.9183 0.9183 1.1055 1.1055 0.9183 0.9183 1.1055 0.9183 1.0224 0.9183 0.9183 * 0.9183 1.1055 0.9183 * 0.9183 0.9183 1.1055 0.9183 0.9183 0.9183 0.9183 0.9183 0.9183 1.0905 1.1055 1.1055 1.1055 1.0905 1.1055 0.8313 0.7685 0.9108 0.9108 0.8922 0.8799 0.7685 0.9346 0.7685 0.7685 0.7685 0.8922 0.7685 * 0.8612 0.7685 0.7685 0.7685 0.9108 0.7685 0.8164 0.7685 0.8313 0.8313 24.4084 26.7112 18.9735 20.6644 27.8807 24.4352 23.9942 20.1002 25.5587 23.4028 24.4166 34.2810 24.3455 20.2324 27.4946 25.5890 24.5583 14.5892 27.0312 20.1436 24.5455 20.0721 23.5139 19.3857 20.1960 26.7063 23.6068 17.8573 23.1752 22.4473 25.1597 18.9442 22.6063 21.3809 20.4807 21.5002 19.8249 24.8879 27.2901 27.4330 26.6545 32.8801 27.5104 20.9338 21.6643 20.9295 20.3061 21.2226 19.7610 17.6204 15.6117 19.3794 19.0436 16.8783 22.9085 19.1877 15.8485 14.7355 21.2651 17.5937 27.2140 20.3681 17.1071 17.0469 16.6347 16.8610 16.8729 26.6607 28.4519 * 20.9220 29.6274 25.0214 24.7856 24.8479 27.6323 * 27.3974 * 26.6078 22.5416 30.1392 27.5171 25.5199 15.2076 29.0261 22.0463 * 20.5755 23.9297 24.4824 21.2638 29.5310 26.1836 16.1837 23.8666 23.7898 26.7173 21.1180 * 23.9643 22.3136 23.4265 20.8449 26.5129 28.9380 29.2395 29.7227 44.4214 31.3974 21.9176 20.1310 20.6828 21.4038 23.6933 20.4329 19.4130 20.0493 20.6931 18.1013 17.0689 22.8358 19.3390 15.1242 16.1820 20.6892 17.3313 * 20.6752 14.6149 17.8313 17.4463 18.0209 15.2939 26.1956 29.8562 * * 31.6484 26.6582 26.8142 24.9419 28.0825 * 28.3973 * 25.5355 22.7078 31.4306 29.3455 26.1078 16.5051 31.3869 23.8076 * 21.7500 * * 21.5791 31.7139 27.7658 * * * 26.4016 21.7416 * * 22.2721 25.7509 * 27.8811 30.7719 31.7414 32.1564 18.8503 32.7532 22.7827 23.3845 24.1065 24.0191 25.8710 22.2323 19.4403 20.2921 20.7555 21.3950 16.6294 23.9741 21.4019 20.3559 16.2418 20.5258 17.3481 * 24.3189 17.2045 19.1975 17.4012 18.9050 17.3155 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 25.7681 28.4067 18.9735 20.8010 29.7472 25.4096 25.2047 23.3753 27.1245 23.4028 26.8076 34.2810 25.5132 21.8542 29.9577 27.5527 25.4514 15.4279 29.1786 22.0056 24.5455 20.8397 23.7277 21.5460 21.0226 29.3306 25.8348 16.9824 23.5315 23.1612 26.1666 20.6376 22.6063 22.6453 21.7043 23.5628 20.3419 26.4667 29.0287 29.5819 29.5372 27.6876 30.8794 21.9287 21.6434 21.8737 21.9290 23.5817 20.8522 18.8097 18.4571 20.2702 19.5260 16.8678 23.2493 19.9847 16.0142 15.7024 20.8816 17.4314 27.2140 21.8100 16.2933 18.0476 17.1789 17.9032 16.4505 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23513 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 250040 ............................................................................. 250042 ............................................................................. 250043 ............................................................................. 250044 ............................................................................. 250045 ............................................................................. 250048 ............................................................................. 250049 ............................................................................. 250050 ............................................................................. 250051 ............................................................................. 250057 ............................................................................. 250058 ............................................................................. 250059 ............................................................................. 250060 ............................................................................. 250061 ............................................................................. 250065 ............................................................................. 250066 ............................................................................. 250068 ............................................................................. 250069 ............................................................................. 250071 ............................................................................. 250072 ............................................................................. 250077 ............................................................................. 250078 2 ........................................................................... 250079 ............................................................................. 250081 ............................................................................. 250082 ............................................................................. 250083 ............................................................................. 250084 ............................................................................. 250085 ............................................................................. 250089 ............................................................................. 250094 ............................................................................. 250095 ............................................................................. 250096 ............................................................................. 250097 ............................................................................. 250098 ............................................................................. 250100 ............................................................................. 250101 ............................................................................. 250102 ............................................................................. 250104 ............................................................................. 250105 ............................................................................. 250107 ............................................................................. 250112 ............................................................................. 250117 ............................................................................. 250119 ............................................................................. 250122 ............................................................................. 250123 ............................................................................. 250124 ............................................................................. 250125 ............................................................................. 250126 ............................................................................. 250128 ............................................................................. 250131 ............................................................................. 250136 ............................................................................. 250138 ............................................................................. 250141 ............................................................................. 250146 ............................................................................. 250149 ............................................................................. 250151 ............................................................................. 250152 ............................................................................. 250153 ............................................................................. 260001 ............................................................................. 260002 ............................................................................. 260003 ............................................................................. 260004 ............................................................................. 260005 ............................................................................. 260006 ............................................................................. 260008 ............................................................................. 260009 ............................................................................. 260011 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00209 1.4718 1.2038 1.0429 1.0199 1.0872 1.5843 0.8410 1.1957 0.8358 1.1292 1.2515 0.9814 0.7926 0.8412 0.8170 0.7831 0.7547 1.4860 0.8305 1.4976 0.9403 1.5963 0.8383 1.2295 1.2744 0.9072 1.1575 0.9532 1.0502 1.5886 0.9965 1.0784 1.3963 *** 1.4464 *** 1.5446 1.4244 0.8995 0.9071 0.9521 1.0298 *** 1.0617 1.2675 0.8390 1.2819 0.9380 0.8826 0.8879 0.9767 1.2637 1.5358 0.8784 0.8979 0.7214 1.6630 *** 1.6129 *** 1.0250 0.9578 1.4759 1.4271 *** 1.1793 1.3859 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.8612 0.9108 0.7685 0.7685 0.8922 0.8313 0.7685 0.7685 0.7685 0.7685 0.7685 0.7685 0.7685 0.7685 0.8313 0.7685 0.7685 0.8614 0.7685 0.8313 0.7685 0.7685 0.8182 0.8182 0.8099 0.7685 0.7685 0.7685 0.7685 0.8612 0.7685 0.8313 0.8470 0.7685 0.8614 * 0.8313 0.8182 0.7685 0.7685 0.7685 0.8612 0.7685 0.7685 0.8922 0.8313 0.8922 0.9346 0.7685 0.7685 0.8313 0.8313 0.9346 0.7685 0.7685 0.7685 0.8313 0.8313 0.8594 0.8953 0.7927 0.7927 0.8953 0.7927 * 0.9454 0.8346 20.8178 19.4367 17.7554 20.3711 25.3236 19.3635 13.4396 16.6723 10.5027 19.0571 16.5565 19.0733 14.0155 11.4573 16.2010 16.1044 16.3759 21.2224 13.7056 20.7827 14.0318 17.5186 21.3506 20.4513 19.5962 19.5217 22.4632 18.0473 16.0203 19.9619 18.6616 20.7246 18.8399 17.9561 18.8877 * 21.3213 20.5035 17.0136 16.7104 16.8696 18.8863 17.1373 19.7966 22.2184 15.6866 25.3415 20.1118 15.8352 11.5396 21.9977 21.2490 22.5187 16.9341 16.4228 20.4581 * * 22.6646 24.6812 16.5931 16.4423 25.5927 24.1078 21.6256 20.1679 21.1625 21.3451 21.4117 18.3322 21.1198 25.0863 21.6547 17.8154 18.3170 10.6908 19.6789 17.5160 17.7270 20.8115 15.2515 16.1984 * 16.9585 21.6617 17.7149 22.9316 14.2271 18.6563 27.2549 21.3830 20.5212 19.9484 21.8001 18.7367 * 22.3312 19.9553 22.7458 19.4534 * 22.0328 21.2234 22.5518 21.4431 17.9468 16.5369 19.6172 19.9774 * 23.7230 22.0486 15.4343 26.8379 20.4085 15.9344 * 22.5832 22.7902 24.5772 17.2328 15.0367 21.8697 * * 25.3084 27.2329 17.6339 16.7742 24.6142 26.4948 17.6040 21.2729 21.4409 23.2285 23.4135 19.8098 23.3862 26.3831 22.9765 17.7005 19.1467 10.6095 20.1900 18.1704 19.2977 16.8247 12.8174 * * * 22.8162 * 24.6587 14.7632 20.9354 38.0031 24.7031 19.6966 * 18.5775 19.7007 * 22.7312 21.3511 22.6298 20.1687 * 24.2209 * 24.2868 22.6591 18.1196 17.8999 21.2824 23.3673 * 24.5854 24.5115 17.2181 27.7077 21.7111 17.6269 * 23.0637 23.8861 27.6158 18.6486 15.0641 17.2205 25.7837 29.0461 25.9250 26.4879 * 16.9421 26.5773 26.7587 18.9522 22.1816 22.7061 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 21.8161 21.3957 18.6971 21.6199 25.6144 21.3756 16.2411 18.0183 10.6008 19.6573 17.4280 18.6884 17.2475 12.9127 16.1997 16.1044 16.6506 21.9460 15.4400 22.7773 14.3259 19.1036 29.5848 21.9463 19.9404 19.7505 20.7280 18.8283 16.0203 21.7001 19.9748 22.0767 19.4858 17.9561 21.7570 9.7147 22.7655 21.5782 17.6992 17.0742 19.4217 20.6608 17.1373 22.7156 22.9495 16.1302 26.6997 20.7174 16.4363 11.5396 22.5479 22.6997 25.2301 17.5743 15.5315 18.4362 25.7837 29.0461 24.6413 26.0819 17.1135 16.7356 25.6220 25.8174 19.2926 21.2122 21.7937 23514 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 260012 260013 260015 260017 260018 260020 260021 260022 260023 260024 260025 260027 260029 260031 260032 260034 260035 260036 260040 260044 260047 260048 260050 260052 260053 260057 260059 260061 260062 260063 260064 260065 260067 260068 260070 260073 260074 260077 260078 260080 260081 260085 260086 260091 260094 260095 260096 260097 260102 260103 260104 260105 260107 260108 260110 260113 260115 260116 260119 260120 260123 260127 260134 260137 260138 260141 260142 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00210 1.0499 1.0044 1.0786 1.3014 1.0599 1.7361 1.3546 1.2242 1.2675 1.1370 1.2646 1.5961 1.0866 *** 1.7985 0.9517 0.9459 0.9500 1.6194 0.9352 1.5009 1.2518 1.1354 1.3148 1.0393 1.0346 1.1931 1.0883 1.1811 0.9686 1.3672 1.7230 0.8937 1.7577 0.9581 1.0189 1.1674 1.6385 1.1970 0.8933 1.4823 1.5874 0.8704 1.5058 1.6399 1.3081 1.4315 1.1515 0.8325 *** 1.4636 1.7197 1.3072 1.8305 1.6192 1.0827 1.1542 1.1207 1.3355 *** 0.9970 0.9648 1.1483 1.6384 1.9066 1.9089 1.0487 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.7927 0.8594 0.7927 0.8953 0.7927 0.8953 0.8953 0.8563 0.8953 0.7927 0.8953 0.9454 0.9454 * 0.8953 0.9454 0.7927 0.9454 0.8251 0.7927 0.8346 0.9454 0.7927 0.8953 0.8594 0.9454 0.7927 0.7927 0.9454 0.9454 0.8346 0.8251 0.7927 0.8346 0.7927 0.7927 0.8346 0.8953 0.7927 0.7927 0.8953 0.9454 0.7927 0.8953 0.8251 0.9454 0.9454 0.7927 0.9454 * 0.8953 0.8953 0.9454 0.8953 0.8953 0.8285 0.8953 0.8285 0.7927 * 0.7927 0.7927 0.8953 0.8594 0.9454 0.8346 0.7927 17.7854 18.4857 21.7581 20.7837 14.3278 22.4709 27.2478 20.5417 19.6324 16.9968 19.3535 22.9973 22.0390 24.3626 21.8830 21.6108 15.0468 19.4559 20.0422 18.2413 22.4585 26.6363 20.8510 21.1297 18.9606 15.8404 17.2807 18.7280 25.2958 21.1284 17.5188 22.0058 14.9792 22.0951 11.2251 17.8185 18.7639 21.9947 16.9217 13.6815 22.6627 22.7394 17.2048 23.9975 20.1043 22.8156 23.5009 19.6203 24.1041 21.6192 22.4769 24.6572 23.1564 22.7975 22.0026 16.3440 20.4880 16.9807 18.7959 18.7651 17.7996 19.7946 18.4511 20.7638 25.6579 21.0771 18.6412 19.3389 19.2065 22.4450 21.1359 14.8425 25.7898 27.8332 21.7707 21.2519 17.5351 20.0901 24.7605 22.2892 24.2877 23.1125 23.3034 16.8502 20.1324 21.9452 20.0686 22.6169 25.8089 20.6364 22.5809 20.0051 16.4875 18.6379 19.6674 26.0439 22.0826 19.1587 23.6969 16.5364 23.9340 14.3881 19.2744 23.9301 23.5466 18.4017 11.2817 23.7447 24.6046 17.1202 26.1149 20.6805 23.8671 25.9932 21.5077 22.9283 23.3175 24.0038 28.4652 24.2001 24.0936 22.2730 19.2467 21.7450 17.2698 22.1588 * 16.1169 22.5328 18.1531 21.3426 27.8229 21.1511 19.6582 20.3061 20.5007 22.5409 22.7022 17.0434 26.0407 27.6330 22.8085 21.2077 18.4829 22.4645 25.3348 23.1185 * 23.8459 24.1143 17.8741 22.1912 23.3566 22.4498 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 24.8654 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 26.7782 25.0171 3.7978 20.9644 21.9859 18.5076 24.9937 * * 21.8534 * 22.7431 28.5610 22.4886 20.3993 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 19.2632 19.3903 22.2644 21.5787 15.4340 24.8648 27.5756 21.6784 20.7002 17.6819 20.6596 24.3810 22.4857 24.3260 22.9657 23.0518 16.5641 20.4830 21.8297 20.3210 23.1892 25.5119 21.9007 22.8077 20.2038 17.1879 18.6135 19.9180 25.9705 21.6180 18.5908 22.9155 16.4270 23.7077 14.0836 19.6354 22.4254 23.7347 18.1811 13.2210 24.2793 24.3659 17.8711 25.8446 21.4540 24.0702 25.8492 20.9049 23.7509 22.4894 24.3941 27.3498 24.6444 23.9907 22.7167 18.7740 21.4408 17.6168 22.8442 18.7651 17.0002 21.3553 18.2845 21.6630 27.3740 21.5378 19.6104 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23515 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 260147 ............................................................................. 260159 ............................................................................. 260160 ............................................................................. 260162 ............................................................................. 260163 ............................................................................. 260164 ............................................................................. 260166 ............................................................................. 260172 ............................................................................. 260175 ............................................................................. 260176 ............................................................................. 260177 ............................................................................. 260178 ............................................................................. 260179 ............................................................................. 260180 ............................................................................. 260183 ............................................................................. 260186 ............................................................................. 260190 ............................................................................. 260191 ............................................................................. 260193 ............................................................................. 260195 ............................................................................. 260198 ............................................................................. 260200 ............................................................................. 260207 ............................................................................. 260208 ............................................................................. 260210 ............................................................................. 260211 ............................................................................. 270002 2 ........................................................................... 270003 ............................................................................. 270004 ............................................................................. 270009 ............................................................................. 270012 2 ........................................................................... 270014 ............................................................................. 270017 ............................................................................. 270021 ............................................................................. 270023 ............................................................................. 270032 ............................................................................. 270036 ............................................................................. 270040 ............................................................................. 270050 ............................................................................. 270051 ............................................................................. 270057 ............................................................................. 270060 ............................................................................. 270079 ............................................................................. 270081 ............................................................................. 270082 ............................................................................. 270084 2 ........................................................................... 280003 ............................................................................. 280005 ............................................................................. 280010 ............................................................................. 280013 ............................................................................. 280020 ............................................................................. 280021 ............................................................................. 280023 ............................................................................. 280030 ............................................................................. 280032 ............................................................................. 280040 ............................................................................. 280047 ............................................................................. 280057 ............................................................................. 280060 ............................................................................. 280061 ............................................................................. 280065 ............................................................................. 280077 ............................................................................. 280081 ............................................................................. 280085 ............................................................................. 280108 ............................................................................. 280111 ............................................................................. 280117 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00211 0.9384 *** 1.0773 1.3864 1.1422 1.0696 1.1854 0.9089 1.1001 1.5811 1.2174 1.8186 1.5692 1.5399 1.6506 1.6276 1.1384 1.3158 1.2140 1.2803 1.1855 1.2198 1.0594 *** 1.2045 1.5796 1.2881 1.2770 1.6910 1.2674 1.4482 1.8188 1.2612 1.0085 1.5160 1.0500 0.7848 1.1798 1.0303 1.5685 1.2222 0.8776 0.8473 1.0052 1.0621 0.9843 1.8332 *** *** 1.8041 1.7943 1.1390 1.4073 1.9343 1.3356 1.6685 0.7767 0.8190 1.6115 1.3565 1.2692 1.3308 1.6019 *** 1.0415 1.2083 1.0762 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.7927 0.8953 0.7927 0.8953 0.7927 0.7927 0.9454 0.7927 0.7927 0.8953 0.9454 0.8346 0.8953 0.8953 0.8953 0.8346 0.9454 0.8953 0.9454 0.8251 0.8953 0.8953 0.8251 * 0.8953 0.9454 0.8822 0.9074 0.8855 0.8822 0.9074 0.9535 0.9535 0.8822 0.9535 0.8822 0.8822 0.8822 0.8822 0.9535 0.8822 0.8822 0.8822 0.8822 0.8822 0.8822 1.0197 * * 0.9555 1.0197 0.8666 0.9666 0.9555 0.9666 0.9555 0.9555 0.9666 0.9555 0.9207 0.9597 0.9555 0.9555 * 0.8666 0.8666 0.8666 16.1171 23.1093 18.8723 22.5705 18.1310 16.9403 22.8409 17.1504 19.7939 25.7802 24.0550 21.7704 23.2824 21.8585 24.2330 21.6620 24.5014 21.1331 22.9556 20.0889 25.3390 22.3913 18.5247 28.3158 * * 19.7588 23.0396 21.5577 21.5655 21.7634 20.3456 23.2320 21.1624 23.7486 20.1801 18.8785 20.7240 21.0901 22.2580 21.9997 * * 15.6833 21.0150 19.6104 26.0937 23.9753 23.8325 23.4920 23.4577 21.5215 19.6265 29.2221 21.5150 23.6597 19.5815 22.5481 23.1128 21.2901 23.8128 22.7244 24.3199 21.8473 20.9016 20.7398 20.5464 17.2291 26.8924 19.4997 24.1246 19.2885 19.5539 25.5151 18.1438 21.1257 29.2184 25.0724 21.4781 24.8541 21.9679 23.3924 23.4317 25.1653 22.4369 24.4705 20.1327 27.6116 25.1134 19.2467 * * * 20.7620 24.2823 22.9081 * 23.1697 25.0650 24.6186 21.6758 25.5525 18.2377 21.8255 * 22.4195 26.4457 22.6251 16.6592 21.6382 17.3174 19.6173 22.2340 27.2844 * 22.6516 24.5214 25.7522 22.2864 22.7207 32.5601 22.6510 25.2965 * 23.6793 25.2288 23.9110 27.9937 24.0516 25.1973 * 22.5584 22.1424 22.0611 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 26.4505 23.3856 26.2979 22.3958 27.5996 24.8624 19.7294 * 25.3782 33.9109 22.7322 26.4843 23.5454 * 25.2873 26.2025 27.5483 21.7056 26.7576 19.6212 20.4242 * * 26.6619 24.2980 * * 17.4862 * * 29.3921 * * 26.1908 26.5068 22.0489 22.3230 30.7481 23.6462 26.9827 * 20.4830 26.2139 24.9482 26.0135 25.5624 26.0541 * 23.2502 23.4770 24.1521 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 17.2858 24.4817 19.7923 23.9984 19.2038 18.6878 25.1725 17.6539 21.1462 27.5317 25.1274 21.8190 24.7933 23.4659 24.6030 23.5713 25.4095 22.3648 24.7042 20.9711 26.8633 24.2536 19.2332 28.3158 25.3782 33.9109 21.1317 24.5714 22.7035 21.5655 23.4084 23.6425 25.1665 21.5330 25.3555 19.3552 20.3944 20.7240 21.7451 25.1119 23.0119 16.6592 21.6382 16.8348 20.3610 21.0235 27.8614 23.9753 23.2571 24.7334 25.3300 21.9595 21.6126 30.8807 22.6240 25.3499 19.5815 22.0597 24.9273 23.4090 25.9591 24.1150 25.2026 21.8473 22.2006 22.1827 22.2744 23516 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 280118 ............................................................................. 280125 ............................................................................. 280126 ............................................................................. 290002 ............................................................................. 290003 ............................................................................. 290005 ............................................................................. 290006 ............................................................................. 290007 ............................................................................. 290008 ............................................................................. 290009 ............................................................................. 290010 ............................................................................. 290012 ............................................................................. 290016 ............................................................................. 290019 ............................................................................. 290020 h ........................................................................... 290021 ............................................................................. 290022 ............................................................................. 290027 ............................................................................. 290032 ............................................................................. 290039 ............................................................................. 290041 ............................................................................. 290045 ............................................................................. 300001 ............................................................................. 300003 ............................................................................. 300005 ............................................................................. 300006 ............................................................................. 300007 ............................................................................. 300010 ............................................................................. 300011 ............................................................................. 300012 ............................................................................. 300013 ............................................................................. 300014 ............................................................................. 300015 ............................................................................. 300016 ............................................................................. 300017 ............................................................................. 300018 ............................................................................. 300019 ............................................................................. 300020 ............................................................................. 300022 ............................................................................. 300023 ............................................................................. 300024 ............................................................................. 300029 ............................................................................. 300034 ............................................................................. 310001 ............................................................................. 310002 ............................................................................. 310003 ............................................................................. 310005 ............................................................................. 310006 ............................................................................. 310008 ............................................................................. 310009 ............................................................................. 310010 ............................................................................. 310011 ............................................................................. 310012 ............................................................................. 310013 ............................................................................. 310014 ............................................................................. 310015 ............................................................................. 310016 ............................................................................. 310017 ............................................................................. 310018 ............................................................................. 310019 ............................................................................. 310020 ............................................................................. 310021 ............................................................................. 310022 ............................................................................. 310024 ............................................................................. 310025 ............................................................................. 310026 ............................................................................. 310027 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00212 0.9146 1.5050 *** 0.8621 1.7448 1.3375 1.2159 1.5966 1.1726 1.8521 1.0895 1.3288 1.1453 1.3967 0.9611 1.7247 1.5056 0.9165 1.3609 1.5069 1.3172 1.5063 1.5520 2.0702 1.4218 1.1092 1.2560 1.2942 1.3026 1.3884 1.0657 1.2155 1.0860 *** 1.2121 1.3882 1.2223 1.1875 1.1118 1.4230 1.2139 1.7645 2.0805 1.7701 1.8371 1.2057 1.3245 1.2346 1.3149 1.2458 1.2847 1.2662 1.6801 1.3585 1.8139 1.8694 1.3353 1.3378 1.1407 1.6282 1.5855 1.6207 1.2275 1.3520 1.2683 1.2192 1.2914 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.8666 0.8666 * 0.9786 1.1416 1.1416 1.0805 1.1416 1.1249 1.0984 1.1416 1.1416 0.9079 1.0805 1.1416 1.1416 1.1416 0.9079 1.0984 1.1416 1.1416 1.1416 1.0668 1.0668 1.0668 1.0668 1.0903 1.0668 1.0903 1.0903 1.0668 1.0668 1.0668 1.0668 1.0668 1.0668 1.0903 1.0903 1.0668 1.0668 1.0668 1.0668 1.0903 1.3191 1.3191 1.3191 1.2192 1.3191 1.3191 1.3191 1.0837 1.1031 1.3191 1.3191 1.0607 1.3191 1.3191 1.2192 1.3191 1.3191 1.3191 1.0837 1.0607 1.2192 1.3191 1.3191 1.2192 19.3466 20.0643 33.8918 16.8363 27.4732 24.6877 24.2211 35.1020 27.0115 26.9020 25.4598 25.8036 22.5111 25.1684 24.2373 26.2510 27.5364 13.5031 27.5425 28.7599 28.6294 26.5644 27.1312 26.7859 22.8163 22.0187 23.6919 24.6295 25.0979 26.3914 21.3397 23.7144 24.4869 18.9756 26.1104 25.7851 23.8076 24.8189 22.3918 24.9992 22.4883 24.5772 26.9093 30.1786 33.9058 30.4234 26.0227 25.9000 28.0970 24.6353 26.7889 26.1586 31.1705 25.0951 29.1931 30.1767 25.7368 25.2636 25.9108 26.8663 25.0147 29.4003 26.7487 26.9499 26.8719 24.6697 22.1935 * 21.8385 * 16.8433 27.1099 27.1531 26.3617 35.4193 26.4086 27.6011 23.8733 27.2675 25.1726 27.2484 21.3094 28.3837 29.8144 17.8850 29.4164 29.6801 30.1346 26.9319 29.4130 27.8059 25.1869 20.6787 25.3125 26.9346 27.3325 28.4234 23.1529 25.5059 24.0620 24.5498 28.3959 28.0308 25.3845 26.8402 23.5948 25.4873 23.9205 26.9484 28.5375 33.9360 35.4567 31.1040 27.5690 27.0436 29.5857 29.7760 25.3139 28.5241 33.1622 28.5016 32.7222 32.4980 28.9788 28.0930 26.9399 31.0524 29.3392 29.6308 26.1914 27.5278 27.7960 25.3970 27.0982 * 21.7658 * 18.3469 28.1625 27.6697 27.9502 37.5559 27.9714 29.8019 23.9654 31.0843 26.1925 28.6158 21.6993 33.2116 29.4422 15.1448 31.7105 31.2941 33.9878 30.9612 27.5032 33.3560 25.5583 23.3200 26.8347 27.5028 28.4044 30.5198 * 27.5151 * * 29.6957 29.7209 25.9656 28.6723 24.4048 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 28.2024 30.9171 31.1274 27.5171 53.3590 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 19.3466 21.2295 33.8918 17.3909 27.5886 26.5417 26.1547 36.0546 27.1141 28.1837 24.4204 28.0502 24.6281 27.0192 22.1469 29.2014 28.9634 15.3083 29.6070 30.0435 31.0661 28.4883 28.0073 29.3633 24.5574 21.9532 25.3232 26.4641 26.9920 28.4955 22.1888 25.6846 24.2732 21.6922 28.0967 27.9654 25.1005 26.8622 23.4922 26.4774 23.2005 26.9920 28.4471 33.2483 35.5944 31.5180 27.5943 26.7958 29.6725 29.0885 26.9172 28.5543 33.0545 28.1586 30.4762 33.0707 29.9150 28.1646 27.8107 29.1388 28.2107 30.1313 27.0808 28.3714 28.7415 25.9064 32.8604 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23517 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 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 310067 310069 310070 310072 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 320001 320002 320003 320004 320005 320006 320009 320011 320013 320014 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00213 1.2218 1.8622 2.9677 1.2894 1.3320 1.3242 1.9813 1.2457 1.3638 1.2679 1.1514 1.3163 1.5833 1.3107 1.3562 *** 1.2751 1.3708 1.3032 1.2802 1.3058 1.0940 1.2669 1.2605 1.3317 1.5192 *** 1.2630 1.3475 *** 1.7716 1.2859 1.2656 1.5940 1.6607 1.2963 1.2485 1.2961 1.2192 1.2110 1.1766 1.2599 1.1909 1.3547 1.1809 2.0766 1.2212 1.3809 1.2871 1.1936 1.2335 1.2365 1.2658 1.2404 1.2786 1.7690 1.1565 1.4765 1.3821 1.1105 1.2830 1.4230 1.3163 1.5090 1.1653 1.1462 1.1040 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 1.2192 1.0607 1.1301 1.0652 1.1301 1.3191 1.3191 1.1301 1.3191 1.1301 1.3191 1.0837 1.3191 1.1618 1.2192 * 1.2192 1.2192 1.1301 1.3191 1.0607 1.3191 1.0607 1.0607 1.2192 1.1618 1.2192 1.0652 1.3191 * 1.1301 1.3191 1.1301 1.3191 1.3191 1.3191 1.0607 1.3191 1.1301 1.0607 1.1618 1.2192 1.0652 1.0837 1.3191 1.3191 1.3191 1.1301 1.0837 1.1301 1.1301 1.1301 1.0607 1.3191 1.3191 1.3191 1.2192 0.9696 1.0908 0.8649 0.8649 0.9558 1.0163 0.9696 0.8649 1.0163 0.8649 25.7246 25.9606 29.5581 25.7088 26.5224 30.1264 32.3865 24.6045 27.4041 26.8145 26.9695 25.1618 31.7376 26.1353 27.4050 26.5332 25.3772 29.2386 27.0324 28.1880 26.3903 28.1753 22.1914 24.9678 25.9868 27.8388 26.3624 25.7690 30.1917 25.3145 28.8791 27.6789 25.7726 32.4533 28.7352 24.7753 24.6083 25.2465 27.3680 25.2751 23.7846 25.3640 25.6405 23.2226 24.6942 28.4705 28.7333 24.9090 26.4175 26.2496 27.8796 25.9143 24.5413 25.1189 28.0517 34.7468 24.7078 23.0290 26.7332 20.7939 19.4799 22.1677 21.1222 21.5870 20.7714 19.4487 19.7656 29.1101 29.1439 30.2345 27.8754 27.8517 32.1471 32.1977 27.1054 28.0068 29.7335 29.0207 27.7752 32.6359 28.3415 28.4715 32.7666 27.2276 32.0113 28.1498 30.6905 26.4606 26.4816 23.2146 27.5400 28.3457 29.5979 26.8068 27.9656 32.1806 26.3520 29.6611 28.4361 26.2479 34.9428 30.7465 26.9589 26.4259 24.6563 29.9437 27.3601 25.5274 27.1661 27.1115 25.7071 25.8727 30.3675 30.9968 29.1548 27.8707 28.8692 28.9928 27.5203 26.2803 26.6287 28.1238 35.6786 27.2010 26.1962 28.6963 22.3911 24.0362 21.2164 22.5615 24.4237 23.1539 27.8671 26.7112 31.3849 30.7707 33.9685 27.5232 29.9162 35.0329 33.4822 28.8292 34.1113 32.8085 30.7358 31.3206 34.0151 32.8380 30.2025 27.8564 27.3033 33.7168 30.8036 34.1860 29.5221 28.0815 25.1575 28.2129 31.4884 33.4440 * 28.1681 33.2310 * 32.0329 29.4834 31.6870 36.4280 32.6644 29.8014 26.6136 28.2392 32.9001 29.3058 26.4966 30.8941 27.7204 29.4999 28.0401 34.4275 31.9769 30.1002 31.2164 30.7475 30.4192 29.6079 29.6020 25.6976 28.8797 37.7876 31.4110 26.9434 30.5158 28.1402 24.9481 23.8264 24.2812 22.8293 24.2279 28.9276 24.5310 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 28.7946 28.6905 31.2972 27.0476 28.1036 32.5209 32.7188 26.9337 29.8744 29.8863 28.9101 28.1678 32.8526 29.2921 28.7345 27.2897 26.7397 31.6981 28.6341 31.0476 27.5782 27.5746 23.5782 26.9521 28.5345 30.4173 26.5479 27.3281 31.9325 25.8709 30.2191 28.5348 27.8786 34.6292 30.7450 27.2209 25.9041 25.9836 30.0920 27.3522 25.2810 27.8574 26.8559 26.1525 26.2654 31.1262 30.6308 28.0512 28.8347 28.7020 29.1502 27.7501 26.9083 25.7970 28.3510 36.1340 27.6263 25.3673 28.6521 23.4549 23.1709 22.4376 22.6734 22.9608 22.7686 24.8284 23.5594 23518 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 320016 ............................................................................. 320017 ............................................................................. 320018 ............................................................................. 320019 ............................................................................. 320021 ............................................................................. 320022 ............................................................................. 320030 ............................................................................. 320033 ............................................................................. 320037 ............................................................................. 320038 ............................................................................. 320046 ............................................................................. 320063 ............................................................................. 320065 ............................................................................. 320067 ............................................................................. 320069 ............................................................................. 320074 ............................................................................. 320079 ............................................................................. 320083 ............................................................................. 320084 ............................................................................. 320085 ............................................................................. 330001 ............................................................................. 330002 ............................................................................. 330003 ............................................................................. 330004 ............................................................................. 330005 ............................................................................. 330006 ............................................................................. 330008 ............................................................................. 330009 ............................................................................. 330010 ............................................................................. 330011 ............................................................................. 330013 ............................................................................. 330014 ............................................................................. 330016 ............................................................................. 330019 ............................................................................. 330023 2 ........................................................................... 330024 ............................................................................. 330025 ............................................................................. 330027 ............................................................................. 330028 ............................................................................. 330029 ............................................................................. 330030 ............................................................................. 330033 ............................................................................. 330036 ............................................................................. 330037 ............................................................................. 330041 ............................................................................. 330043 ............................................................................. 330044 ............................................................................. 330045 ............................................................................. 330046 ............................................................................. 330047 h ........................................................................... 330049 ............................................................................. 330053 ............................................................................. 330055 ............................................................................. 330056 ............................................................................. 330057 ............................................................................. 330058 ............................................................................. 330059 ............................................................................. 330061 ............................................................................. 330062 ............................................................................. 330064 ............................................................................. 330065 ............................................................................. 330066 ............................................................................. 330067 2 ........................................................................... 330072 ............................................................................. 330073 ............................................................................. 330074 ............................................................................. 330075 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00214 1.1520 1.2523 1.4565 1.5397 1.6254 1.0969 1.0284 1.1545 1.1552 1.1959 1.1718 1.2785 1.0973 0.8271 1.0924 1.1664 1.1142 2.5985 1.0974 1.6090 *** 1.4447 1.2641 1.2725 1.5973 1.2917 1.1113 1.2845 *** 1.2998 2.1105 1.3351 0.9933 1.2932 1.5678 1.7206 1.0421 1.4553 1.3838 0.4208 1.2550 1.2667 1.1360 1.0926 1.1922 1.2957 1.2690 1.3308 1.4018 1.1968 1.3533 1.0847 1.6314 1.4539 1.6969 1.3165 1.5179 1.2264 1.1819 1.1415 1.0281 1.3120 1.4150 1.3818 1.1228 1.3126 1.1656 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.8649 0.9696 0.8649 0.9696 0.9696 0.8649 0.8649 1.0163 0.9696 0.8649 0.8649 0.9593 0.9593 0.8649 0.8649 0.9696 0.9696 0.9696 0.8649 0.8649 1.3191 1.3191 0.8565 1.0576 0.8888 1.3191 0.8888 1.3191 * 0.8588 0.8565 1.3191 0.8220 1.3191 1.0767 1.3191 0.8888 1.3191 1.3191 0.8888 0.9117 0.8220 1.3191 0.9117 1.3191 1.2781 0.8313 1.2781 1.3191 0.8565 1.0767 0.9117 1.3191 1.3191 0.8565 0.9117 1.3191 1.3191 0.9204 1.3191 0.8888 0.8565 1.0767 1.3191 0.9117 0.9117 0.9595 19.9326 22.5460 21.4650 26.6900 21.0913 20.7919 16.8696 24.2703 19.6466 19.2962 21.5915 20.7804 19.9012 13.9459 18.5375 28.3086 21.9090 20.6771 * * 30.8509 28.0882 20.2744 24.3703 24.3578 28.3904 20.6816 33.3605 19.8211 19.8035 21.2063 32.0824 18.1603 31.9042 29.4538 35.3598 18.7663 34.1281 31.8452 18.4354 22.0574 18.6316 27.0970 18.3557 34.5461 31.7873 22.0465 30.9046 41.6759 20.1646 24.7766 18.1728 34.9709 32.0982 20.9282 19.2916 36.4176 28.6725 20.0222 36.0976 20.5958 20.9990 24.8927 32.9665 18.4162 21.7299 19.9781 21.7001 23.6861 23.0915 31.2250 28.5620 22.1492 18.0990 24.1185 21.6080 21.2181 22.9114 24.9141 21.6189 20.4431 19.7296 35.5980 23.8092 * * * 31.3735 29.3459 21.6506 23.9959 25.9287 29.7509 21.3269 35.8367 17.9178 20.3641 23.9070 35.4053 18.9388 32.3413 29.2669 36.5648 19.7561 35.1325 33.5312 18.6623 22.4368 21.3762 27.6813 19.6385 36.2481 34.1039 23.1450 34.4956 42.0900 21.1244 25.7022 19.6807 35.1393 32.9295 22.6519 19.5520 38.1019 32.7427 21.4270 38.5719 21.9192 23.0916 34.8416 32.7905 19.0781 20.2874 22.0240 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 * 31.5370 21.8198 35.4986 19.6920 21.8008 24.3512 38.8123 28.4392 34.7814 29.8943 38.8643 20.2775 39.0717 34.2709 19.1589 22.9937 22.5681 28.9409 20.6904 36.0286 34.7480 23.8719 36.1749 44.8494 24.0678 29.2904 18.5290 38.4839 37.8444 24.4680 20.8234 39.7386 33.2848 21.0464 36.6153 23.9128 24.7941 26.4243 36.4336 20.1490 21.4274 22.4188 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 21.7285 23.7296 22.6002 29.7045 25.1851 22.2284 18.9458 25.3263 21.6108 20.2270 22.9610 23.4155 22.8070 19.8406 19.7352 28.2084 23.6814 23.7546 17.2511 24.8752 31.9148 29.5603 21.6443 24.8414 25.1198 29.8730 21.2850 34.8796 19.0804 20.6687 23.1632 35.4565 20.9735 33.0323 29.5534 36.8845 19.6152 36.0189 33.2330 18.7332 22.4866 20.8260 27.8674 19.5992 35.6239 33.5850 23.0325 33.9185 42.8629 21.8925 26.5366 18.7942 36.2207 34.2883 22.6890 19.9138 38.0767 31.6301 20.8258 37.0956 22.1517 23.0025 28.0084 34.0607 19.1772 21.1093 21.4854 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23519 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 330078 ............................................................................. 330079 ............................................................................. 330080 ............................................................................. 330084 ............................................................................. 330085 ............................................................................. 330086 ............................................................................. 330088 ............................................................................. 330090 ............................................................................. 330091 ............................................................................. 330094 ............................................................................. 330095 ............................................................................. 330096 ............................................................................. 330097 ............................................................................. 330100 ............................................................................. 330101 ............................................................................. 330102 ............................................................................. 330103 ............................................................................. 330104 ............................................................................. 330106 ............................................................................. 330107 ............................................................................. 330108 ............................................................................. 330111 ............................................................................. 330114 ............................................................................. 330119 ............................................................................. 330121 ............................................................................. 330122 ............................................................................. 330125 ............................................................................. 330126 ............................................................................. 330127 ............................................................................. 330128 ............................................................................. 330132 ............................................................................. 330133 ............................................................................. 330135 ............................................................................. 330136 ............................................................................. 330140 ............................................................................. 330141 ............................................................................. 330144 ............................................................................. 330148 ............................................................................. 330151 ............................................................................. 330152 ............................................................................. 330153 ............................................................................. 330157 ............................................................................. 330158 ............................................................................. 330159 ............................................................................. 330160 ............................................................................. 330162 ............................................................................. 330163 ............................................................................. 330164 ............................................................................. 330166 h ........................................................................... 330167 ............................................................................. 330169 ............................................................................. 330171 ............................................................................. 330175 ............................................................................. 330177 ............................................................................. 330180 ............................................................................. 330181 ............................................................................. 330182 ............................................................................. 330184 ............................................................................. 330185 ............................................................................. 330188 ............................................................................. 330189 ............................................................................. 330191 ............................................................................. 330193 ............................................................................. 330194 ............................................................................. 330195 ............................................................................. 330196 ............................................................................. 330197 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00215 1.4256 1.3180 1.1477 1.0829 1.1913 1.3193 1.0442 1.4373 1.3675 1.2532 *** 1.0690 1.1327 1.0066 1.8242 1.3460 1.0963 1.3563 1.7244 1.2325 1.1108 1.0397 *** 1.7468 0.9116 *** 1.7658 1.2826 1.2655 1.1790 1.0730 1.3118 1.2237 1.4654 1.7896 1.3034 1.0332 1.0266 1.1030 1.3177 1.7022 1.3678 1.5489 1.3811 1.5392 1.2612 1.2015 1.4792 1.0593 1.7665 1.4095 1.1728 1.1137 0.9453 1.2265 1.3091 2.3204 1.4141 1.2671 1.2490 0.9765 1.2880 1.2567 1.7888 1.7407 1.2724 1.1300 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.8888 0.8220 1.3191 0.8220 0.9315 1.3191 1.2781 0.8276 0.8888 0.8904 * 0.8220 0.8220 1.3191 1.3191 0.8888 0.8220 1.3191 1.2781 1.2781 0.8276 0.8888 * 1.3191 0.8220 * 0.9117 1.0767 1.3191 1.3191 0.8220 1.3191 1.0767 0.9315 0.9595 1.2781 0.8220 0.8313 0.8220 1.3191 0.8565 0.9315 1.3191 0.9595 1.3191 1.3191 0.8888 0.9117 0.8220 1.2781 1.3191 1.3191 0.8220 0.8220 0.8565 1.3191 1.3191 1.3191 1.2781 0.8888 0.8565 0.8565 1.3191 1.3191 1.3191 1.3191 0.8220 20.8379 21.1153 33.5537 19.2135 21.8271 27.1585 29.5181 20.9327 22.9396 21.3659 28.9794 21.1648 18.6291 31.5775 38.4810 23.5254 17.9017 36.8451 38.7822 29.1958 20.2536 17.7020 19.2566 34.6591 17.9757 25.6500 22.8078 27.7155 42.2836 32.7050 16.0311 35.3136 25.6504 21.4225 21.1787 29.3283 17.3920 17.6560 16.4028 32.3332 21.2843 23.5522 32.7159 22.5580 32.1266 29.6042 21.1517 23.5427 18.4262 30.9667 36.2725 25.9946 20.4628 19.0005 19.8951 37.1218 35.2416 30.7479 28.9787 21.1196 19.0726 20.9392 36.2427 38.5372 36.4249 31.1915 20.8386 22.7762 22.1064 36.1171 22.6365 23.2927 28.8425 31.2631 22.7721 22.5796 22.1495 28.9914 22.4895 19.2233 32.8406 39.2601 23.6141 18.8763 33.7556 39.8558 31.8528 21.4680 17.6185 * 36.5873 19.7388 26.3849 24.6945 28.8299 43.7479 34.5289 16.3088 44.0704 26.9969 22.5447 23.5774 30.6616 20.1805 18.5443 17.6782 32.0616 21.9935 23.6939 33.0067 24.1916 34.0373 31.3812 22.4644 24.4306 18.8777 33.7365 38.3498 27.7810 21.1944 20.1850 21.9641 35.8846 36.3831 33.2843 31.0179 22.6803 19.2538 22.3719 36.9866 39.9177 38.6867 32.5883 22.3117 23.3786 22.5237 39.1724 21.5455 23.9568 29.1784 * 23.6174 23.1637 23.0001 31.9872 22.0337 20.2158 34.4621 38.7468 24.8184 21.1452 32.8818 41.2202 31.3888 22.2607 20.9387 * 39.1114 23.9397 * 26.6379 31.6370 44.4667 * 17.4946 36.6962 29.0837 24.2010 25.7573 34.8902 20.9935 * 19.1841 36.5136 23.7172 24.9042 32.2990 28.8391 34.1960 32.1783 24.0200 28.8481 19.4360 34.4405 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 23.4291 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 22.3586 21.9214 36.3260 21.1058 23.0352 28.3884 39.0244 22.4292 22.8973 22.1769 29.7944 21.9119 19.3250 32.9762 38.8311 23.9846 19.3116 34.4566 39.9816 30.7790 21.3131 18.7250 19.2566 36.7610 20.5934 26.0090 24.8334 29.4715 43.5141 33.6278 16.8474 38.2248 27.3649 22.7506 23.5011 31.6934 19.3948 18.0744 17.7056 33.6447 22.3124 24.0644 32.6514 25.0788 33.4347 31.0913 22.5391 25.6753 18.9008 33.1152 37.9349 27.7871 21.3007 19.6031 21.3178 37.1836 37.1311 32.7893 30.8714 22.6030 19.9266 22.4577 36.8214 40.8421 38.4696 32.3484 22.2164 23520 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 330198 ............................................................................. 330199 ............................................................................. 330201 ............................................................................. 330202 ............................................................................. 330203 ............................................................................. 330204 ............................................................................. 330205 ............................................................................. 330208 ............................................................................. 330209 ............................................................................. 330211 ............................................................................. 330212 ............................................................................. 330213 ............................................................................. 330214 ............................................................................. 330215 ............................................................................. 330218 ............................................................................. 330219 ............................................................................. 330221 ............................................................................. 330222 ............................................................................. 330223 ............................................................................. 330224 ............................................................................. 330225 ............................................................................. 330226 ............................................................................. 330229 h ........................................................................... 330230 ............................................................................. 330231 ............................................................................. 330232 ............................................................................. 330233 ............................................................................. 330234 ............................................................................. 330235 ............................................................................. 330236 ............................................................................. 330238 ............................................................................. 330239 h ........................................................................... 330240 ............................................................................. 330241 ............................................................................. 330242 ............................................................................. 330245 ............................................................................. 330246 ............................................................................. 330247 ............................................................................. 330249 ............................................................................. 330250 ............................................................................. 330259 ............................................................................. 330261 ............................................................................. 330263 ............................................................................. 330264 ............................................................................. 330265 ............................................................................. 330267 ............................................................................. 330268 ............................................................................. 330270 ............................................................................. 330273 ............................................................................. 330276 ............................................................................. 330277 ............................................................................. 330279 ............................................................................. 330285 ............................................................................. 330286 ............................................................................. 330290 ............................................................................. 330293 ............................................................................. 330304 ............................................................................. 330306 ............................................................................. 330307 ............................................................................. 330314 ............................................................................. 330316 ............................................................................. 330327 ............................................................................. 330332 ............................................................................. 330333 ............................................................................. 330336 ............................................................................. 330339 ............................................................................. 330340 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00216 1.3527 1.1121 1.6454 1.2540 1.4787 1.3191 1.2677 1.1879 1.1738 1.1533 *** 1.1308 1.9065 1.3146 1.0371 1.6407 1.3773 1.2919 1.0310 1.2912 1.1790 1.3067 1.1699 0.9941 0.9977 1.1923 1.4170 2.2593 1.1320 1.4277 1.2507 1.2261 1.2179 1.8763 1.2925 1.9001 1.3295 1.0067 1.2019 1.2791 1.4142 1.2516 0.9776 1.2367 1.2729 1.4649 0.9506 2.0316 1.4020 1.1013 1.1667 1.4462 1.9363 1.3657 1.7357 *** 1.2821 1.4608 1.2103 1.2270 1.2997 *** 1.2570 *** *** 0.8062 1.1756 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 1.2781 1.3191 1.3191 1.3191 0.9595 1.3191 1.0767 1.3191 1.0767 0.8220 1.3191 0.8220 1.3191 0.8313 0.9595 0.8888 1.3191 0.8565 0.8220 0.9260 1.2781 0.9117 0.8424 1.3191 1.3191 0.8565 1.3191 1.3191 0.9315 1.3191 0.9117 0.8424 1.3191 0.9595 1.3191 0.8313 1.2781 1.3191 0.9595 0.9306 1.2781 1.3191 0.8220 1.0767 0.9117 1.3191 0.8565 1.3191 1.3191 0.8220 0.9204 0.8888 0.9117 1.2781 1.3191 * 1.3191 1.3191 0.9855 1.2781 1.3191 * 1.2781 1.2781 * 0.8565 1.2781 25.3622 34.1354 29.3745 30.7990 24.7422 30.3699 29.0622 30.6158 27.7071 20.8224 24.9434 20.7967 32.7647 19.9226 20.6012 28.7448 34.9345 23.5491 18.8253 22.7847 29.1744 23.5405 18.5590 32.5997 30.2184 21.1277 39.5133 37.7135 21.4643 31.8491 18.3846 19.7561 37.3866 26.7598 30.5172 20.2037 31.8857 25.6063 19.1469 22.1272 27.4131 30.4771 20.0831 26.3652 18.2547 29.0499 18.7991 36.5976 28.8548 20.7973 21.8866 23.8793 26.0446 31.1344 35.5617 17.6506 31.1146 30.4426 23.8583 26.2954 33.7857 19.3465 30.5104 29.7725 32.9548 20.8424 29.8140 29.5359 32.7870 33.3215 34.3545 26.2459 30.3273 30.0101 28.2667 28.7213 21.1094 27.0585 21.7208 33.7670 20.6343 21.4095 27.7400 34.7033 25.9825 18.4291 23.9379 28.9952 23.4783 19.5670 32.1101 33.9324 21.4765 41.9968 36.8500 22.1217 32.9391 19.2407 20.4936 40.7478 27.7213 32.2178 21.6857 31.6763 32.1733 21.4345 23.0641 30.0488 30.9356 20.8456 28.1501 19.9414 30.3709 18.9142 38.2605 29.5106 21.7826 25.1438 23.4816 27.1260 32.3244 36.3764 19.0290 33.4431 30.7551 25.4128 26.0150 33.1512 * 31.8389 33.7637 * 22.2812 31.4322 30.5485 35.0059 39.3682 35.0804 26.5882 37.6849 32.1617 29.6282 29.7988 22.9966 27.2232 22.5191 37.8500 22.5715 24.1106 29.3803 36.5539 23.9746 19.4229 25.7396 29.2719 21.8977 20.6095 33.3175 37.0175 24.2810 45.5132 40.6314 23.3866 35.6347 20.8639 21.5397 36.7910 29.0882 46.0013 22.7032 34.6329 32.2300 22.9834 25.1664 31.9495 30.7942 22.4675 30.0139 20.4635 31.5478 20.9720 52.4880 30.3976 22.2353 25.3582 24.9772 27.9018 33.3377 36.9981 * 34.5111 35.6640 27.5699 25.5597 34.8623 * 33.0652 26.1917 * 22.6569 33.5504 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 28.5487 33.9687 33.7813 33.5414 25.8191 32.8372 30.4707 29.4819 28.7477 21.6469 26.1185 21.6931 34.8451 21.0552 22.0618 28.6143 35.4233 24.4778 18.9058 24.1533 29.1527 22.8832 19.5838 32.6586 33.7403 22.2924 42.4372 38.3961 22.3225 33.4921 19.5443 20.5927 38.3109 27.8974 35.2529 21.5626 32.7279 29.8298 21.2588 23.4900 29.9063 30.7386 21.1560 28.1122 19.5583 30.3522 19.5863 42.6074 29.6096 21.6210 24.1682 24.1439 27.0364 32.3174 36.3009 18.3452 33.0739 32.2831 25.6624 25.9594 33.9322 19.3465 31.9293 29.6723 32.9548 21.9390 31.6312 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23521 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 330350 ............................................................................. 330353 ............................................................................. 330357 ............................................................................. 330372 ............................................................................. 330385 ............................................................................. 330386 ............................................................................. 330389 ............................................................................. 330390 ............................................................................. 330393 ............................................................................. 330394 ............................................................................. 330395 ............................................................................. 330396 ............................................................................. 330397 ............................................................................. 330399 ............................................................................. 330401 ............................................................................. 330402 ............................................................................. 330403 ............................................................................. 340001 ............................................................................. 340002 ............................................................................. 340003 ............................................................................. 340004 ............................................................................. 340005 ............................................................................. 340007 ............................................................................. 340008 ............................................................................. 340010 ............................................................................. 340011 ............................................................................. 340012 ............................................................................. 340013 ............................................................................. 340014 ............................................................................. 340015 h ........................................................................... 340016 ............................................................................. 340017 ............................................................................. 340018 ............................................................................. 340019 ............................................................................. 340020 ............................................................................. 340021 ............................................................................. 340022 ............................................................................. 340024 ............................................................................. 340025 ............................................................................. 340027 ............................................................................. 340028 ............................................................................. 340030 ............................................................................. 340032 ............................................................................. 340035 ............................................................................. 340036 ............................................................................. 340037 ............................................................................. 340038 ............................................................................. 340039 ............................................................................. 340040 ............................................................................. 340041 ............................................................................. 340042 ............................................................................. 340044 ............................................................................. 340045 ............................................................................. 340047 ............................................................................. 340049 ............................................................................. 340050 ............................................................................. 340051 ............................................................................. 340053 ............................................................................. 340055 ............................................................................. 340060 ............................................................................. 340061 ............................................................................. 340064 ............................................................................. 340065 ............................................................................. 340067 ............................................................................. 340069 ............................................................................. 340070 ............................................................................. 340071 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00217 1.4934 1.1504 1.2908 1.2505 1.1112 1.2069 1.9214 1.2676 1.7382 1.6408 1.3921 1.2486 1.3537 1.1709 1.3161 0.7916 *** 1.4809 1.7358 1.0930 1.4023 0.9977 *** 1.0820 1.3214 1.0509 1.2823 1.2354 1.5332 1.3596 1.2110 1.2648 1.1294 0.9618 1.1895 1.2956 *** 1.1553 1.2401 1.1523 1.5451 2.0360 1.3877 1.0281 1.1712 1.0024 1.1871 1.2862 1.9063 1.2302 1.0903 0.9395 0.9726 1.8926 2.0329 1.0881 1.2288 1.5911 1.2318 1.0613 1.8009 1.0787 1.1887 *** 1.8692 1.2588 1.1237 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 1.3191 1.3191 1.3191 1.2781 1.3191 1.0576 1.3191 1.3191 1.2781 0.8588 1.3191 1.3191 1.3191 1.3191 1.2781 0.9260 0.9117 0.9717 0.9312 0.8570 0.9020 0.8570 0.9133 0.9585 0.9476 0.8570 0.8570 0.9585 0.9020 0.9717 0.8570 0.9312 0.9183 0.9020 0.8570 0.9585 0.8570 0.8570 0.9312 0.9414 0.9426 1.0260 0.9717 0.8570 0.9709 0.8570 0.8570 0.9585 0.9414 0.8931 0.8570 0.8570 0.8570 0.9020 1.0260 0.9193 0.8931 0.9717 0.8931 0.9133 1.0260 0.8570 0.8570 * 0.9993 0.8902 0.9476 35.5656 35.6821 36.5461 28.2490 44.3387 25.2064 32.2112 32.7450 33.0953 21.3678 32.1089 31.2429 40.0884 32.1248 33.8633 * * 21.6113 24.0145 20.8205 23.3756 20.8150 19.5208 22.7338 21.3024 18.1926 19.6350 21.0066 22.6757 24.3410 20.2859 21.7083 17.3480 16.7901 21.3385 22.9208 19.9078 20.4906 20.2864 21.0975 22.2028 26.7753 23.2204 16.4821 20.8313 21.9524 13.9936 24.8246 22.4777 17.6319 21.1107 18.2154 17.4066 22.5199 21.2734 20.3262 20.3057 24.9768 23.2990 20.8077 25.1081 19.4523 20.3296 22.2565 24.4650 22.2605 19.9561 39.3541 38.6962 34.3965 30.1505 42.6671 25.9228 34.7552 33.2628 34.8213 23.3505 35.4619 32.5345 34.5110 33.6753 35.7435 21.3302 * 23.2436 25.1099 21.5562 24.2055 22.9830 21.1519 24.2089 23.1349 18.1843 22.0583 22.4787 24.4831 24.3870 22.7574 22.8879 20.3840 17.8768 24.1955 23.6884 * 21.2671 20.9915 22.6107 24.6836 27.4664 24.8031 21.2407 22.2089 22.5089 14.0203 25.6605 24.1523 23.0497 22.1107 21.7089 14.5004 25.3727 22.3082 21.4511 21.9069 26.9361 24.3728 22.4303 26.6657 22.3631 20.8413 * 27.5045 23.6045 22.1854 36.6250 37.6549 35.5975 32.6721 34.7820 27.9943 34.7669 36.0573 34.8095 25.2229 39.6666 35.0297 38.4741 32.3688 40.5332 * 23.1887 25.0041 27.3349 23.3066 25.4474 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 * 22.2521 21.2276 23.6326 26.3298 29.3043 26.7475 23.5476 25.2077 21.6411 14.0713 27.1275 26.3325 23.4891 23.0236 22.8948 23.1918 25.0605 30.4827 24.2533 23.4091 27.7261 24.1057 22.8657 27.5594 22.9143 * * 27.4473 24.9033 25.4537 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 37.1672 37.3737 35.5017 30.3998 40.7280 26.4367 33.9210 33.8898 34.2742 23.3324 35.4994 32.9828 37.5361 32.7392 36.7926 21.3302 23.1887 23.2441 25.5169 21.9251 24.3851 22.0177 20.3174 25.0622 23.0280 18.7756 21.4818 22.1688 24.1069 25.0387 22.0228 22.8228 20.2881 17.3292 23.1233 24.2587 19.9078 21.3515 20.8493 22.4564 24.3471 27.9060 25.0122 20.1377 22.9528 22.0344 14.0327 25.9204 24.3631 21.2362 22.0702 20.8194 18.0750 24.3496 24.7548 22.0481 21.9456 26.5947 23.9407 22.0570 26.4994 21.5916 20.5941 22.2565 26.5163 23.6142 22.5747 23522 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 340072 ............................................................................. 21.3320 ............................................................................ 340073 ............................................................................. 340075 ............................................................................. 340084 ............................................................................. 340085 h ........................................................................... 340087 ............................................................................. 340088 ............................................................................. 340090 ............................................................................. 340091 ............................................................................. 340096 h ........................................................................... 340097 ............................................................................. 340098 ............................................................................. 340099 ............................................................................. 340104 ............................................................................. 340106 ............................................................................. 340107 ............................................................................. 340109 ............................................................................. 340113 ............................................................................. 340114 ............................................................................. 340115 ............................................................................. 340116 ............................................................................. 340119 ............................................................................. 340120 ............................................................................. 340121 ............................................................................. 340123 ............................................................................. 340124 ............................................................................. 340126 h ........................................................................... 340127 ............................................................................. 340129 ............................................................................. 340130 ............................................................................. 340131 ............................................................................. 340132 ............................................................................. 340133 ............................................................................. 340137 ............................................................................. 340138 ............................................................................. 340141 ............................................................................. 340142 ............................................................................. 340143 ............................................................................. 340144 ............................................................................. 340145 ............................................................................. 340146 ............................................................................. 340147 ............................................................................. 340148 ............................................................................. 340151 ............................................................................. 340153 ............................................................................. 340155 ............................................................................. 340158 ............................................................................. 340159 ............................................................................. 340160 ............................................................................. 340166 ............................................................................. 340168 ............................................................................. 340171 ............................................................................. 340173 ............................................................................. 340176 ............................................................................. 340178 ............................................................................. 350002 ............................................................................. 350003 ............................................................................. 350004 ............................................................................. 350006 ............................................................................. 350009 ............................................................................. 350010 ............................................................................. 350011 ............................................................................. 350014 ............................................................................. 350015 ............................................................................. 350017 ............................................................................. 350019 2 ........................................................................... VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00218 1.1835 22.6474 1.3746 1.2112 1.1875 1.1572 1.1889 1.3425 1.2312 1.5335 1.1818 1.1843 1.4546 1.1671 0.8280 1.0782 1.1794 1.3188 1.8523 1.6227 1.5773 1.7011 1.1252 1.0360 1.0374 1.1858 1.0791 1.2269 1.1717 1.2519 1.3631 1.5298 1.1782 0.9920 0.9669 0.8241 1.6446 1.1805 1.4579 1.2329 1.2957 1.0505 1.2003 1.3349 1.1033 1.9092 1.4341 1.1034 1.1424 1.2720 1.3649 *** 1.1811 1.2448 *** *** 1.7334 1.1580 *** 1.6770 1.0756 1.0942 1.9473 0.9131 1.6703 1.4352 1.6643 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 0.8570 21.0148 0.9993 0.8931 0.9717 0.9133 0.8570 0.8570 0.9709 0.9020 0.9133 0.8570 0.9717 0.8570 0.8570 0.8570 0.8924 0.8841 0.9717 0.9993 0.9993 0.8931 0.9717 0.8570 0.9580 0.9133 0.9476 0.9709 0.9993 0.9585 0.9717 0.9414 0.8570 0.8570 0.8931 0.9993 0.9580 0.8570 0.8931 0.9585 0.9585 0.8570 0.9476 0.9020 0.8570 0.9717 1.0260 0.9580 1.0260 0.8570 0.9717 0.9580 0.9717 0.9993 * 0.9426 0.7519 0.7278 * 0.7278 0.8778 0.7278 0.8778 0.7278 0.7519 0.7278 1.1521 Average hourly wage FY 2006 29.4189 24.1297 21.3227 23.0890 18.4202 24.3299 21.7173 24.9411 23.6345 22.5775 25.4823 20.0178 14.3252 22.6979 22.5583 22.3826 26.0776 25.4533 25.1907 26.1641 22.4821 21.8548 20.3701 23.1879 18.3866 23.5405 24.6096 24.1356 23.0937 25.2989 20.4222 22.1588 29.9903 27.4767 24.8132 22.1298 24.8904 25.6538 23.7028 18.8354 23.9998 22.4205 22.2613 25.7078 28.8758 23.4724 22.1872 19.1330 25.7398 16.8076 27.2074 26.6128 * * 20.6474 25.3076 27.5891 19.5870 20.7014 18.5682 22.3896 18.5360 18.6381 20.1943 24.2382 30.2076 26.0225 21.2580 23.9793 22.0070 * 23.4542 25.8266 25.2169 24.2127 27.3308 20.3683 15.7521 22.4894 22.9698 23.4419 28.2546 26.6813 25.0212 25.3213 24.2287 23.0916 21.7576 26.1083 20.8018 25.0189 25.4786 25.4902 25.2941 27.9358 21.3521 22.5558 21.0642 * 27.3355 22.9907 25.3633 27.2686 23.7131 * 25.4534 23.5880 22.0052 26.4896 30.5006 26.4849 23.2991 20.7525 26.0557 17.3249 28.2734 27.5072 * 28.7219 22.0283 21.8061 * 19.4985 23.0873 19.1965 23.1947 17.7565 19.7027 21.0243 32.2306 Average hourly wage ** (3 years) 19.2773 Sfmt 4702 Average hourly wage FY 2005 26.6829 23.2904 20.8175 21.7112 17.8215 22.8687 20.3261 23.1430 22.1174 20.8690 24.2262 17.5114 12.9949 20.1076 21.0960 20.4341 25.0729 19.9142 23.8284 23.9643 21.2239 19.9860 19.9409 22.3711 17.5691 21.4271 22.9672 22.3260 22.7687 24.1370 17.8771 23.1444 33.1751 29.5286 24.2033 20.4320 23.0416 25.4598 21.8120 20.7252 22.6057 20.8156 19.2593 23.7426 26.3663 21.7489 21.2983 18.7569 22.8349 16.8278 25.9603 23.7037 26.5277 * 20.4398 21.0585 28.3773 19.7577 20.2558 17.2489 21.9111 16.1718 18.5437 19.1952 21.3589 E:\FR\FM\04MYP2.SGM 04MYP2 28.9147 24.4391 21.1447 22.8869 19.3351 23.5994 21.9222 24.6682 23.6523 22.5886 25.7030 19.3181 14.3947 21.8047 22.2242 22.1467 26.5138 23.7911 24.7040 25.1777 22.6894 21.7078 20.7129 23.9306 18.8482 23.3764 24.4245 24.1365 23.7854 25.8415 19.8892 22.6188 28.4915 28.5643 25.5266 21.8836 24.4002 26.1330 23.0768 19.6880 24.0568 22.2985 21.1161 25.3204 28.6119 23.8953 22.2743 19.5589 24.9254 17.0046 27.2246 26.0994 26.5277 28.7219 21.0339 22.5764 28.0246 19.5737 21.3437 18.3109 22.5594 17.4777 18.9716 20.1512 26.4362 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23523 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 350027 ............................................................................. 350030 ............................................................................. 350043 ............................................................................. 350058 ............................................................................. 350070 ............................................................................. 360001 ............................................................................. 360002 ............................................................................. 360003 ............................................................................. 360006 ............................................................................. 360007 ............................................................................. 360009 ............................................................................. 360010 ............................................................................. 360011 ............................................................................. 360012 ............................................................................. 360013 ............................................................................. 360014 ............................................................................. 360016 ............................................................................. 360017 ............................................................................. 360018 ............................................................................. 360020 ............................................................................. 360024 ............................................................................. 360025 ............................................................................. 360026 ............................................................................. 360027 ............................................................................. 360029 ............................................................................. 360031 ............................................................................. 360032 h ........................................................................... 360034 ............................................................................. 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 h ........................................................................... 360072 ............................................................................. 360074 ............................................................................. 360075 ............................................................................. 360076 ............................................................................. 360077 ............................................................................. 360078 ............................................................................. 360079 ............................................................................. 360080 ............................................................................. 360081 ............................................................................. 360082 ............................................................................. 360084 ............................................................................. 360085 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00219 1.0413 0.9514 *** 0.9697 1.9138 1.3315 1.1905 1.8081 1.9867 *** 1.5653 1.1890 1.3220 1.3639 1.0996 1.1458 1.4261 1.7197 *** 1.6198 *** 1.3926 1.2762 1.6543 1.0888 *** 1.1314 1.1035 1.7092 1.2117 1.3504 1.4244 1.4713 1.1396 1.4432 1.0612 1.1923 0.9522 1.7400 1.1298 1.6658 1.5398 1.2774 1.3753 1.5352 1.1220 1.4684 1.5341 1.5318 1.2012 1.5310 1.8254 1.1231 1.6302 1.2089 1.3941 1.2640 1.1808 1.3773 1.5368 1.2606 1.7689 1.0696 1.3058 1.3694 1.5327 2.0605 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.7278 0.7278 * 0.7278 0.8778 0.9604 0.8788 0.9604 0.9848 * 0.9263 0.8979 0.9848 0.9848 0.9263 0.9848 0.9604 0.9848 * 0.9197 * 0.9197 0.9069 0.9197 0.9573 * 0.9263 0.8788 0.9848 0.9197 0.9197 0.9604 0.9848 0.8788 0.9197 0.8788 0.9604 0.8788 0.9573 0.9197 0.9069 0.9069 0.8788 0.8788 0.9604 0.8788 0.9197 0.9848 0.8788 0.9197 0.9263 0.9573 0.9573 0.8957 0.9263 0.9848 0.9573 0.9197 0.9604 0.9197 0.9197 0.9604 0.8788 0.9573 0.9197 0.8957 0.9848 17.6731 18.8822 18.8378 15.0196 * 22.2387 20.7586 24.4144 24.0814 19.1315 22.4076 20.6290 21.4293 24.3618 24.4232 22.9372 22.8430 23.6181 29.9085 21.5085 22.5356 21.6676 20.8825 23.5907 20.4924 24.3482 21.1743 21.5621 24.2433 22.3567 32.6245 23.4855 23.4642 21.3307 22.1352 19.7212 22.8425 17.5885 24.7150 22.4939 23.0658 22.5005 19.2884 23.5586 22.4475 21.0768 23.0775 24.5746 21.3424 22.9727 24.6806 22.1110 20.5349 21.8228 21.4478 21.3736 22.2368 23.8492 22.5863 23.3686 23.3799 25.9623 18.7213 22.1973 25.2254 23.3257 24.6618 14.2262 19.2282 20.9732 * 24.4464 23.7750 22.6923 26.3180 25.7041 * 23.2659 22.0262 22.4482 25.5913 25.1588 23.8305 24.6587 25.4969 * 22.3795 24.0612 23.6574 22.3303 24.7093 20.8778 24.4324 22.9759 25.1366 25.6895 25.0910 25.1615 24.8294 22.5921 22.8729 23.2625 20.4724 23.8918 17.1973 27.2274 24.2605 25.1785 23.3285 20.3176 25.1475 23.4638 22.7943 25.5222 26.8091 22.8729 24.0868 25.2316 23.7895 25.7032 23.1687 21.6176 23.0464 23.6172 24.7610 22.5943 24.7086 24.6821 25.8762 19.5436 25.1439 27.4264 25.2059 27.5792 * 18.9978 * * 25.2836 23.9101 24.5789 27.5029 27.9925 * 23.1012 23.1178 25.5340 27.5470 26.8129 25.3861 26.1283 27.2910 * 24.4343 23.5499 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 22.6157 26.3112 23.1024 23.4434 25.3516 28.6518 22.2393 26.3036 27.3362 25.8414 24.2444 24.8863 22.0786 24.1825 24.9055 26.8453 25.9369 25.6505 26.1313 26.0935 20.8309 27.5695 27.1197 25.8415 29.0081 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 15.5713 19.0373 19.9618 15.0196 24.8833 23.2970 22.7274 26.0650 25.9633 19.1315 22.9250 21.9858 23.0257 25.9629 25.4875 24.0832 24.5377 25.5905 29.9085 22.8262 23.3173 23.7829 22.2676 24.6187 21.4073 24.3900 22.4807 23.3553 25.8774 25.0649 26.6839 23.7144 23.3755 22.7498 23.2048 20.6845 23.9800 18.9388 26.8831 24.2864 24.7297 23.5101 20.7734 24.9991 22.9631 22.4515 24.6433 26.7475 22.1811 24.5445 25.7779 23.9678 23.4234 23.3191 21.6950 22.9257 23.6214 25.2573 23.7285 24.5864 24.7447 25.9804 19.7267 24.8761 26.6255 24.8445 27.1579 23524 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 360086 ............................................................................. 360087 ............................................................................. 360089 ............................................................................. 360090 ............................................................................. 360091 ............................................................................. 360092 ............................................................................. 360093 ............................................................................. 360094 ............................................................................. 360095 ............................................................................. 360096 ............................................................................. 360098 ............................................................................. 360099 ............................................................................. 360101 ............................................................................. 360106 ............................................................................. 360107 ............................................................................. 360109 ............................................................................. 360112 ............................................................................. 360113 ............................................................................. 360115 ............................................................................. 360116 ............................................................................. 360118 ............................................................................. 360121 ............................................................................. 360123 ............................................................................. 360125 ............................................................................. 360126 ............................................................................. 360129 ............................................................................. 360130 ............................................................................. 360131 ............................................................................. 360132 ............................................................................. 360133 ............................................................................. 360134 ............................................................................. 360137 ............................................................................. 360141 ............................................................................. 360142 ............................................................................. 360143 ............................................................................. 360144 ............................................................................. 360145 ............................................................................. 360147 ............................................................................. 360148 ............................................................................. 360150 ............................................................................. 360151 ............................................................................. 360152 ............................................................................. 360153 ............................................................................. 360154 ............................................................................. 360155 ............................................................................. 360156 ............................................................................. 360159 ............................................................................. 360161 ............................................................................. 360163 ............................................................................. 360170 ............................................................................. 360172 ............................................................................. 360174 ............................................................................. 360175 ............................................................................. 360177 ............................................................................. 360178 ............................................................................. 360180 ............................................................................. 360185 ............................................................................. 360187 ............................................................................. 360189 ............................................................................. 360192 ............................................................................. 360194 h ........................................................................... 360195 ............................................................................. 360197 ............................................................................. 360203 ............................................................................. 360210 ............................................................................. 360211 ............................................................................. 360212 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00220 1.5132 1.4212 1.1144 1.4694 1.2086 1.2241 1.0308 *** 1.2895 1.0859 1.4042 *** 1.3585 1.0794 1.0416 1.0852 2.0143 1.2415 1.2494 1.2224 1.4861 1.2367 1.4129 1.1792 *** 0.9317 1.4471 1.2314 1.2426 1.6206 1.6811 1.6781 1.6446 0.9699 1.3211 1.3179 1.7297 1.3504 1.0603 1.1923 1.4859 1.4689 0.9512 0.9805 1.4857 1.1333 1.2322 1.3645 1.8834 1.1824 1.3907 1.2111 1.1979 1.1457 *** 2.2595 1.1807 1.5760 1.1222 1.3138 1.1529 1.0716 1.0908 1.1451 1.1668 1.5541 1.3654 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.9069 0.9197 0.8788 0.9573 0.9197 0.9848 0.8788 * 0.8788 0.8788 0.9197 0.8788 0.9197 0.8788 0.9197 0.8788 1.0628 0.9604 0.9197 0.9604 * 0.8788 0.9197 0.9197 * 0.8788 0.9197 0.8957 0.9604 0.9069 0.9604 0.9197 0.8788 0.8788 0.9197 0.9197 0.9197 0.8788 0.8788 0.9197 0.8957 0.9848 0.8788 0.8788 0.9197 0.8788 0.9848 0.8788 0.9604 0.9848 0.9197 0.9069 0.9848 0.8788 0.8788 0.9197 0.8788 0.9069 0.9848 0.9197 * 0.9197 0.9848 0.8788 0.9848 0.8840 0.9197 21.5983 23.9638 21.0229 22.6236 23.5759 21.9732 21.4623 22.6440 23.6518 22.0673 22.7644 20.8524 26.2875 19.8658 23.6880 23.0178 25.5910 22.3348 22.3926 21.3809 23.0070 23.2515 23.1310 21.1408 22.2409 17.9151 20.1257 21.7838 23.4179 22.0958 23.6817 23.8947 25.1442 20.6728 22.2275 24.7973 22.4813 20.0409 21.3211 24.8485 21.7215 22.9352 17.3367 16.2416 23.0020 21.2853 23.3359 21.5114 23.1500 22.2815 22.7104 21.7129 22.7887 20.8194 18.2393 25.1499 21.1245 21.9499 20.0275 24.9995 20.3677 23.1897 23.1378 19.3642 25.0811 22.4529 22.8041 22.3005 25.9131 21.0253 24.4291 26.0541 23.5100 24.1238 27.1864 24.6984 22.2333 23.6413 * 27.7584 21.6450 24.5365 24.3236 26.7880 23.5138 24.0232 23.4049 24.2526 25.2037 24.1761 22.6871 * 19.5336 21.7015 23.1730 25.7991 23.9457 25.3013 25.7647 31.0127 21.2084 23.8938 26.7160 23.4743 22.7172 24.4873 25.8703 22.2179 24.9894 19.0844 17.1274 23.9466 22.6709 25.7108 22.6005 25.7966 22.9359 23.4727 22.8167 24.6152 23.4256 * 26.8720 21.8641 23.8362 24.2512 26.2976 22.3297 25.8043 24.7539 21.5564 26.5665 23.0884 24.5310 22.1859 25.4040 22.7951 26.7717 27.5067 25.6618 23.2648 26.6348 * 24.6317 24.8447 * 26.6208 24.1588 25.9697 25.4184 28.6784 25.6493 24.0052 18.0655 * * 22.6523 22.1096 * * 22.9762 24.0495 25.9453 24.6208 29.2975 26.9522 27.7085 22.1610 24.6306 24.0350 25.8268 24.1953 26.1946 24.7667 24.8629 27.9147 19.0226 * 25.3787 24.0510 33.1613 24.3792 26.9728 24.3620 26.3388 24.9990 26.5949 24.4712 * 26.1514 23.7173 24.8173 24.2136 26.7577 * 26.1280 26.7508 22.1414 27.8415 22.5449 25.2756 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 22.0265 25.0901 21.6142 24.5859 25.7352 23.7647 22.9528 24.9723 24.1867 22.9802 23.7933 20.8524 26.9092 21.9428 24.7438 24.2613 26.9982 23.7408 23.4857 20.9510 23.6564 24.2319 23.2730 21.9849 22.2409 18.7493 21.5955 23.0299 25.1258 23.6001 26.0944 25.5442 27.9618 21.3780 23.6169 25.1500 23.9319 22.4020 24.0470 25.1568 22.8949 25.0211 18.4206 16.6874 24.1428 22.6856 27.1828 22.8785 25.2619 23.3031 24.1922 23.2230 24.7311 22.9543 18.2393 26.0861 22.2403 23.5639 22.8164 26.0512 21.3611 25.1222 24.9131 21.0862 26.5578 22.6945 24.2166 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23525 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 360218 ............................................................................. 360230 ............................................................................. 360234 ............................................................................. 360236 ............................................................................. 360239 ............................................................................. 360241 ............................................................................. 360245 ............................................................................. 360247 ............................................................................. 360253 ............................................................................. 360254 ............................................................................. 360257 ............................................................................. 360259 ............................................................................. 360260 ............................................................................. 360261 ............................................................................. 360262 ............................................................................. 360263 ............................................................................. 370001 ............................................................................. 370002 ............................................................................. 370004 ............................................................................. 370006 ............................................................................. 370007 ............................................................................. 370008 ............................................................................. 370011 ............................................................................. 370013 ............................................................................. 370014 ............................................................................. 370015 ............................................................................. 370016 h ........................................................................... 370018 ............................................................................. 370019 ............................................................................. 370020 ............................................................................. 370022 ............................................................................. 370023 ............................................................................. 370025 ............................................................................. 370026 h ........................................................................... 370028 ............................................................................. 370029 ............................................................................. 370030 ............................................................................. 370032 ............................................................................. 370034 ............................................................................. 370036 ............................................................................. 370037 ............................................................................. 370039 ............................................................................. 370040 ............................................................................. 370041 ............................................................................. 370042 ............................................................................. 370043 ............................................................................. 370045 ............................................................................. 370047 ............................................................................. 370048 ............................................................................. 370049 ............................................................................. 370051 ............................................................................. 370054 ............................................................................. 370056 ............................................................................. 370057 ............................................................................. 370060 ............................................................................. 370064 ............................................................................. 370065 ............................................................................. 370072 ............................................................................. 370076 ............................................................................. 370078 ............................................................................. 370080 ............................................................................. 370082 ............................................................................. 370084 ............................................................................. 370089 ............................................................................. 370091 ............................................................................. 370093 ............................................................................. 370094 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00221 1.1698 1.6048 1.3014 1.1515 1.3119 *** 0.5232 0.3785 2.2434 *** 1.0766 1.1777 *** 1.7759 1.3387 1.6685 1.6782 1.1821 1.0932 1.2069 1.0399 1.3885 1.0810 1.5187 1.0403 0.9737 1.4747 1.4098 1.2184 1.2243 1.1976 1.2396 1.2545 1.5077 1.8453 1.0293 1.0428 1.4479 1.1924 1.0216 1.6563 1.0902 1.0053 0.8812 0.9473 0.9286 0.9116 1.4244 1.0975 1.2985 1.0467 1.2568 1.6060 0.9425 0.9342 0.8954 1.0179 0.7985 *** 1.6061 0.9012 *** 0.9685 1.0714 1.6980 1.6152 1.3966 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.9848 0.9197 0.9604 0.9604 0.9069 0.9197 0.9197 0.9848 0.9069 * 0.8788 0.9573 0.8979 0.9482 0.9573 0.9263 0.8313 0.7615 0.8458 0.7615 0.7615 0.9043 0.9043 0.9043 0.8971 0.8313 0.8682 0.8313 0.7615 0.7615 0.7673 0.7615 0.8313 0.8682 0.9043 0.7615 0.7615 0.9043 0.7986 0.7615 0.9043 0.8313 0.8231 0.8313 0.7615 0.7615 0.7615 0.8971 0.7615 0.9043 0.7615 0.7615 0.7916 0.8313 0.8313 0.7615 0.7615 0.7615 * 0.8313 0.7615 0.7615 0.7615 0.7615 0.8313 0.9043 0.9043 22.8060 24.7681 22.1787 22.8821 23.5802 23.4061 18.1015 * 31.3006 30.0792 * * * * * * 25.5838 18.9544 21.5041 15.6333 16.7598 22.1596 17.1458 21.1512 21.8473 20.3966 20.4407 20.8357 18.1260 16.8631 20.2432 19.3386 20.2845 21.9140 24.1009 19.5811 18.6541 20.0827 16.1540 16.5844 21.0719 20.3137 18.9981 19.0144 14.0899 20.2929 12.6613 19.4856 15.4768 20.4826 12.0397 20.3788 20.4872 17.3020 23.1897 11.9044 18.3966 12.5765 19.0230 22.2318 16.1444 12.6060 16.1278 18.0505 24.2117 23.5685 20.6507 24.4720 26.6444 23.3325 21.3795 24.4398 24.8089 18.7966 25.1083 28.2555 * 17.9652 * * * * * 26.2391 19.7718 24.7694 16.9469 17.2084 22.7419 19.2266 22.6451 24.8138 21.1833 24.2737 23.4286 19.6761 17.4835 18.4217 20.6002 22.0287 22.5734 24.8661 22.1163 20.3315 21.6029 17.6247 16.9222 23.1256 21.0793 21.1061 22.0082 15.3613 21.5588 14.6370 19.7112 17.7273 21.6878 14.6254 21.5521 21.7647 18.0426 23.8007 14.1879 20.6537 14.6387 21.5461 23.9507 17.4857 * 17.2735 19.9021 22.9893 25.7296 22.0591 27.4288 27.0223 24.2539 35.8144 25.2474 24.7001 19.1885 19.8892 30.4276 * * 25.1338 27.3903 22.5431 27.1680 20.8884 27.7549 20.1479 25.3919 20.1063 17.6547 24.2978 19.7821 24.9295 25.3576 23.6693 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 17.7576 23.9685 21.8220 22.4048 22.3496 * * * 20.4657 19.2464 23.2171 17.2618 21.5043 22.0312 19.7284 18.7592 14.2053 20.0226 9.9616 * 25.4161 18.0665 * 16.6514 20.4699 20.8950 26.9774 23.1191 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 25.0106 26.1931 23.2304 24.3729 24.5362 24.1133 18.7327 22.3390 29.8452 30.0792 17.9652 25.1338 27.3903 22.5431 27.1680 20.8884 26.5495 19.6308 23.7972 17.6384 17.2160 23.1423 18.6737 22.9792 24.0194 21.7009 23.3330 22.5984 19.7475 17.6368 19.4375 20.5441 21.9757 22.5236 25.1976 21.8559 20.7201 21.7536 17.3349 17.1504 22.7803 21.0783 20.8291 21.1267 14.7180 20.9707 13.6711 19.9082 17.4431 21.8100 14.4702 21.1653 21.4507 18.3749 21.7395 13.4809 19.6691 11.8723 20.2863 23.9078 17.2314 12.6060 16.7384 19.4850 22.6316 25.3740 21.9907 23526 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 370095 ............................................................................. 370097 ............................................................................. 370099 ............................................................................. 370100 ............................................................................. 370103 ............................................................................. 370105 ............................................................................. 370106 ............................................................................. 370108 ............................................................................. 370113 ............................................................................. 370114 ............................................................................. 370123 ............................................................................. 370125 ............................................................................. 370138 ............................................................................. 370139 ............................................................................. 370141 ............................................................................. 370149 h ........................................................................... 370153 ............................................................................. 370154 ............................................................................. 370158 ............................................................................. 370166 ............................................................................. 370169 ............................................................................. 370176 ............................................................................. 370177 ............................................................................. 370178 ............................................................................. 370179 ............................................................................. 370183 ............................................................................. 370186 ............................................................................. 370192 ............................................................................. 370196 ............................................................................. 370199 ............................................................................. 370200 ............................................................................. 370201 ............................................................................. 370202 ............................................................................. 370203 ............................................................................. 370206 ............................................................................. 370207 ............................................................................. 370210 ............................................................................. 370211 ............................................................................. 370212 ............................................................................. 370213 ............................................................................. 370215 ............................................................................. 380001 ............................................................................. 380002 ............................................................................. 380003 ............................................................................. 380005 ............................................................................. 380006 ............................................................................. 380007 ............................................................................. 380008 ............................................................................. 380009 ............................................................................. 380010 ............................................................................. 380011 ............................................................................. 380014 ............................................................................. 380017 ............................................................................. 380018 ............................................................................. 380020 ............................................................................. 380021 ............................................................................. 380022 ............................................................................. 380023 ............................................................................. 380025 ............................................................................. 380026 ............................................................................. 380027 ............................................................................. 380029 ............................................................................. 380033 ............................................................................. 380035 ............................................................................. 380037 ............................................................................. 380038 ............................................................................. 380039 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00222 0.8800 1.2850 1.0065 0.9736 0.9494 1.8469 1.3329 *** 1.1317 1.5494 *** 0.8500 1.0187 0.9394 *** 1.2033 1.0423 *** 1.0192 0.9772 0.8969 1.1057 1.0170 0.8922 0.9231 1.0143 0.9064 1.7741 1.0758 0.9440 1.1666 1.7335 1.5326 1.3678 1.6351 *** 2.0839 0.9454 1.5402 *** 2.4364 1.1877 1.1956 *** 1.3582 1.1408 1.9556 1.1289 1.8990 0.9763 *** 1.8048 1.7793 1.7996 1.3856 1.4351 1.2181 1.1682 1.2837 1.1324 1.2867 1.2971 1.6592 1.0421 1.2266 1.2591 0.9755 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.7615 0.7916 0.8313 0.7615 0.8038 0.9043 0.9043 0.7615 0.8615 0.8313 0.9043 0.7615 0.7615 0.7615 * 0.9043 0.7615 0.7615 0.9043 0.8313 0.7615 0.8313 0.7615 0.7615 0.8313 0.8313 0.7615 0.9043 0.9043 0.9043 0.7615 0.9043 0.8313 0.9043 0.9043 * 0.8313 0.9043 0.9043 0.9043 0.9043 1.1229 1.0284 1.0284 1.0284 1.0284 1.1229 1.0328 1.1229 1.1229 1.0284 1.0711 1.1229 1.0284 1.0810 1.1229 1.0328 1.0284 1.1229 1.0284 1.0492 1.0445 1.0810 1.0284 1.1229 1.1229 1.1229 14.3563 20.3218 20.2001 13.0681 15.6110 22.4493 24.1115 13.8170 21.4267 19.4933 20.5180 17.9240 19.0403 16.3224 24.7859 18.2260 17.9692 17.4760 17.3412 21.3628 16.5607 22.1456 14.0279 12.9635 21.9673 17.9270 16.3879 24.3832 23.6334 20.7075 16.7164 18.9906 24.0239 19.8772 22.3471 26.3746 * * * * * 20.9585 25.2629 24.6377 26.3472 24.7492 30.0497 24.6149 26.0012 25.5234 21.9382 28.4536 29.2543 27.5171 23.7066 28.0334 26.4794 23.0079 28.8525 23.8666 21.5822 24.2939 30.4783 26.2434 25.0200 29.1804 27.5115 16.5310 21.7150 20.5217 14.1883 16.1408 22.1584 24.2393 * 23.3011 21.0603 22.8174 17.2013 19.8308 17.8900 * 21.0608 18.5417 * 17.3161 21.9070 15.7686 23.0324 15.6723 14.9767 22.8322 20.5025 * 26.1338 29.4383 23.7340 18.1008 23.1240 24.4920 21.2426 27.4495 * 20.0360 * * * * 27.8554 26.3348 * 28.0682 26.0475 31.5207 25.4494 30.4198 27.5291 * 27.7255 31.7440 27.8952 25.8320 29.3001 27.8683 23.7073 30.2628 26.5217 23.8758 26.2070 29.7995 26.4784 27.1884 30.5903 30.1544 * 22.3267 20.5075 14.7712 17.8018 23.8978 26.5867 * 25.3565 21.7880 25.4733 17.1361 18.3113 18.5225 * 22.3537 19.8349 * 18.5578 23.1681 15.8002 25.0509 14.7193 14.6070 23.5794 21.8147 * 31.4930 22.6824 26.0451 17.6317 23.3550 25.1181 23.5190 26.0912 * 21.2682 26.5344 21.0758 29.3777 32.3589 29.7467 27.1861 * 30.2211 * 33.9969 25.8356 31.7042 30.2957 * 29.9648 32.2447 28.0701 28.3563 29.3295 29.2642 26.5439 33.2105 * 25.5161 26.9966 30.8767 * 30.5818 34.2303 32.3959 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 15.4277 21.5064 20.4227 14.0181 16.5505 22.8583 25.0105 13.8170 23.3322 20.8230 22.7986 17.4038 19.0435 17.5400 24.7859 20.7832 18.7951 17.4760 17.7592 22.1327 16.0704 23.4362 14.7923 14.1857 22.6918 20.0076 16.3879 27.6466 25.4359 23.4652 17.5059 21.7730 24.5965 21.5182 25.5795 26.3746 20.6946 26.5344 21.0758 29.3777 32.3589 26.1275 26.3148 24.6377 28.3075 25.3948 31.9322 25.3227 29.4616 27.8451 21.9382 28.7806 31.1318 27.8359 26.0268 28.9428 27.9316 24.4358 30.8181 25.2072 23.7359 25.9075 30.3883 26.3599 27.7342 31.3814 30.0601 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23527 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 380040 ............................................................................. 380047 ............................................................................. 380050 ............................................................................. 380051 ............................................................................. 380052 ............................................................................. 380056 ............................................................................. 380060 ............................................................................. 380061 ............................................................................. 380066 ............................................................................. 380070 ............................................................................. 380072 ............................................................................. 380075 ............................................................................. 380081 ............................................................................. 380082 ............................................................................. 380089 ............................................................................. 380090 ............................................................................. 380091 ............................................................................. 390001 ............................................................................. 390002 ............................................................................. 390003 h ........................................................................... 390004 ............................................................................. 390005 ............................................................................. 390006 ............................................................................. 390008 h ........................................................................... 390009 ............................................................................. 390010 ............................................................................. 390011 ............................................................................. 390012 ............................................................................. 390013 ............................................................................. 390016 h ........................................................................... 390017 h ........................................................................... 390018 ............................................................................. 390022 ............................................................................. 390023 ............................................................................. 390024 ............................................................................. 390025 ............................................................................. 390026 ............................................................................. 390027 ............................................................................. 390028 ............................................................................. 390029 ............................................................................. 390030 ............................................................................. 390031 ............................................................................. 390032 ............................................................................. 390035 ............................................................................. 390036 ............................................................................. 390037 ............................................................................. 390039 h ........................................................................... 390040 ............................................................................. 390041 ............................................................................. 390042 ............................................................................. 390043 ............................................................................. 390044 ............................................................................. 390045 ............................................................................. 390046 ............................................................................. 390048 ............................................................................. 390049 ............................................................................. 390050 ............................................................................. 390052 ............................................................................. 390054 ............................................................................. 390055 ............................................................................. 390056 ............................................................................. 390057 ............................................................................. 390058 ............................................................................. 390061 ............................................................................. 390062 ............................................................................. 390063 ............................................................................. 390065 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00223 1.1950 1.8037 1.3931 1.5718 1.1643 0.9458 1.4020 1.6536 1.2243 1.1747 0.8417 1.3046 1.1379 1.2215 1.2717 1.2689 1.2950 1.6397 1.2571 1.1657 1.5540 0.9829 1.8357 1.1582 1.7277 1.2001 1.3112 1.2176 1.2121 1.1998 *** *** 1.3090 1.2577 1.0501 0.5266 1.2353 1.5482 1.5912 *** 1.1837 1.2104 1.1735 1.2222 1.4446 1.3365 1.1565 *** 1.3009 1.3204 1.1602 1.6591 1.5712 1.5379 1.0828 1.5860 2.0343 1.1848 1.1909 *** 1.0653 1.3195 1.2715 1.5355 1.1167 1.7404 1.2046 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 1.0284 1.0492 1.0284 1.0445 1.0284 1.0445 1.1229 1.1229 1.0284 1.1229 1.0284 1.0284 1.0284 1.1229 1.1229 1.0284 1.1229 0.8530 0.8840 0.8530 0.9317 0.8746 0.9145 0.8840 0.8746 0.8840 0.8348 1.1030 0.9145 0.8446 0.8840 * 1.1030 1.1030 1.1030 1.1030 1.1030 1.1030 0.8840 * 0.9844 0.9500 0.8840 1.1030 0.8840 0.8840 0.8348 * 0.8840 0.8840 0.8300 0.9698 0.8368 0.9422 0.9145 0.9844 0.8840 0.8942 0.8530 0.8840 0.8300 1.1030 0.9317 0.9716 0.8942 0.8746 1.0813 21.5958 26.5017 23.1332 26.2384 21.2567 22.3571 27.8551 27.3827 23.3581 34.1039 21.9516 25.1930 22.1822 28.0668 29.6989 31.8702 31.2807 21.5154 22.0646 19.1857 21.3475 19.0727 23.0378 19.9417 21.9459 19.4377 18.6548 28.5114 22.1679 18.1536 19.1962 19.9117 27.5504 25.3767 25.9806 14.8690 24.0326 33.2139 24.6796 * 20.0598 20.3568 20.8450 23.2173 20.5751 20.1665 18.4580 20.5371 21.0074 22.2351 19.8641 22.4235 20.2082 23.1271 20.3523 24.0933 22.6951 22.1380 19.8602 23.5292 21.4239 24.8235 22.0113 24.4550 17.6303 21.7120 23.1384 28.4373 27.8385 24.2416 28.1305 22.6799 25.0068 30.2507 29.5145 27.5412 * 22.5275 27.4795 21.0708 30.2721 30.8396 33.6822 35.7002 22.4407 23.0113 21.3182 23.4063 19.0318 23.3960 21.0021 24.2789 21.6273 19.8602 * 23.3180 19.9899 20.6575 * 31.0971 27.1600 37.4330 15.0282 27.0802 28.9159 23.6616 24.4276 20.9859 21.2949 20.9971 24.7281 23.3858 22.9008 17.8461 23.1807 20.6789 23.9632 20.9835 24.2586 22.2582 25.0825 23.6622 25.4056 24.5424 21.6736 21.4983 25.5675 * 25.1901 25.3415 25.5012 19.0692 23.5469 23.4021 32.0103 29.8627 25.6190 29.7219 24.9476 25.1475 29.5370 29.8217 * * * 29.0368 21.8850 32.4909 33.4214 34.4536 33.8950 22.5309 22.4388 21.6478 24.3249 * 25.1216 22.2680 25.5482 23.5390 21.9279 28.5076 24.0044 21.9549 * * 29.0710 31.7149 35.3959 17.2977 29.5157 35.6568 25.7246 * 22.1581 22.6828 22.7205 26.2647 24.6032 24.7820 20.3787 * 21.5925 25.6328 22.2549 27.1505 23.0877 27.6367 24.7738 27.1366 26.6931 23.6105 22.8087 25.6945 19.5537 27.9583 27.4799 28.4538 21.4052 24.7614 25.9184 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 27.1504 28.1638 24.3627 28.0410 22.9567 24.2275 29.2476 28.9273 25.5211 34.1039 22.2419 27.3082 21.7195 30.3569 31.3234 33.3615 33.5968 22.1581 22.5092 20.7084 23.1020 19.0497 23.8687 21.0752 23.9471 21.5537 20.1129 28.5093 23.1713 20.1569 19.8788 19.9117 29.1659 28.1614 29.4333 15.7085 26.9256 32.4911 24.7268 24.4276 21.0867 21.4388 21.5225 24.7742 22.8336 22.6385 18.9083 21.7860 21.0799 23.9486 21.0509 24.6634 21.8830 25.3031 22.8564 25.5929 24.6339 22.4994 21.3801 24.9860 20.4834 26.0368 24.8349 26.1704 19.4592 23.4097 24.2223 23528 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 390066 ............................................................................. 390067 ............................................................................. 390068 ............................................................................. 390070 ............................................................................. 390071 ............................................................................. 390072 h ........................................................................... 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 h ........................................................................... 390113 ............................................................................. 390114 ............................................................................. 390115 ............................................................................. 390116 ............................................................................. 390117 ............................................................................. 390118 ............................................................................. 390119 ............................................................................. 390121 ............................................................................. 390122 ............................................................................. 390123 ............................................................................. 390125 ............................................................................. 390127 ............................................................................. 390128 ............................................................................. 390130 ............................................................................. 390131 ............................................................................. 390132 ............................................................................. 390133 ............................................................................. 390135 ............................................................................. 390136 ............................................................................. 390137 ............................................................................. 390138 ............................................................................. 390139 ............................................................................. 390142 ............................................................................. 390145 ............................................................................. 390146 ............................................................................. 390147 ............................................................................. 390150 ............................................................................. 390151 ............................................................................. 390152 ............................................................................. 390153 ............................................................................. 390154 ............................................................................. 390156 ............................................................................. 390157 ............................................................................. 390160 ............................................................................. 390162 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00224 1.2713 1.8233 1.3022 1.3629 0.9895 1.0397 1.5559 1.1407 *** 1.3409 1.8970 1.2828 1.2236 1.2243 1.5445 1.7972 1.1421 1.1685 1.1908 1.4974 1.1901 1.6968 1.2400 1.3469 1.0080 1.0501 1.3679 1.2171 1.1229 1.5720 2.0139 1.1736 1.2850 1.3024 1.4409 1.2529 1.0952 1.1665 1.2920 1.6614 1.0973 1.1985 1.2705 1.3061 1.1865 1.2623 1.2940 1.3983 1.6988 *** 1.0748 1.4810 1.1787 1.3178 1.4621 1.4545 1.2491 1.2294 1.1557 1.2703 0.9999 1.3749 1.2331 1.3484 1.2887 1.1601 1.4642 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.9145 0.9317 0.9716 1.1030 0.8300 0.8530 0.8942 0.8840 * 1.1030 0.8471 1.1030 1.0652 0.8300 0.8300 0.8840 0.8446 0.8446 0.8530 0.9698 1.1030 0.9716 0.9422 0.8840 0.8840 0.8300 0.8840 1.1030 0.8530 0.8840 1.1030 0.8348 0.8446 0.8840 1.1030 1.1030 0.8300 0.8300 0.8530 0.8942 0.8300 1.1030 0.8300 1.1030 0.8840 0.8348 0.8840 1.1030 1.1030 1.1030 0.8840 0.8530 1.0813 1.1030 1.1030 0.8840 0.8300 0.8840 0.8840 1.0813 0.8942 1.1030 0.8300 1.0652 0.8840 0.8840 0.9844 21.7717 23.5136 21.1177 24.4403 17.8117 20.0561 22.7073 21.8456 19.9775 21.2039 19.9169 23.3742 28.1056 18.3551 19.6488 22.4688 19.7361 19.9209 18.3939 22.9502 24.5304 23.4155 20.1271 20.9807 21.0637 16.5081 21.5852 23.7842 17.2667 22.3968 30.5814 15.6710 20.1160 23.6162 24.1951 24.9581 19.0983 17.8460 20.3034 20.8017 18.5130 23.2232 18.2411 25.0836 21.3668 19.4835 19.5296 24.6889 25.2110 24.0445 21.9531 19.5457 21.4705 26.3622 29.8874 20.6580 21.4580 22.3135 20.0261 24.7843 21.5474 25.3391 19.1300 25.0801 20.6933 19.3598 24.0291 23.0891 25.4576 25.9890 26.9235 20.9443 22.0155 24.8013 21.0941 22.6530 18.1276 21.4323 25.0921 28.7974 20.7799 20.7383 20.7474 20.8243 21.0427 21.0754 24.4145 25.3012 26.7267 20.1694 21.6629 18.6703 19.1803 23.1023 24.7486 18.7558 23.3355 30.6809 16.6113 21.7729 22.6630 26.4751 28.5563 20.0040 19.3332 21.2761 22.0556 21.6981 25.2209 19.4406 28.9238 21.8837 21.0694 21.2164 26.8153 26.1458 * 24.8042 21.8830 22.7210 28.2089 32.0827 22.4255 22.3260 23.6380 24.5256 25.1422 11.7774 27.5167 20.4408 27.8096 22.0222 19.5942 * 24.2087 26.3287 25.8291 30.9499 20.6652 24.9388 26.3698 22.8545 24.6359 27.9004 23.3053 27.2616 30.3840 19.8605 22.5317 25.2014 21.5586 21.4401 23.6240 27.0763 25.6660 27.7208 21.2641 24.8898 20.6775 19.6428 24.1386 27.2661 19.9156 23.9808 32.6510 19.2126 22.2591 24.0473 27.7333 29.7436 20.3946 21.5001 22.2746 23.1408 22.5785 28.6269 20.9456 30.9374 23.0255 24.0685 22.5177 27.7250 28.7162 24.4738 22.1415 23.4877 24.2769 30.4246 32.3517 23.8041 25.2460 25.0971 24.1855 27.1539 * 30.0586 20.6982 31.2571 22.7493 21.4877 30.0900 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 23.0471 25.0668 24.3019 27.4435 19.7095 22.3043 24.6228 21.9412 22.3701 21.9007 21.5091 25.2851 29.1503 19.6630 20.9944 22.8601 20.7010 20.8186 20.9725 24.8874 25.2008 26.0717 20.5324 22.6239 20.1561 18.4897 23.0080 25.2833 18.6551 23.2737 31.3439 17.1537 21.3940 23.4341 26.1536 27.8303 19.8418 19.5328 21.3271 22.0024 20.8388 25.7365 19.5654 28.4999 22.1158 21.4556 21.1193 26.4427 26.7622 24.2670 22.9715 21.5609 22.8713 28.3708 31.4330 22.3138 23.0540 23.6939 22.9524 25.7127 15.1275 27.7812 20.0794 28.0054 21.8431 20.1709 26.8901 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23529 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 390163 390164 390166 390168 390169 390173 390174 390176 390178 390179 390180 390181 390183 390184 390185 390189 390191 390192 390193 390194 390195 390197 390198 390199 390200 390201 390203 390204 390211 390215 390217 390219 390220 390222 390223 390224 390225 390226 390228 390231 390233 390235 390237 390238 390246 390249 390258 390262 390265 390266 390267 390268 390270 390278 390279 390285 390286 390287 390288 390289 390290 390291 390294 390296 390298 390299 390300 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00225 1.2667 2.0562 1.1534 1.4369 1.4033 1.1624 1.7303 1.1510 1.2958 1.3648 1.4462 1.0361 1.0850 1.0849 1.2694 1.1071 1.0835 1.0157 *** 1.1011 1.6321 1.3925 1.1641 1.2174 *** 1.2961 1.6357 1.2498 1.2717 *** 1.1533 1.2908 1.0977 1.2483 1.9554 0.8462 1.1871 1.7312 1.3206 1.4382 1.3700 *** 1.5540 *** 1.1671 0.8767 1.5307 *** 1.4456 1.1763 1.1835 1.3066 1.4615 0.5214 1.1519 1.5472 1.1613 1.4298 *** 1.0920 1.9082 *** *** *** *** *** *** Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.8840 0.8840 0.8840 0.8840 0.8530 0.8300 1.1030 0.8840 0.8609 1.1030 1.0652 0.8300 0.8300 0.8840 0.8530 0.8300 0.8300 0.8530 0.8746 0.9844 1.1030 0.9844 0.8746 0.8300 0.9716 0.8300 1.1030 1.1030 0.8609 * 0.8840 0.8840 1.1030 1.0652 1.1030 0.8471 0.9716 1.1030 0.8840 1.1030 0.9422 * 0.8530 * 0.8300 0.8471 1.1030 * 0.8840 0.8609 0.8840 0.8368 0.8530 1.1030 0.8368 1.1030 1.1030 1.1030 1.1030 1.1030 1.1030 0.8840 * * * * * 18.8585 24.2334 19.8531 20.6777 22.7695 20.6958 28.4490 18.0752 17.2384 24.0501 28.4842 * 21.6811 21.1962 20.4476 20.1365 18.5972 19.1883 18.9764 21.5850 26.2024 22.8349 17.3937 18.9787 19.4471 22.7849 26.9436 23.9673 21.0450 25.2617 21.4058 20.0594 23.4385 24.9345 22.8725 16.1289 20.9232 25.6917 21.0164 24.7757 21.8043 23.7068 23.2054 19.2171 22.0687 14.7215 25.0634 21.3264 20.5948 18.2424 21.4801 23.1124 22.5258 21.1387 16.0510 30.6300 25.4499 32.9709 28.0957 25.1658 31.0967 21.0057 33.3537 25.6981 * * * 19.8863 25.1277 20.9510 21.9344 24.1682 21.6562 30.3725 17.1387 19.2731 24.8350 30.4264 25.7357 22.0117 21.3407 21.8871 21.2711 19.2308 20.0395 18.5516 23.1814 28.3480 24.9234 16.8529 19.9653 23.1486 24.8222 28.2741 25.6342 22.4472 26.4180 21.3281 22.8559 24.7553 27.0954 28.2538 18.1226 23.4945 27.0061 22.5999 27.0576 22.8667 * 24.6316 26.4748 23.3275 * 27.2038 * 21.6751 19.2836 22.5464 24.2050 24.0837 21.6893 15.3569 33.5347 27.4090 35.7147 28.5267 28.4577 36.4991 21.3015 * * 26.8290 31.9423 40.4697 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 21.2620 20.1024 25.4235 31.0019 25.7739 18.7222 21.3157 23.7471 26.3658 28.9054 28.6829 23.1450 28.0402 24.3610 25.1705 41.6138 28.7488 27.6407 18.7624 24.9391 28.5890 23.3078 29.2653 24.8690 * 26.9533 * 20.1581 * 29.4626 * 23.4836 20.3918 23.1051 25.0021 24.1496 23.6843 17.0012 35.0427 28.1761 37.6569 29.7287 28.8826 37.9040 * * * * * * Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 20.2736 25.3882 21.8402 22.5085 24.7030 21.7639 30.5109 17.5532 19.1018 25.3975 30.5043 25.1039 23.0449 21.7060 21.7597 21.3477 19.5306 20.1833 19.2196 23.4479 28.5392 24.4854 17.6295 20.1079 21.9484 24.6735 28.0870 26.1129 22.2313 26.4046 22.3261 22.7113 28.9098 26.9594 26.2383 17.7120 23.3545 27.1866 22.3536 27.1070 23.1907 23.7068 24.9348 22.5836 21.8667 14.7215 27.3466 21.3264 21.9520 19.3171 22.3821 24.1351 23.6565 22.1694 16.1304 33.0866 27.0003 35.5140 28.6956 27.4320 35.0787 21.1542 33.3537 25.6981 26.8290 31.9423 40.4697 23530 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 390301 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 400048 400061 400079 400087 400094 400098 400102 400103 400104 400105 400106 400109 400110 400111 400112 400113 400114 400115 400117 400118 400120 400121 400122 400123 400124 400125 400126 410001 410004 410005 410006 410007 410008 410009 410010 410011 410012 410013 420002 420004 420005 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00226 *** 1.2643 1.7313 1.3456 1.1394 1.1205 1.1887 1.1804 1.0804 0.8250 1.0865 1.3545 1.2691 1.3193 1.3649 1.3515 1.1959 1.1949 1.3212 1.3102 1.3444 0.8372 1.0673 1.2057 1.1946 1.2777 1.0975 1.7250 1.1310 1.1988 *** 1.5719 1.1198 1.7425 1.1364 1.1274 1.1815 1.4714 1.0965 1.0774 1.1915 1.2040 1.0880 1.1179 1.1002 1.2310 1.2997 1.0671 1.9548 1.1994 2.8727 1.1319 1.2093 1.3081 1.2319 1.2822 1.2503 1.7094 1.2098 1.2932 1.1636 1.2966 1.7532 1.2276 1.5184 1.9550 1.0179 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.8530 0.4686 0.5178 0.5178 0.4686 0.4686 0.4686 0.4686 0.3186 0.4736 0.4686 0.4686 0.4686 0.4016 0.4686 0.4686 0.4686 0.4686 0.4686 0.4646 0.5178 0.4016 0.3186 0.5178 0.4686 0.5178 0.4686 0.4686 0.4736 0.4686 * 0.4686 0.4686 0.4016 0.4686 0.4686 0.4686 0.4686 0.4413 0.4736 0.4686 0.5178 0.4686 0.4686 0.4686 0.4686 0.4686 0.4686 0.4686 0.4016 0.4686 0.4160 0.4646 1.1233 1.1233 1.1233 1.1233 1.1233 1.1233 1.1233 1.0952 1.1233 1.1233 1.1233 0.9717 0.9433 0.8663 * 11.7572 11.6804 10.5963 11.4041 10.5356 9.2852 8.6022 9.4413 9.2799 8.9111 9.0740 9.9905 11.4580 * 14.6491 10.7475 10.8254 13.7007 13.5224 15.2904 9.8650 5.9206 9.5266 10.7100 9.0275 10.8618 16.5895 8.7218 10.7118 9.2871 13.8036 10.9973 11.5797 7.1781 11.5608 10.1241 12.8921 12.0159 12.7701 12.2859 10.4416 9.7444 7.0411 9.7314 12.4590 11.8837 8.3575 9.6644 10.5643 14.3496 10.6642 * 24.0033 23.6409 24.6522 26.1372 27.7171 25.4183 26.9135 30.3860 29.7664 28.1791 28.9386 25.1067 23.4579 19.5521 * 16.1114 14.8607 13.0776 10.4716 10.2878 8.9919 8.7152 9.2007 10.9354 8.5868 8.3580 9.5584 11.7023 15.6066 15.3497 10.1238 10.7948 14.9892 13.8643 16.0539 9.1316 5.2085 10.3354 10.7195 10.7890 14.0887 15.1639 9.4218 9.5860 8.8646 13.7938 10.1795 12.8288 8.2758 12.7725 9.6902 14.2169 11.8458 13.4777 8.9469 10.0830 12.1920 9.1132 10.2911 11.9324 11.9714 8.6665 9.6463 11.8135 17.2258 10.7425 13.3932 27.0309 25.4578 27.1171 27.1842 30.1360 28.4245 27.7337 30.7826 28.5875 32.1679 31.7482 27.9312 26.0279 19.8167 30.9838 13.1847 16.7583 13.6751 14.3108 10.7207 9.2265 9.2463 9.3116 10.0962 8.5534 8.3802 10.3347 12.5363 17.4086 14.7607 10.2734 11.6165 13.7754 14.1533 16.8806 12.4649 5.8200 10.9808 10.2652 13.7509 10.4266 20.3206 12.7825 10.6849 * 12.8230 10.2677 9.3859 8.3900 14.5339 11.4507 14.2111 12.3449 14.5029 19.3945 11.0072 11.5478 13.7392 12.7600 12.5743 12.7955 8.2197 8.3069 11.9825 16.1812 11.6386 9.8008 28.0816 27.4209 30.1606 29.4395 31.8548 29.6092 29.4094 32.8599 29.9001 32.6009 35.4624 28.2848 28.4845 23.1943 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 30.9838 13.4859 14.1458 12.3819 11.8780 10.5186 9.1710 8.8511 9.3159 10.0495 8.6726 8.5938 9.9727 11.8896 16.6535 14.9193 10.3916 11.0939 14.1263 13.8469 16.0784 10.2156 5.6501 10.2872 10.5650 11.4819 11.8488 17.3616 10.1505 10.3421 9.1244 13.4850 10.4779 10.9876 7.8760 12.8828 10.3951 13.7444 12.0750 13.5496 12.3541 10.4939 11.0784 9.2213 10.8102 12.3218 12.2196 8.4118 9.4955 11.4619 15.8787 11.0069 11.0632 26.3767 25.5908 27.3044 27.6190 30.0135 27.8277 28.0697 31.3979 29.4052 31.1120 32.1157 27.1910 26.0443 20.8182 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23531 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 420006 ............................................................................. 420007 ............................................................................. 420009 ............................................................................. 420010 ............................................................................. 420011 ............................................................................. 420014 ............................................................................. 420015 ............................................................................. 420016 ............................................................................. 420018 ............................................................................. 420019 ............................................................................. 420020 ............................................................................. 420023 ............................................................................. 420026 ............................................................................. 420027 ............................................................................. 420030 ............................................................................. 420033 ............................................................................. 420036 ............................................................................. 420037 ............................................................................. 420038 ............................................................................. 420039 ............................................................................. 420043 h ........................................................................... 420048 ............................................................................. 420049 ............................................................................. 420051 ............................................................................. 420053 ............................................................................. 420054 ............................................................................. 420055 ............................................................................. 420056 ............................................................................. 420057 ............................................................................. 420059 ............................................................................. 420061 ............................................................................. 420062 ............................................................................. 420064 ............................................................................. 420065 ............................................................................. 420066 ............................................................................. 420067 ............................................................................. 420068 ............................................................................. 420069 ............................................................................. 420070 ............................................................................. 420071 ............................................................................. 420072 ............................................................................. 420073 ............................................................................. 420074 ............................................................................. 420078 ............................................................................. 420079 ............................................................................. 420080 ............................................................................. 420082 ............................................................................. 420083 ............................................................................. 420085 ............................................................................. 420086 ............................................................................. 420087 ............................................................................. 420088 ............................................................................. 420089 ............................................................................. 420091 ............................................................................. 420093 ............................................................................. 420097 ............................................................................. 430005 ............................................................................. 430008 2 ........................................................................... 430011 ............................................................................. 430012 ............................................................................. 430013 2 ........................................................................... 430014 ............................................................................. 430015 ............................................................................. 430016 ............................................................................. 430018 ............................................................................. 430024 ............................................................................. 430029 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00227 1.0874 1.5636 1.3786 1.1844 1.1190 0.9635 1.2398 0.9619 1.7534 1.1129 1.2595 1.6530 1.8566 1.5759 1.2331 1.1361 1.2525 1.2494 1.2524 1.0376 1.0680 1.2700 1.2080 1.4889 1.1415 1.0212 1.0684 1.4085 1.0376 1.0455 1.1273 1.0823 1.1956 1.3471 0.9655 1.2942 1.3390 1.0589 1.2778 1.3635 1.0926 1.3459 *** 1.8001 1.5104 1.3725 1.4774 1.3224 1.6210 1.3930 1.7766 *** 1.3873 1.3034 0.9851 *** 1.2209 1.1152 1.2481 1.2707 1.1784 1.2515 1.1338 1.5813 *** *** 0.8995 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.9433 0.9183 0.9807 0.8988 1.0138 0.9057 1.0138 0.8663 0.9057 0.8663 0.9317 1.0138 0.9057 0.8887 0.9317 1.0138 0.9585 1.0138 1.0138 0.9183 0.9183 0.9057 0.8869 0.8988 0.8663 0.8663 0.8663 0.8663 0.8988 0.8663 0.8663 0.8663 0.8869 0.9433 0.8988 0.9316 0.9317 0.8663 0.9057 0.9807 0.8663 0.9057 * 1.0138 0.9433 0.9316 0.9567 0.9183 0.9394 0.9057 0.9433 * 0.9433 0.8988 0.9183 * 0.8475 0.8475 0.8475 0.9616 0.8475 0.8778 0.8475 0.9616 0.8475 0.8475 0.8475 22.7896 22.0228 18.6866 19.1746 17.7300 21.2045 23.1274 17.0051 20.4649 19.6836 22.1616 23.2568 23.7406 21.0637 22.6766 26.2711 20.6649 25.5492 21.6133 21.9737 21.8816 21.9517 21.2604 20.6629 19.9013 20.8471 19.6817 20.0527 17.6727 20.2917 19.9789 17.4764 20.9057 22.0784 20.7782 22.8104 21.7257 17.6291 20.3664 21.8579 16.2578 21.4718 18.7010 24.3273 23.3992 26.7489 23.6936 24.8508 24.4040 24.5760 22.4526 23.5174 23.3240 23.7936 21.4678 * 18.2647 20.0124 19.9835 21.2588 21.3389 22.0285 20.5849 24.2450 17.9850 18.8357 18.9464 22.8920 25.0395 23.8668 21.6478 20.8895 21.5658 24.7383 17.3837 23.6356 20.5472 24.6592 25.1035 29.2961 22.8322 24.2847 27.5740 21.9641 26.8750 22.6741 24.0637 22.9764 23.1515 23.2156 23.9455 21.1177 24.0653 20.3599 21.1640 19.7653 21.4260 20.8684 25.6683 22.1290 22.8674 20.5893 24.6038 22.2638 19.6959 22.4370 23.1727 17.5899 24.0274 * 25.3032 25.2939 28.4569 26.1221 25.3043 25.3180 25.1372 23.2230 23.1273 25.2729 23.4710 25.1457 24.7809 19.9454 20.9442 20.6597 22.7530 22.9675 25.5387 23.2035 26.1495 * * 20.2708 24.0811 25.2650 25.5079 23.4562 21.4030 * 26.1298 17.1229 24.7324 22.5312 25.7225 26.7263 27.4814 24.8624 26.0079 31.8759 22.8294 29.4156 24.2259 25.1148 23.0555 24.1910 23.4769 24.8026 22.2825 24.8931 21.9764 21.6963 23.4311 * * 25.8389 23.3610 24.5715 23.9048 25.0345 23.4248 20.5546 23.4355 24.9418 18.6742 24.5813 * 29.4985 25.5354 28.4734 29.8528 27.1322 26.8692 25.7580 24.3609 * 26.0074 27.0189 27.4766 * 21.8605 22.9340 * 24.0850 23.8572 26.4964 22.7947 27.8453 * * * Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 23.2220 24.2318 22.5621 21.5057 20.0081 21.3876 24.6961 17.1752 22.8696 20.8812 24.3050 25.0152 26.8241 22.9488 24.3704 28.5975 21.8110 27.3838 22.8531 23.7048 22.6545 23.1357 22.6938 23.1828 21.1778 23.2676 20.6871 20.9682 20.1207 20.8684 20.4341 22.4958 22.2043 23.1699 21.7523 24.2301 22.4620 19.3217 22.1331 23.3888 17.5511 23.3018 18.7010 26.4127 24.7810 27.9158 26.5169 25.7973 25.5532 25.1689 23.3441 23.4240 24.9015 24.8440 24.8258 24.7809 19.9621 21.2902 20.3142 22.7129 22.7428 24.6896 22.1979 26.0153 17.9850 18.8357 19.6526 23532 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 430031 2 ........................................................................... 430033 ............................................................................. 430047 ............................................................................. 430048 ............................................................................. 430054 ............................................................................. 430064 ............................................................................. 430077 ............................................................................. 430089 ............................................................................. 430090 ............................................................................. 430091 ............................................................................. 430092 ............................................................................. 430093 ............................................................................. 430094 ............................................................................. 430095 ............................................................................. 430096 ............................................................................. 440001 ............................................................................. 440002 ............................................................................. 440003 ............................................................................. 440006 ............................................................................. 440007 ............................................................................. 440008 ............................................................................. 440009 ............................................................................. 440010 ............................................................................. 440011 ............................................................................. 440012 ............................................................................. 440015 ............................................................................. 440016 ............................................................................. 440017 ............................................................................. 440018 ............................................................................. 440019 ............................................................................. 440020 ............................................................................. 440023 ............................................................................. 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 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00228 0.9339 *** 0.9833 1.2364 0.9420 1.0393 1.6950 1.6248 1.4120 2.1791 1.7787 0.9141 1.8543 2.3163 1.9499 1.1144 1.6911 1.2046 1.4022 0.9406 0.9974 1.1859 0.9389 1.3028 1.4390 1.8237 0.9690 1.7649 1.1326 1.7880 1.0554 0.9515 1.2316 1.1856 *** 1.3373 1.2498 1.0626 1.0136 1.0486 1.5293 1.3430 1.9897 0.9253 0.9316 1.1385 0.8547 1.8251 1.5582 1.2790 0.9362 0.9561 1.2082 1.1252 1.1345 1.0371 1.1730 1.5012 1.0098 1.0870 1.5962 0.9863 1.2170 1.1694 1.1443 0.9466 1.1880 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.8475 0.8475 0.8475 0.8475 0.9616 0.8475 0.9027 0.9360 0.9616 0.9027 0.8475 0.9027 0.9207 0.9616 0.8475 0.7958 0.8964 0.9757 0.9757 0.7915 0.8508 0.7915 0.7915 0.8470 0.8095 0.8470 0.7915 0.8095 0.7958 0.8470 0.9124 0.7915 0.8160 0.7915 * 0.9757 0.8758 0.7915 0.8095 0.7915 0.8470 0.9492 0.9757 0.7915 0.8160 0.9757 0.7915 0.9346 0.9346 0.9312 0.7915 0.7915 0.9757 0.7915 0.8758 0.7915 0.9099 0.9492 0.8799 0.7915 0.7958 0.9099 0.9757 0.8470 0.9099 0.7915 0.9108 15.2321 21.6254 18.2774 20.0607 17.8871 14.3407 21.6786 19.8572 25.6873 22.2824 19.7354 23.8820 20.8743 * * 18.9833 22.0178 21.6336 24.3173 14.8015 20.9237 19.6564 16.7270 20.5036 21.1213 23.4485 20.1504 21.8033 21.2242 21.8854 21.1075 15.5410 19.9751 19.1478 25.1655 24.1379 19.9056 17.0289 14.7683 17.2637 22.2478 21.4990 25.0874 16.9886 15.5784 22.3380 18.7962 23.1553 21.1930 21.1397 19.0165 18.1935 22.0345 15.4208 19.3108 14.1477 21.7512 22.4248 20.2189 19.5458 19.7468 19.4020 19.9099 19.5643 20.9188 18.3717 19.6579 15.6112 * 21.9116 21.1718 * 16.4314 23.4835 21.1109 26.0851 23.8897 20.2570 23.1526 18.5429 24.7074 * 17.4802 23.2177 24.5168 26.7983 13.7042 22.1405 21.1274 16.9060 21.6861 21.4769 22.5583 20.0982 22.5313 21.7239 23.8802 23.1718 17.0335 20.3658 19.5995 26.9149 25.8538 20.0586 18.0944 16.0734 18.7749 23.1121 22.3230 26.4647 17.7647 17.4074 25.5329 20.4812 24.3283 22.9755 21.8972 20.7948 20.1875 23.9083 20.5992 20.4088 14.6242 22.6014 23.9301 22.7133 21.2085 21.8578 20.9742 21.4794 22.1410 23.1705 19.0240 20.9294 15.9156 * 18.8982 23.0783 * 17.5376 25.1763 22.5625 25.7499 25.0828 23.8858 29.5244 19.0014 28.1749 21.7103 19.3100 24.6664 25.9209 28.5951 25.8236 23.4301 21.5970 17.1803 22.5068 22.3029 23.7422 22.1646 22.9364 23.3444 25.2553 23.9475 18.2884 23.2478 20.6798 26.8986 28.0779 26.1060 19.6685 18.5277 20.7917 23.5403 24.3752 28.1729 17.8510 17.9409 26.1341 21.4280 27.7560 25.3043 23.1362 21.9108 21.1133 25.4345 21.4400 22.1068 16.4451 22.9263 26.3531 23.3014 21.8274 22.3256 22.0955 22.3247 23.1089 24.5971 19.4372 27.1443 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 15.5961 21.6254 19.7432 21.5127 17.8871 16.1075 23.4802 21.3078 25.8502 23.8977 21.3414 25.7876 19.4190 26.5823 21.7103 18.5533 23.3294 24.0777 26.6300 17.2437 22.0908 20.8327 16.9489 21.6145 21.6368 23.2495 20.8341 22.4333 22.1229 23.6676 22.7656 16.9816 21.1469 19.8282 26.2876 26.0679 22.0081 18.2797 16.4708 19.0076 22.9348 22.7486 26.6593 17.5455 17.0933 24.7333 20.2387 24.7999 23.1991 22.0679 20.5095 19.9032 23.8916 18.6411 20.7270 15.0915 22.4470 24.2538 22.1119 20.8215 21.2848 20.8374 21.2895 21.6500 22.9451 18.9540 22.1374 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23533 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 440073 ............................................................................. 440081 h ........................................................................... 440082 ............................................................................. 440083 ............................................................................. 440084 ............................................................................. 440091 ............................................................................. 440102 ............................................................................. 440104 ............................................................................. 440105 ............................................................................. 440109 ............................................................................. 440110 ............................................................................. 440111 ............................................................................. 440114 ............................................................................. 440115 ............................................................................. 440120 ............................................................................. 440125 ............................................................................. 440130 ............................................................................. 440131 ............................................................................. 440132 ............................................................................. 440133 ............................................................................. 440135 ............................................................................. 440137 ............................................................................. 440141 ............................................................................. 440142 ............................................................................. 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 ............................................................................. 440220 ............................................................................. 450002 ............................................................................. 450005 ............................................................................. 450007 ............................................................................. 450008 ............................................................................. 450010 ............................................................................. 450011 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00229 1.3595 1.1378 2.1607 0.9067 1.1637 1.6254 1.1346 1.7607 1.0199 0.9843 1.1772 1.2422 0.9851 0.9888 1.5755 1.5716 1.1649 1.1987 1.2681 1.5674 1.0782 1.0485 0.9487 0.8702 1.1976 0.9916 *** 1.1199 1.0185 1.3517 1.0856 1.8738 1.0018 1.4931 1.4244 1.8202 *** 1.5235 0.9905 1.6407 0.8745 1.0488 1.2854 1.2061 0.9106 0.9022 1.5283 0.9990 1.1611 1.0310 1.0821 1.3728 1.0167 1.2566 1.3630 1.2605 0.9405 0.9753 1.3463 0.8931 *** 1.4427 1.0651 1.2962 1.3133 1.5052 1.6756 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.9492 0.8470 0.9757 0.7915 0.7915 0.9099 0.7915 0.9099 0.7958 0.7915 0.8470 0.9757 0.7915 0.7915 0.8470 0.8470 0.7915 0.9346 0.7915 0.9757 0.9757 0.7915 0.7915 0.9757 0.7915 0.7915 * 0.9492 0.7915 0.9757 0.9492 0.9346 0.7915 0.9099 0.9346 0.9757 * 0.9346 0.9346 0.8470 0.7915 0.9492 0.8095 0.8470 0.7915 0.7915 0.9346 0.7958 0.9099 0.9757 0.7915 0.8964 0.9492 0.9757 0.9757 0.9757 0.9757 0.7915 0.9346 0.9757 * 0.8954 0.8422 0.8987 0.8566 0.8327 0.8911 20.7181 18.3141 26.1497 15.7015 15.0510 23.0296 16.6548 21.9870 19.2902 17.3578 19.9715 24.9883 20.1152 18.5389 22.4031 21.1018 20.6363 21.0640 18.9580 23.3600 23.9749 16.5529 19.2607 17.7587 19.7938 18.2019 25.0780 20.7693 18.1316 22.8733 21.1576 22.7498 19.9486 23.7799 20.5719 26.1354 20.3909 23.1692 21.2113 20.8442 19.2201 22.3331 20.4861 21.2398 19.6133 19.3928 24.9282 21.4484 22.1845 23.0193 19.9478 23.2866 21.3228 22.0345 24.4508 24.2660 16.7752 * 23.3544 20.1377 21.9117 24.0411 21.7110 18.3738 20.1816 20.3023 22.1472 22.2959 19.0328 28.7828 16.0956 15.2825 26.1122 17.5140 23.3731 20.7821 18.2508 20.9039 25.8821 21.4271 20.0642 23.9003 21.9337 21.6480 22.4119 20.5716 27.5019 25.3928 18.2073 19.4528 * 22.3671 20.9863 28.9038 23.0697 19.8020 25.4952 23.3037 25.9495 22.7744 25.6333 21.1073 28.6774 16.5305 27.1355 22.1764 20.8723 20.7960 24.0005 22.0079 21.9781 21.1406 20.2630 27.7769 20.8219 23.4172 24.6773 21.7637 24.7851 25.1119 24.3911 26.2498 26.4999 17.0633 17.7639 25.9667 26.3741 * 25.4975 23.4049 19.2875 22.0934 22.4133 24.0715 23.9198 19.7918 27.9724 17.3329 16.3738 25.6797 17.5261 25.3739 22.3438 18.6720 21.3287 28.5705 24.0147 21.7830 25.7636 22.3888 23.4517 24.9598 21.5085 26.2422 26.6615 20.6663 21.3313 * 23.3828 20.7875 31.2003 24.6412 20.4562 26.8308 23.9808 26.5513 22.2846 26.9689 22.8645 28.6854 21.1418 22.6509 22.8768 22.8692 22.0974 22.7299 23.6659 23.3808 22.7150 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 * 25.7171 23.5576 20.7321 22.9669 23.7529 24.8831 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 22.3108 19.0786 27.6484 16.4160 15.6128 24.9494 17.2560 23.6244 20.8223 18.1156 20.7233 26.5016 21.9369 20.1587 24.0777 21.8259 21.9020 22.8950 20.3655 25.6963 25.3742 18.4329 20.0578 17.7587 21.8222 19.9424 28.2394 22.8692 19.4498 25.0868 22.8559 25.0265 21.7049 25.5243 21.5659 27.8923 19.2406 24.5576 22.0809 21.5604 20.6472 23.0174 22.0556 22.2150 21.1984 20.6845 26.6633 21.5303 23.2612 24.4615 21.0131 25.2579 24.1386 23.6341 25.8291 25.9812 17.1850 18.5423 26.1820 23.5719 21.9117 25.1126 22.9913 19.4904 21.7810 22.1525 23.7169 23534 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 450014 450015 450016 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 450078 450079 450080 450081 450083 450085 450087 450090 450092 450094 450096 450097 450098 450099 450101 450102 450104 450107 450108 450109 450113 450119 450121 450123 450124 450126 450128 450130 450131 450132 450133 450135 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00230 1.0286 1.5729 *** 1.3942 0.9466 1.8194 1.3878 1.3228 1.5658 1.5162 1.4488 1.1987 1.6186 1.5259 1.5166 1.5141 1.3588 1.7455 1.6976 1.6507 1.5525 0.8562 0.9271 1.7617 0.9686 0.9574 1.6531 1.1284 1.7820 1.5325 1.3149 1.4037 2.0137 1.1350 0.9362 0.9261 1.5320 1.1799 1.0360 1.7207 1.0173 1.3393 1.1561 1.1362 1.0935 1.3677 1.4253 0.9223 1.1731 1.5502 1.7209 1.1697 1.4575 1.1001 *** *** 1.2979 1.4458 1.1207 1.8251 1.3283 1.2202 1.1654 1.2121 1.5283 1.5415 1.6894 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.8148 1.0226 * 1.0008 0.9451 1.0226 0.8148 0.8954 0.9853 0.8101 1.0226 0.8767 0.9853 0.8422 1.0008 0.8741 0.9955 0.8790 0.8532 1.0226 0.8557 0.9853 0.8038 1.0226 0.8038 0.8038 0.8566 0.8038 0.9451 0.8987 0.9451 0.9955 1.0008 1.0008 0.8038 0.8038 1.0226 0.8621 0.8038 0.9322 0.8038 0.9955 0.8038 0.8038 1.0226 0.8422 1.0008 0.8621 0.9165 0.8532 0.9322 0.8987 0.8954 0.8987 0.8038 0.8038 0.8945 0.9955 0.8422 0.9451 1.0008 0.8945 0.8987 0.8557 0.9893 0.9522 0.9955 20.6936 23.9526 20.1232 22.9019 19.1087 25.0769 19.1645 20.7727 22.7775 19.9198 21.7621 20.5217 26.5990 21.6097 24.1860 23.1179 22.0058 21.2990 21.8886 24.1127 20.9239 21.8840 19.5171 24.5533 17.6543 18.6556 23.2915 18.2235 24.4197 22.0158 22.8792 19.1271 24.0925 20.3683 19.2398 14.8285 24.0085 21.0353 19.2632 22.5063 18.1922 24.5976 17.1073 16.0199 25.8313 19.8012 22.2467 20.4795 21.4482 20.1473 20.9900 19.7126 23.2209 18.8084 15.1459 37.8944 20.8840 24.6090 17.8629 24.2788 24.1961 * 19.6199 20.0434 22.4680 25.3928 22.5673 22.5001 24.0730 22.1368 24.6443 17.7148 28.5578 20.9278 20.5868 25.6030 23.9709 27.0328 20.8306 29.0541 23.4615 25.4580 23.1176 23.3034 23.8047 22.6936 25.8403 22.0695 22.7242 21.6933 27.2523 19.7185 19.4978 25.1229 20.5235 25.6685 24.7442 26.8209 24.2920 26.2864 22.5010 20.0464 17.2196 27.0443 21.2482 * 24.9182 19.4524 26.4203 17.6506 20.4921 25.3618 22.8722 24.9380 22.9005 24.0293 20.6575 23.1773 22.5165 23.8770 19.3561 * * 24.1392 25.8826 19.5872 26.0280 27.3021 21.4190 20.2777 23.2317 26.8476 25.0972 24.3858 * 27.4012 * 26.7999 18.3047 29.1350 22.0558 23.6211 26.8250 23.2995 27.9626 27.0748 28.5266 24.1589 26.2838 24.2684 24.7347 24.9590 24.1181 28.8098 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 22.9835 * 25.8214 22.0840 29.1587 19.4244 23.2071 25.2434 24.1619 26.4965 22.6626 26.6796 23.6905 24.5503 23.8469 25.9326 19.4935 * 54.6681 25.7008 25.7051 21.2154 27.4198 28.3033 23.3633 21.5226 23.7098 28.6954 26.8344 26.0755 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 21.5732 25.2046 21.1548 24.7633 18.3252 27.5806 20.7053 21.6539 25.1270 22.4069 25.5466 22.7202 28.0983 23.0888 25.3196 23.5229 23.3847 23.3165 22.9317 26.9711 22.1959 21.4269 21.3893 26.6907 19.2138 20.0823 24.2283 20.3131 25.7808 24.1658 25.4407 22.4752 26.1666 22.2336 20.3411 15.9697 26.3674 21.7735 19.2632 24.4447 19.8958 26.8455 18.0792 19.7031 25.4570 22.3082 24.6105 21.9800 24.1168 21.4670 22.9587 22.0194 24.3252 19.2181 15.1459 43.1390 23.6793 25.4063 19.5002 26.0262 26.6832 22.3457 20.5273 22.3750 25.9595 25.8308 24.4084 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23535 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 450137 450140 450143 450144 450146 450148 450151 450152 450154 450155 450157 450160 450162 450163 450165 450176 450177 450178 450184 450185 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 450249 450250 450264 450269 450270 450271 450272 450276 450280 450283 450289 450292 450293 450296 450299 450303 450315 450320 450327 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00231 1.6059 0.8835 1.0330 1.1455 *** 1.1489 1.1987 1.1854 1.2665 1.0266 1.0057 0.9248 1.3639 0.9730 1.1177 1.3178 1.2130 0.9642 1.5254 0.9793 1.1635 0.9262 1.1247 1.0805 2.0537 1.3506 1.4168 1.4482 0.9125 1.1655 1.8856 0.9537 1.3415 1.7482 1.1722 0.9721 1.1435 1.5561 1.4143 1.6333 1.6297 0.9831 0.9124 1.0405 1.6743 0.9310 0.9436 1.0022 0.9833 *** 0.9236 1.0146 1.0976 1.1532 1.2039 0.8990 1.5066 1.0602 1.3288 1.2940 0.8704 1.0400 1.5781 0.8372 *** *** *** Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.9955 0.8038 0.9451 0.9593 0.8038 0.9955 0.8038 0.8566 0.8038 0.8038 0.8038 0.8038 0.8790 0.8038 0.8987 0.8945 0.8038 0.8038 1.0008 0.8038 1.0008 0.8038 0.9451 0.9955 1.0008 0.9955 0.9955 0.8293 0.8038 0.9514 0.9165 0.8038 1.0008 0.8987 1.0008 0.8038 0.8038 1.0008 0.9164 0.8038 0.9165 0.8038 0.8038 0.8038 0.8987 0.8566 0.8038 0.8038 0.8038 0.8038 0.8038 0.8038 0.8038 0.9514 0.9451 0.8038 1.0226 0.9955 1.0008 1.0226 0.8038 1.0008 0.8911 0.8790 1.0226 * 0.8038 24.9732 18.3835 18.4204 21.3896 16.6808 22.1351 17.9127 20.0146 16.5204 18.4021 17.8764 20.7736 26.0570 19.8194 16.1632 19.1823 17.2637 19.1186 24.0596 14.3594 22.6275 17.6158 23.2261 20.1718 26.6580 22.7310 20.1938 20.4656 19.5907 22.9226 23.4794 16.7851 20.0280 21.1280 22.4543 21.0691 19.6778 23.5033 20.4453 17.9811 21.3086 22.3954 18.7028 17.7373 22.4477 19.3655 17.4151 13.0790 13.1222 13.3731 13.5345 12.6907 13.9053 18.3659 21.4520 12.8895 23.1664 17.1013 23.7108 23.4257 17.7673 20.4483 22.9849 16.1330 26.4677 26.8089 14.3848 27.0081 22.4695 19.7487 20.9599 * 23.5037 20.1356 21.6351 18.6058 17.9306 17.8812 21.9118 31.0645 20.3280 20.2414 20.9392 19.7657 20.2992 25.3935 15.5838 24.2400 18.9586 25.9078 22.5118 29.2751 22.3348 23.6170 22.0923 20.3350 23.3953 24.4977 19.6340 20.7982 21.7930 23.9112 20.8255 20.6887 26.2975 22.2250 19.8279 23.9532 23.6695 19.1453 19.2987 25.1504 21.8595 18.1155 14.0589 16.5616 * 15.4111 14.8204 15.0879 19.4299 23.7933 16.0264 27.4523 20.0069 27.3864 23.5330 20.0898 29.2006 25.8183 * 27.9780 * * 30.4254 * 21.8705 21.3289 * 25.3498 22.2915 22.7463 21.2021 18.0589 * * 30.9903 23.1400 24.3242 20.9297 21.3322 24.7301 26.8458 * 25.6786 20.4070 26.0298 22.5880 32.2964 24.8972 24.7557 23.5344 20.9809 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 18.7957 15.4636 * * * * 14.4325 21.7719 25.9864 16.6319 28.7233 20.9680 28.5665 25.0411 21.3136 27.9690 26.4933 * * * * Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 27.6976 20.3190 20.0996 21.2289 16.6808 23.7382 20.0948 21.4376 18.7210 18.1275 17.8788 21.3607 29.3951 21.0903 20.2279 20.4107 19.4690 21.2492 25.4934 14.9644 24.2306 19.0169 25.1584 21.7848 29.4595 23.2572 23.2376 22.0868 20.3028 23.5222 24.6956 18.8463 21.4806 22.3693 24.1177 21.2690 20.2506 25.8797 22.3315 19.7433 23.5313 21.2354 19.8415 19.5556 24.1935 20.7705 18.0879 14.1605 14.7712 13.3731 14.4829 13.7206 14.4468 19.9620 23.7631 15.2952 26.4522 19.5520 26.5635 24.0121 19.7647 25.4406 25.0990 16.1330 27.2229 26.8089 14.3848 23536 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 450340 450346 450347 450348 450351 450352 450353 450358 450362 450369 450370 450371 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 450464 450469 450473 450484 450488 450489 450497 450498 450508 450514 450517 450518 450523 450530 450534 450535 450537 450539 450545 450547 450558 450563 450565 450571 450573 450578 450580 450584 450586 450587 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00232 1.3755 1.3855 1.1384 0.9886 1.2212 1.1057 1.2803 2.0076 0.9855 1.0166 1.1704 *** 0.9087 0.9164 1.3340 1.3574 0.9257 1.6460 1.1827 *** 1.0142 0.9249 1.1916 1.2709 0.9558 0.8643 1.2488 1.1760 1.0462 1.2797 1.5343 1.1444 0.6161 1.1971 1.0873 0.9348 1.6600 *** 1.4541 *** 1.3734 1.1123 1.0160 1.0329 0.8732 1.4085 1.1119 0.9088 1.6338 *** 1.1553 0.8962 *** 1.3531 1.2112 *** 0.9601 1.7596 1.3725 1.2388 1.4990 1.1238 0.9390 1.1057 1.0396 0.9605 1.1650 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.8287 0.8422 1.0008 0.8038 0.9514 1.0226 0.8038 1.0008 0.8038 0.8038 0.8038 * 0.8038 0.8038 1.0008 1.0226 0.9451 0.8987 0.9955 0.9518 0.8038 0.8038 0.8532 1.0226 0.8038 1.0008 1.0008 0.9955 1.0226 1.0008 0.9451 1.0008 1.0008 0.9955 0.9514 0.8038 1.0226 0.8038 0.9518 * 1.0008 0.8741 0.8038 0.8038 0.8038 0.9164 0.8422 0.8038 0.8422 * 1.0008 0.8038 * 1.0226 0.8038 * 0.9955 0.8038 0.9955 0.8038 0.8287 0.8038 0.8038 0.8038 0.8038 0.8038 0.8038 20.0621 20.1921 21.7142 15.6324 22.2597 21.8138 19.5263 25.9105 20.6340 16.5636 19.0340 17.3415 17.7955 15.0670 25.8048 29.0865 19.0584 22.4441 20.7160 23.8237 19.1938 19.1571 20.1376 24.6215 16.9558 16.1957 25.1306 26.7662 29.0032 22.0682 22.9545 19.2165 14.1684 21.0247 21.1046 17.9487 24.0081 16.1987 24.0794 18.6002 23.2881 22.5650 18.5941 17.1327 19.2984 20.8183 21.0116 14.4246 21.1015 22.3034 23.3005 22.5156 23.7255 22.5972 18.4299 21.7762 22.6557 21.4201 27.5671 17.2171 21.5688 18.6233 17.3010 18.5225 16.9021 14.9061 19.0648 22.7826 21.9717 22.8133 17.0198 23.5895 23.4297 20.9271 29.3408 22.0223 17.5360 22.6815 * 20.5789 17.4509 29.5108 31.1573 20.9200 24.1598 22.3803 24.6872 23.9689 19.5928 22.0103 27.8138 17.6570 17.8078 27.0283 28.4122 29.5592 23.1253 24.7346 22.0476 14.9983 22.5602 22.3834 19.5709 25.6952 * 26.6781 * 23.0604 22.3949 19.6884 17.6614 16.4358 23.5066 21.4034 15.2707 22.2587 28.6387 26.1998 20.4715 29.4427 23.9256 20.0343 22.8130 21.8106 25.0837 27.9427 22.1971 20.9651 21.6974 20.0454 20.4293 19.0373 14.6574 19.9712 24.0636 22.2469 27.2203 18.7675 25.6859 24.8012 24.4454 30.4280 25.4372 18.4848 20.0832 * 22.2213 23.2285 30.7684 30.6072 22.0482 25.8674 23.8764 18.4551 24.8656 18.2074 23.1739 29.3063 19.6086 20.0350 26.8434 31.0404 30.6659 28.3149 25.2477 21.9351 14.3132 23.5047 23.3042 20.5812 27.8923 * 28.7890 * 25.3527 23.9144 21.4771 18.8344 17.7822 23.9572 22.6552 22.0440 24.1194 * 28.7451 * * 27.5856 21.0442 * 21.6542 26.1551 28.7289 23.8847 22.7703 20.1479 20.2695 21.1574 21.0808 16.1003 20.4512 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 22.3350 21.4909 23.9176 17.1642 23.9245 23.3447 21.5974 28.6741 22.7898 17.6077 20.4877 17.3415 20.1017 18.2702 28.7797 30.3060 20.7572 24.3854 22.4221 22.6427 22.6314 18.9826 21.7697 27.2736 18.1139 18.0319 26.3230 28.7694 29.7888 24.8057 24.3602 21.1413 14.4984 22.3940 22.3121 19.4136 25.9496 16.1987 26.6238 18.6002 23.9206 22.9600 19.8409 17.8832 17.7509 22.7686 21.6987 17.2013 22.4755 25.2834 26.1850 21.4079 26.5477 24.8361 19.8677 22.2858 22.0062 24.1840 28.1251 20.9966 21.7784 20.0755 19.1233 20.0321 18.9453 15.2149 19.8609 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23537 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 450591 ............................................................................. 450596 h ........................................................................... 450597 ............................................................................. 450603 ............................................................................. 450605 ............................................................................. 450609 ............................................................................. 450610 ............................................................................. 450614 ............................................................................. 450617 ............................................................................. 450620 ............................................................................. 450623 ............................................................................. 450626 ............................................................................. 450630 ............................................................................. 450631 ............................................................................. 450634 ............................................................................. 450638 ............................................................................. 450639 ............................................................................. 450641 ............................................................................. 450643 ............................................................................. 450644 ............................................................................. 450646 ............................................................................. 450647 ............................................................................. 450648 ............................................................................. 450649 ............................................................................. 450651 ............................................................................. 450653 ............................................................................. 450654 ............................................................................. 450656 ............................................................................. 450658 ............................................................................. 450659 ............................................................................. 450661 ............................................................................. 450662 ............................................................................. 450665 ............................................................................. 450668 ............................................................................. 450669 ............................................................................. 450670 ............................................................................. 450672 ............................................................................. 450673 ............................................................................. 450674 ............................................................................. 450675 ............................................................................. 450677 ............................................................................. 450678 ............................................................................. 450683 ............................................................................. 450684 ............................................................................. 450686 ............................................................................. 450688 ............................................................................. 450690 ............................................................................. 450694 ............................................................................. 450697 ............................................................................. 450698 ............................................................................. 450700 ............................................................................. 450702 ............................................................................. 450709 ............................................................................. 450711 ............................................................................. 450712 ............................................................................. 450715 ............................................................................. 450716 ............................................................................. 450718 ............................................................................. 450723 ............................................................................. 450724 ............................................................................. 450730 ............................................................................. 450733 ............................................................................. 450742 ............................................................................. 450743 ............................................................................. 450746 ............................................................................. 450747 ............................................................................. 450749 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00233 1.2007 1.0985 0.9702 *** 1.1521 0.9809 1.5974 *** 1.3959 0.9943 1.0833 0.9113 1.5237 *** 1.5840 1.5909 1.5269 0.9690 1.3272 1.4121 1.3665 1.8080 0.9048 0.9413 1.6207 1.1208 0.9014 1.3925 0.9005 1.4288 1.1620 1.5437 0.8590 1.5024 1.2076 1.3351 1.6955 1.0764 0.9403 1.4122 1.3184 1.3836 1.1313 1.2141 1.6245 1.1771 1.4853 1.0990 1.3237 0.8758 0.9198 1.5061 1.2645 1.6067 *** 1.2343 1.2179 1.1954 1.3817 *** 1.2563 *** 1.1492 1.4553 0.9449 1.1996 1.0081 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 1.0008 0.9514 0.8038 0.8038 0.8557 0.8038 1.0008 * 1.0008 0.8038 0.9955 0.8038 1.0008 * 1.0226 1.0008 0.9955 0.8038 0.8101 1.0008 0.8954 1.0226 0.8038 0.8038 1.0226 0.9317 0.8038 0.9164 0.8038 1.0008 0.9893 0.9853 0.8038 0.8954 1.0226 1.0008 0.9955 0.8327 1.0008 0.9955 0.9955 1.0226 1.0226 1.0008 0.8790 1.0226 0.9322 1.0008 0.8987 0.8038 0.8038 0.8741 1.0008 0.8945 * 1.0226 1.0008 0.9451 1.0226 * 1.0226 * 1.0226 1.0226 0.8038 0.9955 0.8038 19.6229 24.3714 19.9596 20.6138 22.0210 16.6870 24.7706 18.5895 22.7514 17.1333 25.1400 17.7454 24.8096 22.8637 24.8258 26.3653 24.2919 17.4072 20.2000 24.4574 21.8500 26.8276 17.3678 17.5761 26.9215 22.7236 16.3057 20.7824 19.6855 26.0224 20.0716 26.3794 15.8571 24.0081 25.0200 19.9621 25.3106 16.3319 24.8137 24.8661 22.9529 28.1917 24.5013 23.8945 17.9181 21.7922 33.1576 21.4784 20.8951 18.1764 17.3458 22.2953 23.4246 22.1489 18.4547 * 24.8614 24.9162 24.1618 21.9630 27.8476 23.8143 25.1295 23.7424 11.1672 21.5883 17.8696 22.4991 24.7477 22.9337 * 23.8820 18.3856 22.5451 * 25.2211 18.1819 28.3354 21.4445 27.8856 24.5409 27.0412 29.5385 27.3593 17.0805 20.9674 27.2047 22.6541 28.8881 18.2826 18.1118 28.9829 21.8654 19.6054 22.7284 19.9597 28.8671 21.5537 24.5815 17.2566 26.4508 25.6411 22.0495 26.7785 19.4030 26.8081 26.1555 24.0218 30.1134 24.0080 26.2906 21.0565 23.7796 28.7529 22.3081 21.2662 18.5436 18.6373 24.8628 25.0932 24.8277 * 16.1897 28.8043 27.6672 27.0055 * 30.7567 25.5624 26.3414 24.7397 16.9209 24.2674 18.4095 23.9992 25.3317 23.1711 * 22.2205 * 26.8710 * 26.5026 17.7138 28.3552 26.8375 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 27.4677 25.1575 27.6359 * * 28.7765 28.4544 30.1500 24.6609 27.6789 23.2367 27.9057 28.0400 23.5790 23.7155 18.6494 18.4602 25.6147 25.4855 28.0104 * 28.0365 30.8440 27.3408 28.0812 * 29.9430 26.4976 26.1190 27.3213 12.4748 22.2870 17.8227 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 22.0639 24.8345 22.1268 20.6138 22.7037 17.5807 24.6655 18.5895 24.9284 17.6710 27.2112 21.3925 27.5230 23.7681 26.8022 28.6129 27.0735 17.3565 20.7972 27.0517 22.8626 28.8704 17.7872 17.8381 29.5833 22.6099 18.6631 22.4984 20.0788 28.5108 21.6941 26.3697 17.2495 25.5681 26.1106 22.3620 26.6135 17.7858 25.8948 26.7882 25.1326 29.5324 24.3870 25.9648 20.7924 24.4771 29.1149 22.4747 22.0489 18.4560 18.1609 24.3137 24.7135 25.1428 18.4547 20.5948 28.2641 26.7229 26.5571 21.9630 29.5510 25.4115 25.8920 25.3404 13.1222 22.7471 18.0184 23538 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 450751 ............................................................................. 450754 ............................................................................. 450755 ............................................................................. 450758 ............................................................................. 450760 ............................................................................. 450761 ............................................................................. 450763 ............................................................................. 450766 ............................................................................. 450770 ............................................................................. 450771 ............................................................................. 450774 ............................................................................. 450775 ............................................................................. 450776 ............................................................................. 450780 ............................................................................. 450788 ............................................................................. 450795 ............................................................................. 450796 ............................................................................. 450797 ............................................................................. 450801 ............................................................................. 450803 ............................................................................. 450804 ............................................................................. 450808 ............................................................................. 450809 ............................................................................. 450811 ............................................................................. 450813 ............................................................................. 450817 ............................................................................. 450822 ............................................................................. 450824 ............................................................................. 450825 ............................................................................. 450827 ............................................................................. 450828 ............................................................................. 450829 ............................................................................. 450830 ............................................................................. 450831 ............................................................................. 450832 ............................................................................. 450833 ............................................................................. 450834 ............................................................................. 450835 ............................................................................. 450838 ............................................................................. 450839 ............................................................................. 450840 ............................................................................. 450841 ............................................................................. 450842 ............................................................................. 450844 ............................................................................. 450845 ............................................................................. 450846 ............................................................................. 450847 ............................................................................. 450848 ............................................................................. 450850 ............................................................................. 450851 ............................................................................. 450852 ............................................................................. 460001 ............................................................................. 460003 ............................................................................. 460004 ............................................................................. 460005 ............................................................................. 460006 ............................................................................. 460007 ............................................................................. 460008 ............................................................................. 460009 ............................................................................. 460010 ............................................................................. 460011 ............................................................................. 460013 ............................................................................. 460014 ............................................................................. 460015 ............................................................................. 460016 ............................................................................. 460018 h ........................................................................... 460019 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00234 1.2551 0.9215 0.9643 1.2430 1.1495 0.8380 1.1245 1.8603 1.1786 1.6492 1.7122 1.1967 0.9653 1.9234 1.5485 1.1361 2.1587 *** 1.4873 1.2163 1.8040 1.6335 1.5600 1.8007 1.1082 *** 1.1421 2.3620 1.4475 1.4188 1.1739 *** 0.9282 1.6369 1.1025 1.1371 1.3563 *** 1.1289 0.9271 0.9946 1.6236 *** 1.2573 1.8144 *** 1.1792 1.1875 1.4887 2.2455 *** 1.8903 1.4892 1.6546 1.4234 1.2864 1.3119 1.3319 1.9172 2.0750 1.2723 1.3340 1.0825 1.2767 *** 0.8785 1.0897 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.8293 0.8038 0.8790 1.0226 0.8954 0.8038 0.8038 1.0226 0.9451 1.0226 1.0008 1.0008 0.8038 0.8987 0.8557 1.0008 0.9165 1.0008 0.8293 1.0008 1.0008 0.9451 0.9451 0.8945 0.8038 * 1.0226 0.9451 0.8945 0.8327 0.8038 0.8987 0.9593 1.0008 1.0008 1.0226 0.8911 * 0.8038 0.8767 1.0226 0.9853 * 1.0008 0.8954 * 1.0008 1.0008 0.9522 1.0226 1.0226 0.9578 0.9436 0.9436 0.9436 0.9436 0.9416 0.9436 0.9436 0.9436 0.9578 0.9578 0.9436 0.9183 0.8134 1.2094 0.8134 23.3154 19.2827 19.2768 22.8713 23.2959 15.5151 19.8939 27.2499 19.9412 25.0490 21.7906 23.6621 14.6695 21.9046 21.4467 19.1371 22.4973 18.6839 19.7790 23.8343 22.8275 18.6555 23.8758 22.7583 21.7208 28.4441 26.7821 24.5885 18.8510 29.5838 20.9509 14.4463 24.7834 * 24.8572 18.3196 21.7217 24.8374 * * * * * * * * * * * * * 24.8844 26.5141 24.3409 25.0063 23.4200 23.3603 24.8233 24.5865 25.1240 21.2634 23.1467 22.6125 23.1068 18.7453 16.7143 18.1995 22.9070 21.3043 19.5168 24.0226 25.7453 16.2605 21.4171 28.8576 20.1763 26.0618 24.8562 25.3924 * 22.8688 24.2643 28.1448 24.7564 23.8708 22.2426 26.3054 26.0003 22.8247 24.7763 23.1022 22.1326 * 29.7067 * 18.7069 21.1788 21.4128 18.2860 26.9917 20.0581 26.4725 26.1256 22.7691 * 15.0454 21.1905 29.5215 17.6635 23.0945 34.4235 26.5040 24.0791 26.8892 26.5609 * * * 25.6932 24.3527 25.2191 22.6809 24.4350 24.2875 24.4453 25.0984 26.2331 22.3601 23.4765 23.9400 24.0939 * 18.8942 20.3625 19.3265 20.8968 18.0092 25.6548 24.6349 15.7483 22.4905 30.0441 20.3656 31.3924 24.9683 24.4006 * 23.9516 25.4172 23.7510 27.9734 20.5379 23.0373 30.6093 26.0980 23.8067 26.3659 25.8491 25.5949 * 31.1431 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 22.1334 30.1213 30.0191 27.0757 26.1372 26.4498 23.5633 25.4787 25.6686 26.5672 26.2833 27.4648 23.4023 25.2448 24.5384 25.6576 * 20.3755 19.9900 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 21.7472 20.5167 18.8178 24.1232 24.3909 15.8642 21.2790 28.7197 20.1550 27.9152 23.8170 24.5023 14.6695 22.9443 23.7014 23.4235 25.1133 20.9547 21.7315 27.0662 25.0247 21.6597 25.0664 24.4306 23.1456 28.4441 29.3455 25.7897 19.3490 23.0851 21.5956 17.2726 26.6450 21.7038 26.1075 23.5951 21.8968 24.8374 15.4717 22.0566 30.4233 18.3289 23.0945 30.4450 27.1743 24.0791 27.3036 27.1855 22.1334 30.1213 30.0191 25.8934 25.6304 25.3907 23.6783 24.4752 24.4644 25.2587 25.3688 26.2912 22.3027 23.9897 23.7842 24.3035 18.7453 18.6334 19.5496 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23539 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 460020 ............................................................................. 460021 ............................................................................. 460023 ............................................................................. 460025 ............................................................................. 460026 ............................................................................. 460029 ............................................................................. 460032 ............................................................................. 460033 ............................................................................. 460035 ............................................................................. 460036 ............................................................................. 460037 ............................................................................. 460039 ............................................................................. 460041 ............................................................................. 460042 ............................................................................. 460043 ............................................................................. 460044 ............................................................................. 460047 ............................................................................. 460049 ............................................................................. 460051 ............................................................................. 460052 ............................................................................. 460053 ............................................................................. 470001 ............................................................................. 470003 ............................................................................. 470005 ............................................................................. 470006 ............................................................................. 470008 ............................................................................. 470010 ............................................................................. 470011 ............................................................................. 470012 ............................................................................. 470018 ............................................................................. 470023 ............................................................................. 470024 ............................................................................. 490001 ............................................................................. 490002 ............................................................................. 490003 ............................................................................. 490004 ............................................................................. 490005 ............................................................................. 490006 ............................................................................. 490007 ............................................................................. 490009 ............................................................................. 490011 ............................................................................. 490012 ............................................................................. 490013 ............................................................................. 490015 ............................................................................. 490017 ............................................................................. 490018 ............................................................................. 490019 h ........................................................................... 490020 ............................................................................. 490021 ............................................................................. 490022 ............................................................................. 490023 ............................................................................. 490024 ............................................................................. 490027 ............................................................................. 490031 ............................................................................. 490032 ............................................................................. 490033 ............................................................................. 490037 ............................................................................. 490038 ............................................................................. 490040 ............................................................................. 490041 ............................................................................. 490042 ............................................................................. 490043 ............................................................................. 490044 ............................................................................. 490045 ............................................................................. 490046 ............................................................................. 490047 ............................................................................. 490048 ............................................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00235 1.0465 1.6825 1.1620 0.9769 0.9752 1.0584 0.9659 0.9161 0.9171 1.2351 0.8624 1.0000 1.3167 1.3210 0.9066 1.2356 1.6135 1.9769 1.1333 1.4446 *** 1.2123 1.8981 1.3303 1.1851 1.1624 1.1493 1.2027 1.2167 1.1669 1.2183 1.1449 1.0907 1.0623 *** 1.2757 1.6453 1.1847 2.2466 1.9263 1.4460 0.9964 1.2634 *** 1.3989 1.2537 1.1521 1.2668 1.4407 1.4865 1.2256 1.6758 1.1416 1.1051 1.8812 1.0518 1.1577 1.1503 1.5115 1.4077 1.2563 1.1666 1.3756 1.3043 1.5526 1.0113 1.4287 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.8134 1.1249 0.9578 0.8134 0.8134 0.8134 0.9578 0.8134 0.8134 0.9578 0.8134 0.9048 0.9436 0.9436 0.9578 0.9436 0.9436 0.9436 0.9436 0.9578 * 1.0668 1.0199 1.0199 1.0199 1.0199 1.0199 1.0903 1.0199 1.0199 1.0199 1.0199 0.8024 0.8024 * 0.9806 1.0813 1.0214 0.8841 1.0230 0.8841 0.8024 0.8596 * 0.8841 0.9806 1.0935 0.9319 0.8706 1.0935 1.0935 0.8450 0.8024 0.8024 0.9319 1.0935 0.8024 0.8024 1.0935 0.8841 0.8024 1.0935 0.8841 1.0935 0.8841 0.8998 0.8450 15.2162 23.8565 25.0874 22.3098 21.9316 24.4379 21.2715 21.7216 16.9657 23.9910 20.0323 26.3795 23.5132 22.0844 26.0277 24.7138 24.9214 21.9357 22.7540 23.1717 23.2274 23.5882 24.1739 24.9625 21.6036 20.7659 23.2072 24.6034 20.5072 21.2904 24.1395 22.4659 22.3622 17.5098 20.9783 22.7154 25.2213 13.4277 22.2526 25.2181 20.0136 15.8346 19.5094 21.2557 20.7691 22.0810 23.3077 21.2094 22.2537 24.4682 24.9734 21.2619 20.3644 18.4826 23.6489 24.4370 17.5104 18.1405 27.0513 19.9314 19.5127 25.4354 20.8739 24.7131 22.0040 19.8220 22.3138 19.4960 24.9725 25.0376 18.7978 22.7589 * 22.8987 22.7816 16.9019 25.2647 19.8478 27.5912 24.0431 23.5819 26.6870 25.7342 25.1721 23.0683 23.4970 24.0797 * 24.5499 24.6660 25.7288 26.0884 21.8951 22.9777 25.9246 22.9159 25.9300 26.7486 23.7745 21.7111 18.5220 23.8112 24.4580 27.6425 16.7679 24.9533 27.5905 22.4410 18.3697 21.4838 22.5641 22.9632 23.2215 24.4524 23.6611 23.5930 25.0277 28.8354 21.7268 19.8345 22.4300 22.8942 27.6355 19.0583 19.6427 30.1820 22.2955 20.5845 28.2969 22.1324 27.2132 24.6391 21.9156 24.1639 19.5669 26.3420 25.3094 * 24.1547 * * 22.0248 17.5723 27.2865 21.1035 28.5656 25.2744 22.9949 28.2089 26.6795 25.7920 24.5164 25.5881 25.3163 * 27.7329 26.4919 29.8255 26.9651 * 26.1273 28.3911 24.3425 28.3419 * 25.8652 21.9953 19.5613 27.3456 25.4597 28.5744 * 26.2481 29.1962 24.5687 19.2275 22.2736 * 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 22.1374 32.8738 24.5738 21.8749 30.8871 20.8351 28.8279 25.6328 22.5424 25.0097 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 17.9384 25.1139 25.1556 20.4201 22.9505 24.4379 22.1308 22.1909 17.1694 25.5949 20.3240 27.5288 24.2809 22.8865 27.0296 25.7463 25.3219 23.1856 24.0241 24.2177 23.2274 25.2768 25.1321 26.8311 24.9417 21.3386 24.1019 26.3395 22.6924 25.0848 25.4614 24.1048 22.0191 18.6066 23.8351 24.2345 27.1963 15.2211 24.5292 27.2686 22.4266 17.8014 21.0913 21.9516 22.9273 23.2792 24.6213 23.2943 23.5199 25.8811 27.9947 22.0522 19.7128 20.9706 23.9005 27.5418 19.2834 19.9691 30.0780 22.3542 20.7701 28.4640 21.2628 27.0743 24.1719 21.3597 23.8716 23540 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 490050 490052 490053 490057 490059 490060 490063 490066 490067 490069 490071 490073 490075 490077 490079 490084 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 490124 490126 490127 490130 490132 500001 500002 500003 500005 500007 500008 500011 500012 500014 500015 500016 500019 500021 500023 500024 500025 500026 500027 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00236 1.5254 1.6709 1.2926 1.5826 1.5692 1.0283 1.8332 1.3174 1.1859 1.5306 1.2929 1.6276 1.4205 1.3109 1.2705 1.1954 1.0683 1.0461 1.1132 1.1103 1.4305 0.9993 1.0181 1.2311 1.2761 0.7943 0.7131 0.9458 1.2758 0.9611 0.9766 1.3198 1.2838 1.6692 1.2540 0.9717 1.1772 1.1327 1.1880 1.7046 1.3161 1.3813 1.4487 1.0953 *** 1.2378 1.0786 1.3182 *** 1.5872 1.4024 1.2634 1.8137 1.2933 1.9138 1.3458 1.5792 1.6444 1.3785 1.6460 1.2688 1.3005 1.1295 1.6961 1.7523 1.4441 1.5647 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 1.0935 0.8841 0.8095 0.8841 0.9319 0.8024 1.0935 0.8841 0.9319 0.9319 0.9319 1.0935 0.8514 1.0230 0.9020 0.8024 0.8706 0.8450 0.8024 0.9319 0.8841 0.9319 0.8024 0.8024 1.0935 0.9319 0.8095 0.9806 1.0935 0.8706 0.9319 0.8024 0.8024 0.9319 1.0935 0.8024 0.8024 0.8024 0.8024 0.9319 0.8841 0.8841 1.0935 0.8024 * 0.8024 0.8024 0.8841 0.8024 1.1573 1.0459 1.1573 1.1573 1.0459 1.1573 1.1573 1.0459 1.1573 1.1573 1.1573 1.0459 1.0794 1.0459 1.0794 1.1573 1.1573 1.1573 26.1521 19.2480 18.6541 22.1612 23.3895 20.6028 31.0162 22.1034 20.4058 20.6957 25.4678 27.6711 22.3230 22.2643 19.2196 19.8598 19.7549 21.1522 20.3015 23.8364 20.7388 21.9886 18.1022 19.7116 28.5200 28.0286 40.6821 31.6541 26.5312 28.7277 28.0978 23.6080 19.4041 23.6028 28.0893 19.9725 19.9151 19.7007 15.6078 25.2230 21.3883 22.2389 27.3509 20.9506 21.3713 20.4660 17.8070 18.6038 19.5849 26.6420 24.0374 27.3435 28.9512 23.5774 28.9380 27.6762 26.2263 27.4248 27.3397 27.7863 25.7691 26.4648 23.9513 27.2967 29.0400 28.7532 30.6901 29.4660 21.4035 20.9367 25.1898 26.1518 21.0828 29.4216 23.3835 21.8730 24.4542 27.0374 25.2859 22.8303 24.8309 19.8100 22.7945 21.4818 21.2123 21.3410 21.6466 23.6779 26.0755 23.5366 20.9805 30.1800 33.1215 38.2813 30.1492 28.7296 27.9090 28.0548 21.3126 20.6373 25.8312 29.1786 20.0555 20.3615 21.3083 17.4111 26.8810 23.7813 23.1535 28.7020 22.9511 29.7939 23.1423 19.4005 22.0769 * 26.7502 25.0665 28.4174 31.4415 26.1318 31.0128 28.3391 29.2045 30.1061 30.1596 29.3634 26.9702 28.5926 27.3823 29.3946 31.7335 31.4152 29.5939 30.5037 22.8889 21.8432 26.1128 28.7276 22.4200 30.3648 24.7146 22.9188 26.8791 28.4381 31.7743 23.8191 26.0800 23.4728 24.6045 22.4186 22.6461 22.2907 23.8656 25.0751 26.5726 23.8005 21.7231 30.4285 17.3295 24.7923 23.0199 29.7000 22.4345 21.9878 22.5974 22.0199 26.6453 29.5698 20.7017 21.4666 22.9017 18.0277 27.4050 25.2549 24.4434 31.0449 23.9233 * 22.2859 20.4289 22.8512 * 29.3707 25.3347 29.6341 32.0972 28.0476 31.8837 30.6508 30.6856 33.7536 32.0592 31.4221 28.6669 30.1690 * 30.7917 34.7252 33.2937 34.2175 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 28.7334 21.2086 20.4783 24.5153 26.1974 21.3908 30.2236 23.4575 21.7183 24.1400 27.0687 27.8898 23.0000 24.4773 20.7435 22.3588 21.1984 21.7546 21.2854 23.0587 23.2941 25.0296 21.5573 20.8214 29.7644 24.4559 34.3492 28.3157 28.3786 26.3471 25.9914 22.4319 20.6805 25.4222 28.9669 20.2462 20.5969 21.2429 17.0302 26.6600 23.5234 23.3020 29.0227 22.6075 25.7258 21.9403 19.2585 21.1640 19.5849 27.5939 24.8482 28.5098 30.7955 25.9648 30.6288 28.9502 28.7227 30.6058 29.8941 29.6282 27.1697 28.5893 25.6872 29.1683 31.7861 31.1325 31.5063 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23541 TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 500030 500031 500033 500036 500037 500039 500041 500044 500049 500050 500051 500053 500054 500055 500058 500060 500064 500065 500071 500074 500079 500084 500086 500092 500104 500108 500110 500118 500119 500122 500124 500129 500134 500139 500141 500143 500147 500148 510001 510002 510006 510007 510008 510012 510013 510015 510022 510023 510024 510026 510028 510029 510030 510031 510033 510038 510039 510043 510046 510047 510048 510050 510053 510055 510058 510059 510061 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00237 1.5791 1.1888 1.2976 1.3747 1.0310 1.4511 1.2975 1.9843 1.3010 1.4422 1.7552 1.2441 2.0525 *** 1.6605 1.2823 1.7416 1.2445 1.1734 *** 1.3420 1.3103 1.2807 0.8995 1.0691 1.6596 1.1857 1.1171 1.3607 1.1916 1.4090 1.5325 0.4749 1.5310 1.2664 0.4570 0.8043 1.1051 1.9174 1.1623 1.2491 1.5458 1.1920 0.9435 1.1671 0.9561 1.8301 1.2510 1.7224 1.0110 0.9965 1.2527 1.1843 1.3895 1.3921 1.0245 1.2658 0.8986 1.2834 1.1340 1.1071 1.5329 1.1350 1.4505 1.2970 0.6811 0.9818 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 1.1705 1.0970 1.0459 1.0459 1.0459 1.1573 1.1229 1.0898 1.0459 1.1229 1.1573 1.0619 1.0898 1.0459 1.0619 1.1573 1.1573 1.0459 1.0459 1.0459 1.0794 1.1573 1.0459 1.0459 1.1573 1.0794 1.0459 1.0459 1.0898 1.0459 1.1573 1.0794 1.1573 1.0794 1.1573 1.0794 1.0459 1.0459 0.8840 0.8450 0.8840 0.9482 0.9528 0.7742 0.7742 0.8429 0.8429 0.7821 0.8840 0.7742 0.8274 0.8429 0.8332 0.8429 0.8303 0.7742 0.7742 0.7742 0.8274 0.8840 0.7742 0.7742 0.7742 0.9482 0.8303 0.8429 0.9310 29.0487 26.0740 25.4345 25.4753 23.5414 26.1409 24.9004 27.0880 26.6407 25.0907 26.9538 26.0112 27.1965 25.3095 27.3411 31.7480 29.2539 26.5880 23.2071 21.9019 27.1775 26.5864 25.9705 20.8601 26.8007 27.4156 24.8448 26.1971 25.1576 26.9006 24.8357 27.8351 21.3921 27.7281 28.2968 19.0982 * * 21.4247 20.9822 21.0214 23.4411 22.7595 16.7710 19.7937 17.9040 22.7534 17.9267 21.3662 16.5389 24.6544 19.8202 19.8220 20.5743 19.6921 16.1016 17.6173 15.5857 19.2802 22.1953 16.3761 18.9990 18.1054 27.7422 20.1104 18.1543 14.8848 30.5926 28.5398 26.6704 26.0223 24.6548 27.9651 26.9101 26.9323 25.6104 26.8971 29.0100 26.8074 28.8062 * 28.4247 33.5169 31.1459 26.0960 * * 28.4934 27.6306 * 23.2466 27.0034 28.7206 25.4785 28.1074 27.2335 27.4405 28.6598 30.0223 24.2990 29.2357 30.7478 20.7093 16.3669 18.2168 22.9351 22.4751 22.2947 24.3499 24.5293 18.5816 19.9710 * 24.1481 19.4321 23.3115 18.0855 23.0518 21.7527 22.3658 21.6294 21.0707 16.8744 19.1280 16.0586 21.2792 23.2093 17.6785 20.1943 20.7538 29.3962 21.9352 18.8712 15.3355 32.7446 31.2186 29.4627 27.0072 26.9969 29.8809 26.5976 30.3164 27.1819 29.9791 31.9406 28.4130 30.8067 * 30.4699 34.1523 31.5371 * * * 29.6623 29.3484 * * * 29.4244 26.4560 * 30.9999 30.1396 31.5438 30.7536 26.8608 31.6591 30.5456 22.1419 24.5807 22.2161 23.4477 25.9597 23.5727 25.2835 24.6959 18.2845 20.8782 * 24.2125 20.4908 24.0444 16.6192 21.7134 22.0060 21.5583 21.7637 23.0305 17.2832 19.5468 * 21.2540 24.0954 17.5096 19.9766 20.8609 30.7868 22.6976 21.9550 * Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 30.8324 28.5887 27.2338 26.1929 25.0377 28.0919 26.1814 28.1645 26.4960 27.4347 29.4441 27.1467 28.9786 25.3095 28.8635 33.1768 30.6791 26.3295 23.2071 21.9019 28.4444 27.9397 25.9705 22.0417 26.9067 28.5667 25.6025 27.1693 27.7928 28.2069 28.2647 29.5772 24.3808 29.5383 29.9289 20.7552 16.9814 20.0814 22.6536 23.1031 22.3142 24.3672 24.0287 17.8391 20.2065 17.9040 23.7112 19.2664 22.9061 17.0257 23.1596 21.2311 21.2766 21.3498 21.2329 16.7659 18.7692 15.8328 20.5978 23.1668 17.1529 19.7250 19.9625 29.3287 21.6021 19.5138 15.1074 23542 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 510062 510067 510068 510070 510071 510072 510077 510082 510085 510086 510088 510089 520002 520003 520004 520008 520009 520010 520011 520013 520014 520015 520017 520019 520021 520024 520026 520027 520028 520030 520032 520033 520034 520035 520037 520038 520040 520041 520042 520044 520045 520047 520048 520049 520051 520057 520058 520060 520062 520063 520064 520066 520068 520069 520071 520075 520076 520078 520083 520084 520087 520088 520089 520091 520092 520094 520095 ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. ............................................................................. 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00238 1.1655 1.1669 1.1126 1.1882 1.2853 1.0629 1.1621 1.1043 1.2020 1.0874 0.9820 *** 1.2821 1.1724 1.3395 1.5856 1.6869 1.1228 1.2647 1.3725 1.0762 1.1411 1.1442 1.2709 1.3765 1.0697 1.0913 1.2710 1.2544 1.7713 1.1260 1.3031 1.1362 1.2757 1.7957 1.2023 1.3551 1.1069 1.0666 1.3206 1.4958 0.9463 1.6494 2.1923 1.6606 1.1487 *** 1.3001 1.2975 1.1228 1.4701 1.5188 0.8883 *** 1.2141 1.5364 1.1767 1.4830 1.7454 1.0616 1.6953 1.3362 1.5475 1.2659 1.0263 *** 1.2045 Fmt 4701 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.7742 0.7742 1.0935 0.8274 0.8274 0.7742 0.9119 0.7742 0.8429 0.7742 0.7742 * 0.9964 0.9478 0.9557 1.0111 0.9478 1.1055 0.9478 0.9478 1.0629 .9478 0.9478 0.9478 1.0698 0.9478 1.1055 1.0111 1.0416 0.9964 1.0629 0.9478 0.9478 0.9478 0.9964 1.0111 1.0111 1.0629 0.9478 0.9478 0.9478 0.9478 0.9478 0.9478 1.0111 0.9478 1.0224 0.9478 1.0111 1.0111 1.0111 1.0416 0.9478 * 0.9957 0.9478 1.0416 1.0111 1.0629 1.0629 0.9557 0.9957 1.0629 0.9478 0.9478 0.9957 1.0416 21.3405 18.0113 19.9056 20.0974 19.4029 18.4566 20.9153 17.2891 20.6364 16.3051 16.4373 * 22.0838 20.4234 22.8530 26.0931 21.5169 26.3965 22.7880 23.1173 20.4281 22.8094 21.7542 22.6895 24.1284 17.5368 25.0504 22.2089 24.3592 23.9474 22.7220 22.2650 22.6160 20.8563 25.0587 23.1036 21.5671 22.6216 21.9935 22.7627 24.1624 22.5686 20.5069 22.7424 27.6695 21.2729 23.2907 21.1271 23.7166 23.3037 24.3043 23.9212 21.4413 32.6484 23.4832 23.7322 22.2993 23.4414 25.7108 24.7909 22.8974 23.8938 24.4435 22.8914 21.8662 22.3925 25.1402 21.1568 22.1582 20.0007 21.1895 21.5439 19.7990 22.8104 16.4742 22.6563 17.8234 18.3401 * 23.7316 21.8662 24.4711 27.8127 23.4265 28.5569 23.7785 24.4766 22.1064 23.0403 23.4044 24.9871 25.4872 18.5072 26.1056 26.2516 25.7778 25.3807 25.3059 23.9791 23.6563 23.2625 28.6984 24.6650 23.8501 22.8236 24.0788 24.9387 24.5844 25.5346 23.1653 24.1083 28.8249 23.3205 * 22.0132 24.9988 25.3674 27.1120 25.8812 23.4746 * 26.3154 26.0600 24.0879 25.7662 27.0012 25.5777 24.5280 26.0882 26.6013 24.8269 23.4043 25.3166 28.6376 23.3216 21.2099 23.1011 23.2382 23.1685 20.1997 23.6585 19.1878 23.7173 17.5933 * 27.7062 24.9950 * 25.4639 29.8354 26.1503 29.2491 25.2747 26.6225 * * 24.6676 25.0377 26.6935 * * 27.5490 25.4164 27.0185 25.3696 24.6125 23.9850 24.7767 29.7234 26.6470 25.1096 22.7596 23.6326 26.0191 26.0030 * 25.1724 25.9256 28.3040 25.3745 * 23.8817 28.2215 27.4101 28.6101 27.1657 24.8184 * 27.6202 27.1699 26.1698 27.5989 28.8407 * 27.3374 26.9936 30.0448 24.6320 * 25.7567 26.7863 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Average hourly wage ** (3 years) 21.9387 20.4433 21.0310 21.5724 21.4107 19.5568 22.4770 17.5963 22.3503 17.2267 17.3534 27.7062 23.6544 21.1608 24.2888 27.9737 23.6455 28.0349 23.9992 24.8211 21.2683 22.9239 23.3009 24.2463 25.4468 18.0423 25.6168 25.5645 25.1844 25.5053 24.4819 23.6548 23.4634 23.0160 27.8508 24.8476 23.5636 22.7396 23.2471 24.5777 24.9427 24.0011 22.8848 24.2130 28.2799 23.3399 23.2907 22.3382 25.7059 25.4095 26.6968 25.6782 23.2981 32.6484 25.7950 25.6758 24.2625 25.6772 27.2481 25.1765 24.8782 25.7252 27.0527 24.0764 22.6433 24.5483 26.8360 23543 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 2.—HOSPITAL CASE-MIX INDEXES FOR DISCHARGES OCCURRING IN FEDERAL FISCAL YEAR 2004; HOSPITAL AVERAGE HOURLY WAGE FOR FEDERAL FISCAL YEARS 2004 (2000 WAGE DATA), 2005 (2001 WAGE DATA), AND 2006 (2002 WAGE DATA) WAGE INDEXES AND 3-YEAR AVERAGE OF HOSPITAL AVERAGE HOURLY WAGES—Continued Case-mix index Provider number 520096 ............................................................................. 520097 ............................................................................. 520098 ............................................................................. 520100 ............................................................................. 520102 ............................................................................. 520103 ............................................................................. 520107 ............................................................................. 520109 ............................................................................. 520111 ............................................................................. 520112 ............................................................................. 520113 ............................................................................. 520114 ............................................................................. 520116 ............................................................................. 520117 ............................................................................. 520123 ............................................................................. 520130 ............................................................................. 520134 ............................................................................. 520136 ............................................................................. 520138 ............................................................................. 520139 ............................................................................. 520140 ............................................................................. 520145 ............................................................................. 520151 ............................................................................. 520152 ............................................................................. 520154 ............................................................................. 520156 ............................................................................. 520160 ............................................................................. 520161 ............................................................................. 520170 ............................................................................. 520173 ............................................................................. 520177 ............................................................................. 520178 ............................................................................. 520189 ............................................................................. 520192 ............................................................................. 520194 ............................................................................. 520195 ............................................................................. 520196 ............................................................................. 530002 ............................................................................. 530004 ............................................................................. 530007 ............................................................................. 530008 2 ........................................................................... 530009 ............................................................................. 530010 2 ........................................................................... 530011 ............................................................................. 530012 ............................................................................. 530014 ............................................................................. 530015 ............................................................................. 530016 ............................................................................. 530017 ............................................................................. 530023 ............................................................................. 530025 ............................................................................. 530026 ............................................................................. 530031 ............................................................................. 530032 ............................................................................. 1.3205 1.3919 2.0001 1.2767 1.0905 1.6066 1.2224 1.0371 *** 1.1078 1.2717 1.1620 1.2099 1.0283 1.0715 *** *** 1.6003 1.8350 1.2505 1.6615 *** 1.0251 1.0564 1.1733 1.0529 1.8094 0.9206 1.2905 1.0948 1.6337 0.9691 1.1063 *** 1.5971 0.3562 1.5022 1.1527 *** 1.2447 1.2307 0.9699 1.2457 1.0112 1.6902 1.6077 1.2773 1.3351 0.9556 1.1558 1.2781 *** 0.9546 1.0215 Wage index FY 2006 Average hourly wage FY 2004 Average hourly wage FY 2005 Average hourly wage FY 2006 0.9957 0.9478 1.0629 0.9561 0.9957 1.0111 0.9478 0.9478 * 0.9478 0.9478 0.9478 0.9957 0.9478 1.1055 0.9478 0.9478 1.0111 1.0111 1.0111 1.0111 * 0.9478 0.9478 0.9478 1.1055 0.9478 0.9478 1.0111 1.0224 1.0111 0.9478 1.0698 * * 1.0111 0.9478 0.9207 * 0.9207 0.9207 0.9207 0.9207 0.9207 0.9207 0.9207 0.9207 0.9207 0.9207 0.9207 1.0146 0.9207 0.9207 0.9207 21.1759 23.6512 25.8184 21.7072 23.7739 23.5984 25.7379 20.6357 26.9666 19.1409 24.0822 21.9847 23.9066 21.9915 21.2360 20.0277 20.8502 23.2573 25.1434 23.7727 23.9176 25.0770 20.1995 22.5440 23.2635 23.7157 22.9475 22.1857 25.5470 24.4723 27.5560 22.3193 23.1658 22.5641 * * * 23.8852 19.7857 22.3309 21.8714 22.0450 21.4890 22.5720 22.4716 21.7314 25.3915 21.0666 19.5630 22.5535 25.4693 21.0732 16.8825 19.4449 22.9929 25.1135 28.0730 24.5914 25.6146 25.5361 27.7413 22.4048 26.3095 20.4034 26.7926 22.0536 26.3057 22.0023 22.2430 * * 25.5145 26.9047 25.4424 26.1616 * 22.9592 23.2493 23.7160 24.9258 24.3528 24.0673 25.6124 26.2224 28.4663 23.0419 26.3172 * * * * 25.2983 * 19.3476 23.8271 24.2426 23.9255 24.1396 24.3454 23.6907 26.3107 21.6575 23.5415 24.1493 27.7988 * 16.3472 22.6584 Average hourly wage ** (3 years) 24.5758 26.3321 30.6150 26.2161 26.8234 27.9147 28.3431 24.9379 * * 27.4135 * 26.9902 * * * * 27.7703 28.4394 26.5110 28.3001 * * 24.9392 * * 25.7588 * 27.2221 28.0995 30.7317 20.2666 28.4720 * 24.9408 36.6973 35.1043 26.8356 * 20.4391 23.8589 26.8316 25.8482 24.8245 25.2526 24.5947 27.6876 * 25.3362 21.3813 28.6938 * * 22.9391 1 Based on salaries adjusted for occupational mix, according to the calculation in section III.C.2. of the preamble to this proposed rule. hospitals are assigned a wage index value according to section III.H. of the preamble of this proposed rule. h These hospitals are assigned a wage index value according to section III.G. of the preamble to this proposed rule. *Denotes wage data not available for the provider for that year. **Based on the sum of the salaries and hours computed for Federal FYs 2004, 2005, and 2006. ***Denotes MedPAR data not available for the provider for FY 2004. 2 These VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00239 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 22.9775 25.1104 28.2679 24.1896 25.4621 25.8275 27.2253 22.6443 26.6016 19.7623 26.1479 22.0194 25.8557 21.9973 21.7461 20.0277 20.8502 25.5032 26.8513 25.3279 26.0657 25.0770 21.5728 23.6620 23.4910 24.3330 24.4208 23.1340 26.1781 26.3133 29.0456 21.8785 26.3169 22.5641 24.9408 36.6973 35.1043 25.4030 19.7857 20.6774 23.1777 24.1997 23.7290 23.8464 24.0014 23.3995 26.4934 21.3685 22.8987 22.6451 27.3568 21.0732 16.6017 21.6640 23544 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 3A.—FY 2006 AND 3-YEAR* AVERAGE HOURLY WAGE FOR URBAN AREAS BY CBSA [*Based on the sum of the salaries and hours computed for Federal fiscal years 2004, 2005, and 2006] CBSA code 10180 10380 10420 10500 10580 10740 10780 10900 11020 11100 11180 11260 11300 11340 11460 11500 11540 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<04>2004 FY 2006 average hourly wage Urban area Abilene, TX ............................................................................................................................................... ´ Aguadilla-Isabela-San Sebastın, 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 ............................................................................................................................................. 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-Frederick-Gaithersburg, 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 .................................................................................................................................................. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00240 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 3-Year average hourly wage 22.1701 13.2502 25.1189 24.1844 23.9528 27.1248 22.5148 27.5389 25.0167 25.6410 26.7068 33.8779 24.1549 24.8624 30.4505 21.4718 25.9098 26.0511 27.4532 26.9604 32.5013 22.6976 26.7647 26.4408 28.9777 27.6740 27.9343 35.0207 24.0727 26.5543 26.1760 23.5603 32.7446 30.1666 32.0917 24.7710 24.0264 25.1185 21.0353 22.3143 23.7061 25.4101 25.3133 32.2755 27.2574 23.0011 29.8809 35.2686 27.5656 26.1311 24.8634 24.9033 26.4165 30.9921 29.4132 25.0564 26.1095 28.6158 25.2526 24.0727 26.8325 23.5802 26.3883 27.1825 28.6200 25.4537 24.5947 30.3410 29.4447 20.4985 11.5908 23.9584 26.6216 22.6259 25.7999 21.3129 25.5680 22.9759 24.0270 25.0247 32.1826 23.0714 22.9488 29.2076 20.7611 24.1044 24.5466 26.1928 26.0983 29.4922 21.8061 24.8652 25.2181 26.6414 26.1267 26.2399 33.2353 22.2239 24.8160 25.1852 22.3855 30.8324 28.0136 29.4434 23.5742 22.4051 23.9577 20.1696 21.3890 22.5941 23.7897 24.3052 30.7174 26.2715 21.8437 28.0919 33.7851 26.6683 28.6493 24.3177 23.6142 25.0134 29.2429 28.1192 23.6833 25.0250 27.0192 24.0014 23.2382 25.4853 22.9895 24.7642 25.6465 26.8014 24.0895 23.3995 28.6963 27.4655 23545 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 3A.—FY 2006 AND 3-YEAR* AVERAGE HOURLY WAGE FOR URBAN AREAS BY CBSA—Continued [*Based on the sum of the salaries and hours computed for Federal fiscal years 2004, 2005, and 2006] CBSA code 17140 17300 17420 17460 17660 17780 17820 17860 17900 17980 18020 18140 18580 18700 19060 19124 19140 19180 19260 19340 19380 19460 19500 19660 19740 19780 19804 20020 20100 20220 20260 20500 20740 20764 20940 21060 21140 21300 21340 21500 21604 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 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<04>2004 FY 2006 average hourly wage Urban area 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 ................................................................................................................................................ 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, 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 ..................................................................................................................................................... Essex County, MA .................................................................................................................................... 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 .................................................................................................................................. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00241 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 3-Year average hourly wage 26.8669 23.1419 22.8278 25.7303 26.9749 24.9298 26.4562 23.3470 25.3362 23.9764 26.8458 27.5495 23.9399 29.9648 26.0448 28.6076 25.2695 25.3127 23.8191 24.3842 25.3708 23.7138 22.5852 26.0379 29.9610 26.9975 29.2431 21.6602 27.4735 25.5030 28.5299 28.7033 25.7563 31.5082 25.1083 24.6642 26.9005 23.1540 25.0500 24.4677 29.4434 30.2425 24.4379 31.8995 11.6386 23.7360 23.8264 26.3708 24.0127 33.8333 29.7989 25.1444 23.2344 26.9936 28.2568 29.1773 23.0272 24.8333 27.4082 26.6167 29.6215 22.3074 26.4676 24.8893 26.2014 24.0232 24.5666 32.2306 26.8293 25.0229 21.5444 21.2133 25.0687 25.1364 23.8550 25.5825 22.3003 24.0049 22.7919 25.0573 25.7193 22.6210 28.7806 22.8828 26.7125 24.8431 22.9099 23.0000 23.2403 24.4405 22.9734 21.4281 24.0560 28.5110 24.6647 27.2952 20.2540 25.9428 23.5042 27.0543 27.3555 24.1573 29.5433 23.7136 22.6125 25.1975 22.0419 23.9275 22.8915 27.9641 29.2693 22.4627 29.8198 10.6772 23.9742 22.4376 24.3719 22.5998 30.2808 28.6871 23.2705 21.0532 25.7252 26.7964 27.0873 21.9069 23.4332 25.7154 24.9487 27.6921 21.3197 25.1553 24.3542 24.6755 22.4577 23.0280 26.3170 25.6655 23546 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 3A.—FY 2006 AND 3-YEAR* AVERAGE HOURLY WAGE FOR URBAN AREAS BY CBSA—Continued [*Based on the sum of the salaries and hours computed for Federal fiscal years 2004, 2005, and 2006] CBSA code 24340 24500 24540 24580 24660 24780 24860 25020 25060 25180 25260 25420 25500 25540 25620 25860 25980 26100 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 29460 29540 29620 29700 29740 29820 29940 30020 30140 30300 30340 30460 30620 30700 30780 30860 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<04>2004 FY 2006 average hourly wage Urban area Grand Rapids-Wyoming, MI ..................................................................................................................... Great Falls, MT ......................................................................................................................................... Greeley, CO .............................................................................................................................................. Green Bay, WI .......................................................................................................................................... Greensboro-High Point, NC ...................................................................................................................... Greenville, NC ........................................................................................................................................... Greenville, 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 ......................................................................................................................... Honolulu, HI .............................................................................................................................................. Hot Springs, AR ........................................................................................................................................ Houma-Bayou Cane-Thibodaux, LA ......................................................................................................... Houston-Baytown-Sugar Land, TX ........................................................................................................... Huntington-Ashland, WV-KY-OH .............................................................................................................. Huntsville, AL ............................................................................................................................................ Idaho Falls, ID ........................................................................................................................................... Indianapolis, 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 ....................................................................................................... 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, AR .............................................................................................................. Logan, UT-ID ............................................................................................................................................ 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00242 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 3-Year average hourly wage 26.2918 25.2873 26.8470 26.4060 25.5495 26.3325 28.3616 08.9125 24.9592 26.6548 28.1814 26.0656 25.4597 31.0121 21.3089 24.9837 .------25.4579 31.3501 25.3627 22.1079 27.9993 26.5266 25.5254 26.3236 27.7571 27.2791 27.5699 26.0171 23.2553 25.0772 26.0254 23.0236 26.7462 23.4699 22.2633 23.3540 22.2913 24.0416 29.1036 30.7469 26.4479 29.7070 23.9626 22.5380 25.9063 23.6960 26.7312 26.7369 24.4215 23.5797 21.9512 29.2180 24.9925 27.1801 27.3767 22.6637 23.6548 31.9355 23.8863 22.1442 24.2087 27.6345 26.1064 25.3464 25.7797 28.5262 24.5286 25.6905 24.9274 23.4084 25.0779 25.1220 24.2161 24.3631 25.8028 09.5939 23.9056 25.0347 25.1270 24.4935 24.2345 29.5959 19.6542 24.3032 .------24.5609 29.2509 24.1181 20.5356 26.1356 25.2510 23.9276 24.2135 26.3923 25.4755 25.6624 24.0809 21.9059 23.6035 24.9544 22.0702 25.0136 22.4350 21.2152 22.1239 21.0721 22.8597 28.0902 28.2579 25.2795 27.8472 23.6807 21.6656 24.4214 22.7400 24.3627 24.6616 23.5470 22.0745 20.7252 27.3940 23.4702 25.5025 25.6366 21.9619 22.8284 30.3760 22.7099 21.4717 23.0471 24.9793 24.8965 22.7343 24.7454 27.0530 23.3089 24.3475 23547 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 3A.—FY 2006 AND 3-YEAR* AVERAGE HOURLY WAGE FOR URBAN AREAS BY CBSA—Continued [*Based on the sum of the salaries and hours computed for Federal fiscal years 2004, 2005, and 2006] CBSA code 30980 31020 31084 31140 31180 31340 31420 31460 31540 31700 31900 32420 32580 32780 32820 32900 33124 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 37460 37620 37700 37860 37900 37964 38060 38220 38300 38340 38540 38660 38860 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<04>2004 FY 2006 average hourly wage Urban area Longview, TX ............................................................................................................................................ Longview, WA ........................................................................................................................................... Los Angeles-Long Beach-Glendale, CA ................................................................................................... Louisville, KY-IN ........................................................................................................................................ Lubbock, TX .............................................................................................................................................. Lynchburg, VA .......................................................................................................................................... Macon, GA ................................................................................................................................................ Madera, CA ............................................................................................................................................... Madison, WI .............................................................................................................................................. Manchester-Nashua, NH .......................................................................................................................... 1Mansfield, OH .......................................................................................................................................... ¨ Mayaguez, PR .......................................................................................................................................... McAllen-Edinburg-Pharr, TX ..................................................................................................................... Medford, OR ............................................................................................................................................. Memphis, TN-MS-AR ................................................................................................................................ Merced, CA ............................................................................................................................................... Miami-Miami Beach-Kendall, FL ............................................................................................................... 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, TN ................................................................................................... Nassau-Suffolk, NY ................................................................................................................................... Newark-Union, NJ-PA ............................................................................................................................... New Haven-Milford, CT ............................................................................................................................ New Orleans-Metairie-Kenner, LA ............................................................................................................ New York-Wayne-White Plains, 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, FL ............................................................................................................................................... Oshkosh-Neenah, WI ................................................................................................................................ Owensboro, KY ......................................................................................................................................... Oxnard-Thousand Oaks-Ventura, CA ....................................................................................................... Palm Bay-Melbourne-Titusville, FL ........................................................................................................... Panama City-Lynn Haven, FL .................................................................................................................. Parkersburg-Marietta, WV-OH .................................................................................................................. Pascagoula, MS ........................................................................................................................................ 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 ................................................................................................... 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00243 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 3-Year average hourly wage 24.4521 26.5976 32.9050 25.9154 24.5905 24.3559 26.5343 24.4061 29.7363 28.8847 ------11.2362 25.0238 28.6299 26.1471 31.1184 27.2942 26.3221 26.6395 28.2858 30.9281 26.4227 22.1076 33.0964 22.5035 26.4882 24.0586 23.6097 24.5017 29.2146 25.0449 27.0713 24.8106 35.3683 28.2979 27.2968 35.7543 34.1064 32.7989 25.1852 36.9026 24.8541 31.8510 42.8742 25.0519 30.8612 27.6769 25.2772 25.2975 30.5859 26.7314 26.4250 25.6249 24.6348 32.4624 27.4887 22.3439 23.2293 22.8397 22.6287 24.7421 30.8573 28.3642 24.3824 24.7296 28.4877 26.1526 14.4851 29.0440 23.4643 26.1814 31.0454 24.2971 22.7060 23.5846 25.0025 22.5247 27.4059 27.6772 ------11.3917 22.9932 27.7062 24.2118 27.6673 25.9755 24.7313 25.3824 26.5793 29.1156 24.2896 20.9624 31.0034 20.9918 25.0486 21.7643 22.7263 21.6486 27.8316 23.0977 25.4822 23.7419 32.9923 26.9037 26.1014 34.1418 31.1564 31.1765 23.9697 35.2542 23.3997 30.4182 40.0207 24.4578 28.5543 25.1761 24.5654 23.7988 28.9079 25.5410 25.3813 23.9585 22.4970 29.7410 25.7496 21.3568 21.7277 21.4591 22.0289 23.2730 28.8565 26.6530 22.1870 23.2597 27.1701 24.5528 13.0375 26.7442 23548 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 3A.—FY 2006 AND 3-YEAR* AVERAGE HOURLY WAGE FOR URBAN AREAS BY CBSA—Continued [*Based on the sum of the salaries and hours computed for Federal fiscal years 2004, 2005, and 2006] CBSA code 38900 38940 39100 39140 39300 39340 39380 39460 39540 39580 39660 39740 39820 39900 40060 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 43100 43300 43340 43580 43620 43780 43900 44060 44100 44140 44180 44220 44300 44700 44940 45060 45104 45220 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<04>2004 FY 2006 average hourly wage Urban area Portland-Vancouver-Beaverton, OR-WA .................................................................................................. Port St. Lucie-Fort Pierce, 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 ........................................................................................................................................... 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 German-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 ................................................................................................................... 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 ........................................................................................................................................ 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00244 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 3-Year average hourly wage 31.4148 28.3669 30.1207 27.6508 30.6398 26.5574 24.1431 25.9442 25.2201 27.1623 25.2538 27.1301 34.1503 30.7272 26.0695 30.8328 23.4915 31.1302 25.5065 27.9047 29.0055 24.9648 26.3370 36.2362 26.5050 28.0585 26.3420 26.7587 25.0452 29.2207 39.5570 25.3485 26.3970 23.1837 25.1428 31.9401 25.2690 41.8804 12.9971 42.2833 13.1085 31.7731 32.3515 32.2413 42.4095 30.5158 37.7122 26.6769 26.5289 23.8629 32.3774 24.9924 26.6281 24.5258 26.1843 26.9025 27.3743 25.6900 30.4868 24.8405 28.7008 23.0819 23.4939 23.4099 31.7047 23.4355 26.8425 30.0701 24.3724 29.7614 26.5761 29.3034 26.3318 28.8359 25.4669 23.0046 24.8140 23.6789 25.4788 23.5560 24.7239 31.2183 28.3079 24.6756 29.3251 22.4289 30.1737 24.5493 25.7304 27.0997 23.6953 23.8100 32.0754 25.8822 26.3196 25.1139 25.8174 23.7896 27.6647 37.1828 24.0517 25.4439 21.9567 23.6255 29.8191 23.6568 38.9640 13.4135 39.0995 12.3738 29.7965 30.4088 28.8239 37.7929 28.6521 34.7294 25.5601 24.9832 22.4039 30.4447 23.3301 25.3544 23.6868 24.0956 25.0103 25.4781 24.5737 28.5450 23.3039 27.2255 22.2164 22.7752 22.4626 28.5078 22.1331 25.0698 28.9533 22.7559 23549 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 3A.—FY 2006 AND 3-YEAR* AVERAGE HOURLY WAGE FOR URBAN AREAS BY CBSA—Continued [*Based on the sum of the salaries and hours computed for Federal fiscal years 2004, 2005, and 2006] CBSA code 45300 45460 45500 45780 45820 45940 46060 46140 46220 46340 46540 46660 46700 46940 47020 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 1This ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... FY 2006 average hourly wage Urban area 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 .................................................................................................................................. Vero Beach, FL ......................................................................................................................................... Victoria, TX ............................................................................................................................................... Vineland-Millville-Bridgeton, NJ ................................................................................................................ Virginia Beach-Norfolk-Newport News, VA-NC ........................................................................................ Visalia-Porterville, CA ............................................................................................................................... Waco, TX .................................................................................................................................................. Warner Robins, GA ................................................................................................................................... Warren-Farmington Hills-Troy, 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, FL ................................................................................. 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 25.8608 23.2574 23.2000 26.7822 24.9561 30.3180 25.1965 23.2484 24.4051 26.0797 23.2558 24.8233 41.6513 26.4579 22.7937 27.5232 24.7332 28.2676 23.8678 24.2312 27.5791 30.5916 23.9572 27.0185 21.8793 28.1544 28.1452 20.0483 25.6152 23.2954 23.4090 29.4490 26.7996 28.5744 25.0655 30.8969 28.4267 12.3449 26.3577 24.0832 30.6351 25.7050 24.1485 22.0638 21.8927 25.0440 23.6665 27.8778 23.6781 22.9280 22.1412 24.9826 21.9605 22.4638 38.4022 25.3120 21.7127 27.0476 23.2422 26.4299 22.0533 22.6117 26.2703 28.8815 22.5445 25.5053 21.4989 26.5892 26.6150 19.3905 24.4842 21.9177 21.9892 28.5184 24.9839 27.1963 24.1158 29.3320 27.0960 12.0750 24.3575 23.4935 27.8070 23.8047 area has no average hourly wage because there are no IPPS hospitals in the area. TABLE 3B.—FY 2006 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 2004, 2005, and 2006] CBSA code 01 02 03 04 05 06 07 08 10 11 12 13 14 15 16 17 ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. VerDate Aug<04>2004 FY 2006 average hourly wage Nonurban area Alabama .................................................................................................................................................... Alaska ....................................................................................................................................................... Arizona ...................................................................................................................................................... Arkansas ................................................................................................................................................... California ................................................................................................................................................... Colorado .................................................................................................................................................... Connecticut ............................................................................................................................................... Delaware ................................................................................................................................................... Florida ....................................................................................................................................................... Georgia ..................................................................................................................................................... Hawaii ....................................................................................................................................................... Idaho ......................................................................................................................................................... Illinois ........................................................................................................................................................ Indiana ...................................................................................................................................................... Iowa ........................................................................................................................................................... Kansas ...................................................................................................................................................... 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00245 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 20.9677 33.5065 24.5771 20.9189 30.3466 26.2370 32.9843 26.8747 24.0946 21.4961 29.6476 22.5556 23.1784 24.1494 23.7869 22.3594 3-Year Average Hourly Wage 19.9301 31.4748 23.5781 19.6660 27.6453 24.6175 31.5388 25.1962 22.8362 20.5018 27.4203 21.6678 21.8542 22.9960 22.2470 21.2491 23550 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 3B.—FY 2006 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 2004, 2005, and 2006] Nonurban area FY 2006 average hourly wage 3-Year Average Hourly Wage Kentucky ................................................................................................................................................... Louisiana ................................................................................................................................................... Maine ........................................................................................................................................................ Maryland ................................................................................................................................................... Massachusetts 1 ........................................................................................................................................ 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 ............................................................................................................................................... West Virginia ............................................................................................................................................. Wisconsin .................................................................................................................................................. Wyoming ................................................................................................................................................... 21.7864 20.8290 24.7292 25.4559 .................... 24.8226 25.6894 21.5005 22.1717 24.6808 24.2446 25.3983 29.8455 .................... 24.1961 22.8600 23.9761 20.3602 24.5857 21.2973 27.4748 23.2205 .................... .................... 24.2359 23.7080 22.1430 22.4855 22.7561 27.4761 22.4489 29.2600 21.6576 26.5156 25.7561 20.6370 19.5920 23.4474 24.0971 .................... 23.3712 24.4485 20.3551 20.6813 23.0871 23.3257 24.4345 26.8676 .................... 22.4946 21.6353 22.5825 20.0510 23.0443 20.1660 25.9138 21.9390 .................... .................... 22.7771 21.9887 20.8103 21.0274 21.7771 24.9413 21.2273 27.4343 20.5854 24.7363 24.1767 CBSA code 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 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 CBSA code 10180 ....... 10380 ....... 10420 ....... 10500 ....... 10580 ....... VerDate Aug<04>2004 Wage index Urban area (constituent counties) 2 Abilene, TX ..................................................................................................................................................... Callahan County, TX. Jones County, TX. Taylor County, TX. ´ Aguadilla-Isabela-San Sebastian, PR ............................................................................................................... Aguada Municipio, PR. Aguadilla Municipio, PR. ˜ Anasco Municipio, PR. Isabela Municipio, PR. Lares Municipio, PR. Moca Municipio, PR. ´ Rincon Municipio, PR. ´ San Sebastian 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. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00246 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 0.8038 0.8611 0.4736 0.5994 0.8979 0.9289 0.8645 0.9051 0.8565 0.8994 23551 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 10740 ....... 10780 ....... 10900 ....... 10900 ....... 11020 ....... 11100 ....... 11180 ....... 11260 ....... 11300 ....... 11340 ....... 11460 ....... 11500 ....... 11540 ....... 11700 ....... 12020 ....... 12060 ....... VerDate Aug<04>2004 Wage index Urban area (constituent counties) 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 (PA Hospitals) ....................................................................................... Warren County, NJ. Carbon County, PA. Lehigh County, PA. Northampton County, PA. 2 Allentown-Bethlehem-Easton, PA-NJ (NJ Hospitals) ..................................................................................... Warren County, NJ. Carbon County, PA. Lehigh County, PA. Northampton County, PA. 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. 2Appleton, 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. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00247 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 0.9696 0.9791 0.8048 0.8618 0.9844 0.9893 1.0607 1.0412 0.8942 0.9263 0.9165 0.9420 0.9546 0.9687 1.2110 1.1401 0.8634 0.9043 0.8887 0.9224 1.0885 1.0598 0.7702 0.8363 0.9478 0.9640 0.9312 0.9524 0.9813 0.9872 0.9637 0.9750 23552 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 12100 ....... 12220 ....... 12260 ....... 12420 ....... 12540 ....... 12580 ....... 12620 ....... 12700 ....... 12940 ....... 12980 ....... 13020 ....... 13140 ....... 13380 ....... 13460 ....... 13644 ....... 13740 ....... VerDate Aug<04>2004 Wage index Urban area (constituent counties) 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. Columbia County, GA. McDuffie County, GA. Richmond County, GA. Aiken County, SC. Edgefield County, SC. 1Austin-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-Frederick-Gaithersburg, MD ........................................................................................................... Frederick County, MD. Montgomery County, MD. Billings, MT ....................................................................................................................................................... 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00248 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 1.1618 1.1082 0.8113 0.8666 0.9567 0.9701 0.9451 0.9621 1.0848 1.0573 0.9892 0.9926 0.9985 0.9990 1.2518 1.1663 0.8605 0.9022 0.9492 0.9649 0.9535 0.9679 0.8422 0.8890 1.1705 1.1138 1.0783 1.0530 1.1471 1.0985 0.8855 0.9201 23553 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 13780 ....... 13820 ....... 13900 ....... 13980 ....... 14020 ....... 14060 ....... 14260 ....... 14484 ....... 14500 ....... 14540 ....... 14740 ....... 14860 ....... 15180 ....... 15260 ....... 15380 ....... 15500 ....... 15540 ....... 15764 ....... 15804 ....... 15940 ....... VerDate Aug<04>2004 Wage index Urban area (constituent counties) 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. Pulaski County, VA. Radford City, VA. 2 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. 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 2 Camden, NJ .................................................................................................................................................. Burlington County, NJ. Camden County, NJ. Gloucester County, NJ. Canton-Massillon, OH ....................................................................................................................................... Carroll County, OH. Stark County, OH. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00249 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 0.8588 0.9010 0.8979 0.9289 0.7519 0.8226 0.8024 0.8601 0.8632 0.9042 0.9083 0.9363 0.9048 0.9338 1.1537 1.1029 0.9743 0.9823 0.8222 0.8745 1.0681 1.0461 1.2607 1.1719 0.9853 0.9899 0.9341 0.9544 0.8888 0.9224 0.8902 0.9234 1.0199 1.0136 1.1078 1.0726 1.0607 1.0412 0.8957 0.9273 23554 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued Wage index CBSA code Urban area (constituent counties) 15980 ....... Cape Coral-Fort Myers, FL ............................................................................................................................... Lee County, FL. Carson City, NV ................................................................................................................................................ Carson City, NV. 2 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. 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. 2 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. 16180 ....... 16220 ....... 16300 ....... 16580 ....... 16620 ....... 16700 ....... 16740 ....... 16820 ....... 16860 ....... 16940 ....... 16974 ....... 17020 ....... 17140 ....... VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00250 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 0.9333 0.9538 1.0229 1.0156 0.9207 0.9450 0.8605 0.9022 0.9591 0.9718 0.8429 0.8896 0.9433 0.9608 0.9717 0.9805 1.0230 1.0157 0.9099 0.9374 0.9207 0.9450 1.0846 1.0572 1.0848 1.0573 0.9604 0.9727 23555 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 17300 ....... 17420 ....... 17460 ....... 17660 ....... 17780 ....... 17820 ....... 17860 ....... 17900 ....... 17980 ....... 18020 ....... 18140 ....... 18580 ....... 18700 ....... 19060 ....... 19124 ....... VerDate Aug<04>2004 Wage index Urban area (constituent counties) 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. 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. 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. Cumberland, MD-WV ........................................................................................................................................ 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. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00251 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 0.8272 0.8782 0.8160 0.8700 0.9197 0.9443 0.9642 0.9753 0.8911 0.9241 0.9457 0.9625 0.8346 0.8835 0.9057 0.9344 0.8570 0.8997 0.9596 0.9722 0.9848 0.9896 0.8557 0.8988 1.0711 1.0482 0.9310 0.9522 1.0226 1.0154 23556 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 19140 ....... 19180 ....... 19260 ....... 19340 ....... 19380 ....... 19460 ....... 19500 ....... 19660 ....... 19740 ....... 19780 ....... 19804 ....... 20020 ....... 20100 ....... 20220 ....... 20260 ....... 20500 ....... 20740 ....... 20764 ....... VerDate Aug<04>2004 Wage index Urban area (constituent counties) 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. 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, IA ................................................................................................................................................. Dallas County, IA. Guthrie County, IA. Madison County, IA. Polk County, IA. Warren County, IA. 1 Detroit-Livonia-Dearborn, MI ........................................................................................................................... Wayne County, MI. 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. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00252 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 0.9033 0.9327 0.9048 0.9338 0.8514 0.8957 0.8716 0.9102 0.9069 0.9353 0.8517 0.8959 0.8285 0.8791 0.9307 0.9520 1.0710 1.0481 0.9650 0.9759 1.0453 1.0308 0.7743 0.8393 0.9821 0.9877 0.9116 0.9386 1.0224 1.0153 1.0260 1.0177 0.9478 0.9640 1.1301 1.0874 23557 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 20940 ....... 21060 ....... 21140 ....... 21300 ....... 21340 ....... 21500 ....... 21604 ....... 21660 ....... 21780 ....... 21820 ....... 21940 ....... 22020 ....... 22020 ....... 22140 ....... 22180 ....... 22220 ....... 22380 ....... 22420 ....... 22500 ....... 22520 ....... 22540 ....... 22660 ....... 22744 ....... 22900 ....... 23020 ....... VerDate Aug<04>2004 Wage index Urban area (constituent counties) 2 El Centro, CA .................................................................................................................................................. Imperial County, CA. Elizabethtown, KY ............................................................................................................................................. Hardin County, KY. Larue County, KY. Elkhart-Goshen, IN ........................................................................................................................................... Elkhart County, IN. Elmira, NY ......................................................................................................................................................... Chemung County, NY. El Paso, TX ....................................................................................................................................................... El Paso County, TX. Erie, PA ............................................................................................................................................................. Erie County, PA. Essex County, MA ............................................................................................................................................ Essex County, MA. Eugene-Springfield, OR .................................................................................................................................... Lane County, OR. Evansville, IN-KY .............................................................................................................................................. 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. Fargo, ND-MN (ND Hospitals) .......................................................................................................................... Clay County, MN. Cass County, ND. 2 Fargo, ND-MN (MN Hospitals) ....................................................................................................................... Clay County, MN. Cass County, ND. 2 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. 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. Fort Walton Beach-Crestview-Destin, FL ......................................................................................................... Okaloosa County, FL. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00253 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 1.0848 1.0573 0.8816 0.9173 0.9616 0.9735 0.8276 0.8785 0.8954 0.9271 0.8746 0.9123 1.0525 1.0357 1.0810 1.0548 0.8735 0.9115 1.1977 1.1315 0.4160 0.5485 0.8778 0.9146 0.9183 0.9433 0.8649 0.9054 0.9426 0.9603 0.8615 0.9029 1.2094 1.1391 1.0654 1.0443 0.8988 0.9295 0.8305 0.8806 0.9649 0.9758 1.0146 1.0100 1.0508 1.0345 0.8231 0.8752 0.8877 0.9217 23558 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued Wage index CBSA code Urban area (constituent counties) 23060 ....... 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. 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. Grand Forks, ND-MN ........................................................................................................................................ 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, 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 .................................................................................................................................... 23104 ....... 23420 ....... 23460 ....... 23540 ....... 23580 ....... 23844 ....... 24020 ....... 24140 ....... 24220 ....... 24300 ....... 24340 ....... 24500 ....... 24540 ....... 24580 ....... 24660 ....... 24780 ....... 24860 ....... 25020 ....... 25060 ....... 25180 ....... 25260 ....... VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00254 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 0.9797 0.9861 0.9514 0.9665 1.0848 1.0573 0.7974 0.8564 0.9461 0.9628 0.8897 0.9231 0.9366 0.9561 0.8587 0.9009 0.8781 0.9148 1.1521 1.1018 0.9590 0.9717 0.9398 0.9584 0.9074 0.9356 0.9597 0.9722 0.9478 0.9640 0.9133 0.9398 0.9414 0.9595 1.0138 1.0094 0.3186 0.4569 0.8922 0.9249 0.9528 0.9674 1.0848 1.0573 23559 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 25420 ....... 25500 ....... 25540 ....... 25620 ....... 25860 ....... 25980 ....... 26100 ....... 26180 ....... 26300 ....... 26380 ....... 26420 ....... 26580 ....... 26620 ....... 26820 ....... 26900 ....... 26980 ....... VerDate Aug<04>2004 Wage index Urban area (constituent counties) Kings County, CA. Harrisburg-Carlisle, PA ..................................................................................................................................... Cumberland County, PA. Dauphin County, PA. Perry County, PA. Harrisonburg, VA .............................................................................................................................................. Rockingham County, VA. Harrisonburg City, VA. 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-Baytown-Sugar Land, 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, 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. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00255 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 0.9317 0.9527 0.9101 0.9375 1.1790 1.1194 0.7685 0.8350 0.8931 0.9255 0.7684 0.8349 0.9133 0.9398 1.1206 1.0811 0.9066 0.9351 0.7903 0.8512 1.0008 1.0005 0.9482 0.9642 0.9124 0.9391 0.9409 0.9591 0.9922 0.9947 0.9751 0.9829 23560 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 27060 ....... 27100 ....... 27140 ....... 27180 ....... 27260 ....... 27340 ....... 27500 ....... 27620 ....... 27740 ....... 27780 ....... 27860 ....... 27900 ....... 28020 ....... 28100 ....... 28140 ....... 28420 ....... 28660 ....... 28700 ....... VerDate Aug<04>2004 Wage index Urban area (constituent counties) Washington County, IA. Ithaca, NY ......................................................................................................................................................... Tompkins County, NY. Jackson, MI ....................................................................................................................................................... Jackson County, MI. Jackson, MS ..................................................................................................................................................... Copiah County, MS. Hinds County, MS. 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. Johnson City, TN .............................................................................................................................................. Carter County, TN. Unicoi County, TN. Washington County, TN. 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. Kennewick-Richland-Pasco, WA ....................................................................................................................... Benton County, WA. Franklin County, WA. Killeen-Temple-Fort Hood, TX .......................................................................................................................... Bell County, TX. Coryell County, TX. Lampasas County, TX. Kingsport-Bristol-Bristol, TN-VA ........................................................................................................................ 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00256 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 0.9855 0.9900 0.9300 0.9515 0.8313 0.8812 0.8964 0.9278 0.9303 0.9517 0.8570 0.8997 0.9561 0.9697 0.8389 0.8867 0.7958 0.8552 0.8348 0.8837 0.7968 0.8559 0.8594 0.9014 1.0403 1.0274 1.0991 1.0668 0.9454 0.9623 1.0619 1.0420 0.8566 0.8994 0.8095 0.8653 23561 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 28740 ....... 28940 ....... 29020 ....... 29100 ....... 29140 ....... 29180 ....... 29340 ....... 29404 ....... 29460 ....... 29540 ....... 29620 ....... 29700 ....... 29740 ....... 29820 ....... 29940 ....... 30020 ....... 30140 ....... 30300 ....... 30300 ....... 30340 ....... 30460 ....... 30620 ....... 30700 ....... VerDate Aug<04>2004 Wage index Urban area (constituent counties) Hawkins County, TN. Sullivan County, TN. 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. 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. 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 ........................................................................................................................................................ 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00257 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 0.9260 0.9487 0.8470 0.8925 0.9555 0.9693 0.9557 0.9694 0.8730 0.9112 0.8429 0.8896 0.7847 0.8470 1.0444 1.0302 0.8934 0.9257 0.9716 0.9805 0.9786 0.9853 0.8101 0.8657 0.8649 0.9054 1.1416 1.0949 0.8538 0.8974 0.7916 0.8521 0.8654 0.9057 0.9878 0.9916 1.0459 1.0312 0.9332 0.9538 0.9060 0.9346 0.9263 0.9489 1.0197 1.0134 23562 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 30780 ....... 30860 ....... 30980 ....... 31020 ....... 31084 ....... 31140 ....... 31180 ....... 31340 ....... 31420 ....... 31460 ....... 31540 ....... 31700 ....... 31900 ....... 32420 ....... 32580 ....... 32780 ....... 32820 ....... VerDate Aug<04>2004 Wage index Urban area (constituent counties) Lancaster County, NE. Seward County, NE. Little Rock-North Little Rock, 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. 2 Longview, WA ................................................................................................................................................. Cowlitz County, WA. 1 Los Angeles-Long Beach-Glendale, CA ......................................................................................................... Los Angeles County, CA. 1 Louisville, 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. ¨ Mayaguez, PR .................................................................................................................................................. Hormigueros Municipio, PR. ¨ Mayaguez Municipio, PR. McAllen-Edinburg-Pharr, TX ............................................................................................................................. Hidalgo County, TX. 2 Medford, OR ................................................................................................................................................... Jackson County, OR. 1 Memphis, TN-MS-AR ...................................................................................................................................... Crittenden County, AR. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00258 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 0.8768 0.9139 0.9183 0.9433 0.8741 0.9120 1.0459 1.0312 1.1762 1.1175 0.9264 0.9490 0.8790 0.9155 0.8706 0.9095 0.9485 0.9644 1.0848 1.0573 1.0629 1.0427 1.0668 1.0453 0.8788 0.9153 0.4016 0.5354 0.8945 0.9265 1.0284 1.0194 0.9346 0.9547 23563 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 32900 ....... 33124 ....... 33140 ....... 33260 ....... 33340 ....... 33460 ....... 33540 ....... 33660 ....... 33700 ....... 33740 ....... 33780 ....... 33860 ....... 34060 ....... 34100 ....... 34580 ....... 34620 ....... 34740 ....... 34820 ....... 34900 ....... 34940 ....... 34980 ....... VerDate Aug<04>2004 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. Morristown, TN .................................................................................................................................................. Grainger County, TN. Hamblen County, TN. Jefferson County, TN. 2 Mount Vernon-Anacortes, WA ........................................................................................................................ Skagit County, WA. Muncie, IN ......................................................................................................................................................... Delaware County, IN. Muskegon-Norton Shores, MI ........................................................................................................................... Muskegon County, MI. 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, TN ......................................................................................................... 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00259 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 1.1123 1.0756 0.9757 0.9833 0.9409 0.9591 0.9522 0.9670 1.0111 1.0076 1.1055 1.0711 0.9535 0.9679 0.7902 0.8511 1.1885 1.1255 0.8044 0.8615 0.9468 0.9633 0.8600 0.9019 0.8439 0.8903 0.8758 0.9132 1.0459 1.0312 0.8952 0.9270 0.9677 0.9778 0.8869 0.9211 1.2643 1.1742 1.0115 1.0079 0.9757 0.9833 23564 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 35004 ....... 35084 ....... 35300 ....... 35380 ....... 35644 ....... 35660 ....... 35980 ....... 36084 ....... 36100 ....... 36140 ....... 36220 ....... 36260 ....... 36420 ....... VerDate Aug<04>2004 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-Wayne-White Plains, 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. 2 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. 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. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00260 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 1.2781 1.1830 1.2192 1.1454 1.1790 1.1194 0.9003 0.9306 1.3191 1.2088 0.8923 0.9249 1.1790 1.1194 1.5474 1.3485 0.8955 0.9272 1.1031 1.0695 0.9893 0.9927 0.9048 0.9338 0.9043 0.9334 23565 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— 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, 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. Oxnard-Thousand Oaks-Ventura, CA ............................................................................................................... Ventura County, CA. Palm Bay-Melbourne-Titusville, FL ................................................................................................................... Brevard County, FL. 2 Panama City-Lynn Haven, FL ........................................................................................................................ Bay County, FL. Parkersburg-Marietta, WV-OH (WV Hospitals) ................................................................................................. Washington County, OH. Pleasants County, WV. Wirt County, WV. Wood County, WV. 2 Parkersburg-Marietta, WV-OH (OH Hospitals) ............................................................................................... Washington County, OH. Pleasants County, WV. Wirt County, WV. Wood County, WV. Pascagoula, MS ................................................................................................................................................ George County, MS. Jackson County, MS. 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. Beaver County, PA. Butler County, PA. Fayette County, PA. Washington County, PA. 36540 ....... 36740 ....... 36780 ....... 36980 ....... 37100 ....... 37340 ....... 37460 ....... 37620 ....... 37620 ....... 37700 ....... 37860 ....... 37900 ....... 37964 ....... 38060 ....... 38220 ....... 38300 ....... VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00261 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 1.0970 1.0655 0.9555 0.9693 0.9446 0.9617 0.9478 0.9640 0.8806 0.9166 1.1604 1.1072 0.9826 0.9881 0.8613 0.9028 0.8303 0.8804 0.8788 0.9153 0.8164 0.8703 0.8613 0.9028 0.8844 0.9193 1.1030 1.0694 1.0139 1.0095 0.8716 0.9102 0.8840 0.9190 23566 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 38340 ....... 38540 ....... 38660 ....... 38860 ....... 38900 ....... 38940 ....... 39100 ....... 39140 ....... 39300 ....... 39340 ....... 39380 ....... 39460 ....... 39540 ....... 39580 ....... 39660 ....... 39740 ....... 39820 ....... 39900 ....... 40060 ....... VerDate Aug<04>2004 Wage index Urban area (constituent counties) Westmoreland County, PA. Pittsfield, MA ..................................................................................................................................................... Berkshire County, MA. Pocatello, ID ...................................................................................................................................................... Bannock County, ID. Power County, ID. Ponce, PR ......................................................................................................................................................... ´ Juana Dıaz 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-Fort Pierce, 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. Dinwiddie County, VA. Goochland County, VA. Hanover County, VA. Henrico County, VA. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00262 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 1.0183 1.0125 0.9348 0.9549 0.5178 0.6372 1.0382 1.0260 1.1229 1.0826 1.0162 1.0111 1.0767 1.0519 0.9884 0.9920 1.0952 1.0643 0.9578 0.9709 0.9379 0.9570 0.9274 0.9497 0.9478 0.9640 0.9709 0.9800 0.9027 0.9323 0.9698 0.9792 1.2207 1.1463 1.0984 1.0664 0.9319 0.9528 23567 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 40140 ....... 40220 ....... 40340 ....... 40380 ....... 40420 ....... 40484 ....... 40580 ....... 40660 ....... 40900 ....... 40980 ....... 41060 ....... 41100 ....... 41140 ....... 41180 ....... VerDate Aug<04>2004 Wage index Urban area (constituent counties) 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 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 .............................................................................................................................................. Edgecombe County, 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. 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. St. Clair County, IL. Crawford County, MO. Franklin County, MO. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00263 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 1.1021 1.0688 0.8450 0.8911 1.1128 1.0759 0.9117 0.9387 0.9975 0.9983 1.0668 1.0453 0.8924 0.9250 0.9414 0.9595 1.2953 1.1939 0.9474 0.9637 1.0030 1.0021 0.9416 0.9596 0.9565 0.9700 0.8953 0.9271 23568 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 41420 ....... 41500 ....... 41540 ....... 41620 ....... 41660 ....... 41700 ....... 41740 ....... 41780 ....... 41884 ....... 41900 ....... 41940 ....... 41980 ....... VerDate Aug<04>2004 Wage index Urban area (constituent counties) 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 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 German-Cabo Rojo, PR ............................................................................................................................ Cabo Rojo Municipio, PR. Lajas Municipio, PR. Sabana Grande Municipio, PR. ´ San German 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. ´ Bayamon Municipio, PR. Caguas Municipio, PR. Camuy Municipio, PR. ´ Canovanas Municipio, PR. Carolina Municipio, PR. ˜ Catano Municipio, PR. Cayey Municipio, PR. Ciales Municipio, PR. Cidra Municipio, PR. ´ Comerıo Municipio, PR. Corozal Municipio, PR. Dorado Municipio, PR. Florida Municipio, PR. Guaynabo Municipio, PR. Gurabo Municipio, PR. Hatillo Municipio, PR. Humacao Municipio, PR. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00264 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 1.0445 1.0303 1.4140 1.2677 0.9099 0.9374 0.9436 0.9610 0.8287 0.8793 0.8987 0.9295 1.1417 1.0950 0.9033 0.9327 1.4970 1.3182 0.4646 0.5916 1.5114 1.3269 0.4686 0.5951 23569 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 42020 ....... 42044 ....... 42060 ....... 42100 ....... 42140 ....... 42220 ....... 42260 ....... 42340 ....... 42540 ....... 42644 ....... 43100 ....... 43300 ....... 43340 ....... 43580 ....... 43620 ....... 43780 ....... 43900 ....... 44060 ....... VerDate Aug<04>2004 Wage index Urban area (constituent counties) Juncos Municipio, PR. Las Piedras Municipio, PR. ´ Loıza Municipio, PR. ´ Manatı Municipio, PR. Maunabo Municipio, PR. Morovis Municipio, PR. Naguabo Municipio, PR. Naranjito Municipio, PR. Orocovis Municipio, PR. Quebradillas Municipio, PR. ´ Rıo 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 Santa Ana-Anaheim-Irvine, CA ....................................................................................................................... Orange County, CA. 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. Scranton—Wilkes-Barre, PA ............................................................................................................................. Lackawanna County, PA. Luzerne County, PA. Wyoming County, PA. 1 Seattle-Bellevue-Everett, WA ......................................................................................................................... King County, WA. Snohomish County, WA. 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. Cass County, MI. Spartanburg, SC ............................................................................................................................................... Spartanburg County, SC. Spokane, WA .................................................................................................................................................... Spokane County, WA. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00265 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 1.1357 1.0910 1.1564 1.1046 1.1525 1.1021 1.5159 1.3296 1.0908 1.0613 1.3480 1.2269 0.9554 0.9692 0.9483 0.9643 0.8530 0.8968 1.1573 1.1052 0.9478 0.9640 0.9518 0.9667 0.8767 0.9138 0.9360 0.9557 0.9616 0.9735 0.9785 0.9852 0.9183 0.9433 1.0898 1.0607 23570 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued Wage index CBSA code Urban area (constituent counties) 44100 ....... 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. 2 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. 2 Terre Haute, IN ............................................................................................................................................... Clay County, IN. Sullivan County, IN. Vermillion County, IN. Vigo County, IN. Texarkana, TX-Texarkana, AR ......................................................................................................................... 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. Okmulgee County, OK. Osage County, OK. Pawnee County, OK. Rogers County, OK. Tulsa County, OK. Wagoner County, OK. Tuscaloosa, AL ................................................................................................................................................. Greene County, AL. 44140 ....... 44180 ....... 44220 ....... 44300 ....... 44700 ....... 44940 ....... 45060 ....... 45104 ....... 45220 ....... 45300 ....... 45460 ....... 45500 ....... 45780 ....... 45820 ....... 45940 ....... 46060 ....... 46140 ....... 46220 ....... VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00266 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 0.8879 0.9218 1.0259 1.0177 0.8251 0.8766 0.8788 0.9153 0.8368 0.8851 1.1333 1.0895 0.8663 0.9064 0.9595 0.9721 1.0794 1.0537 0.8712 0.9099 0.9292 0.9510 0.8632 0.9042 0.8293 0.8797 0.9573 0.9706 0.8921 0.9248 1.0837 1.0566 0.9007 0.9309 0.8313 0.8812 0.8724 0.9108 23571 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 46340 ....... 46540 ....... 46660 ....... 46700 ....... 46940 ....... 47020 ....... 47220 ....... 47260 ....... 47300 ....... 47380 ....... 47580 ....... 47644 ....... 47894 ....... VerDate Aug<04>2004 Wage index Urban area (constituent counties) 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. Vero Beach, FL ................................................................................................................................................. Indian River County, FL. Victoria, TX ....................................................................................................................................................... Calhoun County, TX. Goliad County, TX. Victoria County, TX. 2 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-Farmington Hills-Troy, 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. Warren County, VA. Alexandria City, VA. Fairfax City, VA. Falls Church City, VA. Fredericksburg City, VA. Manassas City, VA. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00267 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 0.9322 0.9531 0.8313 0.8812 0.8873 0.9214 1.4888 1.3133 0.9458 0.9626 0.8148 0.8691 1.0607 1.0412 0.8841 0.9191 1.0848 1.0573 0.8532 0.8970 0.8662 0.9063 0.9858 0.9903 1.0935 1.0631 23572 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 47940 ....... 48140 ....... 48260 ....... 48260 ....... 48300 ....... 48424 ....... 48540 ....... 48540 ....... 48620 ....... 48660 ....... 48700 ....... 48864 ....... 48900 ....... 49020 ....... 49180 ....... 49340 ....... 49420 ....... 49500 ....... 49620 ....... 49660 ....... VerDate Aug<04>2004 Wage index Urban area (constituent counties) 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. Weirton-Steubenville, WV-OH (WV Hospitals) ................................................................................................. Jefferson County, OH. Brooke County, WV. Hancock County, WV. 2 Weirton-Steubenville, WV-OH (OH Hospitals) ............................................................................................... Jefferson County, OH. Brooke County, WV. Hancock County, WV. 2 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 (WV Hospitals) ................................................................................................................. Belmont County, OH. Marshall County, WV. Ohio County, WV. 2 Wheeling, WV-OH (OH 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. 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 ......................................................................................................................................................... ´ Guanica Municipio, PR. Guayanilla Municipio, PR. ˜ Penuelas Municipio, PR. Yauco Municipio, PR. York-Hanover, PA ............................................................................................................................................. York County, PA. 2 Youngstown-Warren-Boardman, OH-PA (OH Hospitals) ............................................................................... Mahoning County, OH. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00268 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 GAF 0.8564 0.8993 0.9964 0.9975 0.7821 0.8451 0.8788 0.9153 1.0459 1.0312 1.0061 1.0042 0.7742 0.8392 0.8788 0.9153 0.9156 0.9414 0.8327 0.8822 0.8368 0.8851 1.0652 1.0442 0.9580 0.9710 1.0214 1.0146 0.9020 0.9318 1.1044 1.0704 1.0459 1.0312 0.4413 0.5711 0.9422 0.9600 0.8788 0.9153 23573 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4A.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR URBAN AREAS BY CBSA— Continued CBSA code 49660 ....... 49700 ....... 49740 ....... 1 Large Wage index Urban area (constituent counties) Trumbull County, OH. Mercer County, PA. Youngstown-Warren-Boardman, OH-PA (PA Hospitals) .................................................................................. Mahoning County, OH. Trumbull County, OH. Mercer County, PA. Yuba City, CA ................................................................................................................................................... Sutter County, CA. Yuba County, CA. Yuma, AZ .......................................................................................................................................................... Yuma County, AZ. GAF 0.8609 0.9025 1.0951 1.0642 0.9188 0.9437 urban area. geographically located in the area are assigned the statewide rural wage index for FY 2006. 2 Hospitals TABLE 4B.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR RURAL AREAS BY CBSA 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 51 52 ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. VerDate Aug<04>2004 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 1 ................................................................................................................................................ 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 ....................................................................................................................................................... West Virginia ..................................................................................................................................................... Wisconsin .......................................................................................................................................................... 0.7495 1.1977 0.8991 0.7478 1.0848 0.9379 1.1790 0.9606 0.8613 0.7684 1.0598 0.8810 0.8285 0.8632 0.8563 0.8032 0.7788 0.7445 0.8840 0.9099 1.0066 0.8923 0.9183 0.7685 0.7927 0.8822 0.8666 0.9079 1.0668 1.0607 0.8649 0.8220 0.8570 0.7278 0.8788 0.7615 1.0284 0.8300 ................ 0.8807 0.8663 0.8475 0.7915 0.8038 0.8134 1.0199 0.8024 1.0459 0.7742 0.9478 0.8208 1.1315 0.9298 0.8195 1.0573 0.9570 1.1194 0.9728 0.9028 0.8349 1.0406 0.9169 0.8791 0.9042 0.8992 0.8606 0.8427 0.8171 0.9190 0.9374 1.0045 0.9249 0.9433 0.8350 0.8529 0.9177 0.9066 0.9360 1.0453 1.0412 0.9054 0.8744 0.8997 0.8045 0.9153 0.8298 1.0194 0.8802 ................ 0.9167 0.9064 0.8929 0.8520 0.8611 0.8681 1.0136 0.8601 1.0312 0.8392 0.9640 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00269 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 23574 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4B.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR RURAL AREAS BY CBSA— Continued CBSA code Nonurban area Wage index 53 ............. Wyoming ........................................................................................................................................................... GAF 0.9207 0.9450 1 All counties within the State are classified as urban, with the exception of Massachusetts. Massachusetts has area(s) designated as rural, however, no short-term, acute care hospitals are located in the area(s) for FY 2006. Massachusetts, New Jersey, and Rhode Island rural floors are imputed as discussed in section III. H. of the preamble of this proposed rule. TABLE 4C.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR HOSPITALS THAT ARE RECLASSIFIED BY CBSA CBSA code 10180 10420 10580 10740 10780 10900 11020 11100 11180 11460 11500 11700 12020 12060 12420 12620 12700 12940 13020 13780 13820 14260 14484 14540 15380 15540 15764 16180 16220 16580 16620 16620 16700 16740 16820 16860 16974 17140 17300 17460 17780 17860 17900 17980 18140 18700 19124 19380 19460 19740 19780 19804 20260 20500 20764 20940 21060 21500 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<04>2004 Wage index Area Abilene, TX ....................................................................................................................................................... Akron, OH ......................................................................................................................................................... Albany-Schenectady-Troy, NY .......................................................................................................................... Albuquerque, NM .............................................................................................................................................. Alexandria, LA ................................................................................................................................................... Allentown-Bethlehem-Easton, PA-NJ ............................................................................................................... Altoona, PA ....................................................................................................................................................... Amarillo, TX ...................................................................................................................................................... Ames, IA ........................................................................................................................................................... Ann Arbor, MI .................................................................................................................................................... Anniston-Oxford, AL .......................................................................................................................................... Asheville, NC .................................................................................................................................................... Athens-Clarke County, GA ................................................................................................................................ Atlanta-Sandy Springs-Marietta, GA ................................................................................................................. Austin-Round Rock, TX .................................................................................................................................... Bangor, ME ....................................................................................................................................................... Barnstable Town, MA ........................................................................................................................................ Baton Rouge, LA .............................................................................................................................................. Bay City, MI ...................................................................................................................................................... Binghamton, NY ................................................................................................................................................ Birmingham-Hoover, AL .................................................................................................................................... Boise City-Nampa, ID ....................................................................................................................................... Boston-Quincy, MA ........................................................................................................................................... Bowling Green, KY ........................................................................................................................................... Buffalo-Niagara Falls, NY ................................................................................................................................. Burlington-South Burlington, VT ....................................................................................................................... Cambridge-Newton-Framingham, MA .............................................................................................................. Carson City, NV ................................................................................................................................................ Casper, WY ....................................................................................................................................................... Champaign-Urbana, IL ...................................................................................................................................... Charleston, WV (WV Hospitals) ........................................................................................................................ Charleston, WV(OH Hospitals) ......................................................................................................................... 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 ................................................................................................................................................... Columbia, SC .................................................................................................................................................... Columbus, GA-AL ............................................................................................................................................. Columbus, OH .................................................................................................................................................. Corvallis, OR ..................................................................................................................................................... Dallas-Plano-Irving, TX ..................................................................................................................................... Dayton, OH ....................................................................................................................................................... Decatur, AL ....................................................................................................................................................... Denver-Aurora, CO ........................................................................................................................................... Des Moines, IA ................................................................................................................................................. Detroit-Livonia-Dearborn, MI ............................................................................................................................. Duluth, MN-WI .................................................................................................................................................. Durham, NC ...................................................................................................................................................... Edison, NJ ......................................................................................................................................................... El Centro, CA .................................................................................................................................................... Elizabethtown, KY ............................................................................................................................................. Erie, PA ............................................................................................................................................................. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00270 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 0.8038 0.8979 0.8565 0.9558 0.8048 0.9844 0.8942 0.9165 0.9231 1.0628 0.7702 0.9312 0.9684 0.9637 0.9451 0.9985 1.2254 0.8470 0.9535 0.8471 0.8872 0.9048 1.1233 0.8222 0.8888 0.9306 1.0903 0.9786 0.9207 0.9335 0.8274 0.8788 0.9317 0.9585 0.9806 0.9099 1.0698 0.9604 0.8092 0.9197 0.8911 0.8346 0.9057 0.8402 0.9848 1.0328 0.9955 0.9069 0.8517 1.0517 0.9413 1.0453 1.0224 0.9993 1.1301 0.9102 0.8286 0.8424 GAF 0.8611 0.9289 0.8994 0.9695 0.8618 0.9893 0.9263 0.9420 0.9467 1.0426 0.8363 0.9524 0.9783 0.9750 0.9621 0.9990 1.1494 0.8925 0.9679 0.8926 0.9213 0.9338 1.0829 0.8745 0.9224 0.9519 1.0610 0.9853 0.9450 0.9540 0.8783 0.9153 0.9527 0.9714 0.9867 0.9374 1.0473 0.9727 0.8650 0.9443 0.9241 0.8835 0.9344 0.8876 0.9896 1.0223 0.9969 0.9353 0.8959 1.0351 0.9594 1.0308 1.0153 0.9995 1.0874 0.9376 0.8792 0.8892 23575 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4C.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR HOSPITALS THAT ARE RECLASSIFIED BY CBSA—Continued CBSA code 21604 21660 21780 22020 22020 22180 22220 22380 22420 22540 22660 22744 22900 23020 23060 23104 23540 23844 24340 24500 24540 24580 24580 24780 24860 25060 25420 25500 25540 25540 25860 26100 26180 26420 26580 26620 26900 26980 27060 27140 27180 27260 27860 27900 28020 28100 28140 28420 28700 28740 28940 29180 29404 29460 29620 29740 29820 30020 30460 30620 30700 30780 30980 31084 31140 31180 31340 31420 31540 31700 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<04>2004 Wage index Area Essex County, MA ............................................................................................................................................ Eugene-Springfield, OR .................................................................................................................................... Evansville, IN-KY .............................................................................................................................................. Fargo, ND-MN (ND, SD Hospitals) ................................................................................................................... Fargo, ND-MN (MN Hospitals) .......................................................................................................................... Fayetteville, NC ................................................................................................................................................. Fayetteville-Springdale-Rogers, AR-MO ........................................................................................................... Flagstaff, AZ ...................................................................................................................................................... Flint, MI ............................................................................................................................................................. Fond du Lac, WI ............................................................................................................................................... Fort Collins-Loveland, CO ................................................................................................................................. Ft Lauderdale-Pompano Beach-Deerfield Beach, FL ....................................................................................... Fort Smith, AR-OK ............................................................................................................................................ Fort Walton Beach-Crestview-Destin, FL ......................................................................................................... Fort Wayne, IN .................................................................................................................................................. Fort Worth-Arlington, TX ................................................................................................................................... Gainesville, FL .................................................................................................................................................. Gary, IN ............................................................................................................................................................. Grand Rapids-Wyoming, MI .............................................................................................................................. Great Falls, MT ................................................................................................................................................. Greeley, CO ...................................................................................................................................................... Green Bay, WI (MI Hospitals) ........................................................................................................................... Green Bay, WI (WI Hospitals) .......................................................................................................................... Greenville, NC ................................................................................................................................................... Greenville, SC ................................................................................................................................................... Gulfport-Biloxi, MS ............................................................................................................................................ Harrisburg-Carlisle, PA ..................................................................................................................................... Harrisonburg, VA .............................................................................................................................................. Hartford-West Hartford-East Hartford, CT (MA Hospitals) ............................................................................... Hartford-West Hartford-East Hartford, CT (CT Hospitals) ................................................................................ Hickory-Lenoir-Morganton, NC ......................................................................................................................... Holland-Grand Haven, MI ................................................................................................................................. Honolulu, HI ...................................................................................................................................................... Houston-Baytown-Sugar Land, TX ................................................................................................................... Huntington-Ashland, WV-KY-OH ...................................................................................................................... Huntsville, AL .................................................................................................................................................... Indianapolis, IN ................................................................................................................................................. Iowa City, IA ...................................................................................................................................................... Ithaca, NY ......................................................................................................................................................... Jackson, MS ..................................................................................................................................................... Jackson, TN ...................................................................................................................................................... Jacksonville, FL ................................................................................................................................................ Jonesboro, AR .................................................................................................................................................. Joplin, MO ......................................................................................................................................................... Kalamazoo-Portage, MI .................................................................................................................................... Kankakee-Bradley, IL ........................................................................................................................................ Kansas City, MO-KS ......................................................................................................................................... Kennewick-Richland-Pasco, WA ....................................................................................................................... Kingsport-Bristol-Bristol, TN-VA ........................................................................................................................ Kingston, NY ..................................................................................................................................................... Knoxville, TN ..................................................................................................................................................... Lafayette, LA ..................................................................................................................................................... Lake County-Kenosha County, IL-WI ............................................................................................................... Lakeland, FL ..................................................................................................................................................... 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, AR ...................................................................................................................... Longview, TX .................................................................................................................................................... Los Angeles-Long Beach-Santa Ana, CA ........................................................................................................ Louisville, KY-IN ................................................................................................................................................ Lubbock, TX ...................................................................................................................................................... Lynchburg, VA .................................................................................................................................................. Macon, GA ........................................................................................................................................................ Madison, WI ...................................................................................................................................................... Manchester-Nashua, NH ................................................................................................................................... 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00271 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 1.0668 1.0492 0.8508 0.8778 0.9183 0.9193 0.8615 1.1713 1.0654 0.9478 1.0146 1.0508 0.7986 0.8672 0.9797 0.9514 0.9461 0.9366 0.9398 0.9074 0.9597 0.9439 0.9478 0.9414 0.9807 0.8612 0.9145 0.8998 1.1085 1.1790 0.8931 0.9133 1.1206 1.0008 0.9119 0.9124 0.9776 0.9574 0.9204 0.8182 0.8799 0.9303 0.7793 0.8458 1.0403 1.0991 0.9454 1.0459 0.8095 0.8904 0.8470 0.8429 1.0444 0.8934 0.9786 0.8649 1.1249 0.7673 0.8830 0.9263 0.9666 0.8552 0.8621 1.1660 0.9264 0.8790 0.8596 0.9087 1.0416 1.0668 GAF 1.0453 1.0334 0.8953 0.9146 0.9433 0.9440 0.9029 1.1144 1.0443 0.9640 1.0100 1.0345 0.8573 0.9070 0.9861 0.9665 0.9628 0.9561 0.9584 0.9356 0.9722 0.9612 0.9640 0.9595 0.9867 0.9027 0.9406 0.9302 1.0731 1.1194 0.9255 0.9398 1.0811 1.0005 0.9388 0.9391 0.9846 0.9706 0.9448 0.8716 0.9161 0.9517 0.8430 0.8916 1.0274 1.0668 0.9623 1.0312 0.8653 0.9236 0.8925 0.8896 1.0302 0.9257 0.9853 0.9054 1.0839 0.8341 0.9183 0.9489 0.9770 0.8984 0.9034 1.1109 0.9490 0.9155 0.9016 0.9365 1.0283 1.0453 23576 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4C.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR HOSPITALS THAT ARE RECLASSIFIED BY CBSA—Continued CBSA code 32780 32820 33124 33260 33340 33460 33540 33660 33700 33860 34060 34980 35084 35380 35644 36084 36100 36140 36220 36260 36420 36500 36540 36740 37860 37900 37964 38220 38300 38340 38860 38900 38940 39100 39340 39580 39740 39820 39900 39900 40060 40220 40340 40380 40420 40484 40660 40900 40980 41060 41100 41180 41620 41700 41884 41980 42044 42140 42220 42260 42340 42644 43300 43340 43620 43780 43900 44060 44180 44300 ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... ....... VerDate Aug<04>2004 Wage index Area Medford, OR ..................................................................................................................................................... Memphis, TN-MS-AR ........................................................................................................................................ Miami-Miami Beach-Kendall, FL ....................................................................................................................... Midland, TX ....................................................................................................................................................... Milwaukee-Waukesha-West Allis, WI ............................................................................................................... Minneapolis-St. Paul-Bloomington, MN-WI ....................................................................................................... Missoula, MT ..................................................................................................................................................... Mobile, AL ......................................................................................................................................................... Modesto, CA ..................................................................................................................................................... Montgomery, AL ................................................................................................................................................ Morgantown, WV .............................................................................................................................................. Nashville-Davidson—Murfreesboro, TN ............................................................................................................ Newark-Union, NJ-PA ....................................................................................................................................... New Orleans-Metairie-Kenner, LA .................................................................................................................... New York-Wayne-White Plains, NY-NJ ............................................................................................................ 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, FL ....................................................................................................................................................... Pensacola-Ferry Pass-Brent, FL ....................................................................................................................... Peoria, IL ........................................................................................................................................................... Philadelphia, PA ................................................................................................................................................ Pine Bluff, AR ................................................................................................................................................... Pittsburgh, PA ................................................................................................................................................... Pittsfield, MA ..................................................................................................................................................... Portland-South Portland-Biddeford, ME ............................................................................................................ Portland-Vancouver-Beaverton, OR-WA .......................................................................................................... Port St. Lucie-Fort Pierce, FL ........................................................................................................................... Poughkeepsie-Newburgh-Middletown, NY ....................................................................................................... Provo-Orem, UT ................................................................................................................................................ Raleigh-Cary, NC .............................................................................................................................................. Reading, PA ...................................................................................................................................................... Redding, CA ...................................................................................................................................................... Reno-Sparks, NV (NV Hospitals) ...................................................................................................................... Reno-Sparks, NV (CA Hospitals) ...................................................................................................................... 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. Louis, MO-IL ................................................................................................................................................ Salt Lake City, UT ............................................................................................................................................. San Antonio, TX ................................................................................................................................................ San Francisco-San Mateo-Redwood City,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 ............................................................................................................................ Sherman-Denison, TX ....................................................................................................................................... Shreveport-Bossier City, LA .............................................................................................................................. Sioux Falls, SD ................................................................................................................................................. South Bend-Mishawaka, IN-MI ......................................................................................................................... Spartanburg, SC ............................................................................................................................................... Spokane, WA .................................................................................................................................................... Springfield, MO ................................................................................................................................................. State College, PA ............................................................................................................................................. 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00272 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 1.0284 0.9108 0.9757 0.9317 0.9957 1.0905 0.9535 0.7902 1.1885 0.8276 0.8332 0.9492 1.2192 0.9003 1.3191 1.5474 0.8955 1.0289 0.9593 0.9048 0.9043 1.0970 0.9555 0.9446 0.8089 0.8844 1.1030 0.8099 0.8840 1.0199 0.9884 1.1229 1.0162 1.0576 0.9578 0.9476 0.9500 1.1909 1.0805 1.0848 0.9319 0.8450 1.1128 0.9117 0.9667 1.0503 0.9414 1.2953 0.9090 0.9785 0.9416 0.8953 0.9436 0.8987 1.4739 0.4686 1.1297 1.0163 1.3480 0.9554 0.9316 1.1573 0.8971 0.8767 0.9616 0.9785 0.9183 1.0722 0.8251 0.8300 GAF 1.0194 0.9380 0.9833 0.9527 0.9971 1.0611 0.9679 0.8511 1.1255 0.8785 0.8825 0.9649 1.1454 0.9306 1.2088 1.3485 0.9272 1.0197 0.9719 0.9338 0.9334 1.0655 0.9693 0.9617 0.8648 0.9193 1.0694 0.8656 0.9190 1.0136 0.9920 1.0826 1.0111 1.0391 0.9709 0.9638 0.9655 1.1271 1.0545 1.0573 0.9528 0.8911 1.0759 0.9387 0.9771 1.0342 0.9595 1.1939 0.9368 0.9852 0.9596 0.9271 0.9610 0.9295 1.3043 0.5951 1.0871 1.0111 1.2269 0.9692 0.9526 1.1052 0.9283 0.9138 0.9735 0.9852 0.9433 1.0489 0.8766 0.8802 23577 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4C.—WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) FOR HOSPITALS THAT ARE RECLASSIFIED BY CBSA—Continued CBSA code Area Wage index 44940 ....... 45060 ....... 45104 ....... 45220 ....... 45300 ....... 45500 ....... 45820 ....... 46140 ....... 46220 ....... 46340 ....... 46660 ....... 46700 ....... 47260 ....... 47380 ....... 47894 ....... 48140 ....... 48620 ....... 48700 ....... 48864 ....... 48900 ....... 49020 ....... 49180 ....... 49660 ....... 49660 ....... 03 ............. 04 ............. 05 ............. 07 ............. 10 ............. 13 ............. 14 ............. 15 ............. 16 ............. 17 ............. 19 ............. 23 ............. 24 ............. 26 ............. 30 ............. 37 ............. 38 ............. 45 ............. 50 ............. 50 ............. 53 ............. Sumter, SC ....................................................................................................................................................... Syracuse, NY .................................................................................................................................................... Tacoma, WA ..................................................................................................................................................... Tallahassee, FL ................................................................................................................................................ Tampa-St. Petersburg-Clearwater, FL .............................................................................................................. Texarkana, TX-Texarkana, AR ......................................................................................................................... Topeka, KS ....................................................................................................................................................... Tulsa, OK .......................................................................................................................................................... Tuscaloosa, AL ................................................................................................................................................. Tyler, TX ........................................................................................................................................................... Valdosta, GA ..................................................................................................................................................... Vallejo-Fairfield, CA .......................................................................................................................................... Virginia Beach-Norfolk-Newport News, VA ....................................................................................................... Waco, TX .......................................................................................................................................................... Washington-Arlington-Alexandria DC-VA ......................................................................................................... Wausau, WI ...................................................................................................................................................... Wichita, KS ....................................................................................................................................................... Williamsport, PA ................................................................................................................................................ Wilmington, DE-MD-NJ ..................................................................................................................................... Wilmington, NC ................................................................................................................................................. Winchester, VA-WV .......................................................................................................................................... Winston-Salem, NC ........................................................................................................................................... Youngstown-Warren-Boardman, OH-PA (PA Hospitals) .................................................................................. Youngstown-Warren-Boardman, OH-PA (OH Hospitals) ................................................................................. Rural Arizona .................................................................................................................................................... Rural Arkansas ................................................................................................................................................. Rural California ................................................................................................................................................. Rural Connecticut ............................................................................................................................................. Rural Florida ..................................................................................................................................................... Rural Idaho ....................................................................................................................................................... Rural Illinois ...................................................................................................................................................... Rural Indiana ..................................................................................................................................................... Rural Iowa ......................................................................................................................................................... Rural Kansas .................................................................................................................................................... Rural Louisiana ................................................................................................................................................. Rural Michigan .................................................................................................................................................. Rural Minnesota ................................................................................................................................................ Rural Missouri ................................................................................................................................................... Rural New Hampshire ....................................................................................................................................... Rural Oklahoma ................................................................................................................................................ Rural Oregon .................................................................................................................................................... Rural Texas ....................................................................................................................................................... Rural Washington (ID Hospitals) ...................................................................................................................... Rural Washington (WA Hospitals) .................................................................................................................... Rural Wyoming ................................................................................................................................................. GAF 0.8663 0.9315 1.0794 0.8420 0.9292 0.8293 0.8785 0.8313 0.8614 0.9164 0.8710 1.3955 0.8841 0.8532 1.0813 0.9964 0.8946 0.8300 1.0652 0.9394 1.0214 0.9020 0.8446 0.8788 0.8991 0.7478 1.0848 1.0448 0.8613 0.8810 0.8285 0.8632 0.8563 0.8032 0.7445 0.8923 0.9183 0.7927 1.0668 0.7615 1.0284 0.8038 1.0061 1.0459 0.9207 0.9064 0.9526 1.0537 0.8889 0.9510 0.8797 0.9151 0.8812 0.9029 0.9420 0.9098 1.2564 0.9191 0.8970 1.0550 0.9975 0.9266 0.8802 1.0442 0.9581 1.0146 0.9318 0.8908 0.9153 0.9298 0.8195 1.0573 1.0305 0.9028 0.9169 0.8791 0.9042 0.8992 0.8606 0.8171 0.9249 0.9433 0.8529 1.0453 0.8298 1.0194 0.8611 1.0042 1.0312 0.9450 TABLE 4F.—PUERTO RICO WAGE INDEX AND CAPITAL GEOGRAPHIC ADJUSTMENT FACTOR (GAF) BY CBSA CBSA Code 10380 21940 25020 32420 38660 41900 41980 49500 .......... .......... .......... .......... .......... .......... .......... .......... Area ´ Aguadilla-Isabela-San Sebastian, PR .................................................... Fajardo, PR ............................................................................................ Guayama, PR ......................................................................................... ¨ Mayaguez, PR ........................................................................................ Ponce, PR .............................................................................................. ´ San German-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. VerDate Aug<04>2004 Wage Index 18:31 May 03, 2005 Jkt 205001 1.0196 0.8956 0.6858 0.8647 1.1147 1.0002 1.0087 0.9500 Hospitals cannot receive the outmigration adjustment if they are reclassified under section 1886(d)(10) of the Act or redesignated under section PO 00000 Frm 00273 Fmt 4701 Sfmt 4702 GAF 1.0134 0.9273 0.7724 0.9052 1.0772 1.0001 1.0059 0.9655 Wage Index -Reclassified Hospitals GAF -Reclassified Hospitals .................... .................... .................... .................... .................... .................... 1.0087 .................... .................... .................... .................... .................... .................... .................... 1.0059 .................... 1886(d)(8)(B) of the Act. Hospitals that have already been reclassified under section 1886(d)(10) of the Act or redesignated under section E:\FR\FM\04MYP2.SGM 04MYP2 23578 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 1886(d)(8)(B) of the Act are designated with an asterisk. Hospitals have the opportunity to use the new additional 30-day period to review their individual situation to determine whether to submit a request to withdraw their reclassification/redesignation and receive the out-migration adjustment instead. We will automatically assume that 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 wish to retain their reclassification/redesignation status and waive the application of the out-migration adjustment. Hospitals are not required to provide CMS with any type of formal notification that they wish to remain reclassified/ redesignated. Out-migration adjustment 010005* ... 010008* ... 010009 ..... 010010 ..... 010012* ... 010022* ... 010025* ... 010029* ... 010035* ... 010038 ..... 010045* ... 010047 ..... 010054 ..... 010061 ..... 010072* ... 010078 ..... 010083* ... 010085 ..... 010100* ... 010101* ... 010109 ..... 010115 ..... 010129 ..... 010143* ... 010146 ..... 010150 ..... 010158* ... 040014* ... 040019* ... 040047* ... 040066 ..... 040069* ... 040070 ..... 040071* ... 040076* ... 040100* ... 040143 ..... 050008 ..... 0.0259 0.0212 0.0092 0.0259 0.0205 0.0714 0.0225 0.0107 0.0375 0.0062 0.0160 0.0155 0.0092 0.0506 0.0310 0.0062 0.0121 0.0092 0.0121 0.0310 0.0464 0.0093 0.0121 0.0375 0.0062 0.0155 0.0093 0.0159 0.0697 0.0090 0.0382 0.0140 0.0140 0.0026 0.1075 0.0159 0.0026 0.0028 050009* ... 050013* ... 050014* ... 050016 ..... 0.0478 0.0478 0.0131 0.0087 050042* ... 050046* ... 0.0219 0.0156 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Out-migration adjustment Qualifying county name Provider number 050047 ..... 0.0028 050055 ..... 0.0028 050065* 050069* 050073* 050076* ... ... ... ... 0.0029 0.0029 0.0269 0.0028 050082* ... 050084 ..... 050088 ..... 0.0156 0.0555 0.0087 050089* ... 0.0152 0.0308 0.0152 050101 ..... 050117 ..... 050118* ... 050122 ..... 050129* ... 0.0269 0.0463 0.0555 0.0555 0.0152 050133 ..... 050136* ... 050140* ... 0.017 0.0308 0.0152 050150* ... 050152 ..... 0.0316 0.0028 050159* ... 050167 ..... 050168* ... 050173* ... 050174* ... 050177* ... 050193* ... 050224* ... 050226* ... 050228* ... 0.0156 0.0555 0.0029 0.0029 0.0308 0.0156 0.0029 0.0029 0.0029 0.0028 050230* ... 050232 ..... 0.0029 0.0087 050236* ... 050245* ... 0.0156 0.0152 050253 ..... 050272* ... 0.0029 0.0152 050279* ... 0.0152 050291* ... 050298* ... 0.0308 0.0152 050300* ... 0.0152 050313 ..... 050325 ..... 050327* ... 0.0555 0.0176 0.0152 050331* ... 050335 ..... 050336 ..... 050348* ... 050366 ..... 050367 ..... 050385* ... Qualifying county name MARSHALL CRENSHAW MORGAN MARSHALL DE KALB CHEROKEE CHAMBERS LEE CULLMAN CALHOUN FAYETTE BUTLER MORGAN JACKSON TALLADEGA CALHOUN BALDWIN MORGAN BALDWIN TALLADEGA PICKENS FRANKLIN BALDWIN CULLMAN CALHOUN BUTLER FRANKLIN WHITE ST. FRANCIS RANDOLPH CLARK MISSISSIPPI MISSISSIPPI JEFFERSON HOT SPRING WHITE JEFFERSON SAN FRANCISCO NAPA NAPA AMADOR SAN LUIS OBISPO TEHAMA VENTURA TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2006—Continued 050090* ... 050099* ... TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2006 Provider number TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2006—Continued 0.0308 0.0176 0.0555 0.0029 0.0096 0.0269 0.0308 SAN FRANCISCO SAN FRANCISCO ORANGE ORANGE SOLANO SAN FRANCISCO VENTURA SAN JOAQUIN SAN LUIS OBISPO SAN BERNARDINO SONOMA SAN BERNARDINO SOLANO MERCED SAN JOAQUIN SAN JOAQUIN SAN BERNARDINO YUBA SONOMA SAN BERNARDINO NEVADA SAN FRANCISCO VENTURA SAN JOAQUIN ORANGE ORANGE SONOMA VENTURA ORANGE ORANGE ORANGE SAN FRANCISCO ORANGE SAN LUIS OBISPO VENTURA SAN BERNARDINO ORANGE SAN BERNARDINO SAN BERNARDINO SONOMA SAN BERNARDINO SAN BERNARDINO SAN JOAQUIN TUOLUMNE SAN BERNARDINO SONOMA TUOLUMNE SAN JOAQUIN ORANGE CALAVERAS SOLANO SONOMA Provider number PO 00000 Frm 00274 Fmt 4701 Sfmt 4702 Out-migration adjustment Qualifying county name 050394* ... 050407 ..... 0.0156 0.0028 050426* ... 050444 ..... 050454 ..... 0.0029 0.0463 0.0028 050457 ..... 0.0028 050469* ... 0.0152 050476 050491 050494 050506 ..... ..... ..... ..... 0.0257 0.0029 0.0316 0.0087 050517* ... 0.0152 050526* ... 050528* ... 050535* ... 050539 ..... 050543* ... 050547* ... 050548* ... 050549 ..... 050550* ... 050551* ... 050567* ... 050568 ..... 050570* ... 050580* ... 050584* ... 0.0029 0.0463 0.0029 0.0257 0.0029 0.0308 0.0029 0.0156 0.0029 0.0029 0.0029 0.0062 0.0029 0.0029 0.0152 050585* ... 050586* ... 0.0029 0.0152 050589* 050592* 050594* 050603* 050609* 050616* 050618* ... ... ... ... ... ... ... 0.0029 0.0029 0.0029 0.0029 0.0029 0.0156 0.0152 050633 ..... 0.0087 050667* ... 050668* ... 0.0478 0.0028 050678* ... 050680 ..... 050690* ... 050693 ..... 050695 ..... 050720* ... 050728* ... 060001* ... 060003* ... 060027* ... 060103* ... 070003* ... 070006 ..... 070010 ..... 070018 ..... 070020 ..... 070021* ... 070028 ..... 070033* ... 0.0029 0.0269 0.0308 0.0029 0.0555 0.0029 0.0308 0.0294 0.0203 0.0203 0.0203 0.0009 0.0047 0.0047 0.0047 0.0073 0.0009 0.0047 0.0047 VENTURA SAN FRANCISCO ORANGE MERCED SAN FRANCISCO SAN FRANCISCO SAN BERNARDINO LAKE ORANGE NEVADA SAN LUIS OBISPO SAN BERNARDINO ORANGE MERCED ORANGE LAKE ORANGE SONOMA ORANGE VENTURA ORANGE ORANGE ORANGE MADERA ORANGE ORANGE SAN BERNARDINO ORANGE SAN BERNARDINO ORANGE ORANGE ORANGE ORANGE ORANGE VENTURA SAN BERNARDINO SAN LUIS OBISPO NAPA SAN FRANCISCO ORANGE SOLANO SONOMA ORANGE SAN JOAQUIN ORANGE SONOMA WELD BOULDER BOULDER BOULDER WINDHAM FAIRFIELD FAIRFIELD FAIRFIELD MIDDLESEX WINDHAM FAIRFIELD FAIRFIELD E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2006—Continued Provider number 070034 ..... 080001 ..... 080003 ..... 100014 ..... 100017 ..... 100023* ... 100045* ... 100047 ..... 100062 ..... 100068 ..... 100072 ..... 100077 ..... 100102 ..... 100118* ... 100156 ..... 100175 ..... 100212 ..... 100232* ... 100236 ..... 100249* ... 100252* ... 110023* ... 110026 ..... 110027 ..... 110029* ... 110041* ... 110063 ..... 110069* ... 110120 ..... 110124 ..... 110136 ..... 110146 ..... 110150* ... 110153* ... 110187* ... 110189* ... 110190 ..... 110205* ... 130003* ... 130011 ..... 130024 ..... 130049* ... 140001 ..... 140012* ... 140026 ..... 140033 ..... 140043* ... 140058* ... 140084 ..... 140100 ..... 140110* ... 140129 ..... 140130 ..... 140155 ..... 140160* ... 140161* ... 140167* ... 140173 ..... 140186 ..... 140199 ..... 140202 ..... 140205 ..... 140234* ... 140291* ... 150002* ... 150004* ... 150008* ... 150022 ..... 150030* ... VerDate Aug<04>2004 Out-migration adjustment 0.0047 0.0059 0.0059 0.0118 0.0118 0.0069 0.0118 0.0021 0.0060 0.0118 0.0118 0.0021 0.0133 0.0398 0.0133 0.0231 0.0060 0.0347 0.0021 0.0069 0.0233 0.0500 0.0220 0.0387 0.0063 0.0777 0.0290 0.0474 0.0873 0.0428 0.0261 0.0642 0.0261 0.0474 0.1172 0.0031 0.0182 0.0779 0.0095 0.0218 0.0275 0.0349 0.0199 0.022 0.0346 0.0147 0.0046 0.0081 0.0147 0.0147 0.0346 0.0096 0.0147 0.0027 0.0286 0.0138 0.0937 0.0046 0.0027 0.0109 0.0147 0.0163 0.0346 0.0147 0.0241 0.0241 0.0241 0.0249 0.0201 Qualifying county name FAIRFIELD NEW CASTLE NEW CASTLE VOLUSIA VOLUSIA CITRUS VOLUSIA CHARLOTTE MARION VOLUSIA VOLUSIA CHARLOTTE COLUMBIA FLAGLER COLUMBIA DE SOTO MARION PUTNAM CHARLOTTE CITRUS OKEECHOBEE GORDON ELBERT FRANKLIN HALL HABERSHAM LIBERTY HOUSTON POLK WAYNE BALDWIN CAMDEN BALDWIN HOUSTON LUMPKIN FANNIN MACON GILMER NEZ PERCE LATAH BONNER KOOTENAI FULTON LEE LA SALLE LAKE WHITESIDE MORGAN LAKE LAKE LA SALLE WABASH LAKE KANKAKEE STEPHENSON LIVINGSTON IROQUOIS WHITESIDE KANKAKEE MONTGOMERY LAKE BOONE LA SALLE LAKE LAKE LAKE LAKE MONTGOMERY HENRY 18:31 May 03, 2005 Jkt 205001 TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2006—Continued TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2006—Continued Out-migration adjustment Qualifying county name Provider number 150034 ..... 150035 ..... 150045 ..... 150060 ..... 150062 ..... 150065* ... 150076* ... 150088* ... 150090* ... 150091 ..... 150102* ... 150113* ... 150122 ..... 150125* ... 150126* ... 150132* ... 150147* ... 150156 ..... 160013 ..... 160026* ... 160030 ..... 160032 ..... 160080* ... 160140 ..... 170137* ... 180012* ... 180049 ..... 180055 ..... 180066* ... 180127* ... 180128 ..... 190001* ... 190003* ... 190010 ..... 190015* ... 190017 ..... 190049 ..... 190054 ..... 190078 ..... 190086* ... 190088 ..... 190099* ... 190106* ... 190116 ..... 190133 ..... 190144 ..... 190147 ..... 190148 ..... 190191* ... 200002* ... 200013 ..... 200019 ..... 200020* ... 200024* ... 0.0241 0.0083 0.0416 0.0052 0.0153 0.0139 0.0189 0.0196 0.0241 0.0573 0.0160 0.0196 0.0199 0.0241 0.0241 0.0241 0.0241 0.0241 0.0218 0.0496 0.0032 0.0272 0.0049 0.0364 0.0331 0.0083 0.0532 0.0532 0.0567 0.0352 0.0282 0.0645 0.0107 0.0401 0.0401 0.0235 0.0645 0.0107 0.0235 0.0129 0.0705 0.039 0.0238 0.0179 0.0238 0.0705 0.0401 0.039 0.0235 0.0129 0.0186 0.0067 0.0067 0.0071 200032 ..... 200034* ... 0.046 0.0071 200040 ..... 200050* ... 210001 ..... 210004 ..... 210016 ..... 210018 ..... 210022 ..... 210023 ..... 210028 ..... 210043 ..... 210048 ..... 0.0067 0.0140 0.0129 0.0040 0.0040 0.0040 0.0040 0.0209 0.0512 0.0209 0.0287 LAKE PORTER DE KALB VERMILLION DECATUR JACKSON MARSHALL MADISON LAKE HUNTINGTON STARKE MADISON RIPLEY LAKE LAKE LAKE LAKE LAKE MUSCATINE BOONE STORY JASPER CLINTON PLYMOUTH DOUGLAS HARDIN MADISON MADISON LOGAN FRANKLIN LAWRENCE WASHINGTON IBERIA TANGIPAHOA TANGIPAHOA ST. LANDRY WASHINGTON IBERIA ST. LANDRY LINCOLN WEBSTER AVOYELLES ALLEN MOREHOUSE ALLEN WEBSTER TANGIPAHOA AVOYELLES ST. LANDRY LINCOLN WALDO YORK YORK ANDROSCOGGIN OXFORD ANDROSCOGGIN YORK HANCOCK WASHINGTON MONTGOMERY MONTGOMERY MONTGOMERY MONTGOMERY ANNE ARUNDEL ST. MARYS ANNE ARUNDEL HOWARD 210057 ..... 220001* ... 220002* ... 220003* ... 220006 ..... 220010* ... 220011* ... 220019* ... 220025* ... 220028* ... 220029* ... 220033* ... 220035* ... 220049* ... 220058* ... 220062* ... 220063* ... 220070* ... 220076 ..... 220080* ... 220082* ... 220084* ... 220089* ... 220090* ... 220095* ... 220098* ... 220101* ... 220105* ... 220163* ... 220171* ... 220174* ... 230003 ..... 230005 ..... 230013 ..... 230015 ..... 230019 ..... 230021 ..... 230022* ... 230029 ..... 230037* ... 230041 ..... 230042* ... 230047* ... 230069* ... 230071 ..... 230072 ..... 230075 ..... 230078* ... 230092 ..... 230093* ... 230096* ... 230099* ... 230106 ..... 230120 ..... 230121* ... 230130 ..... 230151 ..... 230174 ..... 230184 ..... 230195* ... 230204* ... 230207 ..... 230217* ... 230222 ..... 230223 ..... 230227* ... 230254 ..... 230257* ... 230264* ... Provider number PO 00000 Frm 00275 Fmt 4701 Sfmt 4702 23579 E:\FR\FM\04MYP2.SGM Out-migration adjustment 04MYP2 0.0040 0.0056 0.0249 0.0056 0.0306 0.0306 0.0249 0.0056 0.0056 0.0056 0.0306 0.0306 0.0306 0.0249 0.0056 0.0056 0.0249 0.0249 0.0249 0.0306 0.0249 0.0249 0.0249 0.0056 0.0056 0.0249 0.0249 0.0249 0.0056 0.0249 0.0306 0.0035 0.0598 0.0091 0.0359 0.0091 0.0136 0.0113 0.0091 0.0178 0.0099 0.0685 0.0082 0.0487 0.0091 0.0035 0.0145 0.0136 0.0389 0.0079 0.0359 0.0339 0.0030 0.0598 0.0691 0.0091 0.0091 0.0035 0.0389 0.0082 0.0082 0.0091 0.0145 0.0228 0.0091 0.0082 0.0091 0.0082 0.0082 Qualifying county name MONTGOMERY WORCESTER MIDDLESEX WORCESTER ESSEX ESSEX MIDDLESEX WORCESTER WORCESTER WORCESTER ESSEX ESSEX ESSEX MIDDLESEX WORCESTER WORCESTER MIDDLESEX MIDDLESEX MIDDLESEX ESSEX MIDDLESEX MIDDLESEX MIDDLESEX WORCESTER WORCESTER MIDDLESEX MIDDLESEX MIDDLESEX WORCESTER MIDDLESEX ESSEX OTTAWA LENAWEE OAKLAND ST. JOSEPH OAKLAND BERRIEN BRANCH OAKLAND HILLSDALE BAY ALLEGAN MACOMB LIVINGSTON OAKLAND OTTAWA CALHOUN BERRIEN JACKSON MECOSTA ST. JOSEPH MONROE NEWAYGO LENAWEE SHIAWASSEE OAKLAND OAKLAND OTTAWA JACKSON MACOMB MACOMB OAKLAND CALHOUN MIDLAND OAKLAND MACOMB OAKLAND MACOMB MACOMB 23580 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2006—Continued Provider number 230269 ..... 230277 ..... 230279* ... 230295* ... 240011 ..... 240013* ... 240014 ..... 240018* ... 240021 ..... 240044 ..... 240064* ... 240069* ... 240071* ... 240089 ..... 240133 ..... 240152* ... 240154 ..... 240187* ... 240205 ..... 240211* ... 250030 ..... 250040* ... 250045 ..... 250088 ..... 250154 ..... 260011* ... 260025* ... 260047* ... 260073 ..... 260074* ... 260097 ..... 260127 ..... 280054 ..... 280077* ... 280123 ..... 290019* ... 290020 ..... 300007* ... 300011* ... 300012* ... 300017* ... 300020* ... 300023* ... 300029* ... 300034* ... 310002* ... 310009* ... 310010 ..... 310011 ..... 310013* ... 310014 ..... 310018* ... 310021 ..... 310022 ..... 310029 ..... 310031* ... 310032* ... 310038* ... 310039 ..... 310044 ..... 310054* ... 310057 ..... 310061 ..... 310070* ... 310076* ... 310078* ... 310083* ... 310086 ..... 310092 ..... VerDate Aug<04>2004 TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2006—Continued Out-migration adjustment Qualifying county name Provider number 0.0091 0.0091 0.0487 0.0685 0.0506 0.0226 0.0454 0.1196 0.0897 0.0868 0.0138 0.0419 0.0454 0.1196 0.0319 0.0735 0.0138 0.0506 0.0138 0.0705 0.0318 0.0294 0.0042 0.0122 0.0318 0.0007 0.0078 0.0007 0.0197 0.0158 0.0425 0.0158 0.0137 0.0089 0.0137 0.0026 0.1013 0.0080 0.0080 0.0080 0.0361 0.0080 0.0361 0.0361 0.0080 0.0351 0.0351 0.0180 0.0181 0.0351 0.0156 0.0351 0.0180 0.0156 0.0156 0.0137 0.0065 0.0350 0.0350 0.0180 0.0351 0.0137 0.0137 0.0350 0.0351 0.0351 0.0351 0.0156 0.0180 OAKLAND OAKLAND LIVINGSTON ALLEGAN MC LEOD MORRISON RICE GOODHUE LE SUEUR WINONA ITASCA STEELE RICE GOODHUE MEEKER KANABEC ITASCA MC LEOD ITASCA PINE LEAKE JACKSON HANCOCK WILKINSON LEAKE COLE MARION COLE BARTON RANDOLPH JOHNSON PIKE GAGE DODGE GAGE CARSON CITY NYE HILLSBOROUGH HILLSBOROUGH HILLSBOROUGH ROCKINGHAM HILLSBOROUGH ROCKINGHAM ROCKINGHAM HILLSBOROUGH ESSEX ESSEX MERCER CAPE MAY ESSEX CAMDEN ESSEX MERCER CAMDEN CAMDEN BURLINGTON CUMBERLAND MIDDLESEX MIDDLESEX MERCER ESSEX BURLINGTON BURLINGTON MIDDLESEX ESSEX ESSEX ESSEX CAMDEN MERCER 310093* ... 310096* ... 310108 ..... 310110 ..... 310119* ... 320003 ..... 320011 ..... 320018 ..... 320085 ..... 330001* ... 330004* ... 330008* ... 330027* ... 330094* ... 330106 ..... 330126 ..... 330135 ..... 330167 ..... 330175 ..... 330181* ... 330182* ... 330191* ... 330198 ..... 330205 ..... 330209 ..... 330222 ..... 330224 ..... 330225 ..... 330235* ... 330259 ..... 330264 ..... 330276 ..... 330331 ..... 330332 ..... 330333 ..... 330372 ..... 330386* ... 330402 ..... 340003 ..... 340015 ..... 340016 ..... 340020 ..... 340021* ... 340027* ... 340037 ..... 340039* ... 340069* ... 340070 ..... 340073* ... 340085 ..... 340088 ..... 340096 ..... 340097 ..... 340104 ..... 340114* ... 340126 ..... 340127* ... 340129* ... 340133 ..... 340138* ... 340144* ... 340145* ... 340173* ... 360013* ... 360025* ... 360034 ..... 360036* ... 360040 ..... 360065* ... 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00276 TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2006—Continued Out-migration adjustment Qualifying county name Provider number 0.0351 0.0351 0.0350 0.0180 0.0351 0.0630 0.0442 0.0063 0.0063 0.0560 0.0959 0.0470 0.0137 0.0778 0.0137 0.0560 0.0560 0.0137 0.0268 0.0137 0.0137 0.0026 0.0137 0.0560 0.0560 0.0003 0.0959 0.0137 0.0270 0.0137 0.0560 0.0063 0.0137 0.0137 0.0137 0.0137 0.1139 0.0959 0.0116 0.0267 0.1312 0.0207 0.0216 0.0126 0.0216 0.0144 0.0053 0.0448 0.0053 0.0377 0.0115 0.0377 0.0116 0.0216 0.0053 0.0161 0.0961 0.0144 0.0302 0.0053 0.0144 0.0563 0.0053 0.0166 0.0087 0.0263 0.0263 0.0327 0.0141 ESSEX ESSEX MIDDLESEX MERCER ESSEX SAN MIGUEL RIO ARRIBA DONA ANA DONA ANA ORANGE ULSTER WYOMING NASSAU COLUMBIA NASSAU ORANGE ORANGE NASSAU CORTLAND NASSAU NASSAU WARREN NASSAU ORANGE ORANGE SARATOGA ULSTER NASSAU CAYUGA NASSAU ORANGE FULTON NASSAU NASSAU NASSAU NASSAU SULLIVAN ULSTER SURRY ROWAN JACKSON LEE CLEVELAND LENOIR CLEVELAND IREDELL WAKE ALAMANCE WAKE DAVIDSON TRANSYLVANIA DAVIDSON SURRY CLEVELAND WAKE WILSON GRANVILLE IREDELL MARTIN WAKE IREDELL LINCOLN WAKE SHELBY ERIE WAYNE WAYNE KNOX HURON 360070 ..... 360078* ... 360084 ..... 360086* ... 360093 ..... 360095 ..... 360096* ... 360099 ..... 360100 ..... 360107* ... 360131 ..... 360151 ..... 360156 ..... 360175* ... 360177 ..... 360185* ... 360187* ... 360197* ... 370004* ... 370014* ... 370015* ... 370023 ..... 370043 ..... 370065 ..... 370113* ... 370138 ..... 370149 ..... 370179* ... 380002 ..... 380008* ... 380022* ... 380029 ..... 380051 ..... 380056 ..... 390011 ..... 390030* ... 390031* ... 390044 ..... 390046 ..... 390052* ... 390056 ..... 390065* ... 390066* ... 390086* ... 390096 ..... 390101 ..... 390110* ... 390130 ..... 390138* ... 390146 ..... 390150* ... 390151* ... 390162 ..... 390173 ..... 390181* ... 390183* ... 390201* ... 390233 ..... 420007 ..... 420009* ... 420020* ... 420027 ..... 420030* ... 420039* ... 420043 ..... 420062 ..... 420068* ... 420070* ... 420083 ..... Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM Out-migration adjustment Qualifying county name 0.0028 0.0159 0.0028 0.0168 0.0120 0.0087 0.0031 0.0087 0.0028 0.0213 0.0028 0.0028 0.0213 0.0159 0.0212 0.0031 0.0168 0.0092 0.0193 0.0831 0.0463 0.0084 0.0294 0.0121 0.0205 0.0073 0.0356 0.0314 0.0130 0.0201 0.0201 0.0073 0.0073 0.0073 0.0012 0.0274 0.0274 0.0200 0.0098 0.0036 0.0042 0.0501 0.0259 0.0036 0.0200 0.0098 0.0012 0.0012 0.0325 0.0053 0.0206 0.0325 0.0149 0.0074 0.0274 0.0274 0.1127 0.0098 0.0001 0.0162 0.0035 0.0210 0.0103 0.0156 0.0177 0.0247 0.0097 0.0101 0.0001 STARK PORTAGE STARK CLARK DEFIANCE HANCOCK COLUMBIANA HANCOCK STARK SANDUSKY STARK STARK SANDUSKY CLINTON FAYETTE COLUMBIANA CLARK LOGAN OTTAWA BRYAN MAYES STEPHENS MARSHALL CRAIG DELAWARE TEXAS POTTAWATOMIE OKFUSKEE JOSEPHINE LINN LINN MARION MARION MARION CAMBRIA SCHUYLKILL SCHUYLKILL BERKS YORK CLEARFIELD HUNTINGDON ADAMS LEBANON CLEARFIELD BERKS YORK CAMBRIA CAMBRIA FRANKLIN WARREN GREENE FRANKLIN NORTHAMPTON INDIANA SCHUYLKILL SCHUYLKILL MONROE YORK SPARTANBURG OCONEE GEORGETOWN ANDERSON COLLETON UNION CHEROKEE CHESTERFIELD ORANGEBURG SUMTER SPARTANBURG 04MYP2 23581 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2006—Continued Provider number 420093 ..... 420098 ..... 430008 ..... 430048 ..... 430094* ... 440008* ... 440016 ..... 440024 ..... 440025 ..... 440033 ..... 440035* ... 440047 ..... 440050* ... 440051 ..... 440056 ..... 440060* ... 440063 ..... 440073* ... 440105 ..... 440114 ..... 440115 ..... 440143 ..... 440148* ... 440153 ..... 440174 ..... 440180* ... 440181 ..... 440182 ..... 440184 ..... 440185* ... 450032* ... 450039* ... 450050 ..... 450059* ... 450064* ... 450087* ... 450099* ... 450113 ..... 450121* ... 450135* ... 450137* ... TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2006—Continued Out-migration adjustment Qualifying county name Provider number 0.0001 0.0035 0.0504 0.0088 0.0088 0.0663 0.0224 0.0387 0.0037 0.0159 0.0441 0.0499 0.0037 0.0110 0.0321 0.0499 0.0011 0.0513 0.0011 0.0523 0.0499 0.0448 0.0568 0.0145 0.0372 0.0159 0.0407 0.0224 0.0011 0.0387 0.0416 0.0097 0.0750 0.0073 0.0097 0.0097 0.0180 0.0195 0.0097 0.0097 0.0097 SPARTANBURG GEORGETOWN BROOKINGS LAWRENCE LAWRENCE HENDERSON CARROLL BRADLEY GREENE CAMPBELL MONTGOMERY GIBSON GREENE MC NAIRY JEFFERSON GIBSON WASHINGTON MAURY WASHINGTON LAUDERDALE GIBSON MARSHALL DE KALB COCKE HAYWOOD CAMPBELL HARDEMAN CARROLL WASHINGTON BRADLEY HARRISON TARRANT WARD COMAL TARRANT TARRANT GRAY ANDERSON TARRANT TARRANT TARRANT 450144* ... 450151 ..... 450163 ..... 450187* ... 450194* ... 450214* ... 450224* ... 450347* ... 450362 ..... 450370 ..... 450389* ... 450395 ..... 450419* ... 450438* ... 450447* ... 450451* ... 450465 ..... 450547* ... 450563* ... 450565 ..... 450596 ..... 450597 ..... 450623* ... 450626 ..... 450639* ... 450672* ... 450675* ... 450677* ... 450694* ... 450747* ... 450755* ... 450763 ..... 450779* ... 450813 ..... 450858* ... 460017 ..... 460036* ... 460039* ... 470018 ..... 470023 ..... 490019 ..... Out-migration adjustment 0.0573 0.0210 0.0134 0.0264 0.0328 0.0368 0.0411 0.0427 0.0486 0.0258 0.0881 0.0484 0.0097 0.0258 0.0358 0.0551 0.0435 0.0411 0.0097 0.0492 10.0808 0.0077 0.0492 0.0294 0.0097 0.0097 0.0097 0.0097 0.0368 0.0195 0.0484 0.0236 0.0097 0.0195 0.0097 0.0392 0.0700 0.0392 0.0287 0.0118 0.1240 Qualifying county name ANDREWS FAYETTE KLEBERG WASHINGTON CHEROKEE WHARTON WOOD WALKER BURNET COLORADO HENDERSON POLK TARRANT COLORADO NAVARRO SOMERVELL MATAGORDA WOOD TARRANT PALO PINTO HOOD DE WITT FANNIN JACKSON TARRANT TARRANT TARRANT TARRANT WHARTON ANDERSON HOCKLEY HUTCHINSON TARRANT ANDERSON TARRANT BOX ELDER WASATCH BOX ELDER WINDSOR CALEDONIA CULPEPER TABLE 4J.—OUT-MIGRATION ADJUSTMENT—FY 2006—Continued Provider number Out-migration adjustment 490038 ..... 490047* ... 490084 ..... 490105* ... 490110 ..... 500003* ... 500007 ..... 500019 ..... 500021 ..... 500024* ... 500039* ... 500041* ... 500079 ..... 500108 ..... 500118 ..... 500122* ... 500129 ..... 500139* ... 500143* ... 510018* ... 510028* ... 510039 ..... 510047* ... 510050 ..... 510077* ... 510088 ..... 520028* ... 520035 ..... 520042 ..... 520044 ..... 520057 ..... 520059* ... 520071* ... 520076* ... 520094* ... 520095* ... 520096* ... 520102* ... 520116* ... 520132 ..... 0.0022 0.0198 0.0167 0.0022 0.0082 0.0208 0.0208 0.0213 0.0055 0.0023 0.0174 0.0118 0.0055 0.0055 0.0548 0.0459 0.0055 0.0023 0.0023 0.0209 0.0141 0.0112 0.0275 0.0112 0.0021 0.0141 0.0157 0.0077 0.0118 0.0077 0.0118 0.0200 0.0239 0.0181 0.0200 0.0118 0.0200 0.0298 0.0239 0.0077 Qualifying county name SMYTH PAGE ESSEX SMYTH MONTGOMERY SKAGIT SKAGIT LEWIS PIERCE THURSTON KITSAP COWLITZ PIERCE PIERCE MASON ISLAND PIERCE THURSTON THURSTON JACKSON FAYETTE OHIO MARION OHIO MINGO FAYETTE GREEN SHEBOYGAN SAUK SHEBOYGAN SAUK RACINE JEFFERSON DODGE RACINE SAUK RACINE WALWORTH JEFFERSON SHEBOYGAN TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS (DRGS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS) DRG 1 2 3 4 5 6 7 8 MDC TYPE ............... ............... ............... ............... ............... ............... ............... ............... 01 01 01 01 01 01 01 01 SURG SURG SURG SURG SURG SURG SURG SURG 9 ............... 10 ............. 11 ............. 12 ............. 13 ............. 14 ............. 15 ............. 01 01 01 01 01 01 01 MED MED MED MED MED MED MED ......... ......... ......... ......... ......... ......... ......... 16 17 18 19 01 01 01 01 MED MED MED MED ......... ......... ......... ......... ............. ............. ............. ............. VerDate Aug<04>2004 18:31 May 03, 2005 ...... ...... * .... ...... ...... ...... ...... ...... DRG Title Weights CRANIOTOMY AGE >17 W CC .......................................................... CRANIOTOMY AGE >17 W/O CC ...................................................... CRANIOTOMY AGE 0–17 ................................................................... NO LONGER VALID ............................................................................ NO LONGER VALID ............................................................................ CARPAL TUNNEL RELEASE ............................................................. PERIPH & CRANIAL NERVE & OTHER NERV SYST PROC W CC PERIPH & CRANIAL NERVE & OTHER NERV SYST PROC W/O CC. SPINAL DISORDERS & INJURIES ..................................................... NERVOUS SYSTEM NEOPLASMS W CC ......................................... NERVOUS SYSTEM NEOPLASMS W/O CC ..................................... DEGENERATIVE NERVOUS SYSTEM DISORDERS ....................... MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA ........................... INTRACRANIAL HEMORRHAGE OR STROKE WITH INFARCT ...... NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT. NONSPECIFIC CEREBROVASCULAR DISORDERS W CC ............. NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC ......... CRANIAL & PERIPHERAL NERVE DISORDERS W CC ................... CRANIAL & PERIPHERAL NERVE DISORDERS W/O CC ............... Jkt 205001 PO 00000 Frm 00277 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Mean LOS Mean LOS 3.4276 1.9544 1.9830 .0000 .0000 .7868 2.6679 1.5008 7.6 3.5 12.7 .0 .0 2.2 6.6 2.0 10.1 4.6 12.7 .0 0 3.1 9.5 2.9 1.3993 1.2219 .8704 .8972 .8520 1.2533 .9402 4.5 4.6 2.9 4.3 4.0 4.5 3.7 6.3 6.2 3.8 5.5 5.0 5.8 4.6 1.3315 .7191 .9891 .7058 5.0 2.5 4.1 2.7 6.5 3.2 5.3 3.4 23582 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS (DRGS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG 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 48 49 50 51 52 53 54 55 MDC TYPE DRG Title NERVOUS SYSTEM INFECTION EXCEPT VIRAL MENINGITIS ..... VIRAL MENINGITIS ............................................................................. HYPERTENSIVE ENCEPHALOPATHY .............................................. NONTRAUMATIC STUPOR & COMA ................................................ SEIZURE & HEADACHE AGE >17 W CC .......................................... SEIZURE & HEADACHE AGE >17 W/O CC ...................................... SEIZURE & HEADACHE AGE 0–17 ................................................... TRAUMATIC STUPOR & COMA, COMA >1 HR ................................ TRAUMATIC STUPOR & COMA, COMA <1 HR AGE >17 W CC ..... TRAUMATIC STUPOR & COMA, COMA <1 HR AGE >17 W/O CC TRAUMATIC STUPOR & COMA, COMA <1 HR AGE 0–17 .............. CONCUSSION AGE >17 W CC .......................................................... CONCUSSION AGE >17 W/O CC ...................................................... CONCUSSION AGE 0–17 ................................................................... OTHER DISORDERS OF NERVOUS SYSTEM W CC ...................... OTHER DISORDERS OF NERVOUS SYSTEM W/O CC .................. RETINAL PROCEDURES ................................................................... ORBITAL PROCEDURES ................................................................... PRIMARY IRIS PROCEDURES .......................................................... LENS PROCEDURES WITH OR WITHOUT VITRECTOMY ............. EXTRAOCULAR PROCEDURES EXCEPT ORBIT AGE >17 ............ EXTRAOCULAR PROCEDURES EXCEPT ORBIT AGE 0–17 .......... INTRAOCULAR PROCEDURES EXCEPT RETINA, IRIS & LENS ... HYPHEMA ........................................................................................... ACUTE MAJOR EYE INFECTIONS .................................................... NEUROLOGICAL EYE DISORDERS .................................................. OTHER DISORDERS OF THE EYE AGE >17 W CC ........................ OTHER DISORDERS OF THE EYE AGE >17 W/O CC .................... OTHER DISORDERS OF THE EYE AGE 0–17 ................................. MAJOR HEAD & NECK PROCEDURES ............................................ SIALOADENECTOMY ......................................................................... SALIVARY GLAND PROCEDURES EXCEPT SIALOADENECTOMY CLEFT LIP & PALATE REPAIR .......................................................... SINUS & MASTOID PROCEDURES AGE >17 .................................. SINUS & MASTOID PROCEDURES AGE 0–17 ................................ MISCELLANEOUS EAR, NOSE, MOUTH & THROAT PROCEDURES. RHINOPLASTY .................................................................................... T&A PROC, EXCEPT TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE >17. T&A PROC, EXCEPT TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE 0–17. TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE >17 ........ TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE 0–17 ...... MYRINGOTOMY W TUBE INSERTION AGE >17 ............................. MYRINGOTOMY W TUBE INSERTION AGE 0–17 ........................... OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES ..... EAR, NOSE, MOUTH & THROAT MALIGNANCY ............................. DYSEQUILIBRIUM .............................................................................. EPISTAXIS ........................................................................................... EPIGLOTTITIS ..................................................................................... OTITIS MEDIA & URI AGE >17 W CC ............................................... OTITIS MEDIA & URI AGE >17 W/O CC ........................................... OTITIS MEDIA & URI AGE 0–17 ........................................................ LARYNGOTRACHEITIS ...................................................................... NASAL TRAUMA & DEFORMITY ....................................................... OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES AGE >17 .. OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES AGE 0–17 MAJOR CHEST PROCEDURES ......................................................... OTHER RESP SYSTEM O.R. PROCEDURES W CC ....................... OTHER RESP SYSTEM O.R. PROCEDURES W/O CC .................... PULMONARY EMBOLISM .................................................................. RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W CC RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W/O CC. RESPIRATORY INFECTIONS & INFLAMMATIONS AGE 0–17 ........ RESPIRATORY NEOPLASMS ............................................................ MAJOR CHEST TRAUMA W CC ........................................................ MAJOR CHEST TRAUMA W/O CC .................................................... PLEURAL EFFUSION W CC .............................................................. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 01 02 02 02 02 02 02 02 02 02 02 02 02 02 03 03 03 03 03 03 03 MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED * ...... MED ......... MED ......... MED * ...... MED ......... MED ......... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG * .... SURG ...... MED ......... MED ......... MED ......... MED ......... MED ......... MED * ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG * .... SURG ...... 56 ............. 57 ............. 03 03 SURG ...... SURG ...... 58 ............. 03 SURG * .... 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. ............. 03 03 03 03 03 03 03 03 03 03 03 03 03 03 03 03 04 04 04 04 04 04 SURG ...... SURG * .... SURG ...... SURG * .... SURG ...... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED * ...... SURG ...... SURG ...... SURG ...... MED ......... MED ......... MED ......... 81 82 83 84 85 ............. ............. ............. ............. ............. 04 04 04 04 04 MED MED MED MED MED VerDate Aug<04>2004 18:31 May 03, 2005 * ...... ......... ......... ......... ......... Jkt 205001 PO 00000 Frm 00278 Fmt 4701 Sfmt 4702 Weights E:\FR\FM\04MYP2.SGM 04MYP2 Mean LOS Mean LOS 2.7787 1.4424 1.1269 .7695 .9954 .6165 1.8098 1.3455 1.3324 .7210 .3354 .9529 .6185 .2106 1.0047 .6253 .7238 1.1761 .6963 .7109 .9624 .3414 .7865 .6146 .6811 .7462 .7471 .5189 .3008 1.6375 .8661 .8829 .8428 1.3302 .4874 .9577 8.0 4.9 4.0 3.0 3.6 2.5 3.4 3.2 4.4 2.6 2.0 3.0 1.9 1.6 3.7 2.4 1.3 2.7 2.5 1.7 3.0 1.6 2.0 2.4 3.9 2.5 3.2 2.3 2.9 3.2 1.5 1.9 1.5 2.5 3.2 2.1 10.4 6.4 5.2 3.9 4.8 3.1 6.3 5.1 5.9 3.4 2.0 4.0 2.4 1.6 4.8 3.0 1.6 4.1 3.5 2.4 4.1 1.6 2.8 3.1 4.8 3.1 4.2 2.9 2.9 4.4 1.8 2.8 2.0 4.0 3.2 3.1 .8623 1.1330 1.9 2.6 2.6 4.2 .2768 1.5 1.5 .7950 .2107 1.2804 .2984 1.3908 1.1606 .5987 .5940 .7724 .6646 .4860 .4062 .7509 .7479 .8285 .3393 3.0699 2.8748 1.1897 1.2411 1.6212 .8872 1.8 1.5 3.3 1.3 3.0 4.1 2.3 2.4 2.9 3.2 2.5 2.1 3.2 2.6 3.3 2.1 7.6 8.4 3.4 5.4 6.7 4.4 2.5 1.5 5.4 1.3 4.5 6.1 2.8 3.1 3.7 4.0 3.0 2.4 4.0 3.5 4.4 2.1 9.9 11.1 4.7 6.4 8.4 5.5 1.5360 1.3925 .9818 .5736 1.2401 6.1 5.1 4.2 2.6 4.8 6.1 6.8 5.3 3.2 6.4 23583 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS (DRGS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG MDC TYPE DRG Title PLEURAL EFFUSION W/O CC ........................................................... PULMONARY EDEMA & RESPIRATORY FAILURE ......................... CHRONIC OBSTRUCTIVE PULMONARY DISEASE ......................... SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC ....................... SIMPLE PNEUMONIA & PLEURISY AGE >17 W/O CC ................... SIMPLE PNEUMONIA & PLEURISY AGE 0–17 ................................ INTERSTITIAL LUNG DISEASE W CC .............................................. INTERSTITIAL LUNG DISEASE W/O CC .......................................... PNEUMOTHORAX W CC ................................................................... PNEUMOTHORAX W/O CC ................................................................ BRONCHITIS & ASTHMA AGE >17 W CC ........................................ BRONCHITIS & ASTHMA AGE >17 W/O CC .................................... BRONCHITIS & ASTHMA AGE 0–17 ................................................. RESPIRATORY SIGNS & SYMPTOMS W CC ................................... RESPIRATORY SIGNS & SYMPTOMS W/O CC ............................... OTHER RESPIRATORY SYSTEM DIAGNOSES W CC .................... OTHER RESPIRATORY SYSTEM DIAGNOSES W/O CC ................ HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM CARDIAC VALVE & OTH MAJOR CARDIOTHORACIC PROC W CARD CATH. CARDIAC VALVE & OTH MAJOR CARDIOTHORACIC PROC W/O CARD CATH. CORONARY BYPASS W PTCA ......................................................... CORONARY BYPASS W CARDIAC CATH ........................................ OTHER CARDIOTHORACIC PROCEDURES .................................... CORONARY BYPASS W/O PTCA OR CARDIAC CATH ................... MAJOR CARDIOVASCULAR PROCEDURES W CC ........................ MAJOR CARDIOVASCULAR PROCEDURES W/O CC ..................... NO LONGER VALID ............................................................................ AMPUTATION FOR CIRC SYSTEM DISORDERS EXCEPT UPPER LIMB & TOE. UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS. PRM CARD PACEM IMPL W AMI/HR/SHOCK OR AICD LEAD OR GNRTR. OTHER PERMANENT CARDIAC PACEMAKER IMPLANT ............... CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT. CARDIAC PACEMAKER DEVICE REPLACEMENT .......................... VEIN LIGATION & STRIPPING ........................................................... OTHER CIRCULATORY SYSTEM O.R. PROCEDURES .................. CIRCULATORY DISORDERS W AMI & MAJOR COMP, DISCHARGED ALIVE. CIRCULATORY DISORDERS W AMI W/O MAJOR COMP, DISCHARGED ALIVE. CIRCULATORY DISORDERS W AMI, EXPIRED ............................... CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH & COMPLEX DIAG. CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O COMPLEX DIAG. ACUTE & SUBACUTE ENDOCARDITIS ............................................ HEART FAILURE & SHOCK ............................................................... DEEP VEIN THROMBOPHLEBITIS .................................................... CARDIAC ARREST, UNEXPLAINED .................................................. PERIPHERAL VASCULAR DISORDERS W CC ................................ PERIPHERAL VASCULAR DISORDERS W/O CC ............................ ATHEROSCLEROSIS W CC ............................................................... ATHEROSCLEROSIS W/O CC ........................................................... HYPERTENSION ................................................................................. CARDIAC CONGENITAL & VALVULAR DISORDERS AGE >17 W CC. CARDIAC CONGENITAL & VALVULAR DISORDERS AGE >17 W/ O CC. CARDIAC CONGENITAL & VALVULAR DISORDERS AGE 0–17 .... CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC ..... CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC ANGINA PECTORIS ............................................................................ SYNCOPE & COLLAPSE W CC ......................................................... SYNCOPE & COLLAPSE W/O CC ..................................................... CHEST PAIN ....................................................................................... 86 ............. 87 ............. 88 ............. 89 ............. 90 ............. 91 ............. 92 ............. 93 ............. 94 ............. 95 ............. 96 ............. 97 ............. 98 ............. 99 ............. 100 ........... 101 ........... 102 ........... 103 ........... 104 ........... 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 04 PRE 05 MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED * ...... MED ......... MED ......... MED ......... MED ......... SURG ...... SURG ...... 105 ........... 05 SURG ...... 106 107 108 109 110 111 112 113 ........... ........... ........... ........... ........... ........... ........... ........... 05 05 05 05 05 05 05 05 SURG SURG SURG SURG SURG SURG SURG SURG 114 ........... 05 SURG ...... 115 ........... 05 SURG ...... 116 ........... 117 ........... 05 05 SURG ...... SURG ...... 118 119 120 121 ........... ........... ........... ........... 05 05 05 05 SURG ...... SURG ...... SURG ...... MED ......... 122 ........... 05 MED ......... 123 ........... 124 ........... 05 05 MED ......... MED ......... 125 ........... 05 MED ......... 126 127 128 129 130 131 132 133 134 135 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 05 05 05 05 05 05 05 05 05 05 MED MED MED MED MED MED MED MED MED MED 136 ........... 05 MED ......... 137 138 139 140 141 142 143 05 05 05 05 05 05 05 MED MED MED MED MED MED MED ........... ........... ........... ........... ........... ........... ........... VerDate Aug<04>2004 18:31 May 03, 2005 ...... ...... ...... ...... ...... ...... ...... ...... ......... ......... ......... ......... ......... ......... ......... ......... ......... ......... * ...... ......... ......... ......... ......... ......... ......... Jkt 205001 PO 00000 Frm 00279 Fmt 4701 Sfmt 4702 Weights E:\FR\FM\04MYP2.SGM Mean LOS Mean LOS .6943 1.3592 .8854 1.0317 .6085 .8173 1.1859 .7022 1.1435 .6039 .7356 .5340 .5552 .7075 .5386 .8715 .5390 18.3069 8.2206 2.8 4.9 4.0 4.7 3.2 3.4 4.9 3.1 4.7 2.9 3.6 2.8 3.7 2.4 1.7 3.3 2.0 23.5 12.7 3.6 6.4 4.9 5.7 3.8 4.4 6.1 3.8 6.2 3.7 4.4 3.4 3.7 3.1 2.1 4.3 2.5 37.5 14.9 6.0149 8.5 10.2 7.0409 5.4802 5.7861 4.0452 3.8908 2.4927 .0000 3.1547 9.5 9.4 8.6 6.8 5.8 2.6 .0 10.8 11.2 10.7 10.9 7.9 8.4 3.4 .0 13.7 1.7288 6.7 8.9 3.5839 4.5 6.8 2.2975 1.3232 3.0 2.6 4.3 4.2 1.6347 1.3473 2.3814 1.6110 2.1 3.3 5.9 5.3 3.0 5.5 9.2 6.6 .9818 2.8 3.5 1.5321 1.4417 2.9 3.3 4.8 4.4 1.0932 2.1 2.7 2.7261 1.0330 .6919 1.0365 .9412 .5555 .6252 .5323 .6057 .8969 9.4 4.1 4.4 1.7 4.4 3.2 2.2 1.8 2.5 3.3 11.9 5.2 5.2 2.6 5.5 3.9 2.8 2.2 3.1 4.4 .6228 2.2 2.8 .8275 .8313 .5222 .5076 .7513 .5848 .5655 3.3 3.1 2.0 2.0 2.7 2.0 1.7 3.3 3.9 2.4 2.4 3.5 2.5 2.1 04MYP2 23584 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS (DRGS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG 144 145 146 147 148 149 150 151 152 153 154 MDC TYPE DRG Title OTHER CIRCULATORY SYSTEM DIAGNOSES W CC .................... OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC ................ RECTAL RESECTION W CC .............................................................. RECTAL RESECTION W/O CC .......................................................... MAJOR SMALL & LARGE BOWEL PROCEDURES W CC ............... MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC ........... PERITONEAL ADHESIOLYSIS W CC ................................................ PERITONEAL ADHESIOLYSIS W/O CC ............................................ MINOR SMALL & LARGE BOWEL PROCEDURES W CC ............... MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC ............ STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17 W CC. STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17 W/O CC. STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE 0– 17. ANAL & STOMAL PROCEDURES W CC ........................................... ANAL & STOMAL PROCEDURES W/O CC ....................................... HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W CC. HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W/O CC. INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W CC .. INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W/O CC. HERNIA PROCEDURES AGE 0–17 ................................................... APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC ...... APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC .. APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC .. APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC MOUTH PROCEDURES W CC .......................................................... MOUTH PROCEDURES W/O CC ....................................................... OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC .............. OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC .......... DIGESTIVE MALIGNANCY W CC ...................................................... DIGESTIVE MALIGNANCY W/O CC .................................................. G.I. HEMORRHAGE W CC ................................................................. G.I. HEMORRHAGE W/O CC ............................................................. COMPLICATED PEPTIC ULCER ........................................................ UNCOMPLICATED PEPTIC ULCER W CC ....................................... UNCOMPLICATED PEPTIC ULCER W/O CC .................................... INFLAMMATORY BOWEL DISEASE .................................................. G.I. OBSTRUCTION W CC ................................................................. G.I. OBSTRUCTION W/O CC ............................................................. ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W CC. ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W/O CC. ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE 0–17. DENTAL & ORAL DIS EXCEPT EXTRACTIONS & RESTORATIONS, AGE >17. DENTAL & ORAL DIS EXCEPT EXTRACTIONS & RESTORATIONS, AGE 0–17. DENTAL EXTRACTIONS & RESTORATIONS ................................... OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W CC .......... OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W/O CC ....... OTHER DIGESTIVE SYSTEM DIAGNOSES AGE 0–17 .................... PANCREAS, LIVER & SHUNT PROCEDURES W CC ...................... PANCREAS, LIVER & SHUNT PROCEDURES W/O CC .................. 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. CHOLECYSTECTOMY W C.D.E. W CC ............................................ CHOLECYSTECTOMY W C.D.E. W/O CC ......................................... CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC. CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O CC. ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 05 05 06 06 06 06 06 06 06 06 06 MED ......... MED ......... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... 155 ........... 06 SURG ...... 156 ........... 06 SURG * .... 157 ........... 158 ........... 159 ........... 06 06 06 SURG ...... SURG ...... SURG ...... 160 ........... 06 SURG ...... 161 ........... 162 ........... 06 06 SURG ...... SURG ...... 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 06 06 06 06 06 03 03 06 06 06 06 06 06 06 06 06 06 06 06 06 SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... 183 ........... 06 MED ......... 184 ........... 06 MED ......... 185 ........... 03 MED ......... 186 ........... 03 MED * ...... 187 188 189 190 191 192 193 ........... ........... ........... ........... ........... ........... ........... 03 06 06 06 07 07 07 MED ......... MED ......... MED ......... MED ......... SURG ...... SURG ...... SURG ...... 194 ........... 07 SURG ...... 195 ........... 196 ........... 197 ........... 07 07 07 SURG ...... SURG ...... SURG ...... 198 ........... 07 SURG ...... VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00280 Fmt 4701 Sfmt 4702 Weights E:\FR\FM\04MYP2.SGM 04MYP2 Mean LOS Mean LOS 1.2734 .5843 2.6565 1.4778 3.4400 1.4304 2.7986 1.2620 1.8768 1.0833 4.0333 4.1 2.1 8.6 5.2 10.0 5.4 8.9 4.0 6.7 4.5 9.9 5.8 2.6 10.0 5.8 12.3 6.0 11.0 5.1 8.0 5.0 13.2 1.2855 3.1 4.1 .8522 6.0 6.0 1.3317 .6634 1.4163 4.1 2.1 3.8 5.8 2.6 5.1 .8423 2.2 2.7 1.1998 .6763 3.1 1.7 4.4 2.1 .6711 2.2488 1.1833 1.4517 .8918 1.2650 .7251 2.9522 1.1837 1.4115 .7442 1.0138 .5644 1.1228 .9158 .7014 1.0877 .9769 .5609 .8463 2.2 6.6 3.6 3.3 1.9 3.3 1.8 7.8 3.1 5.1 2.7 3.8 2.4 4.1 3.6 2.6 4.5 4.2 2.8 3.4 2.9 8.0 4.2 4.5 2.2 4.9 2.3 11.0 4.1 7.0 3.6 4.7 2.9 5.2 4.4 3.1 5.9 5.4 3.3 4.5 .5846 2.3 2.9 .5700 2.5 3.3 .8689 3.3 4.5 .3248 2.9 2.9 .8435 1.1257 .6052 .6258 3.9443 1.6802 3.2837 3.1 4.2 2.4 3.2 9.0 4.3 9.9 4.2 5.6 3.1 4.4 12.8 5.7 12.1 1.5786 5.6 6.7 3.0503 1.6011 2.5397 8.8 4.9 7.5 10.6 5.7 9.2 1.1571 3.7 4.3 23585 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS (DRGS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG MDC TYPE DRG Title HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR MALIGNANCY HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR NON-MALIGNANCY. OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES .... CIRRHOSIS & ALCOHOLIC HEPATITIS ............................................ MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS ...... DISORDERS OF PANCREAS EXCEPT MALIGNANCY .................... DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W CC DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W/O CC. DISORDERS OF THE BILIARY TRACT W CC .................................. DISORDERS OF THE BILIARY TRACT W/O CC .............................. NO LONGER VALID ............................................................................ HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W CC. HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W/O CC. HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE 0–17 AMPUTATION FOR MUSCULOSKELETAL SYSTEM & CONN TISSUE DISORDERS. NO LONGER VALID ............................................................................ NO LONGER VALID ............................................................................ BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE. WND DEBRID & SKN GRFT EXCEPT HAND, FOR MUSCSKELET & CONN TISS DIS. LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR AGE >17 W CC. LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR AGE >17 W/O CC. LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR AGE 0–17. NO LONGER VALID ............................................................................ NO LONGER VALID ............................................................................ MAJOR SHOULDER/ELBOW PROC, OR OTHER UPPER EXTREMITY PROC W CC. SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC, W/O CC. FOOT PROCEDURES ......................................................................... SOFT TISSUE PROCEDURES W CC ................................................ SOFT TISSUE PROCEDURES W/O CC ............................................ MAJOR THUMB OR JOINT PROC, OR OTH HAND OR WRIST PROC W CC. HAND OR WRIST PROC, EXCEPT MAJOR JOINT PROC, W/O CC LOCAL EXCISION & REMOVAL OF INT FIX DEVICES OF HIP & FEMUR. NO LONGER VALID ............................................................................ ARTHROSCOPY ................................................................................. OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC. FRACTURES OF FEMUR ................................................................... FRACTURES OF HIP & PELVIS ........................................................ SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH OSTEOMYELITIS ................................................................................ PATHOLOGICAL FRACTURES & MUSCULOSKELETAL & CONN TISS MALIGNANCY. CONNECTIVE TISSUE DISORDERS W CC ...................................... CONNECTIVE TISSUE DISORDERS W/O CC .................................. SEPTIC ARTHRITIS ............................................................................ MEDICAL BACK PROBLEMS ............................................................. BONE DISEASES & SPECIFIC ARTHROPATHIES W CC ................ BONE DISEASES & SPECIFIC ARTHROPATHIES W/O CC ............ NON-SPECIFIC ARTHROPATHIES .................................................... SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE. TENDONITIS, MYOSITIS & BURSITIS ............................................... AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE. 199 ........... 200 ........... 07 07 SURG ...... SURG ...... 201 202 203 204 205 206 ........... ........... ........... ........... ........... ........... 07 07 07 07 07 07 SURG ...... MED ......... MED ......... MED ......... MED ......... MED ......... 207 208 209 210 ........... ........... ........... ........... 07 07 08 08 MED ......... MED ......... SURG ...... SURG ...... 211 ........... 08 SURG ...... 212 ........... 213 ........... 08 08 SURG ...... SURG ...... 214 ........... 215 ........... 216 ........... 08 08 08 SURG ...... SURG ...... SURG ...... 217 ........... 08 SURG ...... 218 ........... 08 SURG ...... 219 ........... 08 SURG ...... 220 ........... 08 SURG * .... 221 ........... 222 ........... 223 ........... 08 08 08 SURG ...... SURG ...... SURG ...... 224 ........... 08 SURG ...... 225 226 227 228 ........... ........... ........... ........... 08 08 08 08 SURG SURG SURG SURG 229 ........... 230 ........... 08 08 SURG ...... SURG ...... 231 232 233 234 ........... ........... ........... ........... 08 08 08 08 SURG SURG SURG SURG 235 236 237 238 239 ........... ........... ........... ........... ........... 08 08 08 08 08 MED MED MED MED MED ......... ......... ......... ......... ......... 240 241 242 243 244 245 246 247 ........... ........... ........... ........... ........... ........... ........... ........... 08 08 08 08 08 08 08 08 MED MED MED MED MED MED MED MED ......... ......... ......... ......... ......... ......... ......... ......... 248 ........... 249 ........... 08 08 MED ......... MED ......... VerDate Aug<04>2004 18:31 May 03, 2005 ...... ...... ...... ...... ...... ...... ...... ...... Jkt 205001 PO 00000 Frm 00281 Fmt 4701 Sfmt 4702 Weights E:\FR\FM\04MYP2.SGM 04MYP2 Mean LOS Mean LOS 2.4077 2.7777 6.8 6.4 9.5 9.8 3.7156 1.3463 1.3719 1.1216 1.2026 .7289 9.9 4.7 4.9 4.2 4.4 3.0 13.8 6.3 6.6 5.6 6.0 3.9 1.1730 .6880 .0000 1.9035 4.1 2.3 17.1 6.1 5.3 2.9 17.1 6.9 1.2676 4.4 4.7 1.2786 2.0393 2.4 7.2 2.9 9.7 .0000 .0000 1.9099 .0 .0 3.3 .0 .0 5.8 3.0414 9.3 13.2 1.6068 4.3 5.5 1.0427 2.6 3.1 .5904 5.3 5.3 .0000 .0000 1.1119 .0 .0 2.3 .0 .0 3.2 .8172 1.6 1.9 1.2189 1.5839 .8338 1.1414 3.7 4.5 2.1 2.8 5.2 6.5 2.6 4.1 .6957 1.3137 1.9 3.7 2.5 5.6 .0000 .9699 1.9137 1.2204 .0 1.8 4.6 2.0 .0 2.8 6.8 2.8 .7770 .7393 .6084 1.4237 1.0758 3.8 3.8 3.0 6.7 5.0 4.8 4.6 3.7 8.6 6.2 1.4024 .6613 1.1452 .7752 .7098 .4555 .5910 .5787 5.0 3.0 5.1 3.6 3.6 2.5 2.8 2.6 6.7 3.7 6.7 4.6 4.5 3.1 3.6 3.3 .8556 .7025 3.8 2.7 4.8 3.8 23586 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS (DRGS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG MDC TYPE DRG Title FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE >17 W CC. FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE >17 W/O CC. FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE 0–17 FX, SPRN, STRN & DISL OF UPARM, LOWLEG EX FOOT AGE >17 W CC. FX, SPRN, STRN & DISL OF UPARM, LOWLEG EX FOOT AGE >17 W/O CC. FX, SPRN, STRN & DISL OF UPARM, LOWLEG EX FOOT AGE 0– 17. OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES. TOTAL MASTECTOMY FOR MALIGNANCY W CC .......................... TOTAL MASTECTOMY FOR MALIGNANCY W/O CC ...................... SUBTOTAL MASTECTOMY FOR MALIGNANCY W CC ................... SUBTOTAL MASTECTOMY FOR MALIGNANCY W/O CC ............... BREAST PROC FOR NON-MALIGNANCY EXCEPT BIOPSY & LOCAL EXCISION. BREAST BIOPSY & LOCAL EXCISION FOR NON-MALIGNANCY .. SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W CC. SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W/O CC. SKIN GRAFT &/OR DEBRID EXCEPT FOR SKIN ULCER OR CELLULITIS W CC. SKIN GRAFT &/OR DEBRID EXCEPT FOR SKIN ULCER OR CELLULITIS W/O CC. PERIANAL & PILONIDAL PROCEDURES ......................................... SKIN, SUBCUTANEOUS TISSUE & BREAST PLASTIC PROCEDURES. OTHER SKIN, SUBCUT TISS & BREAST PROC W CC ................... OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC ............... SKIN ULCERS ..................................................................................... MAJOR SKIN DISORDERS W CC ..................................................... MAJOR SKIN DISORDERS W/O CC .................................................. MALIGNANT BREAST DISORDERS W CC ....................................... MALIGNANT BREAST DISORDERS W/O CC ................................... NON-MALIGANT BREAST DISORDERS ........................................... CELLULITIS AGE >17 W CC .............................................................. CELLULITIS AGE >17 W/O CC .......................................................... CELLULITIS AGE 0–17 ....................................................................... TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE >17 W CC. TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE >17 W/O CC. TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE 0–17 ...... MINOR SKIN DISORDERS W CC ...................................................... MINOR SKIN DISORDERS W/O CC .................................................. AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT,& METABOL DISORDERS. ADRENAL & PITUITARY PROCEDURES .......................................... SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DISORDERS. O.R. PROCEDURES FOR OBESITY .................................................. PARATHYROID PROCEDURES ......................................................... THYROID PROCEDURES .................................................................. THYROGLOSSAL PROCEDURES ..................................................... OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC .......... OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W/O CC ...... DIABETES AGE >35 ........................................................................... DIABETES AGE 0–35 ......................................................................... NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W CC NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W/O CC. NUTRITIONAL & MISC METABOLIC DISORDERS AGE 0–17 ......... INBORN ERRORS OF METABOLISM ................................................ ENDOCRINE DISORDERS W CC ...................................................... ENDOCRINE DISORDERS W/O CC .................................................. KIDNEY TRANSPLANT ....................................................................... 250 ........... 08 MED ......... 251 ........... 08 MED ......... 252 ........... 253 ........... 08 08 MED * ...... MED ......... 254 ........... 08 MED ......... 255 ........... 08 MED * ...... 256 ........... 08 MED ......... 257 258 259 260 261 ........... ........... ........... ........... ........... 09 09 09 09 09 SURG SURG SURG SURG SURG 262 ........... 263 ........... 09 09 SURG ...... SURG ...... 264 ........... 09 SURG ...... 265 ........... 09 SURG ...... 266 ........... 09 SURG ...... 267 ........... 268 ........... 09 09 SURG ...... SURG ...... 269 270 271 272 273 274 275 276 277 278 279 280 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 09 09 09 09 09 09 09 09 09 09 09 09 SURG ...... SURG ...... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED * ...... MED ......... 281 ........... 09 MED ......... 282 283 284 285 ........... ........... ........... ........... 09 09 09 10 MED * ...... MED ......... MED ......... SURG ...... 286 ........... 287 ........... 10 10 SURG ...... SURG ...... 288 289 290 291 292 293 294 295 296 297 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 10 10 10 10 10 10 10 10 10 10 SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... MED ......... MED ......... MED ......... MED ......... 298 299 300 301 302 ........... ........... ........... ........... ........... 10 10 10 10 11 MED ......... MED ......... MED ......... MED ......... SURG ...... VerDate Aug<04>2004 18:31 May 03, 2005 ...... ...... ...... ...... ...... Jkt 205001 PO 00000 Frm 00282 Fmt 4701 Sfmt 4702 Weights E:\FR\FM\04MYP2.SGM 04MYP2 Mean LOS Mean LOS .6949 3.2 3.9 .4752 2.3 2.8 .2563 .7734 1.8 3.8 1.8 4.6 .4588 2.6 3.1 .2985 2.9 2.9 .8459 3.9 5.1 .8958 .7129 .9650 .7028 .9710 2.0 1.5 1.8 1.2 1.6 2.6 1.7 2.8 1.4 2.2 .9783 2.1033 3.4 8.5 4.8 11.4 1.0576 5.0 6.5 1.6577 4.4 6.7 .8664 2.3 3.2 .8946 1.1389 2.8 2.4 4.2 3.5 1.8291 .8270 1.0072 .9814 .5536 1.1223 .5302 .6879 .8652 .5371 .7810 .7309 6.2 2.7 5.5 4.5 2.9 4.7 2.4 3.5 4.6 3.4 4.2 3.2 8.6 3.8 7.0 5.9 3.7 6.3 3.2 4.5 5.6 4.1 4.2 4.1 .4897 2.3 2.9 .2596 .7398 .4563 2.1793 2.2 3.5 2.4 8.2 2.2 4.6 3.0 10.5 1.9353 1.9237 4.0 7.8 5.5 10.3 2.0358 .9314 .8875 1.1155 2.6316 1.3434 .7642 .7250 .8175 .4845 3.2 1.7 1.6 1.5 7.3 3.2 3.3 2.9 3.7 2.5 4.1 2.6 2.1 2.8 10.3 4.5 4.3 3.7 4.8 3.1 .5246 1.0293 1.0918 .6113 3.1542 2.5 3.7 4.6 2.7 7.0 4.0 5.2 6.0 3.4 8.2 23587 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS (DRGS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG MDC TYPE DRG Title KIDNEY, URETER & MAJOR BLADDER PROCEDURES FOR NEOPLASM. KIDNEY, URETER & MAJOR BLADDER PROC FOR NON-NEOPL W CC. KIDNEY, URETER & MAJOR BLADDER PROC FOR NON-NEOPL W/O CC. PROSTATECTOMY W CC .................................................................. PROSTATECTOMY W/O CC .............................................................. MINOR BLADDER PROCEDURES W CC ......................................... MINOR BLADDER PROCEDURES W/O CC ...................................... TRANSURETHRAL PROCEDURES W CC ........................................ TRANSURETHRAL PROCEDURES W/O CC .................................... URETHRAL PROCEDURES, AGE >17 W CC ................................... URETHRAL PROCEDURES, AGE >17 W/O CC ............................... URETHRAL PROCEDURES, AGE 0–17 ............................................ OTHER KIDNEY & URINARY TRACT O.R. PROCEDURES ............. RENAL FAILURE ................................................................................. ADMIT FOR RENAL DIALYSIS ........................................................... KIDNEY & URINARY TRACT NEOPLASMS W CC ........................... KIDNEY & URINARY TRACT NEOPLASMS W/O CC ....................... KIDNEY & URINARY TRACT INFECTIONS AGE >17 W CC ........... KIDNEY & URINARY TRACT INFECTIONS AGE >17 W/O CC ........ KIDNEY & URINARY TRACT INFECTIONS AGE 0–17 ..................... URINARY STONES W CC, &/OR ESW LITHOTRIPSY ..................... URINARY STONES W/O CC .............................................................. KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE >17 W CC. KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE >17 W/O CC. KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE 0–17 ...... URETHRAL STRICTURE AGE >17 W CC ......................................... URETHRAL STRICTURE AGE >17 W/O CC ..................................... URETHRAL STRICTURE AGE 0–17 .................................................. OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE >17 W CC. OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE >17 W/O CC. OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE 0–17 ....... MAJOR MALE PELVIC PROCEDURES W CC .................................. MAJOR MALE PELVIC PROCEDURES W/O CC .............................. TRANSURETHRAL PROSTATECTOMY W CC ................................. TRANSURETHRAL PROSTATECTOMY W/O CC ............................. TESTES PROCEDURES, FOR MALIGNANCY .................................. TESTES PROCEDURES, NON-MALIGNANCY AGE >17 ................. TESTES PROCEDURES, NON-MALIGNANCY AGE 0–17 ............... PENIS PROCEDURES ........................................................................ CIRCUMCISION AGE >17 .................................................................. CIRCUMCISION AGE 0–17 ................................................................ OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY. OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXCEPT FOR MALIGNANCY. MALIGNANCY, MALE REPRODUCTIVE SYSTEM, W CC ................ MALIGNANCY, MALE REPRODUCTIVE SYSTEM, W/O CC ............ BENIGN PROSTATIC HYPERTROPHY W CC .................................. BENIGN PROSTATIC HYPERTROPHY W/O CC .............................. INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM ........... STERILIZATION, MALE ...................................................................... OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES ................. PELVIC EVISCERATION, RADICAL HYSTERECTOMY & RADICAL VULVECTOMY. UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W CC. UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O CC. FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES. UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY. UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC ........ 303 ........... 11 SURG ...... 304 ........... 11 SURG ...... 305 ........... 11 SURG ...... 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG * .... SURG ...... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... 326 ........... 11 MED ......... 327 328 329 330 331 ........... ........... ........... ........... ........... 11 11 11 11 11 MED MED MED MED MED 332 ........... 11 MED ......... 333 334 335 336 337 338 339 340 341 342 343 344 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 11 12 12 12 12 12 12 12 12 12 12 12 MED ......... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG * .... SURG ...... SURG ...... SURG * .... SURG ...... 345 ........... 12 SURG ...... 346 347 348 349 350 351 352 353 ........... ........... ........... ........... ........... ........... ........... ........... 12 12 12 12 12 12 12 13 MED ......... MED ......... MED ......... MED ......... MED ......... MED * ...... MED ......... SURG ...... 354 ........... 13 SURG ...... 355 ........... 13 SURG ...... 356 ........... 13 SURG ...... 357 ........... 13 SURG ...... 358 ........... 13 SURG ...... VerDate Aug<04>2004 18:31 May 03, 2005 * ...... ......... ......... * ...... ......... Jkt 205001 PO 00000 Frm 00283 Fmt 4701 Sfmt 4702 Weights E:\FR\FM\04MYP2.SGM 04MYP2 Mean LOS Mean LOS 2.2358 5.9 7.4 2.3647 6.1 8.6 1.1580 2.6 3.2 1.2674 .6192 1.6518 .9082 1.1948 .6425 1.1170 .6756 .5004 2.0801 1.2673 .7965 1.1535 .6388 .8644 .5644 .5569 .8200 .5045 .6417 3.6 1.7 4.0 1.6 3.1 1.5 3.2 1.8 2.3 3.6 4.9 2.4 4.2 2.1 4.2 3.0 2.9 2.3 1.6 2.9 5.5 2.1 6.2 2.0 4.5 1.9 4.8 2.2 2.3 6.8 6.4 3.5 5.8 2.8 5.2 3.6 3.5 3.1 1.9 3.7 .4385 2.1 2.6 .3742 .7085 .4712 .3222 1.0606 3.1 2.6 1.5 1.6 4.1 3.1 3.5 1.8 1.6 5.5 .6119 2.4 3.1 .9788 1.4366 1.0980 .8409 .5737 1.3738 1.1809 .2864 1.2585 .8721 .1557 1.2458 3.6 3.5 2.4 2.5 1.7 3.9 3.2 2.4 1.9 2.5 1.7 1.7 5.4 4.3 2.7 3.3 1.9 6.2 5.1 2.4 3.2 3.4 1.7 2.7 1.1474 3.1 4.8 1.0439 .6080 .7191 .4223 .7274 .2389 .7388 1.8474 4.2 2.2 3.2 1.9 3.5 1.3 2.9 4.7 5.7 3.0 4.1 2.4 4.5 1.3 4.0 6.3 1.5238 4.6 5.7 .8834 2.8 3.1 .7429 1.7 1.9 2.2212 6.5 8.1 1.1428 3.2 4.0 23588 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS (DRGS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG MDC TYPE DRG Title UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC .... VAGINA, CERVIX & VULVA PROCEDURES ..................................... LAPAROSCOPY & INCISIONAL TUBAL INTERRUPTION ................ ENDOSCOPIC TUBAL INTERRUPTION ............................................ D&C, CONIZATION & RADIO-IMPLANT, FOR MALIGNANCY ......... D&C, CONIZATION EXCEPT FOR MALIGNANCY ............................ OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC ............ MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W/O CC ........ INFECTIONS, FEMALE REPRODUCTIVE SYSTEM ......................... MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS. CESAREAN SECTION W CC ............................................................. CESAREAN SECTION W/O CC ......................................................... VAGINAL DELIVERY W COMPLICATING DIAGNOSES ................... VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES ............... VAGINAL DELIVERY W STERILIZATION &/OR D&C ....................... VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C .. POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE. POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE. ECTOPIC PREGNANCY ..................................................................... THREATENED ABORTION ................................................................. ABORTION W/O D&C ......................................................................... ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY. 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 AGE >17 .................................................................. SPLENECTOMY AGE 0–17 ................................................................ OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS. RED BLOOD CELL DISORDERS AGE >17 ....................................... RED BLOOD CELL DISORDERS AGE 0–17 ..................................... COAGULATION DISORDERS ............................................................ RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC .......... RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC ...... NO LONGER VALID ............................................................................ LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W CC. LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W/ O CC. LYMPHOMA & NON-ACUTE LEUKEMIA W CC ................................ LYMPHOMA & NON-ACUTE LEUKEMIA W/O CC ............................ ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE AGE 0–17 ..... 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. MYELOPROLIF DISORD OR POORLY DIFF NEOPL W OTHER O.R.PROC. RADIOTHERAPY ................................................................................. CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS. HISTORY OF MALIGNANCY W/O ENDOSCOPY ............................. HISTORY OF MALIGNANCY W ENDOSCOPY ................................. 359 360 361 362 363 364 365 366 367 368 369 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 13 13 13 13 13 13 13 13 13 13 13 SURG ...... SURG ...... SURG ...... SURG * .... SURG ...... SURG ...... SURG ...... MED ......... MED ......... MED ......... MED ......... 370 371 372 373 374 375 376 ........... ........... ........... ........... ........... ........... ........... 14 14 14 14 14 14 14 SURG ...... SURG ...... MED ......... MED ......... SURG ...... SURG * .... MED ......... 377 ........... 14 SURG ...... 378 379 380 381 ........... ........... ........... ........... 14 14 14 14 MED ......... MED ......... MED ......... SURG ...... 382 ........... 383 ........... 14 14 MED ......... MED ......... 384 ........... 14 MED ......... 385 ........... 15 MED * ...... 386 ........... 15 MED * ...... 387 388 389 390 391 392 393 394 ........... ........... ........... ........... ........... ........... ........... ........... 15 15 15 15 15 16 16 16 MED * ...... MED * ...... MED * ...... MED * ...... MED * ...... SURG ...... SURG * .... SURG ...... 395 396 397 398 399 400 401 ........... ........... ........... ........... ........... ........... ........... 16 16 16 16 16 17 17 MED ......... MED * ...... MED ......... MED ......... MED ......... SURG ...... SURG ...... 402 ........... 17 SURG ...... 403 404 405 406 ........... ........... ........... ........... 17 17 17 17 MED ......... MED ......... MED * ...... SURG ...... 407 ........... 17 SURG ...... 408 ........... 17 SURG ...... 409 ........... 410 ........... 17 17 MED ......... MED ......... 411 ........... 412 ........... 17 17 MED ......... MED ......... VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00284 Fmt 4701 Sfmt 4702 Weights E:\FR\FM\04MYP2.SGM 04MYP2 Mean LOS Mean LOS .7936 .8559 1.0844 .3053 .9742 .8710 2.0317 1.2296 .5734 1.1668 .6297 2.2 2.0 2.2 1.4 2.7 3.0 5.3 4.8 2.3 5.2 2.4 2.4 2.6 3.0 1.4 3.8 4.2 7.7 6.5 3.0 6.7 3.2 .8956 .6037 .5047 .3562 .6762 .5829 .5215 4.1 3.1 2.6 2.0 2.4 4.4 2.6 5.2 3.4 3.2 2.2 2.7 4.4 3.4 1.6547 2.9 4.5 .7508 .3590 .3913 .6059 1.9 2.0 1.6 1.7 2.3 2.8 2.1 2.3 .2071 .5053 1.3 2.6 1.4 3.7 .3187 1.8 2.6 1.3909 1.8 1.8 4.5865 17.9 17.9 3.1325 1.8900 3.2177 1.1388 .1542 3.0278 1.3624 1.9019 13.3 8.6 4.7 3.4 3.1 6.5 9.1 4.5 13.3 8.6 4.7 3.4 3.1 9.2 9.1 7.4 .8303 2.5374 1.3113 1.2212 .6665 .0000 2.9643 3.2 4.1 3.8 4.5 2.7 .0 8.0 4.3 4.1 5.2 5.8 3.3 .0 11.3 1.1793 2.8 4.1 1.8406 .9244 1.9316 2.7989 5.8 3.0 4.9 7.0 8.1 4.2 4.9 9.9 1.2325 3.0 3.8 2.2303 4.8 8.2 1.2066 1.1022 4.3 3.0 5.8 3.8 .3645 .8442 2.5 1.8 3.3 2.8 23589 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS (DRGS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG MDC TYPE DRG Title OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC. OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W/O CC. O.R. PROCEDURE FOR INFECTIOUS & PARASITIC DISEASES ... SEPTICEMIA AGE >17 ....................................................................... SEPTICEMIA AGE 0–17 ..................................................................... POSTOPERATIVE & POST-TRAUMATIC INFECTIONS ................... FEVER OF UNKNOWN ORIGIN AGE >17 W CC .............................. FEVER OF UNKNOWN ORIGIN AGE >17 W/O CC .......................... VIRAL ILLNESS AGE >17 ................................................................... VIRAL ILLNESS & FEVER OF UNKNOWN ORIGIN AGE 0–17 ........ OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES ........ 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 ....................................................................................... CHILDHOOD MENTAL DISORDERS ................................................. OTHER MENTAL DISORDER DIAGNOSES ...................................... ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA .............. NO LONGER VALID ............................................................................ NO LONGER VALID ............................................................................ NO LONGER VALID ............................................................................ NO LONGER VALID ............................................................................ NO LONGER VALID ............................................................................ SKIN GRAFTS FOR INJURIES ........................................................... WOUND DEBRIDEMENTS FOR INJURIES ....................................... HAND PROCEDURES FOR INJURIES .............................................. OTHER O.R. PROCEDURES FOR INJURIES W CC ........................ OTHER O.R. PROCEDURES FOR INJURIES W/O CC .................... TRAUMATIC INJURY AGE >17 W CC ............................................... TRAUMATIC INJURY AGE >17 W/O CC ........................................... TRAUMATIC INJURY AGE 0–17 ........................................................ ALLERGIC REACTIONS AGE >17 ..................................................... ALLERGIC REACTIONS AGE 0–17 ................................................... POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W CC ........ POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W/O CC .... POISONING & TOXIC EFFECTS OF DRUGS AGE 0–17 ................. COMPLICATIONS OF TREATMENT W CC ....................................... COMPLICATIONS OF TREATMENT W/O CC ................................... OTHER INJURY, POISONING & TOXIC EFFECT DIAG W CC ........ OTHER INJURY, POISONING & TOXIC EFFECT DIAG W/O CC .... NO LONGER VALID ............................................................................ NO LONGER VALID ............................................................................ NO LONGER VALID ............................................................................ NO LONGER VALID ............................................................................ NO LONGER VALID ............................................................................ O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES. REHABILITATION ................................................................................ SIGNS & SYMPTOMS W CC .............................................................. SIGNS & SYMPTOMS W/O CC .......................................................... AFTERCARE W HISTORY OF MALIGNANCY AS SECONDARY DIAGNOSIS. AFTERCARE W/O HISTORY OF MALIGNANCY AS SECONDARY DIAGNOSIS. OTHER FACTORS INFLUENCING HEALTH STATUS ...................... EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS. PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS .... UNGROUPABLE .................................................................................. BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY. NO LONGER VALID ............................................................................ ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE AGE >17 ...... 413 ........... 17 MED ......... 414 ........... 17 MED ......... 415 416 417 418 419 420 421 422 423 424 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 18 18 18 18 18 18 18 18 18 19 SURG ...... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... SURG ...... 425 ........... 19 MED ......... 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 449 450 451 452 453 454 455 456 457 458 459 460 461 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 19 19 19 19 19 19 19 20 20 20 20 20 20 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 21 22 22 22 22 22 23 MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... MED ......... .................. SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... MED ......... MED ......... MED * ...... MED ......... MED * ...... MED ......... MED ......... MED * ...... MED ......... MED ......... MED ......... MED ......... .................. MED ......... SURG ...... SURG ...... MED ......... SURG ...... 462 463 464 465 ........... ........... ........... ........... 23 23 23 23 MED MED MED MED 466 ........... 23 MED ......... 467 ........... 468 ........... 23 MED ......... .................. ......... ......... ......... ......... 469 ........... 470 ........... 471 ........... 08 ** .............. ** .............. SURG ...... 472 ........... 473 ........... 22 17 SURG ...... MED ......... VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00285 Fmt 4701 Sfmt 4702 Weights E:\FR\FM\04MYP2.SGM 04MYP2 Mean LOS Mean LOS 1.3035 5.0 6.8 .7784 3.0 4.0 3.9753 1.6705 1.2962 1.1035 .8526 .6088 .7680 .6185 1.9163 2.2400 11.0 5.6 3.6 4.9 3.4 2.7 3.1 2.6 6.0 7.3 14.8 7.5 5.3 6.4 4.4 3.4 4.1 3.7 8.4 11.7 .6187 2.6 3.5 .4655 .5159 .6944 .7893 .6306 .5194 .6322 .2774 .0000 .0000 .0000 .0000 .0000 1.9204 1.9346 .9334 2.5647 .9911 .7540 .5016 .2995 .5572 .0985 .8509 .4288 .2658 1.0388 .5278 .8128 .4700 .0000 .0000 .0000 .0000 .0000 1.3957 3.0 3.2 4.6 4.3 5.6 4.0 2.9 2.2 .0 .0 .0 .0 .0 5.4 5.9 2.3 6.0 2.6 3.2 2.3 2.4 1.9 2.9 2.6 1.6 2.1 3.5 2.2 2.9 1.7 .0 .0 .0 .0 .0 3.0 4.1 4.7 7.2 5.6 7.7 5.9 4.3 3.0 .0 .0 .0 .0 .0 8.8 9.2 3.4 8.9 3.4 4.1 2.8 2.4 2.6 2.9 3.7 2.0 2.1 4.9 2.8 4.1 2.2 .0 .0 .0 .0 .0 5.1 .8496 .6946 .5057 .6015 8.8 3.1 2.4 2.4 10.7 3.9 2.9 3.6 .6922 2.7 4.7 .4789 3.9877 2.0 9.7 2.7 13.2 .0000 .0000 3.1328 .0 .0 4.5 .0 .0 5.1 .0000 3.4949 .0 7.6 .0 12.9 23590 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS (DRGS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG 474 ........... 475 ........... MDC TYPE 04 04 DRG Title SURG ...... MED ......... NO LONGER VALID ............................................................................ RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT. PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS. NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS. OTHER VASCULAR PROCEDURES W CC ...................................... OTHER VASCULAR PROCEDURES W/O CC ................................... LIVER TRANSPLANT AND/OR INTESTINAL TRANSPLANT ............ BONE MARROW TRANSPLANT ........................................................ TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES ...... NO LONGER VALID ............................................................................ CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA ................. LIMB REATTACHMENT, HIP AND FEMUR PROC FOR MULTIPLE SIGNIFICANT TRA. OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA. OTHER MULTIPLE SIGNIFICANT TRAUMA ..................................... HIV W EXTENSIVE O.R. PROCEDURE ............................................ HIV W MAJOR RELATED CONDITION .............................................. HIV W OR W/O OTHER RELATED CONDITION ............................... MAJOR JOINT & LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITY. CHEMOTHERAPY W ACUTE LEUKEMIA OR W USE OF HI DOSE CHEMOAGENT. LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC ........... LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC ....... LUNG TRANSPLANT .......................................................................... COMBINED ANTERIOR/POSTERIOR SPINAL FUSION ................... SPINAL FUSION EXCEPT CERVICAL W CC .................................... SPINAL FUSION EXCEPT CERVICAL W/O CC ................................ BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W CC ... BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W/O CC KNEE PROCEDURES W PDX OF INFECTION W CC ...................... KNEE PROCEDURES W PDX OF INFECTION W/O CC .................. KNEE PROCEDURES W/O PDX OF INFECTION ............................. EXTEN. BURNS OR FULL THICKNESS BURN W/MV 96+HRS W/ SKIN GFT. EXTEN. BURNS OR FULL THICKNESS BURN W/MV 96+HRS W/O SKIN GFT. FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W CC OR SIG TRAUMA. FULL THICKNESS BURN W SKIN GRFT OR INHAL INJ W/O CC OR SIG TRAUMA. FULL THICKNESS BURN W/O SKIN GRFT OR INHAL INJ W CC OR SIG TRAUMA. FULL THICKNESS BURN W/O SKIN GRFT OR INH INJ W/O CC OR SIG TRAUMA. NON-EXTENSIVE BURNS W CC OR SIGNIFICANT TRAUMA ........ NON-EXTENSIVE BURNS W/O CC OR SIGNIFICANT TRAUMA .... SIMULTANEOUS PANCREAS/KIDNEY TRANSPLANT .................... PANCREAS TRANSPLANT ................................................................ NO LONGER VALID ............................................................................ CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH .......... NO LONGER VALID ............................................................................ PERC CARDIO PROC W NON-DRUG ELUTING STENT W/O AMI PERC CARDIO PROC W/O CORONARY ARTERY STENT OR AMI CERVICAL SPINAL FUSION W CC ................................................... CERVICAL SPINAL FUSION W/O CC ................................................ ALCOHOL/DRUG ABUSE OR DEPENDENCE W CC ....................... ALC/DRUG ABUSE OR DEPEND W REHABILITATION THERAPY W/O CC. ALC/DRUG ABUSE OR DEPEND W/O REHABILITATION THERAPY W/O CC. TRANSIENT ISCHEMIA ...................................................................... OTHER HEART ASSIST SYSTEM IMPLANT .................................... NO LONGER VALID ............................................................................ PERCUTNEOUS CARDIOVASULAR PROC W DRUG ELUTING STENT W/O AMI. 476 ........... SURG ...... 477 ........... SURG ...... 478 479 480 481 482 483 484 485 ........... ........... ........... ........... ........... ........... ........... ........... 05 05 PRE PRE PRE PRE 24 24 486 ........... 24 SURG ...... 487 488 489 490 491 ........... ........... ........... ........... ........... 24 25 25 25 08 MED ......... SURG ...... MED ......... MED ......... SURG ...... 492 ........... 17 MED ......... 493 494 495 496 497 498 499 500 501 502 503 504 SURG SURG SURG SURG SURG SURG SURG SURG ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 07 07 PRE 08 08 08 08 08 08 08 08 22 505 ........... 22 MED ......... 506 ........... 22 SURG ...... 507 ........... 22 SURG ...... 508 ........... 22 MED ......... 509 ........... 22 MED ......... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 22 22 PRE PRE 05 05 05 05 05 08 08 20 20 MED ......... MED ......... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... SURG ...... MED ......... MED ......... 523 ........... 20 MED ......... 524 525 526 527 01 05 05 05 MED ......... SURG ...... SURG ...... SURG ...... 510 511 512 513 514 515 516 517 518 519 520 521 522 ........... ........... ........... ........... VerDate Aug<04>2004 SURG SURG SURG SURG SURG SURG SURG SURG SURG SURG SURG SURG ...... ...... ...... ...... ...... ...... ...... ...... 18:31 May 03, 2005 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Jkt 205001 PO 00000 Frm 00286 Fmt 4701 Sfmt 4702 Weights E:\FR\FM\04MYP2.SGM Mean LOS Mean LOS .0000 3.5930 .0 8.1 .0 11.3 2.1792 7.4 10.5 2.0539 5.8 8.7 2.4118 1.4433 8.9426 6.2341 3.3281 .0000 5.1050 3.4619 4.7 2.1 13.7 18.3 9.7 .0 9.3 8.3 7.2 2.8 17.9 21.8 12.1 .0 12.8 10.2 4.7225 8.5 12.4 1.9309 4.4100 1.8294 1.0638 1.6734 5.3 11.7 6.0 3.9 2.6 7.3 16.4 8.5 5.4 3.1 3.5856 8.8 13.6 1.8413 1.0275 8.5766 6.2260 3.6385 2.7792 1.3903 .9033 2.6488 1.4419 1.2014 11.6990 4.6 2.1 13.9 6.6 5.0 3.4 3.1 1.8 8.5 4.9 2.9 21.6 6.1 2.7 17.3 9.0 5.9 3.8 4.3 2.2 10.4 5.8 3.8 27.3 2.3035 2.4 4.7 4.1098 11.2 15.9 1.7419 5.9 8.5 1.2672 5.1 7.3 .8233 3.6 5.2 1.1808 .7452 5.3328 5.9670 .0000 5.5196 .0000 2.0601 1.7772 2.4826 1.6774 .6935 .4767 4.4 2.7 10.7 8.9 .0 2.6 .0 1.8 2.3 3.0 1.6 4.2 7.7 6.5 4.1 12.8 10.0 .0 4.3 .0 2.6 3.5 4.8 2.0 5.6 9.6 .3785 3.2 3.9 .7274 11.5451 .0000 2.3161 2.6 7.3 .0 1.6 3.2 13.9 .0 2.2 04MYP2 23591 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 5.—LIST OF DIAGNOSIS-RELATED GROUPS (DRGS, RELATIVE WEIGHTING FACTORS, AND GEOMETRIC AND ARITHMETIC MEAN LENGTH OF STAY (LOS)—Continued DRG 528 529 530 531 532 533 534 535 536 MDC TYPE ........... ........... ........... ........... ........... ........... ........... ........... ........... 01 01 01 01 01 01 01 05 05 SURG SURG SURG SURG SURG SURG SURG SURG SURG ...... ...... ...... ...... ...... ...... ...... ...... ...... 537 ........... 08 SURG ...... 538 ........... 08 SURG ...... 539 ........... 540 ........... 541 ........... 17 17 PRE SURG ...... SURG ...... SURG ...... 542 ........... PRE SURG ...... 543 ........... 01 SURG ...... 544 ........... 08 SURG ...... 545 ........... 546 ........... 08 08 SURG ...... SURG ...... 547 ........... 548 ........... 549 ........... 05 05 05 SURG ...... SURG ...... SURG ...... 550 ........... 05 SURG ...... DRG Title Mean LOS Weights INTRACRANIAL VASCULAR PROC W PDX HEMORRHAGE .......... VENTRICULAR SHUNT PROCEDURES W CC ................................. VENTRICULAR SHUNT PROCEDURES W/O CC ............................. SPINAL PROCEDURES W CC ........................................................... SPINAL PROCEDURES W/O CC ....................................................... EXTRACRANIAL PROCEDURES W CC ............................................ EXTRACRANIAL PROCEDURES W/O CC ........................................ CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/ SHOCK. LOCAL EXCIS & REMOV OF INT FIX DEV EXCEPT HIP & FEMUR W CC. LOCAL EXCIS & REMOV OF INT FIX DEV EXCEPT HIP & FEMUR W/O CC. LYMPHOMA & LEUKEMIA W MAJOR OR PROCEDURE W CC ..... LYMPHOMA & LEUKEMIA W MAJOR OR PROCEDURE W/O CC .. ECMO OR TRACH W MV 96+HRS OR PDX EXC FACE, MTH, FACE&NECK DX W/MAJ OR. TRACH W MV 96+HRS OR PDX EXC FACE, MTH, FACE&NECK DX W/O MJ OR. CRANIOTOMY W/IMPLANT OF CHEMO AGENT OR ACUTE COMPLX CNS PDX. MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY. REVISION OF HIP OR KNEE REPLACEMENT ................................. SPINAL FUSION EXC CERV WITH PDX OF CURVATURE OF THE SPINE OR MALIG. PERCUTANEOUS CARDIOVASCULAR PROC W AMI W CC .......... PERCUTANEOUS CARDIOVASCULAR PROC W AMI W/O CC ...... PERCUTANEOUS CARDIOVASCULAR PROC W DRUG ELUTING STENT W AMI W CC. PERCUTANEOUS CARDIOVASCULAR PROC W DRUG ELUTING STENT W AMI W/O CC. Mean LOS 7.0396 2.3118 1.2020 3.1221 1.4172 1.5728 1.0198 8.0777 6.9110 13.8 5.3 2.4 6.5 2.8 2.4 1.5 8.0 5.9 17.2 8.3 3.1 9.6 3.7 3.7 1.8 10.4 7.7 1.8333 4.8 6.9 .9815 2.1 2.8 3.2371 1.1892 19.6693 7.0 2.6 38.0 10.8 3.6 45.4 12.7797 29.0 34.9 4.4062 8.5 12.2 1.9612 4.1 4.6 2.4781 5.0779 4.5 7.2 5.2 9.1 2.8246 2.0984 3.2154 4.4 2.7 4.1 5.6 3.0 5.2 2.5116 2.5 2.9 *Medicare data has been supplemented by data from 19 States for low-volume DRGs. **DRGs 469 and 470 contain cases which could not be assigned to valid DRGs. Note: Geometric mean is used only to determine payment for transfer cases. Note: Arithmetic means are presented for informational purposes only. Note: Relative weights are based on Medicare patient data and may not be appropriate for other patients. TABLE 6A.—NEW DIAGNOSIS CODES Diagnosis code Description 259.5 ........ 276.50 ...... Androgen insensitivity syndrome ................................................................................................... Volume depletion, unspecified ....................................................................................................... N Y 276.51 ...... Dehydration .................................................................................................................................... Y 276.52 ...... Hypovolemia .................................................................................................................................. Y 278.02 287.30 287.31 287.32 287.33 287.39 291.82 292.85 327.00 327.01 327.02 327.09 327.10 327.11 327.12 Overweight ..................................................................................................................................... Primary thrombocytopenia, unspecified ........................................................................................ Immune thrombocytopenic purpura ............................................................................................... Evans’ syndrome ........................................................................................................................... Congenital and hereditary thrombocytopenic purpura .................................................................. Other primary thrombocytopenia ................................................................................................... Alcohol induced sleep disorders .................................................................................................... Drug induced sleep disorders ........................................................................................................ Organic insomnia, unspecified ...................................................................................................... Insomnia due to medical condition classified elsewhere .............................................................. Insomnia due to mental disorder ................................................................................................... Other organic insomnia ................................................................................................................. Organic hypersomnia, unspecified ................................................................................................ Idiopathic hypersomnia with long sleep time ................................................................................ Idiopathic hypersomnia without long sleep time ........................................................................... N Y Y Y Y Y N N N N N N N N N ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00287 Fmt 4701 CC Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 MDC 10 10 15 2 25 10 15 2 52 10 15 2 52 10 16 16 16 16 16 20 20 19 19 19 19 19 19 19 DRG 300, 301 296, 297, 298 387,1 3891 490 296, 297, 298 387,1 389 1 490 296, 297, 298 387,1 389 1 490 296, 297, 298 397 397 397 397 397 521, 522, 523 521, 522, 523 432 432 432 432 432 432 432 23592 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 6A.—NEW DIAGNOSIS CODES—Continued Diagnosis code 327.13 327.14 327.15 327.19 327.20 Description CC ...... ...... ...... ...... ...... Recurrent hypersomnia ................................................................................................................. Hypersomnia due to medical condition ......................................................................................... Hypersomnia due to mental disorder ............................................................................................ Other organic hypersomnia ........................................................................................................... Organic sleep apnea, unspecified ................................................................................................. N N N N N 327.21 ...... Primary central sleep apnea .......................................................................................................... N 327.22 ...... High altitude periodic breathing ..................................................................................................... N 327.23 ...... Obstructive sleep apnea (adult) (pediatric) ................................................................................... N 327.24 ...... Idiopathic sleep related non-obstructive alveolar hypoventilation ................................................. N 327.26 ...... Sleep related hypoventilation/hypoxemia in conditions classifiable elsewhere ............................ N 327.27 ...... Central sleep apnea in conditions classified elsewhere ............................................................... N 327.29 ...... Other organic sleep apnea ............................................................................................................ N 362.03 362.04 362.05 362.06 362.07 426.82 443.82 525.40 ...... ...... ...... ...... ...... ...... ...... ...... Nonproliferative diabetic retinopathy NOS .................................................................................... Mild nonproliferative diabetic retinopathy ...................................................................................... Moderate nonproliferative diabetic retinopathy ............................................................................. Severe nonproliferative diabetic retinopathy ................................................................................. Diabetic macular edema ................................................................................................................ Long QT syndrome ........................................................................................................................ Erythromelalgia .............................................................................................................................. Complete edentulism, unspecified ................................................................................................. N N N N N N N N 525.41 ...... Complete edentulism, class I ........................................................................................................ N 525.42 ...... Complete edentulism, class II ....................................................................................................... N 525.43 ...... Complete edentulism, class III ...................................................................................................... N 525.44 ...... Complete edentulism, class IV ...................................................................................................... N 525.50 ...... Partial edentulism, unspecified ...................................................................................................... N 525.51 ...... Partial edentulism, class I .............................................................................................................. N 525.52 ...... Partial edentulism, class II ............................................................................................................. N 525.53 ...... Partial edentulism, class III ............................................................................................................ N 525.54 ...... Partial edentulism, class IV ........................................................................................................... N 567.21 ...... Peritonitis (acute) generalized ....................................................................................................... Y 567.22 ...... Peritoneal abscess ........................................................................................................................ Y 567.23 ...... Spontaneous bacterial peritonitis .................................................................................................. Y 567.29 ...... Other suppurative peritonitis .......................................................................................................... Y 567.38 ...... Other retroperitoneal abscess ....................................................................................................... Y 567.39 ...... Other retroperitoneal infections ..................................................................................................... Y 567.81 ...... Choleperitonitis .............................................................................................................................. Y 567.82 ...... Sclerosing mesenteritis .................................................................................................................. Y 567.89 ...... Other specified peritonitis .............................................................................................................. Y 585.1 ........ Chronic kidney disease, Stage I .................................................................................................... Y 585.2 ........ Chronic kidney disease, Stage II (mild) ........................................................................................ Y 585.3 ........ Chronic kidney disease, Stage III (moderate) ............................................................................... Y VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00288 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 MDC 19 19 19 19 PRE 3 PRE 1 PRE 4 PRE 3 PRE 3 PRE 3 PRE 1 PRE 3 2 2 2 2 2 5 5 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 PRE 3 6 15 6 15 6 15 6 15 6 15 6 15 6 15 6 15 6 15 PRE 11 PRE 11 PRE 11 DRG 432 432 432 432 482 73, 74 482 34, 35 482 99, 100 482 73, 74 482 73, 74 482 73, 74 482 34, 35 482 73, 74 46, 47, 48 46, 47, 48 46, 47, 48 46, 47, 48 46, 47, 48 138, 139 130, 131 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 482 185, 186, 187 188, 189, 190 387,1 389 1 188, 189, 190 387,1 389 1 188, 189, 190 387,1 389 1 188, 189, 190 387,1 389 1 188, 189, 190 387,1 389 1 188, 189, 190 387,1 389 1 188, 189, 190 387,1 389 1 188, 189, 190 387,1 389 1 188, 189, 190 387,1 389 1 512, 513 315, 316 512, 513 315, 316 512, 513 315, 316 23593 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 6A.—NEW DIAGNOSIS CODES—Continued Diagnosis code Description 585.4 ........ Chronic kidney disease, Stage IV (severe) ................................................................................... Y 585.5 ........ Chronic kidney disease, Stage V .................................................................................................. Y 585.6 ........ End stage renal disease ................................................................................................................ Y 585.9 ........ Chronic kidney disease, unspecified ............................................................................................. Y 599.60 ...... Urinary obstruction, unspecified .................................................................................................... 599.69 ...... Urinary obstruction, not elsewhere classified ................................................................................ Y 11 Y 651.70 ...... Multiple gestation following (elective) fetal reduction, unspecified as to episode of care or not applicable. Multiple gestation following (elective) fetal reduction, delivered, with or without mention of antepartum condition. Multiple gestation following (elective) fetal reduction, antepartum condition or complication ...... Anticonvulsants .............................................................................................................................. Antimetabolic agents ..................................................................................................................... Meconium passage during delivery ............................................................................................... Fetal and newborn aspiration, unspecified .................................................................................... Meconium aspiration without respiratory symptoms ..................................................................... Meconium aspiration with respiratory symptoms .......................................................................... Other fetal and newborn aspiration without respiratory symptoms ............................................... Other fetal and newborn aspiration with respiratory symptoms .................................................... Meconium staining ......................................................................................................................... Other excessive crying .................................................................................................................. Asphyxia ........................................................................................................................................ Hypoxemia ..................................................................................................................................... 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 ............... Person history, Infections of the central nervous system ............................................................. Person history, Unspecified disease of respiratory system .......................................................... Person history, Pneumonia (recurrent) ......................................................................................... Person history, Other diseases of respiratory system .................................................................. Person history, Urinary (tract) infection ......................................................................................... Person history, Nephrotic syndrome ............................................................................................. History of fall .................................................................................................................................. Family history, Osteoporosis ......................................................................................................... Family history, Other musculoskeletal diseases ........................................................................... Family history, Genetic disease carrier ......................................................................................... Testing for genetic disease carrier status ..................................................................................... Other genetic testing ..................................................................................................................... Genetic counseling ........................................................................................................................ Encounter for weaning from respirator [ventilator] ........................................................................ Mechanical complication of respirator [ventilator] ......................................................................... Bed confinement status ................................................................................................................. Egg (oocyte) (ovum) donor, unspecified ....................................................................................... Egg (oocyte) (ovum) donor, under age 35,anonymous recipient ................................................. Egg (oocyte) (ovum) donor, under age 35, designated recipient ................................................. Egg (oocyte) (ovum) donor, age 35 and over,anonymous recipient ............................................ Egg (oocyte) (ovum) donor, age 35 and over, designated recipient ............................................ Suicidal ideation ............................................................................................................................. Vaccination not carried out, unspecified reason ........................................................................... Vaccination not carried out because of acute illness .................................................................... Vaccination not carried out because of chronic illness or condition ............................................. Vaccination not carried out because of immune compromised state ........................................... Vaccination not carried out because of allergy to vaccine or component .................................... Vaccination not carried out because of caregiver refusal ............................................................. Vaccination not carried out because of patient refusal ................................................................. Vaccination not carried out for religious reasons .......................................................................... Vaccination not carried out because patient had disease being vaccinated against ................... Vaccination not carried out for other reason ................................................................................. Behavioral insomnia of childhood .................................................................................................. 651.71 ...... 651.73 ...... 760.77 ...... 760.78 ...... 763.84 ...... 770.10 ...... 770.11 ...... 770.12 ...... 770.17 ...... 770.18 ...... 779.84 ...... 780.95 ...... 799.01 ...... 799.02 ...... 996.40 ...... 996.41 ...... 996.42 ...... 996.43 ...... 996.44 ...... 996.45 ...... 996.46 ...... 996.47 ...... 996.49 ...... V12.42 ..... V12.60 ..... V12.61 ..... V12.69 ..... V13.02 ..... V13.03 ..... V15.88 ..... V17.81 ..... V17.89 ..... V18.9 ....... V26.31 ..... V26.32 ..... V26.33 ..... V46.13 ..... V46.14 ..... V49.84 ..... V59.70 ..... V59.71 ..... V59.72 ..... V59.73 ..... V59.74 ..... V62.84 ..... V64.00 ..... V64.01 ..... V64.02 ..... V64.03 ..... V64.04 ..... V64.05 ..... V64.06 ..... V64.07 ..... V64.08 ..... V64.09 ..... V69.5 ....... VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00289 Fmt 4701 CC Sfmt 4702 E:\FR\FM\04MYP2.SGM MDC PRE 11 PRE 11 PRE 11 PRE 11 15 N 11 15 14 N 14 N N N N N N Y N Y N N Y Y Y Y Y Y Y Y Y Y Y N N N N N N N N N N N N N Y Y N N N N N N N N N N N N N N N N N N 14 15 15 15 15 15 15 15 15 15 23 4 4 8 8 8 8 8 8 8 8 8 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 19 23 23 23 23 23 23 23 23 23 23 23 04MYP2 DRG 512, 513 315, 316 512, 513 315, 316 512, 513 315, 316 512, 513 315, 316 331, 332, 333 387,1 389 1 331, 332, 333 387,1 389 1 469 370, 371, 372, 373, 374, 375 383, 384 390 390 390 387,3 389 3 387,3 389 3 387,3 389 3 387,3 389 3 387,3 389 3 390 463, 464 101, 102 101, 102 249 249 249 249 249 249 249 249 249 467 467 467 467 467 467 467 467 467 467 467 467 467 467 467 467 467 467 467 467 467 425 467 467 467 467 467 467 467 467 467 467 467 23594 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 6A.—NEW DIAGNOSIS CODES—Continued Diagnosis code Description V72.86 ..... V85.0 ....... V85.1 ....... V85.21 ..... V85.22 ..... V85.23 ..... V85.24 ..... V85.25 ..... V85.30 ..... V85.31 ..... V85.32 ..... V85.33 ..... V85.34 ..... V85.35 ..... V85.36 ..... V85.37 ..... V85.38 ..... V85.39 ..... V85.4 ....... Encounter for blood typing ............................................................................................................ Body Mass Index less than 19, adult ............................................................................................ Body Mass Index between 19–24, adult ....................................................................................... Body Mass Index 25.0–25.9, adult ................................................................................................ Body Mass Index 26.0–26.9, adult ................................................................................................ Body Mass Index 27.0–27.9, adult ................................................................................................ Body Mass Index 28.0–28.9, adult ................................................................................................ Body Mass Index 29.0–29.9, adult ................................................................................................ Body Mass Index 30.0–30.9, adult ................................................................................................ Body Mass Index 31.0–31.9, adult ................................................................................................ Body Mass Index 32.0–32.9, adult ................................................................................................ Body Mass Index 33.0–33.9, adult ................................................................................................ Body Mass Index 34.0–34.9, adult ................................................................................................ Body Mass Index 35.0–35.9, adult ................................................................................................ Body Mass Index 36.0–36.9, adult ................................................................................................ Body Mass Index 37.0–37.9, adult ................................................................................................ Body Mass Index 38.0–38.9, adult ................................................................................................ Body Mass Index 39.0–39.9, adult ................................................................................................ Body Mass Index 40 and over, adult ............................................................................................ CC N N N N N N N N N N N N N N N N N N N MDC 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 23 10 DRG 467 467 467 467 467 467 467 467 467 467 467 467 467 467 467 467 467 467 296, 297, 298 1 Secondary diagnosis of major problem in DRGs 387 and 389. diagnosis of significant HIV-related condition. 3 Principal or secondary diagnosis of major problem. 2 Principal TABLE 6B.—NEW PROCEDURE CODES Procedure code 00.40 00.41 00.42 00.43 00.45 00.46 00.47 00.48 00.70 Description OR ........ ........ ........ ........ ........ ........ ........ ........ ........ Procedure on single vessel ........................................................................................................... Procedure on two vessels ............................................................................................................. Procedure on three vessels ........................................................................................................... Procedure on four or more vessels ............................................................................................... Insertion of one vascular stent ...................................................................................................... Insertion of two vascular stents ..................................................................................................... Insertion of three vascular stents .................................................................................................. Insertion of four or more vascular stents ...................................................................................... Revision of hip replacement, both acetabular and femoral components ...................................... N N N N N N N N Y 00.71 ........ Revision of hip replacement, acetabular component .................................................................... Y 00.72 ........ Revision of hip replacement, femoral component ......................................................................... Y 00.73 ........ Revision of hip replacement, acetabular liner and/or femoral head only ..................................... Y 00.80 ........ Revision of knee replacement, total (all components) .................................................................. Y 00.81 ........ Revision of knee replacement, tibial component .......................................................................... Y 00.82 ........ Revision of knee replacement, femoral component ...................................................................... Y 00.83 ........ Revision of knee replacement, patellar component ...................................................................... Y 00.84 ........ Revision of total knee replacement, tibial insert (liner) ................................................................. Y 37.41 ........ Implantation of prosthetic cardiac support device around the heart ............................................. Y VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00290 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 MDC 8 10 21 24 8 10 21 2 4 8 10 21 24 8 10 21 24 8 21 24 8 21 24 8 21 24 8 21 24 8 21 24 5 DRG 471, 292, 442, 485 471, 292, 442, 485 471, 292, 442, 485 471, 292, 442, 485 471, 442, 486 471, 442, 486 471, 442, 486 471, 442, 486 471, 442, 486 110, 545 293 443 545 293 443 545 293 443 545 293 443 545 443 545 443 545 443 545 443 545 443 111 23595 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 6B.—NEW PROCEDURE CODES—Continued Procedure code Description 37.49 ........ Other repair of heart and pericardium ........................................................................................... Y 84.56 84.57 86.97 86.98 Insertion of (cement) spacer .......................................................................................................... Removal of (cement) spacer ......................................................................................................... Insertion or replacement of single array rechargeable neurostimulator pulse generator ............. Insertion or replacement of dual array rechargeable neurostimulator pulse generator ................ N N Y Y ........ ........ ........ ........ OR MDC 5 21 24 1 1 DRG 110, 111 442, 443 486 7, 8 7, 8 TABLE 6C.—INVALID DIAGNOSIS CODES Diagnosis code Description 276.5 ........ Volume depletion ........................................................................................................................... Y 287.3 ........ 567.2 ........ Primary thrombocytopenia ............................................................................................................. Other suppurative peritonitis .......................................................................................................... Y Y 67.8 .......... Other specified peritonitis .............................................................................................................. Y 585 ........... Chronic renal failure ...................................................................................................................... Y 599.6 ........ Urinary obstruction, unspecified .................................................................................................... Y 770.1 799.0 996.4 V12.6 V17.8 V26.3 V64.0 Meconium aspiration syndrome ..................................................................................................... Asphyxia ........................................................................................................................................ Mechanical complication of internal orthopedic device, implant, and graft .................................. Diseases of the respiratory system ............................................................................................... Other musculoskeletal diseases .................................................................................................... Genetic counseling and testing ..................................................................................................... Vaccination not carried out because of contradiction ................................................................... Y N Y N N N N ........ ........ ........ ....... ....... ....... ....... CC MDC 10 15 2 25 16 6 15 6 15 PRE 11 11 15 15 4 8 23 23 23 23 DRG 296, 297, 298 387,1 3891 490 397 188, 189, 190 387,1 389 1 188, 189, 190 387,1 389 1 512, 513 315,316 331, 332, 333 387,1 389 1 387,3 389 3 101, 102 249 467 467 467 467 1 Secondary Diagnosis of Major Problem diagnosis of Significant HIV Related Condition 3 Principal or Secondary Diagnosis of Major Problem 2 Principal TABLE 6D.—INVALID PROCEDURE CODES Procedure Code Description 36.02 ........ Single vessel percutaneous transluminal coronary angioplasty [PTCA] or coronary atherectomy with mention of thrombolytic agent. Multiple vessel percutaneous transluminal coronary angioplasty [PTCA] or coronary atherectomy performed during the same operation, with or without mention of thrombolytic agent. Repair of heart and pericardium .................................................................................................... 36.05 ........ 37.4 .......... OR MDC Y 5 Y 5 Y 5 21 24 DRG 106, 516, 517, 518, 526, 527 106, 516, 517, 518, 526, 527 110, 111 442, 443 486 TABLE 6E.—REVISED DIAGNOSIS CODE TITLES Diagnosis Code 403.00 403.01 403.10 403.11 403.90 403.91 404.00 ...... ...... ...... ...... ...... ...... ...... Description CC MDC 404.01 ...... Hypertensive Hypertensive Hypertensive Hypertensive Hypertensive Hypertensive Hypertensive ease. Hypertensive heart and kidney disease, malignant, with heart failure ......................................... Y 5 404.02 ...... Hypertensive heart and kidney disease, malignant, with chronic kidney disease ........................ Y 15 11 VerDate Aug<04>2004 kidney disease, malignant, without chronic kidney disease ................................... kidney disease, malignant, with chronic kidney disease ........................................ kidney disease, benign, without chronic kidney disease ........................................ kidney disease, benign, with chronic kidney disease ............................................. kidney disease, unspecified, without chronic kidney disease ................................. kidney disease, unspecified, with chronic kidney disease ...................................... heart and kidney disease, malignant, without heart failure or chronic kidney dis- Y Y N Y N Y Y 11 11 11 11 11 11 5 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00291 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 DRG 331, 315, 331, 315, 331, 315, 134 332, 333 316 332, 333 316 332, 333 316 115, 121, 124, 127, 535 1387, 389 1 315, 316 23596 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 6E.—REVISED DIAGNOSIS CODE TITLES—Continued Diagnosis Code Description 404.03 ...... Hypertensive heart and kidney disease, malignant, with heart failure and chronic kidney disease. Y 5 404.10 ...... 404.11 ...... Hypertensive heart and kidney disease, benign, without heart failure or chronic kidney disease Hypertensive heart and kidney disease, benign, with heart failure .............................................. N Y 15 5 5 404.12 ...... 404.13 ...... Hypertensive heart and kidney disease, benign, with chronic kidney disease ............................. Hypertensive heart and kidney disease, benign, with heart failure and chronic kidney disease Y Y 15 11 5 404.90 ...... Hypertensive heart and kidney disease, unspecified, without heart failure or chronic kidney disease. Hypertensive heart and kidney disease, unspecified, with heart failure ....................................... N 15 5 Y 5 404.92 ...... 404.93 ...... Hypertensive heart and kidney disease, unspecified, with chronic kidney disease ..................... Hypertensive heart and kidney disease, unspecified, with heart failure and chronic kidney disease. Y Y 15 11 5 728.87 ...... 780.51 ...... Muscle weakness (generalized) .................................................................................................... Insomnia with sleep apnea, unspecified ....................................................................................... N N 780.52 ...... 780.53 ...... Insomnia, unspecified .................................................................................................................... Hypersomnia with sleep apnea, unspecified ................................................................................. N N 780.54 ...... 780.57 ...... Hypersomnia, unspecified ............................................................................................................. Unspecified sleep apnea ............................................................................................................... N N 404.91 ...... 1 Major CC MDC 15 8 PRE 3 19 PRE 3 19 PRE 3 DRG 115, 121, 124, 127, 535 387, 389 1 134 115, 121, 124, 127, 535 387, 389 1 315, 316 115, 121, 124, 127, 535 387, 3891 34 115, 121, 124, 127, 535 387, 389 1 315, 316 115, 121, 124, 127, 535 387, 389 1 247 482 73, 74 432 482 73, 74 432 482 73, 74 problem in DRGs 387 and 389. TABLE 6F.—REVISED PROCEDURE CODE TITLES Procedure Code Description 36.01 ........ Percutaneous transluminal coronary angioplasty [PTCA] or coronary atherectomy .................... Y 5 37.79 ........ Revision or relocation of cardiac device pocket ............................................................................ Y 81.53 ........ Revision of hip replacement, not otherwise specified ................................................................... Y 81.55 ........ Revision of knee replacement, not otherwise specified ................................................................ Y 1 5 9 21 24 8 10 21 24 8 21 24 OR MDC DRG 106, 516, 517, 518, 526, 527 7, 8 117 269, 270 442, 443 486 471, 545 292, 293 442, 443 485 471, 545 442, 443 486 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] *185 59960 59969 *1880 59960 59969 *1881 59960 59969 *1882 59960 59969 *1883 59960 59969 *1884 59960 59969 *1885 59960 59969 *1886 59960 59969 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00292 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23597 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] *1887 59960 59969 *1888 59960 59969 *1889 59960 59969 *1892 59960 59969 *1893 59960 59969 *1894 59960 59969 *1898 59960 59969 *1899 59960 59969 *25040 5851 5852 5853 5854 5855 5856 5859 *25041 5851 5852 5853 5854 5855 5856 5859 *25042 5851 5852 5853 5854 5855 5856 5859 *25043 5851 5852 5853 5854 5855 5856 5859 *25080 5851 5852 5853 5854 5855 5856 5859 *25081 5851 5852 5853 5854 5855 5856 5859 *25082 5851 5852 5853 5854 5855 5856 5859 *25083 5851 5852 5853 5854 5855 5856 5859 *25090 5851 5852 5853 5854 5855 5856 5859 *25091 5851 5852 5853 5854 5855 5856 5859 *25092 5851 5852 5853 5854 5855 5856 5859 *25093 5851 5852 5853 5854 5855 5856 5859 *2595 24200 24201 24210 24211 24220 24221 24230 24231 24240 24241 24280 24281 24290 24291 25001 25002 25003 25011 25012 25013 25021 25022 25023 25031 25032 25033 25041 25042 25043 25051 25052 25053 25061 25062 25063 25071 25072 25073 25081 25082 25083 25091 25092 25093 2510 2513 2521 2532 2535 2541 2550 2553 2554 2555 2556 2580 2581 2588 2589 2592 *27410 5851 5852 5853 5854 5855 5856 5859 *27411 59960 59969 *27419 5851 5852 5853 5854 5855 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00293 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 23598 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 5856 5859 *2760 27650 27651 27652 *2761 27650 27651 27652 *2762 27650 27651 27652 *2763 27650 27651 27652 *2764 27650 27651 27652 *27650 2760 2761 2762 2763 2764 27650 27651 27652 2766 2767 2769 *27651 2760 2761 2762 2763 2764 27650 27651 27652 2766 2767 2769 *27652 2760 2761 2762 2763 2764 27650 27651 27652 2766 2767 2769 *2766 27650 27651 27652 *2767 27650 27651 27652 *2768 27650 27651 27652 *2769 27650 27651 27652 *2860 28730 28731 28732 28733 28739 *2861 28730 28731 28732 28733 28739 *2862 28730 28731 28732 28733 28739 *2863 28730 28731 28732 28733 28739 *2864 28730 28731 28732 28733 28739 *2865 28730 28731 28732 28733 28739 *2866 28730 28731 28732 28733 28739 *2867 28730 28731 28732 28733 28739 *2869 28730 28731 28732 28733 28739 *2870 28730 28731 28732 28733 28739 *2871 28730 28731 28732 28733 28739 *2872 28730 28731 28732 28733 28739 *28730 2860 2861 2862 2863 2864 2865 2866 2867 2869 2870 2871 2872 28730 28731 28732 28733 28739 2874 2875 2878 2879 *28731 2860 2861 2862 2863 2864 2865 2866 2867 2869 2870 2871 2872 28730 28731 28732 28733 28739 2874 2875 2878 2879 *28732 2860 2861 2862 2863 2864 2865 2866 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00294 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23599 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 2867 2869 2870 2871 2872 28730 28731 28732 28733 28739 2874 2875 2878 2879 *28733 2860 2861 2862 2863 2864 2865 2866 2867 2869 2870 2871 2872 28730 28731 28732 28733 28739 2874 2875 2878 2879 *28739 2860 2861 2862 2863 2864 2865 2866 2867 2869 2870 2871 2872 28730 28731 28732 28733 28739 2874 2875 2878 2879 *2874 28730 28731 28732 28733 28739 *2875 28730 28731 28732 28733 28739 *2878 28730 28731 28732 28733 28739 *2879 28730 28731 28732 28733 28739 *28981 28730 28731 28732 28733 28739 *28982 28730 28731 28732 28733 28739 *28989 28730 28731 28732 28733 28739 *2899 28730 28731 28732 28733 28739 *29182 2910 2911 2912 2913 2914 29181 29189 2919 2920 29211 29212 2922 29281 29282 29283 29284 29289 2929 29381 29382 29383 29384 30300 30301 30302 30390 30391 30392 30400 30401 30402 30410 30411 30412 30420 30421 30422 30440 30441 30442 30450 30451 30452 30460 30461 30462 30470 30471 30472 30480 30481 30482 30490 30491 30492 30500 30501 30502 30530 30531 30532 30540 30541 30542 30550 30551 30552 30560 30561 30562 30570 30571 30572 30590 30591 30592 *29285 2910 2911 2912 2913 2914 29181 29189 2919 2920 29211 29212 2922 29281 29282 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00295 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 23600 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 29283 29284 29289 2929 29381 29382 29383 29384 30300 30301 30302 30390 30391 30392 30400 30401 30402 30410 30411 30412 30420 30421 30422 30440 30441 30442 30450 30451 30452 30460 30461 30462 30470 30471 30472 30480 30481 30482 30490 30491 30492 30500 30501 30502 30530 30531 30532 30540 30541 30542 30550 30551 30552 30560 30561 30562 30570 30571 30572 30590 30591 30592 7105 *34461 59960 59969 *42682 4260 42612 42613 42653 42654 4266 4267 42681 42689 4269 4270 4271 4272 42731 42732 42741 42742 *51881 79901 79902 *51882 79901 79902 *51883 79901 79902 *51884 79901 79902 *5670 56721 56722 56723 56729 56733 56739 56781 56782 56789 *5671 56721 56722 56723 56729 56733 56739 56781 56782 56789 *56721 5670 5671 56721 56722 56723 56729 56733 56739 56781 56782 56789 5679 *56722 5670 5671 56721 56722 56723 56729 56733 56739 56781 56782 56789 5679 *56723 5670 5671 56721 56722 56723 56729 56733 56739 56781 56782 56789 5679 *56729 5670 5671 56721 56722 56723 56729 56733 56739 56781 56782 56789 5679 *56733 5670 5671 56721 56722 56723 56729 56733 56739 56781 56782 56789 5679 *56739 5670 5671 56721 56722 56723 56729 56733 56739 56781 56782 56789 5679 *56781 5670 5671 56721 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00296 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23601 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 56722 56723 56729 56733 56739 56781 56782 56789 5679 *56782 5670 5671 56721 56722 56723 56729 56733 56739 56781 56782 56789 5679 *56789 5670 5671 56721 56722 56723 56729 56733 56739 56781 56782 56789 5679 *5679 56721 56722 56723 56729 56733 56739 56781 56782 56789 *56989 56721 56722 56723 56729 56733 56739 56781 56782 56789 *5699 56721 56722 56723 56729 56733 56739 56781 56782 56789 *5800 5851 5852 5853 5854 5855 5856 5859 *5804 5851 5852 5853 5854 5855 5856 5859 *58081 5851 5852 5853 5854 5855 5856 5859 *58089 5851 5852 5853 5854 5855 5856 5859 *5809 5851 5852 5853 5854 5855 5856 5859 *5810 5851 5852 5853 5854 5855 5856 5859 *5811 5851 5852 5853 5854 5855 5856 5859 *5812 5851 5852 5853 5854 5855 5856 5859 *5813 5851 5852 5853 5854 5855 5856 5859 *58181 5851 5852 5853 5854 5855 5856 5859 *58189 5851 5852 5853 5854 5855 5856 5859 *5819 5851 5852 5853 5854 5855 5856 5859 *5820 5851 5852 5853 5854 5855 5856 5859 *5821 5851 5852 5853 5854 5855 5856 5859 *5822 5851 5852 5853 5854 5855 5856 5859 *5824 5851 5852 5853 5854 5855 5856 5859 *58281 5851 5852 5853 5854 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00297 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 23602 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 5855 5856 5859 *58289 5851 5852 5853 5854 5855 5856 5859 *5829 5851 5852 5853 5854 5855 5856 5859 *5830 5851 5852 5853 5854 5855 5856 5859 *5831 5851 5852 5853 5854 5855 5856 5859 *5832 5851 5852 5853 5854 5855 5856 5859 *5834 5851 5852 5853 5854 5855 5856 5859 *5836 5851 5852 5853 5854 5855 5856 5859 *5837 5851 5852 5853 5854 5855 5856 5859 *58381 5851 5852 5853 5854 5855 5856 5859 *58389 5851 5852 5853 5854 5855 5856 5859 *5839 5851 5852 5853 5854 5855 5856 5859 *5845 5851 5852 5853 5854 5855 5856 5859 *5846 5851 5852 5853 5854 5855 5856 5859 *5847 5851 5852 5853 5854 5855 5856 5859 *5848 5851 5852 5853 5854 5855 5856 5859 *5849 5851 5852 5853 5854 5855 5856 5859 *5851 5800 5804 58081 58089 5809 5810 5811 5812 5813 58181 58189 5819 5834 5845 5846 5847 5848 5849 5851 5852 5853 5854 5855 5856 5859 59010 59011 5902 5903 59080 59081 5909 591 *5852 5800 5804 58081 58089 5809 5810 5811 5812 5813 58181 58189 5819 5834 5845 5846 5847 5848 5849 5851 5852 5853 5854 5855 5856 5859 59010 59011 5902 5903 59080 59081 5909 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00298 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23603 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 591 *5853 5800 5804 58081 58089 5809 5810 5811 5812 5813 58181 58189 5819 5834 5845 5846 5847 5848 5849 5851 5852 5853 5854 5855 5856 5859 59010 59011 5902 5903 59080 59081 5909 591 *5854 5800 5804 58081 58089 5809 5810 5811 5812 5813 58181 58189 5819 5834 5845 5846 5847 5848 5849 5851 5852 5853 5854 5855 5856 5859 59010 59011 5902 5903 59080 59081 5909 591 *5855 5800 5804 58081 58089 5809 5810 5811 5812 5813 58181 58189 5819 5834 5845 5846 5847 5848 5849 5851 5852 5853 5854 5855 5856 5859 59010 59011 5902 5903 59080 59081 5909 591 *5856 5800 5804 58081 58089 5809 5810 5811 5812 5813 58181 58189 5819 5834 5845 5846 5847 5848 5849 5851 5852 5853 5854 5855 5856 5859 59010 59011 5902 5903 59080 59081 5909 591 *5859 5800 5804 58081 58089 5809 5810 5811 5812 5813 58181 58189 5819 5834 5845 5846 5847 5848 5849 5851 5852 5853 5854 5855 5856 5859 59010 59011 5902 5903 59080 59081 5909 591 *586 5851 5852 5853 5854 5855 5856 5859 *587 5851 5852 5853 5854 5855 5856 5859 *5880 5851 5852 5853 5854 5855 5856 5859 *5881 5851 5852 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00299 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 23604 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 5853 5854 5855 5856 5859 *58881 5851 5852 5853 5854 5855 5856 5859 *58889 5851 5852 5853 5854 5855 5856 5859 *5889 5851 5852 5853 5854 5855 5856 5859 *5890 5851 5852 5853 5854 5855 5856 5859 *5891 5851 5852 5853 5854 5855 5856 5859 *5899 5851 5852 5853 5854 5855 5856 5859 *59000 5851 5852 5853 5854 5855 5856 5859 *59001 5851 5852 5853 5854 5855 5856 5859 *59010 5851 5852 5853 5854 5855 5856 5859 *59011 5851 5852 5853 5854 5855 5856 5859 *5902 5851 5852 5853 5854 5855 5856 5859 *5903 5851 5852 5853 5854 5855 5856 5859 *59080 5851 5852 5853 5854 5855 5856 5859 *59081 5851 5852 5853 5854 5855 5856 5859 *5909 5851 5852 5853 5854 5855 5856 5859 *591 5851 5852 5853 5854 5855 5856 5859 *5921 59960 59969 *5929 59960 59969 *5930 5851 5852 5853 5854 5855 5856 5859 *5931 5851 5852 5853 5854 5855 5856 5859 *5932 5851 5852 5853 5854 5855 5856 5859 *5933 59960 59969 *5934 59960 59969 *5935 59960 59969 *59389 5851 5852 5853 5854 5855 5856 5859 59960 59969 *5939 5851 5852 5853 5854 5855 5856 5859 59960 59969 *5940 59960 59969 *5941 59960 59969 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00300 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23605 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] *5942 59960 59969 *5948 59960 59969 *5949 59960 59969 *5950 59960 59969 *5951 59960 59969 *5952 59960 59969 *5953 59960 59969 *5954 59960 59969 *59581 59960 59969 *59582 59960 59969 *59589 59960 59969 *5959 59960 59969 *5960 59960 59969 *59651 59960 59969 *59652 59960 59969 *59653 59960 59969 *59654 59960 59969 *59655 59960 59969 *59659 59960 59969 *5968 59960 59969 *5969 59960 59969 *5970 59960 59969 *59780 59960 59969 *59781 59960 59969 *59789 59960 59969 *59800 59960 59969 *59801 59960 59969 *5981 59960 59969 *5982 59960 59969 *5988 59960 59969 *5989 59960 59969 *5990 59960 59969 *5991 59960 59969 *5992 59960 59969 *5993 59960 59969 *5994 59960 59969 *5995 59960 59969 *59960 5921 5935 5950 5951 5952 5954 59581 59582 59589 5959 5970 5981 5982 5990 5994 59960 59969 78820 78829 *59969 5921 5935 5950 5951 5952 5954 59581 59582 59589 5959 5970 5981 5982 5990 5994 59960 59969 78820 78829 *5997 5851 5852 5853 5854 5855 5856 5859 59960 59969 *59981 5851 5852 5853 5854 5855 5856 5859 59960 59969 *59982 5851 5852 5853 5854 5855 5856 5859 59960 59969 *59983 5851 5852 5853 5854 5855 5856 5859 59960 59969 *59984 5851 5852 5853 5854 5855 5856 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00301 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 23606 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 5859 59960 59969 *59989 5851 5852 5853 5854 5855 5856 5859 59960 59969 *5999 5851 5852 5853 5854 5855 5856 5859 59960 59969 *60000 59960 59969 *60001 59960 59969 *60010 59960 59969 *60011 59960 59969 *60020 59960 59969 *60021 59960 59969 *6003 59960 59969 *60090 59960 59969 *60091 59960 59969 *6010 59960 59969 *6011 59960 59969 *6012 59960 59969 *6013 59960 59969 *6014 59960 59969 *6018 59960 59969 *6019 59960 59969 *6020 59960 59969 *6021 59960 59969 *6022 59960 59969 *6023 59960 59969 *6028 59960 59969 *6029 59960 59969 *7530 5851 5852 5853 5854 5855 5856 5859 59960 59969 *75310 5851 5852 5853 5854 5855 5856 5859 59960 59969 *75311 5851 5852 5853 5854 5855 5856 5859 59960 59969 *75312 5851 5852 5853 5854 5855 5856 5859 59960 59969 *75313 5851 5852 5853 5854 5855 5856 5859 59960 59969 *75314 5851 5852 5853 5854 5855 5856 5859 59960 59969 *75315 5851 5852 5853 5854 5855 5856 5859 59960 59969 *75316 5851 5852 5853 5854 5855 5856 5859 59960 59969 *75317 5851 5852 5853 5854 5855 5856 5859 59960 59969 *75319 5851 5852 5853 5854 5855 5856 5859 59960 59969 *75320 5851 5852 5853 5854 5855 5856 5859 59960 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00302 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23607 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 59969 *75321 5851 5852 5853 5854 5855 5856 5859 59960 59969 *75322 5851 5852 5853 5854 5855 5856 5859 59960 59969 *75323 5851 5852 5853 5854 5855 5856 5859 59960 59969 *75329 5851 5852 5853 5854 5855 5856 5859 59960 59969 *7533 5851 5852 5853 5854 5855 5856 5859 59960 59969 *7534 59960 59969 *7535 59960 59969 *7536 59960 59969 *7537 59960 59969 *7538 59960 59969 *7539 5851 5852 5853 5854 5855 5856 5859 59960 59969 *7685 77012 77018 *7686 77012 77018 *7689 77012 77018 *769 77012 77018 *7700 77012 77018 *77010 7685 769 7700 77012 77018 7702 7703 7704 7705 7707 77084 *77011 7685 769 7700 77012 77018 7702 7703 7704 7705 7707 77084 *77012 7685 769 7700 77012 77018 7702 7703 7704 7705 7707 77084 *77017 7685 769 7700 77012 77018 7702 7703 7704 7705 7707 77084 *77018 7685 769 7700 77012 77018 7702 7703 7704 7705 7707 77084 *7702 77012 77018 *7703 77012 77018 *7704 77012 77018 *7705 77012 77018 *7706 77012 77018 *7707 77012 77018 *77081 77012 77018 *77082 77012 77018 *77083 77012 77018 *77084 77012 77018 *77089 77012 77018 *7709 77012 77018 *77981 77012 77018 *77982 77012 77018 *77983 77012 77018 *77984 76501 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00303 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 23608 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] *77989 77012 77018 *78091 79901 79902 *78092 79901 79902 *78093 79901 79902 *78094 79901 79902 *78095 04082 44024 78001 78003 7801 78031 78039 7817 7854 78550 78551 78552 78559 7863 78820 78829 7895 7907 7911 7913 79901 79902 7991 7994 *78099 79901 79902 *7881 59960 59969 *7980 79901 79902 *79901 79901 79902 7991 *79902 79901 79902 7991 *7991 79901 79902 *79981 79901 79902 *79989 79901 79902 *99640 99640 99641 99642 99643 99644 99645 99646 99647 99649 99657 99660 99666 99667 99669 99670 99677 99678 99679 *99641 99640 99641 99642 99643 99644 99645 99646 99647 99649 99657 99660 99666 99667 99669 99670 99677 99678 99679 *99642 99640 99641 99642 99643 99644 99645 99646 99647 99649 99657 99660 99666 99667 99669 99670 99677 99678 99679 *99643 99640 99641 99642 99643 99644 99645 99646 99647 76502 76503 76504 76505 76506 76507 76508 7670 76711 7685 769 7700 77012 77018 7702 7703 7704 7705 7707 77084 7710 7711 7713 77181 77183 77210 77211 77212 77213 77214 7722 7724 7725 7730 7731 7732 7733 7734 7740 7741 7742 77430 77431 77439 7744 7745 7747 7751 7752 7753 7754 7755 7756 7757 7760 7761 7762 7763 7771 7772 7775 7776 7780 7790 7791 7797 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00304 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23609 TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] 99649 99657 99660 99666 99667 99669 99670 99677 99678 99679 *99644 99640 99641 99642 99643 99644 99645 99646 99647 99649 99657 99660 99666 99667 99669 99670 99677 99678 99679 *99645 99640 99641 99642 99643 99644 99645 99646 99647 99649 99657 99660 99666 99667 99669 99670 99677 99678 99679 *99646 99640 99641 99642 99643 99644 99645 99646 99647 99649 99657 99660 99666 99667 99669 99670 99677 99678 99679 *99647 99640 99641 99642 99643 99644 99645 99646 99647 99649 99657 99660 99666 99667 99669 99670 99677 99678 99679 *99649 99640 99641 99642 99643 99644 99645 99646 99647 99649 99657 99660 99666 99667 99669 99670 99677 99678 99679 *99666 99640 99641 99642 99643 99644 99645 99646 99647 99649 *99667 99640 99641 99642 99643 99644 99645 99646 99647 99649 *99677 99640 99641 99642 99643 99644 99645 99646 99647 99649 *99678 99640 99641 99642 99643 99644 99645 99646 99647 99649 *99791 99640 99641 99642 99643 99644 99645 99646 99647 99649 *99799 99640 99641 99642 99643 99644 99645 99646 99647 99649 *99881 99640 99641 99642 99643 99644 99645 99646 99647 99649 *99883 99640 99641 99642 99643 99644 99645 99646 99647 99649 *99889 99640 99641 99642 99643 99644 99645 99646 99647 99649 *9989 99640 99641 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00305 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 23610 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 6G.—ADDITIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6H.—DELETIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6H.—DELETIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are added to the list are in Table 6G-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis.] [CCs that are deleted from the list are in Table 6H-Deletions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected] principal diagnosis. [CCs that are deleted from the list are in Table 6H-Deletions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected] principal diagnosis. 99642 99643 99644 99645 99646 99647 99649 *V460 V4613 V4614 *V4611 V4613 V4614 *V4612 V4613 V4614 *V4613 V4611 V4612 V4613 V4614 *V4614 V4611 V4612 V4613 V4614 *V462 V4613 V4614 *V468 V4613 V4614 *V469 V4613 V4614 *1889 5996 *1892 5996 *1893 5996 *1894 5996 *1898 5996 *1899 5996 *25040 585 *25041 585 *25042 585 *25043 585 *25080 585 *25081 585 *25082 585 *25083 585 *25090 585 *25091 585 *25092 585 *25093 585 *27410 585 *27411 5996 *27419 585 *2760 2765 *2761 2765 *2762 2765 *2763 2765 *2764 2765 *2765 2760 2761 2762 2763 2764 2765 2766 2767 2769 *2766 2765 *2767 2765 *2768 2765 *2769 2765 *2860 2873 *2861 2873 *2862 2873 *2863 2873 *2864 2873 *2865 2873 *2866 2873 *2867 2873 *2869 2873 *2870 2873 *2871 2873 *2872 2873 *2873 2860 2861 2862 2863 2864 2865 2866 2867 2869 2870 2871 2872 2873 2874 2875 2878 2879 *2874 2873 *2875 2873 *2878 2873 *2879 2873 *28981 2873 *28982 2873 *28989 2873 *2899 2873 *34461 5996 *5670 5672 TABLE 6H.—DELETIONS TO THE CC EXCLUSIONS LIST [CCs that are deleted from the list are in Table 6H-Deletions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected] principal diagnosis. *185 5996 *1880 5996 *1881 5996 *1882 5996 *1883 5996 *1884 5996 *1885 5996 *1886 5996 *1887 5996 *1888 5996 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00306 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23611 TABLE 6H.—DELETIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6H.—DELETIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6H.—DELETIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are deleted from the list are in Table 6H-Deletions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected] principal diagnosis. [CCs that are deleted from the list are in Table 6H-Deletions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected] principal diagnosis. [CCs that are deleted from the list are in Table 6H-Deletions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected] principal diagnosis. 5678 *5671 5672 5678 *5672 5670 5671 5672 5678 5679 *5678 5670 5671 5672 5678 5679 *5679 5672 5678 *56989 5672 5678 *5699 5672 5678 *5800 585 *5804 585 *58081 585 *58089 585 *5809 585 *5810 585 *5811 585 *5812 585 *5813 585 *58181 585 *58189 585 *5819 585 *5820 585 *5821 585 *5822 585 *5824 585 *58281 585 *58289 585 *5829 585 *5830 585 *5831 585 *5832 585 *5834 585 *5836 585 *5837 585 *58381 585 *58389 585 *5839 585 *5845 585 *5846 585 *5847 585 *5848 585 *5849 585 *585 5800 5804 58081 58089 5809 5810 5811 5812 5813 58181 58189 5819 5834 5845 5846 5847 5848 5849 585 59010 59011 5902 5903 59080 59081 5909 591 *586 585 *587 585 *5880 585 *5881 585 *58881 585 *58889 585 *5889 585 *5890 585 *5891 585 *5899 585 *59000 585 *59001 585 *59010 585 *59011 585 *5902 585 *5903 585 *59080 585 *59081 585 *5909 585 *591 585 *5921 5996 *5929 5996 *5930 585 *5931 585 *5932 585 *5933 5996 *5934 5996 *5935 5996 *59389 585 5996 *5939 585 5996 *5940 5996 *5941 5996 *5942 5996 *5948 5996 *5949 5996 *5950 5996 *5951 5996 *5952 5996 *5953 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00307 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 23612 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 6H.—DELETIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6H.—DELETIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6H.—DELETIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are deleted from the list are in Table 6H-Deletions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected] principal diagnosis. [CCs that are deleted from the list are in Table 6H-Deletions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected] principal diagnosis. [CCs that are deleted from the list are in Table 6H-Deletions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected] principal diagnosis. 5996 *5954 5996 *59581 5996 *59582 5996 *59589 5996 *5959 5996 *5960 5996 *59651 5996 *59652 5996 *59653 5996 *59654 5996 *59655 5996 *59659 5996 *5968 5996 *5969 5996 *5970 5996 *59780 5996 *59781 5996 *59789 5996 *59800 5996 *59801 5996 *5981 5996 *5982 5996 *5988 5996 *5989 5996 *5990 5996 *5991 5996 *5992 5996 *5993 5996 *5994 5996 *5995 5996 *5996 5921 5935 5950 5951 5952 5954 59581 59582 59589 5959 5970 5981 5982 5990 5994 5996 78820 78829 *5997 585 5996 *59981 585 5996 *59982 585 5996 *59983 585 5996 *59984 585 5996 *59989 585 5996 *5999 585 5996 *60000 5996 *60001 5996 *60010 5996 *60011 5996 *60020 5996 *60021 5996 *6003 5996 *60090 5996 *60091 5996 *6010 5996 *6011 5996 *6012 5996 *6013 5996 *6014 5996 *6018 5996 *6019 5996 *6020 5996 *6021 5996 *6022 5996 *6023 5996 *6028 5996 *6029 5996 *7530 585 5996 *75310 585 5996 *75311 585 5996 *75312 585 5996 *75313 585 5996 *75314 585 5996 *75315 585 5996 *75316 585 5996 *75317 585 5996 *75319 585 5996 *75320 585 5996 *75321 585 5996 *75322 585 5996 *75323 585 5996 *75329 585 5996 *7533 585 5996 *7534 5996 *7535 5996 *7536 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00308 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 23613 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 6H.—DELETIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6H.—DELETIONS TO THE CC EXCLUSIONS LIST—Continued TABLE 6H.—DELETIONS TO THE CC EXCLUSIONS LIST—Continued [CCs that are deleted from the list are in Table 6H-Deletions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected] principal diagnosis. [CCs that are deleted from the list are in Table 6H-Deletions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected] principal diagnosis. [CCs that are deleted from the list are in Table 6H-Deletions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected] principal diagnosis. 5996 *7537 5996 *7538 5996 *7539 585 5996 *7685 7701 *7686 7701 *7689 7701 *769 7701 *7700 7701 *7701 7685 769 7700 7701 7702 7703 7704 7705 7707 77084 *7702 7701 *7703 7701 *7704 7701 *7705 7701 *7706 7701 *7707 7701 *77081 7701 *77082 7701 *77083 7701 *77084 7701 *77089 7701 *7709 7701 *77981 7701 *77982 7701 *77983 7701 *77989 7701 *7881 5996 *7990 7991 *9964 9964 99657 99660 99666 99667 99669 99670 99677 99678 99679 *99666 9964 *99667 9964 *99677 9964 *99678 9964 *99791 9964 *99799 9964 *99881 9964 *99883 9964 *99889 9964 *9989 9964 TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY [FY 2004 MedPAR Update December 2004 GROUPER V22.0] Number of discharges DRG 1 ............................................................... 2 ............................................................... 3 ............................................................... 6 ............................................................... 7 ............................................................... 8 ............................................................... 9 ............................................................... 10 ............................................................. 11 ............................................................. 12 ............................................................. 13 ............................................................. 14 ............................................................. 15 ............................................................. 16 ............................................................. 17 ............................................................. 18 ............................................................. 19 ............................................................. 20 ............................................................. 21 ............................................................. 22 ............................................................. 23 ............................................................. 24 ............................................................. 25 ............................................................. 26 ............................................................. 27 ............................................................. 28 ............................................................. 29 ............................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Arithmetic means LOS 23,272 10,351 4 410 15,592 3,701 1,945 19,511 3,279 54,431 7,337 236,958 76,129 16,264 3,008 33,082 8,568 6,532 2,197 3,316 10,732 63,863 28,153 18 5,387 17,558 6,274 PO 00000 Frm 00309 10th percentile 9.8371 4.5604 9.5000 3.0512 9.2952 2.8652 6.1594 6.0234 3.7600 5.3747 4.9162 5.6626 4.5225 6.3451 3.2114 5.2590 3.4383 9.8403 6.3245 5.2223 3.8906 4.7303 3.1246 6.2778 5.1142 5.7440 3.3202 Fmt 4701 25th percentile 3 1 1 1 2 1 1 2 1 2 2 2 1 2 1 2 1 3 2 2 1 1 1 1 1 1 1 Sfmt 4702 50th percentile 5 2 1 1 4 1 3 3 2 3 3 3 2 3 2 3 2 5 3 2 2 2 2 2 1 3 1 E:\FR\FM\04MYP2.SGM 75 percentile 8 4 8 2 7 2 5 5 3 4 4 4 4 5 2 4 3 8 5 4 3 4 3 3 3 4 3 04MYP2 13 6 14 4 12 4 7 8 5 6 6 7 6 8 4 7 4 12 8 7 5 6 4 4 6 7 4 90th percentile 19 9 15 7 19 7 12 12 7 10 8 11 8 12 6 10 6 19 13 10 7 9 6 8 11 12 6 23614 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY—Continued [FY 2004 MedPAR Update December 2004 GROUPER V22.0] Number of discharges DRG 30 ............................................................. 31 ............................................................. 32 ............................................................. 34 ............................................................. 35 ............................................................. 36 ............................................................. 37 ............................................................. 38 ............................................................. 39 ............................................................. 40 ............................................................. 42 ............................................................. 43 ............................................................. 44 ............................................................. 45 ............................................................. 46 ............................................................. 47 ............................................................. 49 ............................................................. 50 ............................................................. 51 ............................................................. 52 ............................................................. 53 ............................................................. 54 ............................................................. 55 ............................................................. 56 ............................................................. 57 ............................................................. 59 ............................................................. 60 ............................................................. 61 ............................................................. 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 ........................................................... 104 ........................................................... VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Arithmetic means LOS 1 5,090 1,982 27,872 7,895 1,472 1,241 56 448 1,383 1,145 125 1,160 2,803 3,819 1,335 2,478 2,170 190 165 2,225 1 1,354 435 698 102 8 219 2,842 3,343 41,424 8,007 419 17,328 4,816 25 68 1,066 7,935 4 45,034 47,341 2,153 45,631 170,684 7,724 4 65,161 6,950 1,472 21,878 1,861 82,727 413,844 550,707 45,868 45 16,495 1,598 13,338 1,612 59,134 27,017 8 21,547 6,953 23,105 5,237 724 20,953 PO 00000 Frm 00310 10th percentile 19.0000 3.9800 2.4001 4.7722 3.0011 1.6019 4.1281 3.5179 2.3772 4.1063 2.7721 3.1440 4.7836 3.0756 4.1712 2.8854 4.3906 1.8143 2.7632 1.9818 3.9542 7.0000 3.1300 2.5724 4.1547 2.5392 3.2500 5.4064 4.4838 6.0464 2.7728 3.1309 3.6826 3.9720 3.0328 2.3600 4.0000 3.4531 4.3806 2.5000 9.8129 10.8198 4.6716 6.2559 8.1939 5.3718 11.5000 6.6908 5.2373 3.1454 6.2321 3.6239 6.4131 4.9009 5.6477 3.8123 4.3556 5.9978 3.8273 6.1223 3.6340 4.3754 3.3864 2.5000 3.1101 2.1151 4.2502 2.4921 37.3798 14.4988 Fmt 4701 25th percentile 19 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 7 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 3 3 1 2 3 2 8 2 2 1 2 1 2 2 2 2 1 2 1 2 1 2 1 1 1 1 1 1 8 6 Sfmt 4702 19 2 1 2 1 1 1 1 1 1 1 1 3 2 2 1 2 1 1 1 1 7 1 1 1 1 1 1 2 2 1 1 2 2 2 1 2 2 2 2 5 5 2 4 4 3 8 3 3 2 3 2 3 3 3 2 2 3 2 3 2 2 2 2 1 1 2 1 12 8 E:\FR\FM\04MYP2.SGM 50th percentile 19 3 2 4 3 1 3 2 1 4 2 2 4 2 3 2 3 1 1 1 2 7 2 1 2 1 2 3 3 4 2 2 3 3 3 2 3 3 3 2 7 8 4 6 7 4 11 5 4 3 5 3 5 4 5 3 3 5 3 5 3 4 3 2 2 2 3 2 23 12 04MYP2 75 percentile 19 5 3 6 4 1 5 4 2 5 4 4 6 4 5 4 5 2 3 2 5 7 4 3 5 2 4 7 5 8 3 4 4 5 4 3 5 4 6 3 12 13 6 8 10 7 13 9 7 4 8 5 8 6 7 5 5 8 5 8 5 5 4 3 4 3 5 3 48 18 90th percentile 19 8 5 9 6 3 9 6 5 8 6 6 8 6 8 5 8 3 6 4 9 7 7 6 9 6 4 12 9 13 5 6 7 7 5 4 7 7 9 3 20 21 9 10 15 10 14 13 10 6 12 7 12 9 10 7 9 11 7 12 7 8 6 3 6 4 8 5 79 25 23615 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY—Continued [FY 2004 MedPAR Update December 2004 GROUPER V22.0] Number of discharges DRG 105 106 107 108 109 110 111 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Arithmetic means LOS 31,568 3,499 70,111 8,878 50,742 57,167 10,077 37,263 8,514 22,137 118,685 5,151 7,605 993 36,309 159,575 61,768 33,656 130,770 95,808 5,823 695,800 5,181 3,762 89,126 23,839 117,297 7,287 42,414 7,439 1,133 207,068 78,609 38,178 121,892 52,279 249,312 99,715 6,187 10,769 2,634 135,681 19,915 22,708 5,353 5,007 2,092 28,497 6,161 6 8,260 4,106 19,174 11,988 10,428 5,497 10 5,945 2,523 4,933 4,634 1,544 756 17,471 1,484 32,879 2,392 267,905 32,657 14,560 PO 00000 Frm 00311 10th percentile 9.9544 11.2138 10.5005 9.8314 7.7661 8.3880 3.4273 12.5945 8.4514 6.8327 4.2655 4.2386 3.0473 5.4945 9.0439 6.2485 3.3855 4.7990 4.3991 2.7249 11.2705 5.1260 5.1662 2.5944 5.4275 3.8048 2.8049 2.1806 3.1069 4.2879 2.7643 3.9126 2.4367 2.4370 3.4612 2.4785 2.0936 5.6964 2.6198 9.8862 5.8193 12.0864 5.9490 10.8769 5.1362 8.0429 4.9809 13.0520 4.1344 24.1667 5.7196 2.6086 5.1209 2.6625 4.3945 2.0806 2.9000 7.9862 4.2089 4.5046 2.2169 4.9087 2.2844 10.7718 4.0964 6.8401 3.5920 4.7020 2.8910 5.1422 Fmt 4701 25th percentile 4 5 5 1 4 1 1 4 2 1 1 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 5 3 5 3 4 1 3 2 3 1 1 1 1 1 1 1 1 1 3 2 1 1 1 1 2 1 2 1 2 1 2 Sfmt 4702 50th percentile 6 7 7 5 5 3 1 6 4 2 1 1 1 1 3 3 2 1 2 1 6 3 3 1 3 2 1 1 2 2 1 2 1 1 2 1 1 2 1 6 4 7 4 6 2 5 3 6 2 5 2 1 2 1 2 1 1 5 3 2 1 2 1 5 2 3 1 3 2 3 E:\FR\FM\04MYP2.SGM 8 9 9 8 6 7 3 10 7 5 3 2 2 3 6 5 3 3 3 2 9 4 5 1 5 4 2 2 2 3 2 3 2 2 3 2 2 4 2 8 6 9 6 9 5 7 5 10 3 9 4 2 4 2 3 1 2 7 4 3 2 3 2 8 3 5 3 4 2 4 04MYP2 75 percentile 12 13 12 12 9 11 5 16 11 9 6 5 4 7 12 8 4 6 6 3 14 6 6 3 7 5 3 3 4 5 3 5 3 3 4 3 3 7 3 12 7 15 7 14 7 9 6 16 6 27 7 3 7 3 6 3 3 10 5 5 3 6 3 14 5 9 5 6 4 6 90th percentile 18 19 17 19 13 17 7 24 16 14 9 10 7 13 20 12 6 11 9 5 21 10 9 6 10 7 5 4 6 8 5 7 5 5 6 5 4 12 5 17 9 22 9 20 10 14 8 25 8 27 12 5 10 5 9 4 6 14 7 9 4 10 5 22 8 14 7 9 5 10 23616 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY—Continued [FY 2004 MedPAR Update December 2004 GROUPER V22.0] Number of discharges DRG 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 216 217 218 219 220 223 224 225 226 227 228 229 230 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Arithmetic means LOS 8,554 2,909 14,429 92,193 25,897 292,198 86,576 78 5,680 4 621 90,968 13,182 69 10,411 1,322 4,514 521 3,249 701 17,317 4,645 1,425 936 2,665 27,281 31,656 72,845 31,474 2,081 35,754 9,758 461,222 128,455 26,708 10 10,257 17,656 17,622 28,708 21,361 4 13,425 10,889 6,514 6,660 5,074 2,640 1,201 2,565 729 15,118 7,676 4,970 42,408 2,022 9,869 42,943 12,653 2,696 2,742 101,477 15,792 5,840 1,430 21,671 15,118 14,026 4,155 2,148 PO 00000 Frm 00312 10th percentile 4.4329 3.1158 5.8559 5.3215 3.3265 4.4293 2.8664 3.2821 4.4905 2.0000 4.1723 5.5332 3.0882 4.3768 12.6933 5.6899 12.0549 6.6756 10.6190 5.7275 9.0988 4.3208 9.5298 9.6976 13.7471 6.1787 6.4850 5.5246 5.8950 3.8847 5.2393 2.9364 4.5677 6.6967 4.6708 2.9000 9.1059 5.7608 12.4479 5.4480 3.1063 2.7500 3.2055 1.8875 5.1650 6.3380 2.6139 4.1258 2.5129 5.5922 2.8230 6.6726 2.7952 4.6463 4.4748 3.6682 8.2633 6.0632 6.6177 3.7066 6.5864 4.5166 4.4924 3.1334 3.5664 3.3172 4.8397 3.8285 3.8876 2.7514 Fmt 4701 25th percentile 2 1 2 2 1 1 1 1 1 1 1 1 1 1 3 1 5 3 4 2 3 2 2 1 3 2 2 2 2 1 1 1 3 3 3 1 2 1 3 2 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 3 2 2 1 2 1 1 1 1 1 1 1 1 1 Sfmt 4702 50th percentile 2 2 3 3 2 2 1 2 2 1 2 2 1 2 6 3 7 4 6 4 5 3 4 4 6 3 3 3 3 2 2 1 3 4 3 1 4 1 5 3 2 2 1 1 2 2 1 1 1 2 1 2 1 2 3 2 4 3 3 2 3 2 2 1 2 2 3 1 2 1 E:\FR\FM\04MYP2.SGM 4 3 5 4 3 3 2 2 3 1 3 4 2 3 9 5 10 6 9 5 7 4 7 7 10 5 5 4 4 3 4 2 4 6 4 3 7 3 9 4 3 3 2 1 4 4 2 3 2 4 1 5 2 4 4 3 6 5 5 3 5 4 4 3 3 3 4 3 3 3 04MYP2 75 percentile 5 4 7 7 4 5 4 4 5 3 5 7 4 5 16 7 15 8 13 7 11 6 13 12 18 8 8 7 7 5 7 4 5 8 5 4 12 8 15 7 4 3 4 2 7 8 3 5 3 7 3 9 4 6 5 4 10 7 8 5 8 6 6 4 4 4 6 5 5 3 90th percentile 8 5 11 10 6 8 5 6 9 3 8 11 6 8 26 10 22 11 19 9 17 7 19 20 28 12 13 11 12 8 10 6 7 11 7 4 18 14 26 10 5 3 6 3 11 13 5 9 5 12 6 14 6 9 8 7 15 11 13 7 12 8 8 6 7 6 9 8 7 5 23617 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY—Continued [FY 2004 MedPAR Update December 2004 GROUPER V22.0] Number of discharges DRG 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Arithmetic means LOS 1 24,857 10,420 1 7,152 13,512 12,042 2,903 2,991 1,603 636 23,809 3,922 4,307 2,304 272 1,004 10,686 2,639 21,054 5,942 1,349 2,288 228 1,447 112,318 33,865 6 19,272 7,093 6,274 1,833 7,623 2,703 6,114 10,450 6,894 10,859 64 7,331 368 98,963 4,102 254,706 45,347 81 1,478 21,343 3,901 9,649 23,760 13,826 3,087 6,350 2,066 7,093 3,559 26,035 6,480 1,456 508 1 36,565 180,999 2,766 5,927 383 218,684 31,401 61 PO 00000 Frm 00313 10th percentile 1.0000 4.5324 3.0461 7.0000 5.0301 2.6104 1.7498 2.7689 1.4055 2.2052 4.8428 10.7403 6.2358 6.5677 3.1788 4.1838 3.5508 8.3273 3.8151 6.7875 5.8009 3.6449 6.2592 3.2456 4.4630 5.5013 4.0567 4.6667 4.0080 2.8429 4.5695 3.0295 10.0454 5.4802 9.8368 4.1090 2.5582 2.1325 2.7969 10.0308 4.4674 4.2920 3.6675 4.7202 3.0710 3.9383 5.1604 5.8673 3.4107 8.1898 7.3943 8.4735 3.2096 5.4737 2.0736 6.1095 2.0014 4.5265 1.8782 4.8365 2.2165 2.0000 6.7584 6.2874 3.4678 5.7441 2.7546 5.0953 3.5963 3.4918 Fmt 4701 25th percentile 1 2 1 7 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 2 3 2 1 1 1 2 1 1 1 1 1 1 1 2 1 4 3 2 1 1 1 1 1 1 1 1 1 2 1 2 1 1 1 2 1 2 Sfmt 4702 50th percentile 1 3 2 7 2 1 1 1 1 1 2 5 3 2 1 1 1 4 1 3 3 2 3 1 2 3 2 3 2 1 2 1 5 2 5 2 1 1 1 4 2 2 2 2 2 1 2 3 2 5 4 3 2 2 1 2 1 2 1 1 1 2 1 3 1 2 1 3 2 2 E:\FR\FM\04MYP2.SGM 75 percentile 1 4 3 7 4 2 1 1 1 1 4 8 5 4 2 3 2 6 3 5 4 3 5 2 4 5 3 5 3 2 3 2 8 4 7 3 1 1 1 8 3 3 3 4 3 2 4 5 3 6 6 6 3 3 2 4 1 3 1 3 2 2 4 5 2 4 2 4 3 3 04MYP2 1 5 4 7 6 3 2 3 1 2 7 13 8 8 4 5 4 11 5 8 7 5 8 4 6 7 5 6 5 4 6 4 12 6 12 4 2 2 2 13 6 5 4 6 4 4 6 7 4 9 9 11 4 8 2 8 2 6 2 6 3 2 9 8 4 7 3 6 4 4 90th percentile 1 8 5 7 10 5 3 7 2 4 10 21 12 14 7 10 7 16 8 12 11 7 12 7 8 10 7 6 7 5 9 6 19 10 19 7 5 4 5 20 9 8 7 9 6 7 10 11 6 14 14 18 6 12 3 14 4 10 3 11 4 2 16 12 7 11 6 9 6 6 23618 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY—Continued [FY 2004 MedPAR Update December 2004 GROUPER V22.0] Number of discharges DRG 323 324 325 326 327 328 329 331 332 333 334 335 336 337 338 339 340 341 342 344 345 346 347 348 349 350 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 389 390 392 393 394 395 396 397 398 399 ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Arithmetic means LOS 20,482 5,421 9,615 2,584 5 606 72 54,798 4,389 252 9,810 11,931 31,264 25,156 652 1,253 2 3,185 565 2,693 1,461 3,966 247 4,171 575 7,137 975 2,735 7,612 4,937 23,993 5,570 20,798 28,741 14,764 272 2 2,128 1,451 1,622 4,789 456 3,924 3,613 1,843 2,244 1,164 4,871 156 6 388 77 196 508 91 212 43 2,473 132 1 1 1 2,203 1 2,820 116,129 9 18,482 18,288 1,640 PO 00000 Frm 00314 10th percentile 3.0937 1.8843 3.6813 2.6207 2.6000 3.4719 1.8333 5.4332 3.1246 5.4921 4.3009 2.6866 3.2999 1.9182 6.1748 5.1173 5.0000 3.1586 3.4248 2.7037 4.8077 5.7307 3.0202 4.0897 2.3583 4.4541 4.0133 6.3192 5.6967 3.0614 1.9281 8.1269 3.9629 2.4058 2.5880 3.0184 1.0000 3.7810 4.1909 7.7404 6.4792 2.9934 6.6351 3.2419 5.1557 3.3944 3.1847 2.2373 2.7436 4.0000 3.3711 4.4805 2.3163 2.8130 2.1099 2.2642 1.4419 3.6526 2.5606 1.0000 21.0000 1.0000 9.1770 4.0000 7.3553 4.2575 4.4444 5.1407 5.7016 3.3250 Fmt 4701 25th percentile 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 4 1 1 1 1 1 1 1 1 2 1 2 2 2 1 3 2 1 1 1 1 1 1 2 2 1 2 1 2 2 2 1 2 1 1 1 1 1 1 1 1 1 1 1 21 1 2 4 1 1 1 1 2 1 Sfmt 4702 1 1 2 1 1 1 1 2 1 2 2 2 2 1 2 1 4 1 2 1 1 3 1 2 1 2 2 3 3 2 1 4 2 2 1 1 1 2 2 3 3 1 3 1 3 3 2 2 2 2 2 1 1 1 1 1 1 1 1 1 21 1 4 4 2 2 1 2 3 2 E:\FR\FM\04MYP2.SGM 50th percentile 2 1 3 2 2 3 1 4 2 3 3 3 2 2 3 3 6 2 2 1 3 4 2 3 2 4 3 4 4 3 2 6 3 2 2 2 1 2 3 5 5 2 5 2 4 3 2 2 2 2 2 3 2 2 1 1 1 2 1 1 21 1 6 4 5 3 2 4 4 3 04MYP2 75 percentile 4 2 5 3 3 5 2 7 4 7 5 3 4 2 9 7 6 3 4 2 6 7 4 5 3 5 5 7 6 4 2 10 4 3 3 3 1 4 5 9 8 4 8 4 5 4 3 3 3 6 4 4 3 3 2 2 2 4 3 1 21 1 11 4 9 5 3 6 7 4 90th percentile 6 3 7 5 5 7 3 11 6 13 7 4 7 3 14 11 6 7 8 6 11 11 7 8 4 8 8 12 10 4 3 15 7 4 4 7 1 8 9 17 13 6 13 6 8 5 5 3 4 6 6 8 4 6 4 4 2 7 5 1 21 1 19 4 16 8 6 10 11 6 23619 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY—Continued [FY 2004 MedPAR Update December 2004 GROUPER V22.0] Number of discharges DRG 401 402 403 404 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 439 440 441 442 443 444 445 447 448 449 450 451 452 453 454 455 461 462 463 464 465 466 467 468 471 473 475 476 477 478 479 480 481 482 484 485 486 487 ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Arithmetic means LOS 6,328 1,401 31,865 3,802 2,224 584 2,170 1,808 28,417 12 12 5,198 573 50,827 239,006 23 28,508 16,282 2,941 11,882 52 8,637 1,071 14,779 4,313 1,505 773 25,479 71,439 304 420 5,191 1,739 5,613 779 18,017 3,385 5,892 2,346 6,264 1 38,802 7,805 3 27,634 5,437 3,837 846 2,722 7,761 31,045 7,661 219 1,377 1,015 50,481 15,614 8,778 116,534 3,025 29,407 113,660 24,603 802 1,066 5,076 449 3,420 2,562 4,644 PO 00000 Frm 00315 10th percentile 11.0390 4.0293 7.9367 4.1528 9.9150 3.8253 8.1949 5.7954 3.8214 3.2500 2.7500 6.7563 4.0244 14.0035 7.3769 5.2174 6.1657 4.3857 3.3747 4.0613 3.7115 8.2173 11.7274 3.4569 4.1203 4.7375 7.2549 5.4228 7.6737 5.8947 4.2548 2.9626 8.7993 8.7825 3.3813 8.6810 3.4003 4.0324 2.8372 2.5686 2.0000 3.6742 1.9867 1.6667 4.8762 2.7993 4.1058 2.2222 5.1267 10.1584 3.8939 2.9141 3.6347 4.7117 2.6788 12.8082 5.0496 12.4026 11.0157 10.4998 8.5221 7.1046 2.7884 17.9102 21.8208 11.4967 12.7506 9.6038 12.3478 7.0540 Fmt 4701 25th percentile 2 1 2 1 2 1 1 1 1 1 1 2 1 4 2 1 2 1 1 1 1 2 2 1 1 1 1 2 2 1 1 1 1 2 1 2 1 1 1 1 2 1 1 1 1 1 1 1 1 4 1 1 1 1 1 3 3 2 2 2 1 1 1 7 10 4 2 4 2 1 Sfmt 4702 5 1 3 2 4 2 2 3 2 2 1 3 2 6 3 2 3 2 2 2 1 3 4 1 2 2 2 3 3 2 2 1 3 3 1 3 1 2 1 1 2 1 1 1 2 1 2 1 1 6 2 1 1 1 1 6 3 3 5 4 3 2 1 9 16 6 6 5 6 3 E:\FR\FM\04MYP2.SGM 50th percentile 9 3 6 3 7 3 5 4 3 2 1 5 3 11 6 3 5 3 3 3 2 6 8 3 3 3 5 4 6 4 3 2 5 6 2 6 3 3 2 2 2 3 1 1 3 2 3 2 3 8 3 2 2 2 2 10 4 7 9 9 6 5 2 13 20 9 10 7 10 5 04MYP2 75 percentile 14 5 10 5 12 5 10 6 5 4 3 9 5 18 9 5 8 5 4 5 4 10 14 4 5 5 8 6 9 7 5 3 10 10 4 11 4 5 4 3 2 4 2 3 6 3 5 3 6 13 5 4 4 5 3 16 5 18 14 14 11 9 4 22 25 14 17 11 16 9 90th percentile 22 9 16 8 21 7 19 12 6 4 4 13 8 28 14 10 12 8 6 7 7 17 22 7 8 9 15 10 15 12 8 6 19 18 7 18 7 8 5 5 2 7 4 3 10 5 8 4 12 18 7 5 7 9 5 25 8 32 21 21 18 15 6 36 35 21 25 18 25 14 23620 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 7A.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY—Continued [FY 2004 MedPAR Update December 2004 GROUPER V22.0] Number of discharges DRG 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 515 516 517 518 519 520 521 522 523 524 525 526 527 528 529 530 531 532 533 534 535 536 537 538 539 540 541 542 543 ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... 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Arithmetic means LOS 786 13,461 5,204 19,789 4,012 61,628 25,626 307 3,261 29,453 19,400 35,676 48,323 3,122 717 5,909 187 179 1,004 307 641 168 1,755 635 513 227 27,312 38,732 66,287 41,113 11,506 15,266 32,148 5,646 15,866 118,949 315 55,877 192,230 1,770 4,032 2,363 4,799 2,622 47,609 45,285 13,002 19,606 8,641 5,604 5,020 1,510 22,369 24,376 5,415 10th percentile 16.3422 8.3538 5.3918 3.1423 13.6269 6.0515 2.6772 17.4072 8.9877 6.0617 3.7954 4.3236 2.2420 9.9308 5.6987 3.8284 27.1818 4.6704 15.9273 8.4919 7.2044 5.1607 6.4160 4.0787 12.7719 9.9824 4.2899 4.7893 2.5801 3.4800 4.8233 2.0074 5.4742 9.3666 3.8769 3.1907 13.4222 4.3572 2.2326 17.1090 7.9923 3.1240 9.4049 3.7227 3.7364 1.7909 8.2678 5.4113 6.7775 2.8164 10.7639 3.5808 42.8902 32.5434 11.9830 25th percentile 4 2 1 1 3 1 1 8 3 3 2 1 1 4 2 1 8 1 3 1 1 1 1 1 7 5 1 2 1 1 1 1 2 3 1 1 1 1 1 6 1 1 2 1 1 1 1 1 1 1 2 1 17 12 2 50th percentile 7 3 2 2 5 3 1 9 4 4 3 2 1 5 3 2 16 1 7 3 3 2 2 1 8 7 1 2 1 1 1 1 3 4 2 2 3 2 1 10 2 1 4 1 1 1 3 2 3 1 4 1 25 18 5 75 percentile 13 6 4 3 6 5 2 13 6 5 3 3 2 8 5 3 23 1 13 7 5 3 4 2 10 8 2 4 1 2 3 1 4 7 3 3 8 3 1 15 5 2 7 3 2 1 7 4 5 2 7 3 35 27 10 22 10 7 3 23 8 4 19 11 7 5 5 3 13 7 5 36 6 21 11 9 6 8 5 14 12 6 6 3 4 6 2 7 12 5 4 16 5 2 22 10 4 12 5 4 2 11 7 8 4 14 4 52 40 16 90th percentile 35 17 11 5 31 12 5 31 18 10 6 9 4 18 9 7 49 11 33 18 15 11 14 8 23 16 11 9 6 8 11 4 11 19 7 6 32 8 5 30 18 6 20 8 9 3 17 12 14 6 23 7 76 58 24 12,140,152 TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY [FY 2004 MedPAR Update December 2004 GROUPER V23.0] Number of discharges DRG 1 2 3 6 7 ............................................................... ............................................................... ............................................................... ............................................................... ............................................................... VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Arithmetic mean LOS 23,271 10,351 4 410 15,592 PO 00000 Frm 00316 10th percentile 9.8373 4.5604 9.5000 3.0512 9.2952 Fmt 4701 25th percentile 3 1 1 1 2 Sfmt 4702 50th percentile 5 2 1 1 4 E:\FR\FM\04MYP2.SGM 75th percentile 8 4 8 2 7 04MYP2 13 6 14 4 12 90th percentile 19 9 15 7 19 23621 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY—Continued [FY 2004 MedPAR Update December 2004 GROUPER V23.0] Number of discharges DRG 8 ............................................................... 9 ............................................................... 10 ............................................................. 11 ............................................................. 12 ............................................................. 13 ............................................................. 14 ............................................................. 15 ............................................................. 16 ............................................................. 17 ............................................................. 18 ............................................................. 19 ............................................................. 20 ............................................................. 21 ............................................................. 22 ............................................................. 23 ............................................................. 24 ............................................................. 25 ............................................................. 26 ............................................................. 27 ............................................................. 28 ............................................................. 29 ............................................................. 30 ............................................................. 31 ............................................................. 32 ............................................................. 34 ............................................................. 35 ............................................................. 36 ............................................................. 37 ............................................................. 38 ............................................................. 39 ............................................................. 40 ............................................................. 42 ............................................................. 43 ............................................................. 44 ............................................................. 45 ............................................................. 46 ............................................................. 47 ............................................................. 49 ............................................................. 50 ............................................................. 51 ............................................................. 52 ............................................................. 53 ............................................................. 54 ............................................................. 55 ............................................................. 56 ............................................................. 57 ............................................................. 59 ............................................................. 60 ............................................................. 61 ............................................................. 63 ............................................................. 64 ............................................................. 65 ............................................................. 66 ............................................................. 67 ............................................................. 68 ............................................................. 69 ............................................................. 70 ............................................................. 71 ............................................................. 72 ............................................................. 73 ............................................................. 74 ............................................................. 75 ............................................................. 76 ............................................................. 77 ............................................................. 78 ............................................................. 79 ............................................................. 80 ............................................................. 81 ............................................................. 82 ............................................................. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Arithmetic mean LOS 3,701 1,945 19,511 3,279 54,431 7,337 236,958 76,129 16,264 3,008 33,082 8,568 6,532 2,197 3,316 10,732 63,863 28,153 18 5,387 17,558 6,274 1 5,090 1,982 27,872 17,895 1,472 1,241 56 448 1,383 1,145 125 1,160 2,803 3,819 1,335 2,478 2,170 190 165 2,225 1 1,354 435 698 102 8 219 2,842 3,343 41,424 8,007 419 17,328 4,816 25 68 1,066 7,935 4 45,031 47,341 2,153 45,631 170,684 7,724 4 65,161 PO 00000 Frm 00317 10th percentile 2.8652 6.1594 6.0234 3.7600 5.3747 4.9162 5.6626 4.5225 6.3451 3.2114 5.2590 3.4383 9.8403 6.3245 5.2223 3.8906 4.7303 3.1246 6.2778 5.1142 5.7440 3.3202 19.0000 3.9800 2.4001 4.7722 3.0011 1.6019 4.1281 3.5179 2.3772 4.1063 2.7721 3.1440 4.7836 3.0756 4.1712 2.8854 4.3906 1.8143 2.7632 1.9818 3.9542 7.0000 3.1300 2.5724 4.1547 2.5392 3.2500 5.4064 4.4838 6.0464 2.7728 3.1309 3.6826 3.9720 3.0328 2.3600 4.0000 3.4531 4.3806 2.5000 9.8127 10.8198 4.6716 6.2559 8.1939 5.3718 11.5000 6.6908 Fmt 4701 25th percentile 1 1 2 1 2 2 2 1 2 1 2 1 3 2 2 1 1 1 1 1 1 1 19 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 7 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 3 3 1 2 3 2 8 2 Sfmt 4702 1 3 3 2 3 3 3 2 3 2 3 2 5 3 2 2 2 2 2 1 3 1 19 2 1 2 1 1 1 1 1 1 1 1 3 2 2 1 2 1 1 1 1 7 1 1 1 1 1 1 2 2 1 1 2 2 2 1 2 2 2 2 5 5 2 4 4 3 8 3 E:\FR\FM\04MYP2.SGM 50th percentile 2 5 5 3 4 4 4 4 5 2 4 3 8 5 4 3 4 3 3 3 4 3 19 3 2 4 3 1 3 2 1 4 2 2 4 2 3 2 3 1 1 1 2 7 2 1 2 1 2 3 3 4 2 2 3 3 3 2 3 3 3 2 7 8 4 6 7 4 11 5 04MYP2 75th percentile 4 7 8 5 6 6 7 6 8 4 7 4 12 8 7 5 6 4 4 6 7 4 19 5 3 6 4 1 5 4 2 5 4 4 6 4 5 4 5 2 3 2 5 7 4 3 5 2 4 7 5 8 3 4 4 5 4 3 5 4 6 3 12 13 6 8 10 7 13 9 90th percentile 7 12 12 7 10 8 11 8 12 6 10 6 19 13 10 7 9 6 8 11 12 6 19 8 5 9 6 3 9 6 5 8 6 6 8 6 8 5 8 3 6 4 9 7 7 6 9 6 4 12 9 13 5 6 7 7 5 4 7 7 9 3 20 21 9 10 15 10 14 13 23622 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY—Continued [FY 2004 MedPAR Update December 2004 GROUPER V23.0] Number of discharges DRG 83 ............................................................. 84 ............................................................. 85 ............................................................. 86 ............................................................. 87 ............................................................. 88 ............................................................. 89 ............................................................. 90 ............................................................. 91 ............................................................. 92 ............................................................. 93 ............................................................. 94 ............................................................. 95 ............................................................. 96 ............................................................. 97 ............................................................. 98 ............................................................. 99 ............................................................. 100 ........................................................... 101 ........................................................... 102 ........................................................... 103 ........................................................... 104 ........................................................... 105 ........................................................... 106 ........................................................... 107 ........................................................... 108 ........................................................... 109 ........................................................... 110 ........................................................... 111 ........................................................... 113 ........................................................... 114 ........................................................... 115 ........................................................... 116 ........................................................... 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 ........................................................... 146 ........................................................... 147 ........................................................... 148 ........................................................... 149 ........................................................... 150 ........................................................... 151 ........................................................... 152 ........................................................... 153 ........................................................... 154 ........................................................... VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Arithmetic mean LOS 6,950 1,472 21,878 1,861 82,727 413,844 550,707 45,868 45 16,495 1,598 13,338 1,612 59,134 27,017 8 21,547 6,953 23,105 5,237 724 20,929 31,544 3,499 70,111 7,947 50,742 57,167 10,077 37,263 8,514 22,137 118,685 5,151 7,605 993 36,309 159,575 61,768 33,656 130,770 95,808 5,823 695,800 5,181 3,762 89,126 23,839 117,297 7,287 42,414 7,439 1,133 207,068 78,609 38,178 121,892 52,279 249,312 99,715 6,187 10,769 2,634 135,681 19,915 22,708 5,353 5,007 2,092 28,496 PO 00000 Frm 00318 10th percentile 5.2373 3.1454 6.2321 3.6239 6.4131 4.9009 5.6477 3.8123 4.3556 5.9978 3.8273 6.1223 3.6340 4.3754 3.3864 2.5000 3.1101 2.1151 4.2502 2.4921 37.3798 14.5053 9.9561 11.2138 10.5005 10.6922 7.7661 8.3880 3.4273 12.5945 8.4514 6.8327 4.2655 4.2386 3.0473 5.4945 9.0439 6.2485 3.3855 4.7990 4.3991 2.7249 11.2705 5.1260 5.1662 2.5944 5.4275 3.8048 2.8049 2.1806 3.1069 4.2879 2.7643 3.9126 2.4367 2.4370 3.4612 2.4785 2.0936 5.6964 2.6198 9.8862 5.8193 12.0864 5.9490 10.8769 5.1362 8.0429 4.9809 13.0519 Fmt 4701 25th percentile 2 1 2 1 2 2 2 2 1 2 1 2 1 2 1 1 1 1 1 1 8 6 4 5 5 4 4 1 1 4 2 1 1 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 5 3 5 3 4 1 3 2 3 Sfmt 4702 3 2 3 2 3 3 3 2 2 3 2 3 2 2 2 2 1 1 2 1 12 8 6 7 7 6 5 3 1 6 4 2 1 1 1 1 3 3 2 1 2 1 6 3 3 1 3 2 1 1 2 2 1 2 1 1 2 1 1 2 1 6 4 7 4 6 2 5 3 6 E:\FR\FM\04MYP2.SGM 50th percentile 4 3 5 3 5 4 5 3 3 5 3 5 3 4 3 2 2 2 3 2 23 12 8 9 9 9 6 7 3 10 7 5 3 2 2 3 6 5 3 3 3 2 9 4 5 1 5 4 2 2 2 3 2 3 2 2 3 2 2 4 2 8 6 9 6 9 5 7 5 10 04MYP2 75th percentile 7 4 8 5 8 6 7 5 5 8 5 8 5 5 4 3 4 3 5 3 48 18 12 13 12 13 9 11 5 16 11 9 6 5 4 7 12 8 4 6 6 3 14 6 6 3 7 5 3 3 4 5 3 5 3 3 4 3 3 7 3 12 7 15 7 14 7 9 6 16 90th percentile 10 6 12 7 12 9 10 7 9 11 7 12 7 8 6 3 6 4 8 5 79 25 18 19 17 19 13 17 7 24 16 14 9 10 7 13 20 12 6 11 9 5 21 10 9 6 10 7 5 4 6 8 5 7 5 5 6 5 4 12 5 17 9 22 9 20 10 14 8 25 23623 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY—Continued [FY 2004 MedPAR Update December 2004 GROUPER V23.0] Number of discharges DRG 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 210 211 212 213 216 217 218 219 220 223 224 225 226 227 228 229 ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Arithmetic mean LOS 6,161 6 8,260 4,106 19,174 11,988 10,428 5,497 10 5,945 2,523 4,933 4,634 1,544 756 17,471 1,484 32,879 2,392 267,905 32,657 14,560 8,554 2,909 14,429 92,193 25,897 292,198 86,576 78 5,680 4 621 90,968 13,182 69 10,411 1,322 4,514 521 3,249 701 17,316 4,645 1,425 936 2,665 27,281 31,656 72,845 31,474 2,081 35,754 9,758 128,455 26,708 10 10,257 17,656 17,622 28,708 21,361 4 13,425 10,889 6,514 6,660 5,074 2,640 1,201 PO 00000 Frm 00319 10th percentile 4.1344 24.1667 5.7196 2.6086 5.1209 2.6625 4.3945 2.0806 2.9000 7.9862 4.2089 4.5046 2.2169 4.9087 2.2844 10.7718 4.0964 6.8401 3.5920 4.7020 2.8910 5.1422 4.4329 3.1158 5.8559 5.3215 3.3265 4.4293 2.8664 3.2821 4.4905 2.0000 4.1723 5.5332 3.0882 4.3768 12.6933 5.6899 12.0549 6.6756 10.6190 5.7275 9.0988 4.3208 9.5298 9.6976 13.7471 6.1787 6.4850 5.5246 5.8950 3.8847 5.2393 2.9364 6.6967 4.6708 2.9000 9.1059 5.7608 12.4479 5.4480 3.1063 2.7500 3.2055 1.8875 5.1650 6.3380 2.6139 4.1258 2.5129 Fmt 4701 25th percentile 1 1 1 1 1 1 1 1 1 3 2 1 1 1 1 2 1 2 1 2 1 2 2 1 2 2 1 1 1 1 1 1 1 1 1 1 3 1 5 3 4 2 3 2 2 1 3 2 2 2 2 1 1 1 3 3 1 2 1 3 2 1 2 1 1 1 1 1 1 1 Sfmt 4702 50th percentile 2 5 2 1 2 1 2 1 1 5 3 2 1 2 1 5 2 3 1 3 2 3 2 2 3 3 2 2 1 2 2 1 2 2 1 2 6 3 7 4 6 4 5 3 4 4 6 3 3 3 3 2 2 1 4 3 1 4 1 5 3 2 2 1 1 2 2 1 1 1 E:\FR\FM\04MYP2.SGM 3 9 4 2 4 2 3 1 2 7 4 3 2 3 2 8 3 5 3 4 2 4 4 3 5 4 3 3 2 2 3 1 3 4 2 3 9 5 10 6 9 5 7 4 7 7 10 5 5 4 4 3 4 2 6 4 3 7 3 9 4 3 3 2 1 4 4 2 3 2 04MYP2 75th percentile 6 27 7 3 7 3 6 3 3 10 5 5 3 6 3 14 5 9 5 6 4 6 5 4 7 7 4 5 4 4 5 3 5 7 4 5 16 7 15 8 13 7 11 6 13 12 18 8 8 7 7 5 7 4 8 5 4 12 8 15 7 4 3 4 2 7 8 3 5 3 90th percentile 8 27 12 5 10 5 9 4 6 14 7 9 4 10 5 22 8 14 7 9 5 10 8 5 11 10 6 8 5 6 9 3 8 11 6 8 26 10 22 11 19 9 17 7 19 20 28 12 13 11 12 8 10 6 11 7 4 18 14 26 10 5 3 6 3 11 13 5 9 5 23624 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY—Continued [FY 2004 MedPAR Update December 2004 GROUPER V23.0] Number of discharges DRG 230 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Arithmetic mean LOS 2,565 729 15,118 7,676 4,970 42,408 2,022 9,869 42,943 12,653 2,696 2,742 101,477 15,792 5,840 1,430 21,671 15,118 14,026 4,155 2,148 1 24,857 10,420 1 7,152 13,512 12,042 2,903 2,991 1,603 636 23,809 3,922 4,307 2,304 272 1,004 10,686 2,639 21,054 5,942 1,349 2,288 228 1,447 112,318 33,865 6 19,272 7,093 6,274 1,833 7,623 2,703 6,114 10,450 6,894 10,859 64 7,331 368 98,963 4,102 254,706 45,347 81 1,478 21,343 3,901 PO 00000 Frm 00320 10th percentile 5.5922 2.8230 6.6726 2.7952 4.6463 4.4748 3.6682 8.2633 6.0632 6.6177 3.7066 6.5864 4.5166 4.4924 3.1334 3.5664 3.3172 4.8397 3.8285 3.8876 2.7514 1.0000 4.5324 3.0461 7.0000 5.0301 2.6104 1.7498 2.7689 1.4055 2.2052 4.8428 10.7403 6.2358 6.5677 3.1788 4.1838 3.5508 8.3273 3.8151 6.7875 5.8009 3.6449 6.2592 3.2456 4.4630 5.5013 4.0567 4.6667 4.0080 2.8429 4.5695 3.0295 10.0454 5.4802 9.8368 4.1090 2.5582 2.1325 2.7969 10.0308 4.4674 4.2920 3.6675 4.7202 3.0710 3.9383 5.1604 5.8673 3.4107 Fmt 4701 25th percentile 1 1 1 1 1 1 1 3 2 2 1 2 1 1 1 1 1 1 1 1 1 1 2 1 7 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 2 3 2 1 1 1 2 1 1 1 1 1 1 1 2 1 Sfmt 4702 50th percentile 2 1 2 1 2 3 2 4 3 3 2 3 2 2 1 2 2 3 1 2 1 1 3 2 7 2 1 1 1 1 1 2 5 3 2 1 1 1 4 1 3 3 2 3 1 2 3 2 3 2 1 2 1 5 2 5 2 1 1 1 4 2 2 2 2 2 1 2 3 2 E:\FR\FM\04MYP2.SGM 75th percentile 4 1 5 2 4 4 3 6 5 5 3 5 4 4 3 3 3 4 3 3 3 1 4 3 7 4 2 1 1 1 1 4 8 5 4 2 3 2 6 3 5 4 3 5 2 4 5 3 5 3 2 3 2 8 4 7 3 1 1 1 8 3 3 3 4 3 2 4 5 3 04MYP2 7 3 9 4 6 5 4 10 7 8 5 8 6 6 4 4 4 6 5 5 3 1 5 4 7 6 3 2 3 1 2 7 13 8 8 4 5 4 11 5 8 7 5 8 4 6 7 5 6 5 4 6 4 12 6 12 4 2 2 2 13 6 5 4 6 4 4 6 7 4 90th percentile 12 6 14 6 9 8 7 15 11 13 7 12 8 8 6 7 6 9 8 7 5 1 8 5 7 10 5 3 7 2 4 10 21 12 14 7 10 7 16 8 12 11 7 12 7 8 10 7 6 7 5 9 6 19 10 19 7 5 4 5 20 9 8 7 9 6 7 10 11 6 23625 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY—Continued [FY 2004 MedPAR Update December 2004 GROUPER V23.0] Number of discharges DRG 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 331 332 333 334 335 336 337 338 339 340 341 342 344 345 346 347 348 349 350 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Arithmetic mean LOS 9,649 23,760 13,826 3,087 6,350 2,066 7,093 3,559 26,035 6,480 1,456 508 1 36,565 180,999 2,766 5,927 383 218,684 31,401 61 20,482 5,421 9,615 2,584 5 606 72 54,798 4,389 252 9,810 11,931 31,264 25,156 652 1,253 2 3,185 565 2,693 1,461 3,966 247 4,171 575 7,137 975 2,735 7,612 4,937 23,993 5,570 20,798 28,741 14,764 272 2 2,128 1,451 1,622 4,789 456 3,924 3,613 1,843 2,244 1,164 4,871 156 PO 00000 Frm 00321 10th percentile 8.1898 7.3943 8.4735 3.2096 5.4737 2.0736 6.1095 2.0014 4.5265 1.8782 4.8365 2.2165 2.0000 6.7584 6.2874 3.4678 5.7441 2.7546 5.0953 3.5963 3.4918 3.0937 1.8843 3.6813 2.6207 2.6000 3.4719 1.8333 5.4332 3.1246 5.4921 4.3009 2.6866 3.2999 1.9182 6.1748 5.1173 5.0000 3.1586 3.4248 2.7037 4.8077 5.7307 3.0202 4.0897 2.3583 4.4541 4.0133 6.3192 5.6967 3.0614 1.9281 8.1269 3.9629 2.4058 2.5880 3.0184 1.0000 3.7810 4.1909 7.7404 6.4792 2.9934 6.6351 3.2419 5.1557 3.3944 3.1847 2.2373 2.7436 Fmt 4701 25th percentile 4 3 2 1 1 1 1 1 1 1 1 1 2 1 2 1 1 1 2 1 2 1 1 1 1 1 1 1 1 1 1 2 1 1 1 1 1 4 1 1 1 1 1 1 1 1 2 1 2 2 2 1 3 2 1 1 1 1 1 1 2 2 1 2 1 2 2 2 1 2 Sfmt 4702 50th percentile 5 4 3 2 2 1 2 1 2 1 1 1 2 1 3 1 2 1 3 2 2 1 1 2 1 1 1 1 2 1 2 2 2 2 1 2 1 4 1 2 1 1 3 1 2 1 2 2 3 3 2 1 4 2 2 1 1 1 2 2 3 3 1 3 1 3 3 2 2 2 E:\FR\FM\04MYP2.SGM 75th percentile 6 6 6 3 3 2 4 1 3 1 3 2 2 4 5 2 4 2 4 3 3 2 1 3 2 2 3 1 4 2 3 3 3 2 2 3 3 6 2 2 1 3 4 2 3 2 4 3 4 4 3 2 6 3 2 2 2 1 2 3 5 5 2 5 2 4 3 2 2 2 04MYP2 9 9 11 4 8 2 8 2 6 2 6 3 2 9 8 4 7 3 6 4 4 4 2 5 3 3 5 2 7 4 7 5 3 4 2 9 7 6 3 4 2 6 7 4 5 3 5 5 7 6 4 2 10 4 3 3 3 1 4 5 9 8 4 8 4 5 4 3 3 3 90th percentile 14 14 18 6 12 3 14 4 10 3 11 4 2 16 12 7 11 6 9 6 6 6 3 7 5 5 7 3 11 6 13 7 4 7 3 14 11 6 7 8 6 11 11 7 8 4 8 8 12 10 4 3 15 7 4 4 7 1 8 9 17 13 6 13 6 8 5 5 3 4 23626 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY—Continued [FY 2004 MedPAR Update December 2004 GROUPER V23.0] Number of discharges DRG 375 376 377 378 379 380 381 382 383 384 385 389 390 392 393 394 395 396 397 398 399 401 402 403 404 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 439 440 441 442 443 444 445 447 448 449 450 451 452 453 454 455 461 ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Arithmetic mean LOS 6 388 77 196 508 91 212 43 2,473 132 1 1 1 2,203 1 2,820 116,129 9 18,482 18,288 1,640 6,328 1,401 31,865 3,802 2,224 584 2,170 1,808 28,417 12 12 5,198 573 50,826 239,006 23 28,508 16,282 2,941 11,882 52 8,637 1,071 14,779 4,313 1,505 773 25,479 71,439 304 420 5,191 1,739 5,613 779 18,017 3,384 5,892 2,346 6,264 1 38,802 7,805 3 27,634 5,437 3,837 846 2,722 PO 00000 Frm 00322 10th percentile 4.0000 3.3711 4.4805 2.3163 2.8130 2.1099 2.2642 1.4419 3.6526 2.5606 1.0000 21.0000 1.0000 9.1770 4.0000 7.3553 4.2575 4.4444 5.1407 5.7016 3.3250 11.0390 4.0293 7.9367 4.1528 9.9150 3.8253 8.1949 5.7954 3.8214 3.2500 2.7500 6.7563 4.0244 14.0037 7.3769 5.2174 6.1657 4.3857 3.3747 4.0613 3.7115 8.2173 11.7274 3.4569 4.1203 4.7375 7.2549 5.4228 7.6737 5.8947 4.2548 2.9626 8.7993 8.7825 3.3813 8.6810 3.3992 4.0324 2.8372 2.5686 2.0000 3.6742 1.9867 1.6667 4.8762 2.7993 4.1058 2.2222 5.1267 Fmt 4701 25th percentile 1 1 1 1 1 1 1 1 1 1 1 21 1 2 4 1 1 1 1 2 1 2 1 2 1 2 1 1 1 1 1 1 2 1 4 2 1 2 1 1 1 1 2 2 1 1 1 1 2 2 1 1 1 1 2 1 2 1 1 1 1 2 1 1 1 1 1 1 1 1 Sfmt 4702 2 2 1 1 1 1 1 1 1 1 1 21 1 4 4 2 2 1 2 3 2 5 1 3 2 4 2 2 3 2 2 1 3 2 6 3 2 3 2 2 2 1 3 4 1 2 2 2 3 3 2 2 1 3 3 1 3 1 2 1 1 2 1 1 1 2 1 2 1 1 E:\FR\FM\04MYP2.SGM 50th percentile 2 2 3 2 2 1 1 1 2 1 1 21 1 6 4 5 3 2 4 4 3 9 3 6 3 7 3 5 4 3 2 1 5 3 11 6 3 5 3 3 3 2 6 8 3 3 3 5 4 6 4 3 2 5 6 2 6 3 3 2 2 2 3 1 1 3 2 3 2 3 04MYP2 75th percentile 6 4 4 3 3 2 2 2 4 3 1 21 1 11 4 9 5 3 6 7 4 14 5 10 5 12 5 10 6 5 4 3 9 5 18 9 5 8 5 4 5 4 10 14 4 5 5 8 6 9 7 5 3 10 10 4 11 4 5 4 3 2 4 2 3 6 3 5 3 6 90th percentile 6 6 8 4 6 4 4 2 7 5 1 21 1 19 4 16 8 6 10 11 6 22 9 16 8 21 7 19 12 6 4 4 13 8 28 14 10 12 8 6 7 7 17 22 7 8 9 15 10 15 12 8 6 19 18 7 18 7 8 5 5 2 7 4 3 10 5 8 4 12 23627 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY—Continued [FY 2004 MedPAR Update December 2004 GROUPER V23.0] Number of discharges DRG 462 463 464 465 466 467 468 471 473 475 476 477 478 479 480 481 482 484 485 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 511 512 513 515 517 518 519 520 521 522 523 524 525 527 528 529 530 531 532 533 534 535 536 537 538 539 ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 Arithmetic mean LOS 7,761 31,045 7,661 219 1,377 1,015 50,458 15,614 8,778 116,534 3,025 29,425 113,660 24,603 802 1,066 5,076 449 3,420 2,562 4,644 786 13,461 5,204 19,789 4,012 61,628 25,626 304 3,261 27,838 19,057 35,676 48,323 3,122 717 5,909 187 179 1,004 307 641 168 1,755 635 513 227 44,478 66,287 42,044 11,506 15,266 32,148 5,646 15,866 118,949 313 192,230 1,770 4,032 2,363 4,799 2,622 47,609 45,285 7,387 8,055 8,641 5,604 5,020 PO 00000 Frm 00323 10th percentile 10.1584 3.8939 2.9141 3.6347 4.7117 2.6788 12.8082 5.0496 12.4026 11.0157 10.4998 8.5246 7.1046 2.7884 17.9102 21.8208 11.4967 12.7506 9.6038 12.3478 7.0540 16.3422 8.3538 5.3918 3.1423 13.6269 6.0515 2.6772 17.3092 8.9877 5.8368 3.7703 4.3236 2.2420 9.9308 5.6987 3.8284 27.1818 4.6704 15.9273 8.4919 7.2044 5.1607 6.4160 4.0787 12.7719 9.9824 4.3401 2.5801 3.4580 4.8233 2.0074 5.4742 9.3666 3.8769 3.1907 13.4952 2.2326 17.1090 7.9923 3.1240 9.4049 3.7227 3.7364 1.7909 10.3013 7.6500 6.7775 2.8164 10.7639 Fmt 4701 25th percentile 4 1 1 1 1 1 3 3 2 2 2 1 1 1 7 10 4 2 4 2 1 4 2 1 1 3 1 1 8 3 3 2 1 1 4 2 1 8 1 3 1 1 1 1 1 7 5 1 1 1 1 1 2 3 1 1 1 1 6 1 1 2 1 1 1 3 2 1 1 2 Sfmt 4702 6 2 1 1 1 1 6 3 3 5 4 3 2 1 9 16 6 6 5 6 3 7 3 2 2 5 3 1 9 4 3 3 2 1 5 3 2 16 1 7 3 3 2 2 1 8 7 1 1 1 1 1 3 4 2 2 3 1 10 2 1 4 1 1 1 5 4 3 1 4 E:\FR\FM\04MYP2.SGM 50th percentile 8 3 2 2 2 2 10 4 7 9 9 6 5 2 13 20 9 10 7 10 5 13 6 4 3 6 5 2 13 6 5 3 3 2 8 5 3 23 1 13 7 5 3 4 2 10 8 2 1 2 3 1 4 7 3 3 8 1 15 5 2 7 3 2 1 8 6 5 2 7 04MYP2 75th percentile 13 5 4 4 5 3 16 5 18 14 14 11 9 4 22 25 14 17 11 16 9 22 10 7 3 23 8 4 19 11 7 5 5 3 13 7 5 36 6 21 11 9 6 8 5 14 12 6 3 4 6 2 7 12 5 4 16 2 22 10 4 12 5 4 2 13 9 8 4 14 90th percentile 18 7 5 7 9 5 25 8 32 21 21 18 15 6 36 35 21 25 18 25 14 35 17 11 5 31 12 5 31 18 10 6 9 4 18 9 7 49 11 33 18 15 11 14 8 23 16 10 6 8 11 4 11 19 7 6 32 5 30 18 6 20 8 9 3 20 14 14 6 23 23628 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 7B.—MEDICARE PROSPECTIVE PAYMENT SYSTEM SELECTED PERCENTILE LENGTHS OF STAY—Continued [FY 2004 MedPAR Update December 2004 GROUPER V23.0] Number of discharges DRG 540 541 542 543 544 545 546 547 548 549 550 ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... ........................................................... Arithmetic mean LOS 1,510 22,435 24,376 5,415 418,885 42,337 1,958 26,797 11,935 35,690 20,187 10th percentile 3.5808 42.7921 32.5434 11.9830 4.5100 5.1387 9.1062 5.5682 3.0404 5.2044 2.8595 25th percentile 1 17 12 2 3 3 3 2 1 2 1 50th percentile 1 24 18 5 3 3 5 3 2 3 2 75th percentile 3 35 27 10 4 4 7 4 3 4 3 90th percentile 4 52 40 16 5 6 11 7 4 6 4 7 76 58 24 7 8 18 10 5 10 5 12,140,152 TABLE 8A.—STATEWIDE AVERAGE OP- TABLE 8A.—STATEWIDE AVERAGE OP- TABLE 8B.—STATEWIDE AVERAGE ERATING COST-TO-CHARGE RAERATING COST-TO-CHARGE RACAPITAL COST-TO-CHARGE RATIOS—MARCH 2005 TIOS—MARCH 2005—Continued TIOS—MARCH 2005—Continued State Rural 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 ...................... 0.279 0.454 0.295 0.359 0.251 0.328 0.458 0.546 0.386 0.257 0.373 0.404 0.487 0.337 0.439 0.407 0.313 0.401 0.306 0.504 0.762 0.485 0.396 0.404 0.354 0.346 0.437 0.371 0.245 0.467 0.196 0.428 0.372 0.454 0.418 0.389 0.332 0.499 State Urban 0.348 0.784 0.392 0.383 0.354 0.483 0.522 0.548 ................ 0.304 0.426 0.479 0.577 0.442 0.47 0.505 0.471 0.404 0.369 0.489 0.827 ................ 0.496 0.531 0.391 0.408 0.481 0.503 0.558 0.508 ................ 0.414 0.526 0.439 0.467 0.543 0.423 0.481 Pennsylvania ............ Puerto Rico ............... Rhode Island ............ South Carolina .......... South Dakota ............ Tennessee ................ Texas ........................ Utah .......................... Vermont .................... Virginia ...................... Washington ............... West Virginia ............ Wisconsin ................. Wyoming ................... 0.299 0.443 0.439 0.313 0.385 0.337 0.309 0.428 0.577 0.386 0.454 0.492 0.458 0.442 Rural State 0.472 ................ ................ 0.34 0.498 0.402 0.38 0.598 0.635 0.398 0.497 0.472 0.497 0.614 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 ................................... West Virginia ................................ Wisconsin ..................................... Wyoming ....................................... TABLE 8B.—STATEWIDE AVERAGE CAPITAL COST-TO-CHARGE RATIOS—MARCH 2005 State Ratio Alabama ........................................ Alaska ........................................... Arizona .......................................... Arkansas ....................................... California ....................................... Colorado ....................................... Connecticut ................................... Delaware ....................................... District of Columbia ...................... Florida ........................................... Georgia ......................................... Hawaii ........................................... Idaho ............................................. Illinois ............................................ Indiana .......................................... Iowa .............................................. 0.027 0.044 0.029 0.03 0.019 0.03 0.035 0.047 0.029 0.026 0.035 0.034 0.041 0.03 0.041 0.033 Ratio 0.033 0.033 0.032 0.036 0.016 0.036 0.037 0.034 0.032 0.029 0.039 0.039 0.019 0.037 0.015 0.036 0.033 0.039 0.041 0.032 0.031 0.038 0.026 0.033 0.022 0.03 0.04 0.034 0.03 0.039 0.045 0.039 0.037 0.033 0.038 0.046 TABLE 9A.—HOSPITALS RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITALS AND CBSA—FY 2006 Geographic CBSA Provider number 010005 010008 010012 010022 .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00324 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 01 01 01 01 04MYP2 Reclassified CBSA 13820 33860 16860 40660 Lugar LUGAR 23629 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 9A.—HOSPITALS RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITALS AND CBSA—FY 2006— Continued Geographic CBSA Provider number 010025 010029 010035 010044 010045 010065 010072 010083 010100 010101 010118 010120 010126 010143 010158 030013 030033 040014 040017 040019 040020 040027 040039 040041 040047 040069 040071 040072 040076 040078 040080 040088 040091 040100 040119 050006 050009 050013 050014 050022 050042 050046 050054 050065 050069 050071 050073 050076 050082 050089 050090 050099 050102 050118 050129 050136 050140 050150 050159 050168 050173 050174 050177 050193 050224 050226 050228 050230 050236 050243 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00325 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 01 12220 01 01 01 01 01 01 01 01 01 01 01 01 01 49740 03 04 04 04 27860 04 04 04 04 04 38220 04 04 26300 04 04 04 04 04 05 34900 34900 05 40140 05 37100 40140 42044 42044 41940 46700 41884 37100 40140 42220 40140 40140 44700 40140 42220 40140 05 37100 42044 42044 42220 37100 42044 42044 42044 41884 42044 37100 40140 04MYP2 Reclassified CBSA 17980 17980 13820 13820 13820 33860 11500 37860 37860 11500 33860 33660 33860 13820 19460 20940 22380 30780 44180 32820 32820 44180 27860 30780 27860 32820 30780 30780 30780 30780 27860 43340 45500 30780 30780 39820 46700 46700 40900 42044 39820 31084 42044 31084 31084 36084 36084 36084 31084 31084 41884 31084 42044 33700 31084 41884 31084 40900 31084 31084 31084 41884 31084 31084 31084 31084 36084 31084 31084 42044 Lugar LUGAR LUGAR 23630 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 9A.—HOSPITALS RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITALS AND CBSA—FY 2006— Continued Geographic CBSA Provider number 050245 050251 050272 050279 050291 050292 050298 050300 050327 050329 050331 050348 050385 050390 050394 050419 050423 050426 050430 050510 050517 050526 050534 050535 050541 050543 050547 050548 050550 050551 050567 050569 050570 050573 050580 050584 050585 050586 050589 050592 050594 050603 050609 050616 050667 050668 050678 050684 050686 050690 050693 050694 050701 050709 050718 050720 050728 060001 060003 060023 060027 060044 060049 060096 060103 070003 070021 070033 080004 080007 .................................................................................................................................................... .................................................................................................................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00326 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 40140 05 40140 40140 42220 40140 40140 40140 40140 40140 42220 42044 42220 40140 37100 05 40140 42044 05 41884 40140 42044 40140 42044 41884 42044 42220 42044 42044 42044 42044 05 42044 40140 42044 40140 42044 40140 42044 42044 42044 42044 42044 37100 34900 41884 42044 40140 40140 42220 42044 40140 40140 40140 40140 42044 42220 24540 14500 24300 14500 06 06 06 14500 07 07 14860 20100 08 04MYP2 Reclassified CBSA 31084 39900 31084 31084 41884 42044 31084 31084 31084 42044 41884 31084 41884 42044 31084 39820 42044 31084 39900 36084 31084 31084 42044 31084 36084 31084 41884 31084 31084 31084 31084 42220 31084 42044 31084 31084 31084 31084 31084 31084 31084 31084 31084 31084 46700 36084 31084 42044 42044 41884 31084 42044 42044 31084 42044 31084 41884 19740 19740 39340 19740 19740 22660 19740 19740 25540 25540 35644 48864 36140 Lugar LUGAR LUGAR 23631 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 9A.—HOSPITALS RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITALS AND CBSA—FY 2006— Continued Geographic CBSA Provider number 100022 100023 100024 100045 100049 100081 100109 100118 100139 100150 100157 100176 100217 100232 100239 100249 100252 100292 110001 110002 110003 110023 110025 110029 110038 110040 110041 110052 110054 110069 110075 110088 110095 110117 110122 110125 110128 110150 110153 110168 110187 110189 110205 120028 130002 130003 130049 140012 140015 140032 140034 140040 140043 140046 140058 140061 140064 140110 140143 140160 140161 140164 140189 140233 140234 140236 140291 150002 150004 150006 .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00327 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 33124 10 10 19660 10 10 10 10 10 10 29460 48424 46940 10 45300 10 10 10 19140 11 11 11 15260 23580 11 11 11 11 40660 47580 11 11 11 11 46660 11 11 11 47580 40660 11 11 11 12 13 30300 17660 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 40420 14 14 29404 23844 23844 33140 04MYP2 Reclassified CBSA 22744 36740 33124 36740 29460 23020 36740 27260 23540 33124 45300 38940 38940 27260 42260 36100 38940 23020 12060 12060 27260 12060 27260 12060 45220 12060 12020 16860 12060 31420 42340 12060 46660 12060 45220 31420 42340 31420 31420 12060 12060 12060 12060 26180 14260 50 44060 16974 41180 41180 41180 37900 40420 41180 41180 41180 37900 16974 37900 40420 16974 41180 16580 16974 37900 28100 16974 16974 16974 43780 Lugar LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR 23632 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 9A.—HOSPITALS RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITALS AND CBSA—FY 2006— Continued Geographic CBSA Provider number 150008 150011 150015 150030 150048 150065 150069 150076 150088 150090 150102 150112 150113 150125 150126 150132 150133 150146 150147 160001 160016 160026 160057 160080 160089 160147 170006 170010 170012 170013 170020 170022 170023 170033 170058 170068 170120 170142 170175 180005 180011 180012 180013 180017 180018 180019 180024 180027 180028 180029 180044 180048 180066 180069 180075 180078 180080 180093 180102 180104 180116 180124 180127 180132 180139 190001 190003 190015 190086 190099 .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00328 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 23844 15 33140 15 15 15 15 15 11300 23844 15 18020 11300 23844 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 21060 14540 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 14540 18 18 18 19 19 19 19 19 04MYP2 Reclassified CBSA 16974 26900 16974 26900 17140 26900 17140 43780 26900 16974 23844 26900 26900 16974 16974 16974 23060 23060 16974 11180 19780 11180 26980 40420 19780 11180 27900 46140 48620 48620 48620 28140 48620 48620 28140 11100 27900 45820 48620 26580 30460 31140 34980 21060 30460 17140 31140 17300 26580 28700 26580 31140 34980 26580 14540 26580 28940 21780 17300 17300 14 34980 31140 30460 30460 35380 29180 35380 43340 12940 Lugar LUGAR LUGAR LUGAR LUGAR 23633 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 9A.—HOSPITALS RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITALS AND CBSA—FY 2006— Continued Geographic CBSA Provider number 190106 190131 190155 190164 190191 190223 200002 200020 200024 200034 200039 200050 200063 220001 220002 220003 220010 220011 220019 220025 220028 220029 220033 220035 220049 220058 220060 220062 220063 220070 220077 220080 220082 220084 220089 220090 220095 220098 220101 220105 220133 220163 220171 220174 230022 230030 230035 230037 230042 230047 230054 230069 230077 230080 230093 230096 230099 230105 230121 230134 230195 230204 230208 230217 230227 230235 230257 230264 230279 230295 .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00329 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 19 12940 19 19 19 19 20 38860 30340 30340 20 20 20 49340 15764 49340 21604 15764 49340 49340 49340 21604 21604 21604 15764 49340 14484 49340 15764 15764 44140 21604 15764 15764 15764 49340 49340 15764 15764 15764 15764 49340 15764 21604 23 23 23 23 23 47644 23 47644 40980 23 23 23 33780 23 23 23 47644 47644 23 12980 47644 23 47644 47644 47644 23 04MYP2 Reclassified CBSA 10780 35380 12940 10780 12940 12940 38860 40484 38860 38860 38860 12620 38860 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 12700 14484 14484 14484 25540 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 11460 40980 24340 11460 26100 19804 24580 22420 22420 40980 24340 28020 11460 13020 29620 26100 19804 19804 24340 29620 19804 40980 19804 19804 22420 26100 Lugar LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR 23634 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 9A.—HOSPITALS RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITALS AND CBSA—FY 2006— Continued Geographic CBSA Provider number 240013 240018 240030 240031 240036 240052 240064 240069 240071 240075 240088 240093 240105 240150 240152 240187 240211 250004 250006 250009 250023 250031 250034 250040 250042 250069 250079 250081 250082 250094 250097 250099 250100 250104 250117 260009 260011 260017 260022 260025 260047 260049 260064 260074 260094 260110 260113 260116 260183 260186 270003 270011 270017 270051 280009 280023 280032 280057 280061 280065 280077 290002 290006 290008 290019 300003 300005 300007 300011 300012 .................................................................................................................................................... .................................................................................................................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00330 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 24 24 24 41060 41060 24 24 24 24 24 24 24 24 24 24 24 24 25 25 25 25 25 25 37700 25 25 25 25 25 25620 25 25 25 25 25 26 27620 26 26 26 27620 26 26 126 26 26 26 26 26 26 27 27 27 27 28 28 28 28 28 28 28 29 29 29 16180 30 30 31700 31700 31700 04MYP2 Reclassified CBSA 33460 33460 41060 33460 33460 22020 20260 40340 40340 41060 41060 33460 40340 40340 33460 33460 33460 32820 32820 27180 25060 27140 32820 25060 32820 46220 27140 27140 38220 25060 12940 27140 46220 27140 25060 28140 17860 41180 16 41180 17860 44180 17860 17860 44180 41180 14 14 41180 17860 24500 24500 33540 33540 30700 30700 30700 30700 53 24540 36540 16180 39900 29820 39900 31700 31700 15764 15764 15764 Lugar LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR 23635 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 9A.—HOSPITALS RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITALS AND CBSA—FY 2006— Continued Geographic CBSA Provider number 300014 300017 300018 300019 300020 300023 300029 300034 310002 310009 310013 310015 310018 310031 310032 310038 310048 310054 310070 310076 310078 310083 310093 310096 310119 320005 320006 320013 320014 320033 320063 320065 330001 330004 330008 330027 330038 330062 330073 330085 330094 330136 330157 330181 330182 330191 330229 330235 330239 330250 330277 330359 330386 340004 340008 340010 340013 340018 340021 340023 340027 340039 340050 340051 340068 340069 340071 340073 340091 340109 .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00331 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 40484 40484 40484 30 31700 40484 40484 31700 35084 35084 35084 35084 35084 15804 47220 20764 20764 35084 20764 35084 35084 35084 35084 35084 35084 22140 32 32 32 32 32 32 39100 28740 33 35004 33 33 33 33 33 33 33 35004 35004 24020 27460 33 27460 33 33 33 33 24660 34 24140 34 34 34 11700 34 34 34 34 34 39580 34 39580 24660 34 04MYP2 Reclassified CBSA 31700 21604 31700 15764 15764 21604 21604 15764 35644 35644 35644 35644 35644 20764 48864 35644 35084 35644 35644 35644 35644 35644 35644 35644 35644 10740 42140 42140 29740 42140 36220 36220 35644 39100 15380 35644 40380 27060 40380 45060 28740 45060 45060 35644 35644 10580 21500 45060 21500 15540 27060 39100 39100 49180 16740 39580 16740 43900 16740 24860 24780 16740 22180 25860 48900 20500 39580 20500 49180 47260 Lugar LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR 23636 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 9A.—HOSPITALS RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITALS AND CBSA—FY 2006— Continued Geographic CBSA Provider number 340114 340115 340124 340127 340129 340131 340136 340138 340144 340145 340147 340173 350009 360008 360010 360011 360013 360014 360019 360020 360025 360027 360036 360039 360054 360065 360078 360079 360086 360096 360107 360112 360125 360150 360159 360175 360185 360187 360197 360211 360238 360241 360245 370004 370014 370015 370018 370022 370025 370034 370047 370049 370099 370103 370113 370179 380001 380008 380022 380027 380047 380050 380070 390006 390013 390016 390030 390031 390048 390052 .................................................................................................................................................... .................................................................................................................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00332 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 39580 34 34 34 34 34 34 39580 34 34 40580 39580 35 36 36 36 36 36 10420 10420 41780 10420 36 36 36 36 10420 19380 44220 36 36 45780 36 10420 36 36 36 44220 36 48260 36 10420 36 37 37 37 37 37 37 37 37 37 37 37 37 37 38 38 38 38 13460 38 38 39 39 39 39 39 39 39 04MYP2 Reclassified CBSA 20500 20500 39580 20500 16740 24780 20500 20500 16740 16740 39580 20500 22020 26580 10420 18140 30620 18140 17460 17460 17460 17460 17460 18140 16620 17460 17460 17140 19380 49660 17460 11460 17460 17460 18140 18140 49660 19380 18140 38300 49660 17460 17460 27900 43300 46140 46140 30020 46140 22900 43300 36420 46140 45 22220 46140 38900 18700 18700 21660 21660 32780 38900 25420 25420 49660 10900 39740 25420 11020 Lugar LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR 23637 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 9A.—HOSPITALS RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITALS AND CBSA—FY 2006— Continued Geographic CBSA Provider number 390065 390066 390071 390079 390081 390086 390091 390093 390110 390113 390133 390138 390150 390151 390156 390180 390222 390224 390244 390246 390249 400048 410001 410004 410005 410006 410007 410008 410009 410011 410012 410013 420009 420020 420028 420030 420036 420039 420067 420068 420069 420070 420071 420080 420085 430012 430014 430094 440008 440020 440035 440050 440058 440059 440060 440067 440068 440072 440073 440148 440151 440175 440180 440185 440192 450007 450032 450039 450059 450064 .................................................................................................................................................... .................................................................................................................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00333 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 39 30140 39 39 37964 39 39 39 27780 39 10900 39 39 39 37964 37964 37964 39 39 39 39 25020 39300 39300 39300 39300 39300 39300 39300 39300 39300 39300 42 42 42 42 42 42 42 42 42 44940 42 42 34820 43 43 43 44 44 17300 44 44 44 44 34100 44 44 44 44 44 44 44 17420 44 45 45 23104 41700 23104 04MYP2 Reclassified CBSA 47894 25420 48700 13780 48864 44300 49660 49660 38300 49660 37964 47894 38300 47894 48864 48864 48864 13780 48700 48700 13780 41980 14484 14484 14484 14484 14484 14484 14484 14484 14484 14484 24860 16700 44940 16700 16740 43900 42340 16700 44940 17900 24860 42340 48900 43620 22020 53 21780 26620 34980 11700 16860 34980 27180 28940 16860 32820 34980 34980 34980 34980 28940 16860 34980 41700 43340 19124 12420 19124 Lugar LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR 23638 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 9A.—HOSPITALS RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITALS AND CBSA—FY 2006— Continued Geographic CBSA Provider number 450073 450080 450087 450098 450099 450121 450135 450137 450144 450148 450187 450192 450194 450196 450211 450214 450224 450283 450286 450347 450351 450389 450400 450419 450438 450447 450451 450484 450508 450547 450563 450623 450639 450653 450656 450672 450675 450677 450694 450747 450755 450770 450779 450830 450839 450858 450872 450880 460004 460005 460007 460011 460021 460036 460039 460041 460042 470001 470011 470012 490004 490005 490006 490013 490018 490047 490079 490092 490105 490106 .................................................................................................................................................... .................................................................................................................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00334 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 45 45 23104 45 45 23104 23104 23104 45 23104 45 45 45 45 45 45 45 45 45 45 45 45 45 23104 45 45 45 45 45 45 23104 45 23104 45 45 23104 23104 23104 45 45 45 45 23104 45 45 23104 23104 23104 36260 36260 46 46 41100 46 46 36260 36260 47 47 47 25500 49020 49 49 49 49 49 49 49 49 04MYP2 Reclassified CBSA 10180 30980 19124 30980 11100 19124 19124 19124 36220 19124 26420 19124 19124 19124 26420 26420 46340 19124 17780 26420 23104 19124 47380 19124 26420 19124 23104 26420 46340 19124 19124 19124 19124 33260 46340 19124 19124 19124 26420 19124 31180 12420 19124 36220 43340 19124 19124 19124 41620 41620 41100 39340 29820 39340 36260 41620 41620 30 15764 38340 16820 47894 49020 31340 16820 25500 49180 40060 28700 16820 Lugar LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR 23639 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 9A.—HOSPITALS RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITALS AND CBSA—FY 2006— Continued Geographic CBSA Provider number 490109 500002 500003 500016 500024 500031 500039 500041 500072 500139 500143 510001 510002 510006 510018 510024 510028 510030 510046 510047 510070 510071 510077 520002 520021 520028 520037 520059 520060 520066 520071 520076 520088 520094 520095 520096 520102 520107 520113 520116 520152 520173 520189 530002 530025 .................................................................................................................................................... .................................................................................................................................................... .................................................................................................................................................... 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Reclassified CBSA 47260 50 34580 48300 36500 50 14740 31020 50 36500 36500 34060 51 51 51 34060 51 51 51 51 51 51 51 52 29404 52 52 39540 52 27500 52 52 22540 39540 52 39540 52 52 52 52 52 52 29404 53 53 40060 28420 42644 42644 45104 36500 42644 38900 42644 45104 45104 38300 40220 38300 16620 38300 16620 34060 16620 38300 16620 16620 26580 48140 16974 31540 48140 29404 22540 31540 33340 31540 33340 33340 31540 33340 33340 24580 24580 33340 24580 20260 16974 16220 22660 Lugar LUGAR LUGAR LUGAR LUGAR LUGAR LUGAR TABLE 9B.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL UNDER SECTION 508 OF PUB. L. 108–173 Geographic CBSA Provider number 010150 020008 050494 050549 060057 060075 070001 070005 070010 070016 070017 070019 070022 070028 070031 070036 ......................................................................................................................................... ......................................................................................................................................... ......................................................................................................................................... ......................................................................................................................................... ......................................................................................................................................... ......................................................................................................................................... ......................................................................................................................................... ......................................................................................................................................... ......................................................................................................................................... ......................................................................................................................................... ......................................................................................................................................... ......................................................................................................................................... ......................................................................................................................................... ......................................................................................................................................... ......................................................................................................................................... ......................................................................................................................................... VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00335 Fmt 4701 Sfmt 4702 01 02 05 37100 06 06 35300 35300 14860 35300 35300 35300 35300 14860 35300 25540 E:\FR\FM\04MYP2.SGM Wage index CBSA 508 reclassification Own wage index 17980 ........................ 42220 42220 19740 ........................ 35004 35004 35644 35004 35004 35004 35004 35644 35004 ........................ ........................ 1.2841 ........................ ........................ ........................ 1.1709 ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ 1.2926 04MYP2 23640 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 9B.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL UNDER SECTION 508 OF PUB. L. 108–173—Continued Geographic CBSA Provider number 070039 120025 150034 160040 160064 160067 160110 190218 220046 230003 230004 230013 230019 230020 230024 230029 230036 230038 230053 230059 230066 230071 230072 230089 230092 230097 230104 230106 230119 230130 230135 230146 230151 230165 230174 230176 230207 230223 230236 230254 230269 230270 230273 230277 250002 250122 270021 270023 270032 270050 270057 310021 310028 310050 310051 310060 310115 310120 330049 330067 330106 330126 330135 330205 330264 340002 350002 350003 350006 ......................................................................................................................................... ......................................................................................................................................... ......................................................................................................................................... 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VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00336 Fmt 4701 Sfmt 4702 35300 12 23844 47940 16 47940 47940 19 38340 26100 34740 47644 47644 19804 19804 47644 23 24340 19804 24340 34740 47644 26100 19804 27100 23 19804 24340 19804 47644 19804 19804 47644 19804 26100 19804 47644 47644 24340 47644 47644 19804 19804 47644 25 25 27 33540 27 27 27 45940 35084 35084 35084 10900 10900 35084 39100 39100 35004 39100 39100 39100 39100 11700 13900 35 35 E:\FR\FM\04MYP2.SGM Wage index CBSA 508 reclassification Own wage index 35004 26180 16974 16300 ........................ 16300 16300 43340 14484 28020 28020 22420 22420 11460 11460 22420 22420 28020 11460 28020 28020 22420 28020 11460 24340 28020 11460 28020 11460 22420 11460 11460 22420 11460 28020 11460 22420 22420 28020 22420 22420 11460 11460 22420 25060 25060 13740 13740 13740 13740 13740 35644 35644 35644 35644 35644 35644 35644 35644 35300 ........................ 35644 35644 35644 35004 16740 22020 22020 22020 ........................ ........................ ........................ ........................ 1.0228 ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ 1.4734 ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23641 TABLE 9B.—HOSPITAL RECLASSIFICATIONS AND REDESIGNATIONS BY INDIVIDUAL HOSPITAL UNDER SECTION 508 OF PUB. L. 108–173—Continued Geographic CBSA Provider number 350010 ......................................................................................................................................... 350014 ......................................................................................................................................... 350015 ......................................................................................................................................... 350017 ......................................................................................................................................... 350030 ......................................................................................................................................... 350061 ......................................................................................................................................... 380090 ......................................................................................................................................... 390001 ......................................................................................................................................... 390003 ......................................................................................................................................... 390054 ......................................................................................................................................... 390072 ......................................................................................................................................... 390095 ......................................................................................................................................... 390109 ......................................................................................................................................... 390119 ......................................................................................................................................... 390137 ......................................................................................................................................... 390169 ......................................................................................................................................... 390185 ......................................................................................................................................... 390192 ......................................................................................................................................... 390237 ......................................................................................................................................... 390270 ......................................................................................................................................... 410010 ......................................................................................................................................... 430005 ......................................................................................................................................... 430015 ......................................................................................................................................... 430048 ......................................................................................................................................... 430060 ......................................................................................................................................... 430064 ......................................................................................................................................... 430077 ......................................................................................................................................... 430091 ......................................................................................................................................... 450010 ......................................................................................................................................... 450072 ......................................................................................................................................... 450591 ......................................................................................................................................... 470003 ......................................................................................................................................... 490001 ......................................................................................................................................... 490024 ......................................................................................................................................... 530015 ......................................................................................................................................... 070006* ........................................................................................................................................ 070018* ........................................................................................................................................ 070034* ........................................................................................................................................ 140155* ........................................................................................................................................ 140186* ........................................................................................................................................ 250078* ........................................................................................................................................ 270002* ........................................................................................................................................ 270012* ........................................................................................................................................ 270084* ........................................................................................................................................ 330023* ........................................................................................................................................ 330067* ........................................................................................................................................ 350019* ........................................................................................................................................ 430008* ........................................................................................................................................ 430013* ........................................................................................................................................ 430031* ........................................................................................................................................ 530008* ........................................................................................................................................ 530010* ........................................................................................................................................ 35 35 13900 35 35 35 38 42540 39 42540 39 42540 42540 42540 42540 42540 42540 42540 42540 42540 39300 43 43 43 43 43 39660 39660 48660 26420 26420 15540 49 40220 53 14860 14860 14860 28100 28100 25620 27 24500 27 39100 39100 24220 43 43 43 53 53 Wage index CBSA 508 reclassification Own wage index 22020 22020 22020 22020 22020 22020 ........................ 10900 10900 29540 10900 10900 10900 10900 10900 10900 29540 10900 10900 29540 ........................ 39660 43620 43620 43620 43620 43620 43620 32580 26420 26420 14484 31340 19260 ........................ 35644 35644 35644 16974 16974 25060 33540 33540 33540 35644 35644 22020 43620 43620 43620 16220 16220 ........................ ........................ ........................ ........................ ........................ ........................ 1.2316 ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ 1.1746 ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ 0.9897 ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ ........................ TABLE 9C.—HOSPITALS REDESIGNATED AS RURAL UNDER SECTION 1886(D)(8)(E) OF THE ACT Geographic CBSA Provider number 030007 040075 050192 050469 050528 050618 070004 100048 100134 130018 ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00337 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 39140 22220 23420 40140 32900 40140 25540 37860 27260 26820 Redesignated rural area 03 04 05 05 05 05 07 10 10 13 23642 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 9C.—HOSPITALS REDESIGNATED AS RURAL UNDER SECTION 1886(D)(8)(E) OF THE ACT—Continued Geographic CBSA Provider number 140167 150051 150078 170137 190048 230078 240037 260006 300009 370054 380040 380084 390181 390183 390201 450052 450078 450243 450276 450348 500023 500037 500122 500147 500148 ..................................................................................................................................................................... ..................................................................................................................................................................... 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..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... ..................................................................................................................................................................... 14 14020 23844 29940 26380 35660 33460 41140 31700 36420 13460 41420 39 39 39 45 10180 10180 48660 45 28420 49420 50 42644 48300 Redesignated rural area 14 15 15 17 19 23 24 26 30 37 38 38 39 39 39 45 45 45 45 45 50 50 50 50 50 TABLE 10.—GEOMETRIC MEAN PLUS TABLE 10.—GEOMETRIC MEAN PLUS TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATHE LESSER OF .75 OF THE NATHE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING TIONAL ADJUSTED OPERATING TIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT STANDARDIZED PAYMENT AMOUNT STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIF(INCREASED TO REFLECT THE DIF(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND FERENCE BETWEEN COSTS AND FERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDCHARGES) OR .75 OF ONE STANDCHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES ARD DEVIATION OF MEAN CHARGES ARD DEVIATION OF MEAN CHARGES BY DIAGNOSIS-RELATED GROUP BY DIAGNOSIS-RELATED GROUP BY DIAGNOSIS-RELATED GROUP (DRG)—MARCH 2005 1 (DRG)—MARCH 2005 1—Continued (DRG)—MARCH 2005 1—Continued DRG Cases 1 ........................ 2 ........................ 3 ........................ 6 ........................ 7 ........................ 8 ........................ 9 ........................ 10 ...................... 11 ...................... 12 ...................... 13 ...................... 14 ...................... 15 ...................... 16 ...................... 17 ...................... 18 ...................... 19 ...................... 20 ...................... 21 ...................... 22 ...................... 23 ...................... 24 ...................... 25 ...................... 26 ...................... 27 ...................... 28 ...................... 29 ...................... 31 ...................... 32 ...................... VerDate Aug<04>2004 23,252 10,344 4 410 15,583 3,699 1,942 19,496 3,278 54,365 7,327 236,739 76,007 16,254 3,005 33,048 8,553 6,528 2,195 3,315 10,714 63,800 28,130 18 5,385 17,543 6,262 5,087 1,981 18:31 May 03, 2005 Threshold $53,083 $37,759 $48,426 $15,918 $41,465 $30,770 $26,987 $24,514 $17,942 $17,418 $16,737 $24,767 $18,842 $26,229 $14,673 $19,757 $14,440 $41,346 $28,454 $23,057 $15,561 $19,706 $12,635 $25,170 $26,078 $26,266 $14,651 $19,123 $12,778 Jkt 205001 DRG 34 35 36 37 38 39 40 42 43 44 45 46 47 49 50 51 52 53 55 56 57 59 60 61 63 64 65 66 67 PO 00000 Cases ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... Frm 00338 Fmt 4701 27,853 7,887 1,469 1,237 56 447 1,382 1,144 125 1,159 2,798 3,816 1,334 2,474 2,161 190 165 2,223 1,353 435 697 102 8 219 2,841 3,339 41,395 8,002 418 Sfmt 4702 Threshold $19,761 $12,867 $14,560 $23,489 $14,212 $14,248 $19,777 $16,384 $11,950 $13,657 $15,147 $15,156 $10,768 $32,109 $17,332 $18,236 $17,220 $26,424 $18,794 $17,620 $22,175 $15,452 $16,595 $25,804 $27,928 $23,367 $12,285 $11,762 $15,509 DRG 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 ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... ...................... E:\FR\FM\04MYP2.SGM 04MYP2 Cases 17,310 4,810 25 68 1,065 7,925 4 45,004 47,304 2,153 45,589 170,543 7,717 4 65,088 6,944 1,470 21,855 1,859 82,642 413,274 550,119 45,801 45 16,483 1,596 13,330 1,609 59,079 Threshold $13,327 $9,913 $8,304 $15,084 $15,307 $16,547 $7,279 $47,996 $43,717 $24,202 $24,850 $30,457 $17,767 $37,091 $27,672 $19,629 $11,706 $24,898 $14,235 $27,783 $17,776 $20,636 $12,316 $16,785 $23,911 $14,444 $23,013 $12,307 $14,840 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 23643 TABLE 10.—GEOMETRIC MEAN PLUS TABLE 10.—GEOMETRIC MEAN PLUS TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATHE LESSER OF .75 OF THE NATHE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING TIONAL ADJUSTED OPERATING TIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT STANDARDIZED PAYMENT AMOUNT STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIF(INCREASED TO REFLECT THE DIF(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND FERENCE BETWEEN COSTS AND FERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDCHARGES) OR .75 OF ONE STANDCHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES ARD DEVIATION OF MEAN CHARGES ARD DEVIATION OF MEAN CHARGES BY DIAGNOSIS-RELATED GROUP BY DIAGNOSIS-RELATED GROUP BY DIAGNOSIS-RELATED GROUP (DRG)—MARCH 2005 1—Continued (DRG)—MARCH 2005 1—Continued (DRG)—MARCH 2005 1—Continued DRG Cases 97 ...................... 98 ...................... 99 ...................... 100 .................... 101 .................... 102 .................... 103 .................... 104 .................... 105 .................... 106 .................... 107 .................... 108 .................... 109 .................... 110 .................... 111 .................... 113 .................... 114 .................... 115 .................... 116 .................... 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 .................... 146 .................... 147 .................... 148 .................... 149 .................... 150 .................... 151 .................... 152 .................... 153 .................... 154 .................... 155 .................... 156 .................... 157 .................... 158 .................... 159 .................... VerDate Aug<04>2004 26,996 8 21,531 6,934 23,083 5,236 724 20,904 31,499 3,492 69,982 7,942 50,600 57,121 10,070 37,225 8,509 22,119 118,448 5,146 7,591 993 36,272 159,450 61,715 33,617 130,598 95,641 5,822 695,047 5,170 3,751 89,029 23,806 117,219 7,276 42,382 7,433 1,133 206,854 78,506 38,098 121,790 52,218 249,138 99,593 6,178 10,762 2,627 135,543 19,884 22,692 5,351 5,006 2,089 28,473 6,159 6 8,254 4,104 19,160 18:31 May 03, 2005 Threshold $10,870 $8,495 $14,399 $11,081 $17,487 $11,147 $214,160 $117,844 $89,729 $108,656 $85,171 $85,326 $65,918 $59,055 $44,900 $44,754 $31,122 $58,803 $43,379 $26,461 $33,464 $26,580 $36,812 $30,813 $19,625 $27,218 $28,749 $22,067 $42,108 $20,505 $13,906 $20,637 $18,640 $11,216 $12,597 $10,986 $12,400 $17,747 $12,797 $16,622 $10,671 $10,335 $15,337 $12,040 $11,604 $25,098 $11,899 $44,908 $29,912 $51,340 $28,508 $45,073 $25,703 $34,651 $21,823 $55,952 $25,835 $52,265 $26,362 $13,493 $28,111 Jkt 205001 DRG 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 210 211 212 213 216 217 218 219 220 223 224 225 PO 00000 Cases .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... Frm 00339 Fmt 4701 11,968 10,417 5,486 10 5,941 2,518 4,928 4,623 1,544 754 17,464 1,483 32,853 2,388 267,618 32,616 14,542 8,545 2,903 14,417 92,094 25,878 291,824 86,469 78 5,678 4 621 90,890 13,170 69 10,395 1,322 4,505 520 3,247 699 17,294 4,629 1,422 936 2,664 27,245 31,633 72,764 31,436 2,075 35,719 9,747 128,257 26,620 10 10,256 17,645 17,611 28,683 21,323 4 13,414 10,864 6,508 Sfmt 4702 Threshold $17,182 $23,781 $13,865 $14,004 $39,874 $23,716 $28,877 $17,916 $25,383 $14,788 $44,402 $24,371 $27,512 $15,475 $20,328 $11,567 $22,357 $18,625 $14,386 $21,872 $19,340 $11,462 $16,956 $12,060 $10,539 $17,264 $6,213 $17,068 $22,183 $12,414 $12,679 $54,119 $33,415 $50,334 $32,038 $49,676 $32,386 $41,808 $24,029 $38,851 $39,812 $51,676 $26,568 $27,380 $22,089 $23,369 $14,944 $23,543 $14,208 $35,917 $24,559 $26,686 $34,143 $36,166 $42,611 $32,278 $20,929 $31,838 $22,467 $16,561 $24,064 DRG 226 227 228 229 230 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 253 254 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 283 284 285 286 287 288 289 290 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... E:\FR\FM\04MYP2.SGM 04MYP2 Cases 6,656 5,068 2,639 1,198 2,564 721 15,107 7,659 4,964 42,358 2,019 9,863 42,910 12,638 2,693 2,742 101,378 15,777 5,832 1,429 21,645 15,098 14,017 4,149 2,146 24,829 10,404 7,144 13,494 12,014 2,898 2,981 1,603 636 23,791 3,921 4,304 2,303 272 1,003 10,670 2,635 21,019 5,931 1,348 2,287 228 1,445 112,171 33,823 6 19,255 7,092 6,268 1,829 7,615 2,702 6,107 10,432 6,881 10,827 Threshold $29,923 $16,786 $23,112 $14,205 $26,523 $19,464 $35,245 $25,357 $14,917 $14,238 $12,305 $27,442 $21,095 $25,924 $13,360 $22,347 $15,581 $14,369 $9,431 $12,106 $11,781 $17,268 $13,881 $13,866 $9,765 $15,141 $9,271 $16,671 $17,881 $14,270 $19,381 $14,202 $19,576 $19,862 $33,555 $20,803 $29,777 $17,605 $18,035 $23,142 $31,752 $16,856 $19,407 $19,148 $11,532 $23,181 $11,152 $13,974 $17,127 $10,861 $17,172 $14,562 $9,993 $14,563 $9,200 $35,872 $35,486 $32,104 $37,872 $18,298 $17,619 23644 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 10.—GEOMETRIC MEAN PLUS TABLE 10.—GEOMETRIC MEAN PLUS TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATHE LESSER OF .75 OF THE NATHE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING TIONAL ADJUSTED OPERATING TIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT STANDARDIZED PAYMENT AMOUNT STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIF(INCREASED TO REFLECT THE DIF(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND FERENCE BETWEEN COSTS AND FERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDCHARGES) OR .75 OF ONE STANDCHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES ARD DEVIATION OF MEAN CHARGES ARD DEVIATION OF MEAN CHARGES BY DIAGNOSIS-RELATED GROUP BY DIAGNOSIS-RELATED GROUP BY DIAGNOSIS-RELATED GROUP (DRG)—MARCH 2005 1—Continued (DRG)—MARCH 2005 1—Continued (DRG)—MARCH 2005 1—Continued DRG 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 331 332 333 334 335 336 337 338 339 340 341 342 344 345 346 347 348 349 350 352 353 354 355 Cases .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... VerDate Aug<04>2004 64 7,321 367 98,864 4,096 254,455 45,318 81 1,478 21,321 3,896 9,646 23,740 13,816 3,084 6,341 2,061 7,089 3,555 26,019 6,468 1,454 507 36,526 180,759 2,756 5,923 382 218,425 31,366 61 20,454 5,414 9,600 2,574 5 606 71 54,748 4,387 251 9,802 11,919 31,235 25,130 652 1,253 2 3,183 563 2,691 1,461 3,962 247 4,171 575 7,134 973 2,725 7,603 4,922 18:31 May 03, 2005 Threshold $18,543 $41,142 $27,840 $15,044 $14,601 $16,168 $9,887 $9,998 $20,010 $21,770 $12,544 $52,723 $39,286 $38,375 $23,623 $25,247 $12,398 $30,158 $18,659 $23,711 $13,013 $22,529 $14,119 $35,138 $25,061 $16,124 $23,425 $13,277 $17,103 $11,424 $11,164 $16,793 $10,413 $13,014 $9,069 $5,743 $14,673 $10,155 $20,954 $12,467 $18,573 $28,443 $21,877 $16,658 $11,427 $27,712 $23,286 $18,734 $25,976 $17,354 $25,572 $22,328 $21,235 $12,515 $14,696 $8,797 $14,636 $14,967 $32,476 $29,914 $17,549 Jkt 205001 DRG 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 392 394 395 396 397 398 399 401 402 403 404 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 PO 00000 Cases .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... Frm 00340 Fmt 4701 23,932 5,563 20,763 28,654 14,748 272 2 2,127 1,449 1,620 4,786 455 3,920 3,610 1,838 2,236 1,162 4,860 156 6 388 77 195 507 91 212 43 2,472 132 2,202 2,818 115,973 9 18,425 18,256 1,634 6,325 1,401 31,827 3,799 2,222 583 2,170 1,807 28,395 12 12 5,193 572 50,799 238,848 23 28,478 16,269 2,939 11,866 52 8,631 1,071 14,758 4,309 Sfmt 4702 Threshold $14,960 $38,097 $22,658 $15,907 $17,209 $22,454 $11,608 $19,999 $17,758 $32,955 $24,830 $12,018 $23,343 $12,832 $17,389 $11,866 $9,834 $7,061 $13,290 $33,543 $10,147 $25,958 $15,828 $7,202 $7,834 $12,620 $4,126 $9,812 $6,300 $45,471 $31,480 $16,480 $15,832 $24,257 $24,100 $13,682 $43,589 $24,076 $30,787 $18,943 $42,772 $24,742 $33,802 $24,850 $22,712 $7,141 $16,545 $26,451 $16,081 $51,864 $29,646 $20,595 $21,320 $17,124 $12,324 $14,876 $10,935 $29,978 $36,011 $12,572 $9,562 DRG 427 428 429 430 431 432 433 439 440 441 442 443 444 445 447 449 450 451 452 453 454 455 461 462 463 464 465 466 467 468 470 471 473 475 476 477 478 479 480 481 482 484 485 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... E:\FR\FM\04MYP2.SGM 04MYP2 Cases 1,504 769 25,454 71,402 304 420 5,189 1,738 5,606 779 18,000 3,382 5,891 2,345 6,258 38,766 7,787 3 27,610 5,431 3,835 846 2,722 7,751 31,026 7,651 219 1,377 1,013 50,411 32 15,474 8,761 116,437 3,018 29,401 113,571 24,583 800 1,065 5,070 449 3,412 2,562 4,640 786 13,453 5,203 19,730 4,005 61,564 25,546 303 3,255 27,777 19,008 35,640 48,213 3,120 717 5,905 Threshold $10,543 $13,558 $15,545 $12,774 $10,532 $12,850 $5,613 $30,816 $30,736 $18,744 $37,969 $20,255 $14,879 $10,336 $10,696 $16,579 $8,697 $5,847 $20,394 $10,730 $15,920 $9,717 $27,440 $16,591 $13,855 $10,292 $12,019 $12,550 $9,726 $55,817 $13,204 $55,297 $39,707 $51,182 $36,994 $33,866 $40,296 $29,518 $120,367 $86,015 $49,484 $74,694 $50,963 $66,540 $32,711 $58,001 $29,620 $21,034 $32,883 $44,873 $35,020 $20,780 $109,115 $92,679 $59,046 $49,170 $27,782 $18,126 $43,064 $28,008 $24,316 23645 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 10.—GEOMETRIC MEAN PLUS TABLE 10.—GEOMETRIC MEAN PLUS TABLE 10.—GEOMETRIC MEAN PLUS THE LESSER OF .75 OF THE NATHE LESSER OF .75 OF THE NATHE LESSER OF .75 OF THE NATIONAL ADJUSTED OPERATING TIONAL ADJUSTED OPERATING TIONAL ADJUSTED OPERATING STANDARDIZED PAYMENT AMOUNT STANDARDIZED PAYMENT AMOUNT STANDARDIZED PAYMENT AMOUNT (INCREASED TO REFLECT THE DIF(INCREASED TO REFLECT THE DIF(INCREASED TO REFLECT THE DIFFERENCE BETWEEN COSTS AND FERENCE BETWEEN COSTS AND FERENCE BETWEEN COSTS AND CHARGES) OR .75 OF ONE STANDCHARGES) OR .75 OF ONE STANDCHARGES) OR .75 OF ONE STANDARD DEVIATION OF MEAN CHARGES ARD DEVIATION OF MEAN CHARGES ARD DEVIATION OF MEAN CHARGES BY DIAGNOSIS-RELATED GROUP BY DIAGNOSIS-RELATED GROUP BY DIAGNOSIS-RELATED GROUP (DRG)—MARCH 2005 1—Continued (DRG)—MARCH 2005 1—Continued (DRG)—MARCH 2005 1—Continued DRG 504 505 506 507 508 509 510 511 512 513 515 517 518 519 520 521 Cases .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 187 179 1,004 307 641 168 1,755 633 513 227 44,389 66,155 42,015 11,497 15,218 32,138 Threshold $136,123 $27,684 $51,873 $32,100 $24,619 $14,897 $21,890 $12,748 $81,413 $97,844 $88,758 $40,225 $35,092 $43,638 $33,659 $13,596 DRG 522 523 524 525 527 528 529 530 531 532 533 534 535 536 537 538 Cases .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... 5,642 15,863 118,842 313 191,680 1,767 4,030 2,362 4,796 2,622 47,549 45,166 7,384 8,047 8,640 5,598 Threshold $9,515 $7,639 $14,823 $139,715 $44,147 $102,318 $37,957 $24,232 $45,158 $29,368 $31,277 $20,426 $123,742 $108,821 $33,393 $20,028 DRG 539 540 541 542 543 544 545 546 547 548 549 550 .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... .................... Cases 5,014 1,509 22,410 24,343 5,403 417,780 42,280 1,954 26,756 11,898 35,640 20,130 Threshold $44,863 $23,964 $242,891 $155,852 $62,826 $37,604 $44,313 $77,955 $49,899 $41,613 $55,680 $47,573 1 Cases are taken from the FY 2004 MedPAR file; DRGs are from GROUPER Version 23.0. TABLE 11.—PROPOSED FY 2006 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY LTC–DRG 1 ............... 2 ............... 3 ............... 6 ............... 7 ............... 8 ............... 9 ............... 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 ............. VerDate Aug<04>2004 Relative weight Description 5 CRANIOTOMY AGE >17 W CC ..................................................................................... AGE >17 W/O CC ................................................................................. 7 CRANIOTOMY AGE 0–17 .............................................................................................. 7 CARPAL TUNNEL RELEASE ......................................................................................... PERIPH & CRANIAL NERVE & OTHER NERV SYST PROC W CC .............................. 3 PERIPH & CRANIAL NERVE & OTHER NERV SYST PROC W/O CC ........................ SPINAL DISORDERS & INJURIES .................................................................................. NERVOUS SYSTEM NEOPLASMS W CC ...................................................................... 2 NERVOUS SYSTEM NEOPLASMS W/O CC ................................................................ DEGENERATIVE NERVOUS SYSTEM DISORDERS ..................................................... MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA ......................................................... INTERCRANIAL HEMORRHAGE OR STROKE WITH INFARCT ................................... NONSPECIFIC CVA & PRECEREBRAL OCCULUSION WITHOUT INFARCT .............. NONSPECIFIC CEREBROVASCULAR DISORDERS W CC .......................................... 1 NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC .................................... CRANIAL & PERIPHERAL NERVE DISORDERS W CC ................................................ CRANIAL & PERIPHERAL NERVE DISORDERS W/O CC ............................................. NERVOUS SYSTEM INFECTION EXCEPT VIRAL MENINGITIS ................................... 3 VIRAL MENINGITIS ........................................................................................................ 4 HYPERTENSIVE ENCEPHALOPATHY ......................................................................... NONTRAUMATIC STUPOR & COMA .............................................................................. SEIZURE & HEADACHE AGE >17 W CC ....................................................................... 1 SEIZURE & HEADACHE AGE >17 W/O CC ................................................................. 7 SEIZURE & HEADACHE AGE 0–17 .............................................................................. TRAUMATIC STUPOR & COMA, COMA >1 HR ............................................................. TRAUMATIC STUPOR & COMA, COMA <1 HR AGE >17 W CC .................................. 1 TRAUMATIC STUPOR & COMA, COMA <1 HR AGE >17 W/O CC ............................ 7 TRAUMATIC STUPOR & COMA, COMA <1 HR AGE 0–17 ......................................... 3 CONCUSSION AGE >17 W CC ..................................................................................... 7 CONCUSSION AGE >17 W/O CC ................................................................................. 7 CONCUSSION AGE 0–17 .............................................................................................. OTHER DISORDERS OF NERVOUS SYSTEM W CC ................................................... OTHER DISORDERS OF NERVOUS SYSTEM W/O CC ................................................ 7 RETINAL PROCEDURES ............................................................................................... 7 ORBITAL PROCEDURES ............................................................................................... 7 CRANIOTOMY 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00341 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 1.6862 1.6862 1.6862 0.4502 1.3854 0.7586 0.9617 0.7441 0.5834 0.6903 0.6625 0.7758 0.7398 0.7507 0.4502 0.7242 0.4809 1.0284 0.7586 1.1679 0.8101 0.6262 0.4502 0.4502 0.9658 0.9042 0.4502 0.4502 0.7586 0.4502 0.4502 0.8056 0.5758 1.1679 1.1679 04MYP2 Geometric average length of stay 38.0 38.0 38.0 18.8 37.5 24.5 33.2 24.2 21.0 25.5 23.0 25.9 27.0 23.5 18.8 23.6 21.2 27.1 24.5 29.6 25.4 22.4 18.8 18.8 27.7 30.2 18.8 18.8 24.5 18.8 18.8 25.2 24.0 29.6 29.6 5/6ths of the geometric average length of stay 31.7 31.7 31.7 15.7 31.3 20.4 27.7 20.2 17.5 21.3 19.2 21.6 22.5 19.6 15.7 19.7 17.7 22.6 20.4 24.7 21.2 18.7 15.7 15.7 23.1 25.2 15.7 15.7 20.4 15.7 15.7 21 20 24.7 24.7 23646 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 11.—PROPOSED FY 2006 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued LTC–DRG 38 39 40 41 42 43 44 45 46 47 48 49 50 51 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 ........... VerDate Aug<04>2004 Relative weight Description 7 PRIMARY IRIS PROCEDURES ..................................................................................... PROCEDURES WITH OR WITHOUT VITRECTOMY ......................................... 4 EXTRAOCULAR PROCEDURES EXCEPT ORBIT AGE >17 ....................................... 7 EXTRAOCULAR PROCEDURES EXCEPT ORBIT AGE 0–17 ..................................... 7 INTRAOCULAR PROCEDURES EXCEPT RETINA, IRIS & LENS ............................... 7 HYPHEMA ....................................................................................................................... 2 ACUTE MAJOR EYE INFECTIONS ............................................................................... 7 NEUROLOGICAL EYE DISORDERS ............................................................................. 2 OTHER DISORDERS OF THE EYE AGE >17 W CC ................................................... 7 OTHER DISORDERS OF THE EYE AGE >17 W/O CC ................................................ 7 OTHER DISORDERS OF THE EYE AGE 0–17 ............................................................ 7 MAJOR HEAD & NECK PROCEDURES ....................................................................... 7 SIALOADENECTOMY ..................................................................................................... 7 SALIVARY GLAND PROCEDURES EXCEPT SIALOADENECTOMY .......................... 7 CLEFT LIP & PALATE REPAIR ..................................................................................... 7 SINUS & MASTOID PROCEDURES AGE >17 .............................................................. 7 SINUS & MASTOID PROCEDURES AGE 0–17 ............................................................ 7 MISCELLANEOUS EAR, NOSE, MOUTH & THROAT PROCEDURES ........................ 7 RHINOPLASTY ............................................................................................................... 7 T&A PROC, EXCEPT TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE >17 7 T&A PROC, EXCEPT TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE 0– 17. 7 TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE >17 ................................... 7 TONSILLECTOMY &/OR ADENOIDECTOMY ONLY, AGE 0–17 ................................. 3 MYRINGOTOMY W TUBE INSERTION AGE >17 ......................................................... 7 MYRINGOTOMY W TUBE INSERTION AGE 0–17 ....................................................... 4 OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES ................................. EAR, NOSE, MOUTH & THROAT MALIGNANCY ........................................................... 1 DYSEQUILIBRIUM .......................................................................................................... 7 EPISTAXIS ...................................................................................................................... 3 EPIGLOTTITIS ................................................................................................................ OTITIS MEDIA & URI AGE >17 W CC ........................................................................ 1 OTITIS MEDIA & URI AGE >17 W/O CC .................................................................. 7 OTITIS MEDIA & URI AGE 0–17 ................................................................................... 7 LARYNGOTRACHEITIS .................................................................................................. 7 NASAL TRAUMA & DEFORMITY .................................................................................. OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES AGE >17 ................................ 7 OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES AGE 0–17 ............................ 5 MAJOR CHEST PROCEDURES .................................................................................... OTHER RESP SYSTEM O.R. PROCEDURES W CC ..................................................... 5 OTHER RESP SYSTEM O.R. PROCEDURES W/O CC ............................................... PULMONARY EMBOLISM ................................................................................................ RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W CC ............................. RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W/O CC ......................... 7 RESPIRATORY INFECTIONS & INFLAMMATIONS AGE 0–17 .................................... RESPIRATORY NEOPLASMS ......................................................................................... 2 MAJOR CHEST TRAUMA W CC ................................................................................... 7 MAJOR CHEST TRAUMA W/O CC ............................................................................... PLEURAL EFFUSION W CC ............................................................................................ 2 PLEURAL EFFUSION W/O CC ...................................................................................... PULMONARY EDEMA & RESPIRATORY FAILURE ....................................................... CHRONIC OBSTRUCTIVE PULMONARY DISEASE ...................................................... SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC ..................................................... SIMPLE PNEUMONIA & PLEURISY AGE >17 W/O CC ................................................. 7 SIMPLE PNEUMONIA & PLEURISY AGE 0–17 ............................................................ INTERSTITIAL LUNG DISEASE W CC ............................................................................ 2 INTERSTITIAL LUNG DISEASE W/O CC ...................................................................... PNEUMOTHORAX W CC ................................................................................................. 1 PNEUMOTHORAX W/O CC ........................................................................................... BRONCHITIS & ASTHMA AGE >17 W CC ...................................................................... 2 BRONCHITIS & ASTHMA AGE >17 W/O CC ................................................................ 7 BRONCHITIS & ASTHMA AGE 0–17 ............................................................................. RESPIRATORY SIGNS & SYMPTOMS W CC ................................................................ 3 RESPIRATORY SIGNS & SYMPTOMS W/O CC .......................................................... OTHER RESPIRATORY SYSTEM DIAGNOSES W CC .................................................. 1 OTHER RESPIRATORY SYSTEM DIAGNOSES W/O CC ............................................ 6 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM ........................... 7 LENS 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00342 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM Geometric average length of stay 5/6ths of the geometric average length of stay 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 0.5834 1.1679 0.5834 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 0.4502 0.4502 29.6 29.6 29.6 29.6 29.6 29.6 21.0 29.6 21.0 29.6 29.6 29.6 29.6 29.6 29.6 29.6 29.6 29.6 29.6 18.8 18.8 24.7 24.7 24.7 24.7 24.7 24.7 17.5 24.7 17.5 24.7 24.7 24.7 24.7 24.7 24.7 24.7 24.7 24.7 24.7 15.7 15.7 0.4502 0.4502 0.7586 0.4502 1.1679 1.1477 0.4502 0.4502 0.7586 0.5134 0.4502 0.4502 0.5834 0.5834 0.6360 0.4502 1.6862 2.5324 1.6862 0.6955 0.8252 0.5993 0.4502 0.7138 0.5834 0.5834 0.7308 0.5834 1.0797 0.6620 0.7027 0.5004 0.4502 0.6764 0.5834 0.5913 0.4502 0.6436 0.5834 0.5834 0.9262 0.7586 0.8143 0.4502 0.0000 18.8 18.8 24.5 18.8 29.6 26.2 18.8 18.8 24.5 18.0 18.8 18.8 21.0 21.0 20.4 18.8 38.0 43.6 38.0 21.9 22.8 21.5 18.8 20.1 21.0 21.0 21.2 21.0 25.3 19.6 20.8 17.8 18.8 20.2 21.0 17.0 18.8 19.4 21.0 21.0 23.3 24.5 21.1 18.8 1.0 15.7 15.7 20.4 15.7 24.7 21.8 15.7 15.7 20.4 15 15.7 15.7 17.5 17.5 17 15.7 31.7 36.3 31.7 18.3 19 17.9 15.7 16.8 17.5 17.5 17.7 17.5 21.1 16.3 17.3 14.8 15.7 16.8 17.5 14.2 15.7 16.2 17.5 17.5 19.4 20.4 17.6 15.7 0.8 04MYP2 23647 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 11.—PROPOSED FY 2006 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued LTC–DRG 104 105 106 107 108 109 110 111 113 114 115 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 116 ........... 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... VerDate Aug<04>2004 Relative weight Description 7 CARDIAC VALVE & OTH MAJOR CARDIOTHORACIC PROC W CARD CATH ......... VALVE & OTH MAJOR CARDIOTHORACIC PROC W/O CARD CATH ..... 7 CORONARY BYPASS W PTCA ..................................................................................... 7 CORONARY BYPASS W CARDIAC CATH ................................................................... 7 OTHER CARDIOTHORACIC PROCEDURES ................................................................ 7 CORONARY BYPASS W/O PTCA OR CARDIAC CATH .............................................. 4 MAJOR CARDIOVASCULAR PROCEDURES W CC .................................................... 7 MAJOR CARDIOVASCULAR PROCEDURES W/O CC ................................................ AMPUTATION FOR CIRC SYSTEM DISORDERS EXCEPT UPPER LIMB & TOE ....... UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS ...................... 5 PRM CARD PACEM IMPL W AMI,HRT FAIL OR SHK,OR AICD LEAD OR GNRTR P. 4 OTH PERM CARD PACEMAK IMPL OR PTCA W CORONARY ARTERY STENT IMPLNT. 5CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT .................... 4 CARDIAC PACEMAKER DEVICE REPLACEMENT ...................................................... 3 VEIN LIGATION & STRIPPING ...................................................................................... OTHER CIRCULATORY SYSTEM O.R. PROCEDURES ................................................ CIRCULATORY DISORDERS W AMI & MAJOR COMP, DISCHARGED ALIVE ........... 2 CIRCULATORY DISORDERS W AMI W/O MAJOR COMP, DISCHARGED ALIVE .... CIRCULATORY DISORDERS W AMI, EXPIRED ............................................................ 4 CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH & COMPLEX DIAG ..... 3 CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O COMPLEX DIAG ACUTE & SUBACUTE ENDOCARDITIS .......................................................................... HEART FAILURE & SHOCK ............................................................................................. 2 DEEP VEIN THROMBOPHLEBITIS ............................................................................... 7 CARDIAC ARREST, UNEXPLAINED ............................................................................. PERIPHERAL VASCULAR DISORDERS W CC .............................................................. PERIPHERAL VASCULAR DISORDERS W/O CC .......................................................... ATHEROSCLEROSIS W CC ............................................................................................ 1 ATHEROSCLEROSIS W/O CC ...................................................................................... HYPERTENSION .............................................................................................................. CARDIAC CONGENITAL & VALVULAR DISORDERS AGE >17 W CC ......................... 2 CARDIAC CONGENITAL & VALVULAR DISORDERS AGE >17 W/O CC ................... 7 CARDIAC CONGENITAL & VALVULAR DISORDERS AGE 0–17 ................................ CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC ................................... 2 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC ............................. 1 ANGINA PECTORIS ....................................................................................................... SYNCOPE & COLLAPSE W CC ...................................................................................... 1 SYNCOPE & COLLAPSE W/O CC ................................................................................ 2 CHEST PAIN ................................................................................................................... OTHER CIRCULATORY SYSTEM DIAGNOSES W CC .................................................. OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC .............................................. 7 RECTAL RESECTION W CC ......................................................................................... 7 RECTAL RESECTION W/O CC ..................................................................................... MAJOR SMALL & LARGE BOWEL PROCEDURES W CC ............................................ 7 MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC ....................................... 4 PERITONEAL ADHESIOLYSIS W CC ........................................................................... 2 PERITONEAL ADHESIOLYSIS W/O CC ....................................................................... 3 MINOR SMALL & LARGE BOWEL PROCEDURES W CC ........................................... 7 MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC ....................................... 5 STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17 W CC ............. 7 STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17 W/O CC .......... 7 STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE 0–17 ....................... 4 ANAL & STOMAL PROCEDURES W CC ...................................................................... 7 ANAL & STOMAL PROCEDURES W/O CC .................................................................. 7 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W CC ............. 7 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W/O CC .......... 5 INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W CC ............................. 7 INGUINAL & FEMORAL HERNIA PROCEDURES AGE >17 W/O CC ......................... 7 HERNIA PROCEDURES AGE 0–17 .............................................................................. 7 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC .................................. 7 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC .............................. 7 APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC .............................. 7 APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC .......................... 4 MOUTH PROCEDURES W CC ...................................................................................... 7 MOUTH PROCEDURES W/O CC .................................................................................. 7 CARDIAC 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00343 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM Geometric average length of stay 5/6ths of the geometric average length of stay 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.4877 1.2453 1.6862 29.6 29.6 29.6 29.6 29.6 29.6 29.6 29.6 39.2 33.2 38.0 24.7 24.7 24.7 24.7 24.7 24.7 24.7 24.7 32.7 27.7 31.7 1.1679 29.6 24.7 1.6862 1.1679 0.7586 1.1050 0.8200 0.5834 0.8678 1.1679 0.7586 0.8467 0.6890 0.5834 1.1679 0.6755 0.4698 0.6639 0.4502 0.6388 0.7272 0.5834 0.5834 0.6183 0.5834 0.4502 0.4356 0.4502 0.5834 0.7364 0.4544 1.6862 1.6862 1.8800 0.7586 1.1679 0.5834 0.7586 0.7586 1.6862 1.6862 1.6862 1.1679 1.1679 0.7586 0.7586 1.6862 0.7586 0.7586 1.6862 1.6862 1.6862 1.6862 1.1679 0.7586 38.0 29.6 24.5 31.8 22.6 21.0 18.7 29.6 24.5 25.3 21.1 21.0 29.6 23.1 20.4 21.8 18.8 24.7 23.7 21.0 21.0 20.4 21.0 18.8 18.3 18.8 21.0 21.6 18.0 38.0 38.0 40.8 24.5 29.6 21.0 24.5 24.5 38.0 38.0 38.0 29.6 29.6 24.5 24.5 38.0 24.5 24.5 38.0 38.0 38.0 38.0 29.6 24.5 31.7 24.7 20.4 26.5 18.8 17.5 15.6 24.7 20.4 21.1 17.6 17.5 24.7 19.3 17 18.2 15.7 20.6 19.8 17.5 17.5 17 17.5 15.7 15.3 15.7 17.5 18 15 31.7 31.7 34 20.4 24.7 17.5 20.4 20.4 31.7 31.7 31.7 24.7 24.7 20.4 20.4 31.7 20.4 20.4 31.7 31.7 31.7 31.7 24.7 20.4 04MYP2 23648 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 11.—PROPOSED FY 2006 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued LTC–DRG 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 210 211 212 213 216 217 218 219 220 223 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 224 225 226 227 228 229 230 232 233 234 235 236 237 238 239 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 240 ........... VerDate Aug<04>2004 Relative weight Description OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC ............................................ DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC ...................................... DIGESTIVE MALIGNANCY W CC .................................................................................... 2 DIGESTIVE MALIGNANCY W/O CC .............................................................................. G.I. HEMORRHAGE W CC ............................................................................................... 1 G.I. HEMORRHAGE W/O CC ......................................................................................... COMPLICATED PEPTIC ULCER ..................................................................................... 3 UNCOMPLICATED PEPTIC ULCER W CC ................................................................... 3 UNCOMPLICATED PEPTIC ULCER W/O CC ............................................................... INFLAMMATORY BOWEL DISEASE ............................................................................... G.I. OBSTRUCTION W CC ............................................................................................... 3 G.I. OBSTRUCTION W/O CC ......................................................................................... ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W CC ............ ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W/O CC ........ 7 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE 0–17 ................... 3 DENTAL & ORAL DIS EXCEPT EXTRACTIONS & RESTORATIONS, AGE >17 ........ 7 DENTAL & ORAL DIS EXCEPT EXTRACTIONS & RESTORATIONS, AGE 0–17 ...... 7 DENTAL EXTRACTIONS & RESTORATIONS .............................................................. OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W CC ........................................ OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W/O CC .................................... 7 OTHER DIGESTIVE SYSTEM DIAGNOSES AGE 0–17 ............................................... 4 PANCREAS, LIVER & SHUNT PROCEDURES W CC .................................................. 7 PANCREAS, LIVER & SHUNT PROCEDURES W/O CC .............................................. 3 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W CC ...... 7 BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W/O CC .. 4 CHOLECYSTECTOMY W C.D.E. W CC ........................................................................ 7 CHOLECYSTECTOMY W C.D.E. W/O CC .................................................................... 3 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC .................. 7 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O CC .............. 7 HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR MALIGNANCY ........................... 5 HEPATOBILIARY DIAGNOSTIC PROCEDURE FOR NON-MALIGNANCY ................. OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES .................................. CIRRHOSIS & ALCOHOLIC HEPATITIS ......................................................................... MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS ................................... DISORDERS OF PANCREAS EXCEPT MALIGNANCY .................................................. DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC ................................ 2 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC .......................... DISORDERS OF THE BILIARY TRACT W CC ................................................................ 2 DISORDERS OF THE BILIARY TRACT W/O CC .......................................................... 5 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W CC .................. 4 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W/O CC ............... 7 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE 0–17 ............................ AMPUTATION FOR MUSCULOSKELETAL SYSTEM & CONN TISSUE DISORDERS 4 BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE .................. WND DEBRID & SKN GRFT EXCEPT HAND,FOR MUSCSKELET & CONN TISS DIS 5 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE >17 W CC ... 1 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE >17 W/O CC 7 LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR AGE 0–17 ............ 3 MAJOR SHOULDER/ELBOW PROC, OR OTHER UPPER EXTREMITY PROC W CC. 7 SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC, W/O CC .... FOOT PROCEDURES ...................................................................................................... SOFT TISSUE PROCEDURES W CC ............................................................................. 3 SOFT TISSUE PROCEDURES W/O CC ....................................................................... 4 MAJOR THUMB OR JOINT PROC,OR OTH HAND OR WRIST PROC W CC ............ 7 HAND OR WRIST PROC, EXCEPT MAJOR JOINT PROC, W/O CC .......................... 5 LOCAL EXCISION & REMOVAL OF INT FIX DEVICES OF HIP & FEMUR ................ 7 ARTHROSCOPY ............................................................................................................. OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC ............................. 7 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC ....................... 3 FRACTURES OF FEMUR .............................................................................................. FRACTURES OF HIP & PELVIS ...................................................................................... 1 SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH .......................... OSTEOMYELITIS .............................................................................................................. PATHOLOGICAL FRACTURES & MUSCULOSKELETAL & CONN TISS MALIGNANCY. CONNECTIVE TISSUE DISORDERS W CC ................................................................... 1 OTHER 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00344 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM Geometric average length of stay 5/6ths of the geometric average length of stay 1.6319 0.4502 0.8568 0.5834 0.6984 0.4502 0.8510 0.7586 0.7586 0.9834 0.9417 0.7586 0.7753 0.3959 0.4502 0.7586 0.7586 0.7586 1.0009 0.4730 0.4502 1.1679 1.1679 0.7586 0.7586 1.1679 0.7586 0.7586 0.7586 1.6862 1.6862 2.0391 0.6636 0.7939 0.9564 0.6709 0.5834 0.7600 0.5834 1.6862 1.1679 1.6862 1.2016 1.1679 1.2917 1.6862 0.4502 1.6862 0.7586 35.9 18.8 21.8 21.0 22.0 18.8 21.5 24.5 24.5 24.1 23.5 24.5 22.6 17.2 18.8 24.5 24.5 24.5 24.0 18.2 18.8 29.6 29.6 24.5 24.5 29.6 24.5 24.5 24.5 38.0 38.0 36.1 20.5 19.5 22.9 20.6 21.0 21.5 21.0 38.0 29.6 38.0 33.9 29.6 38.0 38.0 18.8 38.0 24.5 29.9 15.7 18.2 17.5 18.3 15.7 17.9 20.4 20.4 20.1 19.6 20.4 18.8 14.3 15.7 20.4 20.4 20.4 20 15.2 15.7 24.7 24.7 20.4 20.4 24.7 20.4 20.4 20.4 31.7 31.7 30.1 17.1 16.3 19.1 17.2 17.5 17.9 17.5 31.7 24.7 31.7 28.3 24.7 31.7 31.7 15.7 31.7 20.4 0.7586 0.9996 0.9487 0.7586 1.1679 0.4502 1.6862 0.4502 1.2832 0.4502 0.7586 0.6553 0.4502 0.8271 0.6923 24.5 28.9 30.0 24.5 29.6 18.8 38.0 18.8 33.9 18.8 24.5 25.2 18.8 28.2 23.6 20.4 24.1 25 20.4 24.7 15.7 31.7 15.7 28.3 15.7 20.4 21 15.7 23.5 19.7 0.7320 24.5 20.4 04MYP2 23649 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 11.—PROPOSED FY 2006 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued LTC–DRG 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... VerDate Aug<04>2004 Relative weight Description 1 CONNECTIVE TISSUE DISORDERS W/O CC .............................................................. SEPTIC ARTHRITIS .......................................................................................................... MEDICAL BACK PROBLEMS ........................................................................................... BONE DISEASES & SPECIFIC ARTHROPATHIES W CC ............................................. BONE DISEASES & SPECIFIC ARTHROPATHIES W/O CC ......................................... 1 NON-SPECIFIC ARTHROPATHIES ............................................................................... SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE ............. TENDONITIS, MYOSITIS & BURSITIS ............................................................................ AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE .................... 2 FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE >17 W CC .................. 1 FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE >17 W/O CC .............. 7 FX, SPRN, STRN & DISL OF FOREARM, HAND, FOOT AGE 0–17 ........................... FX, SPRN, STRN & DISL OF UPARM,LOWLEG EX FOOT AGE >17 W CC ................ 1 FX, SPRN, STRN & DISL OF UPARM,LOWLEG EX FOOT AGE >17 W/O CC .......... 7 FX, SPRN, STRN & DISL OF UPARM,LOWLEG EX FOOT AGE 0–17 ....................... OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES ........ 7 TOTAL MASTECTOMY FOR MALIGNANCY W CC ...................................................... 7 TOTAL MASTECTOMY FOR MALIGNANCY W/O CC .................................................. 2 SUBTOTAL MASTECTOMY FOR MALIGNANCY W CC .............................................. 7 SUBTOTAL MASTECTOMY FOR MALIGNANCY W/O CC ........................................... 7 BREAST PROC FOR NON-MALIGNANCY EXCEPT BIOPSY & LOCAL EXCISION ... 1 BREAST BIOPSY & LOCAL EXCISION FOR NON-MALIGNANCY .............................. SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W CC ...................... SKIN GRAFT &/OR DEBRID FOR SKN ULCER OR CELLULITIS W/O CC ................... SKIN GRAFT &/OR DEBRID EXCEPT FOR SKIN ULCER OR CELLULITIS W CC ...... 3 SKIN GRAFT &/OR DEBRID EXCEPT FOR SKIN ULCER OR CELLULITIS W/O CC 7 PERIANAL & PILONIDAL PROCEDURES ..................................................................... 5 SKIN, SUBCUTANEOUS TISSUE & BREAST PLASTIC PROCEDURES .................... OTHER SKIN, SUBCUT TISS & BREAST PROC W CC ................................................. 3 OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC ........................................... SKIN ULCERS ................................................................................................................... MAJOR SKIN DISORDERS W CC ................................................................................... 1 MAJOR SKIN DISORDERS W/O CC ............................................................................. 3 MALIGNANT BREAST DISORDERS W CC .................................................................. 7 MALIGNANT BREAST DISORDERS W/O CC ............................................................... 2 NON-MALIGANT BREAST DISORDERS ....................................................................... CELLULITIS AGE >17 W CC ............................................................................................ CELLULITIS AGE >17 W/O CC ........................................................................................ 7 CELLULITIS AGE 0–17 .................................................................................................. TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE >17 W CC ........................... 1 TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE >17 W/O CC ..................... 7 TRAUMA TO THE SKIN, SUBCUT TISS & BREAST AGE 0–17 .................................. MINOR SKIN DISORDERS W CC .................................................................................... 1 MINOR SKIN DISORDERS W/O CC .............................................................................. AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DISORDERS 7 ADRENAL & PITUITARY PROCEDURES ..................................................................... SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DISORDERS ... 4 O.R. PROCEDURES FOR OBESITY ............................................................................. 7 PARATHYROID PROCEDURES .................................................................................... 5 THYROID PROCEDURES .............................................................................................. 7 THYROGLOSSAL PROCEDURES ................................................................................. OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC ........................................ 2 OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W/O CC .................................. DIABETES AGE >35 ......................................................................................................... 3 DIABETES AGE 0–35 ..................................................................................................... NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W CC ............................. NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W/O CC .......................... 7 NUTRITIONAL & MISC METABOLIC DISORDERS AGE 0–17 .................................... 4 INBORN ERRORS OF METABOLISM ........................................................................... ENDOCRINE DISORDERS W CC .................................................................................... 1 ENDOCRINE DISORDERS W/O CC .............................................................................. 6 KIDNEY TRANSPLANT .................................................................................................. 4 KIDNEY,URETER & MAJOR BLADDER PROCEDURES FOR NEOPLASM ............... 5 KIDNEY,URETER & MAJOR BLADDER PROC FOR NON-NEOPL W CC .................. 1 KIDNEY,URETER & MAJOR BLADDER PROC FOR NON-NEOPL W/O CC .............. 2 PROSTATECTOMY W CC ............................................................................................. 7 PROSTATECTOMY W/O CC ......................................................................................... 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00345 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 0.4502 0.7931 0.6107 0.5280 0.4651 0.4502 0.5269 0.6627 0.6614 0.5834 0.4502 0.7586 0.6838 0.4502 0.7586 0.7953 0.7586 0.7586 0.5834 0.7586 0.7586 0.4502 1.3245 0.9555 1.0426 0.7586 0.7586 1.6862 1.2945 0.7586 0.8707 0.7490 0.4502 0.7586 0.7586 0.5834 0.6281 0.4440 0.4502 0.6728 0.4502 0.4502 0.6968 0.4502 1.3552 1.6862 1.1270 1.1679 1.1679 1.6862 1.1679 1.3437 0.5834 0.7330 0.7586 0.7232 0.5262 0.5834 1.1679 0.6413 0.4502 0.0000 1.1679 1.6862 0.4502 0.5834 0.5834 04MYP2 Geometric average length of stay 18.8 26.6 23.4 22.2 20.4 18.8 21.4 22.6 24.7 21.0 18.8 24.5 26.3 18.8 24.5 25.3 24.5 24.5 21.0 24.5 24.5 18.8 39.4 31.9 33.1 24.5 24.5 38.0 35.9 24.5 27.6 22.5 18.8 24.5 24.5 21.0 20.9 17.8 18.8 24.3 18.8 18.8 23.9 18.8 35.6 38.0 33.6 29.6 29.6 38.0 29.6 31.7 21.0 24.8 24.5 23.1 18.4 21.0 29.6 21.2 18.8 1.0 29.6 38.0 18.8 21.0 21.0 5/6ths of the geometric average length of stay 15.7 22.2 19.5 18.5 17 15.7 17.8 18.8 20.6 17.5 15.7 20.4 21.9 15.7 20.4 21.1 20.4 20.4 17.5 20.4 20.4 15.7 32.8 26.6 27.6 20.4 20.4 31.7 29.9 20.4 23 18.8 15.7 20.4 20.4 17.5 17.4 14.8 15.7 20.3 15.7 15.7 19.9 15.7 29.7 31.7 28 24.7 24.7 31.7 24.7 26.4 17.5 20.7 20.4 19.3 15.3 17.5 24.7 17.7 15.7 0.8 24.7 31.7 15.7 17.5 17.5 23650 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 11.—PROPOSED FY 2006 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued LTC–DRG 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... VerDate Aug<04>2004 Relative weight Description 4 MINOR BLADDER PROCEDURES W CC ..................................................................... BLADDER PROCEDURES W/O CC ................................................................. 4 TRANSURETHRAL PROCEDURES W CC .................................................................... 7 TRANSURETHRAL PROCEDURES W/O CC ................................................................ 1 URETHRAL PROCEDURES, AGE >17 W CC ............................................................... 7 URETHRAL PROCEDURES, AGE >17 W/O CC ........................................................... 7 URETHRAL PROCEDURES, AGE 0–17 ........................................................................ OTHER KIDNEY & URINARY TRACT O.R. PROCEDURES .......................................... RENAL FAILURE .............................................................................................................. ADMIT FOR RENAL DIALYSIS ........................................................................................ KIDNEY & URINARY TRACT NEOPLASMS W CC ......................................................... 1 KIDNEY & URINARY TRACT NEOPLASMS W/O CC ................................................... KIDNEY & URINARY TRACT INFECTIONS AGE >17 W CC ......................................... KIDNEY & URINARY TRACT INFECTIONS AGE >17 W/O CC ..................................... 7 KIDNEY & URINARY TRACT INFECTIONS AGE 0–17 ................................................ 4 URINARY STONES W CC, &/OR ESW LITHOTRIPSY ................................................ 7 URINARY STONES W/O CC .......................................................................................... 2 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE >17 W CC ........................ 1 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE >17 W/O CC .................... 7 KIDNEY & URINARY TRACT SIGNS & SYMPTOMS AGE 0–17 ................................. 1 URETHRAL STRICTURE AGE >17 W CC .................................................................... 7 URETHRAL STRICTURE AGE >17 W/O CC ................................................................. 7 URETHRAL STRICTURE AGE 0–17 ............................................................................. OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE >17 W CC ............................ 3 OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE >17 W/O CC ...................... 7 OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE 0–17 ................................... 2 MAJOR MALE PELVIC PROCEDURES W CC .............................................................. 7 MAJOR MALE PELVIC PROCEDURES W/O CC .......................................................... 2 TRANSURETHRAL PROSTATECTOMY W CC ............................................................. 7 TRANSURETHRAL PROSTATECTOMY W/O CC ......................................................... 7 TESTES PROCEDURES, FOR MALIGNANCY ............................................................. 4 TESTES PROCEDURES, NON-MALIGNANCY AGE >17 ............................................. 7 TESTES PROCEDURES, NON-MALIGNANCY AGE 0–17 ........................................... 4 PENIS PROCEDURES ................................................................................................... 7 CIRCUMCISION AGE >17 .............................................................................................. 7 CIRCUMCISION AGE 0–17 ............................................................................................ 1 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY 5 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXCEPT FOR MALIGNANCY. MALIGNANCY, MALE REPRODUCTIVE SYSTEM, W CC ............................................. 2 MALIGNANCY, MALE REPRODUCTIVE SYSTEM, W/O CC ....................................... 2 BENIGN PROSTATIC HYPERTROPHY W CC .............................................................. 7 BENIGN PROSTATIC HYPERTROPHY W/O CC .......................................................... INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM ........................................ 7 STERILIZATION, MALE .................................................................................................. OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES ............................................... 7 PELVIC EVISCERATION, RADICAL HYSTERECTOMY & RADICAL VULVECTOMY 7 UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W CC ................. 7 UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O CC ............. 7 FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES ............... 7 UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY .............. 7 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC .................................... 7 UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC ................................ 4 VAGINA, CERVIX & VULVA PROCEDURES ................................................................ 7 LAPAROSCOPY & INCISIONAL TUBAL INTERRUPTION ........................................... 7 ENDOSCOPIC TUBAL INTERRUPTION ....................................................................... 7 D&C, CONIZATION & RADIO-IMPLANT, FOR MALIGNANCY ..................................... 5 D&C, CONIZATION EXCEPT FOR MALIGNANCY ....................................................... 5 OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES ............................ MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC .......................................... 7 MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W/O CC .................................... INFECTIONS, FEMALE REPRODUCTIVE SYSTEM ....................................................... 3 MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS ............. 7 CESAREAN SECTION W CC ......................................................................................... 7 CESAREAN SECTION W/O CC ..................................................................................... 7 VAGINAL DELIVERY W COMPLICATING DIAGNOSES .............................................. 7 VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES ........................................... 7 MINOR 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00346 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM Geometric average length of stay 5/6ths of the geometric average length of stay 1.1679 1.1679 1.1679 1.1679 0.4502 0.4502 0.4502 1.4005 0.8208 1.0001 0.7648 0.4502 0.6185 0.4813 0.4502 1.1679 0.4502 0.5834 0.4502 0.4502 0.4502 0.4502 0.4502 0.8033 0.7586 0.7586 0.5834 1.6862 0.5834 0.5834 0.5834 1.1679 1.1679 1.1679 1.1679 1.1679 0.4502 1.6862 29.6 29.6 29.6 29.6 18.8 18.8 18.8 31.5 22.6 25.5 20.2 18.8 22.1 19.0 18.8 29.6 18.8 21.0 18.8 18.8 18.8 18.8 18.8 23.0 24.5 24.5 21.0 38.0 21.0 21.0 21.0 29.6 29.6 29.6 29.6 29.6 18.8 38.0 24.7 24.7 24.7 24.7 15.7 15.7 15.7 26.3 18.8 21.3 16.8 15.7 18.4 15.8 15.7 24.7 15.7 17.5 15.7 15.7 15.7 15.7 15.7 19.2 20.4 20.4 17.5 31.7 17.5 17.5 17.5 24.7 24.7 24.7 24.7 24.7 15.7 31.7 0.6105 0.5834 0.5834 1.1679 0.6562 1.1679 0.6360 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.6862 1.6862 0.7126 1.1679 0.6455 0.7586 0.7586 0.5834 1.1679 1.1679 20.6 21.0 21.0 29.6 21.6 29.6 23.4 29.6 29.6 29.6 29.6 29.6 29.6 29.6 29.6 29.6 29.6 29.6 38.0 38.0 20.3 29.6 20.7 24.5 24.5 21.0 29.6 29.6 17.2 17.5 17.5 24.7 18 24.7 19.5 24.7 24.7 24.7 24.7 24.7 24.7 24.7 24.7 24.7 24.7 24.7 31.7 31.7 16.9 24.7 17.3 20.4 20.4 17.5 24.7 24.7 04MYP2 23651 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 11.—PROPOSED FY 2006 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued LTC–DRG 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 439 440 441 442 443 444 445 446 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... VerDate Aug<04>2004 Relative weight Description 7 VAGINAL DELIVERY W STERILIZATION &/OR D&C ................................................... DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C ............................. 7 POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE ............. 7 POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE ................. 7 ECTOPIC PREGNANCY ................................................................................................. 7 THREATENED ABORTION ............................................................................................ 7 ABORTION W/O D&C ..................................................................................................... 7 ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY ...................... 7 FALSE LABOR ................................................................................................................ 7 OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS ....................... 7 OTHER ANTEPARTUM DIAGNOSES W/O MEDICAL COMPLICATIONS ................... 7 NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY ..... 7 EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE 7 PREMATURITY W MAJOR PROBLEMS ....................................................................... 7 PREMATURITY W/O MAJOR PROBLEMS ................................................................... 7 FULL TERM NEONATE W MAJOR PROBLEMS .......................................................... 7 NEONATE W OTHER SIGNIFICANT PROBLEMS ........................................................ 7 NORMAL NEWBORN ..................................................................................................... 7 SPLENECTOMY AGE >17 ............................................................................................. 7 SPLENECTOMY AGE 0–17 ........................................................................................... 5 OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS ... RED BLOOD CELL DISORDERS AGE >17 ..................................................................... 7 RED BLOOD CELL DISORDERS AGE 0–17 ................................................................ COAGULATION DISORDERS .......................................................................................... RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC ....................................... 2 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC .................................. 5 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W CC ..................... 7 LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W/O CC ................. LYMPHOMA & NON-ACUTE LEUKEMIA W CC .............................................................. 2 LYMPHOMA & NON-ACUTE LEUKEMIA W/O CC ........................................................ 7 ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE AGE 0–17 ................................ 4 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R.PROC W CC ........ 7 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R.PROC W/O CC .... 4 MYELOPROLIF DISORD OR POORLY DIFF NEOPL W OTHER O.R.PROC ............. RADIOTHERAPY .............................................................................................................. CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS ................ 7 HISTORY OF MALIGNANCY W/O ENDOSCOPY ......................................................... 7 HISTORY OF MALIGNANCY W ENDOSCOPY ............................................................. OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC .......................... 7 OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W/O CC .................... O.R. PROCEDURE FOR INFECTIOUS & PARASITIC DISEASES ................................ SEPTICEMIA AGE >17 ..................................................................................................... 7 SEPTICEMIA AGE 0–17 ................................................................................................. POSTOPERATIVE & POST-TRAUMATIC INFECTIONS ................................................. 3 FEVER OF UNKNOWN ORIGIN AGE >17 W CC ......................................................... 7 FEVER OF UNKNOWN ORIGIN AGE >17 W/O CC ..................................................... VIRAL ILLNESS AGE >17 ................................................................................................ 7 VIRAL ILLNESS & FEVER OF UNKNOWN ORIGIN AGE 0–17 ................................... OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES ...................................... 3 O.R. PROCEDURE W PRINCIPAL DIAGNOSES OF MENTAL ILLNESS .................... 2 ACUTE ADJUSTMENT REACTION & PSYCHOLOGICAL DYSFUNCTION ................. DEPRESSIVE NEUROSES .............................................................................................. NEUROSES EXCEPT DEPRESSIVE ............................................................................... 1 DISORDERS OF PERSONALITY & IMPULSE CONTROL ........................................... ORGANIC DISTURBANCES & MENTAL RETARDATION .............................................. PSYCHOSES .................................................................................................................... 1 CHILDHOOD MENTAL DISORDERS ............................................................................. 2 OTHER MENTAL DISORDER DIAGNOSES .................................................................. 2 ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA .......................................... SKIN GRAFTS FOR INJURIES ........................................................................................ WOUND DEBRIDEMENTS FOR INJURIES ..................................................................... 1 HAND PROCEDURES FOR INJURIES ......................................................................... OTHER O.R. PROCEDURES FOR INJURIES W CC ...................................................... 3 OTHER O.R. PROCEDURES FOR INJURIES W/O CC ................................................ TRAUMATIC INJURY AGE >17 W CC ............................................................................. 1 TRAUMATIC INJURY AGE >17 W/O CC ....................................................................... 7 TRAUMATIC INJURY AGE 0–17 ................................................................................... 7 VAGINAL 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00347 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 1.1679 1.1679 1.1679 1.1679 0.7586 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 1.1679 0.7586 0.7586 1.6862 0.6611 0.5834 0.8665 0.8193 0.5834 1.6862 0.5834 0.8844 0.5834 0.5834 1.1679 1.1679 1.1679 0.8567 1.1719 1.1679 1.1679 0.8990 0.5834 1.4237 0.8255 0.7586 0.8296 0.7586 0.7586 0.9474 0.4502 0.9403 0.7586 0.5834 0.4131 0.4713 0.4502 0.5831 0.4350 0.4502 0.5834 0.5834 1.3758 1.3261 0.4502 1.4028 0.7586 0.7551 0.4502 0.4502 04MYP2 Geometric average length of stay 29.6 29.6 29.6 29.6 24.5 29.6 29.6 29.6 29.6 29.6 29.6 29.6 29.6 29.6 29.6 29.6 29.6 29.6 24.5 24.5 38.0 21.8 21.0 22.5 23.5 21.0 38.0 21.0 21.3 21.0 21.0 29.6 29.6 29.6 23.4 26.4 29.6 29.6 20.5 21.0 35.5 23.4 24.5 24.7 24.5 24.5 27.3 18.8 21.7 24.5 21.0 20.7 23.8 18.8 26.5 24.1 18.8 21.0 21.0 35.6 35.9 18.8 33.4 24.5 25.9 18.8 18.8 5/6ths of the geometric average length of stay 24.7 24.7 24.7 24.7 20.4 24.7 24.7 24.7 24.7 24.7 24.7 24.7 24.7 24.7 24.7 24.7 24.7 24.7 20.4 20.4 31.7 18.2 17.5 18.8 19.6 17.5 31.7 17.5 17.8 17.5 17.5 24.7 24.7 24.7 19.5 22 24.7 24.7 17.1 17.5 29.6 19.5 20.4 20.6 20.4 20.4 22.8 15.7 18.1 20.4 17.5 17.3 19.8 15.7 22.1 20.1 15.7 17.5 17.5 29.7 29.9 15.7 27.8 20.4 21.6 15.7 15.7 23652 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 11.—PROPOSED FY 2006 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued LTC–DRG 447 448 449 450 451 452 453 454 455 461 462 463 464 465 466 467 468 469 470 471 473 475 476 477 478 479 480 481 482 484 485 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 486 487 488 489 490 491 492 493 494 495 496 497 498 499 500 501 502 503 504 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 505 ........... 506 507 508 509 510 511 512 513 515 517 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 518 ........... VerDate Aug<04>2004 Relative weight Description 2 ALLERGIC REACTIONS AGE >17 ................................................................................. REACTIONS AGE 0–17 ............................................................................... 3 POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W CC ................................... 7 POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W/O CC ................................ 7 POISONING & TOXIC EFFECTS OF DRUGS AGE 0–17 ............................................. COMPLICATIONS OF TREATMENT W CC ..................................................................... COMPLICATIONS OF TREATMENT W/O CC ................................................................. 3 OTHER INJURY, POISONING & TOXIC EFFECT DIAG W CC ................................... 7 OTHER INJURY, POISONING & TOXIC EFFECT DIAG W/O CC ................................ O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES ............... REHABILITATION ............................................................................................................. SIGNS & SYMPTOMS W CC ........................................................................................... SIGNS & SYMPTOMS W/O CC ....................................................................................... AFTERCARE W HISTORY OF MALIGNANCY AS SECONDARY DIAGNOSIS ............. AFTERCARE W/O HISTORY OF MALIGNANCY AS SECONDARY DIAGNOSIS ......... 3 OTHER FACTORS INFLUENCING HEALTH STATUS ................................................. EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS ............... 6 PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS ................................ 6 UNGROUPABLE ............................................................................................................. 5 BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY .......... ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE AGE >17 .................................... RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT ....................... 4 PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS ............. NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS ...... OTHER VASCULAR PROCEDURES W CC .................................................................... 7 OTHER VASCULAR PROCEDURES W/O CC .............................................................. 6 LIVER TRANSPLANT ..................................................................................................... 7 BONE MARROW TRANSPLANT ................................................................................... 3 TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES .................................. 2 CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA ............................................ 7 LIMB REATTACHMENT, HIP AND FEMUR PROC FOR MULTIPLE SIGNIFICANT TR. 5 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA ..................... OTHER MULTIPLE SIGNIFICANT TRAUMA ................................................................... 5 HIV W EXTENSIVE O.R. PROCEDURE ........................................................................ HIV W MAJOR RELATED CONDITION ........................................................................... HIV W OR W/O OTHER RELATED CONDITION ............................................................ 5 MAJOR JOINT & LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITY 7 CHEMOTHERAPY W ACUTE LEUKEMIA OR W USE OF HI DOSE CHEMOAGENT 4 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC ....................................... 7 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC ................................... 6 LUNG TRANSPLANT ...................................................................................................... 7 COMBINED ANTERIOR/POSTERIOR SPINAL FUSION ............................................... 4 SPINAL FUSION W CC .................................................................................................. 7 SPINAL FUSION EXCEPT CERVICAL W/O CC ............................................................ 5 BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W CC .............................. 4 BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W/O CC .......................... 5 KNEE PROCEDURES W PDX OF INFECTION W CC ................................................. 4 KNEE PROCEDURES W PDX OF INFECTION W/O CC .............................................. 2 KNEE PROCEDURES W/O PDX OF INFECTION ......................................................... 7 EXTENSIVE BURNS OF FULL THICKNESS BURNS WITH MECH VENT 96+HRS WITH SKIN GRAFT. 4 EXTENSIVE BURN OR FULL THICKNESS BURNS WITH MECH VENT 96+ HOURS WITHOUT SKIN GRAFT. 4 FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W CC OR SIG TRAUMA 3 FULL THICKNESS BURN W SKIN GRFT OR INHAL INJ W/O CC OR SIG TRAUMA FULL THICKNESS BURN W/O SKIN GRFT OR INHAL INJ W CC OR SIG TRAUMA .. 1 FULL THICKNESS BURN W/O SKIN GRFT OR INH INJ W/O CC OR SIG TRAUMA NON-EXTENSIVE BURNS W CC OR SIGNIFICANT TRAUMA ...................................... 1 NON-EXTENSIVE BURNS W/O CC OR SIGNIFICANT TRAUMA ................................ 6 SIMULTANEOUS PANCREAS/KIDNEY TRANSPLANT ................................................ 6 PANCREAS TRANSPLANT ............................................................................................ 5 CARDIAC DEFIBRILATOR IMPLANT W/O CARDIAC CATH ........................................ 5 PERCUTANEOUS CARDIVASCULAR PROC W NON-DRUG ELUTING STENT W/O AMI. 3 PERCUTANEOUS CARDIVASCULAR PROC W/O CORONARY ARTERY STENT OR AMI. 7 ALLERGIC 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00348 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM Geometric average length of stay 5/6ths of the geometric average length of stay 0.5834 0.5834 0.7586 0.7586 0.7586 0.9139 0.5449 0.7586 0.7586 1.2315 0.5815 0.6234 0.5565 0.6959 0.6713 0.7586 2.1439 0.0000 0.0000 1.6862 0.8580 2.0848 1.1679 1.5867 1.3338 1.1679 0.0000 1.6862 0.7586 0.5834 0.7586 21.0 21.0 24.5 24.5 24.5 25.2 23.2 24.5 24.5 34.0 22.4 23.7 24.1 21.8 21.9 24.5 40.0 1.0 1.0 38.0 20.0 34.5 29.6 35.2 30.7 29.6 1.0 38.0 24.5 21.0 24.5 17.5 17.5 20.4 20.4 20.4 21 19.3 20.4 20.4 28.3 18.7 19.8 20.1 18.2 18.3 20.4 33.3 0.8 0.8 31.7 16.7 28.8 24.7 29.3 25.6 24.7 0.8 31.7 20.4 17.5 20.4 1.6862 0.9046 1.6862 0.8348 0.5012 1.6862 1.6862 1.1679 1.1679 0.0000 1.1679 1.1679 1.1679 1.6862 1.1679 1.6862 1.1679 0.5834 1.6862 38.0 26.0 38.0 21.1 16.4 38.0 38.0 29.6 29.6 1.0 29.6 29.6 29.6 38.0 29.6 38.0 29.6 21.0 38.0 31.7 21.7 31.7 17.6 13.7 31.7 31.7 24.7 24.7 0.8 24.7 24.7 24.7 31.7 24.7 31.7 24.7 17.5 31.7 1.1679 29.6 24.7 1.1679 0.7586 0.8403 0.4502 0.7737 0.4502 0.0000 0.0000 1.6862 1.6862 29.6 24.5 29.4 18.8 24.6 18.8 1.0 1.0 38.0 38.0 24.7 20.4 24.5 15.7 20.5 15.7 0.8 0.8 31.7 31.7 0.7586 24.5 20.4 04MYP2 23653 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules TABLE 11.—PROPOSED FY 2006 LTC–DRGS, RELATIVE WEIGHTS, GEOMETRIC AVERAGE LENGTH OF STAY, AND 5/6THS OF THE GEOMETRIC AVERAGE LENGTH OF STAY—Continued LTC–DRG 519 520 521 522 ........... ........... ........... ........... 523 ........... 524 525 527 528 529 530 531 532 533 534 535 536 537 ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... ........... 538 ........... 539 ........... 540 ........... 541 ........... 542 ........... 543 544 545 546 ........... ........... ........... ........... 547 ........... 548 ........... 549 ........... 550 ........... 1 Proposed 2 Proposed 3 Proposed Relative weight Description 5 CERVICAL SPINAL FUSION W CC ............................................................................... SPINAL FUSION W/O CC ........................................................................... ALCOHOL/DRUG ABUSE OR DEPENDENCE W CC ..................................................... 7 ALCOHOL/DRUG ABUSE OR DEPENDENCE W REHABILITATION THERAPY W/O CC. 7 ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/ O CC. TRANSIENT ISCHEMIA .................................................................................................... 7 OTHER HEART ASSIST SYSTEM IMPLANT ................................................................ 5 PERCUTANEOUS CARVIOVASCULAR PROC W DRUG-ELUTING STENT W/O AMI 7 INTRACRANIAL VASCULAR PROC W PDX HEMORRHAGE ...................................... 5 VENTRICULAR SHUNT PROCEDURES W CC ............................................................ 7 VENTRICULAR SHUNT PROCEDURES W/O CC ........................................................ 3 SPINAL PROCEDURES WITH CC ................................................................................ 8 SPINAL PROCEDURES WITHOUT CC ......................................................................... 5 EXTRACRANIAL VASCULAR PROCEDURES WITH CC ............................................. 7 EXTRACRANIAL PROCEDURES W/O CC .................................................................... 7 CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK ........................... 7 CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK ....................... LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC. 7 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC. 4 LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURE WITH CC .............. 7 LYMPHOMA & LEUKEMIA W MAJOR OR PROCEDURE W/O CC ............................. ECMO OR TRACH W MECH VENT 96+ HRS OR PDX EXCEPT FACE, MOUTH & NECK DIAG WITH MAJOR OR. TRACH W MECH VENT 96+ HRS OR PDX EXCEPT FACE, MOUTH & NECK DIAG WITHOUT MAJOR OR. 5 CRANIOTOMY W IMPLANT OF CHEMO AGENT OR ACUTE COMPLEX CNS PDX 5 MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY ..... 5 REVISION OF HIP OR KNEE REPLACEMENT ............................................................ 7 SPINAL FUSION EXCEPT CERVICAL WITH PRINCIPAL DIAGNOSIS OF CURVATURE OF SPINE OR MALIGNANCY. 7 PERCUTANEOUS CARDIOVASCULAR PROCEDURE WITH AMI WITH CC ............. 7 PERCUTANEOUS CARDIOVASCULAR PROCEDURE WITH AMI WITHOUT CC ...... 7 PERCUTANEOUS CARDIOVASCULAR PROCEDURE WITH DRUG-ELUTING STENT WITH AMI WITH CC. 7 PERCUTANEOUS CARDIOVASCULAR PROCEDURE WITH DRUG-ELUTING STENT WITH AMI WITHOUT CC. 7 CERVICAL Geometric average length of stay 5/6ths of the geometric average length of stay 1.6862 1.1679 0.4533 0.4502 38.0 29.6 19.8 18.8 31.7 24.7 16.5 15.7 0.4502 18.8 15.7 0.5069 1.6862 1.6862 1.6862 1.6862 1.6862 0.7586 0.7586 1.6862 1.1679 1.6862 1.6862 1.1670 21.1 38.0 38.0 38.0 38.0 38.0 24.5 24.5 38.0 29.6 38.0 38.0 34.6 17.6 31.7 31.7 31.7 31.7 31.7 20.4 20.4 31.7 24.7 31.7 31.7 28.8 1.1679 29.6 24.7 1.1679 0.5834 4.2566 29.6 21.0 65.6 24.7 17.5 54.7 3.1821 47.9 39.9 1.6862 1.6862 1.6862 1.6862 38.0 38.0 38.0 38.0 31.7 31.7 31.7 31.7 1.6862 1.6862 1.6862 38.0 38.0 38.0 31.7 31.7 31.7 1.6862 38.0 31.7 relative weights for these proposed LTC–DRGs were determined by assigning these cases to proposed low-volume quintile 1. relative weights for these proposed LTC–DRGs were determined by assigning these cases to proposed low-volume quintile 2. relative weights for these proposed LTC–DRGs were determined by assigning these cases to proposed low-volume quintile quintile 3. 4 Proposed 5 Proposed relative weights for these proposed LTC–DRGs were determined by assigning these cases to proposed low-volume quintile 4. relative weights for these proposed LTC–DRGs were determined by assigning these cases to proposed low-volume quintile quintile 5. 6 Proposed relative weights for these proposed LTC–DRGs were assigned a value of 0.0000. relative weights for these proposed LTC–DRGs were determined by assigning these cases to the appropriate proposed low volume quintile because there are no LTCH cases in the FY 2004 MedPAR file. 8 Proposed relative weights for these proposed LTC–DRGs were determined after adjusting to account for nonmonotonicity (see step 5 above). 7 Proposed Appendix A—Regulatory Analysis of Impacts (If you choose to comment on issues in this section, please include the caption ‘‘Impact Analyses’’ at the beginning of your comment.) I. Background and Summary 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– VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 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 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 PO 00000 Frm 00349 Fmt 4701 Sfmt 4702 rules with economically significant effects ($100 million or more in any 1 year). We have determined that this proposed rule is a major rule as defined in 5 U.S.C. 804(2). We estimate that the total impact of these proposed changes for FY 2006 payments compared to FY 2005 payments to be approximately a $2.40 billion increase. This amount does not reflect changes in hospital admissions or case-mix intensity, which would also affect overall payment changes. The RFA requires agencies to analyze options for regulatory relief of small E:\FR\FM\04MYP2.SGM 04MYP2 23654 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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 small entities, either by nonprofit status or by having revenues of $5 million to $25 million in any 1 year. 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. 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 new labor market definitions, we no longer employ NECMAs to define urban areas in New England. Therefore, we now define a small rural hospital as a hospital with fewer than 100 beds that is located outside of a Metropolitan Statistical Area (MSA). 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 proposed rule (or a final rule that has been preceded by a proposed rule) that may result in an expenditure in any one year by State, local, or tribal governments, in the aggregate, or by the private sector, of $110 million. This proposed rule will not mandate any requirements for State, local, or tribal governments. 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. We have reviewed this proposed rule in light of Executive Order 13132 and have determined that it would not have any negative impact on the rights, roles, and responsibilities of State, local, or tribal governments. In accordance with the provisions of Executive Order 12866, this proposed rule was reviewed by the Office of Management and Budget. The following analysis, in conjunction with the remainder of this document, demonstrates that this proposed rule is consistent with the regulatory philosophy and principles identified in Executive Order 12866, the RFA, and section 1102(b) of the Act. The proposed rule will affect payments to a substantial number of small rural hospitals, as well as other classes of VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 hospitals, and the effects on some hospitals may be significant. The impacts of our proposed policy changes on these hospitals are discussed below. II. Objectives V. Impact on Excluded Hospitals and Hospital Units As of March 2005, there were 1,138 specialty hospitals excluded from the IPPS. Of these 1,138 specialty hospitals, 467 psychiatric hospitals, 80 children’s, 11 cancer hospitals, and 21 LTCHs that are paid under the LTCH PPS blend methodology are being paid, in whole or in part, on a reasonable cost basis subject to the rate-ofincrease ceiling under § 413.40. The remaining providers—218 IRFs and 361 LTCHs are paid 100 percent of the Federal prospective rate under the IRF PPS and the LTCH PPS, respectively. In addition, there were 1,342 psychiatric units (paid on a blend of the IPF PPS per diem payment and the TEFRA reasonable cost-based payment) and 1,006 rehabilitation units (paid under the IRF PPS) in hospitals otherwise subject to the IPPS. Under § 413.40(a)(2)(i)(A), the rate-ofincrease ceiling is not applicable to the 46 specialty 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 based on their reasonable costs are subject to TEFRA limits for FY 2006. For these hospitals, the proposed update is the percentage increase in the excluded hospital market basket, currently estimated at 3.4 percent. Inpatient rehabilitation facilities (IRFs) are paid under a prospective payment system (IRF PPS) for cost reporting periods beginning on or after January 1, 2002. For cost reporting periods beginning during FY 2005, the IRF PPS is based on 100 percent of the adjusted Federal IRF prospective payment amount, updated annually. Therefore, these hospitals are not impacted by this proposed rule. Effective for cost reporting periods beginning on or after October 1, 2002, LTCHs are paid under a LTCH PPS, based on a Federal prospective payment amount that is updated annually. LTCHs will receive a blended payment that consists of the Federal prospective payment rate and a reasonable cost-based payment rate over a 5-year transition period. However, under the LTCH PPS, a LTCH may also elect 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. For purposes of the update factor, the portion of the LTCH PPS transition blend payment based on reasonable costs for inpatient operating services would be determined by updating the LTCH’s TEFRA limit by the estimate of the excluded hospital market basket (or 3.4 percent). Section 124 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA) required the development of a per diem prospective payment system (PPS) for payment of inpatient hospital services furnished in psychiatric hospitals and psychiatric units of acute care hospitals and 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 Trust Fund. We believe the proposed changes in this proposed rule will 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 will ensure that the outcomes of this payment system are reasonable and equitable while avoiding or minimizing unintended adverse consequences. 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 2006, on various hospital groups. We estimate the effects of individual policy changes by estimating payments per case while holding all other payment policies constant. We use the best data available, but we do not attempt to predict behavioral responses to our policy changes, and we do not make adjustments for future changes in such variables as admissions, lengths of stay, or case-mix. As we have done in the previous proposed rules, we are soliciting comments and information about the anticipated effects of these proposed changes on hospitals and our methodology for estimating them. Any comments that we receive in response to this proposed rule will be addressed in the final rule. 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 the prospective payment method for these hospitals. Among other short-term, acute care hospitals, only the 46 such hospitals in Maryland remain excluded from the IPPS under the waiver at section 1814(b)(3) of the Act. As of March 2005, there are 3,693 IPPS hospitals to be included in our analysis. This represents about 63 percent of all Medicareparticipating hospitals. The majority of this impact analysis focuses on this set of hospitals. There are also approximately 974 critical access hospitals (CAHs). These small, limited service hospitals are paid on the basis of reasonable costs rather than under the IPPS. There are also 1,138 specialty hospitals and units that are excluded from the IPPS. These specialty hospitals include psychiatric hospitals and units, rehabilitation hospitals and units, long-term care hospitals, children’s hospitals, and cancer hospitals. PO 00000 Frm 00350 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules CAHs (inpatient psychiatric facilities (IPFs)). We published a final rule to implement the IPF PPS on November 15, 2004 (69 FR 66922). The final rule 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 cost-based payment. For purposes of determining what the TEFRA payment to the IPF would be, we are proposing that the IPF’s TEFRA limit will be updated by the estimate of the excluded hospital market basket (or 3.4 percent). The impact on excluded hospitals and hospital units of the update in the rate-ofincrease 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 rate-of-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, 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. However, at the same time, by generally limiting payment increases, we continue to provide an incentive for excluded hospitals and hospital units to restrain the growth in their spending for patient services. VI. Quantitative Impact Analysis of the Policy Changes Under the IPPS for Operating Costs A. Basis and Methodology of Estimates In this proposed rule, we are announcing policy changes and payment rate updates for the IPPS for operating costs. 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 (a 2.5 percent increase), we estimate the total impact of these proposed changes for FY 2006 operating payments compared to FY 2005 operating payments to be approximately a $2.41 billion increase. This amount does not reflect changes in hospital admissions or 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 we are proposing in this rule. However, there are other changes we are proposing for which we do not have data VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 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 of those proposed changes based upon our experience and other more limited data. The data used in developing the quantitative analyses of changes in payments per case presented below are taken from the FY 2004 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, we do not make adjustments for behavioral changes that hospitals may adopt in response to the proposed policy changes, and we do not adjust for future changes in such variables as admissions, lengths of stay, or 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 draw upon 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. Using cases in the FY 2004 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 2006 changes to the capital IPPS are discussed in section VIII of this Appendix. The proposed changes discussed separately below are the following: • The effects of the annual reclassification of diagnoses and procedures and the recalibration of the DRG relative weights required by section 1886(d)(4)(C) of the Act. • The effects of the proposed changes in hospitals’ wage index values reflecting wage data from hospitals’ cost reporting periods beginning during FY 2002, compared to the FY 2001 wage data. • The effect of the proposed change in the way we use the wage data for hospitals that reclassify as rural under section 401 of the BBRA to compute wage indexes. • The effect of the proposed wage and recalibration budget neutrality factors. • The effect of the remaining labor market area transition for those hospitals that were urban under the old labor market area designations and are now considered rural hospitals. • The effects of geographic reclassifications by the MGCRB that will be effective in FY 2006. • The effects of section 505 of Pub. L. 108– 173, which provides for an increase in a PO 00000 Frm 00351 Fmt 4701 Sfmt 4702 23655 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. • The total change in payments based on proposed FY 2006 policies and MMAimposed changes relative to payments based on FY 2005 policies. To illustrate the impacts of the proposed FY 2006 changes, our analysis begins with a FY 2006 baseline simulation model using: the proposed update of 3.2 percent; the FY 2005 DRG GROUPER (version 22.0); the CBSA designations for hospitals based on OMB’s June 2003 MSA definitions; the FY 2005 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)(vii) of the Act, as added by section 501(b) of Pub. L. 108–173, provides that, for FYs 2005 through 2007, the update factors will be reduced by 0.4 percentage points for any hospital that does not submit quality data. For purposes of the FY 2006 simulations in this proposed impact analysis, we are assuming all hospitals will qualify for the full update. Each proposed and statutory policy change is then added incrementally to this baseline model, finally arriving at an FY 2006 model incorporating all of the proposed changes. This allows us to isolate the effects of each proposed change. Our final comparison illustrates the percent change in payments per case from FY 2005 to FY 2006. 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 have updated standardized amounts for FY 2006 using the most recently forecasted hospital market basket increase for FY 2006 of 3.2 percent. (Hospitals that fail to comply with the quality data submission requirement to receive the full update will receive an update reduced by 0.4 percentage points to 2.8 percent.) Under section 1886(b)(3)(B)(iv) of the Act, the updates to the hospital-specific amounts for sole community hospitals (SCHs) and for Medicare-dependent small rural hospitals (MDHs) are also equal to the market basket increase, or 3.2 percent. A second significant factor that impacts changes in hospitals’ payments per case from FY 2005 to FY 2006 is the change in MGCRB status from one year to the next. That is, hospitals reclassified in FY 2005 that are no longer reclassified in FY 2006 may have a negative payment impact going from FY 2005 to FY 2006; conversely, hospitals not reclassified in FY 2005 that are reclassified in FY 2006 may have a positive impact. In some cases, 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. However, this effect is alleviated by section 1886(d)(10)(D)(v) of the Act, which provides that reclassifications for purposes of the wage index are for a 3-year period. A third significant factor is that we currently estimate that actual outlier E:\FR\FM\04MYP2.SGM 04MYP2 23656 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules payments during FY 2005 will be 4.4 percent of total DRG payments. When the FY 2005 final rule was published, we projected FY 2005 outlier payments would be 5.1 percent of total DRG plus outlier payments; the average standardized amounts were offset correspondingly. The effects of the lower than expected outlier payments during FY 2005 (as discussed in the Addendum to this proposed rule) are reflected in the analyses below comparing our current estimates of FY 2005 payments per case to estimated FY 2006 payments per case (with outlier payments projected to equal 5.1 percent of total DRG payments). B. Analysis of Table I Table I displays the results of our analysis of proposed changes for FY 2006. 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 3,693 hospitals included in the analysis. This number is 204 fewer hospitals than were included in the impact analysis in the FY 2005 final rule (69 FR 49758 ). 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 2,537 hospitals located in urban areas included in our analysis. Among these, there are 1,399 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 hospitals located in large urban areas (populations over 1 million), and 1,138 hospitals in other urban areas (populations of 1 million or fewer). In addition, there are 1,156 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 2006 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 are 2,575, 1,410, 1,165, and 1,118, 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 2,615 nonteaching hospitals in our analysis, 841 teaching hospitals with fewer than 100 residents, and 237 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 PO 00000 Frm 00352 Fmt 4701 Sfmt 4702 category groups 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, rural referral centers (RRCs), and Medicare dependant hospitals (MDHs)), as well as rural hospitals not receiving a special payment designation. There were 134 RRCs, 405 SCHs, 158 MDHs, and 73 hospitals that are both SCH and RRC. The next two groupings are based on type of ownership and the hospital’s Medicare utilization expressed as a percent of total patient days. These data are taken primarily from the FY 2002 Medicare cost report files, if available (otherwise FY 2001 data are used). The next series of groupings concern the geographic reclassification status of hospitals. The first grouping displays all hospitals that were reclassified by the MGCRB for FY 2006. The next two groupings separate the hospitals in the first group by urban and rural status. The final two rows in Table I contain hospitals located in rural counties but deemed to be urban under section 1886(d)(8)(B) of the Act and hospitals located in urban counties, but deemed to be rural under section 1886(d)(8)(E) of the Act. BILLING CODE 4120–01–P E:\FR\FM\04MYP2.SGM 04MYP2 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00353 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 23657 EP04MY05.070</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules VerDate Aug<04>2004 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00354 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.071</GPH> 23658 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00355 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 23659 EP04MY05.072</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules VerDate Aug<04>2004 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00356 Fmt 4701 Sfmt 4702 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.073</GPH> 23660 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules BILLING CODE 4120–01–C C. Impact of the Proposed Changes to the Postacute Care Transfer Policy (Column 2) In Column 2 of Table I, we present the effects of Option 2 for the proposed expansion of the postacute care transfer policy, as discussed in section V.A. of the preamble to this proposed rule. We compared aggregate payments using the FY 2005 DRG relative weights (GROUPER version 22.0) and Option 2 for the proposed expansion of the postacute care transfer policy to aggregate payments using the FY 2005 DRG relative weights (GROUPER version 22.0) and the FY 2005 postacute care transfer policy. The changes we are proposing are estimated to result in a 1.1 percent decrease in payments to hospitals overall. We estimate the total savings at approximately $880 million. To simulate the impact of this proposed policy, we calculated two sets of transferadjusted discharges and case-mix index values for hospitals. The first set was based on the FY 2005 transfer policy rules and the second was based on Option 2 for the proposed expanded transfer policy discussed in the preamble to this proposed rule. Estimated payments were computed for both sets of data and were then compared. The transfer-adjusted discharge fraction is calculated in one of two ways, depending on the transfer payment methodology. Under the transfer payment methodology in place in FY 2005, for all but the three DRGs receiving special payment consideration (DRGs 209, 210, and 211), this adjustment is made by adding 1 to the length of stay and dividing that amount by the geometric mean length of stay for the DRG (with the resulting fraction not to exceed 1.0). For example, a transfer after 3 days from a DRG with a geometric mean length of stay of 6 days would have a transfer-adjusted discharge fraction of 0.667 ((3+1)/6). For transfers from any one of the three DRGs receiving the alternative payment methodology, the transfer-adjusted discharge fraction is 0.5 (to reflect that these cases receive half the full DRG amount the first day), plus one half of the result of dividing 1 plus the length of stay prior to transfer by the geometric mean length of stay for the DRG. There are 88 DRGs (including 210, 211) that would qualify to receive the special payment consideration. DRG 209 which formerly received the special payment has been split into two new DRGs 544 and 545. Both DRG 544 and DRG 545 are included in the 88 special payment DRGs as they continue to qualify to receive the alternative payment methodology. As with the above adjustment, the result is equal to the lesser of the transfer adjusted discharge fraction or 1. The transfer-adjusted case-mix index values are calculated by summing the transfer-adjusted DRG weights and dividing by the transfer-adjusted discharges. The transfer-adjusted DRG weights are calculated by multiplying the DRG weight by the lesser of 1 or the transfer-adjusted discharge fraction for the case, divided by the geometric mean length of stay for the DRG. In this way, simulated payments per case can be compared before and after the proposed change to the transfer policy. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 This proposed expansion of the policy, which represents a significant change from our prior policy, has a negative 1.1 percent payment impact overall among both urban and rural hospitals. There is only small variation among all of the hospital categories from this negative 1.1 percent impact. The areas that are most dramatically impacted are urban areas, with urban New England experiencing a 1.9 percent decline in payments and the Middle Atlantic experiencing a 1.2 percent decline. Although rural New England hospitals are losing 1.1 percent, most of the other rural regions lose less than 1 percent from this policy change. Urban areas tend to have a greater concentration of postacute care facilities to which to discharge patients than do rural areas and are, therefore, more likely to be impacted by this policy proposal. D. Impact of the Proposed Changes to the DRG Reclassifications and Recalibration of Relative Weights (Column 3) In Column 3 of Table I, we present the combined effects of the 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 and to recalibrate the DRG weights in order to reflect changes in treatment patterns, technology, and any other factors that may change the relative use of hospital resources. We compared aggregate payments using the FY 2005 DRG relative weights (GROUPER version 22.0) to aggregate payments using the proposed FY 2006 DRG relative weights (GROUPER version 23.0). We note that, consistent with section 1886(d)(4)(C)(iii) of the Act, we have applied a budget neutrality factor to ensure that the overall payment impact of the DRG changes (combined with the wage index changes) is budget neutral. This proposed budget neutrality factor of 1.002494 is applied to payments in Column 6. Because this is a combined DRG reclassification and recalibration and wage index budget neutrality factor, it is not applied to payments in Column 3. The major DRG classification changes we are proposing include: reassigning procedure code 35.52 (Repair of atrial septal defect with prosthesis, closed technique) from DRG 108 to DRG 518 (Percutaneous Cardiovascular Procedure Without Coronary Artery Stent or AMI); reassigning procedure code 37.26 (Cardiac electrophysiologic stimulation and recording studies) from DRGs 535 and 536 to DRGs 515 (Cardiac Defibrillator Implant Without Cardiac Catheterization); splitting DRG 209 into two new DRGs based on the presence or absence of the procedure codes for major joint replacement or reattachment of lower extremity and revision of hip or knee replacement, DRG 545 (Revision of Hip or Knee Replacement) and DRG 544 (Major Joint Replacement or Reattachment of Lower Extremity); reassigning procedure code 26.12 (Open biopsy of salivary gland or duct) from DRG 468 to DRG 477 (Non-Extensive O.R. Procedure Unrelated To Principal Diagnosis); reassigning the principal diagnosis codes for curvature of the spine or malignancy from DRGs 497 and 498 to new DRG 546 (Spinal PO 00000 Frm 00357 Fmt 4701 Sfmt 4702 23661 Fusion Except Cervical with PDX of Curvature of the Spine or Malignancy); splitting DRGs 516 and 526 into four new DRGs based on the presence or absence of a CC, DRG 547 (Percutaneous Cardiovascular Procedure With AMI With CC), DRG 548 (Percutaneous Cardiovascular Procedure With AMI Without CC), DRG 549 (Percutaneous Cardiovascular Procedure With Drug-Eluting Stent With AMI With CC), DRG 550 (Percutaneous Cardiovascular Procedure With Drug-Eluting Stent With AMI Without CC); reassigning procedure code 39.65 (Extracorporeal membrane oxygenation [ECMO]) from DRGs 104 and 105 to DRG 541 (ECMO or Tracheostomy with Mechanical Ventilation 96+ Hours or Principal Diagnosis Except Face, Mouth and Neck Diagnoses With Major Operating Room Procedure). In the aggregate, these proposed changes would result in a 0.1 percent increase in overall payments to hospitals. On average, the impacts of these changes on any particular hospital group are very small, with urban hospitals experiencing a 0.2 percent increase and rural hospitals experiencing a 0.1 percent decrease. The largest impact is a 0.4 percent increase among urban hospitals in New England. This is in part due to the residual effects of the proposed change to the postacute care transfer policy on the relative weights. Including a DRG in the postacute care transfer group reduces the number of cases in the DRG (cases that qualify as transfers are only counted as a fraction of a case) which in turn increases the average charge for the DRG and the weight. E. Impact of Proposed Wage Index Changes (Column 4) 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 2006 is based on data submitted for hospital cost reporting periods beginning on or after October 1, 2001 and before October 1, 2002. The impact of the new data on hospital payments is isolated in Column 4 by holding the other payment parameters constant in this simulation. That is, Column 4 shows the percentage changes in payments when going from a model using the FY 2005 wage index, based on FY 2001 wage data, to a model using the FY 2006 pre-reclassification wage index, based on FY 2002 wage data. The FY 2005 wage index baseline incorporated a blended wage index of 50 percent of the MSA wage index and 50 percent of the CBSA wage index in areas where the CBSA wage index was lower than the MSA wage index to reflect the transition policy that was in effect in FY 2005. The wage data collected on the FY 2002 cost report is the same as the FY 2001 wage data that were used to calculate the FY 2005 wage index. Column 4 shows the impacts of updating the wage data using FY 2002 cost reports. Overall, the new wage data will lead to a 0.4 percent decrease for all hospitals and for hospitals in urban areas. This decrease is due to both fluctuations in the wage data itself and the fact that the transition blended wage index, which benefited areas that were negatively impacted by the labor market E:\FR\FM\04MYP2.SGM 04MYP2 23662 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules the national 6.1 increase in average hourly wage. Of the 3,617 hospitals with wage index values in both FYs 2005 and 2006, 1,642, or 45.4 percent, also experienced an average hourly wage increase of 6.1 percent or more. The following chart compares the shifts in wage index values for hospitals for FY 2006 relative to FY 2005. Among urban hospitals, 58 will experience an increase of between 5 percent and 10 percent and 24 will experience an increase of more than 10 percent. A total of 14 rural hospitals would experience increases greater than 5 percent, but none will experience increases of greater than 10 percent. On the negative side, 56 urban hospitals will experience decreases in their wage index values of at least 5 percent, but less than 10 percent. Fourteen urban hospitals will experience decreases in their wage index values greater than 10 percent. The following chart shows the projected impact for urban and rural hospitals. F. Impact of Proposed Change in Treatment of Section 1886(d)(8)(E) Wage Data (Column 5) G. Combined Impact of Proposed DRG and Wage Index Changes, Including Budget Neutrality Adjustment (Column 6) For the FY 2006 wage index, we are proposing to leave the wage data for a hospital redesignated as rural under section 1886(d)(8)(E) of the Act in the urban area in which the hospital is geographically located for purposes of calculating the wage index of those areas. We are proposing to move the wage data for these hospitals into the rural wage index only if it increases the wage index in the rural area. In this way, the rural floor is only affected by the wage data for these redesignated hospitals if it would increase the rural wage index and thus reset the rural floor at a higher value. Previously, the wage data for these redesignated hospitals was moved into the rural area wage index calculations regardless of whether it increased or decreased the rural wage index, and this caused the rural floor for several States to be lower than it would have been had the redesignated providers’ data not been included. Column 5 shows the impact of adopting this policy. In aggregate, this policy proposal has no effect on payments to providers. Hospitals in the urban New England region experience an increase in payments of 0.2 percent, which indicates that CBSAs in that region that receive the rural floor are now receiving a higher wage index. Hospitals in West North Central are shown to experience a 0.2 decline. However, when the redesignated data are added to the rural wage index, their rural floor increases and they do not actually experience a loss from this policy. Hospitals reclassified as rural under section 1886(d)(8)(E) of the Act will experience a 0.2 percent increase. The impact of the DRG reclassifications and recalibration on aggregate payments is required by section 1886(d)(4)(C)(iii) of the Act to be budget neutral. 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 compared simulated aggregate payments using the FY 2005 DRG relative weights and wage index to simulated aggregate payments using the proposed FY 2006 DRG relative weights and blended wage index. We computed a proposed wage and recalibration budget neutrality factor of 1.002494. The 0.0 percent impact for all hospitals demonstrates that these changes, in combination with the budget neutrality factor, are budget neutral. In Table I, the combined overall impacts of the effects of both the DRG reclassifications and recalibration and the updated wage index are shown in Column 6. The changes in this column are the sum of the proposed changes in Columns 3, 4, and 5, combined with the budget neutrality factor and the wage index floor for urban areas required by section 4410 of Pub. L. 105–33 to be budget neutral. There also may be some variation of plus or minus 0.1 percentage point due to rounding. Among urban regions, the largest impacts are in the West North Central region and Puerto Rico, with 0.3 and 0.4 percent declines, respectively. The Pacific region experiences the largest increase of 1.1 percent. Among rural regions, the New England region benefits the most with a 1.3 percent increase, while the Mountain region experiences the largest decline (1.2 percent). H. Impact of Allowing Urban Hospitals That Were Converted to Rural as a Result of the CBSA Designations To Maintain the Wage Index of the MSA Where They Are Located (Column 7) To help alleviate the decreased payments for urban hospitals that became rural under the new labor market area definitions, for purposes of the wage index, we adopted a policy in FY 2005 to allow them 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. Column 7 shows the impact of the remaining labor market area transition, for those hospitals that were urban under the old labor market area designations and are now considered rural hospitals. Section 1886(d)(3)(E) of the Act specifies that any updates or adjustments to the wage index are to be budget neutral. Therefore, we applied an adjustment of 0.999529 to ensure that the effects of reclassification are budget neutral as indicated by the zero effect on payments to hospitals overall. The rural hospital row shows a 0.3 percent benefit from this provision as these hold harmless hospitals are now considered geographically rural. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00358 Fmt 4701 Sfmt 4702 I. Impact of MGCRB Reclassifications (Column 8) 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 bases other than where they are geographically located, such as hospitals in rural counties that are deemed urban under section 1886(d)(8)(B) of the Act). The changes in Column 8 reflect the per case payment impact of moving from this baseline to a simulation incorporating the MGCRB decisions for FY 2006. These decisions affect hospitals’ standardized amount and wage index area assignments. E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.074</GPH> transition is no longer in effect for FY 2006. Among regions, the largest increase is in the rural New England which is experiencing a 1.0 percent increase. The largest decline from updating the wage data is seen in the urban New England region (a 1.1 percent decrease). In looking at the wage data itself, the national average hourly wage increased 6.1 percent compared to FY 2005. Therefore, the only manner in which to maintain or exceed the previous year’s wage index was to match Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 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 2006 wage index values incorporate all of the MGCRB’s reclassification decisions for FY 2006. The wage index values also reflect any decisions made by the CMS Administrator through the appeals and review process through February 28, 2005. Additional changes that result from the Administrator’s review of MGCRB decisions or a request by a hospital to withdraw its application will be reflected in the final rule for FY 2006. The overall effect of geographic reclassification is required by section 1886(d)(8)(D) of the Act to be budget neutral. Therefore, we applied an adjustment of 0.992905 to ensure that the effects of reclassification are budget neutral. (See section II.A.4.b. of the Addendum to this proposed rule.) As a group, rural hospitals benefit from geographic reclassification. We estimate that their payments will rise 2.0 percent in Column 8. Payments to urban hospitals will decline by 0.3 percent. Hospitals in other urban areas will experience an overall decrease in payments of 0.2 percent, while large urban hospitals will lose 0.4 percent. Among urban hospital groups (that is, bed size, census division, and special payment status), payments generally would decline. A positive impact is evident among all of the rural hospital groups. The smallest increase among the rural census divisions is 0.5 for the Mountain and New England regions. The largest increases are in the rural East South Central region, with an increase of 3.0 percent and in the West South Central region, which would experience an increase of 2.5 percent. Urban hospitals reclassified for FY 2006 are expected to receive an increase of 2.3 percent, while rural reclassified hospitals are expected to benefit from the MGCRB changes with a 3.7 percent increase in payments. Payments to urban and rural hospitals that did not reclassify are expected to decrease slightly due to the MGCRB changes, decreasing by 0.6 percent for urban hospitals and 0.3 percent for rural hospitals. J. Impacts of the Proposed Wage Index Adjustment for Out-Migration (Column 9) 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 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. Using our established criteria, 345 counties and 688 hospitals VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 qualify to receive a commuting adjustment in FY 2006. Due to the statutory formula to calculate the adjustment and the small number of counties that qualify, the impact on hospitals is minimal, with an overall impact on all hospitals of 0.1 percent. K. All Changes (Column 10) Column 10 compares our estimate of payments per case, incorporating all changes reflected in this proposed rule for FY 2006 (including statutory changes), to our estimate of payments per case in FY 2005. This column includes all of the proposed policy changes. Because the reclassifications shown in Column 8 do not reflect FY 2005 reclassifications, the impacts of FY 2006 reclassifications only affect the impacts from FY 2005 to FY 2006 if the reclassification impacts for any group of hospitals are different in FY 2006 compared to FY 2005. • Column 10 reflects all FY 2006 changes relative to FY 2005, shown in Columns 2 through 9 and those not applied until the final rates are calculated. The average increase for all hospitals is approximately 2.5 percent. This increase includes the effects of the proposed 3.2 percent market basket update. It also reflects the 0.7 percentage point difference between the projected outlier payments in FY 2005 (5.1 percent of total DRG payments) and the current estimate of the percentage of actual outlier payments in FY 2005 (4.4 percent), as described in the introduction to this Appendix and the Addendum to this proposed rule. As a result, payments are projected to be 0.7 percentage point lower in FY 2005 than originally estimated, resulting in a 0.7 percentage point greater increase for FY 2006 than would otherwise occur. In addition, the impact of section 505 adjustments accounted for a 0.1 percent increase. Payment decreases of 1.5 percent are primarily attributable to the impact of expanding the postacute care transfer policy (¥1.1 percent). Indirect medical education formula changes for teaching hospitals under section 502 of Pub. L. 108–173, changes in payments due to the difference between the FY 2005 and FY 2006 wage index values assigned to providers reclassified under section 508 of Pub. L. 108– 173, and changes in the incremental increase in payments from section 505 of Pub. L. 108– 173 out migration adjustments account for the remaining ¥0.4 percent. Section 213 of Pub. L. 106–554 provides that all SCHs may receive payment on the basis of their costs per case during their cost reporting period that began during 1996. For FY 2006, eligible SCHs receive 100 percent of their 1996 hospital-specific rate. In addition, in this proposed rule we are proposing to revise the budget neutrality adjustment applied to the hospital-specific rates to reflect only the payment changes resulting from DRG recalibration. Previously, we had also adjusted the hospital-specific rates to reflect payment changes based on area wage levels. The impact of this provision is modeled in Column 10 as well. In addition, section 402 of Pub. L. 108–173 increases the DSH adjustment for hospitals that serve a disproportionate share of low- PO 00000 Frm 00359 Fmt 4701 Sfmt 4702 23663 income Medicare and Medicaid patients, which include rural hospitals and urban hospitals with fewer than 100 beds, SCHs, rural referral centers, and rural hospitals with less than 500 beds. The increase in DSH payments became effective for discharges occurring on or after April 1, 2004. As provided in the new Medicare law, the cap on DSH payment adjustments increased from 5.25 percent to 12 percent for urban hospitals with fewer than 100 beds, SCHs, and rural hospitals with less than 500 beds. There is no cap on rural referral centers, large urban hospitals over 100 beds, or rural hospitals over 500 beds. 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 sum of the changes described above. The overall change in payments per case for hospitals in FY 2006 would increase by 2.5 percent. Hospitals in urban areas would experience a 2.5 percent increase in payments per case compared to FY 2005. Hospitals in rural areas, meanwhile, would experience a 2.6 percent payment increase. Hospitals in large urban areas would experience a 2.4 percent increase in payments and hospitals in other urban areas would experience a 2.7 percent increase in payments. Among urban census divisions, the largest payment increase would be 4.0 percent in the Pacific region. Hospitals in the urban East South Central and West South Central regions would experience the next largest overall increases of 3.0 percent and 3.1 percent, respectively. The smallest urban increase would occur in the New England region, with an increase of 1.0 percent. Among rural regions in Column 10, no hospital category will experience overall payment decreases. The Pacific and Middle Atlantic regions will benefit the most, with 3.3 and 3.2 percent increases, respectively. The smallest increase will occur in the West South Central region, with 2.2 percent increases in payments. Among special categories of rural hospitals in Column 10, those hospitals receiving payment under the hospital-specific methodology (SCHs, MDHs, and SCH/RRCs) would experience payment increases of 2.8 percent, 2.4 percent, and 2.7 percent, respectively. This outcome is primarily related to the fact that, for hospitals receiving payments under the hospital-specific methodology, there were several increases to payments made in relation to implementation of the Pub. L. 108–173. Urban hospitals reclassified for FY 2006 are anticipated to receive an increase of 3.0 percent, while rural reclassified hospitals are expected to benefit from reclassification with a 2.8 percent increase in payments. Those hospitals located in rural counties, but deemed to be urban under section 1886(d)(8)(B) of the Act, are expected to receive an increase in payments of 1.4 percent. BILLING CODE 4120–01–P E:\FR\FM\04MYP2.SGM 04MYP2 VerDate Aug<04>2004 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00360 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.075</GPH> 23664 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 PO 00000 Frm 00361 Fmt 4701 Sfmt 4725 E:\FR\FM\04MYP2.SGM 04MYP2 23665 EP04MY05.076</GPH> Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules Table II presents the projected impact of the proposed changes for FY 2006 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 2005 with the average estimated per case payments for FY 2006, as calculated under our models. Thus, this table presents, in terms of the average dollar amounts paid per discharge, the combined effects of the changes presented in Table I. The percentage changes shown in the last column of Table VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 II equal the percentage changes in average payments from Column 10 of Table I. VII. Impact of Other Proposed Policy Changes In addition to those proposed changes discussed above that we are able to model using our IPPS payment simulation model, we are proposing various other changes in this proposed rule. Generally, we have limited or no specific data available with which to estimate the impacts of these PO 00000 Frm 00362 Fmt 4701 Sfmt 4702 changes. Our estimates of the likely impacts associated with these other proposed changes are discussed below. A. Impact of Proposed LTC-DRG Reclassifications and Relative Weights for LTCHs In section II.D. of the preamble of this proposed rule, we discuss the proposed changes in the LTC-DRG relative weights for FY 2006 based on the proposed version 23.0 of the CMS GROUPER (including the E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.077</GPH> 23666 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules proposed changes in the classifications, relative weights and geometric mean length of stay for each LTC-DRG). Based on LTCH cases in the FY 2004 MedPAR file, we estimate that the proposed changes would result in an aggregate decrease in LTCH payments of approximately 4.7 percent. When we compared the version 22 (FY 2005) LTC-DRG relative weights to the proposed version 23 (FY 2006) LTC-DRG relative weights, we found that approximately 72 percent of the LTC-DRGs had higher relative weights under version 22 in comparison to the proposed version 23. We also found that the version 22 LTC-DRG relative weights were, on average, approximately 16 percent higher than the proposed version 23 LTCDRG relative weights. In addition, based on an analysis of the most recent available LTCH claims data from the FY 2004 MedPAR file, we continue to observe that the proposed average LTC-DRG relative weight decreases due to an increase of relatively lower charge cases being assigned to LTC-DRGs with higher relative weights in the prior year. Contributing to this increase in these relatively lower charge cases being assigned to LTC-DRGs with higher relative weights in the prior year are improvements in coding practices, which are typically found when moving from a reasonable cost-based payment system to a PPS. The impact of including cases with relatively lower charges into LTC-DRGs that had a relatively higher relative weight in the version 22.0 (FY 2005) GROUPER is a decrease in the average relative weight for those LTC-DRGs in the proposed GROUPER version 23.0. We also found that there is over a 15 percent increase in the average LTCH charge across all LTC-DRGs from FY 2003 to FY 2004. For some LTC-DRGs in which the average charge within the LTC-DRG increase is less than 15 percent, the relative weights for those LTC-DRGs will decrease because the average charge for each of those LTCDRGs is being divided by a larger number (that is, the average charge across all LTCDRGs). For the reasons discussed above, we believe that the proposed changes in the LTC-DRG relative weights, which include a number of proposed LTC-DRGs with lower proposed relative weights, would result in approximately a 4.6 percent decrease in aggregate LTCH PPS payments. B. Impact of Proposed New Technology AddOn Payments We are no longer required to ensure that any add-on payments for new technology under section 1886(d)(5)(K) of the Act are budget neutral (see section II.E. of the preamble to this proposed rule). However, we are still providing an estimate of the payment increases here, as they will have a significant impact on total payments made in FY 2006. New technology add-on payments are limited to the lesser of 50 percent of the costs of the technology, or 50 percent of the costs in excess of the DRG payment for the case. Because it is difficult to predict the actual new technology add-on payment for each case, we are estimating the increase in payment for FY 2006 as if every claim with these add-on payments will receive the maximum add-on payment. As discussed in VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 section II.E. of the preamble of this proposed rule, we are not proposing to approve any of the new technology applications that were filed for FY 2006. However, we are proposing to continue to make add-on payments in FY 2006 for an FY 2005 new technology: KinetraTM implants. We estimate this approval would increase overall payments by $12.8 million. The increase in payments for this new technology is not reflected in the tables. C. Impact of Requirements for Hospital Reporting of Quality Data for Annual Hospital Payment Update In section V.B. of the preamble to this proposed rule, we discuss our implementation of section 1886(b)(3)(B)(vii) of the Act, as added by section 501(b) of Pub. L. 108–173, which revised the mechanism used to update the standardized amount of payment for inpatient hospital operating costs. Specifically, section 1886(b)(3)(B)(vii) of the Act provides for a reduction of 0.4 percentage points to the update percentage increase (also known as the market basket update) for each of FYs 2005 through 2007 for any subsection (d) hospital that does not submit data on a set of 10 quality indicators established by the Secretary as of November 1, 2003. The statute also provides that any reduction will apply only to the year involved, and will not be taken into account in computing the applicable percentage increase for a subsequent fiscal year. We are unable to precisely estimate the effect of this provision because, while receiving the full update for those years is conditional upon the submission of quality data by a hospital, the submitted data must also be validated, as described in section V.B. above. The final date for submission of quality data for purposes of receiving the full adjustment in FY 2006 is May 15, 2005. Preliminary results indicate that over 98 percent of IPPS hospitals have submitted quality data. The QIOs are still in the process of validating that data and certifying those hospitals eligible to receive the full update for FY 2006. We have continued our efforts to ensure that QIOs provide assistance to all hospitals that wish to submit data. In the preamble to this proposed rule, we are proposing additional validation criteria to ensure that the quality data being sent to CMS are accurate. Our validation process requires participating hospitals to submit five charts per quarter. We reimburse each hospital for the cost of sending charts to the Clinical Data Abstraction Center at the rate of 12 cents per page for copying and approximately $4.00 per chart for postage. Based on our experience, the average size of a chart is 140 pages. Therefore, we estimate our expenditures for chart collection at $380,000 per quarter. Because we provide reimbursement to hospitals for the costs of chart submission, we believe that this requirement represents a minimal burden to participating hospitals. Based on test applications of these validation criteria to quality data that have been submitted thus far, we currently estimate that approximately 5 percent of hospitals will fail the edits and receive the reduced market basket update to the standardized amount. Based on this PO 00000 Frm 00363 Fmt 4701 Sfmt 4702 23667 reduced payment to some hospitals, we estimate savings to the Medicare program of approximately $20 million for FY 2006. D. Impact of Proposed Policy on Payment Adjustments for Low-Volume Hospitals In section V.E. of the preamble to this proposed rule, we discussed our proposed FY 2006 implementation of section 1886(d)(12) of the Act, as added by section 406 of Pub. L. 108–173, which provides for a payment adjustment to account for the higher costs per discharge of low-volume hospitals under the IPPS. For FY 2006, we are proposing to continue to apply the lowvolume adjustment criteria that we specified in the FY 2005 IPPS final rule (69 FR 49099). Currently, our fiscal intermediaries have identified 10 providers that are eligible for the low-volume adjustment. We estimate that the impact of these providers receiving the additional 25 percent payment increase to be approximately $1.5 million. E. Impact of Proposed Policies on Payment for Indirect Costs of Graduate Medical Education 1. IME Adjustment for TEFRA Hospitals Converting to IPPS Hospitals In section V.F.2. of the preamble of this proposed rule, we discuss our proposal to incorporate into regulations our existing policy regarding the IME adjustment for TEFRA hospitals converting to IPPS hospitals. We establish an FTE resident cap for TEFRA hospitals converting to an IPPS hospital for IME payment purposes as if the hospital had been an IPPS hospital during the base year used to compute the hospital’s direct GME FTE resident cap. We are only aware of four hospitals where this issue has arisen. The proposed addition to the regulations clarifies the established policy for computing an IME FTE resident cap for these hospitals. Because this is a proposal to clarify existing policy and codify it in regulations, there is no financial impact for FY 2006. 2. Section 1886(d)(8)(E) Teaching Hospitals That Withdraw Rural Reclasssification In section V.F.3. of the preamble to this proposed rule, we present our proposal to adjust the IME FTE resident caps of hospitals that rescind their section 1886(d)(8)(E) rural reclassifications so that they do not continue to receive the increase in the FTE resident cap that is applied for rural teaching hositals. The purpose of this policy is to prevent urban hospitals from reclassifying to rural areas under section 1886(d)(8)(E) of the Act for a short period of time, solely as a means of receiving a permanent increase to their IME FTE caps. The impact of this policy is that section 1886(d)(8)(E) hospitals may receive decreased IME payments if they return to urban status. This impact cannot be quantified because we are unable to determine the number of hospitals that would otherwise game the system in the absence of this proposal and we are not aware of any teaching hospitals that became rural under the provision of section 1886(d)(8)(E) of the Act that have subsequently reverted to urban status. E:\FR\FM\04MYP2.SGM 04MYP2 23668 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules F. Impact of Proposed Policy Relating to Geographic Reclassifications of Multicampus Hospitals In section V.H. of the preamble of this proposed rule, we discuss the impact of our implementation of the new labor market areas on multicampus hospital systems. Under our current policy, a multicampus hospital with campuses located in the same labor market area receives a single wage index. However, if the campuses are located in more than one labor market area, payment for each discharge is determined using the wage index value for the labor market area in which the campus of the hospital is located. In addition, current provisions provide that, in the case of a merger of hospitals, if the merged facilities operate as a single institution, the institution must submit a single cost report, which necessitates a single provider identification number. This provision also does not differentiate between merged facilities in a single wage index area or in multiple wage index areas. As a result, the wage index data for the merged facility is reported for the entire entity on a single cost report. The current criteria for a hospital being reclassified to another wage area by the MGCRB do not address the circumstances under which a single campus of a multicampus hospital may seek reclassification. Specifically, we are proposing that for reclassification applications submitted for FY 2006 (that is, applications received by September 1, 2004), we would allow a campus or campuses of a multicampus hospital system to seek geographic reclassification on the basis of the average hourly wage data submitted for the entire hospital system. For reclassification applications that would take effect for FY 2007 (that is, applications received by September 1, 2005) and thereafter, a campus of a multihospital system could not use the wage data of the entire hospital system, but rather, would have the opportunity to separate out campus-specific wage data for purposes of seeking reclassification for such campus. We estimate that this proposal will apply to fewer than 12 multicampus hospital systems nationwide and, therefore, will not lead to additional program expenditures because hospital geographic reclassifications are budget neutral under section 1886(d)(8)(D) of the Act. G. Impact of Proposed Policy on Payment for Direct Costs of Graduate Medical Education 1. GME Initial Residency—Match for Second Year In section V.I.2. of the preamble to this proposed rule, we discuss our proposed changes related to the initial residency period for residents that match into an advanced residency program, but fail to match into a clinical base year of training. We are proposing that, in instances where a hospital can document that, prior to commencement of any residency training, a resident matched into an advanced program that begins in the second residency year, that resident’s initial residency period will be determined based on the period of board eligibility for the advanced program, without VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 regard to the fact that the resident had not matched for a clinical base year training program. For purposes of this proposed rule, we have estimated the impact of this proposed rule change for FY 2006, using assumptions about the national average per resident amount, the number of affected residents, and the national average Medicare utilization rate. We estimate that this provision will affect approximately 600 residents. Using a national average per resident amount of $92,000, and an average Medicare utilization rate of 35 percent, we estimate that, for FY 2006, the impact of treating those residents as a full FTE rather than .50 FTE, Medicare payments for direct GME will increase by approximately $9.7 million. 2. New Teaching Hospitals’ Participation in Medicare GME Affiliated Groups In section V.I.3. of the preamble to this proposed rule, we discuss our proposed changes related to new teaching hospitals’ participation in Medicare GME affiliated groups. Under current regulations, a new teaching hospital located in an urban area that establishes an FTE resident cap under § 413.79(e) may not participate in a Medicare GME affiliated group. We are proposing to revise the regulations to allow a new teaching hospital located in an urban area to participate in a Medicare GME affiliated group, but only if any adjustments made by the Medicare GME affiliation agreement result in an increase to the new teaching hospital’s adjusted resident FTE resident caps for purposes of IME and direct GME payment. There is no estimated increase in program payments related to this proposed change because any additional residents that would be counted at the new teaching hospitals as a result of this change could have been counted prior to the affiliation for Medicare GME payment purposes at the hospital that is losing slots under the affiliation agreement. H. Impact of Policy on Rural Community Hospital Demonstration Program In section V.K. 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 V.K. 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 2006 that will be made to each participating hospital under the demonstration will be approximately $977,410. We based this estimate on the recent historical experience of the difference between inpatient cost and payment for hospitals that have applied for PO 00000 Frm 00364 Fmt 4701 Sfmt 4702 the demonstration. For 13 participating hospitals, the total annual impact of the demonstration program is estimated to be $12,706,334. We describe the budget neutrality adjustment required for this purpose in the Addendum to this proposed rule. I. Impact of Proposed Policy on CAH Relocation Provisions In section VII.B.3. of the preamble to this proposed rule, we discuss the proposed change to the necessary provider provision as it applies to CAHs. As required by statute, no additional CAHs will be certified as a necessary provider on or after January 1, 2006. We are proposing to revise the regulations to allow some flexibility for those CAHs previously designated as necessary providers that embarked on a replacement facility project before the sunset provision was enacted on December 8, 2003, but find that they cannot be operational in the replacement facility by January 1, 2006. We are proposing that, when a CAH is determined to have relocated, it may continue to operate under its existing necessary provider designation that exempts CAHs from the distance from another provider requirement only if certain conditions are met. The proposed clarification to the sunset of the necessary provider provision is intended to allow CAHs to complete construction projects that were initiated prior to the enactment of Pub. L. 108–173. The Health Resources Services Administration (HRSA) estimates that this proposal will apply to fewer than six CAHs nationwide. The average cost of construction of a new 25 bed CAH is approximately $25 million. Given a depreciation schedule based on a 25 useful life and Medicare utilization of approximately 50 percent, the additional capital costs for six CAHs would be $3 million. However, the actual cost to the program would be further reduced since those 6 CAH are currently being reimbursed for their existing capital costs and also the increased operating costs that are associated with operating an aged facility. Accordingly, the budgetary impact for the proposed change on the affected CAHs is estimated at between $1 million and $2 million. Expressed on a per-facility basis, the budgetary impact of this proposed change is estimated at between $167,000 and $333,000 per CAH. VIII. Impact of Proposed Changes in the Capital PPS 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 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 E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules for new capital costs based on a proportion of the capital Federal rate (see § 412.344). As we state in section VI. 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 is: (Standard Federal Rate) × (DRG weight) × (Geographic Adjustment Factor (GAF)) × (Large Urban Add-on, if applicable) × (COLA adjustment for hospitals located in Alaska and Hawaii) × (1 +3 Disproportionate Share (DSH) Adjustment Factor + Indirect Medical Education (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 2004 update of the FY 2004 MedPAR file and the December 2004 update of the Provider Specific File that is used for payment purposes. Although the analyses of the changes to the capital prospective payment system do not incorporate cost data, we used the December 2004 update of the most recently available hospital cost report data (FY 2003) to categorize hospitals. Our analysis has several qualifications. First, we do not make adjustments for behavioral changes that hospitals may adopt in response to policy changes. Second, due to the interdependent nature of the IPPS, it is very difficult to precisely quantify the impact associated with each change. Third, 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 2004 update of the FY 2004 MedPAR file, we simulated payments under the capital PPS for FY 2005 and FY 2006 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.4. of the Addendum of 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 VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 case-mix. We then added estimated payments for indirect medical education, disproportionate share, large urban add-on, and outliers, if applicable. For purposes of this impact analysis, the model includes the following assumptions: • We estimate that the Medicare case-mix index would increase by 1.0 percent in both FYs 2005 and 2006. • We estimate that the Medicare discharges will be 13.5 million in FY 2005 and 13.3 million in FY 2006 for a 1.5 percent decrease from FY 2005 to FY 2006. • 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. The proposed FY 2006 update is 0.7 percent (see section III.A.1.a. of the Addendum to this proposed rule). • In addition to the proposed FY 2006 update factor, the proposed FY 2006 capital Federal rate was calculated based on a proposed GAF/DRG budget neutrality factor of 1.0019, a proposed outlier adjustment factor of 0.9497, and a proposed (special) exceptions adjustment factor of 0.9997. 2. Results In the past, in this impact section we presented the redistributive effects that were expected to occur between ‘‘hold-harmless’’ hospitals and ‘‘fully prospective’’ hospitals and a cross-sectional summary of hospital groupings by the capital PPS transition period payment methodology. We are no longer including this information because all hospitals (except new hospitals under § 412.324(b) and under § 412.304(c)(2)) will be paid 100 percent of the capital Federal rate in FY 2006. We used the actuarial model described above to estimate the potential impact of our changes for FY 2006 on total capital payments per case, using a universe of 3,693 hospitals. As described above, the individual hospital payment parameters are taken from the best available data, including the December 2004 update of the FY 2004 MedPAR file, the December 2004 update to the Provider-Specific File, and the most recent cost report data from the December 2004 update of HCRIS. In Table III, we present a comparison of total payments per case for FY 2005 compared to FY 2006 based on the proposed FY 2006 payment policies. Column 2 shows estimates of payments per case under our model for FY 2005. Column 3 shows estimates of payments per case under our model for FY 2006. Column 4 shows the total percentage change in payments from FY 2005 to FY 2006. The change represented in Column 4 includes the 0.7 percent update to the capital Federal rate, a 1.0 percent increase in case-mix, changes in the adjustments to the capital Federal rate (for example, the effect of the new hospital wage index on the GAF), and reclassifications by the MGCRB, as well as changes in special exception payments. The comparisons are provided by: (1) Geographic location; (2) region; and (3) payment classification. PO 00000 Frm 00365 Fmt 4701 Sfmt 4702 23669 The simulation results show that, on average, capital payments per case can be expected to increase 1.7 percent in FY 2006. In addition to the 0.7 percent increase due to the capital market basket update, this projected increase in capital payments per case is largely attributable to an estimated increase in outlier payments in FY 2006. Our comparison by geographic location shows that urban hospitals are expected to experience a 1.8 percent increase in IPPS capital payments per case, while rural hospitals are only expected to experience a 1.2 percent increase in capital payments per case. This difference is mostly due to a projection that urban hospitals would experience a larger increase in estimated outlier payments from FY 2005 to FY 2006 compared to rural hospitals. All regions are estimated to receive an increase in total capital payments per case from FY 2005 to FY 2006. Changes by region vary from a minimum increase of 0.1 percent (Middle Atlantic rural region) to a maximum increase of 3.3 percent (Pacific urban region). The relatively small increase in projected capital payments per discharge for hospitals located in the Middle Atlantic rural region is largely attributable to the proposed changes in the GAF values (that is, the proposed GAFs for most of these hospitals for FY 2006 are lower than the weighted average of the GAFs for FY 2005) . The relatively large increase in capital payments per discharge for hospitals located in the Pacific urban region is largely due to the proposed changes in the GAF values (that is, the proposed GAFs for most of these hospitals for FY 2006 are higher than the average of the GAFs for FY 2005) and a larger than average increase in estimated outlier payments for FY 2006. Hospitals located in Puerto Rico are expected to experience an increase in total capital payments per case of 1.0 percent. This slightly lower than average increase in payment per case for hospitals located in Puerto Rico is largely due to the proposed changes in the proposed GAF values (that is, the proposed GAFs for most of these hospitals for FY 2006 are higher than the average of the GAFs for FY 2005). By type of ownership, government hospitals are projected to have the largest rate of increase of total payment changes (2.0 percent). Similarly, payments to voluntary and proprietary hospitals are expected to increase 1.6 percent and 1.8 percent, respectively. As noted above, this slightly larger projected increase in capital payments per case for government hospitals is mostly due to the larger than average increase in projected outlier payments for FY 2006 and a smaller than average decrease in the proposed GAF values. Section 1886(d)(10) of the Act established the MGCRB. Previously, hospitals could apply 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; hospitals may apply for reclassification for purposes of the wage index in FY 2006. Reclassification for wage index purposes also E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules affects the GAF because that factor is constructed from the hospital wage index. To present the effects of the hospitals being reclassified for FY 2006 compared to the effects of reclassification for FY 2005, we show the average payment percentage increase for hospitals reclassified in each fiscal year and in total. The reclassified groups are compared to all other nonreclassified hospitals. These categories VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 are further identified by urban and rural designation. Hospitals reclassified for FY 2006 as a whole are projected to experience a 2.0 percent increase in payments. Payments to nonreclassified hospitals in FY 2006 are expected to increase 1.7 percent. Hospitals reclassified during both FY 2005 and FY 2006 are projected to experience an increase in payments of 1.3 percent. Hospitals PO 00000 Frm 00366 Fmt 4701 Sfmt 4725 reclassified during FY 2006 only are projected to receive an increase in payments of 3.2 percent. This relatively large increase is primarily due to the proposed changes in the GAF values (that is, the proposed GAFs for most of these hospitals for FY 2006 are higher than the average of the GAFs for FY 2005). BILLING CODE 4120–01–P E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.078</GPH> 23670 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules (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 Medicare Payment Advisory Commission (MedPAC), recommend update factors for inpatient VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 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) of the Act, we are required to publish update factors recommended by the Secretary in the proposed and final rule. 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 and Federal prospective payment amounts for hospitals and hospitals units excluded from the IPPS. We also PO 00000 Frm 00367 Fmt 4701 Sfmt 4702 discuss our update framework and respond to MedPAC’s recommendations concerning the update factors. II. Secretary’s Recommendations Section 1886(b)(3)(B)(i)(XIX) of the Act sets the FY 2006 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 to the hospital submitting quality information under rules established by the Secretary under section 1886(b)(3)(B)(vii) of the Act. For hospitals that do not provide these data, the update is equal to the market E:\FR\FM\04MYP2.SGM 04MYP2 EP04MY05.079</GPH> Appendix B: Recommendation of Update Factors for Operating Cost Rates of Payment for Inpatient Hospital Services 23671 23672 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules basket percentage increase less 0.4 percentage points. Based on the Office of the Actuary’s fourth quarter 2004 forecast of the FY 2006 market basket increase, we are proposing an update to the standardized amount of 3.2 percent (that is, the market basket rate-of-increase) for hospitals in all areas, provided the hospital submits quality data in accordance with our rules. Section 1886(b)(3)(B)(iv) of the Act sets the FY 2006 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 proposed update to the hospital-specific rate applicable to SCHs and MDHs is also 3.2 percent. Section 1886(b)(3)(B)(ii) of the Act sets the FY 2006 percentage increase in the rate-ofincrease limits for various hospitals and hospital units excluded from the IPPS, that is, certain psychiatric hospitals and units (now referred to as inpatient psychiatric facilities (IPFs)), certain LTCHs, cancer hospitals, and children’s hospitals, equal to the market basket percentage increase. In the past, hospitals and hospital units excluded from the IPPS have been paid based on their reasonable costs subject to TEFRA limits. However, some of these categories of excluded hospitals and units are currently, or soon will be, paid under their own prospective payment systems. Currently, children’s and cancer hospitals and RNHCIs are the remaining three types of hospitals still reimbursed fully under reasonable costs. Those psychiatric hospitals and units of hospitals not yet paid under a PPS are still reimbursed fully on a reasonable cost basis subject to TEFRA limits. In addition, those LTCHs and IPFs paid under a blend methodology have the TEFRA portion of that payment subject to the TEFRA limits. Hospitals and units that receive any reasonable cost-based payments will have those payments determined subject to the TEFRA limits for FY 2006. As we discuss in section IV. of the preamble and in section IV. of the Addendum to this proposed rule, we are proposing to use the estimated FY 2006 IPPS operating market basket percentage increase (3.2 percent) to update the target limits for children’s hospitals, cancer hospitals, and religious nonmedical institutions. As described in greater detail below, under their respective PPSs, LTCHs and IPFs are in a transition period during which some LTCHs and IPFs are paid a blend of reasonable cost-based payments (subject to the TEFRA limits) and a Federal prospective payment amount. Under the respective transition period methodologies for the LTCH PPS and IPF PPS, which are described below, payment is based, in part, on a decreasing percentage of the reasonable cost-based payment amount. As we discuss in section IV. of the preamble of this proposed rule, we are proposing to rebase the market basket used to determine the reasonable cost-based payment amount for LTCHs and IPFs. We are proposing that the portion of payments to LTCHs and IPFs that are reasonable costbased will be determined using the FY 2002- VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 based excluded hospital market basket (currently estimated at 3.4 percent). Effective for cost reporting periods beginning FY 2003, LTCHs are paid under the LTCH PPS, which was implemented with a 5-year transition period. (Refer to the August 30, 2002 final rule (67 FR 55954).) A LTCH may elect to be paid on 100 percent of the Federal prospective rate at the start of any of its cost reporting periods during the 5-year transition period. For purposes of the update factor for inpatient operating services for FY 2006, the portion of the LTCH PPS transition blend payment that is based on reasonable costs would be determined by updating the LTCH’s TEFRA limit by the current estimate of the FY 2002-based excluded hospital market basket (or 3.4 percent). Effective for cost reporting periods beginning on or after January 1, 2005, IPFs are paid under the IPF PPS under which they receive payment based on a Federal per diem rate that is based on the sum of the average routine operating, ancillary, and capital costs for each patient day of psychiatric care in an IPF, adjusted for budget neutrality. During a transition period between January 1, 2005 and January 1, 2008, some IPFs are paid based on a blend of the reasonable cost-based payments, subject to the TEFRA limit, and the Federal per diem base rate. For cost reporting periods beginning on or after January 1, 2008, IPFs will be paid based on 100 percent of the Federal per diem rate. For purposes of the update factor for FY 2006, 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 FY 2002based excluded hospital market basket (or 3.4 percent). IRFs are paid under the IRF PPS for cost reporting periods beginning on or after January 1, 2002. For cost reporting periods beginning during FY 2004, and thereafter, the Federal prospective payments to IRFs are based on 100 percent of the adjusted Federal IRF prospective payment amount, updated annually. (Refer to the July 30, 2004 final rule (69 FR 45721).) III. Update Framework Consistent with the current law, for FY 2006, for IPPS hospitals, we are recommending an update of 3.2 percent, which reflects the CMS Office of the Actuary’s most recent (fourth quarter) 2004 forecast of the FY 2006 market basket increase. In previous years, in making a recommendation, we included an update framework that analyzed hospital productivity, scientific and technological advances, practice pattern changes, changes in case mix, the effects of reclassification on recalibration and forecast error correction. Although we have used this framework in past years, we are no longer including this analysis in our recommendation for the update. We are not discussing the framework because the productivity measure cannot be adequately computed for FY 2006 because of the anticipated effects on admissions due to the expected increases in enrollment in Medicare Advantage plans. The increased enrollment in Medicare Advantage plans has PO 00000 Frm 00368 Fmt 4701 Sfmt 4702 the effect of causing admissions to decline. However, we do not have information on how hospital employment will be affected for our methodology. Thus, in the absence of data to predict the effect of a decline in hospital admissions on hospital employment, we cannot appropriately reflect productivity in our framework. As a result, based on the discussion above, we believe it is appropriate to recommend an update of 3.2 percent, based on the Office of the Actuary’s fourth quarter 2004 forecast of the FY 2006 market basket percentage increase. We note that, although we are not using the framework for our recommendation to update the operating standardized amounts due to the reasons above, we continue to use the framework to calculate the capital standardized amounts as discussed in section III.A.1.a. of the Addendum to this proposed rule. This is due to the fact that the framework for the capital standardized amounts is calculated without a productivity factor and, therefore, the reasons discussed above do not apply to the update framework of the capital standardized amounts. We also note that section 1886(e)(3) of the Act directs the Secretary to report to Congress an initial estimate of the recommendation of an appropriate payment inflation update for inpatient hospital services for the upcoming fiscal year. Earlier this year, the Secretary reported to Congress that the initial estimate of the recommendation of an update factor was 3.3 percent, which was the market basket update for the IPPS standardized amount in the President’s FY 2006 budget. The difference between the Secretary’s initial estimate and the update we are recommending in this proposed rule (3.2 percent) is due to the availability and use of more recent data for the market basket than were available at the time the Secretary’s initial estimate was developed. In addition, the Secretary’s initial estimate was based on the FY 1997-based hospital market basket, while the proposed update in this proposed rule (the current update recommendation) is based on the proposed FY 2002-based hospital market basket. Aside from making a recommendation for IPPS hospitals, in accordance with section 1886(e)(4)(A) of the Act, it is necessary to make a recommendation of the update factor for all other types of hospitals. Consistent with current law, for FY 2006, for SCHs and MDHs, we are recommending an update of 3.2 percent, which reflects the CMS Office of the Actuary’s most recent (fourth quarter) 2004 forecast of the FY 2006 market basket percentage increase. Consistent with our proposal in section IV. of the preamble of this proposed rule, for FY 2006, for cancer hospitals, religious nonmedical health care institutions, and children’s hospitals, we are recommending an update of 3.2 percent to the target limits. Consistent with our proposal in the February 3, 2005 LTCH PPS proposed rule (70 FR 5735), we are recommending an update factor of 3.1 percent for rate year (RY) 2006. For LTCHs that currently may be paid during a transition period a blend of reasonable costbased payments (subject to the TEFRA limits) and Federal prospective payment amounts, E:\FR\FM\04MYP2.SGM 04MYP2 Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / Proposed Rules we are recommending an update factor of 3.4 percent for the portion of the payment that is based on reasonable costs, subject to the TEFRA limits, consistent with our proposal in section IV. of the preamble of this proposed rule. For the Federal portion of this same blended payment amount, we are recommending an update of 3.1 percent. Because the IPF PPS was effective for cost reporting periods beginning on or after January 1, 2005, and the base rates are effective until July 1, 2006, we are recommending an update of zero for IPFs (69 FR 66922). Finally, for the IRF PPS, we have not published a proposed rule proposing an update for FY 2006. As a result, we are recommending an update of 3.1 percent to IRF PPS for FY 2006, the same update used for FY 2005. IV. MedPAC Recommendation for Assessing Payment Adequacy and Updating Payments in Traditional Medicare In the past, MedPAC has suggested specific adjustments to its update recommendation for each of the factors discussed under section III. of this Appendix. In its March 2005 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 the Commission in the past several years. MedPAC stressed that the issue at hand was whether payments were too high or too low, and not how they became either too high or too low. VerDate Aug<04>2004 18:31 May 03, 2005 Jkt 205001 In the first portion of MedPAC’s analysis on the assessment of payment adequacy, the Commission reviewed the relationship between costs and payments. MedPAC’s indicator of the relationship between payments and costs is the overall Medicare margin. The overall Medicare margin is calculated as the difference between payments and costs divided by payments. Based on the latest cost report data available, MedPAC estimated an inpatient hospital Medicare operating margin for FY 2003 of 1.3 percent (down from 5.9 percent and 9.8 percent for FY 2002 and FY 2001, respectively). MedPAC also projected margins for FY 2005, making certain assumptions about changes in payments and costs. On the payment side, MedPAC applied the annual payment updates (as specified by law for FYs 2001 through 2005), and then modeled the effects of other policy changes that have affected the level of payments. On the cost side, MedPAC estimated the increases in cost per unit of output over the same time period at the rate of inflation as measured by the applicable market basket index generated by CMS. In addition to considering the relationship between estimated payments and costs, MedPAC also considered the following three factors to assess whether current payments are adequate: • Changes in access to or quality of care; • Changes in the volume of services or number of providers; and PO 00000 Frm 00369 Fmt 4701 Sfmt 4702 23673 • Change in providers’ access to capital. MedPAC’s recommendation was to increase payments under the IPPS by the projected increase in the hospital market basket index, less 0.4 percent, for FY 2006. MedPAC noted that the indicators of payment adequacy present a mixed picture. MedPAC was concerned about the trend of falling hospital margins, which may result in hospitals having a limited financial cushion for dealing with pressures that may arise in the coming year. On the other hand, MedPAC stated that the current cost trend was unsustainable and may have been driven by a lack of cost containment. Therefore, MedPAC concluded that an update of the hospital market basket index minus 0.4 percent is appropriate. Response: As described above, we are recommending a full market basket update for FY 2006 consistent with current law. We believe this will appropriately balance incentives for hospitals to operate efficiently with the need to provide sufficient payments to maintain access to quality care for Medicare beneficiaries. In addition, 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. 05–8507 Filed 4–25–05; 4:12 pm] BILLING CODE 4120–01–P E:\FR\FM\04MYP2.SGM 04MYP2

Agencies

[Federal Register Volume 70, Number 85 (Wednesday, May 4, 2005)]
[Proposed Rules]
[Pages 23306-23673]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 05-8507]



[[Page 23305]]

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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 405, 412, et al.



Medicare Program; Proposed Changes to the Hospital Inpatient 
Prospective Payment Systems and Fiscal Year 2006 Rates; Proposed Rule

Federal Register / Vol. 70, No. 85 / Wednesday, May 4, 2005 / 
Proposed Rules

[[Page 23306]]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 405, 412, 413, 415, 419, 422, and 485

[CMS-1500-P]
RIN 0938-AN57


Medicare Program; Proposed Changes to the Hospital Inpatient 
Prospective Payment Systems and Fiscal Year 2006 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. 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 as well as proposed policy changes for 
hospitals and hospital units excluded from the IPPS that are paid in 
full or in part on a reasonable cost basis subject to these limits. 
These proposed changes would be applicable to discharges occurring on 
or after October 1, 2005, with one exception: The proposed changes 
relating to submittal of hospital wage data by a campus or campuses of 
a multicampus hospital system (that is, the proposed changes to Sec.  
412.230(d)(2) of the regulations) would be effective upon publication 
of the final rule.
    Among the policy changes that we are proposing to make are changes 
relating to: the classification of cases to the diagnosis-related 
groups (DRGs); the long-term care (LTC)-DRGs and relative weights; the 
wage data, including the occupational mix data, used to compute the 
wage index; rebasing and revision of the hospital market basket; 
applications for new technologies and medical services add-on payments; 
policies governing postacute care transfers, payments to hospitals for 
the direct and indirect costs of graduate medical education, submission 
of hospital quality data, payment adjustment for low-volume hospitals, 
changes in the requirements for provider-based facilities; and changes 
in the requirements for critical access hospitals (CAHs).

DATES: Comments will be considered if received at the appropriate 
address, as provided in the ADDRESSES section, no later than 5 p.m. on 
June 24, 2005.

ADDRESSES: In commenting, please refer to file code CMS-1500-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 to https://www.cms.hhs.gov/
regulations/ecomments (attachments should be in Microsoft Word, 
WordPerfect, or Excel; however, we prefer Microsoft Word).

2. By 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-1500-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 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.
    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. After the close of the 
comment period, CMS posts all electronic comments received before the 
close of the comment period on its public Web site. Written comments 
received timely will be available for public inspection as they are 
received, generally beginning approximately 4 weeks after publication 
of a document, at the headquarters of the Centers for Medicare & 
Medicaid Services, 7500 Security Boulevard, Baltimore, MD 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.
    For comments that relate to information collection requirements, 
mail a copy of comments to the following addresses:

Centers for Medicare & Medicaid Services, Office of Strategic 
Operations and Regulatory Affairs, Security and Standards Group, Office 
of Regulations Development and Issuances, Room C4-24-02 7500 Security 
Boulevard, Baltimore, Maryland 21244-1850, Attn: James Wickliffe, CMS-
1500-P; and
Office of Information and Regulatory Affairs, Office of Management and 
Budget, Room 3001, New Executive Office Building, Washington, DC 20503, 
Attn: Christopher Martin, CMS Desk Officer, CMS-1500-P, Christopher--
Martin@omb.eop.gov. Fax (202) 395-6974.

FOR FURTHER INFORMATION CONTACT:

Marc Harstein, (410) 786-4539, Operating Prospective Payment, 
Diagnosis-Related Groups (DRGs), Wage Index, New Medical Services and 
Technology Add-On Payments, Hospital Geographic Reclassifications, 
Postacute Care Transfers, and Disproportionate Share Hospital Issues.
Tzvi Hefter, (410) 786-4487, Capital Prospective Payment, Excluded 
Hospitals, Graduate Medical Education, Critical Access Hospitals, and 
Long-Term Care (LTC)-DRGs, and Provider-Based Facilities Issues.
Steve Heffler, (410) 786-1211, Hospital Market Basket Revision and 
Rebasing.
Siddhartha Mazumdar, (410) 786-6673, Rural Hospital Community 
Demonstration Project Issues.
Mary Collins, (410) 786-3189, Critical Access Hospitals (CAHs) Issues.
Dr. Mark Krushat, (410) 786-6809, Quality Data for Annual Payment 
Update Issues.
Martha Kuespert, (410) 786-4605 Specialty Hospitals Definition Issues.

SUPPLEMENTARY INFORMATION: 

Electronic Access

    This Federal Register document is also available from the Federal 
Register

[[Page 23307]]

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.access.gpo.gov/nara_docs, 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

AAOS American Association of Orthopedic Surgeons
ACGME Accreditation Council on Graduate Medical Education
AHIMA American Health Information Management Association
AHA American Hospital Association
AICD Automatic cardioverter defibrillator
AMI Acute myocardial infarction
AOA American Osteopathic Association
ASC Ambulatory Surgical Center
ASP Average sales price
AWP Average wholesale price
BBA Balanced Budget Act of 1997, Pub. L. 105-33
BES Business Expenses Survey
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
CBSAs Core-Based Statistical Areas
CC Complication or comorbidity
CIPI Capital Input Price Index
CMS Centers for Medicare & Medicaid Services
CMSA Consolidated Metropolitan Statistical Area
COBRA Consolidated Omnibus Reconciliation Act of 1985, Pub. L. 99-
272
CoP Condition of Participation
CPI Consumer Price Index
CRNA Certified registered nurse anesthetist
CRT Cardiac Resynchronization Therapy
DRG Diagnosis-related group
DSH Disproportionate share hospital
ECI Employment Cost Index
FDA Food and Drug Administration
FIPS Federal Information Processing Standards
FQHC Federally qualified health center
FTE Full-time equivalent
FY Federal fiscal year
GAAP Generally accepted accounting principles
GAF Geographic adjustment factor
HIC Health Insurance Card
HIS Health Information System
GME Graduate medical education
HCRIS Hospital Cost Report Information System
HIPC Health Information Policy Council
HIPAA Health Insurance Portability and Accountability Act of 1996, 
Pub. L. 104-191
HHA Home health agency
HHS Department of Health and Human Services
HPSA Health Professions Shortage Area
HQA Hospital Quality Alliance
ICD-9-CM International Classification of Diseases, Ninth Revision, 
Clinical Modification
ICD-10-PCS International Classification of Diseases, Tenth Edition, 
Procedure Coding System
ICF/MRs Intermediate care facilities for the mentally retarded
ICU Intensive Care Unit
IHS Indian Health Service
IME Indirect medical education
IPPS Acute care hospital inpatient prospective payment system
IPF Inpatient psychiatric facility
IRF Inpatient rehabilitation facility
IRP Initial residency period
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
MCE Medicare Code Editor
MCO Managed care organization
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
MMA Medicare Prescription Drug, Improvement, and Modernization Act 
of 2003, Pub. L. 108-173
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
NCVHS National Committee on Vital and Health Statistics
NECMA New England County Metropolitan Areas
NICU Neonatal intensive care unit
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)
OSHA Occupational Safety and Health Act
PRM Provider Reimbursement Manual
PPI Producer Price Index
PMS Performance Measurement System
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
QIA Quality Improvement Organizations
RHC Rural health clinic
RHQDAPU Reporting Hospital Quality Data for Annual Payment Update
RNHCI Religious nonmedical health care institution
RRC Rural referral center
RUCAs Rural-Urban Commuting Area Codes
SCH Sole community hospital
SDP Single Drug Pricer
SIC Standard Industrial Codes
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

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. IRFs
    b. LTCH
    c. IPFs
    3. Critical Access Hospitals (CAHs)
    4. Payments for Graduate Medical Education (GME)
    B. Major Contents of this Proposed Rule
    1. Proposed Changes to the DRG Reclassifications and 
Recalibrations of Relative Weights
    2. Proposed Changes to the Hospital Wage Index
    3. Proposed Revision and Rebasing of the Hospital Market Basket
    4. Other Decisions and Proposed Changes to the PPS for Inpatient 
Operating and GME Costs
    5. PPS for Capital-Related Costs
    6. Proposed Changes for Hospitals and Hospital Units Excluded 
from the IPPS
    7. Proposed Payment for Blood Clotting Factors for Inpatients 
with Hemophilia
    8. Determining Proposed Prospective Payment Operating and 
Capital Rates and Rate-of-Increase Limits
    9. Impact Analysis
    10. Recommendation of Update Factor for Hospital Inpatient 
Operating Costs
    11. Discussion of Medicare Payment Advisory Commission 
Recommendations
II. Proposed Changes to DRG Classifications and Relative Weights
    A. Background
    B. DRG Reclassifications
    1. General
    2. Pre-MDC: Intestinal Transplantation
    3. MDC 1 (Diseases and Disorders of the Nervous System)
    a. Strokes
    b. Unruptured Cerebral Aneurysms
    4. MDC 5 (Diseases and Disorders of the Circulatory System)
    a. Automatic Implantable Cardioverter/Defibrillator

[[Page 23308]]

    b. Coronary Artery Stents
    c. Insertion of Left Atrial Appendage Device
    d. External Heart Assist System Implant
    e. Carotid Artery Stent
    f. Extracorporeal Membrane Oxygenation (ECMO)
    5. MDC 6 (Diseases and Disorders of the Digestive System): 
Artificial Anal Sphincter
    6. MDC 8 (Diseases and Disorders of the Musculoskeletal System 
and Connective Tissue)
    a. Hip and Knee Replacements
    b. Kyphoplasty
    c. Multiple Level Spinal Fusion
    7. MDC 18 (Infectious and Parasitic Diseases (Systemic or 
Unspecified Sites)): Severe Sepsis
    8. MDC 20 (Alcohol/Drug Use and Alcohol/Drug Induced Organic 
Mental Disorders): Drug-Induced Dementia
    9. Medicare Code Editor (MCE) Changes
    a. Newborn Age Edit
    b. Newborn Diagnoses Edit
    c. Diagnoses Allowed for ``Males Only'' Edit
    d. Tobacco Use Disorder Edit
    e. Noncovered Procedure Edit
    10. Surgical Hierarchies
    11. Refinement of Complications and Comorbidities (CC) List
    a. Background
    b. Comprehensive Review of the CC List
    c. CC Exclusion List for FY 2006
    12. Review of Procedure Codes in DRGs 468, 476, and 477
    a. Moving Procedure Codes from DRG 468 or DRG 477 to MDCs
    b. Reassignment of Procedures among DRGs 468, 476, and 477
    c. Adding Diagnosis or Procedure Codes to MDCs
    13. Changes to the ICD-9-CM Coding System
    14. Other Issues: Acute Intermittent Porphyria
    C. Proposed Recalibration of DRG Weights
    D. Proposed LTC-DRG Reclassifications and Relative Weights for 
LTCHs for FY 2006
    1. Background
    2. Proposed Changes in the LTC-DRG Classifications
    a. Background
    b. Patient Classifications into DRGs
    3. Development of the Proposed FY 2006 LTC-DRG Relative Weights
    a. General Overview of Development of the LTC-DRG Relative 
Weights
    b. Data
    c. Hospital-Specific Relative Value Methodology
    d. Proposed Low-Volume LTC-DRGs
    4. Steps for Determining the Proposed FY 2006 LTC-DRG Relative 
Weights
    E. Proposed Add-On Payments for New Services and Technologies
    1. Background
    2. FY 2006 Status of Technology Approved for FY 2005 Add-On 
Payments
    3. Reevaluation of FY 2005 Applications That Were Not Approved
    4. FY 2006 Applicants for New Technology Add-On Payments
III. Proposed Changes to the Hospital Wage Index
    A. Background
    B. Core-Based Statistical Areas for the Proposed Hospital Wage 
Index
    C. Proposed Occupational Mix Adjustment to FY 2006 Index
    1. Development of Data for the Proposed Occupational Mix 
Adjustment
    2. Calculation of the Proposed Occupational Mix Adjustment 
Factor and the Proposed Occupational Mix Adjusted Wage Index
    D. Worksheet S-3 Wage Data for the Proposed FY 2006 Wage Index 
Update
    E. Verification of Worksheet S-3 Wage Data
    F. Computation of the Proposed FY 2006 Unadjusted Wage Index
    G. Computation of the Proposed FY 2006 Blended Wage Index
    H. Proposed Revisions to the Wage Index Based on Hospital 
Redesignation
    1. General
    2. Effects of Reclassification
    3. Proposed Application of Hold Harmless Protection for Certain 
Urban Hospitals Redesignated as Rural
    4. FY 2006 MGCRB Reclassifications
    5. Proposed FY 2006 Redesignations under Section 1886(d)(8)(B) 
of the Act
    6. Reclassifications under Section 508 of Pub. L. 108-173
    I. Proposed FY 2006 Wage Index Adjustment Based on Commuting 
Patterns of Hospital Employees
    J. Process for Requests for Wage Index Data Corrections
IV. Proposed Rebasing and Revision of the Hospital Market Baskets
    A. Background
    B. Rebasing and Revising the Hospital Market Basket
    1. Development of Cost Categories and Weights
    2. PPS--Selection of Price Proxies
    3. Labor-Related Share
    C. Separate Market Basket for Hospitals and Hospital Units 
Excluded from the IPPS
    1. Hospitals Paid Based on Their Reasonable Costs
    2. Excluded Hospitals Paid Under Blend Methodology
    3. Development of Cost Categories and Weights for the Proposed 
2002-Based Excluded Hospital Market Basket
    D. Frequency of Updates of Weights in IPPS Hospital Market 
Basket
    E. Capital Input Price Index Section
V. Other Decisions and Proposed Changes to the IPPS for Operating 
Costs and GME Costs
    A. Postacute Care Transfer Payment Policy
    1. Background
    2. Changes to DRGs Subject to the Postacute Care Transfer Policy
    B. Reporting of Hospital Quality Data for Annual Hospital 
Payment Update
    1. Background
    2. Requirements for Hospital Reporting of Quality Data
    C. Sole Community Hospitals and Medicare Dependent Hospitals
    1. Background
    2. Budget Neutrality Adjustment to Hospital Payments Based on 
Hospital-Specific Rate
    3. Technical Change
    D. Rural Referral Centers
    1. Case-Mix Index
    2. Discharges
    3. Technical Change
    E. Payment Adjustment for Low-Volume Hospitals
    F. Indirect Medical Education (IME) Adjustment
    1. Background
    2. IME Adjustment for TEFRA Hospitals Converting to IPPS 
Hospitals
    3. Section 1886(d)(3)(E) Teaching Hospitals That Withdraw Rural 
Reclassification
    G. Payment to Disproportionate Share Hospitals (DSHs)
    1. Background
    2. Implementation of Section 951 of Pub. L. 108-173
    H. Geographic Reclassifications
    1. Background
    2. Multicampus Hospitals
    3. Urban Group Hospital Reclassifications
    4. Clarification of Goldsmith Modification Criterion for Urban 
Hospitals Seeking Reclassification as Rural
    I. Payment for Direct Graduate Medical Education
    1. Background
    2. Direct GME Initial Residency Period
    a. Background
    b. Direct GME Initial Residency Period Limitation: Simultaneous 
Match
    3. New Teaching Hospitals' Participation in Medicare GME 
Affiliated Groups
    4. GME FTE Cap Adjustments for Rural Hospitals
    5. Technical Changes: Cross-References
    J. Provider-Based Status of Facilities under Medicare
    1. Background
    2. Limits on Scope of Provider-Based Regulations--Facilities for 
Which Provider-Based Determinations Will Not Be Made
    3. Location Requirement for Off-Campus Facilities: Application 
to Certain Neonatal Intensive Care Units
    4. Technical and Clarifying Changes
    K. Rural Community Hospital Demonstration Program
    L. Definition of a Hospital in Connection with Specialty 
Hospitals
VI. PPS for Capital-Related Costs
VII. Proposed Changes for Hospitals and Hospital Units Excluded from 
the IPPS
    A. Payments to Excluded Hospitals and Hospital Units
    1. Payments to Existing Excluded Hospitals and Hospital Units
    2. Updated Caps for New Excluded Hospitals and Units
    3. Implementation of a PPS for IRFs
    4. Implementation of a PPS for LTCHs
    5. Implementation of a PPS for IPFs
    B. Critical Access Hospitals (CAHs)
    1. Background
    2. Proposed Policy Change Relating to Continued Participation by 
CAHs in Lugar Counties
    3. Proposed Policy Change Relating to Designation of CAHs as 
Necessary Providers
    a. Determination of the Relocation Status of a CAH
    b. Relocation of a CAH Using a Waiver to Meet the CoP for 
Distance

[[Page 23309]]

VIII. Payment for Blood Clotting Factor Administered to Hemophilia 
Inpatients
IX. MedPAC Recommendations
    A. Medicare Payment Policy
    B. Physician-Owned Specialty Hospitals
    C. Other MedPAC Recommendations
X. Other Required Information
    A. Requests for Data from the Public
    B. Collection of Information Requirements
    C. Public Comments

Regulation Text

Addendum--Proposed Schedule of Standardized Amounts Effective with 
Discharges Occurring On or After October 1, 2004 and Update Factors 
and Rate-of-Increase Percentages Effective With Cost Reporting 
Periods Beginning On or After October 1, 2004
I. Summary and Background
II. Proposed Changes to Prospective Payment Rates for Hospital 
Inpatient Operating Costs for FY 2006
    A. Calculation of the Adjusted Standardized Amount
    1. Standardization of Base-Year Costs or Target Amounts
    2. Computing the Average Standardized Amount
    3. Updating the Average Standardized Amount
    4. Other Adjustments to the Average Standardized Amount
    a. Recalibration of DRG Weights and Updated Wage Index--Budget 
Neutrality Adjustment
    b. Reclassified Hospitals--Budget Neutrality Adjustment
    c. Outliers
    d. Rural Community Hospital Demonstration Program Adjustment 
(Section 410A of Pub. L. 108-173)
    5. Proposed FY 2006 Standardized Amount
    B. Adjustments for Area Wage Levels and Cost-of-Living
    1. Adjustment for Area Wage Levels
    2. Adjustment for Cost-of-Living in Alaska and Hawaii
    C. DRG Relative Weights
    D. Calculation of Proposed Prospective Payment Rates for FY 2006
    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, and FY 1996 Hospital-Specific 
Rates for FY 2006
    3. General Formula for Calculation of Proposed Prospective 
Payment Rates for Hospitals Located in Puerto Rico Beginning On or 
After October 1, 2005 and Before October 1, 2006
    a. Puerto Rico Rate
    b. National Rate
III. Proposed Changes to Payment Rates for Acute Care Hospital 
Inpatient Capital-Related Costs for FY 2006
    A. Determination of Proposed Federal Hospital Inpatient Capital-
Related Prospective Payment Rate Update
    1. Proposed 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 Geographic Adjustment Factor
    4. Proposed Exceptions Payment Adjustment Factor
    5. Proposed Capital Standard Federal Rate for FY 2006
    6. Proposed Special Capital Rate for Puerto Rico Hospitals
    B. Calculation of Proposed Inpatient Capital-Related Prospective 
Payments for FY 2006
    C. Capital Input Price Index
    1. Background
    2. Forecast of the CIPI for FY 2006
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. Updated Caps for New Excluded Hospitals and Units
V. Payment for Blood Clotting Factor Administered to Hemophilia 
Inpatients

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 2004; Hospital Average Hourly Wage for Federal 
Fiscal Years 2004 (2000 Wage Data), 2005 (2001 Wage Data), and 2006 
(2002 Wage Data) Wage Indexes and 3-Year Average of Hospital Average 
Hourly Wages
Table 3A--FY 2006 and 3-Year Average Hourly Wage for Urban Areas
Table 3B--FY 2006 and 3-Year Average Hourly Wage for Rural Areas
Table 4A--Wage Index and Capital Geographic Adjustment Factor (GAF) 
for Urban Areas
Table 4B--Wage Index and Capital Geographic Adjustment Factor (GAF) 
for Rural Areas
Table 4C--Wage Index and Capital Geographic Adjustment Factor (GAF) 
for Hospitals That Are Reclassified
Table 4F--Puerto Rico Wage Index and Capital Geographic Adjustment 
Factor (GAF)
Table 4J--Out-Migration Adjustment--FY 2006
Table 5--List of Diagnosis-Related Groups (DRGs), Relative Weighting 
Factors, and Geometric and Arithmetic Mean Length of Stay (LOS)
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 Exclusions List
Table 6H--Deletions from the CC Exclusions List
Table 7A--Medicare Prospective Payment System Selected Percentile 
Lengths of Stay: FY 2004 MedPAR Update December 2004 GROUPER V22.0
Table 7B--Medicare Prospective Payment System Selected Percentile 
Lengths of Stay: FY 2004 MedPAR Update December 2004 GROUPER V23.0
Table 8A--Statewide Average Operating Cost-to-Charge Ratios--March 
2005
Table 8B--Statewide Average Capital Cost-to-Charge Ratios--March 
2005
Table 9A--Hospital Reclassifications and Redesignations by 
Individual Hospital--FY 2006
Table 9B--Hospital Reclassifications and Redesignation by Individual 
Hospital Under Section 508 of Pub. L. 108-173--FY 2005
Table 9C--Hospitals Redesignated as Rural under Section 
1886(d)(8)(E) of the Act--FY 2006
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 Diagnosis-Related Groups (DRGs)--March 
2005
Table 11--Proposed FY 2006 LTC-DRGs, Relative Weights, Geometric 
Average Length of Stay, and 5/6ths of the Geometric Average Length 
of Stay
Appendix A--Regulatory Impact Analysis
Appendix B--Recommendation of Update Factors for Operating Cost 
Rates of Payment for Inpatient Hospital Services

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 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

[[Page 23310]]

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, or FY 1996) 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. (An MDH receives only 50 
percent of the difference between the IPPS rate and its hospital-
specific rates 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.)
    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 PPS, payments are adjusted by the same DRG for the case as they 
are under the operating IPPS. Similar adjustments are also made for IME 
and DSH as under the operating IPPS. In addition, hospitals may receive 
an outlier payment 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: Psychiatric hospitals and units; 
rehabilitation hospitals and units; long-term care hospitals (LTCHs); 
children's hospitals; and cancer hospitals. 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)), psychiatric hospitals and units (referred to as inpatient 
psychiatric facilities (IPFs)), and LTCHs, as discussed below. 
Children's hospitals and cancer hospitals continue to be paid under 
reasonable cost-based reimbursement.
    The existing regulations governing payments to excluded hospitals 
and hospital units are located in 42 CFR Parts 412 and 413.
a. 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 
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 (66 FR 41316, August 7, 2001; 67 FR 49982, 
August 1, 2002; and 68 FR 45674, August 1, 2003). The existing 
regulations governing payments under the IRF PPS are located in 42 CFR 
Part 412, Subpart P.
b. 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, LTCHs are being transitioned 
from being paid for inpatient hospital services based on a blend of 
reasonable cost-based reimbursement under section 1886(b) of the Act to 
100 percent of the Federal rate during a 5-year period, beginning with 
cost reporting periods that start on or after October 1, 2002. For cost 
reporting periods beginning on or after October 1, 2006, LTCHs will be 
paid 100 percent of the Federal rate (May 7, 2004 LTCH PPS final rule 
(69 FR 25674)). LTCHs may elect to be paid based on 100 percent of the 
Federal rate instead of a blended payment in any year during the 5-year 
transition period. The existing regulations governing payment under the 
LTCH PPS are located in 42 CFR Part 412, Subpart O.
c. IPFs
    Under the authority of sections 124(a) and (c) of Pub. L. 106-113, 
inpatient psychiatric facilities (IPFs) (formerly psychiatric hospitals 
and psychiatric units of acute care hospitals) are paid under the new 
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 (November 15, 
2004 IPF PPS final rule (69 FR 66921)). For cost reporting periods 
beginning on or after July 1, 2008, 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 part 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

[[Page 23311]]

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.
    On August 11, 2004, we published a final rule in the Federal 
Register (69 FR 48916) that implemented changes to the Medicare 
hospital inpatient prospective payment systems for both operating cost 
and capital-related costs, as well as changes addressing payments for 
excluded hospitals and payments for GME costs. Generally these changes 
were effective for discharges occurring on or after October 1, 2004. On 
October 7, 2004, we published a document in the Federal Register (69 FR 
60242) that corrected technical errors made in the August 11, 2004 
final rule. On December 30, 2004, we published another document in the 
Federal Register (69 FR 78525) that further corrected the August 11, 
2004 final rule and the October 7, 2004 correction to that rule, 
effective January 1, 2005.

B. 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 
2006. We also are setting forth proposed changes relating to payments 
for GME costs, payments to certain hospitals and units that continue to 
be excluded from the IPPS and paid on a reasonable cost basis, payments 
for DSHs, and requirements and payments for CAHs. The changes being 
proposed would be effective for discharges occurring on or after 
October 1, 2005, unless otherwise noted.
    The following is a summary of the major changes that we are 
proposing to make:
1. Proposed Changes to the DRG Reclassifications and Recalibrations of 
Relative Weights
    As required by section 1886(d)(4)(C) of the Act, in section II. of 
this proposed rule, we are proposing annual adjustments to the DRG 
classifications and relative weights. Based on analyses of Medicare 
claims data, we are proposing to establish a number of new DRGs and 
make changes to the designation of diagnosis and procedure codes under 
other existing DRGs.
    The major DRG classification changes we are proposing include:
     Reassigning procedure code 35.52 (Repair of atrial septal 
defect with prosthesis, closed technique) from DRG 108 to DRG 518 
(Percutaneous Cardiovascular Procedure Without Coronary Artery Stent or 
AMI);
     Reassigning procedure code 37.26 (Cardiac 
electrophysiologic stimulation and recording studies) from DRGs 535 and 
536 to DRGs 515 (Cardiac Defibrillator Implant Without Cardiac 
Catheterization);
     Splitting DRG 209 into two new DRGs based on the presence 
or absence of the procedure codes for major joint replacement or 
reattachment of lower extremity and revision of hip or knee 
replacement, DRG 545 (Revision of Hip or Knee Replacement) and DRG 544 
(Major Joint Replacement or Reattachment of Lower Extremity);
     Reassigning procedure code 26.12 (Open biopsy of salivary 
gland or duct) from DRG 468 to DRG 477 (Nonextensive O.R. Procedure 
Unrelated To Principal Diagnosis);
     Reassigning the principal diagnosis codes for curvature of 
the spine or malignancy from DRGs 497 and 498 to proposed new DRG 546 
(Spinal Fusion Except Cervical with PDX of Curvature of the Spine or 
Malignancy);
     Splitting DRGs 516 and 526 into four new DRGs based on the 
presence or absence of a CC;
     Reassigning procedure code 39.65 (Extracorporeal membrane 
oxygenation [ECMO]) from DRGs 104 and 105 to DRG 541 (ECMO or 
Tracheostomy with Mechanical Ventilation 96+ Hours or Principal 
Diagnosis Except Face, Mouth and Neck Diagnoses With Major Operating 
Room Procedure).
    We also are presenting our reevaluation of certain FY 2005 
applicants for add-on payments for high-cost new medical services and 
technologies, and our analysis of FY 2006 applicants (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 2006.
2. Proposed Changes to the Hospital Wage Index
    In section III. of this preamble, we are proposing revisions to the 
wage index and the annual update of the wage data. Specific issues 
addressed include the following:
     The FY 2006 wage index update, using wage data from cost 
reporting periods that began during FY 2002.
     The proposed occupational mix adjustment to the wage index 
that we began to apply effective October 1, 2004.
     The proposed revisions to the wage index based on hospital 
redesignations and reclassifications.
     The proposed adjustment to the wage index for FY 2006 
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 2006 wage index.
3. Proposed Revision and Rebasing of the Hospital Market Baskets
    In section IV. of this proposed rule, we are proposing rebasing and 
revising the hospital operating and capital market baskets to be used 
in developing the FY 2006 update factor for the operating prospective 
payment rates and the excluded hospital market basket to be used in 
developing the FY 2006 update factor for the excluded hospital rate-of-
increase limits. We are also setting forth the data sources used to 
determine the revised market basket relative weights and choice of 
price proxies.
4. Other Decisions and Proposed Changes to the PPS for Inpatient 
Operating and GME Costs
    In section V. of this proposed rule, we discuss a number of 
provisions of the regulations in 42 CFR Parts 412 and 413 and set forth 
proposed changes concerning the following:
     Solicitation of public comments on two options for 
possible expansion of the current postacute care transfer policy.
     The reporting of hospital quality data as a condition for 
receiving the full annual payment update increase.
     Proposed changes in the payment adjustment for low-volume 
hospitals.
     Proposed IME adjustment for TEFRA hospitals that are 
converting to IPPS hospitals, and IME FTE resident caps for urban 
hospitals that are granted

[[Page 23312]]

rural reclassification and then withdraw that rural classification.
     Proposed changes to implement section 951 of Pub. L. 108-
173 relating to the provision of patient stay/SSI days data maintained 
by CMS to hospitals for the purpose of determining their DSH 
percentage.
     Proposed changes relating to hospitals' geographic 
classifications, including multicampus hospitals and urban group 
hospital reclassifications.
     Proposed changes and clarifications relating to GME, 
including GME initial residency period limitation, new teaching 
hospitals' participation in Medicare GME affiliated groups, and the GME 
FTE cap adjustment for rural hospitals;
     Solicitation of public comments on possible changes in 
requirements for provider-based entities relating to entities the 
location requirements for certain neonatal intensive care units as off-
campus facilities;
     Discussion of the second year of implementation of the 
Rural Community Hospital Demonstration Program; and
     Clarification of the definition of a hospital as it 
relates to ``specialty hospitals'' participating in the Medicare 
program.
5. PPS for Capital-Related Costs
    In section VI. of this proposed rule, we are not proposing any 
policy changes to the capital-related prospective payment system. For 
the readers' benefit, we discuss the payment policy requirements for 
capital-related costs and capital payments to hospitals.
6. Proposed Changes for Hospitals and Hospital Units Excluded From the 
IPPS
    In section VII. of this proposed rule, we discuss the proposed 
revisions and clarifications concerning excluded hospitals and hospital 
units, proposed policy changes relating to continued participation by 
CAHs located in counties redesignated under section 1886(d)(8)(B) of 
the Act (Lugar counties), and proposed policy changes relating to 
designation of CAHs as necessary providers.
7. Proposed Changes in Payment for Blood Clotting Factor
    In section VIII of this proposed rule, we discuss the proposed 
change in payment for blood clotting factor administered to inpatients 
with hemophilia for FY 2006.
8. Determining 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 2006 
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 2006 for hospitals and hospital units excluded from the 
PPS.
9. 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.
10. Recommendation of Update Factor for Hospital Inpatient Operating 
Costs
    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 2006 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.
11. Discussion of Medicare Payment Advisory Commission Recommendations
    Under section 1805(b) of the Act, the Medicare Payment Advisory 
Commission (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 2005 
recommendation concerning hospital inpatient payment policies addressed 
only 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. MedPAC issued a second 
Report to Congress: Physician-Owned Specialty Hospitals, March 2005, 
which addressed other issues relating to Medicare payments to hospitals 
for inpatient services. The recommendations on these issues from this 
second report are addressed in section IX. of this preamble. For 
further information relating specifically to the MedPAC March 2005 
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

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 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. The proposed changes to the DRG 
classification system and the recalibration of the DRG weights for 
discharges occurring on or after October 1, 2005, are discussed below.

B. DRG Reclassifications

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

[[Page 23313]]

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 2005, cases are 
assigned to one of 519 DRGs in 25 MDCs. The table below lists the 25 
MDCs.
[GRAPHIC] [TIFF OMITTED] TP04MY05.000

    In general, cases are assigned to an MDC based on the patient's 
principal diagnosis before assignment to a DRG. However, for FY 2005, 
there are nine 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, lung, simultaneous pancreas/kidney, and pancreas 
transplants and for tracheostomies. Cases are assigned to these DRGs 
before they are classified to an MDC. The table below lists the current 
nine pre-MDCs.

[[Page 23314]]

[GRAPHIC] [TIFF OMITTED] TP04MY05.001

    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. Since 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 (less than 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 a 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, for example, 
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 
class of patients 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 complication or 
comorbidity.
    A substantial complication or comorbidity 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 comorbidities or complications would consistently 
affect the consumption of hospital resources.
    The actual process of forming the DRGs was, and continues to be, 
highly iterative, involving a combination of statistical results from 
test data combined with clinical judgment. In deciding whether to 
create a separate DRG, we 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 DRG. We 
evaluate patient care costs using average charges and length of stay as 
proxies for costs and rely on the judgment of our medical officers to 
decide whether patients are distinct or clinically similar to other 
patients in the DRG. In evaluating resource costs, we consider both the 
absolute and percentage differences in average charges between the 
cases we are selecting for review and the remainder of cases in the 
DRG. We also consider variation in charges within these groups; that 
is, whether observed average differences are consistent across patients 
or attributable to cases that are extreme in terms of charges or length 
of stay, or both. Further, we also consider the number of patients who 
will have a given set of characteristics and generally prefer not to 
create a new DRG unless it will include a substantial number of cases. 
As we explain in more detail in section IX. of this preamble, MedPAC 
has made a number of recommendations regarding the DRG system. As part 
of our review and analysis of MedPAC's recommendations, we will 
consider whether to establish guidelines for making DRG 
reclassification decisions.
    A patient's diagnosis, procedure, discharge status, and demographic 
information is fed 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 payments 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

[[Page 23315]]

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 July 30, 1999 IPPS final rule (64 FR 41500), we 
discussed a process for considering non-MedPAR 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 quality 
of the non-MedPAR data submitted. Generally, however, a significant 
sample of the non-MedPAR data should be submitted by mid-October for 
consideration in conjunction with the next year's proposed rule. This 
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.
    Many of the changes to the DRG classifications 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 next 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 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 changes we are proposing to the DRG classification system for 
FY 2006 for the FY 2006 GROUPER, version 23.0 and to the methodology 
used to recalibrate the DRG weights are set forth below. Unless 
otherwise noted in this proposed rule, our DRG analysis is based on 
data from the December 2004 update of the FY 2004 MedPAR file, which 
contains hospital bills received through December 31, 2004 for 
discharges in FY 2004.
2. Pre-MDC: Intestinal Transplantation
    In the FY 2005 IPPS final rule (69 FR 48976), we moved intestinal 
transplantation cases that were assigned to ICD-9-CM procedure code 
46.97 (Transplant of intestine) out of DRG 148 (Major Small and Large 
Bowel Procedures with CC) and DRG 149 (Major Small and Large Bowel 
Procedures Without CC) and into DRG 480 (Liver Transplant). We also 
changed the title for DRG 480 to ``Liver Transplant and/or Intestinal 
Transplant.'' We moved these cases out of DRGs 148 and 149 because our 
analysis demonstrated that the average charges for intestinal 
transplants are significantly higher than the average charges for other 
cases in these DRGs. We stated at that time that we would continue to 
monitor these cases.
    Based on our review of the FY 2004 MedPAR data, we found 959 cases 
assigned to DRG 480 with overall average charges of approximately 
$165,622. There were only three cases involving an intestinal 
transplant alone and one case in which both an intestinal transplant 
and a liver transplant were performed. The average charges for the 
intestinal transplant cases ($138,922) were comparable to the average 
charges for the liver transplant cases ($165,314), while the remaining 
combination of an intestinal transplant and a liver transplant case had 
much higher charges ($539,841), and would be paid as an outlier case. 
Therefore, we are not proposing any DRG modification for intestinal 
transplantation cases at this time.
    We note that an institution that performs intestinal 
transplantation, in correspondence to us written following the 
publication of the FY 2005 IPPS final rule, agreed with our decision to 
move cases assigned to code 46.97 to DRG 480.
3. MDC 1 (Diseases and Disorders of the Nervous System)
a. Strokes
    In 1996, the Food and Drug Administration (FDA) approved the use of 
tissue plasminogen activator (tPA), one type of thrombolytic agent that 
dissolves blood clots. In 1998, the ICD-9-CM Coordination and 
Maintenance Committee created code 99.10 (Injection or infusion of 
thrombolytic agent) in order to be able to uniquely identify the 
administration of thrombolytic agents. Studies have shown that tPA can 
be effective in reducing the amount of damage the brain sustains during 
an ischemic stroke, which is caused by blood clots that block blood 
flow to the brain. The use of tPA is approved for patients who have 
blood clots in the brain, but not for patients who have a bleeding or 
hemorrhagic stroke. Thrombolytic therapy has been shown to be most 
effective when used within the first 3 hours after the onset of a 
stroke, and it is contraindicated in hemorrhagic stroke. The presence 
or absence of code 99.10 does not currently influence DRG assignment. 
Since code 99.10 became effective, we have been monitoring the DRGs and 
cases in which this code can be found, particularly with respect to 
cardiac and stroke DRGs.
    Last year, we met with representatives from several hospital stroke 
centers who recommended modification of the existing stroke DRGs 14 
(Intracranial Hemorrhage or Cerebral Infarction) and 15 (Nonspecific 
CVA and Precerebral Occlusion Without Infarction) by using the 
administration of tPA as a proxy to identify patients who have severe 
strokes. The representatives stated that using tPA as a proxy for the 
more severely ill stroke patient would recognize the higher charges 
these cases generate because of their higher hospital resource 
utilization.
    The stroke representatives made two suggestions concerning DRGs 14 
and 15. First, they proposed modifying DRG 14 by renaming it ``Ischemic 
Stroke Treatment with a Reperfusion Agent,'' and including only those 
cases containing code 99.10. The remainder of stroke cases where the 
patient was not treated with a reperfusion agent would be included in 
DRG 15, which would be renamed ``Hemorrhagic Stroke or Ischemic Stroke 
without a Reperfusion Agent.'' Hemorrhagic stroke cases now found in 
DRG 14 that are not treated with a reperfusion agent would migrate to 
DRG 15.
    The second suggestion was to leave DRGs 14 and 15 as they currently 
exist, and create a new DRG, with a recommended title ``Ischemic Stroke 
Treatment with a Reperfusion Agent.'' This suggested DRG would only 
include strokes caused by clots, not by hemorrhages, and would include 
the administration of tPA, identified by procedure code 99.10.
    We have examined the MedPAR data for the cases in DRGs 14 and 15, 
and have divided the cases based on the presence of a principal 
diagnosis of hemorrhage or occlusive ischemia, and the presence of 
procedure code 99.10. The following table displays the results:

[[Page 23316]]

[GRAPHIC] [TIFF OMITTED] TP04MY05.002

    The above table shows that the average standardized charges for 
cases treated with a reperfusion agent are more than $16,000 and 
$10,000 higher than all other cases in DRGs 14 and 15, respectively. 
While these data suggest that patients treated with a reperfusion agent 
are more expensive than all other stroke patients, this conclusion is 
based on a small number of cases. At this time, we are not proposing a 
change to the stroke DRGs because of this concern. However, we believe 
it is possible that more patients are being treated with a reperfusion 
agent than indicated by our data because the presence of code 99.10 
does not affect DRG assignment and may be underreported.
    We invite public comment on the changes to DRGs 14 and 15 suggested 
by the hospital representatives. In addition, we are interested in 
public comment on the number of patients currently being treated with a 
reperfusion agent as well as the potential costs of these patients 
relative to others with strokes that are also included in DRGs 14 and 
15.
b. Unruptured Cerebral Aneurysms
    In the FY 2004 IPPS final rule (68 FR 45353), we created DRG 528 
(Intracranial Vascular Procedures With a Principal Diagnosis of 
Hemorrhage) in MDC 1. We received a comment at that

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